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Share the Art of Medicine by Embracing the Role of Mentor – AAFP News

How can medical students in 2019 learn all there is to know in medicine in four (or even five) years of school?

When I was in medical school and residency training more than 30 years ago, there were 400 to 450 FDA-approved medications (including OTC products). Only about 150 of those were applicable to my patients. I learned them all, their possible side effects and contraindications. Since then, the number of FDA-approved drugs has tripled,(www.raps.org) making it impossible to keep up. Now I have to rely on my subspecialty consultants to know the medications specific to their limited scope of practice, which I am exposed to less often.

Similarly, technology has led to more treatments and procedures -- microsurgeries, laser surgeries, robot-assisted surgeries and more -- that may benefit patients. Again, recently I have found consultants recommending therapies with which I am not familiar.

Simply put, the explosion of knowledge in medicine has made staying current challenging. Throw in the evolution of electronic health records, and medical students have more cognitive knowledge to master to become physicians than I or my peers ever did.

But many of us older folks benefited from an excellent education in the doctor-patient relationship and other arts that are crucial in all fields of medical care, not just in primary care. Although even long ago, medical school was no walk in the park, there was time between scientific knowledge acquisition activities to learn this art: how to cultivate an effective and caring doctor-patient relationship and how to use other modalities along with that medical knowledge base to serve patients.

It's no wonder that a current medical student might be drawn to a limited-scope specialty rather than the broad, comprehensive, evolving field that is family medicine. But as family doctors, we know how important it is for every doctor to practice the art as well as the science of our work to be successful in our healing field.

Despite recent advances in the curriculum by some medical schools, students spend much of their first two years focused on core science classes before starting clinical rotations in their third year. By the start of year four, most have made important decisions about their career path, yet many still have their family medicine/primary care rotation ahead of them. It leaves me wondering how -- and when -- students will learn the art of building relationships with patients. And if they don't have adequate exposure to this vital skill, which is at the heart of primary care, what are the odds that they will choose a broad-spectrum specialty like family medicine?

Medical schools should be actively resisting medical practice becoming a lost art. We must know how to care, listen and give our time. Relying on evidence-based medicine alone is no substitute for these skills. Students need to see the power of connecting with patients so that they can see what a rewarding and meaningful specialty family medicine can be for them.

The AAFP and seven other family medicine organizations have undertaken the 25 by 2030 project that aims to achieve 25% of U.S. medical students matching into family medicine by 2030. This is a big reach -- one that is vital to strive toward not just for our specialty, but for our country's health care.

Key to success in this goal is having high school and premed students exposed to the joy of a career in medicine, and medical students exposed early to what we do in our clinics that augments the scientific knowledge they are acquiring and transforms an excellent scientific physician into an excellent clinical doctor.

I wrote in this blog a few years ago that I had started precepting first- and second-year medical students again in my clinic after taking a break from it. What I rediscovered is that working with students is rewarding, and they do not slow me down or present an obstacle to an effective patient visit. More significantly, students are eager to acquire the noncognitive patient-physician relationship-building techniques that I model and teach them in my office. I've had students drive more than an hour to spend time with me in my clinic.

Students have told me that, even on busy days when there isn't much time for answering questions, they can learn a lot just by observing. Although there is so much to learn in medicine, they see the connection I make with patients. After more than 30 years in practice, I can read the expressions on my patient's faces and gauge how they react to my words.

The students I teach, as well as those I am exposed to in my AAFP travels, are eager to learn this aspect of doctoring. I recently gave up some of my clinic teaching to take on co-teaching small group sessions at the medical school. I am struck by the extensive check-off lists of competencies that each student must demonstrate. I empathize with my full-time faculty colleagues who have so much cognitive knowledge to teach (and check off on lists of achievements), and it has helped me understand how they struggle to include relationship-building education.

This early exposure requires schools to carve out time in the first year, and even the first semester, for students to learn the art of doctoring. It also requires us veteran physicians to accept students into our offices to watch us deliver health care and to practice that art as time allows.If you aren't already connected to students, contact a medical school department of family medicine in your area, and embrace the role of mentor.

Alan Schwartzstein, M.D., is the speaker of the AAFP Congress of Delegates.

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Share the Art of Medicine by Embracing the Role of Mentor - AAFP News

Why Medicine Needs a New Hippocratic Oathand What It Should Be – Singularity Hub

Somewhere along the road from sickness to health, the American medical system took a wrong turna big one.

The cost of care in our country is sky-high, yet our population health outcomes tend to be worse than those of other developed countries (many of which have universal health care). Major surgeries, treatments for long-term illnesses like cancer, and medical attention for catastrophic injuries are so expensive that people can lose their homes or be forced to declare bankruptcy. Even a routine visit to a general practitioner can cost hundreds of dollars. Yet Americans have some of the highest rates of heart disease, diabetes, and obesity in the world.

How did we get here?

In a talk at Singularity Universitys Exponential Medicine summit this week in San Diego, Dr. Jordan Shlain shared his thoughts on that question, as well as a framework for moving American healthcare forward. The first step, he believes, is a new Hippocratic oath, one thats been updated for our high-tech age.

It was the fifth century BC when Hippocrates put forth the idea that physicians should try to help people and do no harm (a pretty intuitive concept, one would think), among other ethical standards. The Hippocratic oath was born, and over time its been modified to reflect shifts in medicine and society. But the field of medicine has changed even more than the oath has, and Shlain believes its time for another overhaul.

He pointed to the beginning of early modern medicine as pivotal to the field. As new technologies came along that had potential to treat people more effectively, everyone wanted access to those technologies, so someone had to start manufacturing themand the incentive to do so was a profit.

When X-rays and penicillin were invented, we could see things wed never seen before and treat things wed never been able to treat before, Shlain said. Someone had to make X-ray machines and someone had to form a pharmaceutical company. But the convergence of medicine and business fed mounting costs, conflicts of interest, bureaucracy, and a focus on profits over patients.

Medical technology companies and pharmaceutical companies are now massive and complex, as are the medical and regulatory systems. Theres a lot standing between physicians and patients, Shlain said. It leads us to reactive medicine, and theres physician burnout.

The root of this problem, he believes, is that a corporate oath has superseded the Hippocratic oath in healthcare. The corporate oath says to increase shareholder value, generate profits, and constantly grow margins. But they dont know the outcomes on the other side, Shlain said. Exhibit A? The opioid crisis.

Since 1970, the costs of medications and medical devices have only gone upand so have corporate revenues. went up, cost of devices went up. But despite spending all this money and having all this expensive technology and medications, were not doing too well, Shlain said, pointing to a graph that shows life expectancy in the US falling since 2014. We need to differentiate between consumers and patients.

Shlains new oath consists of nine different statements.

1. I shall endeavor to understand what matters to the patient and actively engage them in shared decision making. I do not own the patient, nor their data. I am a trusted custodian.

Shlain pointed out that rather than asking patients What matters to you? physicians ask, Whats the matter with you? But to get the right answer, it should be a combination, and not just between doctors and patients, but in every interaction in the healthcare system.

2. I shall focus on good patient care and experience to make my profits. If I cant do well by doing good and prove it, I dont belong in the field of the healing arts.

We need to have some version of transparency for our outcomes, Shlain said.

3. I shall be transparent and interoperable. I shall allow my outcomes to be peer-reviewed.

Silicon Valley has gotten better at embracing a culture of learning from failure and even encouraging failure as a path to eventual advancement, but the medical field hasnt done the sameand perhaps rightfully so, since failure can mean a life lost. However, Shlain added, a byproduct of failure is almost always some sort of lesson.

4. I shall enable my patients the opportunity to opt in and opt out of all data sharing with non-essential medical providers at every instance.

Data privacy should be respected both as a path to trust and as a basic patient right.

5. I shall endeavor to change the language I use to make healthcare more understandable; less Latin, less paternal language; I shall cease using acronyms.

I would rename type two diabetes the over-consumption of processed food disease, because thats what it is, Shlain said. You dont get it, you participate in its process. But you didnt know it, because the language obfuscates that. So we really need to dig into language here, because language does tie to the metaphors we live by.

6. I shall make all decisions as though the patient was in the room with me and I had to justify my decision to them.

7. I shall make technology, including artificial intelligence algorithms that assist clinicians in medical decision making, peer-reviewable.

Everyone has proprietary technology and were supposed to use it despite not knowing how it works, Shlain said. Its in the interest of both practitioners and patients for this to change.

8. I believe that health is affected by social determinants. I shall incorporate them into my strategy.

Someones zip code can tell you more about their health than their genetic code, Shlain said. We need to focus on community.

9. I shall deputize everyone in my organization to surface any violations of this oath without penalty. I shall use open-source artificial intelligence as the transparency tool to monitor this oath.

Shlain pointed out that feedback loops in big corporations often arent productive, because people worry about losing their jobs. We need to create some mechanism of a feedback loop to ensure that this happens, he said.

This new oath isnt just for clinicians, Shlain emphasized. Its for everyone who touches the healthcare system in any way. That includes pharmaceutical companies, device manufacturers, medical suppliers, hospitals, and so on.

