A Northwest Portland psychiatrist who the state has reprimanded for wrongly prescribing drugs says he plans to open a facility in the city and charge fees to help patients end their lives under Oregon's Death with Dignity Act. Stuart G. Weisberg has mailed invitations to local doctors and politicians inviting them to a July 21 "presentation" at the deluxe El Gaucho restaurant in downtown to unveil his new business, End of Life Consultants LLC. Weisberg said he has invited Jack Kervorkian, the Michigan pathologist who provided the drugs and the means for terminally ill people to kill themselves and served a prison sentence for his actions. On the website for End of Life Consultants, Weisberg said he has obtained a Portland property that he calls "The Dignity House" where his patients under the Death With Dignity law can receive the medicine and die there.
Amid continued concern about errors by overworked medical residents, hospitals would be forced to curtail shifts and increase supervision of some doctors-in-training under proposed new guidelines for residency programs. The plan from the Accreditation Council for Graduate Medical Education goes well beyond previous efforts to limit work hours. Many patient advocates and physicians hailed it as a step in the right direction, but it would likely pose logistical and financial challenges for teaching hospitals, the Wall Street Journal reports.
In the latest effort to break up the often cozy relationship between doctors and the medical industry, the University of Michigan Medical School has become the first to decide that it will no longer take any money from drug and device makers to pay for coursework doctors need to renew their medical licenses. University officials voted to eliminate commercial financing, beginning next January, for postgraduate medical education, a practice that has come under increasing scrutiny from academics, medical associations, ethicists and lawmakers because of the potential to promote products over patient interests.
As the academic year draws to a close, many residency programs are conducting their final exit interviews. To be most effective, program directors and other exit interviewers must remember that these meetings are a two-way street. Not only do you provide trainees with valuable feedback, you also gain insights for program improvement.
Take advantage of uncensored feedback
Hold exit interviews in the last month of training after residents have completed all of their formal requirements, says Liana Puscas, MD, MHS, otolaryngology residency program director at Duke University School of Medicine in Durham, NC.
"You'll get unfiltered feedback about the program, didactics, faculty, and even other residents," Puscas says.
If you perform exit interviews before residents meet all of their requirements, they may withhold information, fearing retribution that could affect their graduation status.
When you meet with residents, some will be more than willing to share their opinions, whereas others may not see the value of the feedback or feel uncomfortable giving negative responses, says Eric Katz, MD, FACEP, FAAEM, emergency medicine program director at Maricopa Medical Center in Phoenix, adding that he has a strategy for drawing constructive criticism out of residents.
"I'll say, 'You spent three years of your life here. What is the one thing that you've always wanted to say but you've bitten your tongue about?' " Katz says.
That approach often succeeds, but if it doesn't work, don't push. Instead, tell residents that if they change their minds, they can call or e-mail you, Katz suggests.
Another option for getting feedback is to ask residents to complete a survey before the exit interviews, says Christine Cook, MD, OB/GYN department chair and program director at the University of Louisville in Kentucky. Cook asks common questions, such as:
How has the program improved since you started?
Which aspects have you become increasingly disappointed with since you started training?
Identify specific parts of the program you want comments on and add related questions to your questionnaire. For example, Cook emphasizes to faculty members that each trainee has strong and weak points, and it's up to them to help residents play to their strengths and work with their weaknesses. She asks residents to evaluate whether she and the faculty were successful on the survey.
Additionally, during Cook's meetings with graduating residents, she asks whether there are any junior residents who are struggling or doing exceptionally well. Residents also tend to give feedback about which attending physicians are excellent teachers, Cook says.
Impart words of wisdom
Whether you combine the exit interview with the resident's final summative evaluation or choose to hold those conversations at different times, allow residents to review any data you will discuss prior to the meeting, says Katz.
"I don't want them to sit there and read their evaluations with me," he explains. "We should talk about where they feel they are and where they're going."
During his exit conversations with residents, Katz reiterates feedback that he's given during previous conversations, but he puts a real-world spin on it.
For example, when meeting with a resident who hasn't responded well to feedback, rather than discussing an example related to the residency training, Katz will ask the resident to consider a hypothetical situation in which the peer review committee sends him or her letter regarding a patient complaint. Katz then works through the problem and possible responses with the resident.
Don't be hesitant to broach personal topics with graduating residents. Help them set personal and professional goals, Cook says.
Julie McCoy is an associate editor for the residency department at HCPro, Inc. Read more residency news at www.residencymanager.com.
Hundreds of babies delivered prematurely at Dallas-based Parkland Memorial Hospital may be at risk because they are not being kept warm enough immediately after birth, according to a study presented to the hospital's board of managers. The study included recommendations on how preemies delivered by Caesarean section can be kept warmer in the operating room. But it's unclear what the hospital board decided to do because its members abruptly decided to meet behind closed doors. Parkland officials defended the decision but gave conflicting reasons why the private discussions were necessary, the Dallas Morning News reports.
President Obama's nominee to run Medicare and Medicaid, Dr. Donald M. Berwick, has been showing hospitals how they can save lives and money by zealously adhering to clinical protocols for the treatment of patients, the New York Times reports. Hospital executives who have worked with Berwick describe him as a visionary, inspiring leader, but a battle has erupted over his nomination that suggests Berwick faces a long uphill struggle to win Senate confirmation.