Author Archives: billhill

Interprofessional Education

Interprofessional collaboration is a core skill for all clinicians and is a required accreditation element for medical, nursing, pharmacy, physician assistant, and social work program. The competency framework developed by the Interprofessional Education Collaborative outlines four domains for education and practice in team based care:

  • Values and Ethics for Interprofessional Practice: Work with individuals of other professions to maintain a climate of mutual respect and shared values.
  • Roles and Responsibilities: Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.
  • Interprofessional Communication: Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.
  • Teams and Teamwork: Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population- centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.

Socialization of the Individual

Review the lexicon (covers important terms and definitions),explore socialization, watch a TED Talk on bias, and complete readings on narrative humility and reflection in medical education. 

Learn about socialization.  Ready all the sections in 3.2 Understanding the Meaning of Socialization and 3.6 Social Interactions in Daily Life.

This TED Talk reviews one woman’s experience with bias and an approach to address it.

This article discusses the concept of narrative humility in patient interactions.

Consider how reflection in medical education helps us learn.

Supplemental readings:

Honoring the Individual: Narrative and Cultural Humility

This New York Times article, written by Harvard Professor of Economics Sendhil Mullainathan discusses how our identity shapes how we think about inequality and our advantages and disadvantages.

To Help Tackle Inequality, Remember the Advantages You’ve Had, by Sendhil Mullainathan

This PBS Newshour video and brief accompanying article by Kamaraia Roberts about young Black Republicans suggests that individual identities can be challenged by society and peers.

The stigma of being young, black and Republican, by Kamaria Roberts

Watch this compelling YouTube video by Director Vivian Chavez.  Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility and the need for cultural humility to improve provider to patient interaction and care.

Cultural Humility, by Vivian Chavez

History of Public Health

We aim to explore historical trends in human health and life expectancy and to discuss how public health has evolved over time. To learn the history of a major cause of morbidity and mortality that has declined in importance due to public health efforts, please watch segment 04:30-49:30 of the film “The Forgotten Plague” The significance of tuberculosis in the development of America’s public health system is outlined, as described below:

“By the dawn of the 19th century, the deadliest killer in human history, tuberculosis, had killed one in seven of all the people who had ever lived. The disease struck America with a vengeance, ravaging communities and touching the lives of almost every family. The battle against the deadly bacteria had a profound and lasting impact on the country. It shaped medical and scientific pursuits, social habits, economic development, western expansion, and government policy. Yet both the disease and its impact are poorly understood: in the words of one writer, tuberculosis is our “forgotten plague.”

For students who are interested in history or would like more information on the history of public health, please read the New Yorker article entitled “Sick City.” This article describes the past and current public health threat related to cholera, and highlights how environmental forces, the built environment, the adequacy of water and sanitation systems, and global travel are critical elements shaping our health risks.

Healthcare Financing and Reform

Watch the following Khan Academy Videos:

Module 1: Health care system overview 8 minutes

Explains how patients/populations, providers, and payors interact.  Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs.  Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.

Module 2: Paying doctors 12 minutes

Defines FFS, capitation and salary.  Describes the lack of cost accountability to patients and providers in the third party payor system.  Describes issues with capitation with particular attention on “cherry picking” or patient shifting.

Module 3: Medicare overview 16 minutes

Introduces Medicare and Medicaid.  Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid).  Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services).  Describes Medicare parts A-D.

Review the Fact Sheet on Healthcare Financing and Reform

History of Medicine as a Profession

ABIM Medical Professionalism: A Physician Charter

This document reviews the importance of professionalism is the basis of medicine’s contract with society and that understanding the principles and responsibilities of medical professionalism is key to physicians social contract with society.

Why Does Professionalism Matter? : Trust, Transparency and Accountability

This video (3:34) shows senior physicians from around the country exploring why professionalism is integral to physicians maintaining trust with patients. It stresses that trust and accountability are key focuses to continue to keep at the center of physicians practice. At 1 minutes 30 seconds, the provider talks about how at times there will be conflict when there are competing needs but that it is important to embrace and face the conflict to better understand it.

Association Between Physician Burnout and Identification With Medicine as a Calling

This research paper seeks to evaluate the association between degree of professional burnout and physicians’ sense of calling. Study identifies that physicians who experience more burnout are less likely to identify with medicine as a calling. It implies that loss of the sense of medicine as a calling may have adverse consequences for physicians and patients

 

 

 

Bridging Difference: An approach to conflict with colleagues

Conflict is frequent and inevitable in healthcare.  Why?

