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Institute of Medicine urges reforms to improve care for dying people

By Lisa M. Krieger lkrieger@mercurynews.com

An influential national institute has prescribed a powerful cure for America's approach to dying, saying that today's health care system is ill-equipped to provide the comfort and care so cherished in our final days.

The long-awaited report released Wednesday by the Institute of Medicine recommends that regular end-of-life conversations become part of patients' primary care, starting at age 18 and that doctors should be paid for time spent on these discussions -- a controversial initiative eliminated from President Barack Obama's health care law.

The report reflects the growing concern over the dizzying array of high-tech interventions to emerge in recent years that prolong futile suffering, often at great emotional, physical and financial cost. Those interventions were the subject of this newspaper's yearlong series "Cost of Dying." To correct the current, misguided course, Medicare should boost coverage for home health services, not just high-tech hospital care, the report urges. And more doctors must be trained and licensed in end-of-life care, through changes in universities, state medical boards and accrediting agencies, it adds.

"Even though death is very much part of the cycle of life, thinking and talking about one's own death usually remains in the background," said Dr. Philip Pizzo, former dean of Stanford University's School of Medicine and a co-chairman of the report.

"It is our hope,'' said Pizzo, "that this report will lead to improvements in end-of-life care and the experience of dying for all."

The 21-member committee, which included experts in law and medicine, devoted two years to studying federal policy, financing and hospital practices. Recommendations of the institute, a private, nonprofit arm of the National Academy of Sciences in Washington, D.C., often make their way into U.S. laws and federal agency policies.

The "Dying in America" report recommends that federal and state governments and private insurers create financial incentives for patients and clinicians to discuss end-of-life matters, document patient preferences, and provide appropriate services and care.

The report authors also suggest having initial conversations about end-of-life values, guided by a physician, at milestones of life, such as getting a driver's license, turning 18, leaving home or marrying. Additional planning should occur for those in high-risk occupations, at the onset of chronic illness and when applying for Medicare.

"There is unnecessary and gratuitous suffering all over the place," said Dr. BJ Miller, executive director at San Francisco's Zen Hospice, who was not involved in the report. "But when the Institute of Medicine says something, people listen -- at all levels," said Miller, an assistant clinical professor of medicine at UCSF.

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Institute of Medicine urges reforms to improve care for dying people

Introduction to Technology and Future of Medicine Course LABMP 590 2014 Sept 4 – Video


Introduction to Technology and Future of Medicine Course LABMP 590 2014 Sept 4
Dr. Kim Solez presents "Introduction to Technology and Future of Medicine Course LABMP 590" on September 4, 2014, at the University of Alberta in Edmonton, Canada see http://www.singularitycourse.c...

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Cole Zanetti D.O. Predictive Analytics and Big Data in Medicine – Video


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Tim Dry and Barbie Wilde discuss Bad Medicine help fund now – Video


Tim Dry and Barbie Wilde discuss Bad Medicine help fund now
Tim Dry and Barbie Wilde interview from http://www.WithoutYourHead.com edited by Tim Dry for video. Help fund the campaign here: http://www.indiegogo.com/projects/bad-medicine-movie--2 For more informatio...

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Columbia University College of Dental Medicine receives diversity award

PUBLIC RELEASE DATE:

16-Sep-2014

Contact: Karin Eskenazi ket2116@columbia.edu 212-342-0508 Columbia University Medical Center @ColumbiaMed

NEW YORK, NY (September 16, 2014) The Columbia University College of Dental Medicine (CDM) has received the 2014 Higher Education Excellence in Diversity (HEED) award from INSIGHT Into Diversity magazine, the oldest and largest diversity-focused publication in higher education. As a recipient of the annual HEED Awarda national honor recognizing U.S. colleges and universities that demonstrate an outstanding commitment to diversity and inclusionCDM will be featured along with 82 other recipients in INSIGHT Into Diversity magazine's November 2014 issue.

"At the College of Dental Medicine, we are very proud of our targeted efforts to foster a student body diverse in thought, background, and experience within an inclusive environment," said Dennis Mitchell, DDS, MPH, senior associate provost for faculty diversity and inclusion, associate professor of dental medicine, and senior associate dean for student development in the CDM. "As a school that strives to be the No. 1 destination for the world's greatest scholars, we understand that we cannot achieve this aspiration without realizing our core values of inclusion and excellence. Accomplishing this requires that diversity be a fundamental academic accountability for our university, our schools, and our departments and evident through equity in recruiting, advancement, retention, and experience."

INSIGHT Into Diversity magazine selected CDM based on its exemplary diversity and inclusion initiatives as well as its ability to embrace a broad definition of diversity, including gender, race, ethnicity, veterans, people with disabilities, members of the LGBT community, and other underrepresented communities. In keeping with the mission set forth by the CDM admissions policy for diversity, which affirms the College's commitment to ensure a "critical mass" of underrepresented students, as well as a student body that is broadly diverse in character, the school has continued to enroll a diverse DDS class. The last two entering classes (2017 and 2018, 20 percent) have included unprecedented numbers of students underrepresented in the dental profession. Excluding the dental schools of Meharry and Howard University (Historically Black Colleges and Universities) and the University of Puerto Rico, CDM ranks in the top 10 percent of U.S. dental schools for enrollment of underrepresented minority dental students and first among its peer Northeast private dental schools.

The Summer Medical and Dental Education Program (SMDEP), funded through a grant from the Robert Wood Johnson Foundation, is administered in collaboration with the College of Physicians & Surgeons Office of Diversity. CDM has enrolled a total of 35 graduates of the SMDEP program over the past decade, 19 of whom graduated from the CUMC SMDEP program (including three in the Class of 2017).

The Office of Diversity Affairs sponsors recruitment trips to several conferences targeting promising Underrepresented in Dentistry (UID) students. Various student organizations sponsor recruitment events on campus and participate in CDM's hosting program for UID applicants during interview season.

"We hope the HEED award serves as a way to honor those institutions of higher education that recognize the importance of diversity and inclusion as part of their everyday campus culture," said Lenore Pearlstein, publisher of INSIGHT Into Diversity magazine.

Other recipients of the 2014 HEED award are:

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Columbia University College of Dental Medicine receives diversity award

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