Danielle Ofri – Communication Between Patients & Doctors

Play

This week, we are joined by Danielle Ofri. Danielle is a primary care physician at Bellevue Hospital and a prolific essayist and author. We start out talking about her most recent book, What Patients Say, What Doctors Hear. We talk about communication between patients and doctors and why it can be so challenging, and how physician communication can be evaluated and more effectively taught to trainees. Danielle talks about the power dynamics of the medical interview and how it can be uncomfortable for us as physicians to have the tables turned when the patient is more empowered in the conversation. We also talk about the campaign that Danielle has spearheaded to get physicians and other medical professionals involved in the health care reform efforts of the last few months in Washington DC with her House Calls Campaign.

Danielle is a physician at Bellevue Hospital and associate professor of medicine at NYU. She writes about medicine and the doctor-patient connection for the New York TimesSlate Magazine, and other publications. Danielle is co-founder and Editor-in-Chief of the Bellevue Literary Review, the first literary journal to arise from a medical setting. She is the author of a collection of books about the world of medicine. She’s given TED Talks on Deconstructing Perfection and  When Doctors Face Fear, and has performed at The Moth.

If you enjoy the show, please rate and review us wherever you listen, and share us on social media. Tweet us your thoughts @rospodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you, and thanks for listening.

This interview has been lightly edited for clarity.

Joshua Freeman – Designing a Fair & Equitable Healthcare System

Play

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer.  He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions.

This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered.

Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS.

Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

This interview was lightly edited for clarity.

How to Prevent Burnout with Diane Shannon & Paul DeChant

Play

This week, in the second of our series about physician burnout, our guests focus on solutions. Diane Shannon and Paul DeChant, both physicians, join us to talk about their recent book Preventing Physician Burnout, Curing the Chaos and Returning Joy to the Practice of Medicine.

Diane and Paul talk about their experiences with burnout and how they came to work on this project together, how they contend that organizational and structural factors are more important than individual factors in driving burnout, how compensation and intangible rewards can reduce burnout, how leadership in healthcare can address the epidemic of burnout. We also talk about how they have come to believe that the LEAN principles, most especially the pillar of respect for people, is key in transforming healthcare organizations into places where primary care physicians can thrive, why change is so difficult, and some other resources that can help.

Diane Shannon is a general internist who left clinical medicine due to burnout and turned to a career in medical writing and public health. Paul DeChant is a family physician and experienced healthcare executive who has previously worked in organizations such as The Paulo Alto Medical Foundation, Sutter Gould Medical Foundation, and is now a senior advisor with Simpler Healthcare.

If you’ve missed it, have a listen to the first in our burnout series with Colin West, researcher at Mayo Clinic who has done foundational research on burnout and physician well-being. Please rate and review us on itunes, google play, 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, and thanks for listening.

Journal Club – Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

Play

On our journal club this week, we talk about an article published in September 2016 in the journal Academic Pediatrics: Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems? By Sarah McCue Horwitz and colleagues.

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.

Bon Ku – Design Thinking in Healthcare

Play

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.

Journal Club – Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists

Play

For this week’s journal club, we are talking about a recent paper from Health Affairs entitled: Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists  by Michael Barnett, Hal F. Yee Jr, Ateev Mehotra, and Paul Giboney. The paper describes and analyzes data from an e-consult system that was rolled out to a network of hundreds of safety-net clinics in Los Angeles County. We are thrilled to have the lead author, Michael Barnett, join us for our discussion! Michael is an Assistant Professor at Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. He publishes prolifically on a variety of topics, and is particularly interested in the primary care-specialty care interface.

Do you use e-consults in your practice? Or do you wish you had access to such a system? Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in future journal clubs or who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening.

Reprise – David Buck, Caring for High-Need, High-Cost Patients

Play

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.

Lauren A Taylor – Integration of Healthcare and Social Services

Play

Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society.

We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US.  We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right.

Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School.

If you like the show, please subscribe on our website www.rospod.org, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Journal Club – How do Pregnant Women Use Quality Measures when Choosing Their Obstetric Provider?

Play

Today we’re discussing a paper published in the January 2017 issue of Birth titled: How do pregnant women use quality measures when choosing their obstetric provider? by Rebecca A. Gourevitch MS, Ateev Mehrotra MD, MPH, Grace Galvin MPH, Melinda Karp MBA, Avery Plough BA, Neel T. Shah MD, MPP.

The researchers utilized an online forum for pregnant women, Ovia Pregnancy to survey women about how and why they chose their obstetric provider. Interestingly, they found that most women did not utilize quality measures such as c-section rate or obstetric infection rates when choosing a provider. These fascinating findings were widely covered in the media and led to a great discussion. Please have a listen!

Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in journal clubs and who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening!

Lisa Sanders – Patient Stories & Zebras

Play

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.