August 29, 2011
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Linda Giudice, MD, PhD,
Dr. Linda Giudiceremembers the day, about 10 years ago, when a woman she was treating asked if her multiple miscarriages might have been the result of growing up on the Love Canal, a former toxic waste site near Niagara Falls.
That conversation led to a conference of scientists, patients and politicians, and eventually to the establishment of UCSF's Program on Reproductive Health and the Environment.
When the patient posed the question, it was an epiphany for Giudice, who is chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at UCSF.
Other epiphanies, on a more modest scale, are the goal of "Unusual Thinkers: The UCSF Track" at Dreamforce 2011, where Giudice and five other UCSF physicians and scientists will lead separate sessions on Thursday, Sept. 1 at San Francisco's Moscone Center.
UCSF Chancellor Dr. Susan Desmond-Hellmann and UCSF Medical Center CEO Mark Laret will start the day at 11:45 a.m. with a look at the future of health care. The five individual half-hour sessions will last until 3:40 p.m. Get details on the Dreamforce '11 website.
The four-day event will be staged for the ninth straight year by salesforce.com founder Marc Benioff. He and his wife, Lynne, donated $100 million to help build a children's hospital at UCSF Mission Bay that is scheduled to be completed in 2014.
The UCSF track, which was held last year for the first time, is dedicated to helping people think about their health in a new way, much as the UCSF leaders in their field have done in their research and practices.
"Sometimes I see things differently than other people," said Giudice, an obstetrician, gynecologist and reproductive endocrinologist. "I have always asked a lot of questions. It gets the neurotransmitters going."
Giudice said she will talk about chemicals in the environment, including particulate matter and air pollution, and point to the strong evidence that they are affecting reproductive health. But she'll emphasize that we can do things to mitigate their effects, both on the policy side, such as getting chemicals evaluated before they are put on the market, and through individual actions, such as purchasing safer products.
She buys her makeup at a natural grocery store in Palo Alto, relying on recommendations from the Environmental Working Group, and tries to avoid plastic bags, plastic containers, plastic in any form. Even her two sons have followed suit: They stopped using a certain kind of deodorant.
"Something resonated with them," Giudice said. "Most people are not informed. But if we can provide information based on solid data, I think most people will care."
Seth Bokser, MD, MPH
Much like Giudice, Dr. Seth Bokser had an epiphany that helped shape what he does today.
"When I was in medical school, I saw a lot of my instructors bogged down in paperwork and inefficiency," said Bokser, medical director of IT at UCSF Benioff Children's Hospital and an assistant clinical professor of pediatrics. "I thought it would be fulfilling to spend a career not just caring for patients, but also trying to ensure that medical professionals were less distracted with the administrative side and could focus more on the relationship with the patient."
He said the field of electronic-based health care informatics has evolved over the last 20 years and gained critical mass in the last decade. At age 38, he is a national expert.
"The better you can organize, retrieve and assimilate information, the better you can take care of your patients," Bokser said. "The computer provides us with incredible new capabilities to do what we've always done, which is to listen to the patient, communicate with the patient and synthesize the information that they're giving us."
Bokser was in elementary school in a northern New Jersey suburb when he got his first computer. "I was probably the first person on my block to get an Apple IIc," he said. "I was always interested in, enamored of and amazed by computers. But I wasn't the one in high school who had the biggest pencil protector in his front pocket, and MIT was never on my list of possible college choices. I was a history major."
Now he spends 80 percent of his time on informatics and 20 percent seeing patients in the newborn nursery and on the pediatric ward — a shift from his 50/50 days because health care IT innovation and implementation have moved so fast and furiously the last few years.
Still, he's not worried that his job is going to run out of inefficiencies to tackle. "My anecdotal experience is that patients have to tell their story in one form or another about 15 times during the average inpatient admission," Boske said.
Although there's a natural resistance in medical culture to change in general, he said, medicine is moving from a paternalistic to a partnership model. In addition, technology, the Internet and social networks are more consumer-driven than ever.
"Both of these trends are going to really support the evolution of patient-driven, patient-owned medical records," he said.
Josh Adler, MD
Much in that vein, Josh Adler, MD, chief medical officer of UCSF Medical Center and UCSF Benioff Children's Hospital, said the future clearly lies in more participation by people in their own health care. It's especially true in the realm of hospital safety.
"To make a hospital stay safer, they need to move away from, 'I'm turning myself over to you and I'll just wait until it's over.' Physician as decision-maker for the patient — that has to come to an end," Adler said. "But it will be another 20 years before the shared decision-making model becomes the standard."
Given that hospital patients are often scared and feel helpless and unengaged, it can help to write down basic treatments and medications or have a friend or relative do it, Adler said. They should be alert and ask questions, know why they're getting certain tests and drugs, and speak up if a doctor or nurse doesn't wash their hands or if something doesn't seem right.
"It turns out a complex hospital stay has as many steps as launching the space shuttle," Adler said.
Patient safety, or rather the lack of it, was the subject of "To Err is Human," a pivotal report by the Institute of Medicine in 1999 on widespread medical errors and their deadly repercussions. "Hospitals are safer today than they were 10 years ago, although it took a little bit of time to rev up the safety improvement machine," said Adler, who is also medical director of UCSF Ambulatory Care. "But the safety journey is not over."
He said his daughter and his mother have spent a lot of time in hospitals, so he can see the process up close. If he were to be hospitalized, he would worry mainly about the safety of medications and hospital-acquired infections.
"People need to be engaged in the activities of their own care," Adler said.
Engagement is a recurring theme among the Dreamforce participants from UCSF. It's a key concept, said Dr. Laura Esserman, director of the Carol Franc Buck Breast Care Center and professor of surgery and radiology.
Dr. Laura Esserman, MD, MBA
"One of the things I'm going to talk about is how we as a community can think about engaging in health care in a different way," Esserman said. "Demanding outcomes, understanding why people should share their data, and thinking of applications to try and speed learning. This is everyone's problem and everyone's opportunity to contribute."
Does she regard herself as an unusual thinker? "Yes, I do," she said. "I've had sort of an eclectic training. I've been trained in science, immunology, surgery, medicine, systems engineering and business. I'm a systems thinker. I'm very interested in the details but also in being able to step back and think about the big picture. What are the systems we can all use? I really think medicine should be practiced in a different way."
Esserman is running her center, leading two major breast cancer research projects and still practicing as a surgeon. When she was growing up, she wanted to be an actress, singer or doctor. Now she has her own musical theater in the operating room, she said, and she takes song requests from patients before surgery. Last week, one of them asked for "The First Cut is the Deepest."
She is unusual by any standard and is sometimes described as a "superwoman." But she doesn't see it that way. "The costume would come in handy on Halloween," Esserman said, laughing. "But I think of all the things I haven't accomplished yet and all the things I want to get done. There's a lot of work to do."
UCSF Track on Sept. 1
About UCSF Medical Center
UCSF Medical Center consistently ranks as one of the top 10 hospitals in the United States. Recognized for innovative treatments, advanced technology, collaboration among health care professionals and scientists, and a highly compassionate patient care team, UCSF Medical Center serves as the academic medical center of the University of California, San Francisco. The medical center's nationally preeminent programs include children's health, the brain and nervous system, organ transplantation, women's health and cancer. It operates as a self-supporting enterprise within UCSF and generates its own revenues to cover the operating costs of providing patient care.
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