Forum Posts by
Carol Levine
- What Dr. Seuss Saw at the Golden Years Clinic
Posted on February 19, 2019
“Improving patient experience” has become the mantra of many health care facilities in a highly competitive and regulated environment. But just what is it about the patient experience that needs to be improved? Will better food and gift bags do the trick? Or are more basic changes required? To answer that question, I turned to… Read more
- Should We Get Ready for Prime Time?
Posted on September 12, 2017
For the first few years after my husband Howard died, I talked to him often. These were not ghostly, paranormal encounters; I was just thinking out loud about my life without him. Ten years later, these occasions happen less frequently, usually connected with an anniversary or a family event. In my imagination, he looks like… Read more
- The Lady Writer and the Valkyrie: Magda Szabo’s Novel The Door
Posted on February 7, 2017
An old woman desperately needs medical attention. Yet she fiercely refuses every offer of help from friends, neighbors, and the local doctor. No one will get past her door, she vows. Respecting her autonomy means leaving her alone, possibly to die. Intervening to save her means risking her wrath and losing her friendship and respect.… Read more
- Hastings, Botswana, and Edinburgh: Bioethics Meets Detective Fiction
Posted on September 7, 2016
In the bioethics world, all roads eventually lead to Hastings, whether that means the Center in Garrison, N.Y., or Hastings-on-Hudson, N.Y., where the Center was born in 1969 and lived for almost 20 years. The relationships among those who have worked at or visited Hastings make up a global network of scholars, clinicians, lawyers, researchers,… Read more
- Goldilocks and the Three Hospice Patients
Posted on February 19, 2013
Goldilocks, all grown up and working as a Medicare hospice auditor, checks the records of three patients. She frowns at Mr. Brown Bear’s record. He was referred to hospice three days before he died, after spending several costly weeks in an acute care hospital, the last two in an intensive care unit. “This patient was… Read more
- Robot and Frank, and Maybe Me
Posted on August 23, 2012
If movies are one window into the soul of America, “Robot and Frank” has some funny/sad things to say about our current approach to aging. Frank (Frank Langella, as charismatic as ever) is a retired cat burglar, losing his memory and generally deteriorating in his country home. Hunter, his concerned son, brings a robot to… Read more
- “Beware the Ides of March” 2.0
Posted on January 18, 2012
The ancients looked to omens and portents to recognize signs of impending death. Today we do not rely on the ominous words of soothsayers, interpreting the entrails of chickens, or the appearance of owls to discern the odds of someone dying. We are more rational and sophisticated. We believe that computers hold the secrets of… Read more
- A Modest Proposal for Long-Term Care
Posted on November 7, 2011
“Why should taxpayers bail out the people who have squandered their money and can’t afford to pay for a nursing home or home care services?” “Can’t pay for home care? You should have purchased long-term care insurance!” “Long-term care? Doesn’t Medicare pay for that?” These comments occur frequently on blogs and in letters referring to… Read more
- But Wait, Call Now and Get Two ER Appointments for Only $24.99!
