Listen: Insight into the Telehealth Landscape

No Easy Answers in Bioethics Episode 24

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In this episode, Senior Academic Specialist Libby Bogdan-Lovis is joined by Dr. Sarah Pletcher, Vice President and Executive Medical Director of Virtual Care at Houston Methodist. Dr. Pletcher shares her telehealth expertise in a conversation that explores the benefits of telehealth for patients and providers, the influence of the COVID-19 pandemic on telehealth adoption, reimbursement models, the future of telehealth, and more.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Bioethics and Social Justice. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Bioethics and Social Justice in the Michigan State University College of Human Medicine. Center faculty and their collaborators discuss their ongoing work and research across many areas of bioethics. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

New essay from Libby Bogdan-Lovis in ‘Narrative Inquiry in Bioethics’

Libby Bogdan-Lovis photo

Center for Ethics Assistant Director Libby Bogdan-Lovis has an essay in the latest issue of Narrative Inquiry in Bioethics. In her essay, “The Trip to the Dentist,” Bogdan-Lovis writes about her mother, and of a specific experience that would greatly influence subsequent end-of-life decision-making.

The essay appears in the Summer 2020 issue of the journal, which is published by Johns Hopkins University Press. The issue is centered on “Living with Alzheimer Disease and Other Types of Dementia: Stories from Caregivers.”

The full text is available online via Project MUSE (MSU Library or other institutional access may be required to view this article).

Brittany Ajegba presents at Diversity in Medicine Conference

In early March, College of Human Medicine student Brittany Ajegba presented at the second annual Diversity in Medicine Conference at the University of Michigan in Ann Arbor. Ajegba presented a poster titled “Rationales for expanding minority physician representation in the workforce: a scoping review.” The poster presented the work of a multi-institution research team comprised of Karen Kelly-Blake (MSU), Libby Bogdan-Lovis (MSU), Nanibaa’ Garrison (UCLA), Faith Fletcher (University of Alabama at Birmingham), Brittany Ajegba (MSU), Nichole Smith (University of Chicago), and Morgan Brafford (Walden University). The team’s scoping review of the same name was published in the September 2018 issue of Medical Education.

Ajegba shared her experience on attending: “I was so happy I was able to attend and present at the [conference]. While I got to present on our physician-patient racial/ethnic concordance research, it was great to see what researchers from around the country are doing to address underrepresentation in medicine. Being from the area, it was nice to reconnect with future colleagues and to see what work was being done around various topics of diversity in medicine that included but was not limited to: unconscious bias projects, pipeline programs, LGBTQ+ healthcare, and much more.”

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Image description: Brittany Ajegba smiles next to her poster that is pinned on a display board at the Diversity in Medicine Conference. Photo courtesy of Brittany Ajegba.

The team’s poster presented findings of their scoping review of the 2000-2015 literature on strategies for and approaches to expanding underrepresented minority (URM) representation in medicine, “which reveals a repetitive, amplifying message of URM physician service commitment to vulnerable populations in medically underserved communities. Such message repetition reinforces policies and practices that might limit the full scope of URM practice, research and leadership opportunities in medicine. Cross-nationally, service commitment and patient-physician concordance benefits admittedly respond to recognized societal need, yet there is an associated risk for instrumentally singling out members of URMs to fulfill that need. Additionally, the proceedings of a 2001 US Institute of Medicine symposium warned against creating a deterministic expectation that URM physicians provide care to minority populations.”

Listen to Episode 6 of our podcast series No Easy Answers in Bioethics, featuring Libby Bogdan-Lovis and Dr. Karen Kelly-Blake, to learn more about this ongoing research.

Listen: Social Determinants of Health in Medical Education

No Easy Answers in Bioethics logoNo Easy Answers in Bioethics Episode 18

How can social determinants of health be integrated effectively into medical education and clinical practice?

This episode focuses on the topic of social determinants of health, or the social and environmental factors that influence our health and access to resources. Center for Ethics Assistant Director Libby Bogdan-Lovis and Associate Professor Dr. Karen Kelly-Blake speak with College of Human Medicine student Brittany Ajegba, who emphasizes the need for standardization when training physicians on social determinants of health. From medical education to clinical encounters, they provide a variety of perspectives on this increasingly important work.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

Fall 2018 publications from Center faculty

Continue reading below for a list of recent journal articles from Center faculty, including online first publications. MSU Library or other institutional access may be required to view these articles.

