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Is it disgusting? (May-08)

People vary in their attitudes toward physical disabilities. Give us your reactions, and we'll tell you the results of surveys of the general public--and of actual patients.

 

Strongly

disagree

Mildly

disagree

Mildly

agree

Strongly

agree

I try to avoid letting any part of my body touch the toilet seat in a public restroom, even when it appears clean.

1

2

3

4

It would make me uncomfortable to hear a couple making love in the next room of a hotel.

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3

4

It would bother me tremendously to touch a dead body.

1

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3

4

Even if I were hungry, I would not eat a bowl of my favorite soup if it had been stirred by a used-but thoroughly washed- fly-swatter

1

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4

I am bothered by the odor caused by passing gas.

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The smell of other persons' bowel movements disgusts me.

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4

Consider the following

Now we'd like you to think about a specific health condition. Please read this scenario carefully so that you can answer some questions. Imagine you have a colostomy. A colostomy is an operation involving the surgical redirection of your bowels through a hole created in your gut. This hole is called a stoma. Waste passes through your intestines and out the stoma into a bag, which you must empty several times a day. If you wear relatively loose clothing, this bag won't be visible underneath your garments. Occasionally, you'll experience odors and noises caused by gas and waste passing through the stoma into the bag. There's also the chance that the colostomy bag may leak if it's allowed to fill past capacity. Although you'll be restricted from lifting very heavy objects, your daily activities won't otherwise be greatly affected by the colostomy.

To what extent does your colostomy make you feel embarrassed or socially uncomfortable?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 
To what extent does your colostomy make you feel stigmatized?
Not at all 1       2       3       4       5       6       7       8       9        10 Very Much
 

How do your answers compare?

Do your responses to the six questions on the disgust scale correlate with the stigmatization you expressed related to your imaginary colostomy?

In their national survey of the general public (people without colostomies), CBDSM researchers found that people who reported a higher level of disgust sensitivity responded more negatively to colostomy.

Current and former colostomy patients were also surveyed. In these groups, patients with higher disgust sensitivity had more difficulty adjusting to life with a colostomy. Specifically,colostomy patients with higher disgust sensitivity felt more stigmatized in society by their colostomy and felt more bothered by colostomy symptoms, such as leakage. Dr. Dylan Smith and his colleagues postulate that people who have a pre-existing high sensitivity to disgusting stimuli will be less likely to adjust well to life with a colostomy. Alternatively, it could be that people who adjust successfully to a colostomy do so in part by reducing their sensitivity to certain kinds of disgusting stimuli.

If future studies show that we can predict that patients with high disgust sensitivity are likely to have more difficulty adjusting to a colostomy, health-care teams can then seek ways to de-sensitize responses to bowel functioning, in order to aid patients in their adaptation to life with a colostomy. Further, many people with inflammatory bowel syndrome can choose whether or not to have a colostomy for relief of their symptoms. For these patients, a clear understanding of disgust sensitivity could be a factor in helping to make an informed choice about elective colostomy.

Certainly this research suggests that disgust plays a role in perceived and actual stigmatization of disabled patients. Previous studies of patients' adjustment to disability have focused on general responses to adversity, taking into account their social support, their coping style, or their optimism, for example. The uniqueness of this recent CBDSM study is that it considers how the specific challenges of a disability interact with a personality trait relevant to that disability: disgust sensitivity. This personality trait might also be linked to other health conditions, such as amputation or incontinence. In addition, personality traits other than disgust might affect patients' adaptation to other disabilities.

Read the article:

Sensitivity to disgust, stigma, and adjustment to life with a colostomy
Smith DM, Loewenstein G, Rozin P, Sherriff RL, Ubel PA. Journal of Research in Personality 2007;41(4):787–803.

The Disgust Scale used here is adapted from the work of Haidt J, McCauley C, Rozin P. Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences. 1994; 16(5): 701-713.

 

Wed, February 03, 2016

Beth Tarini, MD, MS and colleagues are back in the news regarding their 2013 article in Pediatrics entitled, “Blindness in Walnut Grove: How Did Mary Ingalls Lose Her Sight?” Their article was cited in CNNCBS NewsNew York TimesAnnarbor.com and many others. 

Citation: Allexan SS,  Byington CL, Finkelstein JI, Tarini  BA (2013 ). "Blindness in Walnut Grove: How Did Mary Ingalls Lose Her Sight?" Pediatrics; DOI: 10.1542/peds.2012-1438 [Epub ahead of print]

Research Topics: 

Michael Volk, MSc, MD

Alumni

Michael Volk was an Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the University of Michigan. His clinical practice focuses on the care of patients with liver disease, including those undergoing liver transplantation and those with hepatocellular carcinoma. His research interests focus on the ethics of resource allocation, patient and physician decision making, and chronic disease management. In particular, he has conducted a series of studies designed to improve the way decisions are made about using high risk liver transplant organs.

