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Even as the University of Virginia and other medical schools across the U.S. prepare to graduate a new wave of physicians, what will be these doctors' roles and responsibilities in a health care system increasingly stressed by social and political pressures, cultural challenges, and financial shortfalls? And what will be—what should be—expected of physicians and the medical profession in years to come, in their practice, in communities, in policy circles, in the public square? In this Medical Center Hour, Dr. Christine Cassel, a longtime leader in medicine and medical education, offers her perspectives on what should be expected of physicians and other health professionals in coming years--in their practice, in their communities, in government and policy circles, and in the public square.
Twenty-first century physicians and other clinicians who are caring for patients in an era of unlimited knowledge, rapid knowledge turnover, and ever-more-sophisticated artificial intelligence (Watson!) increasingly need new skills and strategies. Such practitioners need too a renewed capacity for compassion. In this Medical Center Hour, eminent physician leader Dr. Steven Wartman, 2019 recipient of UVA's Brodie Medical Education Award, maps this critical juncture and challenges educators and other health professional leaders to reimagine and reengineer how we prepare doctors and other health care practitioners.
The Brodie Medical Education Award Lecture
Adverse events and poor patient outcomes occur for all doctors, regardless of subspecialty, regardless of educational and training pedigree, and despite best intentions. Such occurrences often exact a significant and sometimes lasting emotional toll on doctors, even apart from any culpability or potential medicolegal ramifications. In this Medical center hour Dr. Farnaz Gazoni demonstrates that adverse events in clinical care and their impact on physicians have substantial, widespread repercussions affecting quality of care and patient safety. But her research and experience show too that, by simply cultivating awareness of this issue, health care institutions and individual practitioners are taking important first steps toward culture change.
The Jessie Stewart Richardson Memorial Lecture, School of Medicine
In observance of National Quality Week (19-25 October), and co-presented with the Patient Safety Committee, UVA Health System
This Richardson Memorial Lecture's origins are the hospital death of infant Lola Jayden Fitch and her family's journey to evoke change. The hour is anchored in the stories of Lola's parents--her mother, who questioned her intuition, and her father, who chose to continue working in the hospital where Lola's death occurred--and in a review of medical staff communication errors that tragically affected Lola's care.
How can we prevent communication breakdowns, improve teamwork, and foster greater transparency and true partnership with families to make health care better and safer, especially for the most vulnerable patients? How can Lola's Song and similar stories--those of patients, families, health professionals, and others--help us to accomplish this important work?
www.lolassong.com
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 the making of a doctor, the residency is the principal formative experience. Its three to nine years of supervised practical learning are the crucible in which medical graduates acquire specialty knowledge and skills, forge a professional identity, and develop the values, attitudes, and behaviors for a lifetime of practice. While there have long been tensions within and around residency, physician-historian Kenneth Ludmerer's new book, Let Me Heal, a history of residency in the U.S. since its 19th century origins, comes at a time when training programs are pressured as never before by government regulation, workforce changes, shifts in disease patterns and sites of care, and highly commercialized health care. In this Medical Center Hour, Dr. Ludmerer mines the history of residency for lessons to address current concerns about medical education and to assure we can make the best doctors for the 21st century.
The Joan Echtenkamp Klein Memorial Lecture in the History of the Health Sciences
Co-presented with the History of the Health Sciences Lecture Series
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 June 2018, Gov. Ralph Northam signed a budget bill that gives 400,000 low-income Virginians access to government health insurance through Medicaid. This action marked an upbeat, bipartisan close to a bitter, four-year battle in the General Assembly. An Affordable Care Act option, Medicaid expansion makes additional low-income persons in participating states eligible for care that is funded chiefly with federal dollars. Virginia’s decision to join 32 other participating states hinged on a legislative compromise with Republicans that imposes work requirements on Medicaid recipients. While a few other states have taken similar positions, debate about work requirements continues in government, policy circles, and the courts. This Medical Center Hour looks at Medicaid expansion in Virginia—to be implemented in January 2019—from policy, political, and health care perspectives, with a focus on what it means locally, in Charlottesville and Central Virginia.
A John F. Anderson Memorial Lecture
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
Thirty years ago, the medical school at East Carolina University created a readers' theater program in which short stories about medicine were adapted as theatrical scripts. Medical students performed a story by reading it aloud, then actors and audience--often a community group--together discussed the drama and the ethical and social issues it raised. These plays and post-performance discussions enlivened and changed how future physicians and audiences--prospective patients all--approached and learned from one another.
The best way to learn about medical readers' theater? Just do it. In this Medical Center Hour, UVA medical student actors present a dramatic reading of physician-poet William Carlos Williams's 1938 short story, "A Face of Stone." Following the performance, the audience joins in, as everyone responds to and discusses the play and the ethical, social, and cultural concerns it explores.
