Michele Heisler, MD, MPA, is Professor of Internal Medicine at the University of Michigan Medical School, Professor, School of Public Health, and Research Scientist at the Ann Arbor VA's Center for Clinical Research Management. Dr. Heisler's clinical interest is chronic disease, with a focus on diabetes. Her research centers on patient self-management of chronic illnesses, patient-doctor relations and disparities in processes and outcomes in chronic illnesses.
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Reshma Jagsi, MD, DPhil, is Professor, Deputy Chair, and Residency Program Director in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.
She graduated first in her class from Harvard College and then pursued her medical training at Harvard Medical School. She also served as a fellow in the Center for Ethics at Harvard University and completed her doctorate in Social Policy at Oxford University as a Marshall Scholar.
Scott Grant, MD, MBE, University of Chicago: "Dealing with complications and poor outcomes and surgical futility"
Scott Grant, MD, MBE, University of Chicago
Abstract: Surgical complications are ubiquitous and effect all surgeons. This talk will review how surgical ethics is distinct from traditional medical ethics in that surgeons have a greater and more direct responsibility for the outcomes of their patients than medical doctors. It will review how surgery harms before healing and the importance of weighing risks and benefits in decision making. Ways of assessing perioperative risk and preventing complications will be reviewed. Strategies for coping with complications will be described. Human error theory and the "Swiss cheese" model of human error will briefly be discussed. The SPIKES protocol for breaking bad news will be reviewed. Different deﬁnitions of futility will be described. Various procedural approaches to futility disputes will be analyzed. The best tool in approaching challenging "futility" situations will be described - open and honest communication between the patient or surrogate and the physician.
Michele Gornick/ Tolu Olorode will be seeking feedback on a draft of our survey for a project “Eliciting Veterans’ perspectives on informed consent processes for sharing big data”
Kayte Spector-Bagdady is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and is also the Chief of the Research Ethics Service in the Center for Bioethics and Social Sciences in Medicine (CBSSM). At UM she also serves as Chair of the Research Ethics Committee, a clinical ethicist through CBSSM’s Clinical Ethics Service, and a member of IRB Council.
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 a Clinical Associate 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).
Tell us what you think about certain public policies designed to reduce the incidence of diabetes in the US.
Please read this hypothetical news article and then answer a few questions at the end.
People with Diabetes Lobby Congress This Week
- strongly disagree
- strongly agree
- strongly disagree
- strongly agree
- strongly disagree
- strongly agree
Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or what?
- Strong Democrat
- Not so strong Democrat
- Independent, close to Democrat
- Independent, close to Republican
- Not so strong Republican
- Strong Republican
- Don't know, haven't thought much about it
How you answered:
Researchers affiliated with CBDSM and the School of Public Health have found that "Americans' opinions about health policy are polarized on political partisan lines. Democrats and Republicans differ in the ways that they receive and react to messages about the social determinants of health."
In the study, lead author Sarah Gollust, PhD, randomly assigned participants to read one of four hypothetical news articles about type 2 diabetes. Diabetes was used as an example of a common health issue that is widely debated and that is known to have multiple contributing factors, including genetic predisposition, behavioral choices, and social determinants (such as income or neighborhood environments).
The articles were identical except for the causal frame embedded in the text. The article that you read in this Decision of the Month presented social determinants as a cause for type 2 diabetes. Other versions of the article presented genetic predisposition or behavioral choices as a cause for type 2 diabetes, and one version had no causal language.
Dr. Gollust then asked the study participants their views of seven nonmedical governmental policies related to the environmental, neighborhood, or economic determinants of diabetes:
- bans on fast food concessions in public schools
- incentives for grocery stores to establish locations where there are currently few
- bans on trans fat in restaurants
- government investment in parks
- regulating junk food advertisements
- imposing taxes on junk foods
- subsidizing the costs of healthy food
Dr. Gollust also asked participants their political party identification and a number of other self-reported characteristics.
The most dramatic finding of this study was that the news story with the social determinants as a cause for type 2 diabetes had significantly different effects on the policy views of participants, depending on whether they identified themselves as Democrats or Republicans. After reading the social determinants article, Democrats expressed a higher level of support for the proposed public health policies. Republicans expressed a lower level of support for the proposed public health policies. This effect occurred only in the group of participants who were randomly assigned to read the version of the news article with social determinants given as a cause for type 2 diabetes. Dr. Gollust summarizes: "Exposure to the social determinants message produced a divergence of opinion by political party, with Democrats and Republicans differing in their opinions by nearly 0.5 units of the 5-point scale."
The study suggests several possible explanations for these results:
"First, the social determinants media frame may have presumed a liberal worldview to which the Republican study participants disagreed or found factually erroneous (ie, not credible), but with which Democrats felt more comfortable or found more familiar. . . Second, media consumption is becoming increasingly polarized by party identification, and . . . the social determinants message may have appeared particularly biased to Republicans. . .Third, the social determinants frame may have primed, or activated, study participants' underlying attitudes about the social group highlighted in the news article. . . Fourth, participants' party identification likely serves as proxy for . . . values held regarding personal versus social responsibility for health."
Dr. Gollust and her colleagues conclude that if public health advocates want to mobilize the American public to support certain health policies, a segmented communication approach may be needed. Some subgroups of Americans will not find a message about social determinants credible. These subgroups value personal responsibility and find social determinants antagonistic to their worldview. To avoid triggering immediate resistance by these citizens to information about social determinants of health, public health advocates may consider the use of information about individual behavioral factors in educational materials, while working to build public familiarity with and acceptance of research data on social determinants.
For more details about this study: