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The stethoscope, an extension of the clinician's ear, is perhaps modern medicine's most characteristic symbol. Through it, doctors listen for the body to disclose its secrets. Doctors must also listen to their patients' stories. In fact, as Oliver Sacks said, "The first act of medicine is listening to a personal story." But hasn't the clinician's ear lost much of its importance now that procedures and machines can give us more direct access to pathology?
In this Richardson Lecture, physician and poet John Coulehan affirms the importance of the clinician's aural attention in the clinical encounter and considers three aspects of the metaphorical clinical ear. First, listening to patients, an active process with vertical (deep listening) and horizontal (narrative) dimensions. Second, listening to the heart, the reflective core of clinical practice. And, finally, hearing the resonance of our own healing words. In medicine, the word can be an instrument of healing.
Co-presented with the Office of Quality and Performance Improvement, UVA Health System
Where you live in a particular U.S. city determines your predicted life expectancy. Neighborhood is destiny, in a way. For example, in New Orleans, there is a twenty-five-year difference in life expectancy from one parish to another only three miles away. This pattern of great gaps in health status, even over short distances, repeats itself in New York, Chicago, the Bay Area, and many other American cities, with harsh consequences.
In 2005, Tulsa, Oklahoma was one of the first cities to recognize such dramatic neighborhood variations in life expectancy, with a fourteen-year difference in life expectancy between north Tulsa and midtown—and to take action. In this presentation, Dr. Gerard Clancy describes specific initiatives and lessons learned on the ten-year journey, from 2005 to 2015, to reverse these health disparities and improve the health of the people in north Tulsa. The successes of the past decade have inspired a new ten-year initiative in Tulsa focused on mental health system improvements.
Co-presented with the Brodie Medical Education Award Committee, the Academy of Distinguished Educators, and the Department of Medicine
Our society is aging, and, thanks partly to the science and success of advanced health care, the journey into one’s last years is often long and richly rewarding. But our medicalization of aging also means that older adults are longtime patients entangled in complex, costly, fragmented, and sometimes ad-libbed “systems” of individualized care that are challenging for them and their caregivers to navigate. When elders’ health and functional status changes, ways of managing their care may come undone, just when robust attention is most needed to effect transitions in their care—and the goals of care.
In this Medical Center Hour, distinguished gerontologist Mary Naylor offers her pioneering approach to the design, evaluation, and dissemination of health care innovations that has at once improved outcomes for chronically ill older adults and their caregivers and lowered health care costs. Her collaborative work with an interprofessional team has yielded the Transitional Care Model, a cost-effective model led by an advanced-practice nurse that improves the transitions of frail elders as they move through both their final years and our fractured health care system.
The Zula Mae Baber Bice Memorial Lecture, School of Nursing
The Koppaka Family Foundation Lecture in Medical Humanities, School of Medicine
Co-presented with the School of Nursing and the Center for Biomedical Ethics and Humanities, School of Medicine
A diverse population of caregivers working in clients' homes constitutes a vital link in our health care “system,” their services filling a gap between institutional care and what families are able to manage on their own. Who are these caregivers, what is their work, and what does their work mean—to them, to the clients and families they serve, to our larger society? Prompted by the recent documentary film, CARE, by Deirdre Fishel, which profiles five caregivers and their elderly clients, this Medical Center Hour inquires into the nature and lived experience of home-based caregiving for elders. What role will such home care play as our society ages and people seek to stay at home with complex, care-intensive medical conditions? How can we better value and compensate care workers and better support families who need their services? What about the sustainability of the home health caregiving economy and its workforce?
A John F. Anderson Memorial Lecture
Co-presented with the Department of Chaplaincy Services, UVA Health System
On 13 September 2017, the University of Virginia proudly dedicates as Pinn Hall the medical education and research building formerly known as Jordan Hall. The building’s new name recognizes UVA medical graduate Vivian W. Pinn MD, Class of 1967, founding director of the Office of Research on Women’s Health at the National Institutes of Health. Dr. Pinn was the second African American woman to graduate from the School of Medicine and went on to a distinguished career in pathology and in medical leadership. One of the medical school’s four colleges bears Dr. Pinn’s name, and she is an active presence in Pinn College student life.
