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PROMOTIONS
Associate Professor:
David Cohen, MD, PhD
Immaculata DeVivo,
PhD, MPH
Assistant Professor:
Hamish Fraser, MB, ChB
Robert Haddad, MD
Anthoni Letai, MD, PhD
Lawrence Madoff, MD
Colm Magee, MD
Associate Clinical Professor:
Shamuel Ravid, MD
NEW FACULTY APPOINTMENTS
Instructor:
Savita Bagga, PhD
Jatin Dave, MD
Wael Elshamy, PhD
Janice LaPlante, PhD
Graham McMahon,
MD, MBBCH
Gregory McMahon, PhD
Lida Nabati, MD
2005 EDUCATION CELEBRATION AWARDS
Distinguished Ambulatory Teacher:
Gail Levine, MD
Distinguished Faculty Mentors:
Phyllis Jen, MD
Lori Tishler, MD
Distinguished Resident Mentors:
Yu Chen, MD
Mara Giattina, MD
Salmaan Keshavjee,
MD, PhD
Sara Schmidt, MD
Alexander Smith, MD
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ANNOUNCEMENTS
HMS Fund for Women's Health Research
Deadline is May 2, 2005
Click here for more details
HMS Eleanor and Miles Shore Scholars in Medicine Program
Deadline is April 11, 2005
Click here for more details.
HMS "Red Book"Now Available ONLINE!
Attention All Investigators!
New NIH Policy on Public Access
Click her to view Resources for New Investigators
Grant Opportunity
Deadline is
March 1, 2005
Click here to view the RFA & Application Instructions
2005 Ellison Medical Foundation's
New Scholars Program
Deadline is March 2, 2005
Click here for more details.
NEW!!
Non ICU Inter-Service Transfer Policy
Orange Pocket Cards
Pick one up TODAY at the Chief's Office in Tower 1
PHOTO GALLERY
View Photos of the 2005 HOUSESTAFF WINTER BALL
Click here
MARK YOUR CALENDERS!
UPCOMING EVENTS:
February 25, 2005
Noon, Bornstein
Medical Grand Rounds
Inaugural Fish Visiting Scholar in Medical Education
Morton Swartz, MD
Professor of Medicine, Massachusetts General Hospital
March 18-19, 2005
Physician-in-Chief Pro Tempore Event
Risa Lavizzo-Mourey, MD
President/CEO,
Robert Wood Johnson Foundation
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View Videos of
Medical Grand Rounds
ONLINE!
Department of Medicine INTRANET
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to subscribe to Your Medicine Online
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YOUR MEDICINE ONLINE
welcomes your comments and feedback.
Letters to the editor and a response will be posted in future issues.
email SooJin Kim
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On Trust and Playing the Best Hand:
A Conversation with K. Frank Austen, MD
Dr. K. Frank Austen served as chairman of the Department of Medicine at the Robert B. Brigham Hospital and was an integral figure in the historic merger that created the hospital we know today as Brigham and Women’s. Forced to abandon his athletic dreams when struck with poliomyelitis at 17, he “turned bad luck into good luck and made the best of what I’ve had.” And what remarkable good luck for the Brigham that he did. Your Medicine Online recently caught up with Dr. Austen to learn more about his history and the history of Brigham and Women’s Hospital. Read More
Great Teachers in Our Midst:
Elliott Antman, MD
We’ve all experienced it. That moment when a teacher sparks a glimmer of light into what was previously pitch black. As their words sink in, that glimmer starts to blaze; before you know it, there is a new understanding and new confidence thanks to that one great teacher.
Who are the great teachers in our midst and what makes them so exceptional? Your Medicine Online dedicates this series of articles to exploring the lives of some of the Department of Medicine’s greatest and most influential teachers.
