Cautionary tale of health disparities in the age of precision medicine

by Kirsten Bibbins-Domingo, PhD, MD, MAS

 

Many of us do not routinely read the genetic literature, but for those of us interested in health disparities, a study in this week’s NEJM and its implications are critically important. 

Partnerships to Prevent Violence: ARISE

By Leigh Kimberg, MD

Each day, an overwhelming majority of our patients arrive in clinic wishing that their healthcare providers would ask them questions about how their personal relationships affect their health and, more specifically, whether an intimate partner, family member or other person has hurt or threatened them.  And, despite the requirement by the Affordable Care Act that all women and girls be offered interpersonal violence (IPV) (intimate partner violence and sexual assault) screening, brief counseling and referral, healthcare providers and healthcare systems have not institutionalized this practice.  “Aspire to Realize Improved Safety and Empowerment” (ARISE), a partnership program newly funded by the Office of Women’s Health in the US Department of Health and Human Services, will fully institutionalize these life-saving practices in the San Francisco Health Network primary care system.

“Where Can This Person Go?”: A Plea for the Expansion of Medical Respite Services

 

by Soraya Azari, MD

While recently working in the hospital I was often asked by my interns and medical students: “so where can this person go?”  An example: a 53 year old homeless man, wheelchair-bound from prior injuries, who had his wheelchair stolen during an assault, which led to pneumonia and hospitalization.  He quickly improved with intravenous antibiotics, was medically stable, and no longer met criteria for inpatient hospitalization.  So then the question is where should he go? 

Moral Compass

By Dean Schillinger, MD

Dear Colleagues,

Today we are releasing a new film, "Biker with a Moral Compass: Dr. Dick Fine and the Evolving Culture of SFGH", a documentary portraying and paying tribute to the life, times and contributions of UCSF and SFGH physician Dick Fine MD, Founder and Former Director of the General Medicine Clinic, among many things.

Please feel free to share this film with colleagues, friends, and family, and consider using it as part of your health professions trainings.    

Finally, I would like to take this opportunity to ask you to consider making a donation on behalf of Dick, and in support of the many causes he has steadfastly stood for. The San Francisco General Hospital Foundation has created the Richard H. Fine Fund, whose purpose is to support education, clinical innovation, and discovery in The Richard H Fine People's Clinic. You can donate here:

• Go to https://sfghf.org/support-us/donate/
• Under the “Please use my Gift” section select “For the following Program or Department” and write in “In Honor of Richard H Fine DGIM Fund”

 Now....ENJOY THE SHOW !

 

Connecting the dots: Health information technology expansion and health disparities

By Courtney Lyles, PhD, Dean Schillinger, MD and Urmimala Sarkar, MD, MPH

Check out our newest essay in PLOS Medicine outlining how health technology could be better designed and implemented to meet the needs of diverse patient populations:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852

Making Older Homelessness a Never Event

by Margot Kushel, MD

On April 2, Bevan Dufty, (@BevanDufty) the director of the HOPE program (Housing Opportunity, Partnerships and Engagement) for San Francisco (aka the official responsible for addressing homeless services and outcomes), posted the following message to his 4500 followers on twitter: “86-year old staying @ECS_SF Next Door Polk/Geary shelter needs help walking/feeding small dog. Without dog, client likely returns to street.”

The future is already here, it just not very evenly distributed.

By Courtney Lyles, PhD

The title of this blog post is a quote by science fiction author William Gibson (who coined the phrase many years ago, by the way).  And I think it is spot on in a number of ways.  It is clear that so many seemingly futuristic technologies have already been developed: from using your smartphone to passively track your activity and mood, to the development of a sensor to test blood glucose through the skin without drawing blood.  But the reality that is so clear to us working in the safety net is that most of these tools are not distributed to those who need it most, and sometimes even only make their way to our settings after they become somewhat obsolete in the tech space.

Martin Luther King Day, 2015

By Margaret Wheeler, MD

For this Martin Luther King Jr. Day, in the fiftieth anniversary year of the Voting Rights Act and the Selma to Montgomery March, it is hard not to draw comparisons between those days and ours.  

Prostate Health Support Group for African American Men

By Nynikka R. A. Palmer, DrPH, MPH

Prostate cancer among African American men is one of the most intractable cancer disparities. African American men bear an excess burden of prostate cancer across all stages of management, including presentation, diagnosis, treatment, survival, and quality of life.

On point: Broadening pain management options with acupuncture

By Maria T. Chao, DrPH, MPA

As I think about the year ahead, one change that I’m really excited about is the prospect of acupuncture for patients at San Francisco General Hospital (SFGH). In the US, pain management is the leading reason that patients seek care from acupuncturists. Acupuncture utilization has increased by 50% over the past decade, but is not commonly used by non-Asian minority populations and those with limited income. Barriers to use include high out-of-pocket costs and limited access to services.

How Can Non-English Speaking Patients 'Meaningfully Use' Patient Portals?

By Neda Ratanawongsa, MD, MPH

 “For Spanish press 1, for Cantonese press 2, for Mandarin press 3, for Taishanese press 4, for Vietnamese press 5 …” 

My exam room phone doesn’t have enough buttons for all the languages I need to serve my patients.   In a typical clinic session, I use an interpreter for half of my clinic visits and phone calls to patients.   It is this amazing linguistic and cultural diversity that drew me to be a primary care provider at the General Medicine Clinic.