Given how fast new technologies are changing the healthcare landscape, we may need a totally new oath in ten years; what happens when robots are performing surgery, AI systems have taken over diagnosis, and gene editing can cure almost any congenital disease? Well need to continuously stay aware of how doctors roles are evolving, and update the ethical codes they practice by accordingly.

What we need is a culture of care, at every level, Shlain said. In order to change our paradigm, we need to have a set of principles that get us there.

Image Credit: Wikimedia Commons

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Why Medicine Needs a New Hippocratic Oathand What It Should Be - Singularity Hub

What is Osteopathic Medicine and OMT? – CapeGazette.com

You may have seen DO at the end of a physicians name but not known the meaning behind this degree. It stands for doctor of osteopathic medicine, and these doctors are trained in modern medicine as well as holistic medicine based on the philosophy that the body is an integrated whole. They receive special instruction in the musculoskeletal system and osteopathic manipulative therapy (OMT), a hands-on approach to diagnosing and treating patients. Bayhealth Primary Care PhysicianVincent Lobo, DO, DACFP, who has been performing OMT in his practice for over 40 years, discusses its uses and benefits.

The premise behind osteopathic or holistic medicine is that the mind, spirit, and structure and function of the body are interdependent. Essentially, if your body is structurally healthy, it heals itself. Pain or other problemsoccur when there are somatic dysfunctions of different levels of the spine, said Dr. Lobo. Somatic dysfunction is defined as a restriction in the bodys framework. This may originate in the skeletal system or fascia, the bodys connective tissue, and may alter the circulatory, lymphatic or nervous system.

If theres a lesion in the back or the spine is out of alignment, for example, the nerves that connect from that area to the internal organs send abnormal nerve impulses that will, in turn, affect those organs, he said. The opposite can also occur when a disorder of an internal organ manifests as a spine problem, such as an inflamed gall bladder causing back pain.

Osteopathic physicians aim to restore the normal mechanics in the body. In an osteopathic structural exam, I typically examine for posture, spinal motion, joint restriction, tissue spasms, spinal curvature, leg lengths, and conditions of the feet, said Dr. Lobo. With OMT, gentle pressure is applied or manual manipulations are done on the muscles, joints or nerves that are the source of the dysfunction. This can improve posture, relieve pressure and reduce pain.

Dr. Lobo said that some of the more common ailments for which he performs OMT are chest wall pain, tension headaches, thoracic pain, sinus problems, neck and low back pain, temporomandibular joint dysfunction (TMJ), and some abdominal pain. There are a variety of OMT techniques, and these are dependent upon the specific problem and a patients age. Two types are muscle energy techniques, involving muscle stretching and contractions, and myofascial release which is like a soft tissue massage.

A critical element of osteopathic medicine is preventative medicine and education, said Dr. Lobo. This includes encouraging patients to maintain healthy diet and physical activity, and teaching them what they can do on their own to help with their medical issues, such as using correct form when lifting, wearing orthotics in shoes, or doing certain exercises.

All DOs have the knowledge, but not all DOs perform OMT, Dr. Lobo said. Its another modality of treatment but like anything else, including physical therapy or acupuncture, nothing is 100%. I think its good for people to know that Bayhealth has this resource through some of its doctors.

To learn more about osteopathic physicians and those who use OMT in their practice, visitBayhealth.org/Find-A-Doctoror call 1-866-BAY-DOCS (229-3627).

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What is Osteopathic Medicine and OMT? - CapeGazette.com

The Guardian view on alternative medicines: handle with care – The Guardian

Human health is complicated, and while the history of medicine is often represented as a triumphant march from darkness into light, for many people it doesnt feel like that. Partly this is because we take so much for granted. Its hard to imagine a time when infection and childbirth were serious threats to life. But its also true that as life expectancy has extended and lifestyles have changed, new illnesses and conditions have taken the place of old ones. Dementia, obesity and anxiety disorders are among them.

Sometimes a visit to the doctor doesnt make us, or our loved ones, feel better. There is nothing wrong with looking beyond conventional medicine for activities or remedies that may help. But people should understand that such alternatives are not tested in the same way as the drugs or exercises prescribed by doctors. While manufacturers, practitioners and users of treatments including herbs and osteopathy may make claims about their effectiveness, the public should treat such claims with healthy scepticism: try something by all means, but do not mistake heartfelt testimonies or lengthy appointments for evidence-based medicine.

There has long been a minority of members of the public who opted out of orthodoxy in medicine as in other areas of life. Until recently this was generally viewed as a personal choice that needed to be challenged only in extraordinary circumstances (for example if life-saving treatment was denied to a child). That this tradition of tolerance is now being questioned is largely due to recent falls in the take-up of childhood vaccinations. Last month Simon Stevens, the chief executive of NHS England, went public with serious concerns about homeopathy, and a decision to renew the accreditation of the Society of Homeopaths is being challenged after it was discovered that some members promoted a nonexistent cure for autism.

The situation is not unique to the UK, with the internet providing conduits for anti-vaxx and other myths that did not previously exist. This week Europes leading doctors issued a warning about unproven Chinese medicines, and the World Health Organizations recent decision to grant them recognition.

Regulation is important, as these doctors point out. Policymakers must be alert to the risks posed by unscrupulous or incompetent operators to vulnerable, unwell people, as well as the danger to the general public of anti-vaxxers. There is also a more general cause for concern if the market for alternative medicine is growing because people are choosing magic over science. Rationality matters in principle. But it need not crowd out curiosity or open-mindedness. Placebo effects are well documented, as is the human need for attention. Unconventional ideas and methods can help people, as long as they understand the difference between what is tested, and proven to be effective, and what is neither.

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The Guardian view on alternative medicines: handle with care - The Guardian

Women in medicine more likely to experience ‘microaggressions’ than men. Here’s what you can do about it. – The Daily Briefing

Female medical faculty members find "microaggressions"indirect, fleeting comments that are "rooted" in "unconscious bias" against a marginalized groupcommon in the workplace, while male faculty say they seldom occur, according to a study published last week in Academic Medicine, the study's lead author VJ Periyakoil, writes for the New York Times' "Well."

Periyakoil is an associate professor at Stanford University School of Medicine.

A few years ago, Periyakoil started the Stanford Project Respect to study communication in health care and "foster mutually respectful interactions between health professionals and their patients."

For the project, Periyakoil and her colleagues hired professional actors to reenact 34 different microagression scenarios as well as controlor "nontoxic"versions of the scenarios. The interactions were recorded and turned into 68 videos that medical faculty at four medical schools across the country viewed in random order. The faculty members were then asked to rate each scenario on the frequency in which they occurred in real life.

The sample group consisted of 124 people, 79 of whom were women and 45 of whom were men.

The results, published last week in Academic Medicine, showed female faculty were more likely than male faculty to say the microaggression scenarios were common in the workplace.

The female faculty members reported that workplace microaggressions were frequent overall. On the other hand, male faculty from the same workplaces said microaggressions were uncommon.

The researchers as part of the project also collected stories of microaggressions from health care workers across the country. One female surgeon recalled being interviewed by a panel of men, which she called a "manel," and being asked how she would, "be able to effectively communicate in the operating room as a woman."

Another said that when she asked her boss about being promoted to a different position, he responded, "Well, I'm just deciding, you know, if I'd like to give you an engagement ring or not. You have to convince me."

In one situation that Periyakoil calls particularly "appalling," a lecturer selected a female student to be a model for his ultrasound skills demonstration and called a certain angle of the instrument probe a "money-shot."

Based on her research, Periyakoil offers suggestions about how medical faculty can confront microaggressions and create a better climate for female faculty and students.

In the moment, calling out microagressions can be "daunting," Periyakoil writes, but at a closer look, "we see that microaggressions are rooted in our unconscious biases that are fed by the gender and racial tensions that seethe under the surface and bubble up when we least expect them."

As a result, the first step to changing the culture is acknowledging the problem, Periyakoil writes.

"If you are the perpetrator and you catch yourself in the act, apologize immediately and sincerely for your misstep. If you are the recipient, speak up respectfully and promptly in the moment," she writes.

Bystanders can also play a critical role in mitigating the culture by calling out microaggressions and supporting victims of the comments.

For example, during a gynecology seminar, a professor asked a female student if she could tell how much estrogen she has inside of her body when she's ovulating. The "mortified" female student sat in silence, but then a male classmate stepped in.

"Professor, I've never, um, ovulated before, but I think I can take this question," he said (Periyakoil, New York Times, 10/31; Vyjeyanthi et al., Academic Medicine, 10/29).

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Women in medicine more likely to experience 'microaggressions' than men. Here's what you can do about it. - The Daily Briefing

WVU Rockefeller Neuroscience Institute first in US to use deep brain stimulation to fight opioid addiction – WVU Medicine

Posted on 11/5/2019

MORGANTOWN, W.VA. -- The West Virginia University Rockefeller Neuroscience Institute and WVU Medicine, today (Nov. 5) announced the launch of a first-in-the-U.S. clinical trial using deep brain stimulation for patients suffering from treatment-resistant opioid use disorder.

Funded through a grant from the National Institute on Drug Abuse, the clinical trial is led by principal investigatorAli Rezai, M.D., executive chair of the RNI, and a multidisciplinary team of neurosurgical, psychiatric, neuroscience, and other experts.

