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What would it mean to name pain not as alien to human existence but as one of the defining conditions of being human? In this presentation, three experts--in disability studies, bioethics, and the cultural study of pain and pain medicine--consider our complicated attitudes toward pain, especially as we regard it in others.
A John F. Anderson Memorial Lecture
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
In summer 2013, UVA landscape architecture graduate students Harriett Jameson and Asa Eslocker travelled to Sardinia, Okinawa, and Loma Linda, California, three landscapes with the highest life expectancy in the world, to explore these places' physical, spatial, and material qualities-topography, plant communitites,urban form-and also the personal attachments that seniors in these sites have to their cultural landscapes. The people in these locales have long been studied for their genetics, diets, and recreation habits. But until Ms. Jameson and Mr. Eslocker arrived, no one had inquired into or demonstrated in these settings the critical role of place in healthy longevity. Through study of these distinctive landscapes and the personal stories of elderly residents, the pair arrived at insights that may help communities rethink and redesign public landscapes to cultivate a culture of health and well being that spans infancy through old age.
In this Medical center hour, Ms. Jameson and Mr. Eslocker focus on how place contributes to healthy aging and preview parts of their full-length documentary film, Landscapes of longevity, which will premiere in Charlottesville in November.
A John F. Anderson Memorial Lecture
Co-presented with the Center for Design + Health, School of Architecture, UVA
American medical education can be proud of its accomplishments. Its graduates populate a sophisticated medical system that often sets global standards in teaching and self-regulation. doctors the world over compete to train and practice in the U.S. There are nearly three applicants for every one place in U.S. medical schools. Things are good. But are they? The U.S. medical system is now by far the world's most expensive, a drag on the economy and a major contributor to accumulating national debt. Physician-writer Atul Gawande notes that the doctor's most expensive instrument is the pen, ordering costly, and sometimes unnecessary, diagnostics and therapeutics. We import a quarter of our doctors, yet major portions of the country are short of physicians. All is not well in medical education. In this Brodie Medical Education Lecture, distinguished physician and health policy expert Dr. Fitzhugh Mullan addresses the technical, cultural, and moral challenges facing American medical education today, and how they go straight to the soul of medicine.
Co-presented with the Brodie Medical Education Committee, the Department of Medicine, and the Academy of Distinguished Educators, as part of UVA's Medical Education Week
Chocolate has been special to human beings for millennia. In our time and culture as in earlier centuries and other cultures, claims abound regarding chocolate's health effects, positive and otherwise. What is it about chocolate—chemically and culturally—that makes it so distinctive in our diets, our emotional lives, our celebrations? Why do we love it so, and what does it do to/for us? In this Medical Center Hour, local chocolatier Tim Gearhart offers insights into chocolate's appeal and effects and gives a glimpse of the craft of artisan chocolate-making.
A John F. Anderson Memorial Lecture
Primum non nocere--"first, do no harm"--is a fundamental principle of medical practice, expressing both the hope and humility of physicians. It cautions doctors that even with the best intentions may come unwarranted consequences. One present-day application of this principle has to do with efforts to eliminate hospital-acquired infections. When we define such infections as inevitable if regrettable collateral damage wherever complex care is provided to very sick patients, we create a rationale for paying for them and institutionalize their harm. And we may lose sight of their tragic human and economic costs, and of clinicians' own involvement. The annual Richardson memorial lecture addresses the human toll of medical error and calls for improved patient safety. In this Richardson lecture, Dr. Richard Shannon challenges the academic medical center not only to create safer systems that prevent bloodstream infections but also to invest every frontline worker with the capability and responsibility to see and solve problems before they propagate into error. Importantly, this is about more than safety. It is about culture change, creating a culture of habitual excellence in everything we do. Safety is simply the unassailable starting point. Another foundational medical principle applies: Cura te ipsum--"physician, heal thyself."
Co-presented with the Patient Safety Committee, UVA Health System
Acclaimed physician-writer Christine Montross (Body of work, 2007; and Falling into the fire, 2013) discusses how diving deeply into her most challenging patient encounters has led her to the ancient concept of "abiding" as a lost tenet of patient care. A psychiatrist and medical educator, Dr. Montross speaks in defense of repugnance, and encourages physicians and doctors-in-training to acknowlege, rather than suppress the discomforts which naturally arise in the practice of medicine.
A John F. Anderson Memorial Lecture
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 recent years in the US, increasing workforce diversity has become a priority in health care and other industries. Many companies, including Fortune 500s, now recognize that having a diverse workforce improves both business and the bottom line—indeed, diversity is key to organizational excellence. In this Medical Center Hour, a panel of physicians explores whether UVA Health System's growing diversity can add value in a very different way: can our organization's greater diversity be a lever to mitigate bias in these increasingly fraught times?
A John F. Anderson Memorial Lecture