We begin this month with Elliott Antman, MD, Professor of Medicine at the Harvard Medical School and Director of the Coronary Care Unit (CCU) at Brigham and Women’s Hospital. What do his trainees say about him? His peers? And what is Dr. Antman’s own version of this story? Read More
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A Letter to the Editor
To the Editor:
I read with interest the article, "Clinical and Education Planning Taskforce: Changing the Face of Housestaff Coverage," in the January issue of the January 2005 Your Medicine Online Department of Medicine E-Newsletter. I am very worried about the downgrading of the role of the resident in the care of patients. In my opinion, there has been an over-reaction to reports about the risks of patient care by residents working 80 hours per week, including a 24-30 hour shift. Indeed, as the manuscript from BWH in the New England Journal cited in the November issue, no difference was noted in mortality and ICU length of stay. Are we really ready to drastically change house staff training on the basis of medication and intern diagnostic errors?
In my opinion, the reduction in hours worked by the house staff has propelled a reduction in their role. Attending physicians used to incrementally cede responsibility to resident physicians because of their more intimate knowledge, longer period of observation, and continuity of care for the patients. Now, as each of these parameters is assumed by attending physicians, residents are allowed fewer decision-making opportunities. This has resulted in downgrading the role of the residents from apprentices towards observers. In my opinion, graduates of the residency program now are not as independent as those even five years ago because of the reduction in their supervised decision making.
I think BWH must remain fully committed to the educational bargain inherent to the academic medical mission: trainees willing to take responsibility should be allowed to assume it under supervision. Although we each remember very difficult days in training, we also remember growing as physicians, stretching our medical wings, and learning to become independent physicians. This process isn't easy, it is stressful. Managing sick patients is hard. That is why trainees are supervised. The CEPT must remember that training is not observing. We are in danger of marginalizing the residents to accommodate rules requirements antithetical to our education mission. I caution the CEPT to go slow and maintain the role of the resident or we risk training a generation of inept physicians.
Sincerely,
Josh Beckman, MD
Click here to view a progress update from the Clinical and Education Planning Taskforce. |
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Medical Education, Ethics and Geriatric Medicine:
An Interview with Christine Cassel, MD |
Photo taken by: Brian Bator at
Mainframe Photographics
She was a year or two out of college when she broke her arm. She had no medical insurance. What to do? For Christine Cassel the answer became clear: Go to medical school.
Now President and CEO of the American Board of Internal Medicine (ABIM), Dr. Cassel is also a specialist in geriatric medicine with a commitment to bring ethical issues to the social challenges of healthcare in America. Your Medicine Online scooped an interview with her after her February 11 Grand Rounds talk, “Improving Performance Through Maintenance of Certification,” part of our Fifth Annual Education Celebration.
Your Medicine Online: Tell us about your background. You did your undergraduate work in philosophy. How did that lead you into your current interests?
Christine Cassel, MD: After finishing my undergraduate degree I took time off. I had a fellowship to get a PhD in philosophy. I’d taken some graduate courses but I was pretty sure I didn’t want to do that, but I wasn’t sure what to do. I was always interested in science but it was in a time when people didn’t encourage girls to go into that. Then I encountered a physician who was a very compelling role model. I had a broken arm and no insurance and this guy helps me deal with this, set the arm, and took care of me. I thought, “Wouldn’t it be neat if I could something like that?” It seemed to fit all my criteria: It was infinitely challenging. It would probably not get boring, always with new science. And there would always be a morally relevant role you could play in any community you were in. I thought, I’ll try this out. It’s a good thing I was naïve about it--I had no idea about the premed mentality. I was in philosophy! So I came to Boston where my family was, did pre-med courses at BU, and got a job as the administrator of a free clinic on Beacon Hill. That gave me a feeling for actually delivering services. I applied to medical school and, after that, you just put one foot in front of the other. But it was a wonderful choice for me. I have never regretted it.
YMO: Have you ever told that physician?
CC:No, I wish I could find him actually. I don’t even know his name. It just came at a moment when I was open. The other thing I needed to do was convince myself, as someone who had studied humanities, languages, philosophy, in my undergraduate education, that I could do things like chemistry. I went to the local library while my arm was healing and took out some chemistry books. And discovered that I liked it. It makes you realize that women need to be given a chance to experience the fun part of learning science. I actually loved organic chemistry; I had a great teacher and that makes a big difference.
