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Start Over Date 2014 Unit Claude Moore Health Sciences Library

12. Overdiagnosed, making people sick in pursuit of health (1:01:12)

Date:
2014-09-24
Main contributors:
University of Virginia. School of Medicine
Summary:
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

13. Patient safety and quality, the new currency of academic medicine (1:01:27)

Date:
2014-03-12
Main contributors:
University of Virginia. School of Medicine
Summary:
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

14. Pushing the interprofessional education envelope (59:57)

Date:
2014-10-29
Main contributors:
University of Virginia. School of Medicine
Summary:
Over the last decade, the number of reports urging American universities to expose their health professional students to interprofessional education (IPE), so that those who will practice together may learn together, has exceeded the number of actual IPE experiences in most nursing and medical students' entire curricula. In 2013, strong new calls for interprofessional education came from the Institute of Medicine and the Josiah Macy Jr. Foundation. What does this mean for the University of Virginia's Schools of Nursing and Medicine, our students, our health systems, and the patients and families we serve? If we were to push the envelope on IPE, where might we best focus our efforts? How might we lead in preparing the next generation of nurses and physicians for better collaboration and team-based care? The Zula Mae Baber Bice Memorial Lecture, School of Nursing

15. Taking good care of our LGBT elders (1:01:03)

Date:
2014-02-12
Main contributors:
University of Virginia. School of Medicine
Summary:
At a time when lesbian, gay, bisexual, and transgender (LGBT) individuals enjoy unprecedented social acceptance and legal protection, many LGBT elders face the daily challenges of aging isolated from family, detached from the larger LGBT community, and ignored by mainstream aging initiatives. These elders are more likely to be single, childless, financially insecure, fearful of encountering bias in health care settings, and socially isolated. And the continuing silence surrounding LGBT elders has left many of them underserved and at risk. This Medical Center Hour makes the case that increased cultural competency measures are necessary within medicine and society to help older LGBT persons overcome barriers to successful aging and to ensure that we are all taking good care of our LGBT elders. A John F. Anderson Memorial Lecture co-presented with qMD A John F. Anderson Memorial Lecture co-presented with qMD

16. Taking good care of our transgender teens (1:01:02)

Date:
2014-11-12
Main contributors:
University of Virginia. School of Medicine
Summary:
At a time when lesbian, gay, bisexual, and transgender (LGBT) individuals enjoy ever greater social acceptance and legal protection, transgender teens and young adults still face challenges on many fronts. Simply negotiating adolescence isn't easy, and gender identity issues can complicate matters. Health care for transgender youth is in transition, as the population becomes better understood. In this Medical Center Hour, a panel of pediatricians makes the case for increased cultural competency in medicine and society alike to help give transgender teens a safe medical home and help them to lead satisfying, successful lives.

17. The ash and the fire, writing about medicine, the body, and the mind (59:48)

Date:
2014-09-17
Main contributors:
University of Virginia. School of Medicine
Summary:
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

18. The medical sublime (57:58)

Date:
2014-03-19
Main contributors:
University of Virginia. School of Medicine
Summary:
In its emphasis on instrumentality, on the patient as something to be acted upon, and on the doctor as an abstracted agent of diagnosis and treatment, medicine often neglects the practitioner's involvement in the clinical scene. Recent attempts to direct attention to this aspect of practice have been stymied by medicine's nearly exclusive reliance on a quantitative, positivist disposition, with which humanist scholarship has had difficulty gaining traction. The narrative medicine movement, as articulated by Dr. Rita Charon of Columbia University College of Physicians and Surgeons, has gained widespread attention within the medical academy. But physician and literature scholar Dr. Terrence Holt argues that, for all its positive features (and despite Dr. Charon's efforts to define it otherwise), narrative medicine as applied remains committed to an interventional model that is at odds with the strengths of the humanities. Drawing on readings of texts such as Shakespeare's King Lear, Coleridge's Rime of the Ancient Mariner, Shelley's Frankenstein, and the poetry of John Keats, Dr. Holt contends that the value of the humanities in medical education and practice is not as an intervention but as a diagnostic modality—and that the proper first object of diagnosis may not be the patient, but the physician. The Ellis Moore Lecture of the School of Medicine

19. The play's the thing: teaching leadership with creative arts (1:02:17)

Date:
2014-04-02
Main contributors:
University of Virginia. School of Medicine
Summary:
Despite their reliance on technical knowledge that requires mastery, medicine, law, and business are all deeply human professions. Medicine is more than body repair, law more than legal systems, business more than the physics of money. While professional education necessarily must be at the cutting edge of technical expertise, it must remember too the human nature—including the values, emotions, and richly complicated lives—of professionals and professional organizations. In this Medical Center Hour, Professor Ed Freeman from UVA's Darden School of Business demonstrates how the creative arts and humanities can be embedded in professional education to address and actively teach ethical conduct in professional life and leadership of complex professional organizations. What lessons in course design, student engagement, and classroom outcomes might medical educators draw from Professor Freeman's courses, "Business Ethics through Literature" and "Leadership, Ethics, and Theater"? A John F. Anderson Memorial Lecture Co-presented with the Institute for Practical Ethics and Public Life, UVA

20. The political science of psychiatric diagnosis, a moral defense of the DSM (1:01:15)

Date:
2014-02-26
Main contributors:
University of Virginia. School of Medicine
Summary:
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