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- sean adams on The Influence of Ownership on Human Behavior: “Feeding the Beast”
- Sam Campbell on Unnecessary EKGs – The Heart of the Matter
- Lorna Lynn on The Influence of Ownership on Human Behavior: “Feeding the Beast”
In Owen Dyer’s recent BMJ article on the Choosing Wisely® campaign, “The challenge of doing less,” I was quoted as saying, “We think that professionalism should trump financial concerns, particularly as this involves potential harm to the patient and sacrifices quality and safety.” In response to this and my assertion that the campaign is about conversations, professionalism and questioning the underlying values of the health care system, Dyer ends his piece with: “It is idealistic view. Is it a naïve one? Certainly, if the Hippocratic oath is a naïve oath.”
Articles on professionalism, the Choosing Wisely® campaign and conflict of interest round out this week’s Recommended Reading installment:
- The author of Professionalism and Caring for Medicaid Patients — The 5% Commitment? urges physicians to commit to making Medicaid recipients comprise at least five percent of their patients, stating that, “It is a core professional principle that physicians should put the patient’s interest first; refusing to care for vulnerable, socioeconomically disadvantaged Medicaid patients seems incompatible with this principle.”
- A JAMA article examines whether a Choosing Wisely recommendation for single-fraction treatment for bone metastases has been incorporated into routine clinical practice for Medicare beneficiaries with prostate cancer and its effect on cost.
- An Academic Medicine article authored by the Institute on Medicine as a Profession found that, as of 2011, most medical schools lacked conflict of interest policies in the areas studied, only 16 percent met national standards in at least half of the areas, and no school met all national standards.
Catch up on noteworthy articles on conflicts of interest, unprofessional behavior and stewardship of resources in this week’s Recommended Reading:
- A medical student discusses the University of Colorado School of Medicine’s approach to managing faculty-industry relationships and how disclosure of these relationships to medical students would model professionalism.
- Authors from Case Western Reserve University School of Medicine report on a continuing medical education course, “Intensive Course in Medical Ethics, Boundaries, and Professionalism,” which is designed for physicians who have had ethical breaches. The authors discuss data on the ethical violations resulting in course referrals, participant demographics, and course outcomes.
I had the honor of speaking at the American Society for Radiation Oncology’s (ASTRO) annual meeting in Atlanta, Georgia on September 23. One of the goals of my session was to announce ASTRO’s Choosing Wisely list of five tests and procedures that patient and physicians should question. Actually, Michael Steinberg, MD, chair of the board of ASTRO, was announcing the five things – I was just the opening act. It was a full house, standing-room-only in a large narrow rectangular room with probably more than 600 people. There was excitement and anticipation in the air; the list had been kept confidential until this moment.
Catch up on the latest research on professionalism training and feedback in medical education and training in this week’s Recommended Reading:
- In “They liked it if you said you cried”: how medical students perceive the teaching of professionalism,” focus groups of Australian medical students revealed that they found their professionalism curriculum overly didactic and narrow, and that some students “gamed the system” by writing reflection pieces they thought their assessors wanted to read. Students advocated for greater input into their professionalism curriculum and more emphasis on role modeling and mentoring during their clinical training.
- A new study reports on medical students’ experiences with the fourth-year Humanistic Elective in Alternative medicine, Activism, and Reflective Transformation (HEART), which was developed by the American Medical Student Association in 2004. A survey of the first eight cohorts of HEART graduates found that the elective taught professionalism and communication skills very well, as well the ability to manage stress, provide self-care and empathize with patients and families.
- A qualitative study assessed internal medicine faculty’s comfort in providing feedback on professionalism to first-year residents both before and after a faculty development program on teaching, and providing feedback on professionalism. Results showed that the development course improved faculty comfort in this area, while also identifying areas for improving faculty development.
The third annual Professionalism Roundtable meeting, sponsored by the ABIM Foundation and the Mayo Clinic, focused on physician well-being and resiliency. Attendees included twenty-five leaders in the field of professionalism from 10 large health care systems.
Mayo Clinic’s Tait Shanafelt, MD, presented some disturbing facts about physician burnout, physician dissatisfaction and its consequences for patients:
- 6.4% of surgeons thought of suicide in the last 12 months (Shanafelt, Archives Surgery 146:54,2011).
- 45% of all physicians report being burnt out (defined as a syndrome of depersonalization, emotional exhaustion and low personal accomplishment leading to decreased effectiveness at work). The stats for Emergency Medicine docs are worse at over 60% while General Internal Medicine, Neurology and Family Medicine, all report over 50%. (Shanafelt, JAMA. Int Med 172:1137,2011).
- Increasing levels of education is positively associated with job satisfaction among professionals except for physicians, for which it has significant negative association.
- Consequences of physician burn-out include professionalism lapses, medical errors, lower patient satisfaction and higher turnover.
A number of medical specialty societies are releasing new Choosing Wisely® lists, and the campaign continues to generate buzz and follow-up initiatives. Catch up on the latest Choosing Wisely articles in this week’s Recommended Reading:
- In “Choosing Wisely: You get what you pay for,” the author reflects on the American Academy of Neurology’s Choosing Wisely recommendations, and argues that consumers must work as partners with physicians in preventing unnecessary tests and procedures.
- Authors of a new Journal of Hospital Medicine piece discuss their tool to decrease catheter-associated urinary tract infections, stating that their tool complements the Society of Hospital Medicine’s Choosing Wisely adult hospital recommendations.
- The authors of a BMC Nephrology commentary describe the launch of the U.S. Centers for Disease Control and Prevention chronic kidney disease surveillance system, which will include tools to raise awareness of chronic kidney disease among consumers. The authors also cite the American Society of Nephrology’s Choosing Wisely recommendations as an important patient resource.
I read Atul Gawande’s recent article in The New Yorker (07.29.13), “Slow Ideas,” with great interest. In it, Gawande asks, “Why do some innovations spread so swiftly and others so slowly?” I immediately harkened back to the Choosing Wisely campaign.
This week yielded articles touching on a wide range of professionalism issues, including social media, reflection during medical education and stewardship of resources.
- A new systematic review examines the impact of social media on medical professionalism. The authors conclude that social media offers both challenges to, and opportunities to enhance, medical professionalism.
- A recent study assesses the impact of a professionalism reflection exercise in a medical school gross anatomy course that included cadaver dissection.
- The Institute of Medicine’s report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,” argues that waste must be eliminated in cancer care. The report cites Choosing Wisely® as one effort to eliminate unnecessary oncology tests and procedures.
The 2013 ABIM Foundation Forum was entitled “Purpose vs. Payment: Motivating Change in Health Care.” The title was, of course, a false dichotomy.
Going into the meeting, I was pretty sure that the collective answer would be “both, of course!” But as the animated and spirited conversations among the participants continued over the three-day meeting, I was struck by how much more captivating, engaging and fulfilling it was to be thinking about purpose rather than payment.