Research
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Who’s Deciding? A Study of Patient-Surgeon Discussions About Contralateral Prophylactic Mastectomy
In this study, we explore conversations about contralateral prophylactic mastectomy–about whether to remove a healthy breast when also removing a breast affected by cancer. We look at who starts these conversations, and whose values drive the decision. Read it here
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When crowdfunding for medical expenses, who gets the money?
Led by a former Duke medical student, Steven Doerstling, we analyzed, oh, 90K online campaigns, where people (or their loved ones) asked for money because of medical problems they were having. Here is a paper that shows how much money they got, and what factors were associated with receiving more or less money. Read more…
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Health Care in an Evolving Immigration Landscape — Providing Care while Upholding the Law
Many clinicians and healthcare provider organizations are struggling to figure out how to do their jobs with all the recent changes in immigration policies. I co-authored a commentary in the NEJM that provides guidance about how to uphold their duty to patients while staying compliant with emerging laws.
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Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction
Led by the amazing Neal Dickert, cardiologist at Emory, we conducted an RCT of an intervention designed to promote cost conversations. Read more here
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Physician Gender and Patient Perceptions of Interpersonal and Technical Skills in Online Reviews
Do patients’ on-line physician reviews reveal gender bias? In a study led by the marvelous Dr. Farrah Madanay, we looked at that question, and found some disturbing results. Female physicians tend to be judged more on their ‘personality’ than male physicians.
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Out of Pocket Getting Out of Hand
In this NEJM Perspective, my (awesome) co-authors and I argue that we need to reduce costs, to patients and society, for drugs that receive ‘accelerated approval’ by the FDA. Drugs, in other words, that still haven’t proven to meaningfully benefit patients.
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Are Students Ready to Run Student-Run Clinics?
With an outstanding student from Baylor College of Medicine, I co-authored an essay on some of the clinical, administrative, and ethical problems raised by student-run clinics. We suggest ways to improve things going forward. Check it out here
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Talking About Suffering in the Intensive Care Unit
We were worried: that when ICU clinicians discuss patient “suffering” with patients’ family, they are using the emotionally powerful word as a way of persuading them to withhold or withdraw life support. Was our worry justified? In this study, led by Brent Kious, we analyze how clinicians and family members used the word when meeting…
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What Do Psychiatrists Think About Caring for Patients Who Have Extremely Treatment-Refractory Illness?
Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient…
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Shared Decision-Making Communication and Prognostic Misunderstanding in the ICU
Surrogates often make decisions on behalf of critically ill patients.1 Surrogate comprehension of patient survival prognosis can affect these decisions: surrogate prognostic estimates of survival that are overly optimistic compared with clinician estimates are associated with increased use of life-sustaining treatments and reduced quality of life for dying patients.2,3 … Different prognostic estimates by surrogates…