The team successfully implanted a Medtronic DBS device in the addiction and reward center of the brain. The trials first participant is a 33-year-old man, who has struggled with substance use disorder, specifically excessive opioid and benzodiazepine use, for more than a decade with multiple overdoses and relapses.

West Virginia has the highest age-adjusted rate of drug overdose deaths involving opioids. In 2017, drug overdose deaths involving opioids in West Virginia occurred at a rate of 49.6 deaths per 100,000 persons, according to NIDA.

Our team at the RNI is working hard to find solutions to help those affected by addiction, Dr. Rezai said. Addiction is a brain disease involving the reward centers in the brain, and we need to explore new technologies, such as the use of DBS, to help those severely impacted by opioid use disorder.

The first phase of this clinical trial involves four participants. To qualify, patients will have failed standards of care across multiple levels of WVU Medicines comprehensive inpatient, residential, and outpatient treatment programs that include medication, as well as psychological and social recovery efforts.

Despite our best efforts using current, evidence-based treatment modalities, there exist a number of patients who simply dont respond. Some of these patients remain at very high risk for ongoing catastrophic health problems and even death. DBS could prove to be a valuable tool in our fight to keep people alive and well, James Berry, D.O., interim chair of the WVU Department of Behavioral Medicine and Psychiatry and director of Addiction Services at RNI, said.

DBS, or brain pacemaker surgery, involves implantation of tiny electrodes into specific brain areas to regulate the structures involved in addiction and behavioral self-control. This study will also investigate the mechanism of the addiction in the brain. The U.S. Food and Drug Administration has approved DBS for treating patients with Parkinsons disease, essential tremor, dystonia, epilepsy, and obsessive-compulsive disorder. The RNI team routinely uses DBS to treat patients with these disorders.

About the Rockefeller Neuroscience Institute

We are improving lives by pioneering advances in brain health. With the latest technologies, an ecosystem of partners, and a truly integrated approach, we are making tangible progress in our goal to combat public health challenges ranging from addiction to Alzheimers, benefiting people in West Virginia, neighboring states, and beyond. Learn more about the RNIs first-in-the-world clinical trials and the top caliber experts joining us in our mission.

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WVU Rockefeller Neuroscience Institute first in US to use deep brain stimulation to fight opioid addiction - WVU Medicine

How to Close the Gender Pay Gap in US Medicine – Harvard Business Review

Executive Summary

Indefensible differences in salary between women and men persist in medicine, with female primary care and specialist doctors earning 25% and 36% less, respectively, than their male counterparts. These differences are especially egregious given that female physicians actually outperform male physicians in some areas. Its hard to imagine by what calculus a health care organization would pay women less than men for their better outcomes. The solutions to this unacceptable state including transparency around salary data, focused coaching and sponsorship, and equitable promotions.

Despite increased attention to gender disparities in the workplace, indefensible differences in salary between women and men persist in medicine. One national study of academic physicians in 24 public medical schools found that female physicians make about 10% less than their male counterparts at all academic ranks, even after adjusting for specialty, hours worked, and other variables. Medscapes 2019Physician Compensation Report finds even greater disparities, with full-time male primary care and specialist doctors earning 25% and 33% more, respectively, than their female counterparts.

These differences are especially notable and disappointing given that female physicians actually outperform male physicians in some areas; one study of 1.5 million Medicare hospitalizations found that female doctors patients had significantly lower mortality and fewer rehospitalizations. Its hard to imagine by what calculus a health care organization would pay women less than men for their better outcomes.

The solutions for closing this gap are complex, but achievable. Drawing on existing research, lessons from other fields, and our own experience as researchers and leaders committed to gender equity, we believe that organizations should pursue three approaches to address the problem.

Enhance Salary Data

Lack of accurate salary data creates a major barrier both to leaders seeking to address inequities and to female physicians as they negotiate. Pay audits and increased transparency could help. Organizations outside of medicine have effectively used audits to reveal pay discrepancies and enhance pay equity. For example, after a 2015 analysis of more than 17,000 salaries at Salesforce, the company found that 6% of the employees (about equally split between men and women) required a salary adjustment, including, CEO Marc Benioff told CNN, quite a few women who were paid less than men.

To create the most useful audits in healthcare it will be essential to assure that they capture total compensation. Many physicians, particularly those practicing in academic settings, receive compensation from both clinical and non-clinical activities. Evidence from outside of medicine suggests that women are more likely to volunteer or be volunteered for non-promotable work, and, within medicine, women perceive that they are more likely to be given uncompensated work (such as unpaid committee or teaching positions and office-improvement projects) alongside clinical care. Comparing compensation for clinical activities alone would not capture these differences which contribute to lower overall salaries for amount worked.

In addition, auditing should take into consideration the demands that female physicians patients make relative to those made of male physicians. There is evidence that female physicians have more female patients, and more patients with psychosocial complexity, than their male counterparts do. Patients in both groups often require longer visits and more management time outside the office. Further, research shows that patients tend to seek a different (and more time-consuming) kind of care from female doctors, often talking and disclosing more and expecting more empathic listening. Accurate auditing will need to account for patient complexity in addition to number of patients seen or the number of patients a physician has on their panel to accurately assess clinical load.

Providing salary transparency is a more controversial approach to promoting equal pay that has been explored in other industries. Public universities such as the University of California system have made compensation data publicly available for many years. In Canada, public disclosure of faculty salaries above a certain threshold reduced the gender pay gap. Some private entities have joined the trend as well. At the software startup Buffer, publicly publishing pay data did not eliminate gender-based salary discrepancies. However, it did push the company to identify and address potential sources of inequity, such as subjectivity in assessing experience and readiness for promotion. While there isnt a case of a health system that has published salary data and demonstrated the subsequent effects, experiences from other industries suggest this approach is worth discussing. We acknowledge that there are certainly many potential negative effects of pay transparency on organizational dynamics, and any transparency initiative should be rolled out with caution. A medical institution considering transparency would need to ensure careful auditing of data ahead of publication, and to have well thought out plans for addressing potential conflicts among staff, as well as between staff and management, that might emerge.

Data from the Harvard Kennedy School shows that women negotiate for lower compensation than men do in the absence of clear industry standards but negotiate for equal salaries when standard salary information was available, suggesting the value of creating environments in which information about compensation is shared across gender lines.

Engage Allies in Coaching and Sponsorship

Much of coaching and peer support for women physicians has focused on same-gender mentorship and peer groups. While these provide female physicians with role models similar to themselves and create comfortable spaces for reflection, given evidence that men are more likely to get explicit information about paths to advancement in management or to receive mentorship or sponsorship at all, they should be engaged as allies in systematic ways. Men can serve as sponsors who recommend women for new opportunities or as coaches who share a different perspective on salary negotiation or insight about the opportunities being presented to male mentees. Studies in other industries show that male sponsorship is crucial to closing the gender pay gap, and theres every reason to think it could have a similar impact in health care. Mixed-gender peer coaching groups can provide similar opportunities for sharing salary or tactical data.

While the most natural source for recruiting an institutions mentors and coaches is from within, there may be value to engaging diverse external coaches as well. At Brigham and Womens Hospital, we have started providing female faculty with access to external coaches in the areas of leadership, network development, time management, and technology use, in addition to more traditional peer support and individual coaching.

We acknowledge that in the MeToo era some men have shied away from mentoring or coaching women altogether, which is a loss for all involved. Its up to health care organizations to encourage mixed-gender mentorship, provide the training and guidelines needed to do it well, and outline clear consequences for inappropriate behavior or abuse of the relationship.

Facilitate Equitable Promotion

Much of the pay disparity in in academic medical centers is driven by academic rank differences, making facilitation of equitable promotion a priority. A small proportion of full medical professors across the U.S. are female, despite increased representation of female physicians on faculty and among medical school graduates (in 2017, for the first time, women outnumbered men entering U.S. medical schools).

These data suggest that new approaches are needed to ensure promotion of women in academic medicine. These may include: 1) revamping promotion guidelines to create tracks that reward activities aside from grant-funded research, such as teaching, that are often not rewarded in traditional promotions but are central to academic medicine; 2) requiring that female physicians be included on all search and promotion committees; 3) ensuring that open leadership positions are widely publicized rather than privately directed to a select group of candidates; 4) providing grants to support womens career advancement, including family travel grants that facilitate womens attendance at conferences with children and childcare providers; and 5) providing one-on-one external coaching to help female physicians create career roadmaps, tailor their CV for promotions, and identify what they need to accomplish in order to be ready for the next step in promotions.

While no institution yet serves as a clear beacon in matters of promotion equity, several have instituted programs that may help narrow the recognition and promotion gap. For example, Dana Farber Cancer Institute in Boston names its most accomplished clinicians as Senior Institute Physicians, ensuring that those excelling in clinical care are recognized for their efforts. Many institutions, among them UCLA and Duke, have several promotion tracks for faculty to ascend, including ones that focus on clinical care rather than research.

The initiatives we propose are just a start in solving a complex and persistent problem, and the data on what approaches will be most successful. Its high time that health care aggressively engage in and rigorously evaluate efforts to close the unproductive and unjustifiable pay gap in medicine.

