Dear Doctor …

Students’ innovation models process

It began as an idea between two first-year medical students; it ended up a disarmingly simple innovation to patient-physician communication.

Introduced to patients early in their medical education through the Family Centered Experience, which matches students with patient-families for a two-year period, Andrew Lin, from Los Angeles, and Aaron Farberg, from Chicago, quickly recognized what so many of us experience: questions that patients want to ask their doctors often occur to them after the physician has moved on — or don’t occur to them at all.

“When people are dealing with chronic disease in particular,” says Farberg, “it’s a lot to take in and difficult to think of everything, including what questions to ask.”

What if, the two wondered, patients were provided with the means to write down questions, and maybe even prompted with questions typical to many patients’ situations? Questions like, what tests are planned for today? What medications will I be on?

“We took our idea to Dean Woolliscroft during one of his open office hours sessions,” says Lin. The dean suggested they seek the guidance of hospitalists Scott Flanders, M.D., and Chris Kim, M.D. (Residency 2004).

Encouraged and mentored by Flanders and Kim on logistics and process, Lin and Farberg began modeling a prototype — cutting paper into squares, experimenting with fonts, making trips to Kinko’s, often into the small hours of the night. Flanders and Kim urged the students to apply for one of the Medical School’s Fostering Innovations Grants, which encourage innovative solutions and improvements in the Health System.

Farberg and Lin’s project was funded.

They interviewed patients. They spoke with stakeholders — nurses, physicians, housekeeping staff whose responsibility it would be to place the items when preparing rooms for new patients. They held focus groups. “We didn’t want to harm the chain of communications,” Farberg says, “so we carefully sought and listened to input from hospital staff and patients, and watched out for any negatives.” They also sought the counsel of the Health System’s marketing and communications staff, who directed them to U-M Printing Services so they wouldn’t have to wield paper-cutters anymore.

The students produced 1,000 notepads they call Dear Doctor Notes, shrink-wrapped with companion pens, and conducted a pilot program lasting more than two months in the general medicine and cardiac units, with control groups in each.

Anecdotal feedback indicates high satisfaction among patients who used the notes. Lin and Farberg are gathering patient survey data and hope to publish the results of their study in a medical education journal, and perhaps present at a national conference. Ultimately, they’d like to see the concept spread throughout the hospitals, and to outpatient clinics as well. “It helps patients chart their own care,” says Farberg. “Family members and friends will sometimes leave questions, too.”

“Doctors say it holds them more accountable,” Lin says. “The questions are there. They have to answer them.”

Nurses report they’re paging physicians less frequently with patient questions, thanks to the notepads. Now in their second year, the enterprising duo is quick to credit the support they got along the way. “It wasn’t just us,” Lin says. “We couldn’t have done it without so many helpful people directing us to the next step.”
—RICK KRUPINSKI

Questions? E-mail Farberg and Lin at deardoctor@umich.edu.

County, U-M Create Autopsy Partnership

In an alliance that’s rare in the United States, the U-M morgue has been doubled in size and capacity, and all of Washtenaw County’s autopsies will now be performed in the renovated facility — effectively doubling the educational opportunities for medical students to participate or observe. The county contributed to the cost of renovations, and the chief medical examiner has moved his office to the medical campus. The partnership centralizes the county’s efforts to improve death investigations, and furthers the U-M’s goal of establishing an academic center of excellence in forensic pathology.
—RK

Former Faculty Member Heads NIH

Francis S. Collins, M.D., Ph.D., former faculty member in the departments of Internal Medicine and Human Genetics and pioneering leader of the Human Genome Project, was sworn in as director of the National Institutes of Health on August 17. The NIH funds research at its 27 institutes and centers, as well as at universities nationwide.

Collins was on the faculty of the Medical School from 1984 to 2003. While at the U-M, he identified the gene for cystic fibrosis and discovered the genes for neurofibromatosis and Huntington’s disease. He also co-authored the definitive medical genetics text, Principles of Medical Genetics.

During a leave of absence from the U-M, Collins led the Human Genome Project — which mapped and sequenced all human DNA — to successful completion in 2003. Data resulting from the project continue to fuel many avenues of biological and medical science. He became director of the National Center for Human Genome Research in 1993, and of its successor, the National Human Genome Research Institute, in 1997, retiring in 2008. In 2007, he was awarded the Presidential Medal of Freedom.

Collins never lost his ties with the Medical School, returning each year to help teach genetics and, in 2000, to deliver the commencement address.
—RK

New Leader for School’s Largest Department

Nationally recognized gastroenterologist and Detroit native John M. Carethers, M.D., is the new leader of the Medical School’s Department of Internal Medicine. Chief of gastroenterology at the University of California, San Diego, and director of UCSD’s NIH Digestive Disease Research Development Center since 2004, Carethers began his U-M appointment November 1.

As chair, Carethers will oversee 585 faculty members in 12 divisions, and the department’s research, education, clinical care and development efforts. He heads one of the nation’s leading internal medicine departments, one that ranks fourth in NIH grant funding.

Carethers is respected among top gastroenterologists for his study of colorectal cancers, particularly among African-Americans. He earned his medical degree from Wayne State University in Detroit, and completed a residency in internal medicine at Massachusetts General Hospital in Boston and, in 1995, a fellowship at the U-M.
—RK

Learn more about John Carethers