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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
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
Opiate abuse and addiction in the U.S. population have reached epidemic proportions, with one result being that primary care practices increasingly see patients for whom addiction is the presenting, or exacerbating, problem. But are primary care practitioners actively engaged in treating addiction? Unfortunately, no, says Dr. Hughes Melton, a primary care physician and Virginia's Chief Deputy Commissioner of Public Health and Preparedness. They lack the practical training and helpful mindset to approach addiction, but, also, addiction is more than a medical problem, with multiple stakeholders beyond patient and family, doctor, and clinic.
In this Medical Center Hour, Dr. Melton and two Generalist Scholars--students preparing for careers in primary care--consider what primary care practitioners need in order to care effectively for this urgent population health problem: practical skills and informed attitudes, to be sure, but also the will and nuanced capabilities to be robust social leaders in the community.
A John F. Anderson Memorial Lecture
Co-presented with the Generalist Scholars Program and the Department of Public Health Sciences in observance of Primary Care Week at UVA
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
Randall Griffin was born and raised in 1967 in Chattanooga, Tennessee, and spent time as a young child in Lanett, Alabama, where his mother’s family worked as sharecroppers. Griffin discusses his Cherokee roots in Standing Rock, Alabama, and his early memories of growing up in public housing in Tennessee. His father was a musician in Tennessee with a band called the Fabulous Battalions. Griffin joined the Navy and was stationed in Norfolk in 1986. Following his time in service, Griffin worked as a manager at a Fertilizer plant in Chesapeake when he lost his left hand in a workplace accident, which disabled him permanently. He later went on to work for the Parks and Recreation Departments in Virginia Beach, Norfolk, Chesapeake, and Portsmouth. In this oral history interview, Griffin discusses his experience often being the first Black person in these departments and his experience with workplace discrimination. He discusses the importance of rec centers in young people’s lives. This interview was conducted in the Cavalier Manor Recreation Center in Portsmouth, Virginia, where Griffin serves as the Recreation Program Specialist.
Ray Smith was born in Douglas Park, Portsmouth, Virginia, in 1954. His father worked in the Norfolk Naval Shipyard, and when the city of Portsmouth built the interstate in Douglas Park, his family and other residents were forced to relocate to the Mount Hermon neighborhood. When the city of Portsmouth announced the closure of I.C. Norcom, a historically Black high school in 1972, Smith and others organized a walkout in protest. I.C. Norcom was saved and eventually rebuilt in 1999, when Smith served on the school board. Smith became involved in city politics working for governor and presidential campaigns and served as the President of the Civic League, a community organization dedicated to improving conditions for the Portsmouth community of Cavalier Manor, of which he was a resident for 45 years. In this interview, Smith discusses the ways that recent tolls in Portsmouth have impacted Portsmouth residents and how the city dealt with Hurricane Isabel.
