Kathy Dracup (pictured)
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| Modern Healthcare, 4/28/08 Kathy Dracup (pictured) |
Cover Story [by:] Rebecca Vesely
With 47 million uninsured nationwide and millions more facing rising premiums for less coverage, the crisis facing the U.S. healthcare system has never been more urgent. The issue is likely to take center stage this summer and fall as Democratic and Republican presidential candidates offer very different ideas as to how to solve the problem.
Activists passionate about this issue-including those rallying around Cover the Uninsured Week events happening this week-will be trying to bend the ear of the candidates, and of whoever occupies the Oval Office next year. Profiled below are just some of the many teachers educating the next generation of healthcare leaders about advocacy.
These six individuals take different approaches to teaching healthcare activism but all have similar lessons to pass on. They emphasized that healthcare professionals need to be informed and engaged in healthcare policy discussions, and know how to make change from within the system.
Providers' powerful voices should be heard more in the halls of Congress and in the media, they said.
And all six agree that healthcare professionals, whether in medicine, nursing, policy or administration, should not only be patient advocates, but also should work with those patients to improve our healthcare system. "We have lots of tough problems," says Gordon Schiff, patient-safety advocate and associate professor at Harvard Medical School. "We need to unleash the energy."
Kathleen Dracup
Dean
University of California, San Francisco
School of Nursing
For Kathleen Dracup, one of the most important things a nursing student can learn is how to voice his or her opinions and be an advocate for patients. Since coming to UCSF in 2000, she has taught future nurses to express their views on the most topical healthcare issues of the day.
Dracup, 65, teaches Issues in Nursing, a required semester-long course that explores contemporary healthcare trends such as universal healthcare, workplace politics, emerging ethical issues and hospital design related to patient safety.
Among the requirements are writing a letter to the editor and an opinion piece on a chosen subject. Students must also debate one another on healthcare issues such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or physician-assisted suicide. Guest lecturers include hospital architects and presentations from students who participated in a day of lobbying in Sacramento, Calif.
"When I came to UCSF, I completely redesigned the class to focus on helping students attain a voice in nurse advocacy because I want them to express the view of nursing clearly when they work on interdisciplinary teams," Dracup says. "Very often, nurses may be the only ones at the table focused on the family network - the family issues such as finances and social systems that affect patient outcomes."
Dracup, who has authored more than 300 papers on cardiac care in her 35-year career as a cardiovascular nurse and university professor, first studied the needs of spouses of terminally ill cardiac patients, and has tested interventions to lower emotional distress of heart disease patients and their families.
Nurses have inherited a long tradition of being "the handmaids of physicians," and typically did not feel comfortable expressing contrary viewpoints. But all that has changed, and today, Dracup says, "it's important that nurses introduced to the profession understand that advocacy role."
Lisa Hale, who is taking the Issues in Nursing course this semester, says Dracup encourages students to use that voice, especially when it comes to the crisis of access and the uninsured. "Nurses are such a huge part of the healthcare system," Hale says. "The course impresses on us the need to speak up at this time."
Michael Ehlert
National president
American Medical Student Association
When Michael Ehlert was an undergraduate at the University of Toledo, he chose not to pledge a traditional fraternity. Instead, he and some friends started their own -- with a twist. Their theme was social equity, which included raising funds for charities and doing community service. Thus began his involvement in advocacy. Later, as a medical student at Case Western Reserve University in Cleveland, Ehlert soon gained a leadership role at the campus chapter of the American Medical Student Association.
He co-hosted the 2004 vice-presidential debate between Dick Cheney and John Edwards on campus. In 2007, he was elected to a one-year term as national president of the independent, not-for-profit medical student leadership organization. AMSA's priorities are advocating for quality, affordable healthcare for all and reducing global health inequities; the group is a fierce supporter of a single-payer system. Its 68,000 members also work to increase diversity in the medical field and improve professional integrity, ethics and well-being -- including campaigning for an 80-hour workweek for medical residents and eliminating conflicts of interests with the pharmaceutical industry.
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Ehlert, who declined to give his age, will resume his residency in urology at 736-bed Henry Ford Medical Center in Detroit in May, said being involved in AMSA is "the most intense and formative leadership experience out there. It caught me up and plugged me in." All physicians should be engaged in policy that affects them and their patients, Ehlert said. "It's important because providers have a voice that carries further than most."
Jeffery Levi
Executive director, Trust for America's Health
Associate professor, George Washington University Department of Health Policy
Jeffrey Levi is probably best known as a longtime, prominent AIDS activist, and today he is passing on his enthusiasm for healthcare advocacy to his students in Washington, many who will go on to hold key positions shaping national healthcare policy. He says AIDS changed healthcare activism in fundamental ways. "What AIDS did for healthcare consumer advocacy was remove researchers from a pedestal," Levi says. "It changed the framework on how disease groups can make their case."