The Center of the Storm: Homelessness and Health

by Margot Kushel, MD

As the Bay Area is deluged with the biggest rainstorm in a decade, most of the region’s schools were cancelled and many workplaces allowed for flexibility, so that people could stay safe and dry in their homes. Churches and homeless service agencies opened their doors to provide temporary shelter for members of our community who are homeless. But the storm of the decade was another blow to those who have already been struck by the perfect storm of rising housing prices, loss of support for affordable housing, and lack of availability of living wage jobs for those without specialized skills.  

Ebola and Immigrant Fears

by Alicia Fernandez, MD

Here is a thought experiment:  Imagine that Thomas Duncan, the unfortunate Texas Ebola patient, had been undocumented in addition to uninsured when he presented to a private hospital in Dallas.

Be sure to consider the impact on his decision making in seeking health care.  Now, imagine the media response.  Imagine the impact on policy makers.

Hold those thoughts.

Insights from mainstream media

By Robert Brody, MD

People Magazine is an unusual source for a blog such as this - we are more likely to comment on articles in more academic journals.  But I believe the following from People.com about a young woman, a UCSF patient, who had to leave California for another state to get the care she wanted, and especially the video in which she tells the story herself, is a powerful reminder about work that still needs to be done to make patient-centered end of life care in the form of death with dignity legal and accessible in this state.

http://www.people.com/article/Brittany-Maynard-death-with-dignity-compassion-choices

Leaving No One Behind: The International Day of Older Persons

By Anna Chodos, MD, MPH

I am wondering if Mr. Rose knows that today is the UN’s 24^th celebration of the International Day of Older Persons (IDOP). The theme is “Leaving No One Behind: Promoting a Society for All.”

He does not talk to many people in a given day.  He lives on his own in a single-room occupancy (a bed and a small bathroom) in one of the many housing units for low-income adults in San Francisco.  At 75, he is one of its oldest residents.  When I visited him there for a home medical visit, he showed me his small fridge full of microwave pizzas and orange soda, which is what he can buy from the drug store near him.  He has difficulty walking, so he gets what he can from the nearest place that sells food.  He is fiercely independent so has refused help from a city in-home support worker that could help him with shopping.  And he said he did not have any friends or family who could help out.  But, he said, he did not feel lonely.

Challenges and opportunities for technology use in safety net settings

by Courtney Lyles, PhD

As a health services researcher, I have been interested in ways to engage individuals with their health or healthcare management – particularly ways that fit into their everyday lives outside of the doctor’s office or hospital.  That’s why the buzz about health information technology seems so promising to me: the potential to provide practical and customizable information/feedback at the right moment.  In addition, the financial incentives are starting to align to promote health technologies.  With the rollout of federal healthcare reform in the past few years, it has become clear that technology will be a fundamental, not tangential, part of healthcare in the near future. 

Yet when I think about patients receiving care in safety net systems like SFGH, I see both opportunities and challenges during this transition to technology-enhanced healthcare.

The war at home against diabetes disparities

by Dean Schillinger, MD

During the recent decade-long Iraq and Afghanistan wars, 1,500 US soldiers lost a limb in combat. This tragedy was widely covered in the media and helped mobilize efforts to reduce exposure to threats in the Near East theatre, expedite troop withdrawals, and improve rehabilitation services for veterans. In that same period of time, over 1.5 million US residents suffered amputations as a result of Type 2 diabetes (DM2). While the number of amputations occurring on the home front as a result of DM2 exceeds that of the overseas front by a factor of 1,000, there is little public awareness of this war being waged at home. While clinicians, patients and families fight thousands of life- and limb-threatening battles on a daily basis, there is scant evidence that the US clinical and scientific community has truly mobilized for a public health war against DM2.

Unnecessary Testing: One Doctor's Experience

by Soraya Azari, MD

I am an extremely fortunate person - not only am I awaiting the arrival of my first child, but I've had a relatively uncomplicated pregnancy.  I say "relatively" because there has been one unpleasant aspect: having to do extra, unnecessary testing.  To explain, a bit of background: during pregnancy it is common to measure a fundal height, which represents the distance from the pubic bone to the top of where the uterus is felt.  This numerical height should roughly equal the number of weeks that have elapsed in the pregnancy.  For example, at 20 weeks gestation, the height from the pubic bone to the top of the uterus should be 20 centimeters.   

An Interview with Urmimala Sarkar, MD, MPH

Associate Professor Urmimala Sarkar was recently interviewed by Dr. Robert Wachter for WebM&M, an online journal and forum about patient safety and health care quality.

Below is the text from their discussion, reprinted with permission of Agency for Healthcare Research and Quality (AHRQ) WebM&M:
"In conversation with Urmimala Sarkar, MD, MPH [interview]." AHRQ WebM&M [serial online]. July/August 2014. Available at: http://webmm.ahrq.gov/perspective.aspx?perspectiveID=161.

In case you missed it…. Why we fill out prior authorization forms for colchicine….

by Kirsten Bibbins-Domingo, MD, PhD

I recently finished several weeks of outpatient attending and spent a good bit of time filling out prior authorization forms for medications not covered under the formulary of our insurers.  Many of these “prior auths” were for colchicine – or more correctly for the new brand name drug Colcrys.