June 10, 2008

Provider-side issues in physician-patient relationships

Rahul K. Parikh is a doctor and writer for Salon. He recently wrote and article for the New York Times concerning the ability and ethics of a doctor rejecting people as patients. Parikh emphasizes that his situation is not about directly denying provision of care:

The physician-patient compact basically states that a doctor will care for a patient in exchange for compensation and that the patient will heed the doctor’s advice. Patients who disagree with their physicians, or just dislike them, are free to go elsewhere.

By the same token, this mutual contract gives a doctor the right to dismiss a patient. The most obvious reasons are failing to pay or missing multiple appointments. Refusing to adhere to treatments can lead to dismissal. So can being abusive to the medical staff.

Of course, we need to exercise this option sensibly. Doctors cannot fire a patient in dire straits like severe pain, bleeding or a life-threatening situation. And of course, we cannot refuse to see patients because of their race, age, sexual orientation and so on.

When I read this article I felt disturbed. The article ends with Parikh considering whether to tell his colleague - the mother's new physician - about his experience with them. He writes:

I decided to keep quiet. After all, it could have just been me.

While it was apparent that the mother was being non-compliant and even hostile towards the concept of preventive medicine for her asthmatic son - the patient was the son, not the mother. Parikh "fired" his basis on the grounds that the mother's refusal for preventative care was dangerous to the son, but at the same time he did not make an effort to explain why preventive care is important. This is particularly striking as he claims that preventive care is embedded in his DNA.

The concept of "firing" a patient becomes even more delicate when we factor in race. The relationship between race dis-cordant physicians and patient is already rocky. Ironically, Parikh has written an article based on Burgess and van Ryn's studies on the role of race and ethnicity within physician-patient relationships. Due to factors like pressure to make a diagnosis within a short period of time, stress, and lack of cultural knowledge on the physician side, it is easy to rely on internalized stereotypes and feel frustrated by patients enough to create bad feelings. This often results in poorer health outcomes for the patients.

Even class and sexual orientation can affect the physician-patient relationship just as much as race. To avoid these rash decisions, it's important to educate physicians on how to interact with patients and create interventions to act upon in certain situations.

For those interested in supplemental reading:
- The reader comments from the NYT article are interesting
- Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping (Burgess, van Ryn, et al)
- Reducing racial bias among health care providers: lessons from social-cognitive psychology (Burgess, van Ryn, et al)
- Why do providers contribute to disparities and what can be done about it? (Burgess, van Ryn, et al)

June 3, 2008

First-person: Providing Abortions

Retired gynecologist Waldo Fielding writes an essay for the New York Times on his experiences encountering at-home abortion attempts during his training during 1948-1953 . Needless to say, many of these attempts were failures and resulted in harm to the women themselves. Fielding's memories are quite clear so some might find the reading a bit squeamish.

Complications from surgically induced abortions is minimal; fewer than 0.3% of abortion patients experience a complication that requires hospitalization[1] and abortions performed in the first trimester pose virtually no long-term risk of such problems as infertility, miscarriage or birth defects, and little or no risk of pre-term or low-birth-weight deliveries.[2]

The societal hostility to abortion has also lead to a hostile medical environment. Although some hospitals offered abortion services alongside other reproductive health services, many no longer do so. As of 1998, the percentage of abortions performed in hospitals hovered at 7%, continuing on a downward trend.[3] 91% of abortions were performed at clinics, with 2% unaccounted for. [4]

Fielding writes:

What Roe said was that ending a pregnancy could be carried out by medical personnel, in a medically accepted setting, thus conferring on women, finally, the full rights of first-class citizens — and freeing their doctors to treat them as such.

Personal beliefs and philosophies aside, denying people the right to health care is unethical. Of course, while this occurs indirectly through lack of health insurance or others barriers of access, what we can do at least is to allow people to seek the care they need instead of criticizing their attempts.

1. Henshaw SK, Unintended pregnancy and abortion: a public health perspective, in: Paul M et al., eds., A Clinician’s Guide to Medical and Surgical Abortion, New York: Churchill Livingstone, 1999, pp. 11–22.
2. Boonstra HD et al., Abortion in Women’s Lives, New York: Guttmacher Institute, 2006.
3. Almeling, Rene et al. Abortion Traning in the US Obstretics and Gynecology Residency Programs, Family Planning Perspectives, 2000, 32(6):268-271 & 320
4. Ibid

For another first-person perspective concerning abortion, Susan Wicklund has written "Common Secret: My Journey as an Abortion Doctor." There is also a short NYT article about her as well.

April 10, 2008

Hello, Spring

Last Monday

Last Friday

November 17, 2007

Eating on campus

I usually bring my lunch to campus. It is less expensive than buying my lunch, although it is more convenient to buy lunch. Some mornings, time flies by and I either make an unbalanced meal or simply give up.

If you are on the West Bank of the Minneapolis, around the medical sciences area, I recommend going to the Fairview Hospital. Take the elevator to the eighth floor and you will arrive at the doors of the hospital cafeteria. Their prices are reasonable compared to eating at University-contracted places, and more importantly health conscious. While you can get fried foods - their french fries are very good - they always have a nice salad bar and some sort of healthy meal set of the day.