Recently assigned an issue

Stahl D. Patient reflections on the disenchantment of techno-medicine. Theoretical Medicine and Bioethics. December 2018;39(6):499-513. Available online November 1, 2018. View full text via Springer Link.

Cabrera LY, Bittlinger M, Lou H, Müller S, Illes J. Reader comments to media reports on psychiatric neurosurgery: past history casts shadows on the future. Acta Neurochirurgica. December 2018;160(12):2501-2507. Available online October 24, 2018. View full text via Springer Link.

Fleck LM. Healthcare Priority-Setting: Chat-Ting Is Not Enough; Comment on “Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage”. International Journal of Health Policy and Management. October 2018;7(10):961-963. Available online July 28, 2018. View full text via IJHPM.

Zhuang J, Bresnahan M, Zhu Y, Yan X, Bogdan-Lovis E, Goldbort J, Haider S. The impact of coworker support and stigma on breastfeeding after returning to work. Journal of Applied Communication Research. 2018;46(4):491-508. Available online July 19, 2018. View full text via Taylor & Francis Online.

Online first

Cabrera LY, Brandt M, McKenzie R, Bluhm R. Comparison of philosophical concerns between professionals and the public regarding two psychiatric treatments. AJOB Empirical Bioethics. Available online November 6, 2018. View full text via Taylor & Francis Online.

Bluhm R, Cabrera LY. It’s Not Just Counting that Counts: a Reply to Gilbert, Viaña, and Ineichen. Neuroethics. Available online October 27, 2018. View full text via Springer Link.

De Vries RG, Ryan KA, Gordon L, Krenz CD, Tomlinson T, Jewell S, Kim SYH. Biobanks and the Moral Concerns of Donors: A Democratic Deliberation. Qualitative Health Research. Available online August 10, 2018. View full text via SAGE Journals.

Cabrera LY, Goudreau J, Sidiropoulos C. Critical appraisal of the recent US FDA approval for earlier DBS intervention. Neurology. 2018. Available online June 13, 2018. View full text via Neurology.

Zhuang J, Bresnahan MJ, Yan X, Zhu Y, Goldbort J, Bogdan-Lovis E. Keep Doing the Good Work: Impact of Coworker and Community Support on Continuation of Breastfeeding. Health Communication. Available online May 17, 2018. View full text via Taylor & Francis Online.

Medical workforce diversity research published in ‘Medical Education’

Karen Kelly-Blake photoLibby Bogdan-Lovis photoAn article from a multi-institution research team led by Center Assistant Professor Dr. Karen Kelly-Blake and Assistant Director Libby Bogdan-Lovis has been published in the September 2018 issue of Medical Education.

In “Rationales for expanding minority physician representation in the workforce: a scoping review,” the authors discuss “rationales for and approaches to expanding under‐represented minority (URM) physician representation in the medical workforce” found in their scoping review of fifteen years of literature.

The full text is available online via Wiley Online Library (MSU Library or other institutional access may be required to view this article).

Dr. Kelly-Blake and Libby Bogdan-Lovis further discussed their article in an interview for the Medical Education podcast series.

Related items from the Center:

Dr. Kelly-Blake presents at National Association of African American Studies and Affiliates Conference

Karen Kelly-Blake photoOn February 15-16, Center Assistant Professor Dr. Karen Kelly-Blake attended the National Association of African American Studies (NAAAS) and Affiliates 25th Joint National Conference held in Dallas, Texas. This conference marked the 25th gathering of scholars from across the U.S. and more than twenty countries. Dr. Kelly-Blake’s presentation was titled, ““Danger Talk”: The Covert Costs of Racial/Ethnic Concordance in the Medical Workforce.” The presentation reported preliminary results of a 2000-2015 scoping literature review that examined medical workforce policy strategies for increasing under-represented minorities in medicine. The research is a multi-institutional collaboration with Libby Bogdan-Lovis, MA (MSU), Nanibaa’ Garrison, PhD (University of Washington), Faith Fletcher, PhD, MA (University of Illinois at Chicago), Brittany Ajegba, MPH (MSU), Nichole Smith (Vanderbilt University), and Morgann Brafford, BS (MSU).

