Medical Professionalism in the New Millennium: A Physician Charter

September 1, 2007 at 11:27 am (Sarah's Posts)

One of my first med school classes assigned this article as reading, and I thought it was pretty darn interesting. It is a pretty visionary viewof the future role of the physician, but it does open up a lot of legal questions about the responsibility of medical professionals both legally and morally. Aside from the responsibilities of an individual physician to an individual patient, they put out that larger issues such as access to care and just distribution of resources are part of the responsibilities of today’s health care professionals.   I haven’t looked to see if there were any responses, but I’d be curious to see how people reacted to being included as stakeholders.

“To maintain the fidelity of medicine’s social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles
of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society.”

Medical Professionalism in the New Millennium: A Physician Charter

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HIV/AIDS documentary link

August 16, 2007 at 12:08 pm (Sarah's Posts)

I just finished watching what I thought was an excellent PBS documentary that follows the history of HIV/AIDS over the last 25 years.  It is 4 hours long, but is divided into sections so you can poke through and see what might be of interest.  If you do scope it out, I’d love to hear what you think.
http://www.pbs.org/wgbh/pages/frontline/aids/

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Thoughts on Michael’s post on “Hospital.”

July 26, 2007 at 1:40 pm (Uncategorized)

I know this is a blog on healthcare, but I think there’s a similar issue plaguing education.  Working at KIPP this year, I’m just realizing that sustainability is absolutely critical to any organization.  I’m finding more and more, that poor and underserved children simply need dedicated teachers who are willing to put in the long hours and make many sacrifices in their own lives.  There are certainly the inherent rewards of getting kids back on track and hopefully opening the doors to many opportunities, but is that enough?  I think your point on serving the poor in the medical world is facing a very similar predicament.  Can we rely on having people with great hearts and an undying dedication to serving the most needy, or do we need to figure out a way to recruit and retain people who otherwise would not strongly consider such direction in their vocations?  Maybe we need Charter Hospitals with private investors?  Can money go that far?  What’s the incentive?

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HPV Call to Action launched today in Nairobi

July 6, 2007 at 9:08 am (Alex's Posts)

Today at the International Women’s Summit in Nairobi, a coalition of 13 high-profile public health organizations launched a call to action for increased access to prevention and treatment of cervical cancer, particularly in the developing world.  To learn more, or sign on as a supporter of the call, you can go to www.cervicalcanceraction.org. Text of the call below.

 

The Global Call to Stop Cervical Cancer 

 

We believe the world has a historic opportunity to ensure that life-saving new technologies to prevent cervical cancer reach women and girls around the world without delay, because:

 

We are aware that cervical cancer, a disease caused by infection with some types of the human papillomavirus (HPV), affects half a million women globally every year.

We are concerned that, globally, more than a quarter of a million women die from cervical cancer every year.

We acknowledge that due to gross disparities between wealthy and poor countries in access to screening and treatment, more than 80% of the cases and deaths from cervical cancer occur in developing countries, making it the most common cancer-related cause of death for women in these countries.

We are encouraged by powerful new tools that have the potential to significantly reduce the burden of cervical cancer around the world, improve reproductive health, and save millions of women’s lives. These include new HPV vaccines that protect girls and young women against the high-risk types of HPV and new HPV screening technologies that are both more accurate and more appropriate for women in low-resource settings.

We recognize that only a comprehensive prevention strategy that pairs cervical cancer vaccination with screening and treatment programs will reverse the threat of cervical cancer to women and girls worldwide.

We know that extraordinary action will be required to give women and girls everywhere, particularly in developing countries, rapid access to these powerful, life-saving technologies.

Therefore, we call for the commitment and action necessary for women and girls around the world to have equal access to the highest quality prevention and treatment options for cervical cancer. Specifically, we call on:

  • Governments to prioritize cervical cancer in their national development and health programs and ensure that the necessary political and financial commitments are made and sustained.
  • Multilateral agencies to provide leadership and maximize their contribution to the necessary processes, including rapid prequalification, that will ensure widespread availability of HPV vaccines and other primary and secondary prevention technologies.
  • The international donor community and development partners to pledge the necessary financial resources so that these new technologies are made available to those who need them most.
  • Medical professionals to educate themselves and their patients about the life-saving innovations available.
  • Industry to provide adequate supplies of these new technologies at radically tiered prices.
  • Civil society to come together to build partnerships and catalyze global action.

 

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Summertime and the Livin is Easy

June 13, 2007 at 12:41 pm (Michael's Posts)

Hey folks
I’m going to be awol (some more) over the summer. Med school starts in the fall and I expect to get back on track with the blog then. I may post occasionally and all other contributors may post as well. I’m just headed out for a bit of a vacation.
Til then!

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Summertime and the Livin is Easy

June 13, 2007 at 12:41 pm (Uncategorized)

Hey folks
I’m going to be awol (some more) over the summer. Med school starts in the fall and I expect to get back on track with the blog then. I may post occasionally and all other contributors may post as well. I’m just headed out for a bit of a vacation.
Til then!

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The Pornography of Poverty

May 21, 2007 at 11:02 am (Links)

Check out this post on one of our tagged blogs, Technology, Health, and Development.

It raises an interesting point about how we see the impoverished parts of the world and reminds us that we might want to change that.

Also check this site out for some really insightful little video interviews on the subject.

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A System of Incentives?