This Medical Center Hour celebrates Dr. Pinn and her accomplishments and calls attention to critical current issues of fair and full access for underrepresented minorities, especially African American women, as students, practitioners, and leaders in medicine but also as beneficiaries of health care. Individually and institutionally, what can we learn from Dr. Pinn to ensure that her legacy matters?
Co-presented with the Department of Medicine and the Generalist Scholars Program, in conjunction with UVA's dedication of Pinn Hall and the UVA medical students' celebration of Primary Care Week
The Affordable Care Act (ACA) has brought transformational changes to the healthcare system, including, in some ACA programs, movement away from a pay-for-volume system to pay-for-performance or outcome. Three programs exemplify this approach: readmission penalties, no payment for selected hospital-acquired conditions (HACs), and value-based purchasing. To date, the HAC nonpayment program has targeted prevention of central-line-associated bloodstream infections, catheter-associated urinary tract infections, selected surgical site infections, and methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections. With better understanding, improved procedural practices, and closer monitoring, more of these infections are proving preventable; infection rates, including for MRSA, have dramatically decreased. In this Medical Center Hour, distinguished medical epidemiologist Dr. William Jarvis discusses these successes, including their financial implications, and how further collaboration between clinicians and infection control programs can prevent even more hospital-acquired conditions.
The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds
Co-presented with the Department of Medicine, UVA
The opioid epidemic is currently exacting a terrible toll on the health, lives, safety, and livelihood of persons and communities across Virginia, the Appalachian region, and, indeed, much of North America. What is being done to address this crisis at the levels of policy and practice in the Commonwealth of Virginia and in Charlottesville-Albemarle and environs? In this Medical Center Hour, the Honorable William A. Hazel Jr MD, Secretary of Health and Human Resources for the Commonwealth, discusses Virginia’s five-pronged approach to the epidemic and the impact of that approach to date. He is joined in this conversation by a primary care physician and community mental health professionals.
The Jessie Stewart Richardson Memorial Lecture of the School of Medicine
Co-presented with the Office of Quality and Performance Improvement, UVA Health System
In a year that has seen gun violence in the U.S. escalate even more—consider the almost-daily gun deaths on the streets of Chicago or the recent Las Vegas massacre—this Medical Center Hour looks anew at this urgent public health problem. Distinguished bioethicist Steven Miles presents a comprehensive status report on gun deaths (homicides and suicides), including issues of gun supply, the relevance of mental illness, race, and poverty to firearm deaths, the effects of gun law reforms, and the prospects for better prevention of gun violence.
A John F. Anderson Memorial Lecture
Have you ever received an unsolicited email from a publisher you’ve never heard of inviting you to submit a paper to a journal with a generic-but-believable-sounding name or a conference abroad or at an airport hotel? These publishers may advertise their journals as “open access” and promise to make your work visible to well-known indices; they may claim “impact factors” and editorial board members who are leaders in their field. All that’s required of you is a modest fee—an "author’s processing charge"—and these publishers can deliver the lifeblood of any academic career: a peer-reviewed publication. There’s just one catch: the journals are fake.
These journals are labeled "predatory," and they are sometimes associated with the broader open-access movement. This Medical Center Hour tours the strange world of predatory publishing and describes some of its more outrageous excesses. But, as Brandon Butler will argue, the fake journals are just a distraction. The academy today faces more serious challenges as it wrestles with how best to share research and knowledge. How should academia confront the predatory moves of its most well-established publishing partners and take better advantage of open access?
A John F. Anderson Memorial Lecture
Health care information can confuse doctors and patients alike. What are the risks and benefits of mammograms, of aggressive blood pressure control, of EKGs, of lung cancer screening, of heart stents? When patients can’t accurately answer these questions, they find it difficult to have sensible conversations about their health care with their doctors. And lack of comprehensible medical information not only interferes with shared decision-making between physician and patient but can also lead to over-screening and over-treatment, with deleterious consequences for patients as well as for the health care delivery system and medical reform.
In this Medical Center Hour, internist Andy Lazris and scientist Erik Rifkin assess this challenging situation and then present, as one solution, a novel decision aid called a Benefit Risk Characterization Theater (BRCT). When health care information is conveyed simply, factually, and in a non-numerical format, true shared decisions become possible. They offer BRCTs to explain the risks/benefits of some common medical interventions and demonstrate how this approach can improve health care delivery, lead to greater patient satisfaction, and result in less over-treatment, one of the main drivers of low-value health care cost.
Co-presented with the Department of Medicine