Sex in Medicine--& a medical student's reflection

For the second consecutive year, medical students, faculty advisors, and a collaboration of a dozen student clubs at SUNY Downstate organized a series of lectures, discussions, and workshops on a topic often overlooked—and a facet often underserved—within American medicine.  In February, 2010, “Sex in Medicine Week” allowed participants and audience members to explore issues ranging from “Relationships, Sexuality, and Disability,” to sexual assault & the healthcare provider’s role, to the unique experiences of LGBT patients within a healthcare setting.  

What follows is a reflection written after attending a “Sex in Medicine Week” event. The author is a SUNY Downstate 2nd year medical student.

Conscientious Care for the Patient
By Alaina Burns

    Imagine that you and your life partner are about to board a cruise ship for a vacation with your three children when your partner suddenly suffers a massive stroke. Your partner is taken to the nearest hospital, but you are physically denied visitation rights; your partner dies eighteen hours later, and you are allowed entrance to the room only when the priest is reading the final rights.
    …Or imagine that you have been receiving care from your physician for a chronic medical condition, and one day, you happen to mention your partner. Your physician, who has been treating you for over a year, suddenly refuses to write you your next prescription.
    …Or imagine that you are a woman who has been receiving preparatory treatment for in vitro fertilization from the only in-network provider offered by your insurance plan. When, after a year, the staff at the clinic learn about your partner, they subsequently refuse to continue treatment.
    These cases might seem unbelievable, but they are all true; and they all took place in recent years, right here in the United States: in Miami, Washington state and California, respectively.  Welcome to the difficult reality faced by many lesbian, gay, bisexual and transgender (LGBT) patients who try to navigate the American healthcare system.
   Doctor’s offices and hospitals are often vulnerable spaces for all patients, but they can be particularly unpleasant for people who identify as LGBT. As part of SUNY Downstate’s 2010 “Sex in Medicine Week,” Dr. Maile O’Hara gave a talk, entitled, “Being a Good Doctor for ALL of Your Patients: Specific Needs of Lesbian, Gay, Bisexual, and Transgender Patients,”* in which she spoke about what medical professionals can do to provide more sensitive care for LGBT patients. Dr. O’Hara, a clinical psychologist at the Bellevue/NYU Program for Survivors of Torture, has worked extensively with the LGBT population.
    Among Dr. O’Hara’s recommendations for healthcare practitioners are these:

• Treat your patients who are LGBT with the same respect with which you treat all patients.
• Recognize that many LGBT people have had negative experiences with the health care system in the past.
• Ensure that your office has a nondiscrimination policy and that decorations and selections of items such as magazines and pamphlets are inclusive of the LGBT community.
• Treat the partners of LGBT patients as you would spouses, even if they are not legally married.

    In an era when most people can rest assured knowing that their civil rights are guaranteed, LGBT individuals, on the other hand, are made aware that discrimination can still lurk in the most unexpected of places. No national anti-discrimination law exists that protects lesbian, gay and transgender people, and among states, only twenty-one and the District of Columbia currently protect individuals from discrimination based on sexual orientation.
    Visiting the doctor, for any person, can often be stressful and scary for various reasons.  But for LGBT people, in an unwelcoming healthcare setting, the experience can be doubly terrifying. Educating yourself and being aware of the unique issues faced by people who are LGBT is the first step in providing conscientious care for all of your patients.

*To view the slides presented during Dr. Maile O’Hara’s talk, given at SUNY Downstate on February 25, 2010, please click on the “LGBT Q&A” link on the top left margin of this page.

Read More...

Health Professionals March for Reform, March 22

WHAT: A march on Washington for health reform
WHEN: Monday, March 22, 2010, 11am
WHO: Hundreds of health professionals (doctors, nurses, and more) from across the country
WHY: Our patients need it, our communities need it, our country needs it. A sea of white coats and scrubs on Pennsylvania Ave will give Congress a strong message – we must pass health reform now.
MORE INFO: www.healthmarch.org

Who Are We?

We are health professionals — doctors, nurses, dentists, pharmacists, physicians assistants, and friends of health professionals.

We come from all over the country and one thing unites us: each of us has been touched by the patients we see and the struggles they have faced in our current health care system. This is why we are marching together to fight for the health care reform that we can and must achieve as a nation.
Do we agree on every single aspect of health reform? Of course not. Do we agree that moving forward with health reform will lay the foundation to a better health care system for our patients and for America? Absolutely!

Our patients need better access to care, a regulated insurance industry, improved quality and lower costs. Health professionals know that health reform for our patients and for America is not optional.

That's why we are marching on Washington DC on March 22 — to make sure Congress hears us and gets the job done.

We know. We care. Reform can't wait.

See you on March 22,

 For more details visit www.healthmarch.org.

Read More...

Help to spread the Healthcare Reform Facts now!

