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.

From randomized trials to the real world

By Urmimala Sarkar, MD, MPH

Often, at scientific conferences, the most important learning happens in the question and answer period. I spoke at the American Diabetes Association conference earlier this year, presenting results of an observational study we did on medication adherence and diabetes. We found that if people starting using the online patient portal (sometimes called the personal health record), to order their medication refills, they were more likely to take their medication regularly. Dr. Katherine Newton of Group Health Research Institute spoke before me, describing a randomized study showing that a clinical pharmacist-led blood pressure management program did not lower blood pressure any more than usual care by an outpatient provider.

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.