Saturday, June 16, 2018

Locked Up on Father's Day

Precious Children Locked Up

Children, minors under age 18, are the most precious resource available to our own culture and to all the world.  They represent all the hope and all the future possibilities available to everyone, everywhere.  This hopeful preciousness is agnostic to their national origin, their parents’ status in social strata, their health or physical status, their religious background, or their race or ethnicity.   Dependent on the adults “in the room,” their lives are precious, and they must hold special status in every aspect of society, and everywhere in the world.    In the United States we have a long history of protecting children (at least trying to), and our laws attempt to provide access to health and education and assure quality of life to the fullest extent possible.  When we consider violence or other inhumane acts against children we are outraged. 

 Recall the media coverage, the marches and protests that occurred, in response to recent school shootings in Texas and Florida.  Think of Newtown and the humanitarian and noble response of Americans to that disaster, where many precious six-year-old lives were lost.  Our collective conscience must never allow us to disregard the principled value we hold for children.  It is in our DNA as Americans and shared  by all civilized people of the world.

Juxtapose this view against your own experience as a child, parent, or grandparent.  All of us connect in some way to that innate childhood connection with adults critical to our safety, protection, and love.  For me, I think of my two sons (now grown up) and my three grandsons, ages 6, 4, and (almost) 2.  My connection with all of them is profound.   I can’t disconnect or dishonor that relationship in any way.   They are all precious.   When I see the sweetness and vulnerability of my grandsons I am awed.  When I see their joyousness, their robust life- changing personalities, and their need for connection with their parents I am humbled. Some say that when they see the face of a young child, they see the face of God.  Regardless of one’s religious bent, isn’t it fair to say that in such faces one sees the reality of goodness?

And now, I can’t think of those faces, connections, and smiles without comparing them with the hundreds of children who have been ripped out of their parents’ arms by my government.  I can’t justify this for any political, legal, or moral reason.  When I hear others try to legitimize this on religious grounds, I am sickened at the hypocrisy and hatefulness of their argument.  I can only see my little grandsons, being taken from their parents, moved to a fenced in “shelter”, and being held against their will.  I can only feel the amazing heartbreak, outrage, and shock this would cause their parents.   I am deeply aware of the wounds, the pain, and the anger that would persist over generations and lifetimes.     I identify with these feelings viscerally. 

I hope that many speak out and act against this.  While I know that our political leaders on both sides are failing us here, I hope that churches, communities, and other organizations find ways to fight these horrific actions, against children and families, by our government.   This must stop. 

Saturday, June 9, 2018

A Good Day at the IHP: Saturday, June 9, 2018

At the Institute, there are many great days every year.  Today was one of those days for me.  It was a home run kind of day.   On one of the first really beautiful Saturdays of this spring, there was intense activity inside the IHP.  The third floor of the Shouse Building was almost vibrating with learning.  In each case the learning was voluntary (not required) and was collaborative.  

Walking down the hallway I bumped into some of our students who are enrolled in a voluntary medical Spanish course.  This is not part of their curriculum, but something they have taken on at their own expense so that they can reach out and serve the large group of individuals who are non-English speakers.  I admire these students for their dedication and for the leadership that they model for all of us.  They inspire me.

Continuing down the hallway, I strolled (by accident) into a group of DNP students and faculty.  They are here for one of their periodic intensive weekends of study.  The rest of their program is completed online.  These are nurse leaders and executives, all with at least a masters degree,  who have voluntarily taken on this intensive two year course of study to complete their doctoral study in our remarkable Doctor of Nursing Practice program.   Learning together, these nurse leaders are mapping next generation practices for our ever changing and ever challenging healthcare systems.   They inspire me too.

Across the hall was my final destination for the day.  I had the good fortune to attend the completion celebration for the 13 graduates in our MS In Health Professions program.  These individuals, from the United States, Japan, Singapore, and Saudi Arabia are all earning this voluntary post-graduate degree.   They are an interprofessional group that includes physicians, nurse practitioners, physician assistants, pharmacists, physical therapists, and the first ever speech-language pathologist to complete this degree at the Institute.   They attended a series of on campus activities over the past three days.  Their scholarly projects and their commitment to the education of health professionals will change the course and the quality of education in their own institutions and beyond.   Today’s event was made even more special because it is the last such event for Dr. Deborah Navedo, who was one of the founders of the program and served as program director since its first class was enrolled in 2011.  These students, all busy professionals who have completed this rigorous program of study, inspire me too.   (Special congratulations to Assistant Professor Josh Merson of our PA program, one of today’s grads). 

I know I am fortunate to have my professional home in an institution deeply committed to serving such exemplary learners, to transforming healthcare and education, and building tomorrow’s leaders.   I hope you all share my pride and inspiration. 

