18-16 Segment 1: Diagnosing Perinatal Depression

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Imagine going to the doctor with your newborn baby because you are interested in receiving help for symptoms of depression only to be taken to the emergency room by the police. This is what happened to new mother Jessica Porten who had been experiencing symptoms of perinatal depression–previously known as postpartum depression–when she attempted to seek medical treatment. While this sounds like an overreaction in this situation, Dr. Darby Saxbe and Dr. Tiffany Moore Simas both agree that the healthcare provider was just attempting to protect the mother and the child by avoiding any harm. In any situation like this, Dr. Moore Simas, Associate Professor of Obstetrics and Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences at the University of Massachusetts Medical School and co-chair of Maternal Mental Health Expert Work Group at the American College of Obstetricians and Gynecologists, explains that either way a physician will face scrutiny by overreacting or underreacting, so it is best to overreact when there are safety concerns. Yet, symptoms similar to Porten’s are common in new mothers, so why do these situations continue to happen?

Dr. Saxbe, Assistant Professor of Psychology at the University of Southern California, explains that one in seven women are affected by perinatal depression, with some populations being more highly affected. But, it still remains massively undertreated because of the stigmatization of mental illness. Dr. Saxbe states that many new moms feel it is wrong to not feel overjoyed by the birth of their child, so they do not feel comfortable seeking treatment. Furthermore, Dr. Moore Simas explains that the symptoms of perinatal depression are often times not associated with depression, but instead, they are attributed to being apart of pregnancy or postpartum.

While stigmatization and confusion of the symptoms do decrease the likelihood of diagnosing perinatal depression, there appears to be another problem with the lack of training given to OBGYN’s. Dr. Saxbe explains that they often have little to no training in psychiatry, and remain unqualified in properly screening and diagnosing perinatal depression. But, Dr. Moore Simas states, recently schooling to become an OBGYN  has started to introduce mental health training as a component in order to improve the care provided to women experiencing perinatal depression. With increased knowledge on psychiatry and increased accessibility to psychiatric care, women with perinatal depression will be able to receive better treatment and many of these cases will no longer go undiagnosed.

Guest:

  • Jessica Porten, new mother diagnosed with depression
  • Dr. Darby Saxbe, Assistant Professor of Psychology at the University of Southern California
  • Dr. Tiffany Moore Simas, Associate Professor of Obstetrics and Gynecology, Pediatrics, Psychiatry and Quantitative Health Sciences at the University of Massachusetts Medical School, and co-chair of Maternal Mental Health Expert Work Group at the American College of Obstetricians and Gynecologists

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18-16 Segment 2: Foreign Accent Syndrome

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In a medical emergency that results in a brain injury, such as a stroke, there are a number of health complications that can affect the patient afterward. One of the more well-known subsequent results is aphasia which is the impairment of speech and language. However, many people do not know that once the aphasia wears off, the patient may still be left with an accent. This sudden change in speaking is actually a syndrome known as foreign accent syndrome. However, Dr. Jack Ryalls, Professor of Communication Sciences and Disorders at University of Central Florida, explains that research has proven that these patients’ new way of speaking is actually not an accent. Furthermore, Dr. Sheila Blumstein, Albert D. Mead Professor of Cognitive Linguistics and Psychological Sciences at Brown University, states that people will perceive these as foreign accents, but in actuality, people who suffer from foreign accent syndrome have only developed slight variations in how they pronounce words which indicates to those listening to them that they have an accent.

So, what happens to those who suffer from foreign accent syndrome? Dr. Ryalls explains that chances of recovery are very slim–only about 30% are able to recover their old accent because therapy has been proven to not be beneficial. Along with this, people with foreign accent syndrome are likely to experience distress. Dr. Blumstein states that how an individual sounds and speaks contributes a lot to their self-identity, so it can affect a person’s perception of oneself. This distress can be furthered, too, by a change in how they are identified in the world. Dr. Blumstein explains that foreign accent syndrome can be isolating because many people will view this person as being from a foreign country. While many people do not recover, some are able to regain their old accents. Researchers have been looking into cases of recovery in order to improve the chances of recovery for others who suffer from foreign accent syndrome.

Guest:

  • Dr. Sheila Blumstein, Albert D. Mead Professor of Cognitive Linguistics and Psychological Sciences at Brown University
  • Dr. Jack Ryalls, Professor of Communication Sciences and Disorders at the University of Central Florida

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18-15 Segment 1: Adventures of a Paramedic

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Have you ever wondered what it is like to be a first responder? We talk with Kevin Hazzard, former paramedic and author of A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back, who tells us about his experiences as a paramedic and what it takes to be able to deal with emergency situations.

As a first responder, paramedics must enjoy the chaos and must be able to adjust to any situation. Hazzard explains that the practices of medicine that are taught during training are not always the most effective way to approach an emergency situation because EMTs and paramedics tend to be outmatched. Furthermore, he states that being a paramedic is often like being a detective because first responders must be attentive to the details surrounding them in order to figure out what happened and how to best treat the victim. An EMT or paramedic must be capable of listening to the victim and the bystanders, as well as making observations about the environment, because they are incapable of running tests that can provide them with answers. Hazzard describes the care provided by first responders as a primitive form of medicine because they are not able to use a lot of advanced medical techniques that medical practices have access to.

