Dispelling Common Myths about Opioid Use Disorder in Pregnancy

By Sarah Bernstein, MD and Jessica Gray, MD
March 21, 2019

The opioid crisis and rise in overdose deaths in recent years has received a great deal of media attention. Though the media has helped to raise awareness, it has also contributed to stigmatization of individuals struggling with addiction. Pregnant and parenting women are among those who have been severely affected by the epidemic and perhaps most shamed by society for their use. Sadly, at a time when many women feel motivated to connect with the health care system and make healthy choices, women with addiction often avoid interacting with providers due to feelings of shame and mistrust. There are many misconceptions regarding the risks and benefits of medical treatment for women with substance use disorders as well as the treatment of neonatal withdrawal. We hope to dispel some of these myths and provide a better understanding of the evidence supporting the treatment of substance use disorders in the setting of pregnancy as well as neonatal withdrawal. Continue reading “Dispelling Common Myths about Opioid Use Disorder in Pregnancy”

Promoting and Implementing Size Inclusivity in Health Care

By Jamie M. Marchetti, MS, RDN, LD
March 14, 2019

Beth was obese. She had been bigger her whole life, so this was not news as she reached her late-twenties. Beth ( her name has been changed to protect her privacy) was getting married and ready to start a family, so she went to her obstetrician/gynecologist to have her intrauterine device (IUD) removed and to discuss the implications of her polycystic ovarian syndrome (PCOS) on fertility. The doctor scoffed and stated, “I don’t know how we’re going to get it out. At your size, I’m not even sure how they managed to get the IUD into you.” Further, it was discovered that Beth had grapefruit-sized cysts on both ovaries, and the doctor told her that neither he nor any doctor would do surgery to remove the cysts given her body size. Beth was desperate, so through her hurt and anger, she chose a crash diet to follow, which resulted in acute renal failure within weeks. Heartbroken and at the end of her rope, Beth found herself crying in a dietitian’s office, convinced that the well-balanced diet she was already eating must be harming her since doctors insisted she must not be nourishing herself properly if she wasn’t losing weight. Beth explained that she was content with her body, but that she was tired of seeking medical care and being treated poorly because of her size. Continue reading “Promoting and Implementing Size Inclusivity in Health Care”

Addressing the Urology Doctor Shortage: Implications For Patient Care

By Kevin R. Loughlin MD, MBA
February 14, 2018

Health care issues continue to receive extensive coverage in the lay press, however the current and future physician manpower issues which significantly impact patient care have been largely ignored. I would like to review the urologic workforce issues and their consequences. Continue reading “Addressing the Urology Doctor Shortage: Implications For Patient Care”

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 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”