fall | 2013 in this issue · the difference between an optometrist and ophthalmologist, according...

1

Fall | 2013

Care Extender Internship Program

The Inside Scope

| it begins with U

+ The importance

of effective

doctor-patient

communication

continued on page 6

1

The term “bedside manner” refers

to the way a physician interacts

with his or her patients.

It is the cornerstone of effective

and meaningful doctor-patient

interactions, and often

determines how satisfied,

The Import of Bedside Manner

3

Unfortunately, effective

communication skills may be

glossed over in the midst of the

rigorous and abundance of

concepts that medical students

are expected to master. This

2

informed, and comfortable a

patient feels about his or her

care.

The Problem

Medical schools train doctors to

have strong foundations in the

sciences and the healing arts.

In this Issue: The Import of Bedside Manner

1

Careers in Medicine: Optometry

2

11 Outstanding Care Extenders

10 New Staff Members

(continued on pg. 6)

Important Dates 12

Fall| 2013

2 Care Extender Internship Program

| it begins with U

Careers in Medicine Optometrist (O.D.)

+

(continued)

1

History and the O.D. versus O.M.D. conflict

The history of optometry, especially in America, has

been tumultuous to say the least. As early as the

1900s, optometrists represented by the American

Optometric Association (AOA) have been in

constant conflict with the American Academy of

Ophthalmology (AAO) and the American Medical

Association (AMA).

Several accounts exist of early optometrists having

been threatened, arrested, and even jailed for

infringing upon the practices of medicine. Dr. Fred

Baker of Dallas, Texas, for instance was charged

with “practicing medicine without a license” after

2

having fitted a pair of eyeglasses.

Although decades have passed since then, the

friction between the two professions is still present.

Optometrists as an organized profession has had to

fight tooth and nail for their rights to practice as

healthcare providers, whether it be against the

discriminatory and anti-competitive practices of

health plans or the AMA. The battle still continues,

as optometrists aim to expand their scope of

practice to include optical surgical procedures—

with 46 legislative attempts in 21 states since 1997.

Fall| 2013


| it begins with U

(continued)

4

In fact, about 30% of the

American public doesn’t know

the difference between an

optometrist and ophthalmologist,

according to a study conducted

by the National Consumer’s

League. Many are aware that

ophthalmologists have a wider

scope of practice and can

perform surgical procedures, but

there is a greater fundamental

distinction between the two:

optometrists are graduates of

optometry school, while

ophthalmologists are graduates

of medical school. After earning

a medical degree, it often takes

an additional three to four years

before an individual can

become an ophthalmologist. It is

no surprise, therefore, that

ophthalmologists are against

3

Why the resistance? According

to physicians, it stems from a

disparity in education and

clinical experience. “They

[optometrists] want to practice

medicine without going to

medical school,” says Dr. Daniel

Briceland, a highly rated

ophthalmologist in Sun City,

Arizona, and secretary for state

affairs with the American

Academy of Ophthalmology.

“This is how people get hurt.”

While ophthalmologists argue

that optometrists have not had

sufficient training to perform

these risky procedures,

optometrists assert that the ability

to perform these procedures will

greatly benefit rural areas that

lack and therefore are in need of

eye doctors. Furthermore, the

demand for eye doctors exceeds

the number of ophthalmologists

available for treatment, and

visiting an optometrist is often

more cost-effective than seeing

an ophthalmologist. This then

raises the concern that the

distinction between the two

professions will become blurred,

ultimately confusing patients as

to which healthcare provider to

see.

5

optometrists from expanding their

scope of practice.

This antagonism is especially

prevalent in the treatment of

diabetic patients, who often

suffer from optical complications

such as retinopathy. In diabetic

retinopathy, the blood vessels

that supply the retina become

damaged, which can adversely

affect vision and may ultimately

lead to blindness. According to

the American Diabetes

Association, while both

optometrists and

ophthalmologists can detect the

signs of retinopathy,

ophthalmologists are the only

ones that can treat it.

Fall| 2013


| it begins with U

6

Of course, excellent optometrists

and terrible ophthalmologists do

exist, and both professions are

capable of providing effective

and necessary optical care.

Nevertheless, the struggle

between the two professions is

long from over. As put by Dr.

Mitchell T. Munson, President of

the AOA: “We’ll continue our

efforts…to assure fairness and

patient choice in the delivery of

the essential health care services

optometrists provide…In fact, if

we have to take on and defeat

organized medicine all over

again on this issue, then so be it.”

