The Role of Nurse Practitioners in Health Care Reform

This article was originally published by Georgetown University’s family nurse practitioner programs.

The Affordable Care Act created new health care delivery and payment models that emphasize teamwork, care coordination, value, and prevention: models in which nurses can contribute a great deal of knowledge and skill. Indeed, the nursing profession is making a wide-reaching impact by providing quality, patient-centered, accessible, and affordable care.

- Institute of Medicine 1

An estimated 27 million Americans have gained health insurance coverage during the past five years thanks to the Affordable Care Act (ACA).2 But that, coupled with an aging population and an expansion of preventive care benefits, is putting significant strain on the country’s primary care provider workforce. (more…)


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Sexism in Medical Education

heather newThe medical school professor stands affront  a group of first year students in a mid-size auditorium. “I need a go-to guy,” he says, “someone to direct my questions towards.” He scans the room. “I’ve never actually had a go-to girl, before,” he admits. Later in the lecture, he makes a joke at a male student’s expense. “I joke!” he laughs. “Usually I don’t pick on the girls of the class – they can be too emotional – its true! My wife tells me it’s true.”

During an exercise aimed at discussing issues of public health, the facilitator disagrees with a student who says that men and women should be treated equally as patients: “Men and women are inherently different,” he says, and later: “Women are less physically strong than men. If I were in battle, I wouldn’t want a woman fighting next to me. She just wouldn’t be able to carry me out.” (more…)

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Doctors: It’s Not What You Say, But How You Say It

Val Jones, MD

Today’s post originally ran on Better Health on December 28, 2015.

Most physicians will be thrust into the role of patient or caregiver at some point during their careers. Unfortunately, it’s not until this occurs that many become fully aware of the finer points of excellent care and communication. Take for example, the simple act of reporting test results to a patient. We do this every day, but may not realize that how we frame the information is as important as the data themselves.

I came to realize this on a recent hospital visit when I was in the role of healthcare proxy for a loved one with heart disease. Not only did various physicians present information with different degrees of optimism, but individual doctors presented things differently on different days…depending on (I guess) how tired/hurried they were. (more…)

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Leveraging the Expertise of America’s Most Trusted Profession

Pamela Cipriano, PhD, RN, NEA-BC, FAAN

The following post was first published in Huffington Post’s Politics Blog on December 29, 2015.

During a time when Americans’ confidence in many U.S. institutions has declined, the public’s trust in nurses remains unmatched.

For the 14th year in a row, the public rated nursing as the most honest and ethical profession in America, with an 85 percent rating, according to a recently released Gallup survey. Nurses have claimed the top spot since 1999, the first year they were included in the survey, with the exception of 2001, when firefighters were voted No. 1 following the attacks on September 11.

While the U.S. health care system struggles to retain the public’s confidence, with only 37 percent of respondents saying they have a “great deal” or a “quite a lot” of confidence in the system according to findings from a June 2015 Gallup poll, the evidence is clear that nurses have the respect of Americans. (more…)

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What Causes A Toxic Hospital Culture?

Val Jones, MD

Dr. Jones’ post was first published on Better Health on September 30.

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e. disenfranchisement of medical staff, burn out, and joyless medical care) is presented by Dr. Robert Khoo at KevinMD.

Interestingly, a few hospitals still maintain a power shift in the other direction – where physicians have a strangle hold on operations, and determine the facility’s ability to make changes. This can lead to its own problems, including  unchecked verbal abuse of staff, inability to terminate bad actors, and diverting patients to certain facilities where they receive volume incentive remuneration. Physician greed, as Michael Millenson points out, was a common feature of medical practice pre-1965. And so, when physicians are empowered, they can be as corrupt as the administrations they so commonly despise. (more…)

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When In Doubt, Ask A Family Member

Val Jones, MD

The post below ran on September 9 on Better Health.

I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, and so I rely on my knowledge of neuroanatomy, infectious disease, and pharmacology to guide my work up. However, I have learned that asking the patient’s family members about what they were like (in their healthier state) is extremely important as well. Personality quirks, likes and dislikes, and psychiatric history all offer clues to ongoing behavioral challenges and mental status changes.

