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Health information technology (health IT), including electronic health records (but much, much more), enables health care providers--from individual clinicians to widely networked health care organizations--to better manage patient care through streamlined sharing of health information. Since 2004, the Office of the National Coordinator for Health Information Technology has led U.S. efforts to deploy advanced health IT in order to improve clinical service delivery and support patient engagement. As a result, nearly every hospitalization and most doctor visits now have a digital footprint, and an extraordinary amount of health data exists that simply didn't a decade ago. The health IT goal now is to foster seamless and secure data sharing to improve the health and care of individuals and populations alike.
In this special Medical Center Hour, Dr. Vindell Washington, National Coordinator for Health Information Technology, introduces this key national initiative and cites the promise and chief challenges for this increasingly central component of our nation's health care system.
A John F. Anderson Memorial Lecture
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
In the summer of 1816, an eighteen-year-old English girl on a lark in Switzerland with a married man and her stepsister began writing a story that would outlive her by centuries. Mary Shelley's novel, Frankenstein, published in 1818, still fascinates and confounds us today, told and retold in so many genres that even those who have never read the original know the story. This Medical Center Hour marks Frankenstein's 200th anniversary by exploring two of the many reasons for its apparent immortality. First, this novel probes the central quest of medicine and biology: What is life? Second, it asks—but leaves for us to answer—the essential ethical question: Should we as human beings manipulate the spark of life?
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
In this Medical Center Hour, award-winning journalist Meera Subramanian explores the human and global health implications of India’s ravaged environmental landscape. Her new book, A River Runs Again: India's Natural World in Crisis, investigates five environmental crises by profiling ordinary people and micro-enterprises determined to guide India and its burgeoning population into a healthier future. An organic farmer revives dead land; villagers resuscitate a river run dry; cook-stove designers seek a smokeless fire; biologists bring vultures back from the brink of extinction; and, in one of India’s poorest states, a bold young woman teaches adolescent girls the fundamentals of sexual health. In these individual stories resides hope for a nation and its people and the potential for a sustainable and more prosperous world.
A John F. Anderson Memorial Lecture/Exploring the Global South
Co-presented with the Center for Global Health, Institute for the Humanities and Global Cultures (Global South Initiative), Department of Public Health Sciences, and Virginia Quarterly Review
RN-MD collaboration in health care (or the lack thereof) is one of the more vexed issues facing our struggling health care system. Yet it rarely gets addressed in a substantive and purposeful way. The problem begins with the training of nurses and doctors. Nursing schools have seldom taught the nuts and bolts of working with physicians. Medical schools have taught future doctors almost nothing about working with nurses. Often the result in clinical practice is that each group finds the other difficult. Even so, nurse-physician collaboration is what makes health care possible, and good collaboration makes high quality care much more likely. In this Medical center hour, nurse and author Theresa Brown considers new, potentially revolutionary initiatives in health professional education, including at UVA, that bring nursing and medical students together as learners. Will interprofessional education lead to better RN-MD collaboration in practice and, as a result, to better patient care?
The Zula Mae Baber Bice Memorial Lecture
Co-presented with the School of Nursing
Over the last half-century, pain medicine has been defined by controversy: when is pain real? Does too-liberal, overly compassionate relief create addiction? Is chronic pain a legitimate basis for disability claims and long-term benefits? What should we do when end-of-life pain care resembles physician-assisted suicide or euthanasia? Professor Keith Wailoo explores the political and cultural history of these complex medical and social debates, examining how pain medicine emerged as a legitimate yet controversial field; how physicians, patients, politicians, and the courts have shaped ideas about pain and its relief; and how the question “who is in pain and how much relief do they deserve?” has become a microcosm of broader debates over disability, citizenship, liberalism, and conservatism in American society.
Co-presented with History of the Health Sciences Lecture Series and
the Institute for Practical Ethics and Public Life, UVA
History of the Health Sciences Lecture
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
Fifty years ago President Lyndon B. Johnson envisioned a Great Society, an America free from poverty and racial injustice and full of equality of opportunity and social mobility for all. Many legislative planks of his Great society platform--civil and voting rights, educational opportunity, fair housing practices, urban planning, mass transit, and health care --represent what we today consider "social determinants of health." This Medical center hour with bioethicist Erika Blacksher reviews how Americans are faring today in relation to key aspirations of LBJ's Great Society, especially those that bear on health. Americans generally live shorter, less healthy lives than their counterparts in peer nations, and within the U.S. health varies dramatically among social and economic groups and from region to region. What ethical concerns are raised by significant health disparities? Are such disparities unjust, as many in public health assume? If so, what are our responsibilites, and what ethical limits might constrain our pursuit of a more equitable distribution of health?
Co-presented with the History of the Health Sciences Lecture Series and the Institute for Practical Ethics and Public Life
The Diagnostic and statistical manual of mental disorders (DSM) is perhaps the most contested document in American medicine, vital for the organization and funding of psychiatric research and mental health care, yet perennially criticized both from within and behond the mental health community. Heated debate accompanied the 2013 publication of the manual's fifth edition, DSM-5. Critics charged that the new edition masks political interests (e.g. interests of psychiatrists and pharmaceutical companies) under the guise of science at patients' expense. DSM-5 defenders championed the inclusiveness and transparency of the review process and evidence-base behind the manual's diagnostic decisions. In this Medical center hour, psychiatrist and theologian Warren Kinghorn argues for a mediating alternative: that the DSM may be best understood as neither an apolitical "encyclopedia" of psychopathology nor a political cloak for psychatric power, but rather as a working document of a living moral tradition. In this case the tradition-constituted discourse allows for appreciation of the DSM as a useful scientific document that reflects the moral assumptions and convictions of the communities that created and continue to sustain it.
Co-presented with the History of the Health Sciences Lecture Series