Scope of Practice

It is important to understand the

distinctions between

optometrists, ophthalmologists,

and dispensing opticians—all of

whom work with improving ocular

health and well-being.

Optometrist (O.D.):

• Test vision

• Check for eye diseases

• Prescribe eyeglasses,

contact lenses, and eye-

related medications

• Provide vision-related

therapy

• Provide pre- and

postoperative care for

7

patients undergoing eye

surgery

• Promote eye health

Ophthalmologist (O.M.D.):

• Perform eye surgery

• Treat eye diseases

• Prescribe eyeglasses and

contact lenses

Dispensing Optician:

• Fill and adjust eyeglasses

• Fill contact lens

prescriptions

• Assist customers in

selecting eyeglass frames

and lens treatments

• Repair or refit broken

eyeglass frames

Academic Preparation

To become an optometrist,

students must first earn an

undergraduate degree. A

bachelor’s degree is not

required, but recommended.

Prior to applying to optometry

school, students must take the

Optometry Admissions Test (OAT),

after which the application

process must be completed

through the Association of

Schools and Colleges of

Optometry (ASCO).

Upon acceptance into

optometry school, students must

Optometrist (O.D.)

Duties:

• Examine eye exams to check for the presence of vision problems and ocular disease

• Prescribe eyeglasses or contact lenses as appropriate

Ave. Salary: $94,990

Education & Testing:

• Undergraduate degree

• OAT • Optometry

School • Residency

(optional) • National and

state licensing

Years in School: 8

Fall| 2013


| it begins with U

9

options to pursue residencies in

specialized eye care such as

pediatric optometry, geriatric

optometry, refractive and ocular

surgery, and community health

optometry, among others. If

students don’t wish to specialize,

they then need to take licensing

exams through the National

Board Examiners in Optometry

(NBEO).

Programs

According to ASCO, there are

currently 21 accredited

10

optometry schools in the United

States, one of which is located in

Puerto Rico. Accredited

institutions in the state of

California awarding doctor of

optometry degrees include (click

to follow links):

• University of California,

Berkeley

• Western University of

Health Sciences

• Southern California

College of Optometry at

Marshall B. Ketchum

University

Salary

Optometrists earn an average

annual salary of $94,990 as of

May 2010 (BLS).

Job Outlook

Since the number of accredited

optometry schools in the United

States is so small compared to

accredited schools of other

health professions, licensed

optometrists often have good job

prospects, with a projected 33%

increase in job growth in the next

seven years. !

8

endure four years of rigorous

science-based coursework,

covering topics ranging from

anatomy and biochemistry to

optics and visual science.

Optometry students also have

supervised clinical rotations,

where they are able to gain a

hands-on experience to patient

care under the guidance of

trained optometrists and

ophthalmologists.

Following graduation from

optometry school, students have

http://www.ketchum.edu

http://optometry.berkeley.edu

http://www.westernu.edu/optometry

Fall| 2013


| it begins with U

Bedside Manner (con’t)

(continued)

4

inevitably produces doctors who

are skilled in their practice, but

may be lacking a connection

with people.

It turns out that when it comes to

medical skills and people skills,

most patients prefer that doctors

have good interpersonal skills. This

is shown in an April 2013 survey by

Vanguard Communications,

which reports that patients are

almost four times as likely to be

concerned about their

physician’s service and bedside

manner than about knowledge

and expertise. If patients cannot

emotionally connect with their

doctors, it makes the healing

process much more difficult.

This failure to communicate

effectively could result in

negative implications for both

5

the doctor as well as the patient.

For instance, patients that don’t

feel understood by their doctors

will be less likely to follow through

in treatment regimens and

recommendations. This may result

in frustration for both the patient

and the physician, which may

then lead to subsequently

unproductive interactions.

Ultimately, the patient may seek

another doctor whom they feel

will listen to and better

understand them.

Sometimes, it can simply be a

subtle difference between asking

a patient “Is there anything else”

or “Is there something else”.

Based on a 2007 study published

in the Journal of General Internal

Medicine, UCLA sociologist and

conversation analyst John

*

Patients are four

times as likely

to be

concerned

about their

physician’s

bedside

manner than

about medical

knowledge and

expertise.

6

Heritage found that framing the

question differently, using

“something” instead of

“anything”, reduced the

incidence of unaddressed

medical concerns by 75%.