Help to get the word out on why this healthcare reform is crucial, by printing & posting up fact sheets like this one:

Or, you can also go to that Organizing for America webpage to share many healthcare reform facts via Facebook, Twitter, or email.

Read More...

NYT Staff Editorial: "This may be the last best chance. [We] should fight to win"

The Live Bipartisan Health Care Summit--this coming Thursday morning 10am EST--of the president bringing together Republican and Democratic Congressional leaders, arrives to a TV (you can also watch it online, free, live & streaming right here at DownstateCafe.blogspot.com, or at http://drsforamerica.org/summit.php!) near you...

The New York Times has issued this verdict on current developments (read full article here):

"The president was right to invite Republican leaders to a health care summit this week. He should hear them out but also challenge them — directly — to come up with credible ideas that would both expand coverage for tens of millions of uninsured Americans and begin to rein in out-of-control medical costs. For too long they have been allowed to obstruct and demagogue.

And Mr. Obama will need to keep pushing in the days that follow and stiffen the spines of any wavering Democrats.

Most important, Mr. Obama needs to clearly explain the stakes to the American people. Reform is essential for Americans who have no health insurance. But it is just as crucial to the millions more who are just one layoff away from losing their coverage, and many millions more who watch with fear as the cost of care and their insurance premiums rise relentlessly. 

After delving into the pros & cons of "The President's Plan" for healthcare, just hot off the press this morning (and accessible for user-friendly browsing of its entirety & main points, at www.whitehouse.gov/health-care-meeting/proposal), the staff editorial ends,

"...Mr. Obama’s proposals provide a firm basis for both the Senate and House to move forward with comprehensive reforms. If the Republicans resort to filibusters to block passage, the Democrats should use a budget reconciliation procedure that requires only a majority vote for passage in the Senate.

This may be the last best chance for decades to come to reform the nation’s broken health care system. Mr. Obama and Democratic leaders should fight to win." (read full article here)

After so many hopes for this crucial healthcare reform, then disappointment, then hopes then disappointments again, then hopes,--who, with the resilient spirit, thinks the hopes will be answered?  Let's hope so.  Any thoughts?

Read More...

Did'ya catch the Super Bowl??--Announcing a "Bipartisan Summit on Health Care"

"President Obama said Sunday that he would convene a half-day bipartisan health care session at the White House to be televised live this month, a high-profile gambit that will allow Americans to watch as Democrats and Republicans try to break their political impasse.

Mr. Obama made the announcement in an interview on CBS during the Super Bowl pre-game show, capitalizing on a vast television audience. He set out a plan that would put Republicans on the spot to offer their own ideas on health care and show whether both sides are willing to work together.

...the bipartisan meeting, set for Feb. 25..."(full article at New York Times)

Read More...

U MUST SEE! THIS IMPASSIONED PLEA, on the ground w/ suffering America: Ed Schultz reporting from a temporary free clinic

Finally, someone who voices the raw anger and frustration at where the hell this political football has been kicked...

Finally, a piece of media that spotlights the real stories concerning the urgency of Health System Reform, stories that have been missing from the terrible, endless Washington debates...

Read More...

Obama says: Let's keep our eyes on the Health Reform prize

So, Americans, what's the big deal?  What's at stake?  Here's from the Man at the top, his take:

Read More...

Healthcare Reform (don't miss the train!)

Dear friends & colleagues,

Health Insurance/Healthcare reform has come a long way, and it's not too late to learn what it's all about (esp. with the holidays coming up, so that you'll be able to converse about healthcare with others back home), and more importantly, to make a difference by adding your uniquely influential voice as a medical student/future physician.  For an easy & quick way to learn about/add your voice to this reform that will significantly affect us all, check these out:

1. Doctors for America is a grassroots group of 16,000 physicians and medical students.  I've pasted their latest email update for you to see (below).  Within it is this fantastic link to a poll of the "6 key reforms," which, when you click on each reform's "see how the bills address this," will give you a very clear & succinct synopsis.  Joining their listserve is easy, and the resources on their website are just as user-friendly & informative: http://drsforamerica.org/

2. Sign on to the American Academy of Family Physician's "Connect for Reform" group.  You must first register here (free for medical students) to become an AAFP member.  Then after you register, go to http://www.aafp.org/ and click on the "AAFP Connect for Reform" button to sign on.
    •    receive periodic emails with the inside scoop on Health Reform, and easy ways that healthcare professionals and students can join to help.
    •    Connect with other members, and add your voice to advocacy actions.

3. If you have any other ideas/suggestions/links for how students can join the conversation and help, or if you'd like to write any kind of healthcare-related article yourself, please email me and I can post onto DownstateCafe.blogspot.com .