A John F. Anderson Memorial Lecture
Co-presented with the Sloane Society for Medical Humanities, UVA
As a UVA undergraduate (Class of 2010), Pennsylvania native Matthew Miller had a catastrophic, near fatal cycling accident on the Blue Ridge Parkway while training for an Ironman triathlon. He lost control of his bike as a caravan of classic cars passed by in the opposite lane; Miller plowed into an oncoming Porsche, breaking every bone in his face. Pulitzer Prize winning journalist Michael Vitez's articles about Miller for The Philadephia Inquirer (reprinted in the Charlottesville Daily Progress) led to his book, The road back: a story of grit and grace (2012). This compelling narrative of Miller's remarkable survival and recovery. He is now a third year medical student at the University of Pennsylvania not only celebrates the strength and resiliency of the human spirit but also vividly attests to the power of medicine at its best. This Medical center hour, with Michael Vitez and UVA surgeon J. Forrest Calland, one of Miller's doctors, suggests that the best way to explore and explain what's happening in medicine may be to tell stories of ordinary people, patients and professionals meeting extraordinary challenges.
A John F. Anderson Memorial Lecture
In 1984, Ronald Reagan’s reelection campaign introduced the theme “Morning in America," promoting an image of the U.S. as a hopeful nation moving toward a better future. As one campaign advertisement asserted, “It’s morning again in America, and under the leadership of President Reagan, our country is prouder and stronger and better.” Fast forward to 2016. “Hopeful” or making the country “prouder" aren't descriptors most Americans would apply to either this presidential campaign or the contenders. One day post-election, what do experts think will be the “better future” under our new President and Congress? And how might the new President’s health care agenda be felt in the Commonwealth of Virginia?
A John F. Anderson Memorial Lecture
Musicologist April Greenan outlines use of music in western medicine as an agent of both healing and prevention, reviewing data documenting music's beneficial effects on patients, and suggests ways that health professionals might purposefully employ music in patient care. How might doctors guide patients to use music on their own in managing pain, anxiety, depression, the side-effects of chemotherapy? Given the ubiquity and affordability of recorded music today, might it represent a cost-effective way to help improve health care and health?
A John F. Anderson Memorial Lecture
Dr. Aaron Vinik recounts his journey through the golden years of biomedical and clinical research as he has studied and tested regeneration of pancreatic islet cells and nerve fibers. There are lessons here for coming generations of physician-scientists--about discovery, about collaboration, about being mentored, about, as Ralph Waldo Emerson suggests, venturing where there is no path and leaving a trail.
The Alpha Omega Alpha Lecture of the School of Medicine
The year 2018 marks the centennial of the "Spanish" influenza pandemic, the world's deadliest event, killing at least 50 million persons worldwide. This pandemic's sudden emergence and high fatality are stark reminders of the threat influenza has posed to human health and society for more than a millennium. Unusual features of the 1918-1919 outbreak, such as the age-specific mortality pattern and unexpectedly high frequency of severe and fatal pneumonias, are still not fully understood. But the recent sequencing and reconstruction of the 1918 virus—work accomplished by NIH scientist Jeffery Taubenberger and colleagues—have yielded answers to crucial questions about the virus's origin and pathogenicity. In this Hayden-Farr Lecture at Medical Center Hour, Dr. Taubenberger summarizes key findings, considers yet-to-be answered questions about the 1918 influenza, and looks ahead to 21st century public health preparedness and the need to optimize preventive vaccines and vaccination strategies.
The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds/History of the Health Sciences Lecture
Co-presented with the Department of Medicine, Historical Collections in the Health Sciences Library, and Influenza! 1918-2018
Growing enthusiasm in medicine and in the population at large for early diagnosis has engaged many doctors in a systematic search for abnormalitites in persons who are well. While physicians, patients, and the press tend to focus on the potential benefits, Dr. H. Gilbert Welch in his work has exposed the often-ignored harm associated with this practice: overdiagnosis. Diagnoses of a great many conditions, including high blood pressure, osteoporosis, diabetes (and prediabetes), and even cancer, have skyrocketed in recent years, yet many individuals so labeled are destined never to develop symptoms, much less die, from their conditions. They are overdiagnosed. And overdiagnosed patients as Dr. Welch points out in the Medical Center Hour, cannot benefit from treatment since there is nothing to fix. But they can be harmed. Understanding the trade-offs involved is critical, Dr. Welch argues, so that health care systems don't further narrow the definition of "normal" and, ironically, turn more and more well persons into patients.
Co-presented with the Department of Public Health Sciences, School of Medicine; the Sadie Lewis Webb Program in Health Law, School of Law; and the Institute for Practical Ethics and Public Life, UVA
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
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
Hospitals and clinics and safety-net organizations across the U.S. are increasingly challenged to provide medically appropriate care to undocumented and uninsured immigrants. These "patients without passports" do not qualify for public benefits that finance health care for low income persons and often lack other means to secure care for themselves and their families. In this Medical Center Hour, Nancy Berlinger, co-director of The Hastings Center’s Undocumented Patients project, explores the ethical and practical dimensions of health care access for this cohort of immigrants, drawing on data from Virginia and other states and on her work with New York City policymakers to improve health care access for vulnerable populations. UVA emergency medicine physician David Burt offers a local perspective.
A John F. Anderson Memorial Lecture
Co-presented with Institute for Practical Ethics and Public Life
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