Wednesday, October 4, 2017

October 3, 2017
A long preamble to a simple invitation… 
Almost every morning I read a few online news sources. A typical day at my desk begins with quick perusal of Statnews Morning Rounds an online healthcare news source, the online version of Boston Globe, Academe Today (online Chronicle of Higher Education), and finally Inside Higher Ed. 

 Finding out what is happening in the world, in healthcare, and in the world of higher education help me think about my work and the Institute. I find that I constantly need to ask myself if we are paying attention to the “right stuff.” Every day I realize my gratitude for being able to work and learn at the IHP and I hope you feel the same way.

A few of this morning’s headlines, however, hit me in the gut.  I find a connectedness in the following headlines that is difficult and downright scary for me. 

An Unspeakable Carnage (Boston Globe, 10/3/2017)  
Las Vegas Hospitals Rush to Help Shooting Victims (Statnews, Oct.3, 2017) 
 Half of people in Puerto Rico don’t have clean water (Statnews, 10/3/17)  
Don’t Expect Congress to take action on mass shootings (Boston Globe, 10/3/17) 
Alzheimer’s Patient in multimillion dollar pharma ad may soon be homeless (Statnews 10/3/17) 
Scholars renew calls for US to fund research on gun violence (Inside Higher Ed, 10/3/17) 
Health providers weigh in on reused syringes (statnews, 10/3/17) 

 Gun violence, clean water, environmental issues, homelessness for disabled persons, and the drug epidemic weigh heavily on all of us, but I see a thread in all of these headlines -the healthcare thread- that links these messages with each other and with us as tin the academic setting . Our students, who are being prepared as healthcare providers and researchers, who will be called upon to address the impact of violence by caring for victims as first responders and rehabilitationists, to address the impact of environmental problems and weather related disasters, to study the effect of low resources on the health of populations, and to continue to address the needs of underserved people in our society. The root themes of poverty, racial and gender based inequity, and education cannot be ignored as underlying contributors to these vexing nightmarish problems. There is no opportunity to avoid the impact of these issues on our work together, as we face the future of our healthcare system. The reality of these now all too common occurrences and their systemic underpinnings are now part of our pedagogy and cannot be ignored in the classroom or clinical educational setting.

On a more hopeful side, I believe that as an educational community, we are preparing health care leaders who will be well equipped to tackle these problems when they occur. Most important, I believe that our graduates will help accomplish the goal of addressing causal factors that mitigate these horrific events in our future. As educators, we can help accelerate these future solutions by assuring that our students leave equipped with tools and skills for leadership, problem solving, innovation, and advocacy. These systems oriented solutions are critical additions to the excellent foundational work in clinical skill development, patient decision making, and ethical and interprofessional practice that are the hallmarks of an MGH Institute education.

In the coming weeks, I want to spend extra time reflecting on these solutions as we continue to face disturbing headlines. Let me know if you are interested in joining me for reflection and discussion around these issues and their impact on our work. Email me at and I will follow up with you soon!

Wednesday, May 6, 2015

I have not posted to my blog in over a year.    Today, I was inspired to compose some thoughts after reading an article that a colleague sent me from the New York Times.  It feels good to be blogging again.   I look forward to hearing your thoughts.   

In the May 1 issue of the New York Times it was enlightening to see a discussion of interprofessional education (IPE) highlighted in a column (unfortunately) titled “Doctors and Nurses Not Learning Together” by Dr. Dhruv Khullar ( a resident at Mass General).    Dr. Khullar is a frequent contributor to the column and has produced several op-ed pieces on health care.   In the article under discussion, the writer discusses the lack of exposure in medical school to mutual education opportunities with nurses, physician assistants, social workers, or pharmacists.  He indicates that in his residency he began to understand and appreciate the roles that these others play in the care of the patient.  He also notes that his education has provided no particular focus on the role of the physician as the leader of the health care team, a role he suggests as essential. He praises the work of the Josiah Macy Foundation, Robert Wood Johnson Foundation and others in driving the discussion toward team based care as better care.    While there a number of key points that I found missing from the discussion, it is important that consideration of IPE advance to the public forum and what better place for this to occur than the New York Times?  Congratulations to Dr. Khullar for using this important forum to raise these issues.  While clearly from a learner/trainee perspective, he brings a valued and valid viewpoint to the discussion.
                In response to the NYT article, a lengthy discussion is posted online.  The responses were almost all from physicians and nurses debating (with heat) the relationship issues that have infected some segments of the conversation between these two critically important groups for a very long time.     One respondent, a student from the MGH Institute cited her positive IPE experience, and a few others commented positively on their learning experiences elsewhere.  Most respondents, however, raised political, financial, power differential issues as obstacles to collaboration.   Very few respondents, other than a few students noted above, spoke to critical issues of patient care, outcomes, safety, health, and economics as the drivers for educating groups of health care professionals together.   These are the central issues, not politeness and politics, that need to serve as a rationale for delivering the best care collaboratively.  Debate about leadership and power need to take a backseat to patients, families and communities.  These structural and political issues, while important, are historical hot buttons that will not be resolved easily.  In the meantime, putting the patient at the center, making it safe for all members of the team to speak up, expecting everyone to work at the “top of their license,” and using evidence based approaches to communication and problem solving are all more likely to affect outcomes and health than the “captain of the ship” argument.  
                Another piece to this story that is at the center of the discussion so important to the IHP is the role of non-nurse and non-physician providers in healthcare safety and outcomes.  One could argue that the best providers of rehabilitation, psychological and behavioral health, health navigation, and nutrition services have done their work so well, that they are often invisible to physician and nurse colleagues.   These “other” professionals (I avoided the term allied deliberately)  are evaluating, assessing, interpreting, prescribing and carrying out interventions, measuring impact of care, communicating with families, patients, and making important connections across the individual’s life experience.     One could argue that for most patients with chronic or disabling conditions, that their contacts with these providers are far more frequent than they are with primary care of medical specialists.   The role of these other specialists is only beginning to emerge in the literature as to their impact on primary care, their role in outcomes, and their importance as teachers of physician and nurse colleagues.  
I hope that you will take time to read Dr. Dhuvar’s article, as it provides an important context that nicely explains why we are doing IPE at the Institute.  More important, I hope that you will find time to advance the debate beyond arguments of salary and power.  Instead, take some time to debate the impact that competent interprofessional care can bring to your patients.  

