Tag: physical examination

Bioethics Blogs

NIH Family Members Giving Back: Rebecca Shlafer

Rebecca Shlafer/Credit: Brady Willette

When Rebecca Shlafer clicks on her office lights each morning at the University of Minnesota Medical Center, Minneapolis, she usually has a good idea of what to expect from the day ahead as lead of a nine-person research team that studies the effects of incarceration on children and families. It’s her volunteer work that can be unpredictable.

For the past eight years, this developmental child psychologist has donated her free time to serve as a guardian ad litem for abused or neglected children who’ve been removed from their homes and placed under protective supervision of Minnesota’s Fourth Judicial District. In that volunteer capacity, Shlafer advocates in court for the well-being of the child, but doesn’t foster the youngster or provide any day-to-day care.

Shlafer, who recently completed a training grant with NIH’s National Center for Advancing Translational Sciences, first got into volunteering as a graduate student, when she signed up to deliver warm meals to the hungry throughout the Twin Cities area. While completing her Ph.D., she heard about the Hennepin County Guardian ad Litem Program and thought it would be a great fit to use her degree as a community volunteer. Shlafer completed a mandatory 10-week training course, then took on her first case in 2009.

Since then, she’s advocated on behalf of more than 20 abused or neglected kids and estimates she’s donated a total of 750 hours—and counting. As a guardian ad litem, Shlafer thinks holistically about each child, “putting on my Mom hat” to assess his or her needs, be it physical, psychological, or emotional.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

A New Edition of JAMA Is Now Available

JAMA (vol. 315, no. 22, 2016) is available online by subscription only.

Articles include:

  • “Reengineering the Physical Examination for the New Millennium?” by William G. Nelson, Antony Rosen, and Peter J. Pronovost
  • “Social Entrepreneurship: Improving Global Health” by Yee Wei Lim, and Audrey Chia
  • “Is the United States Prepared for a Major Zika Virus Outbreak?” by Lawrence O. Gostin and James G. Hodge Jr
  • “Implementing MACRA: Implications for Physicians and for Physician Leadership” by Jeffrey D. Clough and Mark McClellan
  • “Time at the Bedside (Computing)” by Zuzanna Czernik

 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Screening Athletes for Heart Problems Does More Harm Than Good, Say Experts

April 21, 2016

(The Guardian) – The results, they argue, offer little support for the notion that screening saves lives. In an American study, they report, examining personal and family histories and carrying out a physical examination only raised suspicions of a heart disease in 3% of athletes who went on to die suddenly. The use of ECGs, the authors add, is also flawed and would not identify 25% of those who have a disease that could cause sudden cardiac death. What’s more, for the most common conditions picked up at screening, the majority of people “will never experience any symptoms and lead a normal life if the disease is left undetected,” they write.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Two Cheers for Choosing Wisely

The Choosing Wisely campaign is one of the most exciting experiments in health care in quite a while. If it lives up to its potential, Choosing Wisely could prevent some of the harm caused by unnecessary tests and treatments, while helping to bring down medical costs. But the real challenge to the campaign is whether it actually “empowers” consumers to do anything other than hurl themselves at a brick wall.

Choosing Wisely, begun in 2012, challenges medical specialties to create lists of the five most commonly misused and overprescribed interventions. Today there are more than 50 lists. Consumers Union is helping the campaign to bring its message to consumers in user-friendly form. And, indeed, the campaign is doing a wonderful job. The website (choosingwisely.org) has not only the lists, but terrific back-up resources to help laypeople understand the reasoning behind the lists. There are explanations about everything from why to avoid feeding tubes for Alzheimer’s patients, to how often one needs a colonoscopy.

True, Choosing Wisely is a work in progress. I wish dentists and orthodontists would sign on. And the current lists have been criticized for focusing on low-ticket items or on interventions performed by other specialties. Number one on the list from the American Academy of Ophthalmology, for example, is routine electrocardiograms (EKGs) before cataract surgery, a relatively low cost intervention provided commonly by primary care physicians.

The rationale for the campaign is to “educate and empower” consumers (whom they insist on calling “patients”) and to “promote conversations between providers and patients.” The goal is to help consumers choose care that is evidence-based and not harmful.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Kaci Hickox: Public health and the politics of fear

Steven H Miles, M.D.

Kaci Hickox is a nurse who went to Sierra Leone with Doctors without borders to treat the emergency with Ebola. She is professionally brave, articulate and well trained. Sierra Leone, with 5000 cases, is one the epicenters of the Ebola epidemic.[1] [2] She was last exposed to patient care on October 21.[3] On Friday October 24, she returned to the United States, entering at Newark International Airport in New Jersey. There she was met by a disorganized set of officials who tried to determine what to do with her. She was repeatedly interviewed. Her temperature on arrival was normal but was repeated several times using a forehead scan thermometer, which will give falsely high readings of persons under stress. Eventually, a temperature was high.[4] She was sent to a University Hospital in Newark that found her to be afebrile and asymptomatic.

Nevertheless, New Jersey Governor Chris Christie intervened and ordered her to be confined, saying she was “obviously sick.” She was placed in isolation, threatened with 21 days of hospitalization and promptly threatened to sue for violation of her civil liberties and unjustified confinement. On October 27, an unapologetic Governor Christie allowed her to be discharged with the expectation she would go directly to her home in Maine, saying, “I didn’t reverse any decision . . .. She hadn’t had any symptoms for 24 hours. And she tested negative for Ebola. So there was no reason to keep her. The reason she was put into the hospital in the first place was because she was running a high fever and was symptomatic.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The D.O. Is in Now

[The New York Times]

The old Blumstein’s department store sits across 125th Street from the legendary Apollo Theater. It’s something of a Harlem landmark, where “don’t buy where you can’t work” protests led to the hiring of African-Americans as the first salesclerks in 1934 and where the Rev. Dr. Martin Luther King Jr. was stabbed by a mentally unstable woman during a book signing in 1958. Now a row of colorful clothing and jewelry stores lines the ground floor. But the rest of the building has been gutted and fitted with lecture halls, classrooms, laboratories and a library to house the Touro College of Osteopathic Medicine.

Harlem is a fitting location for Touro’s new medical school. Many osteopathic schools have an added mission: to dispatch doctors to poorer neighborhoods and towns most in need of medical care.

“The island of Manhattan has lots of doctors, but not here in Harlem,” said Dr. Robert B. Goldberg, dean of the college, which taught its first class in 2007.

Inside, Touro seems indistinguishable from a conventional medical school — what doctors of osteopathic medicine, or D.O.s, call allopathic, a term that some M.D.s aren’t much fond of. A walk through the corridors finds students practicing skills on mannequins hard-wired with faulty hearts. They dissect cadavers. They bend over lab tables, working with professors on their research. And, unlike their allopathic counterparts, they spend roughly five hours a week being instructed in the century-old techniques of osteopathic medicine, manipulating the spine, muscles and bones in diagnosis and treatment.

In one classroom, several students lay flat on examining tables while classmates, under the guidance of Dr.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.