How professionalism grades hurt medical student professionalism

I love the profusion of new ways to teach and assess professionalism in medical school. It’s a huge advance from the days when people like me could still get in.

Yet, there are sharks in those waters. My friend and med ed collaborator Dr. Roshini Pinto-Powell of Dartmouth’s Geisel School of Medicine and I describe one of those sharks: numerical professionalism grades.

It starts with good intentions: we create a grading rubric on the thought that we should take professionalism AT LEAST as seriously as other topics in medical school. And the easiest way to grade is on a Likert scale.

Yet, we argue, boiling down something as complicated as professionalism into a simple, arguably meaningless professionalism grade is perilous. One reason why is that it imposes external incentives on a complex task, a combination known to sap students’ internal motivation.

That means we might begin with the intention of highlighting the importance of medical student professionalism, and end by undermining it.

Fortunately, there are better ways forward.

To read more, check out our full text publication at the Journal of General Internal Medicine, here.

How we honor a new organ donor

The double doors of the surgical intensive care unit opened into a hallway crowded with dozens of hospital employees. A hospital bed emerged, and we all fell silent.

Most beds roll out of the I.C.U. briskly, en route to radiology or an operating room, whirring with the beeps and blinks of monitors and the quick conversation of busy nurses.

This bed was different. It moved at a stately pace, and the team that accompanied it was changed as well. Nurses steered, but there was no chitchat this time. A tall anesthesiologist learned over the head of the bed to squeeze a bag valve oxygen mask with clocklike regularity.

People in street clothes trailed close behind the bed, unsure of where to look. These were the parents of the young woman in the bed, the one we had all come to honor.

This was an “honor walk” for a dying patient about to donate her organs to others.

To learn more, check out my new article at The New York Times.

Why volunteer for a vaccine study?

Despite a legacy of scientific misconduct,and the usual complexities of conducting science across cultural differences, people in countries across the world volunteer for vaccine studies. 

Why? What motivates them? What are their fears?

Medical anthropologist Sienna Craig, I and our esteemed colleagues recently investigated. Check out our new paper, here in BMC Public Health.

A harder death for people with intellectual disabilities

Several weeks after my patient was admitted to the intensive care unit for pneumonia and other problems, a clear plastic tube sprouted up from the mechanical ventilator, onto his pillow and down into his trachea. He showed few signs of improvement. In fact, the weeks on his back in an I.C.U. bed were making my 59-year-old patient more and more debilitated.

Still worse, a law meant to protect him was probably making him suffer more.

When the prognosis looks this bad, clinicians typically ask the patient what kind of care they want. Should we push for a miracle or focus on comfort? When patients cannot speak for themselves, we ask the same questions of a loved one or a legal guardian. This helps us avoid giving unwanted care that isn’t likely to heal the patient.

This patient was different. Because he was born with a severe intellectual disability, the law made it much harder for him to avoid unwanted care.

To learn more, including what happened, read my new post here at The New York Times.

Will New Hampshire open safe sites for people who inject drugs?

New Hampshire is still in the throes of one of the worst opioid epidemics in the country. Deaths are mounting, and mostly in young people.

As hospitals around the nation and our fair state scale up to provide medication assisted therapy and other evidence-based ways to help, safe injection sites remain controversial.

Based on data from Vancouver's Insite program showing lower public drug use, less needle sharing, and prevention of infectious diseases like HIV, I think it's time for us to get over our hangups and act to save lives.

It was fun and illuminating to talk with Laura Knoy's and guests on NHPR's Exchange. For a stream of the hour-long show, click here. 

Did I make a professionalism mountain out of a medical education molehill?

Every March I run the last required course at Dartmouth's Geisel School of Medicine. It’s a three-week-long, 47-hour sprint – a sort of boot camp for professional formation. Midway through the usual mechanics of instruction, I got an email that felt routine at first - but then it felt like an opportunity to talk with a student about professionalism.

Click here to read it, over at Reflective MedEd. What do you think? Did I make a professionalism mountain out of a logistical molehill? How do you try to support your students’ professional formation?

Go ahead, hit "record" in the doctor's office

The elderly woman’s right knee was bright red and twice its normal size. Her doctor explained that her prosthetic knee joint was infected and would have to be removed — antibiotics alone couldn’t cure her.

Her doctor (T.L.) began discussing treatment options, but the patient stopped him. “Do you mind if I record you?” she said, picking up her cellphone.

Surprised, the doctor leaned back in his chair.

This simple request can elicit starkly different reactions from patients and clinicians.

To learn more, check out my new article (with co-author Glyn Elwyn) at STAT.

How (and why) academics can (should!) write for the popular press

It has been wonderful to publish in The New York Times, The Atlantic's health section, and other popular outlets. 

Writing for the popular press has felt like learning in a whole new language. The rules of academic writing do not apply. 

Through luck, the smoking hot wisdom of a nationally prominent education writer, and invaluable training as part of Dartmouth's chapter of the Op-Ed Project, I've been able to write about what moves me.

For tips on how (and why) academics can (should!) write for the popular press, check out this interview on episode #61 of the popular podcast #AmWriting hosted by Jessica Lahey and her former New York Times editor KJ Dell'Antonia.

When you are too sick to fly

Air travel is a great way to get free peanuts, a deep vein thrombosis and the worst cold of your life. Plus: baggage fees!

Ever since Andrew Speaker took to the friendly skies with drug resistant tuberculosis, and brave Ebola outbreak workers returned sick to the United States, avid international attention has focused on the infectious risks of air travel, too.

Could the next pandemic spread on planes? 

We should care more about the people who live in areas where millions of people get sick from infectious scourges without having to invoke international travel. Yet it is reasonable for people who travel in rich countries to want to stay healthy as well. 

Proudly quoted in this brief article by Allison Fox of HuffPo.

What's the best way to incentivize immunizations?

Vaccination saves lives.

Yet, resistance to immunization has become entrenched in some sociodemographic strata. Wealthy, educated liberals who care about organic food and "natural" products among them. 

Under-immunization of school-aged children in turn has led to outbreaks of measles and other transmissible infections, and contributes to  thousands of preventable influenza deaths in children each year. 

It's not enough to tout the benefits of vaccines, and then stand back with syringe in hand. Potential vaccines want to know vaccines are safe, and hear misconceptions about the low risks of vaccines. A seminal article by my Dartmouth colleague Brendan Nyhan showed that trying to disabuse vaccine skeptics of their misconception too may fail. 

Many states and countries are piloting various incentive programs designed to enhance immunization rates without engaging in potentially polarizing debate. From making immunizations mandatory to attend school to linking welfare benefits to vaccine receipt and even straight up cash incentives, lots of experiments are happening. Some of them even work.

Check out this great article by Susan Scutti of CNN and its accompanying video. I was proud to be quoted in it.