Along with these skills, first responders rely on a certain level of emotional capability in these emergency situations. Hazzard explains that it is important to be able to be detached from the victims because if not, many would be incapable of doing the job. He states that a first responder cannot think about the pain of the victim because it will hinder their ability to perform vital tasks. However, in certain situations, empathy provides the most effective care. Hazzard explains that some people call 911 because they are frightened or unsure of what is going on, and the best way to help them in this situation is to simply talk to them. Furthermore, he expresses that paramedics must be able to cope with the fact that they are almost always going to be put into compromising situations.

In the end, first responders must be dedicated to their jobs. Hazzard explains that as a tax funded field, they are not given the best supplies, and are often told to made do with what they have. Some even spend their own income to purchase better equipment. Despite the tough circumstances and compromising situations, most first responders continue to be committed to saving the lives of the American people that need their help.

Guest:

  • Kevin Hazzard, former paramedic and author of A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back

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18-15 Segment 2: The Mystery of Meniere’s Disease

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Imagine waking up and no longer being able to hear in one of your ears. And, after losing the ability to hear, you are suddenly affected by bouts of vertigo attacks that can last anywhere from a few minutes to a few hours. This is what happened to James Raath, business consultant and author of Love Mondays, who suffers from Meniere’s disease which is a disease that is caused by a fluid imbalance in the inner ear that forces the membrane separating the chambers to rupture.

Dr. David Friedland, Professor and Vice Chair of Otolaryngology and Communication Sciences at Medical College of Wisconsin, explains that this disease is commonly diagnosed, however, it is an uncommon disease to have. While the main symptoms, tinnitus and vertigo, are experienced by many people, the presence of both does not necessarily imply that the person has Meniere’s. Furthermore, Dr. Friedland explains that it is unknown whether the rupturing of the membrane is caused by the endolymphatic sac absorbing too little or too much fluid. But, the sufferer will be relieved of the symptoms once the membrane fixes itself. However, regular occurrences of this rupturing can have long term effects. Dr. Friedland explains that a person may suffer from progressive loss of hearing and increased weakness in the balance system.

So, what can be done to stop the progression of this disease? Dr. Friedland explains a few ways in which physicians can go about treating Meniere’s disease. The first, he says, is allergy medicine because allergies appear to be a trigger that can set off the fluid imbalance. Another way that he suggests to counteract the disease is to consume a low salt diet and water pills. In some cases, Dr. Friedland states some patients may get a shot that can drain excess fluid in the ear and improve the hearing loss. A final treatment that he explains is ablation which destroys the balance cells within the inner ear. The goal of this procedure is to reduce vertigo by making it so that an imbalance of fluid in the ear does not affect the balance system that causes vertigo. However, he warns that this procedure does not change the disease process, but instead, only changes the balance system so it cannot be stimulated by the disorder. While there is no cure to Meniere’s disease, there are many ways in which those who suffer from the disease can work to counteract or slow down the process.

Guests:

  • James Raath, business consultant and author of Love Mondays
  • Dr. David Friedland, Professor and Vice Chair of Otolaryngology and Communication Sciences at Medical College of Wisconsin

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18-14 Segment 1: The Price Consequences of Doctor Consolidation

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In some areas, it has become almost impossible to find independent physician practices. Many of these smaller practices have opted into being bought by hospitals and other large medical groups. So, what has prompted the increase of consolidation in the medical field? And what does this mean for patients?

The incentives of consolidation have been researched, but the results do not point to one reason. Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine, explains that physicians running smaller practices might benefit from no longer having their own business. Another possibility, Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management at Northwestern University, explains, is that some hospitals may view consolidation as a way to improve the quality of healthcare and decrease the costs to help physicians and their patients. However, data has indicated that the factor with the largest role in consolidation has to do with increasing the amount that hospitals are getting paid, and decreasing the amount paid to pharmaceutical companies. Even though research has not provided an overarching incentive that drives consolidation, the data seems to point to increasing income for hospitals rather than providing patients with better care. Furthermore, hospital consolidation has not been shown to benefit the patient. Dr. Baker explains that data indicates that the cost of healthcare has not gone down for patients with consolidation. Since the cost of healthcare has increased for patients, many have started to wonder how consolidation has been able to continue and what is being done to control it.

In the medical field, it is important to maintain consistency in market concentration and ensure that the markets are still competitive. One way in which authorities in the medical field work to maintain market concentration is by regulating transactions that reach a price threshold. However, Dr. Ody explains that hospitals have been able to avoid these regulations by partaking in multiple smaller transactions that invest in a small number of physicians at a time in order to ensure that the cost is below the threshold for evaluation. By avoiding regulations, hospitals have been able to grow into much larger entities that generate a lot of power and income from smaller practices. Since consolidation has prompted increased healthcare costs, it currently appears to be detrimental to the medical field rather than helpful. Yet, it could be worth it if hospitals were able to determine a method of consolidation that decreases healthcare costs and improves the quality of care that is provided to patients.