Editors note:Because of an editing error, we have corrected the statement in the first paragraph that full-time female primary care and specialist doctors make 25% and 33% less than their male counterparts to read that full-time male primary care and specialist doctors make 25% and 33% more, respectively, than their female counterparts.

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How to Close the Gender Pay Gap in US Medicine - Harvard Business Review

Five Things You May Not Know about Naturopathic Medicine – Patch.com

Naturopathic medicine blends age-old healing traditions with scientific research and modern medicine. Naturopathic doctors (NDs) view symptoms as the body's way of communicating an underlying imbalance and looks at treating the root cause of illness versus just the symptoms. The ultimate goal being to treat the whole person.

Naturopathic medicine treats everything from common health concerns such as high blood pressure or cholesterol, joint and muscle pain, allergies, headaches, to more complex issues like irritable bowel syndrome or other digestive issues. Today, it is becoming even more mainstream with the current sociocultural movement towards preventive health care, stopping disease before it starts, or before it becomes devastating. This whole-person approach can also help patients find new ways for dealing with stress or fatigue, fostering a new way of approaching and dealing with everyday stressors.

If you've never considered naturopathic medicine, here are a few things you might want to know.

1. Naturopathic medicine can complement your primary care.

The best part about a naturopathic physician is that they can work alongside your primary care doctor. In fact, some health systems and physicians even provide naturopathic care with traditional medical care. Physicians who complete the required training can administer naturopathic care in the same office and during the same appointment as your regular checkups.

2. Naturopathic physicians must be accredited.

State-licensed NDs graduate from accredited naturopathic medical programs and pass a national board exam. There are six such programs at seven campuses in North America.

3. Some of our most common ailments can benefit from naturopathic medicine.

Many conditions you may have experienced both acute and chronic could benefit from naturopathic approaches, particularly if you're interested in alternatives to prescription drugs or certain over-the-counter medicines. In naturopathy, a practitioner may suggest herbal remedies, vitamin therapies, dietary changes, and other interventions before resorting to pharmacology. However, NDs will never dismiss the need for certain pharmaceutical drugs, if the patient's issue requires that level of intervention.

4. Naturopathy is more than herbs.

Naturopathic medicine takes a holistic approach to care using non-invasive therapies and techniques that promote the body's own self-healing and regulation of biological processes. Some of these approaches include herbs or plant-based medicines, but not all.

Establishing a healthy diet, supplementing with vitamins, regular exercise and stress-reduction techniques from yoga to mindfulness practices are other important components of a naturopathic treatment plan. The good news is, an ND can help you develop a plan that works for you and helps you overcome your health issues, while having a lasting impact on your overall wellbeing.

5. Visits may be covered by your insurance.

The demand for naturopathic medicine is growing. We see NDs at traditional health systems, as well as systems developing an entire new service line dedicated to this care. It is also becoming more common to be covered by your insurance.

In fact, Humana will introduce naturopathic medicine benefits on Medicare Advantage plans in select counties in Washington for the 2020 plan year. The Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP) starts Oct. 15 and goes through Dec. 7. To find a plan that meets your health care needs visit Humana.com/Medicare or contact Humana to set up an appointment with a licensed insurance agent.

If you are looking to integrate naturopathic medicine into your care plan, the first step is to select a health plan that includes the benefit and the next is to talk to your primary care physician. If they are not eligible to practice naturopathy themselves, they can connect you to someone who can.

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Five Things You May Not Know about Naturopathic Medicine - Patch.com

There is crying in medicine, and thats OK by this doctor – The Philadelphia Inquirer

Exam tables can be awkward and create physical distance, so I prefer to have the patient seated close by in a comfortable chair until it is time for the examination. Keeping computer records is important, but eye contact and physical engagement are essential when the conversation gets emotional. Having tissues in the room, visible and within my patients reach, is not a minor detail. It sends a clear message that tears can be part of medical rapport, diagnosis, and healing.

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There is crying in medicine, and thats OK by this doctor - The Philadelphia Inquirer

Sheriff’s Office adds Operation Medicine Cabinet drop-off site in Wixom – The Oakland Press

A new, 24/7 drop-off site for unused or outdated prescription medicine opened in Wixom this week.

A ribbon-cutting for the newest Operation Medicine Cabinet Prescription Drug Collection Program drug drop-off location in Oakland County was held on Thursday at the Wixom Police Department.

The program allows individuals a safe place to drop off their outdated or unused prescription drugs. A drop-box is located in the lobbies of law enforcement agencies across the county for residents to access all day, every day.

A ribbon-cutting for the newest Operation Medicine Cabinet Prescription Drug Collection Program drug drop-off location in Oakland County was held on Thursday, Nov. 7, 2019, t the Wixom Police Department,49045 Pontiac Trail, just east of Wixom Road.

Police Chief Ron Moore joined with Oakland County Sheriff Michael Bouchard, Julie Brenner, Alliance for Healthy Communities Coalition executive director, and members of Wixom TEAM for the event.

The Wixom Police Department is at 49045 Pontiac Trail, just east of Wixom Road.

A list of Oakland Countys drop-off collection sites is at:https://www.oakgov.com/sheriff/Community%20Services/domestic/Pages/Ope ration-Medicine-Cabinet.aspx.

The program's partner law enforcement agencies include:

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A Pontiac man has been bound over to Oakland County Circuit Court, charged with first-degree murder in the death of another Pontiac man.

The Oakland County Sheriffs Office is seeking the publics help in identifying a man who reportedly beat a medical resident and stole his cel

Oakland County Sheriff Mike Bouchard is asking the community to donate clean, gently-used coats and jackets or buy a new one to help peopl

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Sheriff's Office adds Operation Medicine Cabinet drop-off site in Wixom - The Oakland Press

Medicine disposal kiosks collect nearly two tons in first year of operation – Kitsap Sun

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Estefanny Carrera a dental receptionist at Peninsula Community Health Services with the medicine disposal box in the lobby.(Photo: Larry Steagall / Kitsap Sun)

In their first year of operation, Kitsap's medicine drop-offkioskssaw a ton of action... literally.

Kitsaps MED-Project collected more than 3,800 pounds of medicine last year,according to the programs first annual report. And public health officials expect that number will only increase as more people learn about the free service.

After the Kitsap Public Health District overhauled a medicine take-back program a few years ago,the program has gradually expanded to 13 kiosks, as well as amail-in site, at pharmacies, health care clinics and law enforcement offices across Kitsap County.

Its kind of been a slow rollout across the country with more and more partners coming out and convenientlocations across the county, said Kitsap Public Health District spokesman Tad Sooter.

MED-Project, a contractor hired by drug manufacturers, began operating in March 2018. That came after the Kitsap Public Health Board voted in 2016 to require drug manufacturers to install and handle medicine disposal kiosksfollowing similar ordinances passed in King and Snohomish counties.

The Kitsap County Sheriff's Officepreviously offered medicine disposals at several locations, but the health district had said the program was inadequate. Many residents were looking for more convenient access.

I think that this program, in contrast to some of the historical programs, has a little more enthusiasm, said Bryan McKinnon,with the public health districts Solid and Hazardous Waste program. People are really happy to have options.

The new program hasmore drop-off locations, but the sheriff's medicine disposal system does not have data to track usage trends, said Jan Brower, Solid and Hazardous Waste manager.

Still, Brower expects to see a rise in the number of medicine drop-offs in the coming years. Were hoping as the program matures, and we do more education and outreach, even more people will participate in the program, she said.

Erica Liebelt, executive and medical director of the Washington Poison Center, says secure medicine drop-off programs like the one in Kitsap help preventaccidental poisoning and drug abuse and curtailenvironmental pollution.

Medications left in the household increase the risk that people who shouldn't be taking them would use them in the wrong fashion, she said. The bottom line is we dont want unused medications lying around the house with the vulnerability of people who shouldnt be getting them.

In Washington, poisonings from pain medications were the most frequent calls to the Washington Poison Center last year. Studies have found that about 70 percent of those who abuse prescription medicine obtain the drugs from friends or family, according to the Washington State Department of Health.

Having unused medicine lying around the house can be especially dangerous for young children, Liebelt said.

In 2015, there were nearly 500 calls to the Washington Poison Center regarding accidental medication poisoning of children 6 and younger in Kitsap County, according to the public health district.

Kitsap is among six counties in Washington state with the medicine drop-off service. But next year, Washington will implement a statewide medicine disposal program funded by drug manufacturers, which is expected to start between spring and late fall of 2020.

Brower, of the Kitsap Public Health District, hopes the statewide program will continue to spread awareness.

Moving forward we really want to focus on getting the information out there so everyone knows what to do with expired or unused medication, she said.

Read or Share this story: https://www.kitsapsun.com/story/news/2019/11/05/medicine-disposal-kiosks-collect-nearly-two-tons-first-year/4161532002/

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Medicine disposal kiosks collect nearly two tons in first year of operation - Kitsap Sun

Caregiving and the Soul of Medicine – Medscape

This transcript has been edited for clarity.

