Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: A prevention program was undertaken as a consequence of bioterrorist attacks involving the distribution of Bacillus anthracis in mailed packages and letters in the fall of 2001. As of December 5, 2001, the Centers for Disease Control and Prevention (CDC) has identified a total of 22 cases of anthrax that were presumed to result from workplace exposures related to these acts of bioterrorism. Post-exposure prophylaxis for approximately 10,000 persons was undertaken.

The CDC has contracted with RTI International to conduct telephone interviews and medical record follow-up of all persons for whom post-exposure antibiotic prophylaxis was recommended. RTI obtains consent from respondents who report potential possible severe adverse events (PSAEs) to the antibiotics and/or vaccination for the purpose of obtaining medical records from their providers for analysis. The evaluation consists of four longitudinal follow-ups conducted at the following four intervals after the initial receipt of the post-exposure prophylaxis: 60 days, 6 months, 12 months, and 24 months.

On April 14, 2003, new Health Insurance Portability and Accountability Act (HIPAA) regulations were put into effect, limiting the release of medical records by health care providers. CDC and RTI were concerned that these HIPAA revisions would adversely impact medical record collection activities resulting in lower response rates from medical providers.

RTI faced this challenge by changing procedures to specifically allay concerns about the applicability of HIPAA regulations in obtaining records from medical providers. RTI achieved a 56 percent response rate in the initial 60-Day Program Evaluation, a 74 percent response rate in the 6-Month Follow-up, and an 86 percent response rate in the 12-Month Follow-up. Preliminary results indicate that the medical providers were more willing to cooperate if the applicability of HIPAA was clarified, even though the new HIPAA regulations required more stringent procedures to obtain medical records.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This study examined nonverbal communication in relation to Electronic Medical Record (EMR) use during the medical interview. 6 physicians were videotaped during their consultations with 50 different patients at a single setting Veterans Administration Hospital. 3 different office spatial designs were identified and named “open,” “closed” and “blocked.” The “open” arrangement put physicians in a position to establish better eye contact and physical orientation than did the alternative “closed” and “blocked” office configurations. Physicians who accessed the EMR and took “breakpoints” (short periods of no computer use and sustained eye contact with patients) used more nonverbal cues than physicians who tended to talk with their patients while continuously working on the computer. Long pauses in conversational turn taking associated with EMR use may have positively influenced doctor-patient communication. High EMR use interviews were associated with patients asking more questions than they did in low EMR use interviews. Implications for medical education and future research are discussed.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This paper will consider the discourse surrounding the rise and fall of a private medical market to understand how the “market” operates as a symbol that crystallizes moral concerns about the intersection of money and medicine. To do this I construct a narrative account of the discourse surrounding the rise and fall of the directly consumable full body computed tomography (FBCT) scan market. I identify the claims-making activities of entrepreneurs, the response from the medical profession and discourse in the news media and medical literature. It is clear that the concern over the FBCT scan market is about more than the “worried wealthy” being exposed to radiation. The market served as a moral metaphor that crystallized a number of concerns reflected in a niche economic exchange about access, the potential for abuse of medical innovation, an individual’s rights versus the public good, the economic value of health risk knowledge and the degree to which the values of the market are compatible with the medical profession’s fiduciary obligation to the public.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This article adds to the growing area of resident socialization research by exploring a seldom-studied aspect of American medical resident socialization: residents’ perceptions of communication between doctors and patients. Medical residents in the US are valuable to study because they are learning to become physicians; they are learning how to communicate with patients; they are also observing countless interactions between attending physicians and patients.
Twenty-eight residents participated in semi-structured interviews ranging from 30 minutes to 90 minutes in length. Data was analyzed using inductive thematic analysis. Results are presented in five main areas this article. These areas are residents’ views of the importance of communication, resident descriptions of factors contributing to poor interactions between physicians and patients, and resident descriptions of their ideal patients and ideal physician-patient interactions. A review of study limitations and future research avenues are also presented.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The meaning of integrative, complementary and alternative medicine (I/CAM), in the U.S. and other nations’ health care fields, is a dynamic and contested terrain involving the legitimacy and efficacy of treatments, the professionalization of I/CAM providers, and broad conceptions of health, health care, wellness, and illness. This study investigates the varying roles of 122 U.S. medical schools in the social and cultural constructions of I/CAM. Our data show that over half of medical schools in the U.S. offer no education and training in I/CAM, as well as no I/CAM service provision in their affiliated medical centers. Of the schools that do incorporate some degree of I/CAM, more are focused on research and education than service provision, and only two specifically self-identify as agents of change in the health care field. Although a few schools present I/CAM as legitimate, contemporary, and even taken-for-granted, the I/CAM involvement of most U.S. medical schools portrays a conservative picture, supporting the mainstream more than introducing new physicians to medical pluralism.