I am slowly converting my friends and acquaintances to Fairview's cafeteria. The penthouse-like view of the city from three of four walls helps immensely.

November 10, 2007

Better than a floppy disk, Possibly better than an USB drive

It wasn't too long ago when my friends and I relied on floppy disks to transport our important research papers and homework around campus. Unlike a zip drive, they are both cheap and small. However, it was easy to leave them at the computer lab and because of their frail nature, they were damaged easily, rendering hours of work null. They also did not have a large capacity, so the increasing demand for class projects in the form of PowerPoint presentations created some conflict.
Cinco ou seis anos há - não que tempo comprido - quando meus amigos e eu confiamos em discos flexíveis para transportar papéis importantes e tralbalho em torno do campus. Ao contrário de um zip drive, são baratos e pequenos. Entretanto, era fácil deixá-los no laboratório do computador e por causa de sua natureza frágil, foram danificados fàcilmente, rendendo zero horas do trabalho. Também não tiveram uma capacidade grande, assim que a demanda crescente para projetos usando PowerPoint criou algum conflito.

The summer before my junior year my father gave me a 256 megabyte USB jump drive. They were still very new in 2003, and few students carried them. Also, they were expensive; mine was about US$50. However, 256 MB is a great improvement over 2.4 megabytes and I was quick to sing its praises.
O verão antes de meu ano terceiro, meu pai me deu um USB drive com 256 megabytes. Eram ainda muito novos em 2003, e poucos estudantes carregaram-nos. Também, eram caros; meu era sobre US$50. Entretanto, 256 MB é muito melhor do que 2.4 MB e era rápido cantar seus elogios.

My father recently bought me a 2 megabyte USB drive for under US$20. Actually, since it was part of a buy one, get one free promotion at a local electronics store, it was really US$10.
Recentemente meu pai comprou-me uma USB drive com 2 MB para US$20. Realmente, desde que era uma venda - compra uma, receba outro livre em uma loja eletrônica, ele era realmente US$10.

While I do use this to save the PowerPoint lecture notes that all my professors are quite fond of, I have also become enchanted with Google Documents. Unless you forget the password to your Gmail account, there is little chance of losing track of your papers. Any computer, regardless of operating system or version of operating system, can read Google Documents, which also has a spreadsheet component. I have not utilized this yet. I also enjoy the collaborative aspect; you can share documents with others. This is helpful when working on a group project.

October 22, 2007

It's the middle of October, really?

I only realized last week that a third of the semester has gone by. How did that happen?
The past three weeks I have had exams for Epidemiological Methods 1, Biostatistics 1, and Economics of the Health Care System. One exam a week. That doesn't sound too bad, as opposed to three exams in one week, but somehow I was unable to study enough for them. I resolve immediately to change this!
A última semana realizei de repente por que um third do semester foi. Como isso aconteceu? As três semanas passadas, tive examens para Métodos Epidemiological 1, Biostatistics 1, e Economia do Sistema do Cuidado de Saúde. Tive um exam um a semana. Não é demasiado mau, ao contrário de ter três exams em uma semana. Mas era incapaz de estudar bastantes para eles. Resolvo imediatamente mudar este!

October 14, 2007

Almost two months

It's been almost two months since I've moved to Minneapolis. I arrived on Wednesday, August 22 at 9:55pm. That sounds neither like a short time or a long time. However, I feel like it has already been a long time since I moved here.
Tenho estado em Minneapolis quase dois meses. Chegui na Quarta-feira, Agosto 22nd em 9:55 na noite. É nem uma estadia longa nem uma estadia curta. Embora, sinto como tenho vivido aqui já para por muito tempo.

Minneapolis is much bigger than Madison. This campus is also widely spread out. Fortunately, the buildings in which I have classes are close together.
Minneapolis é muito mais grande do que Madison. Este campus é mais expansivo. Felizmente, os edifícios em que tenho classes são próximos junto.

I live in the Como neighborhood (not to be confused with Como Park). My house is equidistant to the St Paul and Minneapolis campuses. Currently I bike to school; this takes around fifteen to twenty minutes. I am a slower cyclist, but it is more convenient than taking the bus. I hope that I can continue to bike in the winter.
Vivo na vizinhança de Como (para não ser confundido com o parque de Como). Minha casa é equidistante aos campuses do St Paul e do Minneapolis. A corrente, ando de bicicleta à escola; chegou antes quinze a vinte minutos. Eu sou um cyclist mais lento, mas é mais conveniente do que andar de ônibus. Espero que eu possa continuar a andar de bicicleta no inverno.

My bedroom in the beginning/Meu cuarto de dormir a princípio

August 15, 2007

bom dia

o mundo


    Name: Melissa Lo
    Status: Masters of Science Candidate
    Program: Health Services Research, Policy, and Administration
    Division: Health Policy and Management
    School: School of Public Health


    My areas of interest are data analysis, health disparities, and policy analysis.

    My house is equidistant to both the Minneapolis and St Paul campuses.

    I ride a 1995 Specialized Hardrock with a cro-mo frame.

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