Abraham Verghese, MD: Hello. This is Abraham Verghese. Welcome to a new episode of "Medicine and the Machine," which I have the great pleasure of cohosting with Eric Topol. Today we have a very special guest, a man I've looked up to pretty much all my career. Arthur Kleinman is a professor of psychiatry and medical anthropology at Harvard University. He carved out new territory early in his career by creating the field of social medicine and medical anthropology, literally putting it on the map and training several notable students, including Paul Farmer, who've gone on to do great things.

Arthur is the author of many influential books. One that truly informed my thinking was The Illness Narratives.[1] But he has a new book out called The Soul of Care,[2] which we'd like to talk about today. Arthur, welcome to this podcast. Thank you so much for spending time with us.

Arthur M. Kleinman, MD, MA: Thank you, Abraham, for having me. I'm delighted to be here.

Verghese: To begin, would you tell us how you got into this field of medical anthropology and social medicine? How did it evolve that your career began that way?

Kleinman: I was one of those strange types who, when he went to medical school, could have gone into something else. I could have gone to graduate programs in the arts and sciences. I was always very interested in history and in social theory, and after I had been in medical school and then at the National Institutes of Health, I was sent to Taiwan during the Vietnam War. As a US Public Health Service officer, I became very interested in the issue of how medicine was carried out in different cultures. I was from the United States, and I was in Taiwan and saw a radically different healthcare system and distinctive ways of caring for people. So, since my wife was a China scholar, and I knew the Chinese language, I thought I should attend to this culture in a deep sense and become an anthropologist. And that's what I did. I went from Taiwan to Harvard, studied social and cultural anthropology, and helped develop the field of medical anthropology. I guess the distinction I draw, Abraham, is that you are, in my view, a great writer as well as an outstanding physician. I see myself as a physician but not as a writer, even though I've written about 40 books.

Eric J. Topol, MD: Only 40? Wow.

Kleinman: I am a William Jamesian, almost a footnote to William James. Remember, William James said that everything comes out of experience. My great curiosity was about experience. How do people live with suffering? How do they respond to it? How do practitioners of very different kinds in different local worlds, worlds across the seas and worlds neighboring each other, how do they do things distinctively? So I had that sort of focus on experience. That sums up my interest, with one caveat: to use experience in order to help others.

Verghese: That brings us to your new book, which is a real departure in the sense that it's intensely personal. I'm sure you wished to never have to write a book like this, and yet, The Soul of Care is such a gift. Without giving too much away, in this book you talk about your transition from being an academic and physician to becoming a caregiver. I just want to quote from a passage you write in this book. "Care is also about the vital presence, the liveliness, and fullness of being; about the caregiver and the care recipient. Acts of caring call that presence out from within us. Care does not end with death, but involves actively caring for memories."

Tell us about the genesis of this book. Then I'd like to shift this discussion for a bit to talking about care, because it's a paradox. Healthcare is the business Eric and you and I are involved with. And yet care, especially the way you construct it, is almost tangential to the discussion of healthcare and healthcare reform. So tell us about this book and how it came about.

Kleinman: As you suggested, this was a painful book to write. For a little over a decade, I took care of my late wife, Joan Kleinman, who had early-onset Alzheimer's disease. And not only did she have Alzheimer's disease, but it was a particularly frustrating type, because it started in the occipital lobes of her brain, which are responsible for, among other things, the interpretation of images. So she was functionally blind as well as suffering from dementia. This was very cruel because she was a visual person, a fine painter and calligrapher in the Chinese tradition.

As this awful decade developed, it was as if a veil of ignorance was pulled away from my eyes and I was seeing caregiving from the inside as a family caregiver. And I realized that, with all these decades of experience I'd had doing research on healthcare and being an active clinician, I really had lost the sense of what caregiving is for a family member. This was so striking, and powerfully so to me, that I felt I wanted to write a book that was at once raw in its personal naturedeeply raw, I thinkbut also in which I could generalize from my individual example to care more generally.

So, the first thing was, what do I mean by care? How is it possible, for example, to have healthcare without care, which is where we fit in the crisis of healthcare right now. By care, I meant just the kinds of things you read. I meant, first of all, the nature of the relationship that caregivers have with each other, since I believe that's the most fundamental dimension of care. It's a relationship. And it's a relationship in which, once we focus on the care, it's easy to forget about the care recipientthat is, the patient or family member who needs care, but who is just as important, if not more important, than the caregiver.

And in this relationship, as I've experienced it and looked at it cross-culturally, there is a kind of gift exchange. It is an exchange of gifts in an anthropological sense in that the care recipient gives the gift of their vulnerability and their need to be helped, assisted; in turn, the caregiver gives the gift of their involvement and their attention, which is tied, I think, to their presence.

We're all familiar with the criticism of medicine, that frequently doctors are so absorbed by the screen on their computers that they have their backs turned to the patient and are not present. But when you look at family care, it involves a kind of a deep presence. It's that relationship that's begun long before and will end later. And it's not just a one-time shot but something of intimacy and tension, because even for the most loving and committed caregiver, care is tough work. It's hard physical work. It's tough emotional work. And it's moral work as well. So, besides presence, there's also the issue of enduring. You have a long illness experience of a disorder that cannot be cured but has to be managed. In that long illness experience, I really don't think any of us are truly resilient, where we're like rubber bands and we simply spring back to what we were before. This experience is so demanding, so difficult. The real issue, and it's one that we don't like to talk about in the United States because it doesn't have a kind of Hollywood ending, is enduring. How do we endure? That's what I felt throughout my 10 years of taking care of my wife. I was challenged to the core and wasn't sure I could endure. I felt at times that I was enduring the unendurable.

Clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays.

So, what is enduring about? How do we keep going? Because of my own experience, I looked at and spoke with many other family caregivers and was astonished by how many of them felt they came to a wall they couldn't get over, and yet because of their love and their concern for the person they were taking care of, they got over the wall; they made themselves get up, get over the wall, and keep going. I was impressed with how enduring is critical to care.

And then the last partit's surprising that I learned this from my personal experience; I should have known it from my professional experiencebut care does not end with the death of the person you're caring for. You're caring for memories after that. A clinician also cares for memories, remembering how to think about the care and how to perhaps use a particular case to improve care in the future. The family member, of course, is rebuilding a story about one's life and one's family. Central to that is the memory of the care you gave and what you've gone through. The attention to those memories, their ordering, the time we spend developing them becomes a very important part of our lives after the practical acts of care no longer need be given because the person has passed. Those are the kinds of things I was concerned with.

I came to realize two things: First, that care was disappearing from clinical medicine, that clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays. And second, there's some question as to whether in the future, even in families, we'll have care, given the limited time that family members have today, the fact that both husbands and wives workthis was women's work in the pastand men in our time, no matter how "woke" and liberated they claim to be, are not picking up the task of care.

Topol:The Soul of Care is an extraordinary book and, in many ways, a gut-wrenching story. You've defined care so elegantly. The other word, of course, is "soul." You captured this well in the recent Lancet piece you authored in August.[3] I want to read one sentence from it. It's about the soul of medicine, as you wrote in The Soul of Care. You wrote, "I find the expression 'soul-less' a resonant one to depict what is happening to caregiving in medicine in our times, where the health system's goals of efficiency and cost-effectiveness, new technological requirements that absorb the clinician's alertness and attention, and the sheer pressure of insufficient time to listen and explain have a dire effect on providing the best of care." Can you amplify on that?

Kleinman: I think that is, in fact, the case. My colleague, Atul Gawande, has written a terrific piece[4] that you probably read in The New Yorker about the Epic system, Harvard's electronic medical record system. It was developed without the idea of care in mind, and Atul pointed out that it is so complicated, so difficult to use, that the clinicians spend virtually all their time trying to make sense of it, and they use it to provide information about the patient that is critical to the treatment. So in a setting like that, the whole attention of the clinician is away from the patient.

The second thing that's happenedand Abraham, you may be the expert on this, but as a consultation psychiatrist, that is, a psychiatrist who works with people in internal medicine and surgery, I've been impressed by how internal medicine residents today seem to distrust their clinical skills of physical examination and want to jump right away to objective test results that come from the various machines we work with, which are more precise than we can be with auscultation and other acts of physical diagnosis. Yet, when physical diagnosis is done the way you do it, and the way I feel it should be done, it is a wonderful example of caregiving. It's the laying on of hands, the supporting of the person. It's the resonant sense that we're in this together, that I'm here with you. That's not the way I'm seeing the physical exam being carried out today. It's much more perfunctory. It's a sort of run-up to doing the tests that are more precise. The physical exam has lost its place as crucial to the actual caregiving through touching and connecting. That is a part of my concern.

Another part of my concern is that when you start a clinical interaction in medicine, bioethicists have clearly pointed out that the first actions are acknowledgement and affirmation. The doctor acknowledges and affirms the patient for being there legitimately with a problem that needs attention and affirms their suffering. And in turn, the patient affirms the doctor's right to explore their body and to ask questions. I think if you have your back turned to the patient, if you're focused on the technology of the computer, it's very difficult to establish this acknowledgement and affirmation of the humanness of the person. Hence, you begin the doctor-patient interview without that human connection being acknowledged and affirmed. Frankly, I think that's disastrous.

