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Health care information can confuse doctors and patients alike. What are the risks and benefits of mammograms, of aggressive blood pressure control, of EKGs, of lung cancer screening, of heart stents? When patients can’t accurately answer these questions, they find it difficult to have sensible conversations about their health care with their doctors. And lack of comprehensible medical information not only interferes with shared decision-making between physician and patient but can also lead to over-screening and over-treatment, with deleterious consequences for patients as well as for the health care delivery system and medical reform.
In this Medical Center Hour, internist Andy Lazris and scientist Erik Rifkin assess this challenging situation and then present, as one solution, a novel decision aid called a Benefit Risk Characterization Theater (BRCT). When health care information is conveyed simply, factually, and in a non-numerical format, true shared decisions become possible. They offer BRCTs to explain the risks/benefits of some common medical interventions and demonstrate how this approach can improve health care delivery, lead to greater patient satisfaction, and result in less over-treatment, one of the main drivers of low-value health care cost.
Co-presented with the Department of Medicine
In September 1925, while the family of English composer, Herbert Howells, was on vacation in the English countryside, their son, nine-yer-old Michael Howells fell ill with polio and died in London three days later. Howells channeled his grief into the composition of the "Requiem," which drew heavily on an earlier, unpublished work. In this Medical Center Hour, fourth-year medical student and musician Rondy Michael Lazaro explores the historical context of polio in the 1930s and how the loss of Howells's young son played out in the composer's music. Mr. Lazaro conducts a chamber chorus in the performance of two movements from Howell's "Requiem."
Co-presented with the History of the Health Sciences Lecture Series
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
Since its creation in 1999, the same year the Institute of Medicine issued its landmark report, To err is human, the Richardson Memorial Lecture has sparked and sustained conversation at the University of Virginia on the sensitive subject of medical error. The annual lectures ever since have brought to UVA noted experts on medical mistakes, communication about error, and the importance of clinicians' attending carefully to patients as persons. Collectively, the Richardson Lectures have provided opportunities for students, clinicians, educators, and administrators to learn better how to prevent medical errors, communicate about them when they do happen, improve quality of care in complex clinical systems, and assure patients and families of the best possible care and outcomes. The 2013 Richardson Lecturer is internationally known patient-safety expert Dr. Peter J. Pronovost, whose scientifically validated checklist protocol, developed at the Johns Hopkins University, is improving patient safety in health care institutions across the US and the world.
Co-presented with the Patient Safety Committee, UVA Health System
Social and cultural factors, as well as biomedical ones, shape the way we understand and react to diseases. In the case of a disease associated with sex, social and cultural factors figure especially prominently in its history. Since moral and religious views influence almost everything connected with sex, including sexually transmitted infections (STI), syphilis can be an excellent case study to help us appreciate disease in a broader human context. This Medical Center Hour delves into the story of syphilis in America, from colonial times to the present; it looks back too at the origins and spread of the disease in Europe. How did medical science come to understand syphilis and develop treatments for it? What about public health protections against this socially stigmatized STI from prevention campaigns and quarantine of infected persons (usually, women only) to mandated reporting of infections? To what extent does syphilis's identity as an infection popularly associated with sex and sin complicate our response to it and to persons who contract and suffer with it? Finally, how might American social and cultural stigmas around syphilis have contributed to the intentions behind and conduct of the U.S. Public Health Service's unethical research studies at Tuskegee (1932-1972) and in Guatemala (1946-1948)?
Co-presented with the History of the Health Sciences Lecture Series
In 1759, London’s British Museum opened its doors for the first time, the first free national public museum in the world. In this Phi Beta Kappa Lecture at Medical Center Hour, historian James Delbourgo explores the role of slavery and imperialism in making this now venerable institution possible by exploring the career of its founder, Anglo-Irish physician Sir Hans Sloane. Sloane worked in Jamaica as a plantation doctor, used money from sugar plantations in the caribbean and from the Atlantic slave trade to support his collecting, and created his own personal imperial network to assemble one of the greatest cabinets of curiosities in the world—and one of the key institutional legacies of the Enlightenment.
Co-presented with Phi Beta Kappa (Beta of Virginia), President's Commission on Slavery and the University, Department of History, and History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
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
Our bodies are malleable, changing with age and the demands we place on them. And throughout our life, how we stand—our posture—defines us as healthy or ill, able or disabled, beautiful or ugly, even human or not human. The history of posture is also the history of our reading of human anatomy. From the ancients to the moderns, how the body’s anatomy is understood has shaped understandings of what is human (did Neanderthal Man “stand up straight” or slouch?), what is beautiful (“Posture Queen” competitions in 20th century America), what is patriotic (no slouching in ranks!). What we ascribe to upright posture is very much being the perfect human, today and projected into the past. In this Medical Center Hour, distinguished scholar Sander Gilman reflects on how our understanding of posture figures in the history of anatomy and how the history of anatomy has helped craft our understanding of posture. What do shifting cultural perspectives on bodily uprightness tell us about the claims society makes with respect to who we are and what we are able to do?
Co-presented with the History of the Health Sciences Lecture Series, Claude Moore Health Sciences Library; and the Institute for Practical Ethics and Public Life.
This program is also offered in conjunction with UVA's second biennial disability studies symposium, "Disability Across the Disciplines," 19 February 2016.
Physician-writer Samuel Shem's iconic black humor-laced novel, The House of God (1978), written while he was a resident, was an exposé of medicine's often-heartless training culture at the time. The book became unofficial required reading for generations of persons going into medicine. His most recent novel, Man's 4th Best Hospital (2020), appeared when clinician morale was low, burnout rampant, and physician suicide on the rise; if anything, the COVID pandemic has exacerbated these conditions. In this Hook Lecture, Shem discusses how his books arose out of perceived injustice to take the measure of medicine's culture, and how he has used fiction both to resist injustice and to call upon doctors, nurses, and others to reclaim their once-humane calling.
Edward W. Hook Memorial Lecture in Medicine and the Arts
Medicine Grand Rounds
Co-presented with the Department of Medicine and with generous support from the School of Medicine's Anderson Lectures
Why do modern Americans eat so much sugar, and to what effect? This Medical Center Hour offers dual perspectives on the sweet stuff, what it does to/in us, and its many meanings in history and for health. UVA historian David Singerman and UVA physician Jennifer Kirby examine sugar’s impact on the body—past and present, historically, socially, physiologically, and nutritionally.