This fact was never clearer than when I met an elderly gentleman with a new stroke. He was extremely drowsy, non-participatory, and was not oriented to anything but his name. (more…)

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Confronting Scandalous Physician Behavior: The Annals Of Internal Medicine Takes The First Step

Val Jones, MD

This post first appeared on Better Health.

If you have not read the latest essay and editorial about scandalous physician behavior published in the Annals of Internal Medicine (AIM), you must do so now. They describe horrific racist and sexist remarks made about patients by senior male physicians in front of their young peers. The physicians-in-training are scarred by the experience, partially because the behavior itself was so disgusting, but also because they felt powerless to stop it.

It is important for the medical community to come together over the sad reality that there are still some physicians and surgeons out there who are wildly inappropriate in their patient care. In my lifetime I have seen a noticeable decrease in misogyny and behaviors of the sort described in the Annals essay. I have written about racism in the Ob/Gyn arena on my blog previously (note that the perpetrators of those scandalous acts were women – so both genders are guilty). But there is one story that I always believed was too vile to tell. Not on this blog, and probably not anywhere. I will speak out now because the editors at AIM have opened the conversation. (more…)

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Over-Reliance on Tests: Why Physicians Must Learn to Trust Themselves & Their Patients

Val Jones, MD

The post below ran yesterday on Better Health.

I met my newly admitted patient in the quiet of his private room. He was frail, elderly, and coughing up gobs of green phlegm. His nasal cannula had stepped its way across his cheek during his paroxsysms and was pointed at his right eye. Although the room was uncomfortably warm, he was shivering and asking for more blankets. I could hear his chest rattling across the room.

The young hospitalist dutifully ordered a chest X-Ray (which showed nothing of particular interest) and reported to me that the patient was fine as he was afebrile and his radiology studies were unremarkable. He would stop by and check in on him in the morning.

I shook my head in wonderment. One look at this man and you could tell he was teetering on the verge of sepsis, with a dangerous and rather nasty pneumonia on physical exam, complicated by dehydration. I started antibiotics at once, oxygen via face mask, IV fluids and drew labs to follow his white count and renal function. He perked up nicely as we averted catastrophe overnight. By the time the hospitalist arrived the next day, the patient was looking significantly better. The hospitalist left a note in the EMR about a chest cold and zipped off to see his other new consults. (more…)

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Newly Minted Doctors Begin Their First Jobs In July: Should You Be Afraid?

Val Jones, MD

Today’s post first ran on Better Health on July 4.

The short answer, in my opinion, is yes.

The long answer is slightly more nuanced.  As it turns out, studies suggest that one’s relative risk of death is increased in teaching hospitals by about 4-12% in July. That likely represents a small, but significant uptick in avoidable errors. It has been very difficult to quantify and document error rates related to inexperience. Intuitively we all know that professionals get better at what they do with time and practice… but how bad are doctors when they start out? Probably not equally so… and just as time is the best teacher, it is also the best weeder. Young doctors with book smarts but no clinical acumen may drop out of clinical medicine after a short course of doctoring. But before they do, they may take care of you or your loved ones.

It has been argued that young trainees “don’t practice in a vacuum” but are monitored by senior physicians, pharmacists, and nurses and therefore errors are unlikely. While I agree that this oversight is necessary and worthwhile, it is ultimately insufficient. Let me provide an illustrative example. (more…)

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TBT: Turf versus Access to Care

Diana Mason

This week’s TBT post was written during last year;s National Nurses Week. Although the situation has improved there still is a ways to go. The post is a good reminder of what nurses do and how an expanded role for them would improve the health care system.

This is Nurses Week, often a time when health care organizations patronize nurses with free food and tchotchkes. We’d rather have the right to be able to contribute our talents and expertise to improving the health of people by being able to practice to the full extent of our education and training. Last week, the New York Times published a commentary on The Opinion Pages by cardiologist Sandeep Jauhar that continued to prop up the old and inaccurate message by organized medicine that nurse practitioners must be supervised by physicians. It perpetuates turf battles instead of focusing on improving access to safe, quality, affordable care. At a time when the Affordable Care Act has provided millions of people with coverage for care, building our primary care capacity is essential. (more…)

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Mind-Body (in my case Mind-Butt) Connection

Archelle Georgiou, MD

Colonoscopy…no way, no how, don’t want it, don’t need it. I’d rather have colon cancer. I don’t have any risk factors anyway. Can’t I have a root canal instead?