May 21, 2007 at 1:42 am (Michael's Posts)

I’m reading this book Hospital by Sydney Lewis (as I mentioned previously) and it’s raising interesting questions. One of the things that came up today is how we get doctors to take care of poor people. The doctors’ testimonies in the book seem to indicate that the only way they got the system of care to work at County (at least in the 60s and 70s and 80s) was to employ a large number of interns and residents whose goal was to further their education by working at County. The idea was that if you could make it through County, you could make it anywhere. In the most sceptical light, it was a super resume boost. The overwhelming majority of them didn’t remain in practice at County and they didn’t remain in practice in the service of poor people, either. Now this may be the bias of the interviewed doctors (because they often did spend a lot of time there) but it also raises an interesting question: without plenty of money, how can you get quality people to provide care to poor people? What other incentives might draw people to these situations? Is the incentive of an education-in-the-trenches morally okay? I mean, are the people who are providing care in those circumstances doing so for the right reasons? Does that matter?

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Class Consciousness!

May 15, 2007 at 2:51 am (Michael's Posts)

Huh! What is it good for!

Well, I don’t know yet. However, I’m reading a book by Sydney Lewis about Cook County Hospital (It’s called Hospital. I added it to my book list post) and various people have brought up the issue of class.

Even though this book is about a hospital in Chicago, this question applies to all of the work that we have talked about in this forum. It’s an uncomfortable question (talking about money is never easy) but it is really necessary to address for all global health folks.

A lot of people have said that the issue of class in this public medicine mecca is always there. This may seem obvious, but it’s important (maybe?) to remember. The interns are mostly from the middle or upper class and surely the doctors are mostly from a similar background. Class awareness plays a prominent role in the questioning of new interns, according to one attending physician who discussed the important questions for candidates for residency. He wants people to at least be honest and aware of the fact that there is a huge gulf between provider and patient.

Some of the time the question of race division is raised and people choose to rephrase it as a matter of class. I think that in America the two are linked deeply, if not inexorably. So we must address both and we ought to understand that they ought to be addressed together. Or must we? In my experience, it’s been a mixed bag as far as what works the best as an approach to these issues. However, I have been finding (and other race-conscious white folks I know find this as well) that if you look through all that stuff and simply be in contact with the humanity of the person you’re talking to, it works pretty well. But does this mean ignoring the differences? Does it mean discounting them?

As far as provider-provider divisions are concerned, it seems that the bottom line for the black people I have read interviews from is whether or not the white intern or doctor or fellow nurse has a funky attitude or not. I find this to be true in my own experience as a volunteer.  However, I have witnessed otherwise and I’ve talked to some of the attendings I work with now about a racial division in the clinic. They have said it’s alive and well and troublesome.

Are these divisions important to recognize? Well, doctors from well-to-do backgrounds can think that a patient’s inability to rustle up bus fare or find a caretaker for a child are poor excuses for missing a clinic appointment. In reality, these are life truths for the patient that appear as very real barriers to getting care. According to some of the health workers interviewed in the book, poor people complain about discomfort less than the more well-off. This might contribute to a tendency to report feeling “fine” when they are in pain, which in turn can make it hard to know if a medicine is working or appropriately dosed. In these cases, a class awareness contributes to respecting and working with a patient’s life difficulties instead of getting impatient with them for missed appointments.  It also helps a doctor think about how to ask better questions of their patients so as to get the best information from them.

I have also been reading that people are people are people and that we should treat everyone like a human being.  With equal compassion and care, is all this discussion of class really all that important?  That sounds flip, but if we really think about it, what part of the class discussion do we need and what part do we not need?

I’ll probably post on this more as I read and think.  Please comment!!

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Advocates Wanted

May 7, 2007 at 1:22 am (Michael's Posts)

I hope to never be at a party as sad as the one I attended at Cook County a couple weeks ago. The medicine Division Head was there as was the director of the clinic I work in. As were most of the doctors who were in clinic that day. As were a few of the doctors and nurses who were being fired.

As I have mentioned before, Cook County (Chicago and a few of its surrounding suburbs) is downsizing its health operations. What this means is the county is over-budget and they’re cutting jobs to bring balance to the fiscal situation. Never before, however, have the doctors who sacrifice more lucrative practices to treat needy patients had their positions in the county in danger. Many doctors and nurses were sent pink slips this spring and many more will recieve sad mail in the fall.

The really awful part about this method of budget-balancing is that it occurs not on the backs of the doctors (it’s hard to be unemployed for a very long time as a doctor. At least as far as I can tell). I’m not worried about these people, at least. They are compassionate, wonderful doctors and will find gainful (and most probably much more lucrative) work elsewhere. The sad part of this story is the people who they serve will continue to see the little bit of assistance they recieve from the county dribble away.

Richard J Daley and his cronies have screwed the poor people in this city over and again and they always get away with it. This is the same attitude that saw the destruction of public housing along with exuses that were was no money in the budget to rebuild. However, there’s money to build an olympic village, apparently (we’re the US bid for the 2016 games) and money to go forward with the beautifucation of downtown (everyone who visits here says that it’s a very beautiful city. Well, it is. The part of it you’ve seen, at least.) They’re doing it again and getting away with it again. How? How can the county government cut services to thousands of people and not have some kind of backlash?

This is an important topic to discuss as the questions of “Global health” hinge greatly on the willingness of governments to help the disenfranchised. Chicago’s government is doing, well, a piss-poor job of standing up for the destitute in its boundaries. Why? Whose job is it to stand up for them if the state won’t? How can we make them change their minds?

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