Caring for Patients Using Sign Language: The ADA Legacy of George H.W. Bush

By Ami Bhatt, MD, FACC
December 6, 2018

On July 26, 1990, President George H. W. Bush signed into law the Americans with Disabilities Act. The ADA was touted for promoting health as well as civil rights.

I learned first-hand about the experience of patients with disabilities by caring for patients with concomitant congenital deafness and congenital heart disease. I am fortunate to have cared for a cadre of these patients with a dedicated sign language interpreter over the past decade. She represented me to the patients and the patients to me. Importantly, in addition to translating language, she expressed the tone of voice and achieved the delivery of emotions which are essential to effective and compassionate communication. She was also a trusted partner in my practice of medicine. Since she also knew my patients’ histories, I could trust her to accompany the patient at other doctors’ visits, to help the patient communicate what I had shared, and vice versa. Continue reading “Caring for Patients Using Sign Language: The ADA Legacy of George H.W. Bush”

The Science of Health Care Improvement: Overcoming Unintended Variation

By Ted James
November 29, 2018

“Uncontrolled variation is the enemy of quality.”
– Edwards Deming

Widespread variations in clinical practice that cannot be explained by differences in medical condition or patient preference are routinely observed across multiple specialties and clinical settings. The problem with unexplained variation in health care is that it negatively impacts clinical outcomes, increases the cost of care, and diminishes value for our patients. Continue reading “The Science of Health Care Improvement: Overcoming Unintended Variation”

Optimizing Motivation Theory for Medical Training: Teaching on the Wards

By Eric Gantwerker MD, MMSc (MedEd), FACS
November 15, 2018

As we take theory to practice we discuss what motivates our trainees to learn and how can we use motivational learning theory to promote deep and meaningful learning among our trainees.

Self-determination theory (SDT) purports that humans are by nature curious and have the desire to learn.1,2 SDT underlies the concept of motivation; described as a continuum from amotivation (lack of motivation) to extrinsic motivation (external rewards) to intrinsic motivation (inherent interest).3 A closely related concept is self-regulated learning (SRL), described by Zimmerman et al., that delineates the complex interplay between motivations, learning, assessment, and metacognition that impacts effective learning processes.4,5

Intrinsic motivation and SRL have been associated with deeper forms of learning, improved performance, increased interest, commitment, and satisfaction.2,3 As we take theory to practice we discuss what motivates our trainees to learn and how can we use motivational learning theory to promote deep and meaningful learning among our trainees. Strategies to foster intrinsic motivation and SRL have been tied to three basic psychological needs: autonomy, competence, and relatedness.1,2 In addition, some common practices are discussed regarding their impact on motivation and SRL. Continue reading “Optimizing Motivation Theory for Medical Training: Teaching on the Wards”

HMS Online CME Courses Approved for MAT Waiver Training

by The HMS CME Online Team
November 2018

NP and PA MAT Waiver Training

Through the Comprehensive Addiction and Recovery Act (CARA), nurse practitioners (NP) and physician assistants (PA) can become waivered to prescribe buprenorphine in the treatment of opioid use disorder (OUD) after completing 24 hours of specialized training.

We are pleased to announce that The Substance Abuse and Mental Health Services Administration (SAMHSA) has approved two of Harvard Medical School’s CME Online Opioid Use Disorder Education Program courses as fulfilling the 16-hour portion of the NP/PA 24-hour required training for waiver eligibility. These courses are: Continue reading “HMS Online CME Courses Approved for MAT Waiver Training”

The Future of Patient Engagement in the Digital Age

By Ted A James, MD, MHCM, FACS
October 10, 2018

We live in a digital age of information and innovation, where technological advances continue to make accessibility and independence the norm. Health care, however, has a peculiar relationship with technology. Although we have experienced life-changing advances in medical science, health care delivery systems often fail to meet today’s expectations of convenience, transparency, and choice. Most other industries are far ahead of health care when it comes to engaging with the people they serve (e.g., Uber, Airbnb, Amazon, etc.). As a result, people are less willing to accept the delays, inconvenience, and lack of control traditionally experienced in health care. We are unlikely to succeed in achieving high-value care (i.e., greater quality, lower cost) unless our health care systems can factor patient engagement into the equation. A digital health revolution is coming, and those who prepare and are ready to adapt stand to reap the benefits. Continue reading “The Future of Patient Engagement in the Digital Age”

Making sense of opioid prescribing in the midst of the overdose crisis

By Sarah Wakeman, MD
September 18, 2018

In the face of a growing crisis of overdose deaths, predominantly driven by opioid-related fatalities, there has been a tremendous focus on decreasing the prescribing of opioid pain relievers. The reason for the drive to reduce prescribing is pretty simple; when we looked at the onset of the current crisis of opioid-related deaths, it was strongly correlated with rising rates of prescription opioids and treatment admissions for prescription opioid use disorder. As policy makers and clinicians looked at this correlation, a simplistic narrative emerged. If increased prescribing rates “caused” the overdose crisis, then reducing prescribing should curtail deaths. Unfortunately, as the saying goes, “For every complex problem there is an answer that is clear, simple and wrong.” As prescribing rates have decreased over the past five years, we have seen opioid-related deaths increase significantly. Continue reading “Making sense of opioid prescribing in the midst of the overdose crisis”

Do You Need an MBA to Be a Physician Leader?

By Ted A James, MD, MHCM, FACS
September 6, 2018

…leadership skills, like any other type of skill, can be learned and improved…. More challenging, however, is the development of the personal attributes that are necessary for effective leadership.”

-Charanjit S. Rihal, MD
Chair, Department of Cardiovascular Medicine, Mayo Clinic

Physicians as Administrative Leaders

Physicians possess a deep understanding of what is required to optimize the process of caring for people, and health care systems that are serious about transformation need to harness the power, talent, and creativity of clinicians as organizational leaders. Toward this end, a growing number of physicians are moving into executive leadership, and organizations are experiencing the benefit of having these physicians in key roles, providing input into what is best for patients and the organization as a whole. Continue reading “Do You Need an MBA to Be a Physician Leader?”