Talk about perfect timing. Just on the heels of Tuesday’s fantastic event at HLS on the Guatemala STD Inoculation studies (video to come soon), the Presidential Commission for the Study of Bioethical Issues has released A Study Guide for “Ethically Impossible” STD Research in Guatemala from 1946 to 1948. This is the Commission’s first foray into pedagogy, and an absolutely fantastic way to keep the discussion going. Be sure to check it out, and to share widely.
The Dartmouth Atlas of Health Care recently published a report entitled, “What Kind of Physician Will You Be?: Variation in Health Care and Its Importance for Residency Training.” (2012; http://www.dartmouthatlas.org/pages/residency). Briefly, this report analyzes Medicare data to create indexes and variables used to describe varying levels of treatment intensity, particularly at the end of life, for 23 top U.S. medical centers. This report is targeted to medical students who are choosing their residency programs, hoping that prospective residents look at a wider-array of factors, including: how well these hospitals utilize effective, proven health care interventions; to what extent the care they provide is dependent on supply-induced demand; and how well the hospitals allow for patient preferences in treatment plans.
This report grabbed my attention given that I conduct research in end-of-life (EOL) care, and I am sympathetic to efforts to improve the quality of care provided to people with advanced and terminal diseases. I am also quite interested in how our medical system can change the culture of medical care to provide higher-quality EOL, and to reduce the use of often ineffective and invasive medical interventions, particularly through hospitalization and ICU admissions. The education of residents seems like a good place to start in changing the current intensity and specialty-driven culture.
However, the gaps in this report compromise its arguments and potentially reduce its effectiveness. I will only highlight two here.
My colleague Jonathan Lazar who studies the way in which the web creates barriers to people with disabilities mentioned to me a neat program/event that may be of interest to some BOH readers in the Boston area: As part of the Architecture Boston Expo currently going on there is a Universal Design: Accessibility Exhibit, which features two spaces for attendees to navigate. One is made up using universal design features, the other features “common” design errors (sometimes quite subtle) making it difficult or impossible to use.
Architects and other attendees are put in a wheelchair and asked to try to make use of both spaces. The idea is that by experiencing the space as would someone with a disability, architects will be better able to understand the ways in which their small decisions have big impacts on people’s lives.
I thought this was a really interesting and novel approach to the problem, and one wonders whether architecture schools should make these kinds of experiences part of the curriculum?