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The Affordable Care Act (ACA) has brought transformational changes to the healthcare system, including, in some ACA programs, movement away from a pay-for-volume system to pay-for-performance or outcome. Three programs exemplify this approach: readmission penalties, no payment for selected hospital-acquired conditions (HACs), and value-based purchasing. To date, the HAC nonpayment program has targeted prevention of central-line-associated bloodstream infections, catheter-associated urinary tract infections, selected surgical site infections, and methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections. With better understanding, improved procedural practices, and closer monitoring, more of these infections are proving preventable; infection rates, including for MRSA, have dramatically decreased. In this Medical Center Hour, distinguished medical epidemiologist Dr. William Jarvis discusses these successes, including their financial implications, and how further collaboration between clinicians and infection control programs can prevent even more hospital-acquired conditions.
The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds
Co-presented with the Department of Medicine, UVA
Over the past decade, several leading U.S. medical schools have developed courses combining art appreciation and clinical observation skills. Medical students venture from the clinical setting to the art gallery, where they are challenged by gallery educators and medical professors to observe and to articulate what they see in the art before them. Such courses aim to cultivate and deepen students' visual literacy, verbal facility, and tolerance for ambiguity with the expectation that more finely tuned visual observation and communication skills will help them to be better doctors.
Working with a task force in the UVA School of Medicine, Fralin Museum of Art academic curator Jordan Love has created and piloted The Clinician's Eye, an interactive workshop that aims to refine apprentice clinicians' skills through training in visual analysis. This Medical Center Hour invites audience members to participate—hands-on—in a version of this workshop.
A John F. Anderson Memorial Lecture
The history of eugenics is often characterized as a cautionary tale of life in the bad old days, when pseudoscientific assumptions about genetic determinism provided a respectable veneer that enabled barely submerged racism, xenophobia, and blatant discrimination against persons with disabilities to take root in American law. Some argue that, today, our science is sound, our attitudes enlightened; we need not be hobbled by fear of long-expired bad eugenic habits.
In this Medical Center Hour, Paul Lombardo, who has written extensively on eugenics and the law in America, challenges such assumptions, asserting that the same tendencies that led to a century of eugenic law and policy continue to inform our public debate over democratic values and the proper role of science as a tool for solving social problems.
The Joan Echtenkamp Klein Memorial Lecture in the History of the Health Sciences
Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library
We hear much these days about the widening gap in America between the rich and the poor, the haves and the have-nots. Inequality is all around us, and it exacts a serious toll on health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. Indeed, there is a 35-year difference in life expectancy between America's wealthiest (and healthiest) and poorest (and sickest) neighborhoods.
Internist David Ansell MD has worked for four decades in hospitals serving Chicago's poorest communities. While he's witnessed first-hand the structural violence—racism, economic exploitation, and discrimination—responsible for the "death gap," he argues that geography need not be destiny. In this Medical Center Hour, Dr. Ansell outlines how we can address this national health crisis and act to remedy the circumstances that rob many Americans of their dignity and their lives.
Co-presented with Alpha Omega Alpha National Medical Honor Society, UVA chapter
Nimura, Janice P., University of Virginia. School of Medicine
Summary:
The world recoiled at the idea of a woman doctor, yet Elizabeth Blackwell persisted, and in 1849 became the first woman in the U.S. to receive an MD. Her achievement made her an icon. Her younger sister Emily followed her, eternally eclipsed despite being the more brilliant physician of the pair. Together, they founded the first hospital staffed entirely by women, in New York City. While the Doctors Blackwell were visionary and tenacious—they prevailed against a resistant male medical establishment—they weren't always aligned with women's movements, or even with each other. In this Medical Center Hour, biographer Janice Nimura celebrates the Blackwells as pioneers, change agents, and, for women in medicine today, compelling yet somewhat equivocal role models.
Co-presented with Historical Collections, Claude Moore Health Sciences Library
A documentary film series and website about Virginia's history since the Civil War.
Episode 1– New Deal Virginia explores two significant changes in Virginia history: the creation of Shenandoah National Park and the electrification of rural Virginia. Both stories trace the effects of the federal government on the lives of everyday rural Virginians in the 1930s. Letters, maps, newspaper stories and teaching resources accompany this exploration and film (30 minutes).
