Dr. Naomi T. Laventhal joined the University of Michigan in August 2009, after completing her residency in pediatrics, fellowships in neonatology and clinical medical ethics, and a master’s degree in public policy at the University of Chicago. She is an assistant professor in the Department of Pediatrics and Communicable Diseases in the Division of Neonatal-Perinatal Medicine, and in the Center for Bioethics and Social Sciences in Medicine (CBSSM).
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The August 2016 issue of AMA Journal of Ethics features commentaries by Christian Vercler, Lauren Smith, and Andrew Shuman.
"Is Consent to Autopsy Necessary? Cartesian Dualism in Medicine and Its Limitations"
Commentary by Megan Lane and Christian J. Vercler
"I Might Have Some Bad News: Disclosing Preliminary Pathology Results"
Commentary by Michael H. Roh and Andrew G. Shuman
"Requests for VIP Treatment in Pathology: Implications for Social Justice and Systems-Based Practice"
Commentary by Virginia Sheffield and Lauren B. Smith
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.
With just a simple search term and a click of the mouse, a person can find a large amount of health information on the Internet. What role does the Internet play in how patients make medical decisions? Does using the Internet as a source for information to help patients make informed decisions vary by health condition? Does the Internet substitute for detailed discussions with a health care provider?
Consider the following:
Imagine that you recently visited your health care provider for an annual physical examination. During the exam your doctor told you that you are at the age where you should start thinking about getting a screening test for colon cancer. In this conversation your health care provider explained some of the reasons why you should get screened. At the end of the visit, you had more information about screening tests for colon cancer but had not yet decided whether or not you wanted to get tested.
- Don't know
How do your answers compare?
In a recent study published in the journal Medical Decision Making, CBSSM investigators Brian Zikmund-Fisher, Mick Couper, and Angela Fagerlin examined Internet use and perceived importance of different sources of information by patients making specific medical decisions.
In this study, US adults aged 40 years and older were asked about how they got information about 9 common medical decisions, including decisions about common prescription medication (for high blood pressure, cholesterol, and depression), cancer-screening tests (for colorectal, breast, and prostate cancer), and elective surgeries (for lower back pain, cataracts, and knee/hip replacement). In addition, they study compared participants' ratings of the Internet as a source of information with their ratings of other sources, such as their health care provider.
So, how did your responses compare to the average adult in this study's population?
Results from this study showed that most patients did not use the Internet to make specific medical decisions like the ones you considered. On average, about 26% of participants made use of the Internet for information to make decisions about colon cancer screening tests and about 47% used it to inform a decision about lower back pain surgery.
Among participants who chose to use the Internet for finding information about specific medical decisions, data show that Internet use varies significantly across different types of medical decisions. Internet users were more likely to use the Internet for information related to elective surgery (36%), such as lower back pain surgery, and prescription medication (32%) than for cancer-screening decisions (22%), such as colon cancer screening.
Another element of this study looked at participants' ratings of different information sources. You are unlike other participants in this study in that you did not consistently rate health care providers as the most important source for information about colon cancer screening and lower back pain surgery. The CBSSM study found that, for both Internet users and nonusers, health care providers were rated highest as a source for information for all 9 decisions studied. Among Internet users, however, the Internet was rated as their 2nd-most important source of information.
The researchers found that Internet use to inform specific medical decisions varied by age ranging from 38% for those aged 40 to 49 years to 14% for those aged 70 years or older. Approximately 33% of 50 to 59 year olds used the Internet to make these medical decisions and 24% for those in the 60 to 69 year age category. This result is consistent with previous research on the demographics of Internet use.
The study authors concluded that the Internet has an impact on people's access to health care information; however, "the data suggest that access is not the same as use, and use for one medical decision does not imply use for all health decisions." In other words, people use the Internet differently depending on the context. The authors end by stating, "Clinicians, health educators, and health policy makers need to be aware that we remain a long way away from having Internet-based information sources universally used by patients to improve and support the process of medical decision making."
For the full text of this article:
Couper M, Singer E, Levin CA, Fowler F, Fagerlin A, Zikmund-Fisher BJ. Use of the internet and ratings of information sources for medical decisions: Results from the DECISIONS survey. Medical Decision Making 2010;30:106S-114S.