Verghese: I'd like to ask you about something I found to be extraordinary. If you plot the course of your wife's illness, the trajectory of it, medical diagnosis was a small element of it early on. But then if you look at the percentage of time of people who really mattered to you and your wife during this long course of illness, very few physicians are involved. Most of them have bit parts that are often detrimental to the care and not necessarily helpful. The most important individual you acknowledge again and again was the professional caregiver who worked with you. What are we going to do as a nation when we talk about healthcare reform, when we need much more, from the sounds of it, from the professional caregiver and much less from the high-tech stuff we spend a lot of time on?

Kleinman: It's a great question. I could not have taken care of my wife for 10 years, doing the things I had to do, if it weren't for the assistance of a terrific home health aide. This was a woman of Irish background who came from a family in which there were multiple generations of home health aides. She was just great with Joan. Not only was she great in helpingshe worked 5 days a week, 9 to 5but she pointed out to me that I worked 2 full days on the weekend and from 5 in the evening to 9 in the morning, 5 days a week. The respite she gave me, the chance to get away and do my work, made me a much more successful caregiver. In fact, I don't think I could have done it with without her. I lucked out.

The astonishing thing was that the medical specialty, neurology, which is responsible for patients with dementia, the neurodegenerative disorders, and stroke, is organized around diagnosis and a few medications, most of which are limited in their effectiveness. But the profession itself seems to have come to a conclusion that has nothing to do with aftercare. Some of the great neurologists in the country are at Harvard Medical School, and they made the diagnosis of Joan's Alzheimer's disease at least a year before it probably would have been made otherwise. They all wanted to help me; they knew me well and wanted to help me. Not one said anything about the care I would have to provide and what Joan would be going through. It astonished me. No one recommended a home health aide for me, which, as I just suggested, turned out to be absolutely crucial. And no one said anything about how I'd have to reconfigure the house so that Joan would be more comfortable there and I could take better care of her. No one mentioned anything about what the day-to-day living experience would be like, and where I would need assistance and how I could get it. And that was astonishing.

I went back to certain of my neurology colleagues and I realized that they just didn't see this as their purview, which is sad. Nor had they, as far as I could see, organized for Alzheimer's the kind of care team we take for granted in the area of oncology where, if the oncologist can't do it, there's a social worker, a physical therapist, or someone else who will step in to provide the kind of care that's needed. This is a huge problem for the neurodegenerative disorders. And I don't see an easy solution to it. In fact, I think it may get worse.

For example, who are the home health aides? By and large, they are poor women, often women of color, women who do not necessarily want to go into home healthcare but it's the only job open to them. This is certainly true of recent immigrants to the United States, who often dominate the field in Boston. It's primarily Asian immigrants who do this. And yet they do a remarkable job. Along the way, in both homecare and when Joan had to go into a cognitive care unit, her support from home health aides and from health aides in the clinic was just tremendous. They pick up where physicians fall off. But they're decreasing in number as people find that they can do other things, make more moneyit's so poorly paidhave more status, and so on. They're dropping out of home healthcare as soon as they can.

We're constantly talking about the quality of care, but we have no measures for quality of care. We don't measure relationships. We don't measure explanations. We don't measure listening.

And we don't even have good studies. As a researcher, I was astonished to discover that we have hardly any studies that tell us the content of the work that home health aides actually do, or how well they are prepared for it, and how well they deliver it. All of these things struck me as a sign that care is not in the minds of the people who organize the domain of healthcare for dementia and neurodegenerative diseases generally.

Here's another part of it that was astonishing to me, as I began to think this through. We're constantly talking about the quality of care, but we have no measures for quality of care. We don't measure relationships. We don't measure explanations. We don't measure listening. We don't measure skills in touching and supporting someone. We don't measure any of the things that are central to caregiving, and yet we claim quality care. So what do we mean when we say that? We're essentially substituting institutional measures of efficiency for measures of care. I think if more people were aware that we don't examine quality, they would be more concerned about this and what I see as a great crisis.

Verghese: I'm struck that in Eric's latest book, Deep Medicine, [5] he talks about how, in a way, machines have eclipsed us in terms of capability; at least theoretically, machines have gotten to that point. Yet, it indicates that this is the moment for us to get better at our humanness, so to speak. In a way, Eric, I think you were speaking very much to this new frontier we've managed to dodge because we've been so busy with our diagnostic instruments and therapies. But we have to come back to this kind of humanness because the machine can never do any of this for us.

Topol: That's right, Abraham. And that's why you grabbed me, Arthur, with the term "soul-less" and how medicine has moved in that direction. In fact, as you pointed out, we don't even talk about soul, no less think about it. Time is a big factor, the gift of time. You go back to the neurologist who didn't talk to you and your wife about what was ahead with her condition and your caregiving. A lot of this comes down to the reality that there's so little time to connect. The exam is another part of that, as you've mentioned; if we can restore that time, do you think we could get the soul back in medicine?

Kleinman: I believe so. First of all, you and Abraham are outstanding examples of the fact that we have practitioners who are able to bring the soul to bear or tend to it. But I think we have to try at many different levels, and to be honest about the lack of resources. I begin with families. Family members who provide care are providing it uncompensated. They need to be compensated. I think the country will come to this recognition laterally, after we begin to realize that if there were a 10% decrease in the number of families who care for people with dementia and neurodegenerative diseases, end-stage disorders of every kind, it would overwhelm all the hospitals, all the nursing homes, and all the facilities we have. So we must keep this going.

Second are the home health aides and long-term care insurance that goes with it. We don't provide those things. If we did, we would have a different family setting. They are provided in Japan and in Scandinavia. Then we think about medical school itself and the practice of medicine. In certain of the German medical schools and in a few of the Dutch medical schools, before the medical students start medical school, they spend a week or 10 days in the homes of families with patients who have serious end-stage disorders, very serious disabilities, and chronic conditions. They're expected to deliver care of a family kind. Now, these are medical students; they're just starting, and they're doing the cleaning, the washing, the bathing, the feeding, etc. I happened to have been a visiting professor at Leiden University in the Netherlands a few years ago, and I spoke to a number of their faculty who had gone through this program. They told me it was the single most important part of medical school.

We need that in the United States. It would remind doctors that it all begins by seeing the life-world in which illness is experienced. Recently, the National Academy of Medicine put out a report called "Families Caring for an Aging America."[6] It pointed out that it is commonplace for an elderly patient to have a surgical procedure and to return home after 2 or 3 days in the hospital with two tubes coming out of the abdomen, which no one has explained to the familywhat the tubes do and how you take care of them. And the family is petrified that they could infect the patient, that they could do something disastrous in the care of the patient, simply because no one explains the care to the family.

Right through the healthcare system, if the chair of an academic department of medicine or surgery or psychiatry demanded that the service chief in cardiology or nephrology demonstrate high-quality caregiving practices, then that will be modeled by the rest of the clinical team, down to the medical student. What is modeled in our time is the opposite of that.

We've basically turned over the clinical teaching of medical students to residents. The three of us were all residents. I remember my residency at Yale; when you're a resident, you're a survivor. You want to get out of the damn hospital. You're taking all the shortcuts in order to get out, and in so doing, you're giving a reverse message to the medical students. They've learned all of these things they should be doing, from taking a careful history to demonstrating empathy, and you're doing all the opposite things. So they come to see that if the resident is doing it, that's the way it is.

We have to change the way we teach medical students. For the past 5 years or so, I've been giving lectures at many medical schools across the United States, and I've been impressed with the fact that virtually every medical school is trying something new in regard to training medical students to be more human in their care. Of course, everyone is doing something different. But this is promising to me. There's an awareness that we can't go on like this. We have to return to certain core ideals of healthcare in which caregiving is crucial and in which doctors are able to participate.

I think we're not going to let doctors off the hook in the future. I was impressed by the experience with my wife, and by the number of family members I encountered who were taking care of their family member with Alzheimer's, all of whom felt frustrated and angryfrustrated by how difficult the care was, and angry about the fact that the professional medical side seemed cut off from what they were experiencing. That's the source of my optimism.

Verghese: Arthur, I think your book is going to be a siren call for change. You've been the frontrunner of new ways of thinking for so many years, but this may be your most important legacy.

I want to read the last sentence of the book, because it's so powerful. It's a bit about writing and it's a bit about you: "I am letting go of Joan by completing a long-drawn-out grieving process with this living testimonial. And in another, equally uncanny sense, the writing has enabled me to allow my old self to slip away, and to be replaced by the author of a book, this book, who is not only a carer of memories but decidedly a different human being."

You truly have captured this personal transformation, but I think it's going to help all of us to plot a new course, because you're rightwe definitely need a sea change in the way we give care.

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Abraham Verghese, MD, is a critically acclaimed best-selling author and a physician with an international reputation for his focus on healing in an era when technology often overwhelms the human side of medicine.

Arthur M. Kleinman, MD, MA, is a founder of the field of medical anthropology. He has written over 40 books, including The Illness Narratives: Suffering, Healing, and the Human Condition. His latest book is The Soul of Care: The Moral Education of a Husband and a Doctor.