Last Name: 
Volk

Megan Knaus, MPH

Research Associate

Megan joined CBSSM in 2014 and has worked on multiple grant funded research projects related to health communication, patient-provider decision making, and health interventions driven by behavioral economics. She currently works with Dr. Brian Zikmund-Fisher on a National Science Foundation grant testing infectious disease communication strategies.

Last Name: 
Knaus

Geoffrey Barnes has been selected as one of 12 IHPI junior faculty members to serve on the Junior Faculty Advisory Council (JFAC) to advocate for junior faculty professional development programs and activities within IHPI, and to provide perspective and feedback on issues and opportunities identified and brought to the JFAC by the Institute Leadership Team.

Mon, January 06, 2014

Dr. Reshma Jagsi worked on a study detailing the decline of US research spending versus the increase in spending in Japan and China. In the UMHS article, she says, "The United States has long been a world leader in driving research and development in the biomedical science. It's important to maintain that leadership role because biomedical research has a number of long term downstream economic benefits, especially around job creation," 

Research Topics: 

Dr. Jason Karlawish, Professor of Medicine and Medical Ethics at the University of Pennsylvania, will discuss his forthcoming novel, "Open Wound: The Tragic Obsession of Dr. William Beaumont" on Thursday, October 20, 3-5 pm, at the Biomedical Research Science Building (BSRB), Room 1130.  "Open Wound" is a fictional account of true events along the early 19th century American frontier, tracing the relationship between Dr. William Beaumont and his illiterate French Canadian patient.  The young trapper sustains an injury that never heals, leaving a hole in his stomach that the curious doctor uses as a window both to understand the mysteries of digestion and to advance his career.  A reception will follow the talk, and books will be available for purchase on site from Nicola's Books.  The event is co-sponsored by the Center for Bioethics and Social Sciences in Medicine, the Center for the History of Medicine, and the University of Michigan Press.  Click here for more information about the book. 

CBSSM Seminar: Rana Awdish, MD

Thu, February 15, 2018, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Dr. Rana Awdish is the author of In Shock, a memoir based on her own critical illness. She is also Director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit and a practicing Critical Care Physician. She lectures to physicians, health care leaders and medical schools across the country on the necessity of compassionate care. She was recently named Medical Director of Care Experience for the Health System.

In Shock will describe Dr. Awdish's personal transformation from critical care physician to critically ill patient and describe how the events surrounding her near death changed her understanding of the culture of medicine and lead her to alter the course of her institution. Focusing on Physician communication training, narrative medicine and visual thinking strategies, and a culture of caring, she will illuminate the path towards creating a more resilient culture for everyone involved in health care.

 Objectives:

1. Describe the ecosystem of medical training and practice and the way it compromises empathy and compassion.

2. Illustrate how medical humanities and a purpose driven culture can be used to promote a culture of resilience.

3. Recognize the barriers to implementing institutional change and empowering individuals.

4. Identify practices that will engage providers and leaders in promoting development of resilient systems.

Rana Awdish, MD
Director, Pulmonary Hypertension Program, Henry Ford Hospital, and Medical Director, Care Experience, Henry Ford Health System, Detroit, MI

Dr. Rana Awdish is the Director of the Pulmonary Hypertension Program at Henry Ford Hospital in Detroit and a Critical Care Physician. She also serves as Medical Director of Care Experience for the Henry Ford Health System. Dr. Awdish’s mandate as well as her passion is to improve the patient experience across the system. 

After suffering a sudden critical illness herself in 2008, she has become a tireless activist, refocusing her fellow providers on the patient experience and improving empathy through connection and communication. She lectures to physicians, hospital leadership and medical schools around the country. Her book, In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope, has been featured in the Washington Post, NPR, The Today Show, The Times Literary Supplement, and is now an LA Times Bestseller.

Dr. Awdish received the Schwartz Center’s National Compassionate Caregiver of the Year Award in 2017. She was named Physician of the Year by Press Ganey in 2017 for her work on improving communication, and received the Critical Care Teaching Award in 2016. She, along with three others, began the CLEAR Conversations Project at Henry Ford, using improvisational actors to train physicians in patient-centered empathic communication. 

Prior to coming to Henry Ford, Dr. Awdish completed her training at Mount Sinai Beth Israel in Manhattan. She attended Wayne State University Medical School, and completed her undergraduate degree at the University of Michigan in Ann Arbor. She is board-certified in Internal Medicine, Pulmonary and Critical Care Medicine.

Maria Silveira, MD, MPH, is the lead author on an article in the New England Journal of Medicine (April 1, 2010) on end-of-life decision making. Silveira and her colleagues found in a large-scale study that more than a quarter of the elderly lacked decision-making capacity as they approached death. Those who had advance directives were very likely to get the care that they wanted. Co-authors on the study are Kenneth Langa, MD, PhD, and Scott Y.H. Kim, MD, PhD. Read a press release about the article here.

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