Archive by category 'Interviews'
August 20th, 2010
Jan Henderson is a medical historian who blogs at The Health Culture. This the last of a three part interview with her.
Do you support the Obama healthcare program?
It’s a first step. I think it’s important and historic that Congress was able to pass any legislation at all.
Shortly before it passed, I saw an episode of the Charlie Rose show where the guests were Marcia Angell, the former NEJM editor, and Wendell Potter, a former insurance agency executive who’s now very active with the Center for Media and Democracy.
Angell took the position that Congress should not pass the bill because it didn’t sufficiently curb the power of the insurance industry.
She was not going to settle for anything less — very idealistic, in the best sense of the word. I didn’t agree with her at the time. I thought it was important to pass a bill, even an imperfect one. But ultimately she’s right.
My personal philosophy is that everyone has a right not only to health care, but to health and to a decent quality of life. I sometimes despair at how difficult it will be to achieve this.
Do you support single payer?
For reasons of equitable access to health care, yes. Practically, I’m not so sure.
I think the insurance companies have disgraced themselves and should not be allowed to continue what they’ve been doing.
I have concerns, however, about the government’s ability to run such a massive operation efficiently, which is critical when lives are at stake. I take some heart from those who argue that Medicare has been a very successful program.
I wouldn’t place any bets on what’s going to happen. When times are difficult economically, a conservative point of view tends to win the day.
What is your area of particular expertise in history of medicine and science?
As a graduate student, my area of expertise was mathematical astronomy – Babylonian, Ptolemaic, and Renaissance – Copernicus.
Once I started teaching two survey courses every semester on science and medicine – one from antiquity to the Renaissance, the other from the scientific revolution to the present – I featured the history of medicine because of its interest both to me and my students.
All sciences are subject to events and ideas in the culture of their time, but that influence is often easier to see in medicine.
My graduate school training favored an ‘internalist’ approach to science and medicine: studying the original texts in their original languages.
The more I taught, the more I was attracted to an ‘externalist’ approach – understanding science as a product of its time and culture.
I approach the history of medicine as intellectual history and find that the most interesting ideas often come from sociologists, anthropologists, economic historians, and even media critics.
What are the three most important medical advances in the last 100 years, 50 years, and 20 years?
If I could be a bit fluid with those milestones, the most important advances – the ones that initiated modern medicine – were anesthesia in the 1840s, the germ theory of disease in the 1850s, and antisepsis in the 1860s.
The next big advance was the development of antibiotics during World War II.
In more recent times, the most important developments will probably come from genetics.
I know many observers are a bit surprised and disappointed that sequencing the genome hasn’t revealed a direct correlation between genetic information and disease. It’s a field that hasn’t yet delivered on its promise. I suspect it will, however. The implications for reproductive technologies are enormous.
There have been a great many important technical advances in surgery and diagnostics over the last 100 years, but technical advances are more or less predictable.
The discoveries of the past that I most admire are those that were unexpected and required someone to relinquish a previously held belief.
Why has the patient safety push of the last 15 years failed to improve overall patient safety even the tiniest bit?
Because there isn’t a simple technical fix. The problem is often one of inadequate communication. That requires changing human behavior, which is very resistant to change and takes time.
Many safety issues involve team work. Gawande’s work on checklists describes the improved communication among team members once they’ve gone through a list together.
The medical profession keeps talking about what to do. Meanwhile the statistics remain ghastly. There was just a story out of the UK on how nearly one in five dosages of pain killers are in error, resulting in death and injury.
I hope it doesn’t take a catastrophe – like the death of a favorite celebrity from medical error – to ramp up the pressure.
Did you ever think about becoming a physician?
Yes, I spent some time during graduate school thinking I should switch to medical school. I had never taken courses like organic chemistry, however, and it would have been a big undertaking. I admire anyone who makes it through medical school, internship, and residency.
Recent studies show that medical school students who have a humanities background are as successful as students who have fulfilled all the traditional pre-med requirements. Things are different today.
What is one little known fact about the history of medicine that you think people should know?
I’m interested in how attitudes towards death and dying have changed over time. There’s a little known incident from the late 19th century that made a difference in the care of the dying.
Easing the pain of death was a common medical practice in the 19th century. The doctor’s black bag contained laudanum as early as the 17th century.
The 19th century added morphine in 1806, codeine in 1836, and aspirin in 1892, along with the anesthetics chloroform and ether.
At a time when physicians had very little to offer patients by way of cures – other than the ineffective “heroic” measures of bloodletting and purges – it was palliative care that made physicians welcome at the deathbed.
In those days, easing pain at the time of death was not called palliative care, but euthanasia. The term referred to the outward death of the body, in contrast to the death of the spirit. Euthanasia literally means a good death.
In 1870 a school teacher named Samuel Williams published an essay that used the term euthanasia to mean something else: mercy killing. The essay generated considerable interest and discussion. To make a long story short, the original meaning of the term euthanasia was completely lost.
Between those late 19th century discussions of euthanasia as mercy killing and 1975, when Balfour Mount introduced the term palliative care, there was no name for supportive care of the dying.
Without a name, there could be no specialists in the subject, no professors to teach it, no training for physicians. There was little discussion of the subject in medical schools.
Without a name, the subject could not be indexed and researched in medical literature. There could be no advances in knowledge or improvement in techniques.
What we now call palliative care had greatly enhanced the reputation of the medical profession in the late 19th century. How could the original meaning of “euthanasia” be so easily displaced?
In an essay on the subject, Ezekiel Emanuel – Rahm’s brother – suggests that it happened at a particular moment in the development of capitalism – a time of economic panics and stock market crashes, raw individualism, economic competition, and appeals to the Darwinian concept of survival of the fittest.
Euthanasia of the elderly, who were no longer productive members of society, was simply part of the universal struggle of the strong over the weak.
This incident illustrates the power of language. If you control the vocabulary – so important today in discussions of morally tinged political issues – death panels, right to life – you can prevail.
August 18th, 2010
Jan Henderson, PhD, is a Harvard-trained mathematician and Yale-trained medical historian. She shares some of her thinking about healthcare in America in the second part of a three-part interview below.
Which medical journals do you read regularly?
I read the New England Journal of Medicine and the Journal of the American Medical Association.
NEJM has been admirably proactive about conflict of interest. I admire Marcia Angell, who was on the editorial staff for over 20 years. The editorials in NEJM on the health care debate were excellent.
JAMA is a bit more conservative in its commentary, but there are many things I appreciate about it.
They preserve the humanist side of the medical profession with regular features on art, poetry, and essays by doctors. They publish excerpts from JAMA 100 years ago, which is always fascinating.
And they have book reviews. I was disappointed that NEJM decided to discontinue book reviews earlier this year.
I read as much of the Lancet as is available without a subscription, which includes much of the editorial comment. They place a greater emphasis on health in the developing world, undoubtedly a remnant of British Empire days.
There’s a nice review of medical journals called Journal Watch. It’s written by a physician Richard Lehman with an understated British sense of humor.
What is your opinion of Atul Gawande’s public policy positions?
I’m a big fan of Dr. Gawande. The Lancet once said that by advocating safety checklists, he has probably saved more lives than any other physician in history.
The quality of life for patients near death is such an important issue. This is very difficult to discuss in our culture. We don’t want to be reminded of death. So I was pleased to see him open up this topic for discussion.
There was an online comment in response to the article that illustrates its impact. A reader wrote about her father, a smoker who was dying of lung cancer and struggling with a drug treatment that made him very sick.
She sent Gawande’s article to her parents. After reading it, they made plans to discuss treatment and end-of-life issues with their physician. They expressed their gratitude. Gawande’s writing makes a difference.
One of many things I liked about his health care article on McAllen, Texas was the physician’s perspective he provided at the end – something easily overlooked by those not directly involved with patients.
He said there would be dangers in changing health care too rapidly and too drastically. We’re talking about the health and lives of real people here, he said. With a radical change, some people would suffer from the transition.
Personally I’d love to see big changes in health care, but I really appreciated that point of view.
As a keen observer of medical culture, do you have a problem with the ethics of physicians blogging sometimes in great detail about their patients – oftentimes in unflattering ways? Do you feel that patients are being unfairly used?
Of course that’s an unwise and unethical thing to do. But I see a great deal of discussion, in blogs and in medical journals, that tries to educate the medical community about the issues. I hope this is just a period of transition we’re going through.
What are your thoughts on the culture change occurring in medicine regarding the elimination of physicians personally accepting patient care responsibility through the reduction of resident work hours and the forced imposition of duty hour restrictions. How do you feel about medical care rapidly becoming one of a shift-work?
