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Beth A. Tarini, MS, MD

Alumni

Beth A. Tarini is an Associate Professor of Pediatrics & Division Director of General Pediatrics and Adolescent Medicine at the University of Iowa. Before that, she was an Assistant Professor in the UM Department of Pediatrics and Communicable Diseases. She received her MD from Albert Einstein College of Medicine (2001) and a master's degree from the University of Washington (2006), where she was a Robert Wood Johnson Clinical Scholar. In addition to her clinical interest in preventative care, she pursues an active research program on issues of newborn screening and genetic testing.

Last Name: 
Tarini

Ken Langa, MD, PhD

Faculty

Dr. Langa is the Cyrus Sturgis Professor in the Department of Internal Medicine and Institute for Social Research, a Research Scientist in the Veterans Affairs Center for Clinical Management Research, and an Associate Director of the Institute of Gerontology, all at the University of Michigan. He is also Associate Director of the Health and Retirement Study (HRS), a National Institute on Aging funded longitudinal study of 20,000 adults in the United States ( http://hrsonline.isr.umich.edu ).

Last Name: 
Langa

Bioethics Grand Rounds -Susan Goold, MD

Wed, July 26, 2017, 12:00pm
Location: 
UH Ford Auditorium

Susan Goold, MD, MHSA, MA, FACP Title: “Trust me, I’m an Accountable Care Organization”

Abstract: Accountable care organizations (ACOs) are a new form of health care organization in which a network of health care providers is given a financial incentive to reduce total costs of care while meeting certain quality benchmarks for a defined patient group. What are the moral responsibilities of such organizations, if any? How might ACOs and those who work in them care for patients in an accountable, trustworthy way?

 

Mon, May 15, 2017

U-M is keeping the dialogue going by offering an online teach-out on the topic of the importance of science and research. "Stand Up for Science: Practical Approaches to Discussing Science That Matters" was recently offered. In this video, Brian Zikmund-Fisher, and Elyse Aurbach, co-founder and co-director of a science communication program called RELATE, explain the importance of science and research. Watch video and read more about the teach-out here.

Research Topics: 
Fri, September 15, 2017

A study on surgeon influence on double mastectomy co-authored by Sarah Hawley and Reshma Jagsi was recently highlighted in Time Health.  This study found that attending surgeons exerted a substantial amount of influence on the likelihood of receipt of contralateral prophylactic mastectomy after a breast cancer diagnosis. Steven Katz was first author of this study.

Fri, December 15, 2017

In light of the #MeToo campaign denouncing sexual assault and harassment, Reshma Jagsi has written a perspective piece in the New England Journal of Medicine about sexual harrassment in academic medicine. Also check out her interview in MHealth Lab and several other articles citing her NEJM article.

Research Topics: 

Leaving the Emergency Room in a Fog (Sep-09)

Consider this scenario:

Alfred made a visit to his local Emergency Room. What was his diagnosis? What did the medical team do for his problem? What was he supposed to do to continue care at home? And what symptoms was he supposed to watch for to alert him to return to the ER?

Alfred woke up at 4 am on Sunday morning with pain in his left foot. That place where his new running shoes had rubbed a raw spot earlier in the week was getting worse. By 9 am, the foot was red and swollen, with a large oozing sore, and Alfred decided to go to the Emergency Room at his local hospital.

Late on Sunday afternoon, Alfred returned home from the ER. He crutched his way into the house and collapsed on the sofa. His teenage son quizzed him.

"What did they say was wrong?"
"Oh, an infection," replied Alfred.
"Well, what did they do for it?"
"I think they cut a chunk out of my foot," said Alfred.
"Whoa! Did they give you any medicine?"
"Yeah, a shot," said Alfred.
"And what’s with the crutches?"
"I’m supposed to use them for a while," said Alfred, looking annoyed.
"How long a while?"
"It’s written down," said Alfred, digging a crumpled sheet of paper out of his pocket.
"Says here you should take some prescription and elevate your left leg for two days."
"Two days? I have to go to work tomorrow," groaned Alfred.
"And you’re supposed to go back to the ER if you have a fever or pain in your leg. Where’s the prescription?"
"Here, look through my wallet. Maybe I stuck it in there," said Alfred.
The good news is that Alfred recovered completely, with some assistance and cajoling from his son. But how common is it for people who go to the Emergency Room to be foggy about what happened and what they should do once they leave the ER?
What do you think is the percentage of ER patients who do not understand at least one of the following: their diagnosis, the emergency care they received, their discharge care, or their return instructions?
 