Posted on August 29, 2011
Emergency rooms hold a special place in the American health care system. They are the safety net of the safety net. Everyone who shows up has to be assessed, stabilized, and treated, regardless of one’s ability to pay. And everyone gets treated according to an equitable triage system: the most seriously injured or ill first,… Read more
- Dementia from the Inside Out
Posted on March 10, 2011
Most depictions of dementia describe the impact of behavior and cognitive deficits from the outside – the observations of clinicians, family members, co-workers, and neighbors. It is rare to find a perspective from the inside out – the experience of the person with advanced dementia. A mystery novel is an unlikely place to look for… Read more
- In Memoriam: Gladys Gonzalez-Ramos
Posted on February 11, 2011
On October 18, 1999, the members of The Hastings Center-United Hospital Fund Working Group called “The Cultures of Caregiving” were gathered in the library to begin the afternoon discussions. We had invited Gladys Gonzalez-Ramos, an associate professor of social work at New York University, to describe her experience of caregiving for her parents, who had… Read more
- On Metaphors, Mental Illness, and, Mayhem
Posted on January 31, 2011
My Jewish mother could have gone daughter-to-daughter with any Chinese Tiger Mom. In addition to getting the highest marks in school and playing the piano beautifully, my sister and I were expected to look pretty at all times. Mom, however, strayed from the Tiger Mom doctrine and offered occasional praise, usually on the high marks-piano… Read more
- CMS’s Final Rule on Hospital Visits
Posted on January 3, 2011
On January 18 the Center for Medicare and Medicaid Services’ (CMS) final rule on eliminating discrimination in hospital visitation policies will go into effect. Following President Obama’s executive memo last April, CMS published a proposed rule on May 26 and opened a 60-day public comment period. The new standard, part of the Conditions of Participation… Read more
- Deconstructing Medicare’s Improvement Standard
Posted on November 23, 2010
For 81-year-old Wanda Papciak, a Pittsburgh resident, 2008 was a bad year. In April she had hip replacement surgery, was discharged home, readmitted to the hospital for an infection, and discharged to a skilled nursing facility (SNF) for rehabilitation therapy. She was readmitted to the hospital, discharged to a different SNF, and received more therapy… Read more
- Eliminating Bias in Hospital Visitation: Room for Improvement
Posted on October 4, 2010
Last April President Obama issued a memorandum requesting that the Secretary of Health and Human Services issue new rules to ensure that hospitals that participate in Medicare and Medicaid respect the rights of patients to designate visitors and surrogate decision-makers. The case of Janice Langbehn, prevented from seeing her dying partner, Lisa Pond, in a… Read more
- President Obama’s Groundbreaking Order on Hospital Visitation and Decision-making
Posted on April 19, 2010
On April 15, President Obama issued a memorandum to the Secretary of Health and Human Services, Kathleen Sibelius, directing her to issue new rules to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors and surrogate decision-makers. “Hospitals should treat all visitors, including people who are not… Read more
- Bioethics: Le Reality Show
Posted on March 19, 2010
Stanley Milgram’s 1960s experiments, which aimed to show just how far people would go to inflict what they believed were real electric shocks to people, are a sentinel episode in early bioethics history. The experiments were widely criticized as unethical because the researchers lied to the participants, telling them that they were “assistants” rather than… Read more
- NFL and Dementia: A Postscript
Posted on December 7, 2009
Faster than a speeding pigskin, the National Football League has moved to change rules, consultants, and public perception about its stance on head injuries and subsequent cognitive problems. (For previous Bioethics Forum posts, click here and here.) On November 24, after the NFL Players Association called for his removal as co-chair of the league’s research… Read more
- NFL and Dementia: Research Ethics Joins the Fray
Posted on November 5, 2009
It’s not often that professional football, family caregiving, research ethics, and a Congressional hearing are wrapped up in one not-so-neat package. But the latest chapter of the controversy about the link between the hard hits that characterize the game (and delight the fans) and early-onset dementia brings all these elements together. Last December I posted… Read more
- The Missing Link in Chronic Care Coordination
Posted on March 27, 2009
The Medicare Trust Fund is not going to be saved by care coordination, at least not in the way it is currently understood. That is the conclusion of a four-year government-funded study of 15 programs enrolling over 18,000 chronic care patients. The study, published last month in the Journal of the American Medical Association, was… Read more
- All in the Family: Children as Home Health Aides
Posted on February 27, 2009
Miley Cyrus and other young celebrities aside, most American children and teens are not profit centers. But, without earning a penny, some add substantial economic value to their families. Harking back to an earlier time when children (the more the better) were valued as farmhands, domestic workers, wage earners, or marriageable ties to wealth or… Read more
- On Health Care Reform and the Paranormal
Posted on February 24, 2009
Reality TV shows feature paranormal college students, plumbers, cops, kids – even pets. Why stop with haunted inns or abandoned prisons? Let’s call in a team to deal with the really scary happenings – the ones in Washington. Jared, paranormal legislative aide and founder of Paranormal Policy Wonks, sets the stage: “We’re going to investigate… Read more
- A Team Meeting without the Quarterback
Posted on December 18, 2008
It’s a classic scene: A team meeting about the patient with the person who knows the patient best – the family caregiver – excluded. The only difference is that this team was not made up of doctors, nurses, and social workers; its members were retired football players and the National Football League Commissioner Roger Goodell.… Read more
- The New Language of Health Care: How’s Your HPIQ?