This has been an interesting development in the history of medicine.
In 20th century America, business and industry became bureaucratized and were subjected to outside control. The medical profession held out against this change for a very long time.
It argued that the doctor/patient relationship was special and unique among professions and should be under the control of doctors and patients, not outside bureaucracies.
The medical profession may have also been concerned about loss of prestige and income, but the sanctity of the doctor/patient relationship was central to resisting external control. This more or less committed the practice of medicine to the model of the solo practitioner.
That model didn’t survive 20th century advances in medical knowledge and technology. The lone practitioner was overwhelmed with information.
I was just reading something from a 1910 JAMA on the plight of the physician: “For the overworked physician to steal an hour for the perusal of Carlyle or Coleridge when he ought to be ‘reading up’ an obscure case seems a sort of professional suicide.” And that was only 1910!
As medicine had increasingly more to offer, the demand for medical care increased. Ultimately the solo practitioner model was unable to meet the health care needs of the nation.
Bureaucratized shift-work is not good for doctors and it’s not good for patients. I don’t know what the solution will be.
Primary care doctors are asking to be paid by the hour, not for piece work. That might help. The wealthy can afford concierge doctors. Maybe something will come out of the medical home concept.
If doctors and patients get unhappy enough, perhaps a creative solution will evolve.
Related Posts
Jan Henderson, PhD – Medical Historian and Medical Blogger
August 16th, 2010
Jan Henderson is a medical historian and the editor of the thoughtful, well-written blog The Health Culture. We recently had a chance to get her thoughts on some of the ongoing developments in medical blogging and the healthcare delivery system.
Where are you from?
I was born outside Boston, but lived in California until college, when I returned east. I lived in Massachusetts, Connecticut, New York, and New Jersey until fifteen years ago, when I returned to northern California.
Where did you go to school and what was your academic major?
I was an undergraduate at Harvard, where I majored in math. I have a PhD from Yale in the history of science and medicine.
What has been your career path from your last educational schooling endeavor and now?
After getting my doctorate, I taught the history of science and medicine at Queens College, CUNY. When budget cuts eliminated the non-tenured faculty positions in my department, I spent a year as a fellow at the Institute for Advanced Study in Princeton.
I was offered a teaching position on the west coast, but wasn’t ready to leave New York.
Since then I’ve alternated between writing about what truly interests me and earning a living. I’ve published two books, spent time at a media industry publication, evaluated mainframe artificial intelligence software, and managed technical documentation and marketing in the personal computer industry.
I left the corporate world in 2000 and spent several years teaching traditional Chinese medicine.
What do you see as the mission of your blog?
I started blogging because I wanted to understand something that changed medicine and ideas about health in the 1970s.
Prior to that time, the policies of the Kennedy and Johnson administrations had assumed the state should be responsible for the health of its citizens.
When political and economic thinking became more conservative in the 1970s and 1980s, governments began to promote the idea that individuals were personally responsible for their health and should practice healthy lifestyles.
A large segment of the population – mainly the educated and economically secure – welcomed these ideas. Feeling personally responsible for one’s health and practicing healthy lifestyles gives one the reassuring illusion of control.
In particular, it’s a good distraction from the things that are beyond individual control, like salmonella in our peanut butter and the superbug MRSA at the gym.
I was caught up in the healthy lifestyles attitude myself. When I look back, I could kick myself for not recognizing what was going on.
Public opinion could have been rallied to support those health issues that need government backing – workplace safety, a healthy environment, an equitable distribution of access to affordable health care.
But politics took a different path and the public went jogging.
I have nothing against healthy behavior and the concept of prevention. What bothers me is misleading the public for political purposes.
Aside from smoking, the evidence for changing behavior is slim – either it doesn’t last (obesity) or, in some cases, it turns out to be wrong (all fats are unhealthy, fruits and vegetables prevent cancer, HRT).
I guess my mission is to be alert and not get fooled again. By writing about what’s currently happening in health and medicine, I’m collecting pieces of a puzzle.
It’s always hard to see the big picture in the moment, but eventually the pieces add up. Also, while history never repeats itself exactly, looking back at the history of medicine provides clues to the present.
Why don’t you accept advertising on your site?
I have nothing against advertising per se. I had Google ads on my blog until May 1, when I changed blogging softwares. For the moment I’m enjoying the uncluttered look.
I find online advertising objectionable when there’s a conflict of interest. I would question the health advice of Dr. Andrew Weil, given the intensity of his sales pitch.
And while WebMD may be a reliable source of information on some health matters, it’s not free to be objective about issues of interest to a prospective cosmetic surgery client.
What medically related blogs do you read?
I’m afraid this is a rather long list. I’m not a specialist when it comes to medicine.
I read KevinMD, of course. Not only does it cover the current issues in medicine and health care, but it gives an inside look at what physicians and other health care professionals are thinking.
During the debate on health care legislation, my favorite sites were Health Beat by Maggie Mahar and GoozNews by Merrill Goozner. Both are experienced journalists and insightful bloggers.
For the pharmaceutical industry, I read Ed Silverman at Pharmalot. He attracts a large number of readers from both inside and outside the industry, and they leave highly educational comments.
For news on health care and pharma, as well as a look at how those inside the industry see things, I read FierceHealthcare and FiercePharma.
For an analysis of health news I read Behind the Headlines from the UK’s National Health Service. They present the science – or lack of it – behind outrageous and distorted headlines. Health news is pretty much the same in the US and the UK, although the slight differences are interesting.
Another UK site I appreciate is Bad Science by the physician Ben Goldacre, author of a book by the same name. The things that make him angry are definitely worth being angry about.
On medical journalism, Gary Schwitzer deserves a medal. His blog is called Health News Review. He also has a website where he systematically analyzes and rates health reporting.
On bioethics, the Hastings Center has a Bioethics Forum, plus there are many other resources on their website.
Dr. Maurice Bernstein runs a Bioethics Discussion Blog. He usually cites an article and then poses a question to his readers. Some of the threads are fascinating, like the one on how readers feel about seeing a male or female physician.
That topic gets so many responses that Bernstein has to close the thread and allow a cooling off period before reopening the discussion. The comments were an eye-opener for me.
On nutrition, food safety, the FDA, and the food industry, I read Marion Nestle. She blogs for the Atlantic and has her own website, Food Politics.
Maryn McKenna wrote an excellent book on community-acquired MRSA, and I rely on her blog Superbug for updates on antibiotic resistance. She’s a medical journalist who understands the technicalities and explains them clearly.
On psychiatry, there’s the Carlat Psychiatry Blog by Dr. Daniel Carlat. I thought his latest book (Unhinged) could have been more objective.
Understandably he defends his profession, whereas I think there’s good evidence anti-depressants have been overprescribed or prescribed for the wrong reasons. But he definitely raises and discusses the issues in psychiatry today.
Thaddeus Pope writes on the ethical and legal issues raised by the ability of modern medicine to keep us alive, both at the end and the beginning of life. His blog is called Medical Futility. He’s a law professor.
I really enjoy a relatively new blog on geriatrics and palliative care called GeriPal. It’s written and frequented by a very nice group of people.
I also read another excellent blog on hospice and palliative medicine that’s been around for years: Pallimed. These are professionals who deal with end-of-life issues every day.
Finally, for fun and inspiration I read Street Anatomy – a daily illustration of the use of anatomy in art, advertising, fashion, commercial products, and street life.
Related Posts
Jan Henderson, PhD – Medical Historian and Blogger (Part 2 of 3)
Jan Henderson, Phd – Medical Historian and Blogger (Part 3 of 3)
May 5th, 2010
Pete Combs received his cooking training at the Culinary Institue of America and is the Executive Chef at the University of Kentucky/Chandler Medical Center. We recently met with him to get his thoughts on hospital food and other items.
Where are you from?
I was born in Pt. Pleasant, New Jersey. My parents then moved to Skaneatlas, New York. They were originally from Philadelphia, Pennsylvania.
Where did you go to college and what was your academic major?
I went to Purdue University and graduated with Bachelor of Science in Restaurant and Hotel Management and a minor in accounting.
I then went to The Culinary Institute of America. I went there to further my cooking skills that had started at the age of 13 in a country Ccub kitchen. My friend’s Dad owned it and gave me an opportunity to work there.
Why the Culinary Institute of America and not some other cheaper, “easier” school?
I picked the CIA because I believe its the best and most equipped culinary school in the country.