Best,
Abe

from: Vivek Murthy MD, MBA
to: abraham.young
date: Fri, Dec 18, 2009 at 1:18 PM
subject: Moving Forward
Abraham -

Need your input: What's most important to you in this health reform bill?

Rank Your Priorities

 So we can take a stand together

After a whirlwind week in the health reform fight you might be wondering what all the developments mean for reform, whether a bill is still worth supporting, and what our community of physicians should fight for at this moment.

What happened:

This week, the public option and its substitute (the Medicare early buy-in provision) were both dropped from the Senate bill as Senate leadership worked to win 60 votes for the overall bill. This was quite a disappointment to our members after working for a public option for many months and considering it to be an important component of successful reform.

Aside from the public option, the Senate - unlike the House - has not included provisions to address defensive medicine. The Senate also does not include a permanent fix to the flawed Medicare payment formula (SGR); there is currently only a one year patch of the SGR.  The bill is certainly far from perfect.
 
What didn't happen:

Health reform isn't over and the final bill hasn't been written. Moreover, a lot of very important provisions are still in both the House and Senate bills. And that's because time-after-time we've spoken out for the issues we care about - expanding coverage, strengthening primary care, making premiums affordable, investing in prevention and improving quality.

As it stands, the current bill will cover 31 million more Americans, establish the strongest restrictions on insurance companies in history, and invest substantially in improving our health care delivery system - all while reducing the national deficit over 10 years. (See below for more details).

What now:

This brings us to this moment. The ultimate success of health reform depends on what we do in the next few weeks. The Senate is working to secure the 60 votes necessary to stop a filibuster on the Senate floor. Once they do so and pass a bill, the Senate and House bills will then be merged. 

While there are provisions in the bill that help doctors and patients, any of these can be weakened or stripped altogether from the final bill. So your voice is as important now as ever.  As the Senate hammers out the details over the next 24-48 hours, tell us:

We have identified 6 key reforms which are at risk. Please rank these issues according to what you believe is most important.

Your efforts have brought us to the brink of history and we hope that you will continue to fight with us to enact health reform for all Americans.

Thank you for all that you've done.
Vivek Murthy MD, MBA

President
Doctors for America

Overview of the Senate Bill
Key Element of the bill:
    •    Cover the uninsured: Expands health insurance coverage to 31 million previously uninsured Americans.

    •    Regulate the insurance industry: Prevent insurers from denying coverage based on pre-existing conditions, dropping individuals who become ill and imposing caps on health care spending. 

    •    Help people afford insurance: Subsidize insurance premiums on a sliding-scale for small businesses and the middle class.

    •    Support primary care: Investments in physician workforce expansion, including new loan forgiveness programs, scholarships and National Health Service Corps funding - for primary care.

    •    Payment reform: Payment reform that rewards value in health care delivery through new pilot programs for the medical home and accountable care organizations. 

    •    Investments in prevention and public health: Establishes fund of $7 billion dedicated to prevention and public health related activities. 

    •    Control Cost: Multiple cost control mechanisms with the potential to reduce national health care spending by $683 billion over a decade.
Reasons to keep fighting:
... to make insurance coverage affordable for all Americans.
... to ensure that enough doctors are there to take care of the newly insured.
... to secure fair pay for the hard work physicians routinely do.
... to create a truly fair insurance market via increased regulation.
... to cultivate innovation and efficiency in health care delivery.

For more information about the Senate bill and how it affects doctors, seniors, children and women – visit the DFA resource center.

--
Doctors for America is a grassroots group of over 16,000 physicians and medical students in all 50 states. Together we are committed to building a health system that works better for us and better for our patients. To contact us please e-mail info@drsforamerica.org

Read More...

Dr. Neil Calman, president/founder of the Institute for Family Health, blogs about talking with Downstate medical students

(To read the full post & other invaluable writings of Dr. Calman, visit http://neilcalman.blogspot.com/)

"On a rainy and blustery evening last week, I had the pleasure of speaking to an amazing group of first and second year medical students at Downstate Medical School in Brooklyn... My message was that patients are increasingly demanding primary care as a trusted way of negotiating an otherwise incredibly confusing and fragmented health care system. I stressed that primary care physicians must stay focused on the needs of their patients above all else and that our loyalty and responsibility towards our patients must always remain first and foremost in our minds and actions – unfettered to the maximum extent possible – by advertising and loyalties to our hospitals or peers.

...A tougher question came from a young man in the front of the room who asked how our community health care system could survive financially taking care of the number of uninsured that we currently cared for.

...I stood there proud that our organization – the Institute for Family Health – had been able to accomplish this.

