Current Issue
Spring 2014
BMM Current Issue
Download PDF
 
 
Letter from the Dean
A New Day?
This edition of Brown Medicine contains some fascinating articles, including a feature on the work of one of our outstanding faculty, Assistant Professor of Biology Casey Dunn. I also reflect on my first two years as dean, and thus this letter will be quite short.

You will note that a group of medical students decided to design a course that teaches about our system—the good, the bad, and the ugly of health care in America. I am convinced that medicine is changing and will change even more in the near future. Physicians will be mostly employed by larger organizations, compared to the historic solo or small group practices. Primary care doctors will no longer go to the hospital to care for their patients, but will rely on hospitalists and the hospital-based specialists in medicine and surgery. Physicians will be monitored much more closely by their employers through digital technology. They will be expected to produce complete data on their patients through electronic medical records, and will be held accountable for quality, errors, and cost through such systems. Salaries and compensation will be lower, but hours will be fewer. Doctors will be expected to work in teams of health care providers, many of whom have expertise beyond their own, including pharmacists, nutritionists, nurses, physical therapists, and social workers. Accountable care organizations will have much more control over the activities of physicians.

While all of this seems intrusive, I believe it will actually make the practice of medicine better for patients and less onerous and more satisfying for physicians. Employment of physicians will remove the tyranny of the market. Physicians will not need to focus on their cash flow, office operations, malpractice, or negotiating with insurance companies. Instead, doctors will be able to concentrate on the care of their patients. Also, rather than working ridiculous hours and having burdensome paperwork, they will be freer to care for patients. Finally, teams will remove the burden of being the all-knowing, autonomous, “perfect” doctor. Together, I believe that all these changes will enable us to focus more on what we do best and enjoy most: caring for our patients.
Dean Wing
Letter from the Editor
Village People
The dean’s not the only one seeing his vision become reality. Early last summer we were discussing what kind of coverage to give the new medical school project in the fall issue of Brown Medicine. My office had been covering the building for a long time, mostly using floor plans and architectural renderings, but the actual renovation was finally under way. Suddenly I had a vision of my own: Dean Wing so driven, so focused on his goals that the building gradually rose up around him as he worked, almost as a function of his will.

That is not far from what was happening: a drive-by revealed that the building was no longer an idea on paper. It was starting to be a reality in the most visible and (forgive me) concrete way possible. This is what I wanted to convey on the cover—not a dean standing next to a maquette or pretending to look at blueprints, but a man who (with help from many dedicated colleagues) gets things done.

I conveyed my vision to Mindy Oswald, our art director, and we set about enlisting the many people needed to make it happen. Indeed, it took a village. We had to scout the location with Scott Kingsley, the photographer. To scout the location, we had to involve Steve Phillips, the project manager. Steve in turn had to call Peter Holden, director of Biomed facilities, at his vacation hideaway to coordinate the delivery—from God knows where—of an executive-style desk. Karen Scanlan, the dean’s communications manager, had not only to convince her boss this was a good idea, but to gather his desk accessories before the shoot. The workers had to give us space, and the dean had to trust us. And it all had to happen while I was on vacation.

Somehow it worked. While I was reading last year’s bestseller, Netherland, on a hammock in Maine, these great people came together and made the vision a reality. I tip my hat to them all.
Dean Wing, Karen Scanlan, Peter Holden, and Steve Phillips
Letters to the Editor
Don’t Forget the Surgeons
I was very interested to read about some of the disaster response activities of our new Acting Deputy Surgeon General, RADM David Rutstein, MPH MD’83 (“Force of Nature,” Spring 2010).

One of the elements that has been missing from US disaster response planning is the ability to rapidly deploy trauma-trained volunteer civilian surgeons.

When the USNS Comfort arrived on scene at Port-au-Prince, it had only one orthopaedic surgeon on board to assist in the management of thousands of fractures and crush injuries. The Navy made a request to the Orthopaedic Trauma Organization (OTA) and the American Academy of Orthopaedic Surgeons (AAOS) to provide civilian surgeons to augment their team. A very difficult Memorandum of Understanding (MOU) that indemnified the Navy and placed these organizations in to potentially significant liability positions caused considerable delay in getting the orthopaedic surgeons into place.

As a direct response to the earthquake in Haiti, the OTA and the AAOS have commissioned a joint project team. The general consensus is that a cadre of experienced civilian surgeon volunteers who are prequalified, properly educated, and trained to work in disaster medicine should be developed. They should come under a federal umbrella when activated so as to obviate issues of state licensing and credentialing as well as liability/ disability/health insurance coverage. These physicians could be organized and monitored by their respective specialty organizations. A strong liaison with the military should be established, and credentialing, training, and immunization status would be set to preapproved standards. MOUs … would be pre-negotiated. Ultimately, the resulting model could be used to similarly engage other medical specialties.

One of the goals of the AAOS/OTA Project Team is to study these questions in depth and to work with government agencies and the military to bring about changes to improve rapid response to disasters. At this time, the orthopaedic consultants to the Surgeons General of the Army, Navy, and Air Force are assisting us with this process. Input and support by the Office of the Surgeon General of the United States would also be critical to making successful changes in the early phase response process.

Christopher T. Born, MD, FAAOS, FACS
Professor of Orthopaedics, Alpert Medical School
Director of Orthopaedic Trauma, Rhode Island Hospital

The writer is chairman of the OTA Disaster Management and Emergency Preparedness Committee, co-chairman of the AAOS/OTA Haiti/Disaster Project Team, and Orthopaedic Group Leader, IMSuRT-East of HHS/ASPR/ OPEO/NDMS.


Cost Conscious
Dr. Neel T. Shah’s opinion piece (“Assuming Responsibility for Patients’ Pockets,” Spring 2010) called for greater awareness of the cost-effectiveness of the tests that physicians order. Dr. Shah will be pleased to know that in April, the American College of Physicians (ACP), the largest medical specialty organization and the second-largest physician group in the United States, announced its High-Value, Cost-Conscious Care Initiative. This effort will assess benefits, harms, and costs of diagnostic tests and treatments for various diseases to determine whether they provide … medical benefits that are commensurate with their costs and outweigh any harms. The objective is to provide physicians and patients with evidence-based recommendations for specific interventions for a variety of clinical problems.

The initiative will include the development of ACP’s High-Value, Cost-Conscious Care Recommendations that will be submitted for review and consideration for publication in the Annals of Internal Medicine. Also, the next edition of ACP’s Medical Self-Assessment Program (MKSAP) will focus on optimal diagnostic and treatment strategies, based on considerations of value, effectiveness, and avoidance of overuse and misuse. Additional phases of the initiative may include patient education materials and curricula for medical students and residents.

Yul D. Ejnes ’82 MD’85
Clinical Associate Professor of Medicine, Alpert Medical School
Chair-elect, Board of Regents, American College of Physicians


Nice to Be Noticed
The New England Society for Healthcare Communications recognized Brown Medicine with two Lamplighter Awards at its annual ceremony last May. These awards were established to showcase and honor communications excellence in New England. The 2010 competition included 340 entries from more than 75 organizations. Kris Cambra’s article “Room to Grow” (Fall 2009) won the Award of Excellence in the Feature Articles category. And in the Publications: External Periodicals category, Brown Medicine took home the gold!
Letter to the Editor
Brown Medicine welcomes readers' letters, which may be edited for length or clarity and included in the print version. Send letters to brown_medicine@brown.edu
 
Email this Article     Print this Article    Bookmark and Share