  • We have different personal and professional values. Moral issues and values often play a role in medical care and decision-making, and the values of individual team members may at times conflict.
  • We may have a different understanding of the same patient or situation. For example, one physician may see a patient as having a potentially treatable illness, while another sees him as someone who is suffering and should be allowed to die peacefully.
  • There is often not a single “right” or evidence-based answer. The different experiences of team members may lead to different approaches to the same patient or issue.
  • We come from diverse cultural backgrounds. Team members – including patients – all bring their personalities and cultures to the table, and icebergs can bump.
  • Working in healthcare is stressful and can cause individual ‘resource depletion’. Fatigue, stress, and burnout all make conflict more likely.
  • We may have inadequate institutional resources, leading to tussles to get our patients what they need – the next operating room, an expensive medication, etc.

Health professionals AND medical students need to have a constructive approach to conflict

  • To provide the safest and highest quality care for patients
  • To create a safe learning and working environment for ourselves and our colleagues
  • To build and maintain relationships with each other. Health care team members often work together for years.  Medical school classmates will be a source of support for each other, and may find themselves in the same residency programs and ultimately practicing together.

Conflict Handling Modes

TKI Conflict Handling Modes

TKI Conflict Handling Modes

Competing

A competing style is higher in assertion and lower in cooperation.  Someone using a competing style might approach the conflict by making as strong a case as they can for their own position.  They may be very amiable and polite about it – competing does NOT mean harsh – but they have a viewpoint that they strongly assert.

Perhaps someone using a competing style is very confident that hers is the correct position.  She may be in a position of power and intend to pursue this course even if it is unpopular with others – a competitive style may avoid wasting time in meaningless discussion if the course is already set.

Collaborating

A collaborating style is both assertive and cooperative.  Someone using a collaborative style might approach a conflict as an opportunity to work together to build the best possible understanding or solution.  He would express his own perspective, but would also elicit and listen to the perspectives of others.

Perhaps someone using a collaborative style knows that each member of the group is likely to have different ideas and input, and that all might be contribute to the group’s understanding of a critical issue, or to solving a challenging problem.  He may want to build strong relationships within the group, even though it might take a lot more time than a less cooperative style.

Compromising

A compromising style is medium in both assertiveness and cooperativeness.  Someone using a compromising style might approach the conflict as an opportunity to meet in the middle, to give and take to find something all group members can live with.

Avoiding

An avoiding style is low in both assertiveness and cooperativeness.  Someone using an avoiding style does not share their own perspective or listen to others – they don’t want to engage with this conflict right now!

Perhaps someone using an avoiding style needs time to process their own thoughts or cool down, and they plan to return to the topic later on.  Or perhaps the issue is unimportant to them, or they don’t think they have the power to make change.

Accommodating

An accommodating style is low on assertiveness, but high in cooperativeness.  Someone who is using an accommodating style is putting the concerns or needs of others ahead of their own.

Perhaps someone using an accommodating style knows that the issue is far more important to the other(s) than it is to them, or that the relationship is more important than the issue.

An Approach to Handling Conflict

Can we insert vital talk web page here?  http://vitaltalk.org/guides/conflicts/  ALT TEAM

 

Key Ethics Term: Expressivist Objection

Some object to prenatal diagnosis on the basis that it ‘expresses’ a discriminatory attitude towards those with (dis)ability. Namely, the act of screening for genetic information that might demonstrate risk for certain forms of (dis)ability (e.g. developmental (dis)ability associated with Down Syndrome) so that one might then choose to terminate the pregnancy endorses normative assumptions that treat those with (dis)ability negatively or as unequal in moral worth.

It is important in weighing this objection against other considerations to consider the perspective of those who have a screened for or similar genetic trait. Likewise, you might consider how you would feel if any genetic trait that you have were screened for regularly and pregnancies were regularly terminated because of it.


For further reading…

  • Boardman, FK. (2014). The expressionist objection to prenatal testing: the experiences of families living with genetic disease. Social Science & Med, 107:18-25.

  • Edwards SD. (2004). Disability, identity and the “expressivist objection”, J Med Ethics, 30(4):418.

  • Kittay, E. and Carlson, L. (2010) Cognitive Disability and its Challenge to Moral Philosophy, Wiley-Blackwell: Oxford.