The System Under Stress: Testing the Physician-Patient Relationship

By Sagar Patel, MD; Arush Singh, MD; and Sachin H. Jain, MD

Authors’ Note: This piece focuses on the VA Health Care System.  Thousands of medical students and residents rotate to the VA and as such it is one of the largest federal training opportunities for new doctors.

The first years of medical school incorporate a longitudinal curriculum devoted to the physician-patient relationship. Through early clinical encounters, medical students begin to understand and appreciate the uniquely intimate relationship between physicians, patients, and their families.  Three weeks into our rotation together at the Boston VA Medical Center, our assumptions about the physician-patient relationship were tested.

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People, Not Just Institutions, Can Be Hubs of Innovation

socialized_medicineBy Jennifer J. Salopek

Kieran Murphy, MD, is an interventional radiologist at the University of Toronto who holds 62 patents; the devices he invented or improved are used more than 62,000 times per year. Murphy, who believes that interventional radiology attracts inventive people, is interested in the genesis of innovation and how it can be diffused. His research has led him to conclude that people, as well as places, can be innovation hubs. He has also demonstrated that social networks are not only evidence but drivers of innovation.

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Posted in Health Care Innovation, Leadership, Medical Education, Socialized Medicine | Leave a comment

Health Wonk Review: Polar Vortex Edition, July 2014

Okay, so the vaunted summer polar vortex didn’t exactly bring the expected plummeting temperatures this week, but at least the oppressive humidity is lessened. Along with that refreshing change, some fresh thoughts from our Health Wonkers:

Over at InsureBlog, Henry Stern, LUTCF, CBC, kicks things off with a post on “SexistCare.” Stern reveals that the ACA mandates a whole raft of benefits specifically for women and children, but none for men. He wonders why mammograms are covered as preventive care, for example, but there are no corresponding provisions for prostate cancer screening. “Where’s the hue and cry?” he asks.

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Trustees Can Improve Diversity Stewardship in Higher Education

By Marc A. Nivet and Anne C. Berlin

Originally posted June 5, 2014

Often the discourse on the role of boards in diversity leadership begins and ends with board composition. This is still an important cause, as it brings broad perspective and signals inclusiveness from the top down, among other net positives. But, a board’s diversity charge should go beyond composition.

Diversity is increasingly embraced as a strategic imperative and driver of institutional excellence, and as a means for competitive differentiation in a crowded market, especially when it comes to attracting top students, faculty and staff.

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Tackling Misperceptions About Med Student Debt

By Julie Fresne

I read with interest the recent Wing of Zock posting, “It’s Time for Innovation in How We Pay for Medical School.” While I’m encouraged that this post addressed the important topic of medical education cost and debt, it’s unfortunate that it reinforces misperceptions that exist about education debt and repayment.

While many claim that debt leads medical students to choose more lucrative specialties, AAMC research indicates that debt does not play a determining role in specialty choice for most students. The report, “Physician Education Debt and the Cost to Attend Medical School,” includes a section outlining evidence on the “minor role of debt in specialty choice.” Studies show that specialty choice is a complex and personal decision involving many factors. Some students with high debt do in fact choose primary care and AAMC data suggests that there is no systematic bias away from primary care specialties by graduates with higher debt levels. In addition, an Academic Medicine article co-authored by AAMC staff concluded, “A primary care career remains financially viable for medical school graduates with median levels of education debt,” after rigorously analyzing the household finances of a typical physician repaying education debt.

Finally, the post fails to mention that the new income-driven repayment plans for federal loans make repayment affordable for all indebted medical students, regardless of their specialty or debt level. These plans, such as “Pay As You Earn,” link payments to income, not debt levels, providing all indebted students, not just those seeking a public service career, with a manageable monthly payment and potential forgiveness options.

I appreciate discussion of this important topic on Wing of Zock and hope that these posts stimulate useful conversation. I also hope that some of the evidence cited here offers encouragement for those considering a career in medicine who may be deterred by misperceptions about medical student debt. The AAMC has a wealth of useful resources for those aspiring to a medical career, including Aspiring Docs for inspiration, FIRST for financial information, Careers in Medicine for specialty choice help, and the Fee Assistance Program for financial support in taking the MCAT and applying to medical school.


Julie Fresne is director of student financial services for the Association of American Medical Colleges in Washington, DC. She can be reached at

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From “Patient-Centered” to “Relationship-Centered” Care at Cleveland Clinic

In the June 2014 issue of Harvard Business Review, Cleveland Clinic CEO Toby Cosgrove and co-author Thomas H. Lee wrote that, to engage doctors in the health care revolution, we must start with their relationship with patients. “[G]et physicians thinking about what kind of care makes them ashamed or proud,” they write. A unique new course helps prepare Cleveland Clinic docs to move from “patient-centered” to “relationship-centered” care; the one-day program is now required for all Cleveland Clinic staff. The program is peer-facilitated and features skills practice via role plays and experiential reinforcement of the learning. Wing of Zock Founding Editor Jennifer Salopek recently sat down with Sumita Khatri, MD, to learn more about the course, which was honored in the AAMC’s Clinical Care Innovation Challenge. An abstract of the project can be found here.

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Physician Filmmaker Documents One of America’s Busiest ERs in Code Black

By Sarah Sonies

There are few places of such constant drama and excitement as a hospital emergency room. Crowded with patients awaiting urgent care, Los Angeles County Hospital’s ER is one of the busiest.

Code Black, a documentary directed by ER doc and first-time filmmaker Ryan McGarry, MD, highlights the physicians fighting to save lives in one of the largest public hospitals in the country. Continue reading

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Wing of Zock “Chart Review” Blog Carnival, July 2014 Edition

By Sarah Sonies

chart_review (2)Summer has (finally!) arrived and this Chart Review is a scorcher.

Baltimore to Beijing: Adventures in Global Health Careexplores academic medicine’s commitment to community health at home and abroad in a profile of partner institution Fundación Santa Fe de Bogotá, a medical school and health system in Colombia. The institution practices what they have dubbed “communitarianism,” providing useful services to the public and shaping community through health services and research in underserved areas of Bogota and surrounding areas. The post draws parallels North American academic health centers’ “triple mission.”

The Doctor’s Tablet features commentary on a novel clinical study the University of Pittsburgh Medical Center and other collaborating institutions recently completed. In the study, the blood of severely injured trauma patients was drained and injected with salt water to provide needed time for the surgeons to administer lifesaving procedures. The blood was restored to the patients after treatment. The study itself is compelling, and the trial also raises some key issues in bioethics: primarily, when it might be acceptable to conduct research without the consent of the research subject? The post includes a list of guidelines and regulations for researchers and clinicians. Continue reading

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