Episode 3 – Massive Resistance became Virginia's policy to prevent school desegregation in the wake of the Brown v. Board of Education Supreme Court decision in 1954. Many of Virginia's white leaders resisted integration with all of their considerable political and legal means. The story of massive resistance and of black Virginians' protests against segregation began in the early 1950s and continues today. This two-part film (one hour) traces the history of massive resistance in Virginia and considers some of its legacies. "Massive Resistance" was an Emmy Nominee in 2000 of the Washington, D.C. Chapter of the National Academy of Television Arts and Sciences and will be shown nationally on PBS in February 2002 for Black History Month.
Episode 4 – Virginia Fights World War II explores the transformative changes that Virginia experienced in World War II. Virginia mobilized hundreds of thousands of citizens during World War II and became the home base for a host of navy, army munitions, and defense industries. Virginia's soldiers fought in the Pacific and landed at Omaha Beach on D-Day. This two-part film (one hour) follows the stories of everyday Virginians, those who fought at D-Day and those who patrolled Virginia beaches, worked in the munition plants, flew missions in Europe, and fell in love during the war. This site contains the image archive for the film--over 1,600 images of Virginia or Virginians in World War II.
As our companion animals grow old and infirm, veterinarians and human caregivers alike face a complex and confusing array of choices and decisions. This Medical Center Hour explores some of the central moral challenges in end-of-life care for animals, from pain management and quality-of-life assessments to palliative treatment, hospice care, and making that final decision to hasten an animal's death. Considering this "last walk" with our pets, bioethicist Jessica Pierce and compassionate care advocate Susan Bauer-Wu borrow some ethical guideposts from the field of human bioethics (and offer a few in return).
A John F. Anderson Memorial Lecture
Co-presented with the Institute for Practical Ethics and Public Life, UVA
With malaria a real threat to American troops' fighting fitness, the U.S. government during World War II mounted an all-out hunt for a malaria cure. Tropical-disease researchers with the Rockefeller Foundation took the lead on a secret project that adopted German research models and methods, including use of institutionalized Americans—inmates in six mental hospitals and several large prisons—both for culturing the parasites that cause malaria (there was no animal model) and for testing experimental drugs against the disease. After thousands of failed starts (and much human harm), the researchers had their "magic bullet": a German antimalarial compound captured in battle. This drug, reformulated in the U.S., is chloroquine, one of the most important pharmaceuticals ever made to fight malaria.
In this Medical Center Hour, public health journalist Karen Masterson and infectious diseases specialist Dr. Richard Pearson delve into this tale of secret science in the service of war efforts and into research that was conducted before promulgation of federal rules and regulations governing human participation in biomedical research.
Co-presented with the History of the Health Sciences Lecture Series of Historical Collections, Claude Moore Health Sciences Library
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
This is a flythrough animation of the 3D data from laser scanner data collection at The Mews, Pavilion III, Academical Village, University of Virginia. Data was collected at different periods from 2016, 2023 and 2024. Data was collected with FARO Focus 3D laser scanners and processed with FARO Scene v.2023. Data was imported into Autodesk ReCap for editing and optimization and for the purpose of creating this animation video.
With health care reform on the near horizon and other social realities (aging, immigration, chronic conditions, quests for prevention and wellness) dramatically changing health care in the U.S., what kinds of doctors will our health care system (and its patients) require? Clearly, not just medical school curricula but also the selection process for medical students will be key determinants of whether we have physicians fully prepared to practice as the 21st century progresses. This Medical center hour addresses transformational changes underway in the pre-professional preparation and selection of the nation's medical students, including a new version of the MCAT exam, which goes "live" in 2015. What does this new MCAT signal for premedical students as they prepare for medical school? How might colleges and universities offer their premedical students academic experiences that will better equip them for medical school and medical practice in the 21st century?
Co-presented with the Institute for the Humanities and Global Cultures, UVa
A John F. Anderson Memorial Lecture
The opioid epidemic raging in the U.S., including in Virginia and neighboring states, took nearly two decades to develop and will take years to quell. So says the recent National Academy of Medicine (NAM) report, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (July 2017). Drug overdose due to opioid medications is now this country's leading cause of unintentional injury death. The current crisis is particularly challenging because the epidemic's broad reach "has blurred the formerly distinct social boundary between prescribed opioids and illegally manufactured ones, such as heroin," asserts the NAM committee's chair, UVA law professor Richard J. Bonnie.
In this Medical Center Hour, Professor Bonnie and palliative care specialist Dr. Leslie Blackhall address the impact of this epidemic on public health and patient care and discuss what actions regulatory bodies, health care organizations, and health care professionals could take.
A John F. Anderson Memorial Lecture