The issue also extends to the

health care team. If doctors

engage in poor bedside manner

with other healthcare providers

that they work with, then that

physician may be compromising

his or her patient’s care. In a

study led by Dr. Andrew Klein,

director of the Comprehensive

Transplant Center at Cedars Sinai

in Los Angeles, and Pier Forni,

Fall| 2013


| it begins with U

7

founder of the Johns Hopkins

Civility Project at Johns Hopkins

University, it was found that the

incivility of surgeons affected the

OR staff, which in turn affected

the patient being operated on.

Those patients who had rude

surgeons tended to experience

higher levels of mortality and

post-surgery complications.

Furthermore, the research team

discovered that 75% of

pharmacists in hospitals and

nurses would rather avoid

confrontation with a difficult

physician than inquire or clarify

prescriptions written by these

doctors. In these cases, although

the physician may not be directly

interacting with the patient, his or

her demeanor can undeniably

affect the patient’s health.

How does it happen?

So how does poor bedside

manner come about? Don’t

hospitals and health care systems

have methods in place that

ensure proper patient

interactions? Most institutions do,

9

discussion, and sitting down with

the patient. These five key

strategies are similar to UCLA

Health’s own commitment to

care through C-ICARE, which

stands for Connect, Introduce,

Communicate, Ask, Respond,

and Exit.

After observing a total of 732

inpatient interactions, the study

team discovered that the interns

only introduced themselves 40%

of the time, explained their role

37% of the time, touched the

patient 65% of the time, asked

open-ended questions 75% of the

time, and sat down 9% of the

time.

When researchers followed up

with the interns, asking them how

they thought they did, the

numbers were drastically

different. They estimated to have

introduced themselves and

explained their roles 80% of the

time, while sitting down with

patients 58% of the time.

These disparities between how

you perceived yourself

performing and how you actually

performed is one of the reasons

why collecting objective data is

“ ”

The interns estimated themselves as sitting

down with patients 58% of the time, when

they actually only did it 9% of the time.

8

but Leonard S. Feldman, assistant

professor of medicine at Johns

Hopkins University School of

Medicine and associate director

of the Johns Hopkins School of

Medicine internal medicine

residency program, posits that

these regulations may not be

enough. Humans learn by

example, and when our role

models do things a certain way,

we often copy it. For instance,

doctors in training may imitate

the behaviors they observe in

their superiors, who may often

neglect to engage the patient.

In a study Feldman directed,

trained observers spent three

weeks shadowing twenty-nine

internal medicine interns to

gather information on their

communication skills, five of

which were deemed as key

strategies for what the research

team called “etiquette-based

communication”: introducing

oneself, explaining one’s role in

patient care, touching the

patient, asking open-ended

questions to encourage (continued)

Fall| 2013


| it begins with U

10

so important, Lauren Block, a

former Johns Hopkins fellow and

co-author of the study reasons.

Bullying

Another reason why doctors

may be lacking in

communication skills is because

of the negative experiences

and interactions they may have

had with their superiors as a

resident or intern.

In a study of 1500 medical

students, 42% claimed to have

been harassed by their

superiors, while 84% reported to

have been belittled. If doctors

are not treated with civility, this

negative behavior may

translate to their patients and

perhaps even future doctors

and residents. Psychological

studies have also shown that

experiencing this type of

bullying often incites

reciprocation of these behaviors

upon others.

Burning Out

Doctors, regardless of age or

experience in the profession, are

also prone to suffering from

burnout. Defined as having a

loss of enthusiasm for work,

feelings of cynicism, and a low

12

who have already survived rigorous

training. These numbers speak to

bigger problems in the health care

environment,” says Dr. Tait D.

Shanafelt, professor of medicine at

the Mayo Clinic in Rochester,

11

sense of personal

accomplishment, burnout can

have negative consequences

for both the doctor as well has

his or her patients. While being

burned out it is no fun for the

physician experiencing it, it is

definitely not safe for the

patients: doctors who have lost

their spark are more likely to

make mistakes.

A 2012 study found that of 7000

surveyed doctors, almost half

complained of suffering from

symptoms of burnout. The

numbers varied according to

medical specialty, with

emergency medicine topping

the charts at 65% and

preventative medicine,

occupational medicine, or

environmental medicine at the

lower end of the spectrum with

30% reported burnout.