Registration is now open for the April 25, 2017 CBSSM Research Colloquium & Bishop Lecture in Bioethics. This event is free and open to the public. Registration is encouraged, as it will help us to estimate numbers for catering and lunch. Please RSVP by April 18th.
The keynote address is the Bishop Lecture in Bioethics, an endowed lectureship made possible by a gift from the estate of Ronald C. and Nancy V. Bishop. Norman Daniels, PhD will present the Bishop Lecture with a talk entitled: “Universal Access vs Universal Coverage: Two models of what we should aim for."
Norman Daniels, PhD is Mary B. Saltonstall Professor of Population Ethics and Professor of Ethics and Population Health in the Department of Global Health and Population at the Harvard School of Public Health.
Location: Great Lakes Room, Palmer Commons, 100 Washtenaw Ave, Ann Arbor, MI 48109
Click here to register for the Colloquium!
Click here for the Colloquium Schedule and Presentation Abstracts.
Announcement of Position: Clinician Ethicist
The Program in Clinical Ethics within the Center for Bioethics and Social Sciences in Medicine (CBSSM) represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities. The aims of this program are to: liaise with and provide support to the adult and pediatrics ethics committees; streamline clinical ethics consultation; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.
The Program in Clinical Ethics is co-directed by the chairs of the adult and pediatric ethics committees and consultation services, Christian J. Vercler, MD MA and Andrew G. Shuman, MD. A dedicated clinician ethicist will manage the program on a daily basis. A cadre of eight faculty ethicists will rotate on service throughout the year and work closely with the clinician ethicist. Trainees and students will rotate as well. Dedicated administrative support will be organized through CBSSM.
One individual will serve as the program’s clinical ethicist. This individual will serve as the “first responder” and contact person for all ethics consults during business hours, ensure continuity with consults, and work in conjunction with faculty ethicists. The role will include arranging team/family meetings, ensuring follow-ups on all consults, and arranging additional consultations as needed for selected cases. He/she will also regularly review relevant institutional policies and attend all ethics committee meetings. Another major component of this role will be to organize and participate in educational efforts and preventative ethics rounds. This position will provide $50,000 of direct salary support annually, to be distributed and allocated in conjunction with their home department. The initial appointment will last two years and is renewable.
Candidates are expected to be employees or faculty at UMHS with a master’s or equivalent terminal degree in their field; any professional background is acceptable. Direct experience with clinical ethics consultation is required. Familiarity with ethics education and related clinical research would be helpful. Excellent organizational and communication skills across multidisciplinary medical fields are required. Candidates are expected to have qualifications that meet the standards outlined by The American Society for Bioethics and Humanities (ASBH) for accreditation for clinical ethics consultants.
Candidates will be vetted, interviewed and chosen by a nomination committee. Candidates are asked to submit:
- Curriculum vitae or resume
- One page maximum summary of (1) education/training related to ethics consultation; (2) clinical ethics consultation experience; and (3) motivation/interest in the position
- Letter of support from Department Chair/Division Head/Center Director or equivalent
- Submit formal application via email to: email@example.com
- Application is due December 11, 2015 with interviews shortly thereafter
- Appointment will take effect January 1, 2016
- Co-Directors of the Program in Clinical Ethics: Christian J. Vercler, MD MA & Andrew G. Shuman, MD
- Administrative contact: Valerie Kahn – firstname.lastname@example.org 734 615 5371
The 2017 Bishop Lecture in Bioethics was presented by Norman Daniels, PhD, Mary B Saltonstall Professor and Professor of Ethics and Population Health in the Department of Global Health and Population at Harvard School of Public Health. Dr. Daniels presented a talk entitled, "Universal Access vs. Universal Coverage: Two models of what we should aim for." The Bishop Lecture served as the keynote address during the CBSSM Research Colloquium.