What has been your career path from the CIA to the hospital cafeteria at the University of Kentucky?
I worked at the country club during high school and in the summers whiole attending Purdue.
During the school year, I was line cook for the Sheraton in Lafayette, IN. While attending the culinary school, I worked at the Applewood Inn on the Hudson River in New York.
After graduation from Culinary, I went to work as a production manager for Cooker Restaurant Corporation. I was also part of the recipe and development team for the company. I worked the restaurant in Shaker Heights, Ohio.
I then was transferred to Nashville, TN. The Cooker Restaurant in Nashville had two kitchen and had 450 seats.
After working for them for four years, I went onto work for Phil Hickey and Mike Huffler, which were instrumental in starting the Cooker Restaurant Corporation. They opened a restaurant called the Green Hills Grille in a ritzy part of Nashville where much of the music producers as well as artists frequented.
I was their Chef and then was promoted to General Manager. After working there for five years, I was offered a position as Executive Chef for Baptist Hospital in Nashville which was managed by Morrisons.
A patron of the Green Hills Grille was a regional culinary chef for Morrisons and he had been approaching me with the idea for years. The executive chef at the time, had been there and was soon to retire.
I decided to take the position which really proved to be a great career decision. Morrisons became part of a larger company called Compass.
Compass is the largest foodservice company in the world with diverse sectors that cover fine dining, museums, fortune 500 companies, healthcare, stadiums, colleges, high schools, and even events as large as the winter olympics.
I left my position in 2003 to travel as a regional culinary chef for the company and after two years of traveling decided I liked being at the unit level.
The opportunity came about at the University of Kentucky which was a large account for the healthcare sector. I have been here for four years and have loved every minute of it.
What has been your biggest cooking disaster?
My biggest cooking disaster was when I was about 17 and we were doing a golf outing for about 300 people.
One of the entrees was a New York strip steak. We usually cooked them on a wood grill beside a large gazebo.
Unfortunately, the wood shipment didn’t come in and we used charcoal instead. Well needless to say, cooking 300 strip steaks and using lighter fluid causes alot of flare ups or too high flames.
The steaks got a little charred, but James Garner, yeh the Rockford Files star didn’t mind at all. He was the spokesman for “beef” at the time and thought it was hilarious. They seemed to like the steaks “Pittsburgh Style”.
December 20th, 2009
Dr. Jeffrey Kirsch is a leader in the field of academic anesthesiology and a prolific scientific author. His most recent book Avoiding Common Anesthesia Errors was published in July, 2007 by Lippincott Williams & Wilkins.
Where are you from?
I was raised in Detroit, Michigan.
Where did you go to college and what was your academic major?
I graduated from The University of Michigan in 1979. My academic major was in Physiology.
What was your career path from college to Chair of Anesthesiology at Oregon Health and Science University?
I started my research in cerebral physiology with Dr. Louis D’Alecy at The University of Michigan in 1975, as a college freshman. My passion for scientific inquiry was ignited by the eight wonderful years throughout undergraduate and medical school years that I worked with Dr. D’Alecy.
My main research focus while at Michigan involved trying to better understand the role of metabolic substrate availability and cerebral tolerance to hypoxia.
After graduating from The University of Michigan School of Medicine, I moved to Baltimore to train in Anesthesiology with Dr. Mark Rogers and work in the laboratories of Dr. Richard Traystman.
Both Drs. D’Alecy and Traystman taught me the importance of investing in oneself to create the time necessary to do the work of conducting high quality research, writing grants and papers.
My clinical focus was in Neurosurgical Anesthesia and Critical Care. Drs. Mark Rogers and Robert McPherson provided excellent clinical mentorship.
My research focus at Hopkins was in mechanisms of brain injury from ischemia. I have been continuously funded by NIH since finishing my clinical fellowship in Neurosurgical Anesthesiology and Critical Care.
When I joined the Hopkins faculty I became associate residency director. I ultimately also became program director and vice chair of education and training.
While at Hopkins I became active in the American Society of Anesthesiology(ASA), SNACC and the Society of Critical Care Medicine (SCCM). After twenty years at Hopkins, I was recruited to chair the Department of Anesthesiology at Oregon Health and Science University.
What would you say to a bright 21 year old college junior who told you they were thinking about medical school?
Go into medicine because of your passion to help other people, not because you happen to be good in science. If you are unsure of that passion, you should work in a medical environment for a couple of years before deciding to apply for medical school.
Why do you think that the incidence of medical errors has not significantly decreased, despite much attention and effort being applied to the problem.
I believe that medical errors occur because there is often a lack of personal effort for on-going medical education for healthcare professionals.
We need to develop a culture that is more welcoming of questions by any member of the team regardless of their status within the team. We all need to embrace the concept of transparency of quality data to facilitate improved patient care.
I believe that the Maintenance of Certification project of the American Board of Medical Specialties and adoption of computer assisted order entry will be helpful in decreasing the frequency of medical errors.
Why did you and the other authors decide to donate your royalties for your book Avoiding Common Anesthesia Errors to the Foundation for Anesthesia Education and Research (FAER)?
FAER funds projects to improve research and education in Anesthesiology. The editors and authors believe that providing financial resources to a foundation that will help to improve the knowledge base and education of anesthesiology providers will decrease the frequency of errors in our specialty.
It was an honor to donate the royalties to an organization that shares our vision of improving patient care in Anesthesiology.
What is your next book?
Acute Brain and Spinal Cord Injury: Evolving Paradigms and Management. I am a co-editor with Drs. Bhardwaj and Ellegala.
What is the hardest part about being a clinical anesthesiologist?
The most difficult issue for me to deal with as a practicing anesthesiologist is trying to cope with other members of the peri-operative team who lack insight into their own practice and opportunities that they have for improved care and efficiency.
What is the hardest part about being a Chair?
My goal is to achieve excellence in all areas of the department. Excellence requires change. Helping members of the department welcome change, with the goal of greater excellence, can be a great challenge.
What is the next job in medicine that you would like to have?
My current position as Chair of the Department of Anesthesiology and Peri-Operative Medicine and Chief of Staff of OHSU provides plenty of challenge. I do not have my eyes on any other opportunities in medicine.
Disclosure: The interviewer and a family member have collaborated with Dr. Kirsch on a book project.
November 22nd, 2009
Joseph Zuckerman, MD, is the President Pro tem of the American Academy of Orthopedic Surgeons and Chair and Walter A.L. Thompson Professor of Orthopedic Surgery at NYU Hospital for Joint Diseases. We recently spoke with Dr. Zuckerman about his career and some of the issues facing orthopedic surgeons.
Where are you from?
I was born in the Bronx and grew up in Long Island.
Where did you go to college?
I attended Cornell University and majored in Biology with a concentration in anatomy and physiology.
When in your training did you decide to be an orthopedic surgeon?
I have wanted to be a doctor since I was about ten years old. I used to watch Ben Casey on television and that show convinced me to become a physician.
I always liked bones and joints. I had an interest in that type of anatomy. When I was young I had a cast and I thought that it would be fun to be able to put casts on people. I admit this was not very sophisticated reasonong to determine a career choice.
What was the worst moment of your residency?
I made a (non-fatal but serious) mistake when I was an intern on the medical service at the VA hospital. It had a profound effect on me of never wanting to be in that type of situation again. It drove home to me that what we do is incredibly powerful and we need to think about everything we do.
What one person has been the most influential on your career as an orthopedic surgeon?
There are primarily two individuals I would name. The first is Victor Frankel. He was the chairman of orthopedics during my residency at the University of Washington for my first three years.
He then left to become the chairman of orthopedics at the Hospital for Joint Diseases. He ultimately recruited me to join his department. He has always been incredibly supportive of my career and has given me opportunities that I would not have had otherwise.
The other is Clement Sledge who was chairman of orthopedic surgery at Brigham and Women’s Hospital when I did my fellowship. He also subsequently became president of the American Academy of Orthopedic Surgeons. I have had a career long relationship with him as a mentor, advisor and friend.
What are the two most important specific attributes needed to be a good orthopedic surgeon?
To be a top-flight orthopedic and to excel you have to love what you do. If you don’t love what you do, you won’t have the passion needed to succeed. It is the passion that allows you to devote the time and effort and to do all the things that are necessary to excel, whether it be in the operating room or in teaching or in academic pursuits.
You are a shoulder specialist. What is the most exciting advance on the horizon in shoulder surgery?
I think there are two things. First, the continuing progression of miminally invasive techniques, arthroscopic techniques. And, second the continued development of shoulder arthroplasty to treat a wider range of conditions about the shoulder. It should give many more patients a better quality of life as a result.