According to the researchers,

the burnout appears to be

minimally influenced by number

of hours worked or the ability to

balance work and personal life.

“We’re not talking about a few

individuals who are disorganized

or not functioning well under

pressure; we’re talking about

one of out every two doctors (continued)

Fall| 2013


| it begins with U

13

Minnesotta, who led the study.

Flooded with insurance

regulations and various

administrative tasks, physicians

are often pressed for time to do

what they were trained to do:

help heal others. With this type of

setting, Shanafelt remarks,

“doctors are losing their

inspiration, and that is a very

15

Glass, Verghese hopes to teach

medical students how to

approach patients and impart a

good first impression by recording

the world from his point of view

as he performs a demonstration

with a patient.

At UCLA Health, we try to ensure

14

frightening thing.”

Physicians are seeking solutions

More and more doctors are

becoming aware of this issue and

are doing what they can to fix it.

Dr. Abraham Verghese from the

Stanford School of Medicine, for

example, employs technology to

aid him in this goal. With Google (continued)

Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population, JAMA Internal Medicine

Fall| 2013


| it begins with U

16

communities are well treated

using a variety of measures, one

of which includes C-ICARE. By

Connecting with our patients,

Introducing ourselves,

Communicating our roles, Asking

and Responding to patient

concerns, and Exiting with

courtesy, we strive to provide our

patients with the best care

possible.

As Care Extender volunteers, we

are also a part of the healthcare

team, making it our duty to also

18

all, as healthcare professionals of

the future, wouldn’t it be better

to establish these good habits

now rather than later? !

17

actively engage in C-ICARE,

whether it be in our interactions

with patients, patient families,

Care Partners, nurses, doctors, or

any hospital staff member. After

1

The Care Extender Internship

Program would like to

welcome its newest additions

to the team:

• Emmie Giang

DC RR Greeters A

2

• Monique Arrigotti

DC 8 North

• Nathan Stumpf

DC SMH Greeters A

• David Minishian

DC SMH Greeters B

3

• Kevin Lee

Special Projects

Coordinator

Welcome aboard! We look

forward to working with you in

the rotations to come.!!

Welcome, New Staffers! +

1

The Care Extender Program

would like to acknowledge

the following CEs for

completing the most surveys:

2

• Patrick Keller

• Laurel Nelms

• Nathan Stumpf

• Noemi Quinteros

Urzagaste

3

• Neveen Youssef

Thank you for practicing

C-ICARE and collecting

valuable feedback from

patients! !

Support Survey Excellence +

Fall| 2013


| it begins with U

1

These Care Extenders have gone

far beyond their duties and are

honored for their initiative and

service to the patients of both

UCLA hospitals. Thank you!

Santa Monica-UCLA:

• Haroutun Harry Mikaelyan

Cardiac Catheterization

Lab

• Tiffany Chow

Leslie Ibarra

Les Kelley Clinic

• Alexis Cabrera

Labor and Delivery A

Care Extenders of the Rotation for Summer 2013

+

3

• Abigail Leonen

Tinsley Webster

NICU

• Lena Purtu

Post Partum

Ronald Reagan UCLA:

• Mary Oh

Daniel Villagran

Nursing Floor 8-North

• Nicole Kravchenko

Pediatrics

* Did you know?

Care Extenders that have been nominated as “Care Extender of the Rotation” at

least two times may be eligible for a letter of recommendation.

Although all completing CEs will receive a letter of completion, only our most

outstanding volunteers will be considered for a letter of recommendation. For

more questions, please email [email protected].

“

” - Edgar F. Allen

Your life and mine

should be

valued not by

what we take,

but by what we

give.

2

• Huy Nguyen

Christina Page

Medical Surgical

Fall| 2013


| it begins with U

+

Fall 2013 rotation begins.

11.04.13

11.13.13

Sign up for preferences.

Extension Request Forms due.

11.17.13

Preferences are due.

12.15.13

02.10.14

Winter 2014 rotation begins.

Su M T W R F Sa

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

Important Dates +

Su M T W R F Sa

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

Su M T W R F Sa

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

Su M T W R F Sa

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28

November December January

February

02.02.14 & 02.09.14

Winter 2014 Training Day & department meetings.

Fall 2013 Training Day & department meetings.

10.26.13 & 11.03.13

Department assignments posted.

01.12.14

fall | 2013 in this issue · the difference between an optometrist and ophthalmologist, according...

Documents