These are the thoughts that swirled through my head starting at age 49 as I anticipated turning 50 and hitting the magic moment for this right of passage.

But, several months ago, the resistance disappeared. I made the appointment in March and didn’t think about it again until I had to start the prep at 4 pm on the day before my procedure. Drinking 64 oz of Crystal Light with Miralax and 10 ounces of magnesium citrate made me feel like a bloatedwhale. I was stuck in a bathroom, chilled from the cold liquid, and could only tolerate wearing grey flannel sweats. (more…)


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The Quiet Revolution: The Power of Storytelling in Health Care

Beth Toner

In 1981, my 61-year-old father died of lung and liver cancer. I was just 14 years old. This, during the “Cancer Dark Ages” – a time when there was no ondansetron to offset the devastating nausea and vomiting that so often accompanied chemotherapy, and dying at home was as alien a thought as, well, an alien. Watching his nine-month decline was, without a doubt, the most difficult experience of my childhood, and perhaps my life.

It would be years before I could set foot in a hospital without being overwhelmed by crippling sadness. Despite the fact that I’m enthusiastically extroverted with a penchant for sharing too much information, for many years I spoke rarely of that time – and then, only in generalities. (more…)

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Making Policy Personal

Shortly after I moved to Washington, D.C. to begin a fellowship with HHS, my aunt was diagnosed with stage four ovarian cancer. I took a trip back to Michigan three months later to celebrate Thanksgiving at my parents’ home where she lived. The chemotherapy she had received during that intervening time had rendered her nearly unrecognizable.  I was at home when she asked me to take her to the emergency room; she died later that day in the ICU.

I have kept the program from her memorial service pinned to the bulletin board in my office ever since. If you read the dates underneath her name, you will notice that she died the day before her 50th birthday. And even if you read the attached pages of scribbled notes that were my feeble attempt at eulogizing her life, you may not really understand why I keep this type of reminder by my desk rather than a memento of a happier time. (more…)

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Man of the Month Revisited: Dr. William Cohn

Photo Courtesy of Houstonian Magazine

Last week, we honored medical heart technologist, surgeon, and  innovator Dr. William Cohn as our man of the month. This week, he sat down with us to chat a bit  more about what he has been up to and new advances in the field of medical innovation.

How did you become interested in the intersection of technology and health care?

I’ve always been attracted to the vibe of heart surgery. It seems like the ultimate gig: it combines my passion for innovation and working in health. Growing up in Houston, I had an older brother who was very brilliant and into science. In our garage, we had a lab set up, where we made explosives, lasers, (more…)

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A Disruptive Conversation with the Co-founders of Personal Medicine Plus

HODGE_PHONE_SCREENSHOT8_white (3)

We love stories about women that are truly changing the face of health care, particularly through innovation. Today is no exception. We recently sat down with Co-founders Natalie Hodge, MD and Brandi Harless, MPH of Personal Medicine Plus, an app that allows individuals to self-manage health through behavior tracking and health data metrics. Both Hodge and Harless shared their experience in developing their tool, being a woman innovation leader, and a few words of wisdom and inspiration to other women interested in following their goals. Check it out below.

What drew you to health innovation technology?

NH: My first passion was in medicine. I always had a deep interest in people and solving problems, so naturally that fits well with a career in medicine.  The interesting thing is that the problems of my early career have largely been solved by vaccines.  And in the 15 years we spent diagnosing disease, the obesity epidemic floated to the top. That’s when the opportunity for me to marry medicine and innovation arose.

BH: After studying global health at Boston University and working on health issues in Kenya, Haiti and Sierra Leone, I accidentally moved back to my hometown in rural Kentucky.  Not knowing if I would stay around, I started working with HIV patients and getting involved in the health of the local community.  After leading a local health clinic for a while, I realized the extreme need to help rural patients turn back their lifestyle illnesses.  When Natalie approached me to work on this startup that would do exactly that, I WAS IN!  (more…)

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