AMA Journal of Ethics Podcast

Often, when we visit our doctor, we simply want to know, "What is it? What is the name of the ailment that is causing me to feel this way? Do my symptoms add up to something that can be recognized with a single label? And what will that label mean?" Very often, the diagnosis we get affects the course of our lives. This month, Virtual Mentor spoke with Dr. Catherine Belling, associate professor of medical humanities and bioethics at Northwestern University Feinberg School of Medicine, about the power of diagnosis and how it can change the way we view ourselves, others, and the world around us.

We hear a lot about health care reform from the perspective of physicians who are already members of the medical establishment—whether they are for health care reform, or against it. But what about new and future doctors who will enter medicine during this dynamic period of change and restructuring? This month Virtual Mentor spoke with Dr. Alex Ding, a resident physician in the department of radiology at Massachusetts General Hospital, and Mr. Jordan VanLare, a fourth-year medical student at Columbia University College of Physicians and Surgeons, about their impressions of health reform and how it will impact the medical practice environment they will soon enter.

Since the 2008 election, health care reform has been one of the key issues dominating political and civil discourse throughout the country. Recently the debates around health reform have only intensified as looming cuts threaten to reduce physician Medicare by nearly 30%. This month, Virtual Mentor spoke with Dr. Peter W. Carmel, President of the Board of Trustees of the American Medical Association (AMA), to discuss health reform and, specifically, why the AMA supports the full repeal of the formula used to calculate Medicare payments to physicians.

Some say little has improved in the 12 years since the Institute of Medicine drew the nation’s attention to the unacceptable number of “adverse unexpected events”—read “errors”—in U.S. hospitals. Virtual Mentor spoke with Dr. David Classen, associate professor of medicine at the University of Utah, about the current state of patient safety in the United States. Dr Classen discussed the goals and challenges of improving patient safety in inpatient and ambulatory settings and how health care reform will impact future efforts to improve patient safety.

One initiative in the system wide, concerted effort to bring medical errors under control has been the development of patient safety training and educational programs for nurses, physicians, and other health professionals. Virtual Mentor spoke with Patricia Sokol, RN, JD, senior policy analyst at the American Medical Association, about the growing number of institutions that offer graduate training for health professionals in patient safety science and how these programs are critical to establishing a safer overall health care system.

Over the past several years Health Information Technology, or Health IT, has been one of the fastest growing segments in the health care marketplace. While much of this growth has focused in health informatics, particularly the widespread adoption of electronic health records, telemedicine has also become an increasingly important means for improving the quality of clinical care. According to the American Telemedicine Association, "Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status." The promise of telemedicine is that it will improve the delivery and efficiency of healthcare services. This month Virtual Mentor spoke with Dr. Emeka Okafor, Assistant Professor of Emergency Medicine at the University of Texas Medical School at Houston, about the benefits of, and barriers to, telemedicine, and what can be done to help regulate this growing industry.

In advance directives, we tell our physicians and surrogate decision makers what types of care we want--and don't want--when we can no longer make decisions for ourselves. But research consistently shows a gap between patients' preferences for end-of-life care and what their surrogate decision makers think those patients want. Neuroscience and, more specifically, a specific form brain imaging -- fMRI -- may be able to help close that gap. By imaging a person's brain while he or she is making a decision, researchers can tell which part of the brain is being brought to the specific decision-making task. Such findings have shown that the part of the brain that becomes active when a research subject is making decisions based on purely personal preference is different from the part that becomes active when the subject is making socially or morally guided decisions. Instructing a surrogate to make one's end-of-life decisions should be a social, morally guided decision, not a purely personal one. So perhaps posing end-of-life care questions in a social, moral frame rather than a purely personal frame will elicit care decisions from patients that align more closely with decisions their surrogates would make.

Interview with AMA Vice President Saul Levin about the effect of Don't Ask, Don't Tell on physicians and why the AMA supports of repeal of the controversial 1993 Act.

Over the past decade there have been numerous stories about overcrowded ERs. One way many communities addressed such overcrowding was to divert ambulances away from overcrowded hospitals to less busy ones that had available room and resources to treat patients. In Jan 2009, Massachusetts became first state to successfully ban the practice of ambulance diversion. Virtual Mentor spoke with Dr. Stephen Epstein of Harvard Medical School about the Massachusetts ban and what other communites can learn from one state's experience.

Cosmetic surgery is a hotly debated issue in our society. Is it a consumer good or a medical procedure? Should elective procedures be taxed? Does plastic surgery promote oppressive norms of beauty? Virtual Mentor asked six "people on the street" in Chicago for their views about the personal and social effects of elective cosmetic surgery.

Despite the fact that the majority of Americans are now medically defined as overweight, stigma against individuals who are obese remains a widespread phenomenon. Virtual Mentor asked Dr. Rebecca Puhl, Director of Research and Anti-Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University to comment on the prevalence in our society and in health care and what can be to help ameliorate it.

Some physicians believe that knowing about patients' religious and spiritual beliefs helps them care for the whole person. There is even evidence that patients who are part of faith traditions and attend services regularly are healthier. Other physicians believe medicine and religion should be kept separate, and encourage their patients to talk to a chaplain for spiritual support in times of suffering. This interview with a physician-theologian, medical student, and patient explores a range of perspectives on what has become a hotly debated topic. To read more about the role of spirituality in patient care, see the October 2009 issue of Virtual Mentor at www.journalofethics.org

For somewhere between $200 and $2,000, curious individuals can sign up with an Internet service, send in a drop of saliva or some cheek cells and receive a report on their ancestry and their predisposition to a number of medical conditions from type 2 diabetes to baldness or back pain. "Ethics Talk" interviewed two people who used the online service for very different reasons. To read more about genetic testing and information, see the September 2009 issue of Virtual Mentor at www.journalofethics.org.

Fewer medical students are selecting primary care specialties such as family medicine and pediatrics, a trend which could cause a shortage in the types of physicians society needs most. Two medical students explain the reasons for their choices of specialty and comment on possible reasons for the trend.

Today&s patients are better informed about possible causes and treatments for their symptoms than ever before. A physician works through a challenging encounter with a patient who comes to her office demanding a particular brand name drug and will accept nothing less--or so it seems at first.