Category Archives: History

Introduction to Health Equity

1. Read:  Read the first 3.5 pages of this article “The Many Roads Towards Achieving Health Equity

GOAL: Introduce key terms and reviews the history of health equity briefly

This article helps to build a broad overview of health equity, it’s evolution, and pertinent terms that will be discussed in class.  The remainder of the article references areas of further reading for interested students.

 

 

Socialization and Implicit Bias

1. REVIEW the following terms from the EHM Lexicon. Identity, Implicit Bias, Cultural Competency and Narrative Humility.

GOAL: Familiarize yourself with terms and definitions that will be discussed during the session

2. WATCH: Socialization: Crash Course Sociology #14

GOAL: Discover the basic tenants of socialization

3. READ: Professional Socialization in Medicine

GOAL: Learn ways that medical professionals are socialized in their training

Read this opinion piece about the ways in which we are socialized in medicine.

4. READ: Implicit Bias in Healthcare Professionals

GOAL: Gain an appreciation of how implicit bias can lead to direct and indirect consequences in patient care.

Read the systematic review and focus on the sections of “Background” (2-3) and “Existence of Implicit Biases/Stereotypes…” (13-14).

OPTIONAL:

1. READ: the last sections from Implicit Bias in Healthcare Professionals, “Checking Perception” and “Getting Competent” to refresh your memory

GOAL: Learn basic first steps for recognizing bias in your communication and interaction with others.

2. READ:this article that covers the importance concept of narrative humility

GOAL: Reflect on how narrative humility can improve our experience with patients

Introduction to Healthcare Systems

Review:

Review the fact sheet that includes fundamental information about healthcare financing.

Fact Sheet on Healthcare Financing and Reform

Watch:

Search the Khan Academy website (khanacademy.org) and create a log-in. Locate the “Health Care System” modules.  To do this, first select the “Science” category, then “Health and Medicine”, then “Health Care System”.  All students should arrive to class capable of quickly accessing the Khan Academy website.

View Khan Academy Modules as necessary. Three Khan academy modules are listed below.  The content of these modules is summarized.  Students with background knowledge in the listed content and fact sheet content are NOT required to view the modules.  The modules are a supplementary assignment and should be completed  based on student background and understanding of the US healthcare system and payment systems.  Note: students may need to access Khan Academy modules for small group work during the breakout session.

Module 1: Health care system overview (8 minutes)

Explains how patients/populations, providers, and payors interact.  Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs.  Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.

Module 2: Paying doctors (12 minutes)

Defines FFS, capitation and salary.  Describes the lack of cost accountability to patients and providers in the third party payor system.  Describes issues with capitation with particular attention on “cherry picking” or patient shifting.

Module 3: Medicare overview  (16 minutes)

Introduces Medicare and Medicaid.  Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid).  Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services).  Describes Medicare parts A-D.

 

History of Medicine as a Profession

ABIM Medical Professionalism: A Physician Charter

This document reviews the importance of professionalism is the basis of medicine’s contract with society and that understanding the principles and responsibilities of medical professionalism is key to physicians social contract with society.

Why Does Professionalism Matter? : Trust, Transparency and Accountability

This video (3:34) shows senior physicians from around the country exploring why professionalism is integral to physicians maintaining trust with patients. It stresses that trust and accountability are key focuses to continue to keep at the center of physicians practice. At 1 minutes 30 seconds, the provider talks about how at times there will be conflict when there are competing needs but that it is important to embrace and face the conflict to better understand it.

Association Between Physician Burnout and Identification With Medicine as a Calling

This research paper seeks to evaluate the association between degree of professional burnout and physicians’ sense of calling. Study identifies that physicians who experience more burnout are less likely to identify with medicine as a calling. It implies that loss of the sense of medicine as a calling may have adverse consequences for physicians and patients

 

 

 

The Bell Curve

Many of you are familiar with Atul Gwande and his writings.  We will refer to The Bell Curve, What happens when patients find out how good their doctors really are? by Dr. Gwande many times in EHM.  This article emphasizes many aspects of the course.  Some of the major themes are health systems improvements, social determinants of health, inter professional education, communication, professionalism and ethics.

Click the link to download The Bell Curve highlighted for this reading.

We have highlighted the passages with in the reading that are directly related to this session.

  • What did you find surprising about this article?
  • How did you feel when you read about the initial appointment Honor and Don Page had with the team at Cincinnati Children’s Hospital?
  • What did you think about the appointment Alyssa had with Cori Danes?
  • Compare and contrast that with Janelle’s appointment with Dr. Warwick at Fairview-University Children’s Hospital in Minneapolis.
  • Write down some different strategies employed by both care teams.  Are there other strategies you might have employed when communicating with these two patients?
  • Did this article make you rethink your understanding of ‘non-adherence’?  If so, how?