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Tue, May 23, 2017

CBSSM Director, Reshma Jagsi's recent JAMA Oncology article, "From Muslim Registries to Radical Health Care Reform—Caring for Patients in an Era of Political Anxiety" was cited in the New York Times article, "An Expert in Fear."

Jennifer Acosta, MPH

Research Associate

Jenny joined CBSSM in July 2017. She works with Dr. Geoff Barnes on projects focused on improving care for patients on anticoagulants by addressing barriers to medication adherence and patient, physician, and hospital staff communication.

Last Name: 
Acosta
Mon, July 31, 2017

David Sandberg was recently quoted in BuzzFeed article, "A Landmark Lawsuit About An Intersex Baby’s Genital Surgery Just Settled For $440,000." Dr. Sandberg is the coinvestigator of a research initiative across several hospitals to try to better understand outcomes of patients with differences of sexual development.

Thu, September 28, 2017

Geoff Barnes was recently interviewed for the article, "Stroke, Bleeding Risks High in A-fib Patients With Contraindications to Anticoagulation" in tctMD/the heart beat.

Fri, November 17, 2017

Naomi Laventhal and Kayte Spector-Bagdady were quoted in Michigan Medicine for the article, "Born at the Right Time" about an artificial placenta being developed at C.S. Mott Children’s Hospital for the treatment of extreme prematurity.

Samantha Harrison, MPH

Research Associate

Sam joined CBSSM in November 2017. She works with Drs. Julie Wright, Michele Gornick, and Renuka Tipirneni on projects examining provider-patient communication regarding chronic kidney disease, VA data sharing, and the effect of Medicaid expansion on healthcare for low-SES aging adults.

Last Name: 
Harrison

CBSSM Faculty, Kayte Spector-Bagdady, Ray De Vries, and Lisa Harris, along with Lisa Low recently co-authored a Hastings Center Report article, "Stemming the Standard-of-Care Sprawl" about clinician self-interest and the case of electronic fetal monitoring.

Link to article here.

Research Topics: 

Joel Howell was honored by the American College of Physicians (ACP) at its annual convocation ceremony in April. Howell was named a new Master of the American College of Physicians for 2017-2018. Each year, a select group of these Fellows are chosen from among the nominees for Mastership by the ACP Awards Committee and approved by the ACP Board of Regents.

Sorry, Doc, that doesn't fit my schedule (Feb-04)

Patients sometimes skip treatments because they just feel too busy. What should physicians do when their patients ignore their recommendations?

Imagine you are a businessperson who works long hours and you are on your way up to having a successful and lucrative career. You have a major business deal that will consume nearly all of your time over the upcoming month and your boss is relying on you to make sure the deal goes through. This is your chance to really make your mark and show your corporation that you are the kind of person that can handle deals as big as this one. Also suppose you have been smoking on and off for 25 years. You know it's a bad habit that could destroy your lungs, but you just can't quite kick it. Lately, you have been feeling tired, you have been experiencing chest pains when you are really busy at work and when you exercise, and you have had trouble breathing when climbing a flight of stairs. The chest pains are usually relieved by a little rest, but you decide it's time to get this examined by a doctor.

One day after work, you go to see Dr. Coral, who gives you a stress test and determines that you'll need an appointment for an angiogram to better evaluate your coronary arteries. Fortunately, you find one free day right before things get hectic at work, so you schedule the angiogram. Now imagine you have just had the angiogram and you are recovering in a paper gown waiting for Dr. Coral to come back with the results. Dr. Coral enters the room to speak with you and he has a serious look on his face. He says,

"I have both good and bad news for you. The angiogram shows that your 3 main coronary arteries are all severely blocked. The good news is that we caught this before you had a major heart attack."

"The bad news is that I am recommending you have triple bypass surgery as soon as possible. Your heart is working overtime, and it is just a matter of time until it gives out."