Posted on August 1, 2008
What do you call a person admitted to a hospital? If you said “patient,” you’re hopelessly out of date. The person lying there awaiting surgery or recovering from a heart attack is a “consumer.” The person examining the consumer is a “provider.” Depending on the situation, she may be a “hospitalist,” “intensivist,” “proceduralist,” “surgicalist,” or… Read more
- Help, I’m Drowning! Rescue Swimmers for Family Caregivers
Posted on May 2, 2008
During the 17 years I took care of my late husband, who was totally dependent because of a severe traumatic brain injury, I was frequently overwhelmed. Most family caregivers feel the same – sometimes, often, or always. They say, “I’m drowning” or “I can’t keep my head above water.” And yet, health care and social… Read more
- Back to the Future: Reviving House Calls
Posted on May 29, 2007
When I was growing up, Dr. Redlich, our family physician, made house calls. Before the era of immunizations for common childhood illnesses, children got sick a lot. A refugee from the Nazis, Dr. Redlich had a thick German accent and a heavy hand with a needle (this was the beginning of the unfortunate shot-of-penicillin-for-everything enthusiasm).… Read more
- WARNING: Caregiving Can Be Hazardous to Your Health
Posted on April 29, 2007
“How long has it been since your last checkup?” my doctor asked disapprovingly. “Too long,” I admitted, “much too long.” Last December, the twin forces of guilt for my avoidance behavior and the prospect of losing the unused funds in my Tax-Saver health care account combined to propel me to my doctor’s office. I finally… Read more
- Update on TGN1412 Trial
Posted on March 28, 2007
On March 26, 2007, the European Medicines Agency in London released for comment its “first-in-man” clinical trials guidelines for potential high-risk medicinal products. The guidelines follow extensive discussion of the serious adverse events that occurred to six subjects in the TGN1412 trials last year. The focus is on “products where the mode of action, the… Read more
- Speak Up or Shut Up: What’s a Health Care Provider-Family Member to Do?
Posted on September 26, 2006
What’s the appropriate role of a health care professional when a family member is in the hospital? Two physicians, writing in two major newspapers on the same day, come to opposite conclusions. Benjamin Brewer, a family practice physician in the rural village of Forrest, Illinois, has no patience for family members who are also health… Read more
- For Brain-Injured Soldiers and Their Families, the Battle Never Ends
Posted on August 3, 2006
Every war creates military and civilian casualties — not just those who die but also those who survive with the wounds typical of that conflict. Every war also creates new approaches to military medicine, many of which have been translated into better civilian care. Surgical techniques, rapid evacuation to trauma centers, antibiotic use, infection control… Read more
- Coma: Reel Life Is Not Real Life
Posted on June 22, 2006
It’s a familiar scene in the movies or on television. “Your wife is in a coma,” the doctor says, “and we’ll just have to watch and wait.” No one should go to the movies for a medical education, but given the power of film to influence popular attitudes and belief, one might think that depictions… Read more
- After the TGN1412 Tragedy: Addressing the Right Questions at the Right Time for Early Phase Testing
Posted on April 17, 2006
Five of the six British men who suffered devastating illnesses after receiving an experimental compound – TGN1412 – in the first phase of human testing are now reported to be out of hospital, and the sixth is apparently out of intensive care. Although it is unclear whether they will suffer long-term health effects from this… Read more
- A Letter to Tony Soprano, Family Caregiver
Posted on March 24, 2006
Dear Mr. Soprano, We were very sorry to learn about the unfortunate incident that resulted in your hospitalization. We hope you have a speedy recovery. Gunshot accidents can happen to anyone, and we know your primary concern is not for yourself but for your beloved uncle, who must have thought he was shooting at a… Read more