Abstract: We contrast two models of health care insurance, the Universal Coverage model underlying the Affordable Care Act and the Universal Access model underlying the (now withdrawn) American Health Care Act. Our goal is to evaluate the strongest argument for the Universal Access model. That model suggests that if people have real choices about health care insurance, some will buy it and some will not, and no one should be mandated to buy it. We argue that the Universal Access model presupposes that people can afford insurance, and that means subsidizing it for millions of people as the Universal Coverage model underlying the ACA does. These costs aside, the strongest argument for the Universal Access model is that giving people true choice may make the population level of well-being higher. Some people will have other priorities that they prefer to pursue, especially if they can free ride by enjoying the benefits of a system that provides health care without their contributing to it. If the additional costs that third parties have to pay as a result of the increase in real choice are significant, then the strongest argument for Universal access fails: the benefits of choosing not to be insured are outweighed by the imposed costs on others from these choices.
Norman Daniels, PhD is Mary B. Saltonstall Professor of Population Ethics and Professor of Ethics and Population Health in the Department of Global Health and Population at the Harvard School of Public Health. Formerly chair of the Philosophy Department at Tufts University, his most recent books include Just Health: Meeting Health Needs Fairly (Cambridge, 2008); Setting Limits Fairly: Learning to Share Resources for Health, 2nd edition, (Oxford, 2008); From Chance to Choice: Genetics and Justice (2000); Is Inequality Bad for Our Health? (2000); and Identified versus Statistical Lives (Oxford 2015). He has published 200 peer-reviewed articles and as many book chapters, editorials, and book reviews. His research is on justice and health policy, including priority setting in health systems, fairness and health systems reform, health inequalities, and intergenerational justice. A member of the IOM, a Fellow of the Hastings Center, and formerly on the ethics advisory boards of the CDC and the CIHR, he directs the Ethics concentration of the Health Policy PhD at Harvard and recently won the Everett Mendelsohn Award for mentoring graduate students.
Founded in 2006, MICHR develops research talent through its predoctoral and postdoctoral education programs; helps investigators launch their ideas through pilot grant funding and consultation; connects researchers with community groups, clinics, practice-based networks, and potential study volunteers; and supports research teams with clinical research management services, including biostatistical design and analysis, study management and monitoring, data management, a clinical trials office for industry partnerships, and a fully-equipped and professionally-staffed clinical research unit.
PI(s): Sara Adar
Co-I(s): Robert Bagramanian, Cleopatra Caldwell, Dana Dolinoy, Vicki Ellingrod, Karen Farris, William Giannobile, Kyle Grazier, Janet Larson, Phyllis Meadows, Hal Morgenstern, Douglas Noll, Trivellore Raghunathan, Dean Smith, Catherine Spino, Marita Titler, Alexander Tsodikov, Mark Van Oyen, Roger Albin, Neil Alexander, Lawrence An, Brian Athey, Charles Burant, James Cavalcoli, Arul Chinnaiyan, Daniel Clauw, Matthew Davis, Scott Flanders, Michael Geisser, Debbie Gipson, Susan Goold, Lee Green, David Hanauer, Sarah Hawley, Raymond Hutchinson, Lori Isom, Claire Kalpakjian, Michael Klinkman, Nicholas Lukacs, George Mashour, Bethany Moore, Susan Murphy, Gilbert Omenn, Michelle Riba, Blake Roessler, Mark Russell, Thomas Shanley, Donna Shewach, Yolanda Smith, Delia Vazquez, Stewart Wang, John Wiley, David Williams, Sandra Wong, Kai Zheng, Marc Zimmerman, Anna Kratz, Barbara Brush, Kelley Kidwell, David Gordon, Brooks Gross, Elizabeth Koschmann, Alan Weder
"Implementation of the Program in Clinical Ethics"
Janice Firn, MSW; Andrew Shuman, MD; Christian Vercler, MD
Abstract: The Program in Clinical Ethics within the Center for Bioethics and Social Sciences in Medicine represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities at UMHS. We will introduce and outline the projects and services available to all members of the UMHS Community.
H. Myra Kim is a Research Scientist at the Center for Statistical Consultation and Research and and Adjunct Professor at the Department of Biostatistics. She received her Sc.D. in Biostatistics from Harvard University in 1995 and worked at Brown University as an Assistant Professor from 1995 to 1997. She has worked at UM since 1997 and has collaborated with various researchers from around the UM community as well as from other universities.