One of the stated goals for your term leading the AAOS is to improve practice management. What do you mean by that?
Taking care of patients in the office, emergency room, or operating room is of critical importance. And the reality is that the vast majority of orthopedic surgeons in this country have to operate a small business. Sometimes it is a large business, depending on how many people are in the group. Having the skills to do that successfully are not necessarily learned anywhere along the way.
So, the American Academy of Orthopedic Surgeons has a very robust practice management initiative because we want to be able to provide these tools for our members and help them succeed. This becomes more important each year as our practices face more and more challenges.
You have stated that increasing diversity is also one of the goals of your presidency. How will you achieve that?
Diversity comes in many ways. It’s gender diversity, racial diversity and ethnic diversity. The AAOS is committed to promoting diversity in all of our programs. We have a Diversity Advisory Board that looks at every new project and program to determine whether diversity issues are being addressed. For committee appointments , we obviously want the most highly skilled and knowledgeable people, but we also consider diversity in our selections.
Joseph Zuckerman, MD interview – Part 2
November 1st, 2009
Connie Strasheim is a medical journalist who has detailed her struggle to get well after contracting Lyme disease. She is the author of the newly published book Insights Into Lyme Disease: 13 Lyme-literate Health Care Practitioners Share Their Healing Strategies. She gives us more of her thoughts.
What treatment was most helpful to your recovery?
It’s hard to say. The cumulative effects of all of my treatments have benefited me. A healthy diet, hormonal supplementation , prayer and energy medicine (Bionic 880 device) have probably produced the most dramatic results.
What has been the financial cost of your treatments?
Thousands upon thousands of dollars. It’s hard to say. I probably spend an average of 1-2K per month on my health now. In my first years with Lyme, it was probably more like 2-3K per month.
How did you get the idea to do your latest book?
I decided that there wasn’t enough information out there from the experts on how to treat chronic Lyme disease. And because it’s such a complicated, difficult disease to treat, I decided that the more information I could get “out there”, the better off people would be.
How are you doing with sales?
It’s so far doing pretty well for a Lyme disease book. But what most people don’t realize is that most authors don’t make a living writing books–that is actually difficult to do, but they often invest a lot of time and energy into writing them.
This book was no exception. It was a tremendous project, but well worth it because I think it will help many. And if I make some money in the process, then great! I will be really happy about that.
What are you doing to promote your book?
I share it with people whenever I can. My publisher and I have a number of different marketing strategies in place and others that we are working on.
What would you change about your latest book if you could do it over again?
That’s a good question. So far I have no regrets. I would probably try to streamline the writing process a bit better.
It’s difficult to involve fourteen people, including my publisher, in the editing process.
Lyme practitioners are notoriously publicity shy. How did you convince the people in your book to publicly disclose their treatment regimens?
I didn’t have to convince them. The doctors that participated in this book want to see people well. They are willing to take risks to help others.
But writing about treatments in a book isn’t the same as giving random medical advice to people. The information in the book is for informational purposes only, it isn’t intended as treatment advice, and we put a disclaimer at the front of the book that states this.
In turn, this protects the health care providers.
Are you concerned that you might be a target for a lawsuit if someone tries a treatment described in your book and has a bad outcome?
No, because I am not giving treatment advice. I am simply a provider of information, and again, the disclaimer at the front of the book makes this clear.
Do you have errors and omission insurance on your book?
No, I don’t.
Other than your books, what one single Lyme book would you recommend to your readers?
Good question. If you want to learn about the politics and history of Lyme, P. Weintraub’s book, Cure Unknown, is a good resource.
Dr. Singleton has written a good, comprehensive book on Lyme treatments. But all of the books out there have value.
Why is there such controversy in the treatment of Lyme Disease? How do you respond to some patients’ charges that there is a “conspiracy” to deny Lyme patients care.
Controversy exists because organizations like the CDC, Centers for Disease Control, as well as IDSA, the Infectious Disease Society of America, have a political agenda which prevents them from recognizing chronic Lyme disease and its prevalence, despite the fact that an abundance of evidence exists to prove that it is, in fact, a serious and widespread problem.
Testing guidelines are outdated and flawed, patients can present with over 300 different symptoms, further complicating diagnosis, and treatment is extremely expensive.
The cost of antibiotic treatment, which is, on average, $100,000 for a person with chronic Lyme, means that insurance companies are reluctant to recognize and treat it.
Other reasons for the controversy exist, too many to name here, so I would recommend P. Weintraub’s book for anyone who wants to learn more.
I can’t speak about whether a conspiracy exists to deny Lyme patients proper care, but nothing would surprise me, after what I have seen and learned over the past five years about this disease.
What is your next writing project?
Good question. Guess I need to ask God about that one.
I would actually like to write a book on spirituality, but I may end up doing another book on Lyme that addresses new treatments or areas of research that haven’t been given much attention.
What accomplishment in your life are you most proud of?
Growing stronger through my trials with Lyme disease, and surviving it with my sanity intact.
Click here for part 1 of this this interview.
November 1st, 2009
Connie Strasheim is a recovering Lyme disease patient, medical blogger, and the author of the recently published book Insights Into Lyme Disease: 13 Lyme-Literate Health Care Practitioners Share Their Healing Strategies. We spoke with her recently to get her thoughts.
Where are you from?
Denver, Colorado
Where did you go to college and what was your academic major?
University of Colorado at Boulder, BA, Spanish for Business.
What has been your career path from college to now?
I was a flight attendant for United Airlines for eight years, and spent my twenties traveling the world, leading and participating in humanitarian missions trips.
I quit my job at United when I became disabled by Lyme disease at the age of 30. After that, I worked part-time as a private Spanish instructor and medical interpreter, whenever my health allowed me to.
I also began to intensively research Lyme disease and, over the past three years, I have written a blog (lymebytes.blogspot.com) and two books on the subject.
When did you get Lyme disease? What has been your treatment strategy in getting well?
I don’t know for how long I have had Lyme. I began to experience mild symptoms in my early twenties, although I may have been infected as early as my childhood. I became disabled by Lyme in 2004.
In the three years leading up to my “crash” in 2004, my back pain and symptoms of anxiety had intensified significantly.
Then, on September 26, 2004,I began to experience a multitude of other symptoms – extreme fatigue, gut pain and digestive problems, tachycardia, trouble standing and breathing, brain fog and depression.
It took me nearly a year to get diagnosed. The thirteenth doctor that I saw diagnosed me.
I began antibiotic treatment in July, 2005, but the drugs weakened me so much that after only two months, I decided to pursue other paths to healing.
Over the next few years, I used Rife machines, high doses of salt and Vitamin C, herbs, and a number of other “alternative” remedies, which helped me to varying degrees.
The Bionic 880 device and herbal remedies seemed to be most effective for treating the infections, however. The Bionic 880 is a device which is used in Germany by some doctors to treat Lyme disease.
Adjunct therapies, such as a healthy diet, hormonal and nutritional supplements, were just as, if not more important than, the “bug killers” for my recovery.
Do you believe you are cured of Lyme disease?
That’s a good question. I believe that the main Lyme infection Borrelia is in remission, but I yet have symptoms, which may be due to any number of causes.
People aren’t always healed completely just because they get the infection under control. The pathogens damage the body significantly, and sometimes, symptoms remain for other reasons.
I have back pain and some auto-immune issues, which may have been present prior to Lyme, or which are the result of biological processes that were triggered by Lyme.
I am also still treating for a Babesia infection, which may account for my remaining symptoms. Tests and treatments have revealed that Borrelia is not currently a problem for me, however.
Healing from chronic Lyme disease isn’t about just healing from an infection though - it’s about healing from a multitude of biochemical dysfunctions in the body that may or may not be a direct result of the infections.
While my back pain is yet quite severe, my other symptoms are relatively mild at the moment, if I do everything right and take care of myself.
What does your current treatment regimen consist of?
I continue to treat for Babesia with the Bionic 880 device. I also take allergy drops, a few supplements for detoxification and nutrition, as well as bioidentical hormones.
I do physical therapy and a technique called Quantum Neurology for my back pain.
Then of course, there is my lifestyle, which involves healthy eating, prayer, exercise and living a simple, quiet life, as much as I am able to.
Click here for part 2 of this interview
October 23rd, 2009
Anthony Fleg, MD, MPH is a family practice resident and medical activist at the University of New Mexico. We recently had a chance to meet with Dr. Fleg to talk with him about his vision for healthcare.