Dr. Kelly-Blake discussed the rationales and strategies that are employed to increase under-represented minority (URM) physician workforce capacity. She began by asking the audience to provide reasons for why it would be important to increase URMs in the medical workforce. The top three replies were: communication, cultural sensitivity, and the need to reflect general population demographics. Dr. Kelly-Blake agreed with the audience that these are often the primary justifications provided in the literature. Under-represented minorities (URMs) disproportionately shoulder the burden of care to the underserved, and most often in under-resourced communities. The problem, or the “danger talk” is that selectively placing service expectations not similarly placed on White physician colleagues along with unexamined assumptions of racial/ethnic concordance between patient and physician may place an unfair and unequal burden on URMs. Dr. Kelly-Blake further suggested that such service commitment rhetoric might unwittingly dissuade URM physicians from pursuing research and professional leadership opportunities. In short, welcoming URM physicians into the “house” of medicine, but then limiting their service to the kitchen. Dr. Kelly-Blake concluded that increasing URM physician presence in the medical workforce is indeed admirable and welcomed, but policy initiatives that influence URM’s futures in the medical workforce may have hidden, unanticipated and restrictive consequences.

To learn more about this research, watch the Bioethics Brownbag & Webinar Series talk from Dr. Kelly-Blake, “Covert Costs of Racial and Ethnic Concordance in the Medical Workforce,” recorded on January 18, 2017.

Covert Costs of Racial and Ethnic Concordance in the Medical Workforce

bbag-icon-decCovert Costs of Racial and Ethnic Concordance in the Medical Workforce

Event Flyer

Over the past century US medical workforce demographics have shifted. Moving away from a white male dominated profession, there is a welcomed push towards increasing gender, ethnic, racial and linguistic representation. Commonly, that push is linked to notions of desirable doctor/patient identity matching – described here as “concordance.” That demographic shift is accompanied by policy initiatives and rhetoric shaping the professional futures of Native American, African American, and Latino underrepresented minority (URM) physicians. Do these policy initiatives carry social costs that inadvertently influence URM’s futures in the medical workforce? This analysis considers the nature of medical workforce policy strategies. Findings suggest that selectively placing service expectations not similarly placed on their non-minority physician colleagues along with unexamined assumptions of racial/ethnic concordance between patient and physician may place an undue burden on URMs.

jan18-bbagJoin us for Ms. Bogdan-Lovis and Dr. Kelly-Blake’s lecture on Wednesday, January 18, 2017 from noon till 1 pm in person or online.

Dr. Kelly-Blake is an Assistant Professor in the Center for Ethics and the Department of Medicine. Ms. Bogdan-Lovis is the Assistant Director for the Center for Ethics. Bogdan-Lovis and Kelly-Blake are co-leading a multi-institutional research project on Doctor-patient Race/Ethnic Concordance in the Medical Workforce. They are interested in unpacking the complexities surrounding underrepresented minority service to the underserved and how that service may distract those physicians from pursuing other medical professional opportunities.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our mailing list.

Center faculty present at 18th Annual ASBH Meeting

asbh logoThe 18th Annual American Society for Bioethics and Humanities Meeting was held October 6-9 in Washington, DC. Center faculty Libby Bogdan-Lovis, Karen Kelly-Blake, Devan Stahl, and Len Fleck presented at the conference. The post below details each researcher’s presentation in their own words.

bogdanlovis-crop-facKelly-blakeLibby Bogdan-Lovis, MA
Assistant Director, Center for Ethics and Humanities in the Life Sciences
In concert with research collaborators Karen Kelly-Blake, Nanibaa’ Garrison, (Seattle Children’s Hospital) and Faith Fletcher (University of Illinois Chicago), we presented “Medicine’s Mirror Image Agenda: Covert Costs of Racial/Ethnic Concordance in the Medical Workforce.” Our project is supported by the contributions of research assistants Brittany Ajegba (MSU College of Human Medicine student), Nichole Smith (Vanderbilt premedical undergraduate), and Morgann Brafford (MSU psychology/anthropology undergraduate).