Guests:

  • Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine
  • Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management, Northwestern University

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18-13 Segment 2: Teaching Doctors To Listen

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We all know that doctors endure years and years of schooling and training in order to learn how to diagnose their patients and provide them with the best care. But, studies have shown that many doctors tend to miss details about other aspects of a patient’s life that can also have an affect on their wellbeing. Dr. Saul Jeremy Weiner, Professor of Medicine, Pediatrics & Medical Education at University of Illinois and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care, explains that patients will make important comments that do not necessarily pertain to their symptoms, but that this information is often overlooked despite being critical for a doctor to understand in order to provide the patient with an effective care plan. But, what is the overall impact of this on the patient?
Dr. Weiner and Dr. Alan Schwartz, Michael Reese Endowed Professor of Medical Education at University of Illinois, Chicago, and co-author, Listening For What Matters: Avoiding Contextual Errors in Health Care, have done their own research that has shown the effects of doctor’s that are too focused on the biomedical details in providing care for patients. Dr. Schwartz explains that the results of their research showed that doctors who address the patient’s personal life were able to provide a much more successful care plan for the patient. Furthermore, the study also showed that the cost of healthcare for the patient increased when the doctor was too concerned with the science of the diagnosis. In order to have the most successful outcome without increasing the cost of healthcare, doctors must address more than just the patient’s biomedical symptoms.

So, how can doctors learn to listen to their patients more efficiently? Dr. Weiner suggests using an approach commonly used in other industries: mystery shoppers. In the medical field, a mystery shopper is an unannounced standardized patient that is trained to go into a physician’s office and provide data to help identify problems–a tool that many doctors have found to be helpful in improving their practice. Dr. Schwartz states that by investing in improving contextual care doctor’s will be able to provide better care for their patients and decrease the cost of healthcare, too. However, all patients and employees in the medical field must be willing to undertake these methods and procedures in regular practice in order to improve the overall experience for everybody.

Guests:

  • Dr. Saul Jeremy Weiner, Professor of Medicine, Pediatrics & Medical Education at University of Illinois and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care
  • Dr. Alan Schwartz, Michael Reese Endowed Professor of Medical Education at University of Illinois, Chicago, and co-author of Listening For What Matters: Avoiding Contextual Errors in Health Care.

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18-13 Segment 1: Sexually Abusive Doctors

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Almost every portrayal of doctors depicts them to be unequivocally good, and many people believe this portrayal. However, this belief has been under scrutiny recently. In light of the recent case against Dr. Larry Nasser, physicians and patients have started to focus their attention on doctors who sexually abuse patients and investigate the outcomes of these crimes, and the results are nothing short of disheartening.

Danny Robbins, an investigative reporter for Atlanta Journal-Constitution, has spent a lot of time examining the official response to this problem of doctor’s who sexually abuse their patients. He found that more than 2,400 doctors have been sanctioned by medical boards for sexual abuse of their patients, but more than half of these doctor’s still had their medical licenses. Among the doctors who did have their license taken away, Robbins discovered that many were able to easily get them back and continue practicing. The reasoning behind this is similar to a reasoning found in the criminal justice system: people working in these fields do not want to report each others misbehaviors. Robbins explains that oftentimes medical boards will shield these crimes from the public by not reporting them to the criminal justice system unless the victim reports it. But, even in the event of a victim reporting the abuse, the attorney general is left to negotiate with the doctor’s lawyer, and the medical boards follow the negotiation agreed upon by the doctor and the attorney general. Despite the number of doctors that are reported for sexually abusing their patients, few of them face punishments, and among those that do, the punishments are not severe and leave the abuse unknown to the public.

With little being done to deter doctor’s from misbehaviors, what can patients do to protect themselves? Dr. Altaf Saadi, neurologist and former sexual assault crisis line worker, explains that patients are always given the option to have a nurse present in the exam room. Along with this, Robbins also states that patients can go online and see if their doctor has been sanctioned at all. However, these records are often left vague, and one might have to do a little more research in order to determine what the violation was. However, Dr. Saadi believes that physicians also have a role in changing this. She explains that physicians should work to counter the environment that allows for these crimes to go unheard. Furthermore, it is important to address the medical boards that allow these doctors to get away with sexually abusive behaviors. Robbins states that the medical boards need to consist of a more diverse group of members who are not all doctors because many boards have few consumer members, if any at all. In order to see a change in the ways that these cases are handled, both physicians and patients have important roles in changing the ways in which medical boards and the criminal justice system pursue these offenses in the future.

Guests:

  • Dr. Altaf Saadi, neurologist and former sexual assault crisis line worker
  • Danny Robbins, investigative reporter for Atlanta Journal-Constitution

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