Category: Medical Quality

an ambulance parked at the entrance of an emergency department

Psychiatric Care in Crisis

The Petrie-Flom Center Staff Leave a comment

By Zainab Ahmed

Psychiatric care in the Emergency Department is all-or-nothing and never enough. Often, legal holds are the only intervention available, and they rarely are therapeutic. Upon discharge, our patients are, once again, on their own.

The ED acts as a safety-net for a failing health system, one that places little value on mental health services, either preventative or follow-up. The demand for acute psychiatric care is high; however, EDs have little physical capacity for psychiatric patients.

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Surgeon and anesthetist doctor ER team with medical clinic room background.

On Experiencing IBD as a Woman

Amalia Sweet Leave a comment

By Amalia Sweet

At the end of last summer I stopped eating. It wasn’t that I wasn’t hungry — I was, constantly — but rather that pretty much everything I tried to put in my stomach triggered excruciating abdominal pain. 

While still in Chicago where I was working toward my master’s degree, I went to University Health Services. When tests revealed I was anemic but free of ulcers and Celiac disease, they suggested I work to reduce my stress and follow up with a gastroenterologist when I returned home to Boston later that month. 

I called every medical practice I could think of in the greater Boston area and no one had availability sooner than four months out. Without a primary care physician and desperate for a diagnosis, I went to the ER. In spite of my anemia and the fact that I had lost a scary amount of weight in a short period of time, the ER refused to provide a prioritized referral and told me my symptoms were a product of me being sedentary when in fact I was sedentary because of my symptoms. 

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Child holding paper family in LGBT rainbow colors.

Gamete Regulation and Family Protection in a Post-Dobbs World

The Petrie-Flom Center Staff Leave a comment

By Courtney G. Joslin

Increasing numbers of people are forming families through assisted reproduction. Recently, there has been a push to impose new regulations on various aspects of this process. Some of these new laws open up participants to a range of possible penalties — civil, criminal, and/or professional discipline — for past “misconduct.” Other laws seek proactively to regulate the fertility care process. For example, some laws regulate the collection and dissemination of medical and identifying information about gamete providers — that is, sperm and egg donors. Other proposals seek to require gamete providers to agree to the release of their medical records.

It is surely important to assess and evaluate fertility care practices and to consider whether additional regulation is appropriate in this space. Particularly in the post-Dobbs era — an era marked by increasing attacks on reproductive health care (including access to IVF) and on LGBTQ people — it is also important to proceed cautiously and to consider how these proposals may adversely impact reproductive autonomy and family recognition.

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Remarkable macro view through the microscope at process of the in vitro fertilization of a female egg inside IVF dish in the laboratory. Horizontal.

That’s Criminal: The Choices Fertility Specialists May Have to Make

The Petrie-Flom Center Staff 1 Comment

By Gerard Letterie

Fertility care operates in a delicate emotional space that demands complete trust across the consult table. Trust that decisions will be made with the patient’s best interests. Trust that guidance will be offered exclusive of any other competing influence, be it financial, personal, or convenience.

In a post-Dobbs setting, new, restrictive laws may disrupt this delicate equilibrium. This concern is materializing with an increasing velocity as states look to further limit reproductive autonomy.

Next in the crosshairs might be the disposition of embryos in the context of IVF. Dobbs has energized the pro-life movement to expand beyond abortion to other reproductive technologies within the context of the catchphrase “life begins at conception.”

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person walking away from a surgical mask lying on the ground.

Personal Crusades for Public Health

Katherine Macfarlane Leave a comment

By Katherine Macfarlane 

Public health in the U.S. has collapsed. In its place, we are left with an insufficient, impoverished alternative: personal crusades. This essay describes the cost of casting aside what is best for the public’s health in favor of individual choice, especially to those who are high-risk for serious illness or death from COVID-19. It explores how they must negotiate public health measures on their own.

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Insurance concept. Wooden blocks with insurance icons. family, life, car, travel, health and house insurance icons on blue background.

Autonomy, Insurance, and Luck

Leslie C. Griffin Leave a comment

By Leslie C. Griffin

You will be surprised I’ve been through all the experiences described in this post, and that I’m still alive to tell you about them. Even I can’t believe it some days. It’s quite a list, so sometimes I mention it to my friends, so they will be as amazed as I am.

I am a lifelong academic, so I also think about what lessons they’ve taught me.

One is the philosophical principle of autonomy, which I regularly teach in my bioethics class. In my opinion, it means you always have to be prepared for the very worst. You have to live knowing it could happen to you. The worst doesn’t always occur. But when it does, you need to find a positive way to look at it and to make good decisions about it.

Two is the practical decision to have your legal documents in place. A durable power of attorney. Health insurance and property insurance. These practical items also help a lot in getting you through terrible situations. Lack of insurance makes everything dreadful.

Autonomy and insurance help you through a lot of crises. My crises include a blizzard, a tornado, an earthquake, a car accident, a hurricane, and two murderers.

You also need good luck.

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Adderall bottle on shelf.

Losing Control of Controlled Substances? The Case of Telehealth Prescriptions 

Minsoo Kwon Leave a comment

By Minsoo Kwon

Telehealth services that specialize in the treatment of mental health concerns, such as Cerebral Inc., highlight the ongoing challenge of appropriately balancing accessibility of care with patient safety.

While increased accessibility of mental health care services through telehealth is a valuable goal, if our aim is the well-being of patients, safety must be paramount.

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Supreme Court of the United States.

What the Supreme Court’s Expected Ruling on Affirmative Action Might Mean for US Health Care

The Petrie-Flom Center Staff Leave a comment

By Gregory Curfman

Affirmative action in higher education may soon be abolished by the Supreme Court, resulting from its review of Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina.

The consequences for the physician workforce may be dire. Diversity among physicians is a compelling interest in our increasingly diverse society. Without affirmative action in higher education, our physician workforce may become less diverse, and the quality of health care may suffer.

This article explains the history of affirmative action in the U.S., past Supreme Court decisions, and the key arguments being considered in the two cases currently under review.

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