Thursday, October 17, 2013

Shout Out to PT Professionals for National Physical Therapy Month

A note from Alex:   It is National Physical Therapy Month.     I am interrupting the series on "The Impact of Impact" and will follow up with Part III soon.   In the meantime I wanted to acknowledge National Physical Therapy Month with a shout out to our own PT program.  I also am taking this moment to express some thanks for special attention I have received from the PT profession over the past year or so. I don't usually use this blog for highly personal matters, but I am violating that rule today.   In any case, I hope that you will join me in saluting and thanking our PT colleagues-faculty, students and staff.    We have a phenomenal department here at the IHP, remarkable students and alums, great PT colleagues at Mass General, SRH, and BWH who are all part of our clinical education enterprise.    We are truly privileged to have so many rehabilitation clinicians, educators, and scholars in our midst.  Say thanks to PT!

Dear Physical Therapists,

I am taking this opportunity to give a public thank you for your work.   I have worked with great PTs for most of my clinical and academic life.  Since joining the Institute, I have learned more and more about the significant contributions beyond the obvious.  Some of these include the highly creative curricular leadership of the IHP,  the dynamism and maturity of our PT students,  the respect of our programs in PT by others,and the great alumni involvement,  Our PT colleagues at the IHP do so much to contribute to the life of the Institute community.   Our last two Faculty Chairs (Drs. Tracy Brudvig and DJ Mattson)  have come from the Physical Therapy Department, with several more preceding them in earlier years.  Much of the energy and leadership around IPE has come from our PT Faculty, including the current leader of IMPACT, Dr. Mary Knab.   In almost every activity at the IHP, the strong positive, and gifted Physical Therapy "voice" can be heard.     For all of these contributions (and I could go on and on) I am grateful and appreciative.  I know our whole IHP community is so proud of these obvious reasons to shout out "Happy PT month."

However, I want to take a moment to be much more personal.   Over the past year or so I have been the personal recipient of physical therapy.   I was and continue to be "the patient."   I have experienced the continuum of care in PT in a highly individualized and focused manner.   I want to use this experience to share a bit of what I have learned about PT and why I am so grateful  Bear with me.

My first direct experience with PT started over a year or so ago when I experienced a "frozen shoulder."   The pain was the worst part.  I listened to my physician ("let's wait and see"), took some meds for a while, and tried to wait it out.   It improved enough to function, but it hurt all the time. When I finally got around to seeing Mr. Jon Hagan, PT, OCS  at the MGH Charlestown Community Center for therapy, I was quickly amazed.   Boom... a few sessions- no more pain, over time increased range of motion, and some simple follow up visits to make sure all was on track.   At the time, I was so grateful for the relief and the rehab.   I hope that Jon knows how much I appreciate him and the great care.  I also hope he knows that his talent and encouragement are remarkable.  Happy PT Month to Jon Hagan. 

The lessons I learned from Jon provided a simple preface to  a book that is not quite finished.   Last February I had a "little" neurosurgery for an acoustic neuroma at the Massachusetts General Hospital.   Before surgery, I knew that I would be deaf in the left ear, and "might" experience a few other problems.   Due to the size of the tumor, the ultimate complications included a number of of the "mights".  Among those were vision problems (double vision), balance problems, facial weakness, and some "minor" speech and swallowing problems.   Yes, my "benign" tumor hit the sweet spot where all those cranial nerves come together.  Sort of the trifecta for a speech language pathologist, wouldn't you say?   