Where are you from?
I was born in Richmond, Virginia to a mom who was a 3rd year medical student. We moved shortly thereafter to the Baltimore area, where I grew up and proudly call home.
Where did you go to college/grad school/medical school and what was (were) your academic majors?
I attended Haverford College and U. Maryland Baltimore County, earning a B.A. from the former in “Public Health Studies” which involved a thesis from my work in the St. Elizabeth’s neighborhood of north Philadelphia, looking at how health was affected by the housing, crime, educational, and employment difficulties of the community.
After two years of teaching elementary school in Baltimore, I attended U. North Carolina Chapel Hill for medical school and public health.
Why did you decide to go into family practice?
From the days of thinking about a career in medicine, my vision has always been to help bring high quality care to medically underserved communities, and in these settings family medicine will allow me to do a little of everything, to be of most use to the communities I am serving.
What was the impetus for the founding of the Native Health Initiative? What is your role in the organization today?
The Native Health Initiative grew out of a collective decision by community members and health professions students that the lack of attention given to American Indian communities’ health was neither acceptable nor inevitable.
Our goal was to begin working on health projects identified by the Tribes, using health professions students and community members as volunteers to carry out the work.
Your funding for the 2008-9 year was quite modest. Do you have any plans or desire to seek more funding and what do you need to do be more successful at fundraising?
NHI has a different model of funding – whereas many organizations define their credibility by how much monetary funding they are able to acquire, NHI measures how much we can do without monetary funding, using an ethic we call “loving service” in which all volunteers – from clinicians to tribal leaders – are giving from their heart, putting their unique talents and energies into making NHI work.
As an example, we would see our funding for our 2009 Summer Health Justice Internships, with 10 student interns serving in North Carolina and New Mexico, as plentiful.
Yes, we only had $1500 to spend, but we were able to generate 6,000 hours of loving service over the summer!
I think these days particularly show that relying solely on monetary funding is not a great idea for the non-profit, change-the-world efforts.
However, when you focus more on how to equally distribute power, how to ensure that the process of doing the work is empowering to all, and is done from the heart, you find a “funding source” that does not dry up!
How is your organization different from other Native American Organizations?
In no way taking away from the other great work being done, NHI is a unique model for addressing health inequities.
A few things immediately come to mind in terms of how we are different – Returning to Indigenous values that place one’s sincerity and integrity as paramount to titles, degrees, funding.
NHI is working not only to amplify this ethic in our Native communities, but also to bring this wisdom to the University settings to help them improve their work with underserved populations.
NHI sees itself as a global health project.
We have taken the existing model of global health, where wealthy folks from wealthy countries go to volunteer in the “developing world” and have advocated for a more honest version of global health, one that includes the U.S. and its underserved populations.
Thus, we are the only U.S. based program bringing students from abroad to work in settings of health need in this country.
And we can say proudly that our work is being noticed – the Global Health Education Consortium (GHEC) recently awarded NHI as its 2009 Global Health Project of the Year!
How you can effectively impact the healthcare of the Native American tribes you work with when none of your volunteers are licensed, independent medical practitioners?
Our work on health issues has a much different focus than the medical and clinical ways we think of health.
This comes from a very simple foundation of NHI – community leaders identify the health needs, and the issues that have been identified have centered around youth empowerment, for example curbing the high rates of high school dropout, preservation of culture, and health education.
For our volunteers, many of whom are medical and pre-medical students, this is a very eye-opening experience, reminding us that communities see “health needs” in a very different way.
But you cannot argue that the vast majority of inequities in health have little to do with health care, but everything to do with the social determinants of health, the elements far upstream from health care that create unhealthy or healthy individuals and communities.
Can you explain/describe your stated goal of eliminating the use of commercial tobacco and supplanting it with the use of traditional tobacco as a spiritual/healing substance?
Tobacco is a name given to a wide variety of medicinal, ceremonial, and sacred plants in American Indian cultures. Ranging from lavender to “sweet grass”, tobacco is present in almost all Indigenous societies, with one important common theme – it was never a substance of abuse.
When we walk into the local convenience store and see tobacco companies selling “toxic tobacco” with myriad images of Indian chiefs and symbols on their products, we should all be infuriated.
NHI’s Keep Tobacco Sacred campaign is about re-teaching and re-claiming the true intention of tobacco.
In our American Indian communities, we are teaching the traditional and ceremonial uses of tobacco as a way to decolonize the notion that many of them have of tobacco – that I should smoke because that cigarette package has a picture of my ancestor on it. As we say to youth – breathe tradition, not addiction!
August 8th, 2009
Dr. Tony Slonim is a practicing pediatric intensivist, an expert in the study and prevention of medical errors, and a senior healthcare executive. His new book Avoiding Common Pediatric Errors will be published next month by Lippincott Williams & Wilkins. We recently had a chance to speak with Dr. Slonim.
Where are you from?
Originally, from New Jersey, but most recently, I’ve been in the Washington DC region for 12 years prior to moving to Roanoke, Virginia last April.
Where did you go to college and what was your academic major?
I went to NYU. I had a double major in economics and psychology.
You have a nursing degree as well as a medical degree. Why did you decide to become a nurse? Where did you work?
I have always really enjoyed clinical work and wanted to assure that I could professionally care for patients even if I wasn’t successful in getting into medical school.
I enjoyed nursing school very much. Nursing is a great profession and physicians need to have an appreciation for the work that nurses do and their contribution to patient care as a critical member of the healthcare team.
I worked for 3 years at the Mountainside Hospital in Glen Ridge, New Jersey as an emergency department nurse. It was a great opportunity for me to be able to care for patients as both a nurse and a physician in my carerr.
I learned that patients treat their providers very differently. Patients are very formal with their physicians, but will joke around and tease nurses in a way that makes the work very rewarding. I still miss some of the experiences that I had as a nurse.
What was your career path from the end of medical school to your current position?
After medical school, I wanted to open up a private practice near my home town and care for families. I did a combined residency in New Jersey at St. Joseph’s Medical Center in Internal Medicine and Pediatrics.
It was a great experience for me. I couldn’t have selected a better program for my training experience. It was very hands on. Unfortunately, I spent so much time in the ICUs that I actually felt out of place in the office setting and much more comfortable in the ICU setting.
So, I applied to and was accepted in fellowship training at NIH in a combined med-peds critical care fellowship. I received my pediatrics experience at DC Childrens.
My research was focused on healthcare quality and ICU outcomes. I was fortunate in finding a faculty position at DC Childrens after I graduated and remained there until 2007 in a variety of roles related to the administrative side of medicine, specifically focused on medical performance, quality and patient safety. This overlapped nicely with my emerging research interests in quality, patient safety, and medical errors.
Last year, I accepted a position at the Carilion Clinic as the Vice President of Medical Affairs at Carilion Roanoke Memorial Hospital, an 850 bed academic medical center in Roanoke Virginia.
In this role, I help to oversee the provision of quality healthcare with an amazing team of individuals focused on assuring that our community receives the best medical care they can. I continue to write and perform research, since these are two of my personal passions.
You were the Vice President of Medical Affairs at the Carilion system for four days when the tragedy at Virginia Tech happened. How did you hear of the tragedy and what were your initial thoughts when you heard the news?
The Virginia Tech incident was a terrible tragedy for our community and in many ways for our nation and world. There is supposed to be fun and excitement associated with the pursuit of higher education and none of us expects such tragedy to arise on a college campus.
We were notified on the morning of the incident and immediately prepared for the worst. Like any other trauma center, our teams and resources kicked into high gear to assure that we were prepared to handle any victims. Unfortunately, many victims died on the scene and never reached us.
What are the two biggest problems in healthcare today?
I think that currently the two biggest problems are one of value and mis-allocation.
First, I’ll discuss the value issue. As a wealthy country that spends an exorbitant amount of resources on healthcare, we should be realizing healthcare outcomes that are the best in the world. Unfortunately, this is not the case.
I believe healthcare quality and efficiency can be improved so that patients receive healthcare of greater value. I believe in this for my own organization and I believe that more broadly through quality research and publications, we might be able to help others accomplish these goals too.
Second, I am concerned about the misallocation of care in this country. While we have certain areas where there is waste, this is contrasted with pockets of maldistribution of providers and lack of fundamental healthcare services. These inequities should not be allowed to continue to exist.
What would you say to a college senior who said “I just got into both Harvard Med and Harvard Law. Do you have any advice for me?”
I believe that career choices are a very personal experience. Rarely do you know why or how you come to a certain career decision.