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Caregiving and the Soul of Medicine - Medscape

Impeachment is the ER. We need to practice preventative medicine. – The Week

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If the impeachment inquiry against President Trump moves to a trial in the Senate, Sen. Cory Booker (D-N.J.) told reporters this week, his role there must take precedence over his presidential campaign. "We are doing something that is with the gravity of removing the sitting president from office," Booker said. "I will be there. I will be focused. And I will do my work."

Insofar as any member of Congress deserves plaudits for promising to prioritize duly representing his constituents over seeking greater personal power, that's dandy. But Booker's framing of his work as remedying a crisis of presidential misconduct evinces a too-common misconstruction and one which helped us into this mess in the first place. It makes the legislature's restraint on executive power entirely ex post facto, letting lawmakers skip the more necessary work of trimming the imperial presidency back to its basic administrative roots.

Impeachment is necessary and sometimes unavoidable, but it is not prophylactic. Partisanship keeps it from functioning as a reliable protection against future wrongdoing, because even the worst presidents can expect near-lockstep support from their own party in Congress, and almost every president in the last half century has had at least a few years of a friendly majority in one house or both.

Divided government likewise offers no guarantee of accountability, as House Majority Leader Nancy Pelosi's foot-dragging on this very impeachment inquiry has revealed. Political considerations, chiefly alienating independent and swing voters, will often outweigh ethical concerns. "High crimes and misdemeanors" are significantly in the eye of the beholder, and the beholder is looking at the next election cycle.

That reality makes impeaching the president rather like a trip to the emergency room. Yes, it might save your life. It's also mostly unconnected to the day-to-day of responsible, healthy living except if it's your own fault that you're in the emergency room, in which case the visit should prompt some changes to whatever part of your lifestyle is the culprit.

The congressional Democrats spearheading this impeachment have no apparent intention of making such a change. They'll bandage a broken skull and send the patient right back to biking without a helmet. They'll try to oust this president and leave the very same tools of corruption and abuse for the next one. They'll let him claim, in deed if not in word, that he has the "right to do whatever he wants as president," armed with pen and phone.

This state of affairs can only be acceptable to the selfish or naive. It appeals to politicians and partisans because the power they persistently leave unchecked will sometimes fall to them. Why melt the crown if it may yet rest upon your head? And it appeals to those who retain a civics class credulity about American politics, clutching against all evidence to the belief that we may yet develop markedly better and broader electoral tastes. Unless Mr. Rogers rises from the grave with a hankering for the campaign trail, I wouldn't count on it.

The safer and more certain option is massive structural reform. Congress must put meaningful restrictions on the power of the presidency. The executive branch has for decades crept beyond its proper administrative function to usurp congressional authority, dictating the priorities of state well beyond the vague leeway of executive discretion.

Incidentally, it is this very pseudo-lawmaking which made Trump's alleged quid pro quo possible. Reform could indicate to foreign leaders that the president is an administrator with no power to refrain from disbursing funds Congress told him to disburse. It could place stricter limits on national emergency declarations, ensuring the president cannot unilaterally move money around in direct contravention of Congress. It could significantly curtail presidential immunity, making the president subject to indictment. Perhaps most importantly, it could limit the scope of executive orders, the favored method for presidents of both parties to exercise unconstitutional policy-setting authority.

This is a difficult and unlikely ask in that it requires sacrificing short-term partisan advantage for a long-term shot at more functional and congenial governance. I get the implausibility here.

Still I recommend it, and will continue to recommend it forever, because impeachment is confusing, uncertain, retroactive, narrowly targeted, and politically fraught. It may censure or remove a bad president, but it does so only in connection to a small selection of provable misdeeds and via a process that will always be subject to accusations of injustice. The best impeachment remains a contributor to political rancor and fails to stop further executive overreach. It's an ounce of cure when we need a pound of prevention.

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Impeachment is the ER. We need to practice preventative medicine. - The Week

Yale School of Medicine student overcomes homelessness and strives for PhD – WTNH.com

(WTNH) One young woman is not letting lifes challenges stand in her way of her dreams.

Chelesa Fearce, a first year student at Yale School of Medicine, is working towards her medical degree and PhD in chemistry.

But before she made her way to Yale, Fearce and her family were homeless in Atlanta, Georgia, often finding themselves staying at shelters of homes of friends.

Despite her struggles, Fearce was a top student at Charles Drew High School and became valedictorian.

To learn more about Fearce, watch the interview above or watch her Web Extra here.

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Yale School of Medicine student overcomes homelessness and strives for PhD - WTNH.com

American Universal Medicine hosts Minority and Indigenous Integrative Health Summit – WCJB

GAINESVILLE, Fla. (WCJB)-- Fitness and nutrition remain at the top of the list when it comes to staying healthy.

American Universal Medicine is hosting a three-day summit titled The Minority and Indigenous Integrative Health Summit" at the Santa Fe College's Center for Innovation and Economic Development.

The goal of the summit is to tell people about health disparities and different health options.

We want to have a pyramid of health knowledge to help benefit our communities not just for now but for the future, said Dr. KA Shakoor, American Universal Medicine founder and director.

The summit will continue on Wednesday and Thursday starting at 9 a.m.

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American Universal Medicine hosts Minority and Indigenous Integrative Health Summit - WCJB

Penn Medicine breaks ground in Lancaster on Pa.’s second proton therapy site – PhillyVoice.com

A new cancer treatment facility in Lancaster will be one of just two sites in Pennsylvania to offer proton therapy to cancer patients.

Penn Medicine broke ground Tuesday on the facility, an expansion of its Ann B. Barshinger Cancer Institute.

The 8,000-square-foot, four-story building will be the first proton therapy center in Central Pennsylvania. Construction is expected to be completed by the fall 2021.

The project represents a $48 million investment, according to Penn.

Proton therapy, a relatively new type of radiation therapy, often is used to treat cancers as well as benign tumors, according to the Mayo Clinic. Instead of using X-rays, which also touch non-cancer cells, proton beams enter the body at low doses of radiation that spare healthy tissue, according to Penn Medicine.

Clinical trials and studies suggest proton therapy causes fewer side effects than traditional radiation because it enables doctors to target more precise areas.

Proton therapy is an option for a number of cancer types, including brain cancer, spinal tumors, breast cancer, head and neck cancer, gastrointestinal cancers, gynecological cancers, kidney cancer, lung cancer, lymphoma, mesothelioma, oropharyngeal cancer, pediatric cancer, and prostate cancer, according to Penn.

Because it's relatively new, proton therapy availability is limited across the United States. There are currently just 28 active proton therapy centers, according to the National Association for Proton Therapy, with five more, including the Lancaster site, under construction or development.

The Roberts Proton Therapy Center at the University of Pennsylvania Health is the only proton therapy site in Pennsylvania.Since the center opened in Philadelphia in 2010, Penn radiation oncologists have treated more than 6,000 patients using proton therapy.

There are two other proton therapy facilities in New Jersey the ProCure Proton Treatment Center in Somerset and the Laurie Proton Therapy Center at RWJBarnabas Health in New Brunswick.

"Current patients who may benefit from proton therapy especially for hard-to-treat cancers can only receive this therapy at a handful of specialized centers across the country," Dr. James Metz, chair of radiation oncology at Penn Medicine, said in a release. "This project represents the next phase of proton therapy, further enhancing patients access."

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Penn Medicine breaks ground in Lancaster on Pa.'s second proton therapy site - PhillyVoice.com

If food is medicine, why isnt it taught at medical schools? – The New Food Economy

Students in medical schools across the country spend less than 1 percent of lecture time learning about diet.

Earlier this year, Mount Sinai, the biggest hospital network in New York City, invested in a meal delivery service. Though it seemed like an unusual move at the time, the networks decision makes sense if you consider the intrinsic relationship between food and healtha connection underscored by countless other recent examples of healthcare initiatives that harness diet as a tool to improve well-being.

At a California rehabilitation facility, for instance, doctors use the rituals of eating to help people recover from trauma. And over the past decade, cities across the country have launched food prescription programs that incentivize participants in the Supplemental Nutrition Assistance Program (SNAP) to buy fresh fruits and vegetables at farmers markets. A number of nonprofit organizations have launched medically-tailored meal services for people suffering from diet-related diseases.

Culturally and politically, were increasingly acknowledging that what we eat plays a major role in our health. Which is why its especially strange that healthcare providers know so little about it.

Medical curriculums have been developed historically, foregrounding disciplines like biology, behavior, and disease to the detriment of food and nutrition.

In a new report published by the Harvard Food Law and Policy Clinic, researchers write that, on average, students in medical schools across the country spend less than 1 percent of lecture time learning about diet, falling short of the National Research Councils recommendation for baseline nutrition curriculum. Neither the federal government, which provides a significant chunk of funding to medical schools, nor accreditation groupswhich validate themenforce any minimum level of diet instruction.

And it shows: While you and I might show up for our annual physicals expecting feedback on our what and how much we should be eating, just 14 percent of doctors feel qualified to offer that nutrition advice.

How did the gap get this wide? Much of it can be explained by the way medical curriculums have been developed historically, foregrounding disciplines like biology, behavior, and disease to the detriment of food and nutrition. Today, the legacy of this framework makes it hard for medical schools to retroactively integrate nutrition into their curriculums.