The news is shocking, but in addition to your health concerns, you also have the business deal to worry about. This deal is an opportunity to make a name for yourself, and your boss has been very vocal that he was counting on you, trusting that you'd be the one for the job. You find yourself having to weigh your work ambitions against the recommendation from Dr. Coral because if you get surgery, there is no way you'd be able to take on your current work responsibility.
 
Which of the following decisions would you be most likely to make?
 
  • I would put aside Dr. Coral's recommendation and instead take responsibility at work for the current deal. I'll wait to have surgery in about a month.
  • I would follow Dr. Coral's recommendation by having surgery immediately, even though this forfeits the current opportunity at work.

A little feedback on what you chose.

It's not that physician's don't care about your other values, but they are primarily concerned about your health, and you might not even have lived long enough to finish the business deal if you didn't have this surgery immediately. This does, however, bring up an important fact: patient's do sometimes reject their physician's medical judgment, and it can be at a great cost to their health.
 
Why should a patient be part of the decision-making process?
 
Why shouldn't Dr. Coral just tell you that you need surgery and leave no alternative? Efforts to share decision-making with patients are important because they acknowledge patients' rights to hold views, to make choices, and to take actions based on personal values and beliefs. In addition to being ethically-sound, this shared decision-making process also leads to improved patient health outcomes.
 
What can a physician do to help the patient choose surgery?
 
To answer this question, first it needs to be emphasized that in order for a patient to be able to participate in the decision-making process, the patient must be able to soundly make decisions. This sounds abstract and subjective, but it can be broken down into something a little more concrete. Decision-making capacity (DMC) is based on four guidelines:
 
The patient is able to:
 
  • understand the information about the condition and the choices available;
  • make a judgment about the information in keeping with his or her personal values and beliefs;
  • understand the potential outcomes or consequences of different choices; and
  • freely communicate his or her wishes
Based on these four elements, it is possible to see what a physician can do to help facilitate a "good" health decision. In order to make sure a patient fully understands the situation, a physician can ask him or her to state their understanding of the problem and of the treatment options. Also, a physician should use clear and unambiguous language with the patient at all times. Although a report might be quite clear from a physician's perspective, a patient might not be as clear about all the details. In the situation you were asked to imagine, Dr. Coral should tell you that you will die without this surgery and that waiting is not a safe option.
Also, there might be other factors keeping a patient from following a physician's recommendation. Again, in your hypothetical situation, your boss was putting a lot of pressure on you not to let him down. Also, this decision would potentially have an effect on your advancement at work. You might not have felt free to elect surgery even if you knew it was the only good decision for your health. By directly acknowledging and addressing a patients' concerns, physicians may facilitate a decision for the surgery.
 
In conclusion, if a physician feels that a patient is not able to fulfill one or more of the elements of DMC then his or her ability to make that decision should be brought into question and surrogate decision makers should be sought. For more serious decisions, the standards for DMC should be higher than for less important decisions or those with less significant outcome differences among the choices.
 
For more information see:

 

Mon, June 11, 2018

A new study shows how to personalize the lung cancer screening decision for every patient. The results could help doctors fine-tune their advice to patients, so that it’s based not just on a patient’s individual lung cancer risk and the potential benefits and harms of screening, but also a likely range of patient attitudes about looking for problems and dealing with the consequences.

Published in the Annals of Internal Medicine, the study forms the backbone for new free online decision tools aimed at physicians and their teams, and at members of the public.

http://ihpi.umich.edu/news/scan-or-not-scan-research-shows-how-personali... tool for clinicians, called Lung Decision Precision, was designed by a University of Michigan and Veterans Affairs team to help clinicians talk with patients and their loved ones about whether to a lung CT scan might be a good idea for them.

The same team has also launched a website for patients and their loved ones, www.shouldiscreen.com, that gives easy-to-understand information about the positives and potential negatives of lung cancer screening, and allows individuals to calculate their personal risk of lung cancer.

Tanner Caverly, M.D., M.P.H., led the team that did the new computer-based simulation analysis using data from major studies of lung cancer screening, and national data on the potential screening population under the current guidelines.

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