I’ve never been an attorney, so I don’t know how rewarding that profession might be. For me, medicine is something I’ve wanted to do since I was in grammar school…a calling of sorts, although that sounds very cliché.
Despite the opportunity I get to contribute broadly to caring for populations of patients through my writing, research and administrative work, the biggest personal satisfier for me is caring for a critically ill patient and their family in the ICU.
Despite all the first authored papers, books and grants, the thank you notes from my patients hold the most special place for me in my professional life.
Being a physician for me is a privilege. It something I always wanted to do, but wasn’t sure that I would be able to achieve. So, I treasure every moment I have in this profession. It is pretty interesting.
Approximately five years ago, I had a serious illness and saw healthcare from the other side of the bed. I never would have realized just how attached a patient could be to their providers.
I was so appreciative of not only the medical care, but also the compassion and warmth exhibited by so many members of my clinical team for what could have been a disastrous life event for me and my family.
Why have medical errors not really decreased since the landmark 1998 study by the Institute of Medicine?
With all of the attention and all of the press around medical errors, I think that fundamentally, the system is designed incorrectly and will continue to lead to outcomes that fail to meet our expectations.
In order to be successful at improving healthcare in America, we need to reexamine the things we’re doing and assure they add value to the healthcare experience.
Patients are sicker, providers are working harder than ever, our incentives are misaligned and our patients are not getting the care they deserve. To some extent, I believe we need to start with a clean slate.
You have written several medical textbooks, Which is your best one and why?
I have been fortunate in being able to participate with some great people while writing my textbooks. Each book really helps me to learn new things about the practice of medicine and about myself.
I am very proud of several categories of books I’ve written. The first category is aimed at helping physicians study for board examinations. I have published approximately five books in this category aimed at internal medicine candidates, pediatrics candidates, and critical care candidates.
The second category is aimed at helping doctors to be better doctors. This is work that we’ve collaborated on for the Common Medical Errors Series. I will have published three books in this category aimed at helping clinicians perform better.
It is quite a privilege to be able to help patients ‘remotely’ by contributing even in some small degree through the education of our colleagues, fellows, residents and students and I take great pride in that work.
I hope that maybe over the years I might have contributed a clinical pearl or nugget to another provider that was able to be used to benefit a patient.
Finally, the third category is the textbook I wrote with Murray Pollack called Pediatric Critical Care Medicine. This work was a core textbook in the discipline of pediatric critical care medicine and was certainly the most challenging project I’ve been involved in with over 120 contributors and the opportunity to frame the state of practice for this discipline.
What one thing in your career would you do over again if you had the chance?
Things fall into place for a variety of reasons. I would have never planned to go the route I went through my schooling and education, but it certainly has worked out well for me and provided me with insights and an opportunity to view the world and be informed with a variety of different lenses, which contributes to my work on a daily basis.
What innovations are you trying to implement in the Carilion System?
I accepted the position at Carilion because of the outstanding leadership team and the dedication of that team to the community we serve.
For me, healthcare and public health are very important principles. I believe that if we’re successful, every individual patient and family will feel as though they’ve been treated with the best that US healthcare has to offer and that the care for the populations and communities we serve will actually improve.
To that end, our approach to caring for patients is fundamentally different. We have a number of physicians in leadership roles and they are paired with administrative partners who work as dyads to both understand and improve the way care is delivered for patients in our communities.
I believe that this will allow us to focus on things that are important for our patients’ outcomes and deliver on results.
What motivates you to get out of bed in the morning?
The feeling that today I might make a difference in someone’s life and make them feel as though the care they or their family member is receiving makes them feel as though they are the most important person in the world.
Disclosure: the interviewer has collaborated on several book projects with Dr. Slonim
May 3rd, 2009
Jennifer Brumbaugh is a formally trained medical illustrator at Thomas Jefferson University. She specializes in medical illustrations of the pancreas. We recently had a chance to sit down and talk with her about her career.
Where are you from?
I was born on Barksdale Air Force Base in Louisiana but most of my childhood was spent in Pennsylvania. I consider myself a Bucks County native.
Where did you go to college and what was your academic major?
I graduated from Penn State with a BFA in Fine Arts and a minor in Art History. But I also went to Syracuse and the University of Colorado before ending up in Happy Valley.
What was your career path from college to your current position?
After Penn State, I worked as a waitress full-time for a few years while I went to night school. I knew that I wanted to apply to graduate programs in medical illustration but needed to build up my portfolio and finish the science requirements.
I took art classes at the Pennsylvania Academy of Fine Arts to build up my traditional skills and portfolio and finished my science courses at Thomas Jefferson University.
I started at Johns Hopkins in 1997 and graduated in 1999. For my thesis project, I chose to develop an educational website for patients with pancreatic cancer.
While working on the project, I met the (current Chair of Surgery at Jefferson.) I wanted to build up some web development skills before I graduated and started job hunting.
That job hunt never started. I ended up being hired by my preceptor, Dr. Ralph Hruban, in the Department of Pathology at Johns Hopkins. I expanded upon my thesis project and ended up working there for 7 years in the Informatics Division. It really was a very long extension of my educational experience at Hopkins. I had the luxury of learning a lot on the job.
Fast forward to October 2005, I was married, 7 months pregnant, living in Philadelphia and driving to Hopkins a couple times a week. The phone rang one day and the (Jefferson Surgery Chair) called to ask me if I’d be interested in working with him at Jefferson. It was a no-brainer.
I’ve been at Thomas Jefferson for almost two years now as a Webmaster and Medical Illustrator.
How old were you when you realized you had artistic talent?
I’ve been drawing as long as I can remember. I guess I started to realize that I had some talent during high school. I attended weekend classes at Moore College of Art. That was a defining experience.
Why medical illustration and not some other area of art?
I appreciate art for art’s sake but the idea of working by myself in a studio and trying to exhibit and sell pieces doesn’t appeal to me. I enjoy “commercial” work – photography, graphic design and illustration. Some of my classmates would say that I “sold out”.
But, I love being able to use my knowledge and skills to make a living. I had seriously considered applying for medical school before I heard about medical illustration as a career.
My fine art work was mostly figure drawing and I have always been fascinated by anatomy, so medical illustration was the perfect fit.
Can you describe the courses you took in your medical illustration training? Did you have to take a gross anatomy course in your medical illustration training?
I went to the Art as Applied to Medicine Program at Johns Hopkins, one of only four programs left in the country. It’s a two-year master’s degree program.
The first year we took Gross Anatomy, Histology, Comparative Pathology and Cell Biology with the first year medical students along with several illustration courses covering traditional and digital techniques.
The first part of the second year was mostly comprised of observing and sketching in the operating rooms and autopsy room. Then the rest of the program was spent working on our thesis project.
Who is the top medical illustrator of all time?
Being a Johns Hopkins graduate, I would have to say Max Brodel. He was born in Leipzig, Germany and arrived in Baltimore in the very late 1800’s. He worked at Johns Hopkins with some legendary surgeons including Howard Kelly and Thomas Cullen.
He was the founding director of the program I attended. The archive of all his work is housed next to the student studio space at Hopkins and available to study. His pen and ink and carbon dust illustrations are absolutely mind blowing.
Do you draw either for fun or profit that is not medical illustration?
Unfortunately, it’s been a very long time since I’ve done any artwork just for the fun of it. I do miss it but spending time with my 2-year old daughter trumps everything else right now.
Did you ever have any squeamishness looking at surgical procedures or cadavers?
I am usually so fascinated that I don’t really think about it. The only part of surgery that does bother me sometimes is the incision.
I was fine with the cadavers but autopsy was pretty unnerving at first.
What part of the body is hardest for you to draw?
I don’t necessarily find any part difficult to draw. I find surgical illustration to be a huge challenge.
The drawing is often the easiest part. It’s the composition of the illustration that is difficult- to make sure that not only the anatomy is correct but that the sequence of events, techniques, and instruments are accurately depicted.
What is your preferred medium in doing medical illustration?
I always go back to simple pencil and paper. It’s what I’m most comfortable with.
How has the computer changed medical illustration?
It’s really just another medium and tool in our bag of tricks. When illustrators first started to use computers to render their images, the artwork looked very stiff and flat and the artist’s touch was lost.
But, as time went on illustrators figured out how to use the computer to the best of their advantage. A very popular technique is to do the original sketch in pencil on paper, scan the drawing in, and add color with the airbrush tool in Adobe Photoshop.
Another technique is to customize brushes in Adobe Illustrator that recreate the variability of tradition pen and ink.
