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A letter confronting racism, injuries after giving birth, and a survey on ‘disobedience’

July 21, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our new section at the bottom of this page. 

In the wake of the latest police shootings of African-American men, a few clinicians posted a letter online, calling on physicians and other healthcare professionals to add their names to show their support for confronting racism. The letter has generated more than 3,000 clinician signatories in just days on the site Medium. Initiated by Rachael Bedard, MD, a palliative care fellow at Mt. Sinai Hospital, the post requires clinicians to agree to five principles, among them to “dismantle the structural racism embedded in the healthcare delivery system” and to learn how to provide and teach trauma care. Bedard, interviewed for our blog, stresses that clinicians see the impact of discrimination on health every day. “It’s present when we examine our patients because we see how the lack of resources— housing, education, food insecurity—impacts health. So too does exposure to violence, incarceration, and living in an unjust world.” On STAT news, a young doctor, Jennifer Adaeze Okwerekwu, MD, complains that her medical education did not provide the needed training to “address the crisis in communities I hope to serve… While medical schools remain largely silent about the systemic racism that underscores police violence, many of my peers across the country are speaking up.” Okwerekwu has signed the Medium letter. We encourage all clinicians to do the same. Sign the letter here.

Millions of women experience injuries after giving birth, according to an article in Cosmopolitan magazine. Their symptoms range from incontinence to painful sex, back aches and crippling pelvic pain; yet many of their injuries go undiagnosed and untreated. A small University of Michigan study involving 68 women found that 29 percent of the mothers showed evidence on MRI of undiagnosed pubic bone fracture; 49 percent were suffering from incontinence a year after giving birth; and 24 percent found painful sex 18 months after they delivered. Because many women feel these complaints are too taboo to discuss with physicians, they suffer in silence. And when they do tell their physicians, some find their doctors are ill-quipped to treat pelvic disorders or dismiss their complaints as “emotional.” A recent report on pain and prevention from the Institute of Medicine found that that women “have faced not only severe pain, but also misdiagnoses, delays in correct diagnosis, improper and unproven treatments, gender bias, stigma, and ‘neglect, dismissal and discrimination’ from the health care system.” In the Cosmo article, Sarah Fox, MD, a professor and researcher at Brown University and former president of the International Pelvic Pain Society, points out that “American physicians and American healthcare providers can go through all of their training and never get any instruction on managing women’s pain.” Fox and other physicians are now calling for medical education to include information on these injuries and conditions.

Last May we featured Howard Waitzkin, MD, in this publication, after he penned a piece for Medscape, confessing he was a “disobedient doctor” for refusing to comply with time-consuming, unnecessary administrative demands that took him away from patient care. He asked, in his piece, “Dare I encourage disobedience in unison?” Medscape this month published reader responses to his question and others from the editors. Here’s what readers had to say. When asked if physicians’ disobedience, (for example, refusing to comply with non-evidence based but mandated requirements) is a necessary and appropriate response to a growing number of demands, 84 percent said yes. Two thirds of those responding to the poll agreed that potential disruptions in patient care and safety was “a justified price to pay for physician autonomy.” Readers, in fact, emphasized the importance of enlisting patient support in the fight against overregulation. A family physician offered that “medical professionals, in conjunction with our patients, need to take control and demand a shift in priorities that puts the doctor/patient relationship back in the center of this conversation.” Another asserted “We can’t claim innocence if we do nothing to change the system.” We encourage these courageous clinicians to join the Right Care Alliance and raise their voices for that change.

Announcement:

Reminder: Don’t forget that Right Care Action Week is coming up! Our theme this year is listening, and we will be promoting three types of events—all involve listening. Learn more and sign up here.

Headlines:

Overuse

Access

End of life

Aging

Public health

Pharma

Doctor-patient communication

Evidence

Quality and safety

Payments

Practice models

Cost of care

Burnout

RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.