This article headlined in the Globe yesterday. It outlines the ethical framework by which hospitals and physicians, with ethics committees, discuss and then reach decisions in difficult cases where a families request may be declined.
Friday, July 16, 2010
Family’s wish, doctors’ dilemma - The Boston Globe
This article headlined in the Globe yesterday. It outlines the ethical framework by which hospitals and physicians, with ethics committees, discuss and then reach decisions in difficult cases where a families request may be declined.
Wednesday, July 14, 2010
Top 5 Reasons We Exist
(1) Each hospital is required to have some kind of ethics service (a mechanism in place to address difficult ethical decisions and disagreements in health care as required by the Joint Commission on the Accreditation of Hospitals (http://www.jointcommission.org/ ))
but…
(2) Hospital ethics committees are most often comprised of doctors, nurses, social workers, and other hospital staff – with only a couple community members to provide the “outside” voice of the community.
So…
(3) Hospital ethics committees can sometimes lack broad representation from the diverse communities they serve,
And…
(4) the cultural, religious, and moral values of local community members may not be adequately or comprehensively represented.
And…
(5) As national health care policy discussions unfold and intensify, the need for inclusive ethics policies becomes increasingly relevant.
The Bottom Line: hospital ethics committees should have a direct line of communication with the community they serve!
Our Solution: In Boston, Harvard Medical School’s Division of Medical Ethics is piloting an innovative approach to broadening community representation and bridging the communications gap between health care practitioners and communities: a Community Ethics Committee (CEC).
Read more about it in the blog post (below) that describes our abstract to the ASBH conference.
Read more about Medical Ethics at Wikipedia: http://en.wikipedia.org/wiki/Medical_ethics
Read more about Ethics Committees: http://www.uoflhealthcare.org/Default.aspx?tabid=526
Same-Day Doctor's Visits
This is an interesting development in medicine . . . "open access" to health care!
Apparently a doctor in Worcester (Dennis Dimitri) has been doing this in his private practice for four years and it seems to work great! A patient gets an appointment the same day based on a first-call, first-appointment system. There are pre-scheduled appointments, too, but there are also folks who can just walk in! The appointments are alittle longer than the traditional 10-minute slot and the reports are that patient satisfaction rises with this open access system in place.
It's an idea that was presented by the Institute of Healthcare Improvement (whose head, Dr. Donald Berwick, now oversees the Centers for Medicare and Medicaid Services), apparently pioneered by Kaiser Permanente many years ago. Less than 20% of practices use mostly same-day appointments.
http://www.kaiserhealthnews.org/Stories/2010/July/14/waiting-for-the-doctor.aspx
Anyway, just another thing to "put in the hopper" in looking at health care and what works best for both patient and providers.
Our poster abstract for the ASBH conference in San Diego
http://www.asbh.org/
Our poster was accepted, and we're looking forward to sharing our story and our model with you.
Abstract Text:
"Community Voices and Views in Clinical Bioethics Policies: Piloting an Innovative Approach to Broadening Community Representation"
Each hospital must have some kind of ethics service – a mechanism in place to address difficult ethical decisions and disagreements in health care as required by the Joint Commission on the Accreditation of Hospitals. Typically, hospital ethics committees are comprised of medical physicians, nurses, social workers, and other hospital staff, sometimes including a community member who provides an “outside” voice. As a result, hospital ethics committees can sometimes lack broad representation from the diverse communities they serve, and the cultural, religious, and moral values of local community members may not be adequately or comprehensively represented. As national health care policy discussions unfold and intensify, the need for inclusive ethics policies becomes increasingly relevant. In Boston, Harvard Medical School’s Division of Medical Ethics is piloting an innovative approach to broadening community representation and bridging the communications gap between health care practitioners and communities: a Community Ethics Committee (CEC). This group, comprised completely of community members not employed by health care facilities, has been active for three years and is diverse in terms of religious affiliation, age, socioeconomic status, cultural and language groups, and educational backgrounds. When the ethics committee at a hospital wants a community perspective and input on an issue, particularly in the development of policy, a request is made for the CEC to review and comment. Issues that the CEC has addressed include pediatric organ donation using cardiac death criteria, non-therapeutic CPR, staff interactions with patients via social internet media, and palliative sedation. The CEC works with a wide array of local communities to gather opinions and perspectives on a given issue for the purpose of providing policy recommendations. The team augments their outreach with several customized social media technologies, including blogs and Twitter. As part of its mission and as an adjunct to formal policy recommendations to ethics committees at participating hospitals, the CEC plans to conduct educational outreach to local communities, expanding the dialogue which the committee members began in its policy review. Additionally, several CEC members now serve as community representatives on hospital ethics committees, increasing their exposure to the issues addressed by these groups. We describe the current CEC model and recommend that CECs be replicated throughout the country to enable improved representation and facilitate meaningful communication between practitioners and communities. Ultimately, we envision a network of CECs that would share findings at the regional and national levels.
Primary Contributor: Lori Bruce , M.A. (Presenting) ;
Co-Contributors: Carol L Powers, J.D. , HMS Community Ethics Committee, and Christine Mitchell , RN, MS, MTS , Harvard Medical School
Happy 3rd birthday!
As we reflect on our goals for the upcoming year, we wanted you to know that our
primary focus is increasing our communication with the community - that means
more requests for input from you on various medical ethics policies, and that also means we
intend to post more summaries of the various policies we analyze. We look forward
to deepening our relationships with many Boston-based communities so that we can
better represent you to the Harvard Teaching Hospitals.
We have recently filed for status as a non-profit, and look forward to interacting with
the national bioethics community at this year's American Society for Bioethics & Humanities conference.
If you attend, please stop by our poster and visit us.
Thank you, Boston, for your support!
Tuesday, July 13, 2010
Some Docs avoid Facebook, others seek a web presence
http://www.usatoday.com/news/health/2010-07-08-SOCIALDOCS08_ST_N.htm?POE=click-refer
What do you think??
Wednesday, July 7, 2010
Screams from Greek stage aim for doctors’ hearts - The Boston Globe
As a person who was priveleged to see this performance, I believe this article summarizes how powerfully readings from Greek tragedies can fasciitate thoughtful discussion among medical professionals, ethicists and others around the complex issues of humane end of life care.
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