For me, the best part of working on the computer is being able to fix mistakes easily. There’s nothing worse than working on an intricate illustration with a traditional airbrush and have it spit paint everywhere. That doesn’t happen with the computer and if it did, you could just undo it.
How do you prevent your work from pirated or illegally copied, particularly on the Internet?
When I first started working, I looked into all different ways of protecting my work with watermarks and digital signatures. But there are ways to get around that.
If I’m really concerned I will put a watermark over the image but other than that I just keep the files small and at screen resolution so they won’t print out well.
April 5th, 2009
Dr. David Feldshuh is a working emergency room physician and the director of the theatre program at Cornell University in Ithaca, New York. He is also an accomplished playwright whose play Miss Evers’ Boys was nominated for a Pulitzer Prize in 1992. We recently spoke with him.
Where are you from?
Born in New York City, first nine years raised in the Bronx. I could hear the cheers from Yankee Stadium.
How disappointed were you when Miss Evers’ Boys did not win the Pulitzer?
I received a call from the LA Times asking where I would be at 3 p.m. because I had been nominated for the Pulitzer Prize in drama.
At first I thought it was a joke. When I realized this was an actual reporter, I said that, unfortunately, I wouldn’t be available. The reporter was insistent and I repeated that I wouldn’t be available. He suggested that perhaps I was working in the hospital.
I said again that I wouldn’t be available. I knew two things. I had written the best play I could.
Secondly, I had a group tennis class at 3 p.m. and needed to be there for my classmates to play doubles. I was more than honored to be nominated.
How did you become interested in the Tuskegee Experiment and how did that interest get turned into a play?
I read Bad Blood by Professor Jim Jones. It’s a terrific book that combines historical perspective with personal narrative.
I first saw mention of the book when I was thumbing through the Journal of the American Medical Association when I was a resident in emergency medicine in 1980.
What is your weekly schedule like? How many hours do you work as a physician and what are your duties?
I work 1 or 2 shifts a week (7.5 hours each) at a busy (4-6 patients an hour), free standing urgent care center that is unusual in also diagnosing (hopefully) abdominal pain, vaginal bleeding, mental status changes, chest pain, etc.
This is not from choice but because our patient population frequently believes they have arrived at the ER.
Do you support a national health plan for the US where all citizens are insured?
Yes, I do.
The obvious question is how to accomplish this goal and put more resources into patient care and less into redundant administration that treats physicians as corporate employees or worse with the result that physicians lose the sense of caring that interested them in medicine in the first place.
This is a huge challenge and a worthy goal. But, I suspect a number of false steps will be taken before a viable system is constructed that recognizes the value of fostering a personal relationship between physician or other caregiver and patient.
By the way, I’m a big fan of the many dedicated, knowledgeable and humane nurses, PAs and NPs in practice.
What theatre or arts project has been the most fun for you?
I was trained in and enjoy directing productions with large casts and grand, theatrical gestures.
Plays such as Cyrano de Bergerac or Shakespeare plays hold special challenges with respect to interpretation and execution.
Because of economics, fewer and fewer directors have experience in directing large productions with many actors which I find sad because I have found this kind of production among the most exciting.
When you teach Fundamentals of Directing I and II, what does the syllabus consist of?
Although I had been directing professionally for twenty years, it took me five years to create my own approach to teaching directing.
Essentially, I surveyed many productions and asked a simple question – “Why and how does this scene effectively engage an audience?” I then created a list of roughly 50 techniques and exercises that I believed all successful scenes employ.
In the first directing class I teach these techniques. In the second directing class students apply these techniques to directing three very different scenes.
By the end of the sequence, students know more than they can do but they are, I believe, in a position to continue to learn from making and watching theatre.
What is your strength as a director?
I hope my strengths are a clear vision, the ability to inspire confidence in a team of creative artists toward achievement of a common goal, visual excitement, and insight into helping less experienced actors achieve credible performances.
Who is your favorite playwright?
Shakespeare. He writes plays that demand a point of view and combine theatrical insight with deep character analysis.
What is your current theatre project?
Leonard Bernstein’s Mass is my current theatrical project. It’s a huge opera/theatre piece that originally opened the Kennedy Center in Washington and that will involve in our production over 130 singers.
I will direct Mass in the spring of 2009 as part of the 20th anniversary season of Cornell University’s Schwartz Center for the Performing Arts, where I am Artistic Director and a professor in the theatre department.
What would you do differently in your career – either in theatre or medicine?
I tell my students that despite the fact that people continually instruct that you must make a choice, if you are lucky you can have more than one passion.
I am lucky to be able to work and teach in theatre and continue my fascination with medicine and patient care.
I wouldn’t do anything differently but I suspect that if I had remained in medicine fulltime, I would be working today at the remarkable institution where I completed my emergency medicine residency – Hennepin County Medical Center in Minneapolis.
Each summer when I return to Minnesota for the summer I stop into the Department of Emergency Medicine’s critical care weekly conference.
I am always in awe of the depth and breadth of current training and practice in emergency medicine as well as the insistence that growth can only come from self-critique in an objective and non-punitive environment.
How often do you get to Broadway to see a show?
Roughly 10 times a year. Ithaca is 4 hours from NYC and I love seeing productions that are stunningly written, acted, or directed. My most recent visit was to the musical, Passing Strange.
What is your “still to be visited” top travel destination or site?
My “travels” take me to new learning experiences but are not linked to places. I love to take new courses, courses in which I return to being a beginner. Most recently these “places” include fly fishing and Chinese brush painting. Learning always feels energizing to me and the scope of learning in both theatre and medicine continues to fascinate me.
April 4th, 2009
Elliott R. Haut, MD, is a trauma surgeon and critical care physician at Johns Hopkins Hospital. He has recently published
Avoiding Common ICU Errors.
Can you describe your current research projects?
My current research interests fall into two main categories. The first is outcomes related to the system of trauma care.
My research group uses information from large databases to determine the best system to treat trauma patients.
We are currently working on a project that hopes to answer the question of, “What saves lives after major trauma?
The system or the surgeon.”
My other main interest revolves around deep vein thrombosis (DVT). DVT has been suggested by multiple national
agencies as an important quality of care marker as a preventable complication.
However, my research has shown that there may be inherent flaws in using simple hospital DVT rates, and that these rates
alone are not valid markers of the quality of care.
As we look more closely for DVT’s, we find more, and we might therefore be labeled as providing poor quality of care,
as measured by DVT’s found, when we are actually looking harder for these complications to treat proactively.
I recently wrote an invited commentary on this touchy, yet nationally important, subject entitled “Venous Thromboembolism:
Are Regulatory Requirements Reasonable?” for the Society of Critical Care Medicine’s newspaper.
What publication are you most proud of?
From a trauma system standpoint, my article titled “Injured Patients Have Lower Mortality When Treated By ‘Full-Time’
Trauma Surgeons Vs. Surgeons Who Cover Trauma ‘Part-Time’” will have the most impact.
This project is helping to establish trauma surgery as its own separate field by showing scientifically that those physicians
having an expertise and a specific body of knowledge of trauma surgery improves outcomes for injured patients.
In terms of “cool”, the article in Rolling Stone Magazine (March 6, 2003) is at the top of the list.
I was in the right place at the right time during my trauma fellowship, when Rolling Stone came to Penn to do an article on
violent trauma in Philadelphia.
My boss at the time, Bill Schwab, asked me to show the writer around and make us look good. Next thing I know, there I am
written about and quoted in Rolling Stone.
Why is there so much penetrating trauma in the neighborhood around Hopkins?
If I could answer that, I would do it and fix the problem. Unfortunately, it is multifactorial, with so many interrelated reasons.
Partially, it is related to a culture of violence- the media, music, movies, and television portraying violence as culturally acceptable and even admirable behavior.
One of my mentors, Eddie Cornwell, has been working tirelessly to fight urban violence and he is currently promoting
public service announcements and a video called Hype Versus Reality, showing people what it is really like to be shot, not the
glamorized way it is portrayed in movies, TV, or music videos.
If you could be known for solving one clinical problem, what would it be?
I think this would have to be the problem of DVT. Deep vein thrombosis and
pulmonary embolism are the number one preventable cause of death in hospitalized patients.
Up to two million patients per year may be affected by DVT and PE, and more people die of this than breast cancer and
AIDS combined each year.
It is a huge public health problem that really has not received the media attention that it deserves.