Our team reported results of a 2000-2015 scoping literature review to examine presumed benefits of matching underrepresented minority (URM) physicians with patients sharing similar race/ethnic identities. In our analysis we considered the nature of medical workforce policy strategies. We reported that the most frequently cited rationales for increasing the URM medical workforce were service commitment and enhanced physician-patient relationship. The primary strategy for achieving this goal was pipeline programs. We argued that even though URMs provide a substantial proportion of medical care to the underserved, and quite possibly such workforce patterns reflect focused altruism to serve one’s own, parity and service rhetoric may covertly shape the professional lives of Native American, African American, and Latino underrepresented minority (URM) physicians. We questioned whether those strategies might not unevenly affect URM physicians, selectively placing service expectations not similarly placed on their non-minority physician colleagues. We concluded by explaining that social justice of the profession entails equitable sharing of responsibility to meet the needs of the underserved and that social justice in the profession demands that URM physicians deserve an unfettered future and should not be viewed as instruments to fix societal structural determinants of health.

stahl-crop-2015Devan Stahl, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences
This year at ASBH I had the opportunity to organize and lead two sessions. First, as the co-leader of the Bioethics and Christian Theology Affinity Group, I helped to organize a panel which featured Dr. Lydia Dugdale’s new book, Dying in the Twenty-First Century: Toward a New Ethical Framework for the Art of Dying Well. Dr. Dugdale’s presentation was followed by two responses by Dr. Paul Scherz and Dr. Mark Cherry. The session was well-attended and generated much conversation.

The next day, I helped to lead a workshop: “Responding to Those Who Hope for a Miracle: Conceptual Resources and Practical Responses for Clinical Ethicists” with Drs. Trevor Bibler, Myrick Shinall and Ashley Stevens. The workshop began with an overview of the theological concepts that frequently accompany the beliefs of patients and families who hope for a miracle. We then presented case studies to show four ways patients employ the term “miracle” as they struggle to understand God and strategies for responding to these four types of invocators. We lead breakout sessions to help attendees identify the types of miracle language discussed and best practices for responding to each. The session was very popular, which unfortunately meant several people could not fit in the space provided. Positively, the workshop had a lot of good discussion and participation by attendees.

fleck-crop-facLen Fleck, PhD
Professor, Center for Ethics and Humanities in the Life Sciences
I presented Saturday morning at ASBH. The title of my presentation was “Last Chance Therapies: LVAD and a Heart Transplant?” The ethical issue I was addressing here is related to cardiac transplantation. Only about 2200 hearts are available for transplantation each year in the US, so this is an absolutely scarce resource. Dick Cheney, former Vice-President, after five heart attacks (starting at age 37) and every imaginable cardiac intervention to sustain his life, was diagnosed as being in late-stage heart failure in late 2010. He had surgically implanted at that time a Left Ventricular Assist Device [LVAD] to maintain marginal heart function. He almost died in surgery, spent 40 days in the ICU, and was listed for a heart transplant. He received that transplant at age 71 in 2012. Many will argue (including me) that Cheney had had his “fair innings,” and that a younger person, a bit further down on the transplant list, should have gotten that transplant. But that person died instead (the “unknown” patient, and without any monument).

Click through to continue reading about Dr. Fleck’s research

Libby Bogdan-Lovis published in ‘AIDS Patient Care and STDs’

bogdanlovis-crop-facCenter Assistant Director Libby Bogdan-Lovis co-authored the article “‘‘She Told Them, Oh That Bitch Got AIDS’’: Experiences of Multilevel HIV/AIDS-Related Stigma Among African American Women Living with HIV/AIDS in the South,” published in the July 2016 issue of AIDS Patient Care and STDs.

The article, authored by Faith Fletcher, PhD, MA, Lucy Annang Ingram, PhD, MPH, Jelani Kerr, PhD, MSPH, Meredith Buchberg, MPH, Libby Bogdan-Lovis, and Sean Philpott-Jones, PhD, MSB, uses narrative data to explore the stigma that HIV-positive African American women living in the southern United States face in their daily lives. The text is available in full on the AIDS Patient Care and STDs website.

Abstract: African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.

To learn more about Dr. Faith Fletcher’s work in this area, visit our webinar archive to watch her lecture “Ethical Implications of HIV Pre-Exposure Prophylaxis (PrEP) for African American Women and Adolescent Girls,” recorded in February 2016 as part of our Bioethics Brownbag & Webinar Series.