Bon Ku – Design Thinking in Healthcare

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This week we are joined by Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Reprise – Natalie Spicyn, Unionizing Clinicians

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This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city.  Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining.  Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Photo: Rally outside Chase Brexton Health Care in Baltimore, Maryland, on Aug. 19, 2016. Photo: Jay Mallin, jay@jaymallinphotos.com, Courtesy of 1199 SEIU

Lisa Sanders – Patient Stories & Zebras

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This week, we are joined by Lisa Sanders. You may recognize her name from the monthly “Diagnosis” column that she writes for the New York Times Magazine. She writes about unusual cases and diagnostic dilemmas, exploring both a patient’s experience of disease but also their journey through the healthcare system. She is the author of a book exploring similar themes, Every Patient Tells a Story. Her column was the inspiration for the popular TV show House, and she served as a technical advisor for the show. Dr. Sanders is an associate professor of medicine and a clinician educator in the primary care internal medicine residency program at Yale University School of Medicine.

Today, we talk about her journey in medicine, going from outsider to insider in medicine, and using English rather than medicalese. She talks about what it is like to live in a world of zebras when most of us are used to horses, and how she finds her fantastic cases. Lastly, she shares what it is like to work as a technical advisor on a hit TV show.

Send your interesting cases to Dr. Sanders for her column: lisa.sandersmdATgmail.com.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Andrew Schutzbank – Iora Health

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This week we are joined by Andrew Schutzbank, the Vice President of Product and Technology at Iora Health. His passion for revolutionizing health care began as a medical student at Tulane in pre- and post-Katrina New Orleans and continued during his Internal Medicine & Primary Care residency at the Beth Israel Deaconess Medical Center. He writes at schutzblog.com and joins us today to talk his work at Iora Health.

We discuss how the idea of completely starting over brought him to Iora Health after his residency, how Iora Health’s model works and how they navigate risk, the central role of Health Coaches in the care team, what challenges Iora is still grappling with, about Iora Health’s novel EHR, Chirp, and finish up with his reflections on how software development and patient care are similar.

Please rate and review us on itunes or stitcher, and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

David Buck – Caring for High Need, High Cost Patients

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This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.
You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

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Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center.

We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45).

You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Natalie Spicyn: Unionizing Clinicians

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This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city.  Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining.  Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Photo: Rally outside Chase Brexton Health Care in Baltimore, Maryland, on Aug. 19, 2016. Photo: Jay Mallin, jay@jaymallinphotos.com, Courtesy of 1199 SEIU

Andrew Morris-Singer: Organizing & Advocacy

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We are joined this week by Andrew Morris-Singer, a general internist and founder of Primary Care Progress. Primary Care Progress is a national non-profit organization dedicated to building a stronger primary care system. Working with current and future healthcare professionals from across disciplines and career stages – from students and faculty to providers and health systems leaders – PCP offers leadership development and support that emphasizes relational skills, individual resiliency, and advocacy. Andrew has a unique background as a community organizer with more than 15 years of experience. He is a lecturer in Global Health and Social Medicine at Harvard Medical School, an Assistant Professor in the Dept of Family Medicine at OHSU and an Adjunct Professor in the Department of Family and Preventive Medicine at the University of Utah. He currently sees patients in Portland, Oregon. On the show, we talk about relational leadership,  advocacy and activism in primary care.

Photo: Andrew Morris-Singer MD

Journal Club: Sinsky et al, Allocation of Physician Time in Ambulatory Practice

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David Rosenthal, Thomas Kim, and Audrey Provenzano discuss the recent manuscript published in Annals of Internal Medicine by Sinsky and colleagues, Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.

Have you ever wondered how much time you spend each month fighting with technology or filling out VNA forms? Well, Christine Sinsky and her colleagues studied this and have some answers for us…all of which raise more fascinating questions about how we practice medicine.

Tweet us your thoughts @rospodcast, and send us feedback at contact@rospod.org!