The American Public Heath Association has called it a “silent epidemic” and the following link can explain how big a problem
this is in American healthcare. http://www.apha.org/NR/rdonlyres/A209F84A-7C0E-4761-9ECF-61D22E1E11F7/0/DVT_White_Paper.pdf
What would you say to a bright young medical student who is thinking about going into general surgery?
GREAT! As a general surgeon, especially an acute care / trauma / critical care surgeon, you will be well trained to deal with
any clinical problem that comes your way.
I can diagnose and treat nearly any acute surgical or medical emergency. We are perfectly qualified to take care of all types of sick patients whether it is in the emergency department, operating room, or Intensive Care Unit.
The pendulum has swung towards super-specialization within medicine, but we as acute care surgeons are giving some pushback.
We can deal with many complex difficult issues in a wide variety of fields.
Do you support the move by The Centers for Medicare and Medicaid (CMS) to not pay hospitals and providers for “preventable mistakes.”
Clearly, physicians should be held accountable for providing appropriate treatment and employing the best practices to
avoid preventable medical errors.
However, CMS has to identify “preventable” complications very carefully. Some complications can happen even if we do our
best to avoid them.
What gets you out of bed in the morning?
As a trauma surgeon, I start each day not knowing if that will be the day I save a life.
I have many patients out there who have been through multiple huge operations, weeks in the ICU, dozens of units of blood transfusions,
and long rehabilitation stays who now are back as functioning members of society.
There is nothing more amazing than shaking someone’s hand a year after his or her injury and saying, “You are all better. Congratulations. You don’t need me anymore. I hope to never see you again.” That’s what gets me out of bed in the morning.
Disclosure: the interviewer is a former staff member at Johns Hopkins Hospital and has co-edited a medical manuscript with Dr. Haut.
March 28th, 2009
Elliott R. Haut, MD, is Assistant Professor of Surgery at the Johns Hopkins Hospital in Baltimore, Maryland. He is a specialist in trauma surgery and critical care medicine. We recently had a chance to speak to Dr. Haut about his medical career and interests.
Where are you from?
I grew up in the suburbs outside of Philadelphia. I also lived in different parts of the city – West Philly, Society Hill, Rittenhouse Square – for another 12 years.
Where did you go to college and what was your academic major?
I went to Brown University in Providence, Rhode Island where I majored in chemistry and economics.
The best thing about my time at Brown was meeting my wife, which happened on the first day of freshman orientation.
Ironically, when I took my first faculty job, the other two people in my division were also Brown University graduates.
What has been your career path from college to your current position?
My career path was one of the most direct routes possible- high school, college, medical school, internship, residency, fellowship, and right into my first academic job.
This traditional pathway is not the only way to get where I am; it just seemed to work out well for me at the time.
What do you like most about practicing at Hopkins?
I would have to say that my favorite thing about working at Johns Hopkins is the joy I get from the people I work with.
I have an incredible group of colleagues on the trauma service and in the Intensive Care Unit.
This includes not only the attending physicians, but the fellows, residents, interns, medical students, nurses, respiratory therapists, pharmacists, social workers, physical, occupational, and speech therapists, as well as countless other people that makes what we do possible.
Nothing gets done in a vacuum. It all gets done with this amazing teamwork.
What do you like least about practicing at Hopkins?
Despite Hopkins’s great reputation, it is still like other hospitals in the country where we struggle to get things done with limited resources.
There are never enough facilities for testing, therapists for rehab, doctors for consults, phlebotomists to draw blood, and critical care transport teams to move patients around the hospital.
If you weren’t a doctor, what would you be doing?
My training and focus has made me an expert in my field of trauma-critical care.
If I couldn’t be a doctor, I’d probably own a toy store, become a park ranger, or be a professional poker player.
What are your current clinical interests?
I am primarily a trauma surgeon, and my main clinical role is the
actual hands on care of injured patients.
East Baltimore is kind of a tough neighborhood and we see many patients with penetrating trauma, meaning stab and gunshot wounds.
I also practice acute care and elective general surgery and spend time dedicated in the Intensive Care Unit (ICU) as a critical care intensivist, dealing with the sickest of the sick patients.
In addition, I perform bedside procedures (percutaneous tracheostomies and endoscopically placed feeding tubes) in the ICU, saving patients from the traditional trip to the operating room.
I love the variety that trauma, acute care surgery, and the ICU brings. I rarely do the same operation twice. I never know what I am going to do until it happens.
Related Posts
Elliott Haut, MD – Trauma Surgeon and Book Author (Part 2 of 2)
Disclosure: The interviewer is a former staff member at the Johns Hopkins Hospital and has coedited a medical manuscript with Dr. Haut.
March 26th, 2009
Kurt Shutterly is the Vice President for Operations at the organ procurement organization Center for Organ Recovery and Education. One of 63 federally mandated OPO’s, CORE covers central and western Pennsylvania, southern New York, and West Virginia and and has one of the largest volume organ procurement rates in the country. We recently had a chance to meet with him to discuss organ tranplantation.
Where are you from?
Belle Vernon, Pennsylvania
Where did you go to college and what was your academic major?
I went to Penn State University right out of high school majoring in Criminology. I completed three and a half years of college and saw that there wasn’t much of an opportunity for obtaining a job that paid well and left the school.
I got married and worked in the family business until I decided to attend nursing school to become an RN.
What has been your career path from college to your current position?
I worked in the family trucking business for eight years until we had our first child in 1990. I didn’t like being away from home and decided to enter nursing school.
Upon graduation, I worked at Washington Hospital as a critical care nurse and left the hospital in 2000 to work for The Center for Organ Recovery & Education (CORE) as an organ procurement coordinator.
I left CORE for a short time to work as a Clinical Liaison for LifeCare Hospitals of Pittsburgh and returned to CORE in 2005 as the Director of Professional Services and was promoted to VP, Clinical Operations in 2007.
What is the biggest misconception that public has about organ donation and transplantation?
There are some misconceptions that we work hard to eradicate.
The most common misconception is that if a person is designated as a donor on his or her driver’s license and is in an accident, the medical community will not work as hard to save his or her life. Nothing could be further from the truth.
Each physician and medical professional working on patients take all life saving measures to save the patient. That is first and foremost in the medical team’s minds.
In fact, the medical team working on patients has no knowledge about the patient’s choice to be an organ donor. The attending medical team is totally separate from the transplant team.
What are your current views on the New Jersey case where an oral surgeon was recovering and distributing tissue without consent from families and without testing?
This case made news because it was extremely unusual and illegal. The justice system and the medical “checks and balances” system worked in the way these systems are designed to function.
It is good to know that our justice system is healthy and working to bring any illegal activity to an end.
Why hasn’t the organ donation rate improved appreciably in the last 15 years?
Transplantation and donation are not new concepts. The miracle of the gift of life is a mature concept and people tend to think less of something that is not “new”.
We work hard each day to fulfill end of life wishes of those designated as donors, despite the critical need for donors.
What are your specific job duties?
My title is Vice President of Clinical Operations with The Center for Organ Recovery & Education. I’m responsible for the day to day operations of the clinical staff related to organ, tissue, and eye donation.
What organs are the most difficult to recover?
Heart and lungs due to the changes that occur when a patient progresses to brain death. There are approximately 100,000 people awaiting a life saving organ transplant.
What happens when a patient’s drivers license says yes to donation but the family says no?
In Pennsylvania and West Virginia, driver’s license designation is legal first person consent. By law, this designation means the person’s end of life wishes are to be fulfilled.
Should a family have questions or concerns, we work with each family member to help educate them. In our experience, most families are comforted by the fact that their loved one lives on in another.
Organ procurement organizations also have many donor family resources, bereavement resources and special recognitions to help the families through the difficult grieving period.
What is the hardest part of your job?
The unpredictability of donation. Our organization is not a 9-5 job; we are responsible to the hospitals and donor families all hours of the day and night.
I have a strong support system at home that allows me to fulfill my administrative responsibilities at CORE.
How do you respond to the resentment people have about foreigners coming into the United States and paying cash for their organ transplant?
Personally, I have not experienced this resentment. The law in the United States precludes payment of organ donation/transplants.
How do you rate the Bush administration in terms of furthering organ donation?
The federal government has been very supportive of donation and transplantation. Organ procurement organizations work closely with the federal government to ensure quality and credentials are upheld.
The change in administrations should only continue the support of donation and transplantation.
What do you do to relax?
Any time that I can spend with my wife and teenage children helps me unwind. I volunteer in the local youth sports programs and I’m a PIAA football referee during the fall.
Disclosure: The interviewer is a former transplant surgeon and as by required by state law has referred patients to CORE for evaluation for organ donation.
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