  • 38%
  • 48%
  • 78%
  • 88%

How do your answers compare?

A recent study in the Annals of Emergency Medicine found that 78% of emergency room patients showed deficient comprehension in at least one of these areas:
 
  • Diagnosis
  • Emergency care that was given
  • Post-ER care needs
  • Symptoms that would require a return to the ER
51% of patients showed deficient comprehension in two or more areas. Only 22% of reports from patients were in complete harmony with what their care teams reported in all four areas. The biggest area of misunderstanding was in patients' post-ER care needs, such as medications, self-care steps, follow-up from their regular doctors, or follow-up with specialists.
 
Even more alarming is that, according to the study, "most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall." The patients were quite sure of what they knew 80% of the time—even when what they knew was not right.
 
These results suggest that Emergency Room teams need to do a better job of making sure that patients go home with clear information and instructions—and that patients and their loved ones shouldn't leave until they fully comprehend their situation.
 
Lead author Kirsten G. Engel, MD, conducted this study, "Patient Comprehension of Emergency Department Care and Instructions," with Michele Heisler, MD, Dylan M. Smith, PhD , Claire H. Robinson, MPH, Jane H.Forman, ScD, MHS, and Peter A. Ubel, MD, most of whom are affiliated with CBDSM.
 
The researchers carried out detailed interviews with 140 English-speaking patients who visited one of two Emergency Departments in southeast Michigan and were released to go home. These interviews were compared with the patients' medical records, and the comparisons revealed serious mismatches between what the medical teams found or advised and what the patients comprehended.
 
"It is critical that emergency patients understand their diagnosis, their care, and, perhaps most important, their discharge instructions," says Kirsten Engel, a former UM Robert Wood Johnson Clinical Scholar who is now at Northwestern University. "It is disturbing that so many patients do not understand their post-Emergency-Department care, and that they do not even recognize where the gaps in understanding are. Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the Emergency Department."
 
Peter A. Ubel, the study's senior author, agrees: "Doctors need to not only ask patients if they have questions, but ask them to explain, in their own words, what they think is wrong with their health and what they can do about it. And patients need to ask their doctors more questions, and even need to explain to their doctors what they think is going on."
 
Read the article:

 

Woll Family Speaker Series: Debate on Conscience Protection

Fri, March 09, 2018, 12:00pm to 1:00pm
Location: 
Med Sci II, West Lecture Hall

The Woll Family Speaker Series on Health, Spirituality and Religion

We are excited to be hosting a debate on Conscience Protection on Friday March 9th from 12-1 as part of the UMMS Program on Health, Spirituality and Religion. Please save the date! CME Credit provided (see below).

Point: Healthcare professionals are "obligated to provide, perform, and refer patients for interventions according to the standards of the profession.” NEJM, 2017

Counterpoint: Healthcare professionals have the right to opt out of performing or referring for procedures they view as objectionable in accord with their religious or personal values.

Join Dr. Naomi Laventhal and Dr. Ashley Fernandes in this academic discussion as part of the University of Michigan Program on Health, Spirituality and Religion.

Tanner Caverly, MD, MPH

Faculty

Tanner Caverly has been a general internist and Health Services Research Fellow at the Ann Arbor VA Medical Center and a Clinical Lecturer at the University of Michigan Medical School since July 2013. He graduated from medical school at The Ohio State University School of Medicine and Public Health, and subsequently traveled to the University of Colorado, where he completed internal medicine residency training, a year as Chief Medical Resident, and a Primary Care Research Fellowship / Masters in Public Health.

Last Name: 
Caverly
Thu, February 11, 2016

Raymond De Vries, PhD and Scott Kim, MD, PhD 's study of euthanasia and assisted suicide (EAS) for persons with psychiatric illnesses was recently written up in the New York Times. They found that persons receiving EAS for psychiatric disorders in the Netherlands were mostly women, of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. They also reported that in more than half of approved cases, people had declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. Dr. De Vries and Dr. Kim are current and former co-directors of the Center for Bioethics and Social Sciences in Medicine (CBSSM) .


Citation: Kim SYH, DeVries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016.

 

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