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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
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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
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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
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(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.
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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
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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
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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
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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)
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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)
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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
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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 +
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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 CEnewslettercoordinator@gmail.com.
“
” - 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
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12 Care Extender Internship Program
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+
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
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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
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Su M T W R F Sa
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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
Recommended