Levi, 54, served as deputy director of the White House Office of National AIDS Policy during the Clinton administration and in executive positions at the AIDS Action Council, AIDS Action Foundation and National Gay and Lesbian Task Force.
As current executive director of Trust for America's Health, he is spearheading public-health initiatives, including the Healthier America Project, which strives to improve transparency, access, emergency preparedness and prevention strategies.
What Levi learned from his years as an AIDS activist and lobbyist, and now teaches to his students, is the importance of communication. "Part of the challenge of any advocacy is really being able to communicate in a language policymakers and elected officials understand," he says. "How do you talk about research that doesn't make people's eyes glaze over?" Organizing around the uninsured is in some ways more difficult, Levi says. "One thing that made AIDS advocacy easy to organize was it was organizing people who were along the same political lines," he says. "That's harder generally among other groups, such as the uninsured."
Although some of his students will go on to work in advocacy, many will not. "They will be on the receiving end of advocacy," he says, and should know how advocates think. "I don't think advocacy is a pejorative term," Levi says. "It comes with a set of values."
Peter Lurie
Deputy director
Health Research Group
Public Citizen
Back in 1997, Peter Lurie taught a rather novel course at the University of Michigan at Ann Arbor. Seventeen undergraduate students identified a problem in healthcare and addressed it by developing a research-based protocol, collecting and analyzing data and then presenting it in a way that would likely affect public policy, such as a report or news release. Experts spoke to the students on a variety of healthcare topics, such as access and the uninsured. After that first course, three of the students published their findings in peer-reviewed journals and gained media coverage. The projects focused on hepatitis B vaccination availability among gay men; cigarette labels in developing countries; and sex education information on the Internet. "We developed an approach to healthcare activism that involves data," says Lurie, 48, a physician who also holds a master's degree in public health.
Since then, at least a dozen universities and other education programs have adopted courses based on the one developed by Lurie, including the University of Maryland, University of Pennsylvania School of Medicine and Johns Hopkins School of Public Health. Public Citizen provides the schools grants of between $2,000 and $4,000 per course. That funding is from the Open Society Institute's Medicine as a Profession program and the Irene Diamond AIDS Research Center.
"We find there's enormous enthusiasm among students for this sort of thing," Lurie says. "When they come into medical school, they are very enthusiastic about social change. By the end, they've run out of gas because of the demands. We want to stoke that enthusiasm."
Galit Sacajiu
Associate director
Residency Program in Social Internal Medicine and Primary Care
Montefiore Medical Center
Medical students from all over the country travel to Montefiore Medical Center in New York for one month every October for a unique purpose: to learn about healthcare advocacy. While there, Galit Sacajiu serves as their mentor and teacher, guiding mostly fourth-year medical students through a course on qualitative research methodology and bringing in guest lecturers on public speaking, health policy and the media.
"I think the vast majority of medical students go into the field trying to help the health of individuals in society," Sacajiu says. "Along the way it gets lost between exams, student debt and biomedical training." Since the program's inception more than six years ago, about 70 students have completed the course. At the end of the month, students present a research topic, which they must complete on return to their home institutions with the help of a local mentor.
Hot topics include access to healthcare, population-based health, environmental toxins and social factors that can affect health outcomes such as housing and education. Sacajiu, 43, who grew up in Israel, got her undergraduate and medical school degrees from New York University and a master's in public health from Columbia University, where she worked with the New York City Department of Health. "It's so great to teach this course because it gets like-minded people together who are idealistic and look at the world in a positive way," she says. "There are not too many opportunities for these topics
Gordon Schiff
Patient-safety advocate
Associate professor, Harvard Medical School
Researcher and physician, Brigham and Women's Hospital, Boston
To many coming up in the healthcare field, Gordon Schiff is a trailblazer and an inspiration. A physician and teacher in internal medicine for the past 32 years, he is a leader in patient safety, serving as past director of clinical quality research and improvement at John H. Stroger Jr. Hospital of Cook County in Chicago and on countless other patient-safety initiatives.
One of Schiff's latest roles is as a principal investigator for the Formulary Leverage Improved Prescribing program, part of a collaboration between researchers at the Stroger Hospital, the University of Illinois at Chicago and in Cook County that encourages medical and pharmacy students to think more critically about pharmaceuticals by working across disciplines to better understand prescribing trends and off-label drug usage.
The project is funded by the $430 million settlement between Pfizer and state attorneys general over off-label marketing of the seizure drug Neurontin. Schiff, 57, also works to bring his students in touch with people who lack health insurance, and teaches them to take patients' "social history," learning about their living and family situations to get a better picture of overall health.
"Students really need to see the consequences of not having access to health insurance," Schiff says. "If one is committed to taking care of patients, one quickly realizes that what can be done for that one patient is circumscribed by the barriers they face in getting good care in the first place.
Advocacy is about changing the status quo. The only alternative to the status quo is change."
From: Modern Healthcare, April 28, 2008 Issue, pp. 6 - 7,16
© Copyright 2008 Crain Communications Inc.