So, the first chapter of PT, post surgery, was the part where you realize "Dude,  I am in the Neuroscience ICU at MGH and I can't get out of bed.  In fact, I don't want to even try!"   I can't recall the names of the Physical Therapists from the MGH PT Department who came to my rescue.  I wish I could.  They were all so amazingly skilled.   They knew how to get me up (gently at first), help me get into the chair, start walking around the ICU with all kinds of bells and whistles attached, and how to educate the hospital staff about what I needed to do.   Their knowledge of my condition, of the environment, and the link between my health status and what I needed to accomplish in order to get home were all amazing.   While these skills that I am acknowledging have to be the most routine and the most basic for PT clinicians in the acute care setting, they are far from routine from the patient's perspective.   I know that these PT neuro experts were the ones who helped me every day for that week, who pointed out little (and I mean tiny) steps toward the goal of discharge from the ICU and then the hospital, and who reassured me every "step" of the way.   One of the most impressive pieces of all of this was the way that the PT team communicated with each other as I progressed in my stay.   They were skilled at keeping each other aware of all "my"  details and they didn't need to keep asking me the same history questions at every visit.   All clinicians have something to learn from that!  So, to all of the Physical Therapists at Mass General, especially my therapists in the Neurosciences Unit, thanks for helping me to get home safely and with a bit of confidence.  You are all stars in my book.  (Just so you know, I am walking all over Boston now!).

Chapter II moves to my home.  About a week before my operation, I was contacted by two of our faculty members, both neurology PT specialists (Janet Callahan, PT, DPT, NCS and Anne McCarthy Jacobson PT, DPT, NCS).  They generously volunteered to check in on me after discharge and to see if there was anything I would need.   (Ha!  They didn't know what they were in for).    I was grateful (so grateful) for the attention, but assumed that after surgery I would need some rest, but why would I need PT?  Those balance problems were a possibility but I had confidence I wouldn't need them.    My first words, on the way home from the hospital, to my wife were " could you see when Janet could come over?"  Most fortunate for Anne and not so much so for Janet, her schedule allowed her to be "the one."   Janet spent several hours with me over the next few weeks.   In terms of symptom management for double vision and balance, she is a pro.   In terms of kindness, humor, clinical skill, encouragement, and generosity she is gifted.    I will spare the details about all we went through, but my progress was swift and within 10 days or so, I was starting to take a walk outside along the harbor.   My gratitude to Janet is immeasurable.   While some of those balance exercises, could qualify me for the flying Wallendas if mastered, I learned so much about the neurological system, balance, and about physical therapy.   I am still using what Janet helped me learn and practice.   P.S-  I would put the day that the double vision cleared among my best life rewards!   So Janet, Happy PT month.  You are remarkable!   Anne Marie, thanks for making yourself available too.   For both of you, your advice and support to people with balance and other neurological problems is a gift to rehab.  Our students are so fortunate to learn from you!  

Chapter III (apologies for length, but my PT story is sort of like Harry Potter-lots of volumes).   I mentioned my facial weakness, similar to Bell's Palsy.   There was very limited movement on the left side of my mug.   My surgeons (and they are the best) recommended that I wait for about six months before starting therapy for my facial muscles.   There is a rationale (I am still arguing with them about the rationale), but I waited.  That was a very long six months.   In late July, I began to see a new therapist, Mara Robinson, PT, MS, NCS at Mass Eye and Ear Infirmary.    Notably, (Mara is a 1997 graduate of the MS program at the Institute) Mara is a facial PT specialist and sees patients in the Facial Nerve Department at MEEI.   She is a star.  My guess is that she has seen more folks with acoustic neuroma complications and Bell's Palsy than about anyone else. Her knowledge of the unique and challenging facial musculature is beyond belief.  She knows it all.   We started with some facial exercises (again I will spare the details) .  Doing these exercises daily in the mirror is somewhat comical, yet highly logical.  At times, when I am exercising I feel like a facial contortionist .   However, within a few weeks of starting, I started to see lots of improvement.  Do you know what it feels like to lose a smile and get it back?  Do you know what it feels like to again feel comfortable when you are out or have to meet strangers?  Do you know how good it is to hear from family and colleagues that you look so much better?   For all of this and so much more, Happy PT month to Mara.   

I am happy to celebrate PT month this year and I will be for every year to come.   I say this as I walk, smile, and see more clearly.   I know that I am better for having had the opportunity to benefit from the expertise offered by my physical therapists.  Thanks (and Happy PT Month) to all Physical Therapists!