Because [nutrition] wasnt prioritized for so long, there arent a lot of faculty and medical schools that have any knowledge about nutrition and diet, says Emily Broad Leib, the reports lead author. To build it into schools now requires real investment in hiring and training.

People believe that nutrition is easy, when in reality, nutrition is most of medicineand then a lot more.

The report recommends a wide range of policy changes that could function as carrots and sticks in getting nutrition onto course outlines. They range from making federal funding contingent on nutrition training to performance-based incentives that encourage schools to include diet-related subjects in curriculums.

Why are we spending so much government money to educate physicians and residents, and yet were not getting any impact in terms of these this large set of [diet-related] diseases? Broad Leib asks.

The recommendations also implicate other players in the world of medicine, like accreditation organizations and licensing boards, for not requiring a baseline level of dietary expertise from schools and doctors, respectively. Part of the reason that may be is the prevailing attitude society has toward food as a soft science.

People believe that nutrition is easy, when in reality, nutrition is most of medicineand then a lot more, says Martin Kohlmeier, a professor of nutrition at the University of North Carolina-Chapel Hill. You have cultural, food production, and food safety issues. It is a challenge for physicians to learn enough.

Doctors with expertise in nutrition are more likely to spot diet-related issues earlier in a patients prognosis.

Kohlmeier leads the Nutrition in Medicine Project, a free, online nutrition curriculum tailored to medical students and doctors. Kohlmeier estimates that 150,000 students have participated in some aspect of the program since its launch in 1995. Nevertheless, he stresses, voluntary education is only a temporary fix for a systemic problem.

A lot of institutions have electives, all kinds of nice things that maybe 1 to 5 percent of their students use. And Im always saying: You are going to be treated by the physician who skipped those classes.

But why teach doctors nutrition and diet when there already exists a specialty in those fields? Nutritionists and dieticians are experts in the way our individual biologies are affected by what we eat. What role will they play if our general practitioners develop that same expertise?

Shoring up what doctors know about food wont render nutritionists moot, says Carol DeNysschen, a registered dietician and chair of the health, nutrition, and dietetics program at the State University of New York-Buffalo.

The more that [doctors] know, the more they realize what they dont know, and the more they realize how complicated it can be to develop an individualized nutrition plan for people and to get them the support they need to monitor or manage [issues like] their weight, their diabetes, DeNysschen says.

DeNysschen characterizes the relationship between doctors and nutritionists as a symbiotic one. Doctors with expertise in nutrition are more likely to spot diet-related issues earlier in a patients prognosis, and that could mean more referrals to diet experts. The more nutrition knowledge they have, the more theyre aware of looking for those areas where a nutritionist or dietitian could interject, she says.

Beyond the healthcare implications, the Harvard report also makes an economic case for teaching doctors about food. Taxpayer dollars fund most physician residencies in the United States through Medicare. (Medical school graduates train to become doctors via residency in a hospital.) Simultaneously, Medicare serves as the national insurance program for aging Americans, and thus, incurs the costs of diet-related diseases during that stage of our lives. Therefore, the report argues, requiring nutrition education in medical residencies is another way for Congress to trim its own bills.

Thats one element of the case that Broad Leib will likely make next week at a Congressional hearing. Though the report largely focuses on federal policy changes, some local lawmakers are introducing legislation that would require nutrition education among doctors within their jurisdictions. In New York, for example, state legislators recently proposed a bill that would require practicing physicians to receive six hours of nutrition coursework or training every two years. In Washington, D.C., municipal lawmakers introduced a bill that would require continuing education for doctors to be expanded to include nutrition coursework.

Poor diet continues to be one of the biggest contributors to chronic disease and mortality in the U.S., killing one in five Americans every year. Thats a higher rate than three other risk factorspollution, lack of exercise, alcohol and drug usecombined. As the tide continues to rise in favor of ideas and policies that combine food and healthcare, medical schools may be next to center nutrition in their work. Someones just got to prescribe it.

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If food is medicine, why isnt it taught at medical schools? - The New Food Economy

Northwestern Medicine’s Dr. Jim Adams warns that other countries are having bad flu seasons and as it moves towards Chicago, it looks like it’s going…

Dr. Jim Adams, Chief Medical Officer and SVP of Northwestern Medicine joins The Roe Conn Show with Anna Davlantes to discuss why this flu season might be worse than last year. Also, Dr. Adams explains why owning a dog may lower your risk of death after a heart attack.http://serve.castfire.com/audio/3688822/3688822_2019-10-16-005222.64kmono.mp3

Better knowledge means better health for you and your family. Turn to Northwestern Medicine at nm.org/healthbeatnews for health tips, research and more.Follow your favorite Roe Conn Show characters on TwitterAnd be sure to follow Roe on Facebook!

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Northwestern Medicine's Dr. Jim Adams warns that other countries are having bad flu seasons and as it moves towards Chicago, it looks like it's going...

Editas Medicine and AskBio Enter Strategic Research Collaboration to Explore In Vivo Delivery of Genome Editing Medicines to Treat Neurological…

CAMBRIDGE, Mass. and RESEARCH TRIANGLE PARK, N.C., Oct. 15, 2019 (GLOBE NEWSWIRE) -- Editas Medicine, Inc. (Nasdaq: EDIT), a leading genome editing company, and Asklepios BioPharmaceutical, Inc.(AskBio), a fully integrated adeno-associated virus (AAV) gene therapy company, today announced the companies have entered a strategic research collaboration to explore in vivo delivery of genome editing medicines to treat neurological diseases. This collaboration brings together AskBios leading capsid development, clinical stage AAV vector delivery system, and manufacturing expertise with Editas Medicines leading genome editing technologies to potentially develop novel medicines for patients with high unmet need.

We are excited to collaborate with AskBio, a team with unparalleled experience in AAV technology and clinical-stage manufacturing. We believe that together we can deliver innovative genome editing medicines to the nervous system and rapidly advance medicines to treat neurological diseases and help patients in great need, said Charles Albright, Ph.D., Executive Vice President and Chief Scientific Officer, Editas Medicine.

The team at Editas Medicine has one of the most innovative technology platforms dedicated to finding solutions to severe diseases where there are few or no treatment options a mission consistent with AskBios, said Jude Samulski, Ph.D., Co-Founder, AskBio. With this shared goal in mind, we will combine our technologies to create an innovative approach to treating neurological diseases.

About Editas MedicineAs a leading genome editing company, Editas Medicine is focused on translating the power and potential of the CRISPR/Cas9 and CRISPR/Cpf1 (also known as Cas12a) genome editing systems into a robust pipeline of treatments for people living with serious diseases around the world. Editas Medicine aims to discover, develop, manufacture, and commercialize transformative, durable, precision genomic medicines for a broad class of diseases. For the latest information and scientific presentations, please visit http://www.editasmedicine.com.

About AskBioAsklepios BioPharmaceutical, Inc. (AskBio) is a privately held, clinical stage gene therapy platform company dedicated to improving the lives of children and adults with rare genetic disorders. AskBios gene therapy platform includes an industry-leading proprietary cell line manufacturing process known as Pro10 and an extensive AAV capsid library. The company has generated hundreds of proprietary third generation gene vectors, several of which have entered clinical testing. AskBio maintains a portfolio of clinical programs across a range of indications, including Pompe, Limb Girdle Muscular Dystrophy, Cystic Fibrosis, Myotonic Muscular Dystrophy, Huntingtons, Hemophilia (Chatham Therapeutic/Takeda) and Duchenne Muscular Dystrophy (Bamboo Therapeutics/Pfizer). For more information, visit http://www.askbio.com.

Editas Medicine Forward-Looking Statements This press release contains forward-looking statements and information within the meaning of The Private Securities Litigation Reform Act of 1995. The words anticipate, believe, continue, could, estimate, expect, intend, may, plan, potential, predict, project, target, should, would, and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Editas Medicine may not actually achieve the plans, intentions, or expectations disclosed in these forward-looking statements, and you should not place undue reliance on these forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations disclosed in these forward-looking statements as a result of various factors, including: uncertainties inherent in the initiation and completion of preclinical studies and clinical trials and clinical development of Editas Medicines product candidates; availability and timing of results from preclinical studies and clinical trials; whether interim results from a clinical trial will be predictive of the final results of the trial or the results of future trials; expectations for regulatory approvals to conduct trials or to market products and availability of funding sufficient for Editas Medicines foreseeable and unforeseeable operating expenses and capital expenditure requirements. These and other risks are described in greater detail under the caption Risk Factors included in Editas Medicines most recent Quarterly Report on Form 10-Q, which is on file with the Securities and Exchange Commission, and in other filings that Editas Medicine may make with the Securities and Exchange Commission in the future. Any forward-looking statements contained in this press release speak only as of the date hereof, and Editas Medicine expressly disclaims any obligation to update any forward-looking statements, whether because of new information, future events or otherwise.

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Editas Medicine and AskBio Enter Strategic Research Collaboration to Explore In Vivo Delivery of Genome Editing Medicines to Treat Neurological...


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