YMO: and your interest in ethics…
CC:I always had this philosophical bent, and so when I got involved in clinical aspects of medicine, immediately intricate issues of values arose. I started reading in that area but I wasn’t planning to make a career out of it. I was at the University of California at San Francisco doing clinical research in immunology; I imagined a career as an immunologist. But I was involved in clinical trials even as a house officer that I found extremely troubling. These were the early days when there was less awareness about things like informed consent. I found myself being drawn away from t-cells and b-cells and asking: How do you make these decisions, both about human subjects but also in ordinary clinical care? There was a very good ethics program at UCSF and physicians were just beginning to see this could be an area for clinical research. And that’s what led to geriatrics. I wanted a clinical specialty where I could continue to do research in ethics; geriatrics seemed like one that would be a never-ending source of difficult decisions and ethical issues. It turned out to be true.
YMO: Speaking of geriatrics, you wrote a key textbook, Geriatric Medicine, and have a new book coming out, on Medicare. What is the future of Medicare? A big question, but…
CC: Yes! The book is in press, Medicare Matters: Older Americans and the Social Contract. In it I make the case that Medicare’s problems are fixable, and that Medicare is an essential part of the social contract in a society where all of us have the great good fortune of being able to expect that we’re going to grow old. The aging of society is not just a burden on the federal budget, after all--it is also very good news, for
Photo taken by: Brian Bator at Mainframe Photographics
YMO:And so often they are.
CC: Right. So it isn’t a war between the generations. Anything that you do to Medicare is going to affect the whole rest of the family. People forget that. So that’s the first point.
Second, geriatric medicine is a medical specialty that has defined a model of care for older people that really works. Good geriatric medicine would reduce unnecessary and expensive interventions, by doing only what makes sense, avoiding redundancy. By being able to coordinate care, it avoids adverse effects, keeps people out of the hospital, etc. We now know how to do that. But for most of the United States we don’t have a payment model that supports this. Instead we pay more for hospitalizations or visits for high tech intervention, and much less for coordinating care that could prevent these things. But there are successful models of integrated systems in the United States. The example that I use in my book is Kaiser Permanente, but there are others. They are globally budgeted; not fee for service. So you don’t have the incentive to wait until the patient gets sick before you see them. Instead, the incentive is to call them up and say “How are you feeling, Mrs. Jones. Maybe if you take a little extra medicine, you won’t have to make that doctor’s visit.” Empowering them to stay home. Empowering the system to come up with ways to reach out in the community to the patients and help them manage their own health, using the hospital only as a last resort. This saves huge amounts of money that you can then use on other things. We have those systems. We know that they work. But the “American People” have decided that managed care doesn’t work. And they’re wrong. I’m arguing that there are ways of doing this that are quite feasible. We just aren’t looking where they are.
Third, none of this is really going to be possible unless we come to terms with the fact that we do have to do something I call “rationing” of health care. It’s this concept that advertising used to convince people that “managed care is terrible, because they’re going to ration.” But we’re rationing now, by high upfront deductibles. People say, “Do I really want to go in for that diabetes check if I have to pay $35 or $100 out of my own pocket? Maybe I won’t.” So you wait until the person gets sick and shows up in the emergency room. That’s rationing. We could be more “rational” if we would be willing to talk about the fact that everybody can’t have everything but we do have a good evidence base for what is effective. Let’s decide that Medicare isn’t going to cover those things in order to cover what we know works. If people decide they want those things, then they can pay for that out of pocket, rather than pay for that diabetes visit out of pocket.
But to make this happen requires legislation, and standing up to some very powerful vested interests – companies who are advocating for Medicare to cover their thing, whatever it is. So those are the three basic messages of the book.
To get back to the question, “What’s the future of Medicare?”, I’m worried about it, because people are manipulated by the political rhetoric and don’t understand. So I think if the medical profession was more together around this message, it would provide that different voice, rather than the politicians’. Yet I am concerned that here the medical profession has been very fragmented, with specialty societies all advocating for themselves. Instead we need to look at the whole picture of healthcare.
That said, I am an advocate for Medicare as essential to our successfully going forward. It may even be a model for insurance for the rest of the population. It’s a very visible clinical issue.
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