Yet I missed a real opportunity to underscore the fundamental reason we need health reform in this country. People need health insurance. Our country cannot depend solely upon health centers like ours as the safety net for everything patients who are uninsured need for their care. They must have coverage to pay for all the essential health care services they need. Primary care is the front end of an entire health care system which must provide access to people for diagnostic services, treatments, hospitalizations and medicines. With people of color 2 to 3 times more likely to be uninsured in New York City providing insurance for everyone is an absolutely essential step towards eliminating racial and ethnic disparities in health outcomes. And with primary care providers already struggling to create viable practice models in underserved areas, only full insurance coverage of the people who need these providers can sustain these practices and attract new doctors to these areas. 

I am sorry I missed the opportunity to explain more to the students in Brooklyn last week about the failings of our current health care system. But I am not worried that their education will be lacking for very long. Soon the students will begin their clinical rotations in the hospital and there they will no doubt experience, first-hand, the failings of our current system to provide health care for all our people. They will see people suffering the effects of poorly treated chronic diseases – losing their legs and their kidneys to long-standing diabetes. They will see people with cancers that would have been curable if only they had been detected earlier. They will see people with advanced infections that have gone untreated for days or months and now require prolonged hospitalizations. These lessons will hit hard and perhaps some of them will understand and will choose to become the next generation of primary care physicians and the new champions for needed change in our health care system."

(To read the full post & other invaluable writings of Dr. Calman, visit http://neilcalman.blogspot.com/)

Read More...

Welcome to Primary Care Week @ Downstate!!!

 (**Speaker Bios below)
Tuesday, November 10th - Primary Care 101

When: Noon to 1 PM
Where: Student Center Main Lounge
FREE Food: Heros/Kosher Sandwiches
Speaker: Dr. Michael Gusmano, Research Director for Alliance for Health & the Future (Dr. Gusmano will be speaking about the growing need for primary care physicians and about public health policy)

Wednesday, November 11th - Faces of Primary Care

When: 5:30 PM to 7 PM
Where: Student Center Main Lounge
FREE Food: Italian/Kosher Sandwiches
Speakers:

Dr. Margaret Golden, Pediatrics Clerkship Director at Downstate

Dr. Heather Paladine, Director of Women's Health at Columbia University Medical Center
Anthony Accurso, 4th Year Medical Student at Downstate

(This is more of a Q&A session - a great opportunity to ask the panelists about their personal experiences in primary care)

Thursday, November 12th - Future of Primary Care

When: 5:30 to 7 PM
Where: Student Center Main Lounge
FREE Food: Thai
Speakers:

Dr. Neil Calman, Family physician and President/CEO of the Institute for Family Health, NY

Lauren Hughes, National President of AMSA

(Dr. Calman will be talking about the future of primary care and how PCPs contribute to the community)

So, come learn more about the unsung heroes of medicine! Hope to see all of you there!!!  (We will also be giving out PRIZES! If you would like Kosher food to be served, please e-mail Regina Finan at Regina.Finan@downstate.edu.)

**Speaker Bios: 

Neil Calman, M.D.
Neil Calman, MD, is president and co-founder of the Institute for Family Health, developing family health centers in the Bronx and Manhattan.  In 2002, the Institute became one of the first community health center networks in the country to implement a fully integrated electronic medical record and practice management system, improving both preventive and chronic care treatment outcomes. In recognition, Dr. Calman received the 2006 Physician's Information Technology Leadership Award, presented annually by the Healthcare Information and Management Systems Society.  Dr. Calman serves on the Primary Care Health Information Consortium, the NYSDOH's Information Technology Stakeholder Group Planning Committee, is the Chair of the Clinical Committee of the Community Health Care Association of New York State. He has also been appointed to the Health Policy Roundtable of the Aspen Institute, a group charged with delineating the values and principles on which the United States must base its future health care system.

Heather Paladine, M.D.
Heather Paladine, MD, attended Mount Sinai School of Medicine in New York.  She then completed a residency in Family Medicine at Oregon Health and Science University and went on to do a fellowship in Maternal and Children's Health Care at California Hospital in Los Angeles.  After working in Washington, Oregon, and California, she recently returned to New York City to become faculty at the New York Presbyterian/Columbia University Family Mediciine residency program, where she is Associate Residency Director and Director of Women's Health.

Michael Gusmano, M.A., Ph.D.

Dr. Michael Gusmano is the director of research for the Alliance for Health & the Future and co-director of the World Cities Project at the International Longevity Center-USA. Dr. Gusmano's work has focused on comparing the health status and use of health and social services for older persons. His other research interests include politics of healthcare reform, Medicare, Medicaid, and comparative welfare state analysis. Dr. Gusmano was a senior research associate in the Division of Health and Science Policy at the New York Academy of Medicine.

Margaret Clark-Golden, M.D.
Associate Professor at Downstate Medical Center
Pediatrics Clerkship Director at the Children's Hospital at Downstate

M.D. - Duke University School of Medicine

Residency: Cook County Hospital (Pediatrics) and Michael Reese Hospital Medical Center (Pediatrics)

Read More...