{"id":28759,"date":"2014-09-30T05:32:50","date_gmt":"2014-09-30T10:32:50","guid":{"rendered":"http:\/\/deafnetwork.com\/wordpress\/?p=28759"},"modified":"2014-09-30T05:32:50","modified_gmt":"2014-09-30T10:32:50","slug":"deaf-hospitalist-focuses-on-teaching-co-management-patient-centered-care","status":"publish","type":"post","link":"https:\/\/deafnetwork.com\/wordpress\/blog\/2014\/09\/30\/deaf-hospitalist-focuses-on-teaching-co-management-patient-centered-care\/","title":{"rendered":"Deaf Hospitalist Focuses on Teaching, Co-Management, Patient-Centered Care"},"content":{"rendered":"

Deaf Hospitalist Focuses on Teaching, Co-Management, Patient-Centered Care<\/strong><\/p>\n

From: The Hospitalist, August 2014<\/p>\n

Hospitalist team leader, educator Christopher Moreland, MD, MPH, FACP, has changed how peers regard doctors with disabilities<\/p>\n

by<\/span><\/span> Gretchen Henkel<\/p>\n

What\u2019s the bigger picture here?<\/p>\n

“What\u2019s the bigger picture here?\u201d Hospitalist Christopher Moreland, MD, MPH, FACP, drops his question neatly into the pause in resident Adrienne Victor, MD\u2019s presentation of patient status and lab results.<\/p>\n

We\u2019re on the bustling 9th floor of University Hospital at the University of Texas Health Science Center (UTHSCSA) in San Antonio during fast-paced morning rounds. As attending physician, Dr. Moreland is focusing intently on Dr. Victor\u2019s face, simultaneously monitoring the American Sign Language (ASL) interpretation of Todd Agan, CI\/CT, BEI Master Interpreter. Immediately after his question to Dr. Victor, the discussion\u2014conducted in both ASL and spoken English\u2014shifts to the patient\u2019s psychosocial issues and whether a palliative care consult would be advisable.<\/p>\n

It\u2019s clear that for Dr. Moreland, the work, not his lack of hearing, is the main point here. A hospitalist with the UTHSCSA team since 2010, Dr. Moreland quickly established himself not only as a valuable HM team member and educator, but also as a leader in other domains. For example, in addition to his academic appointment as assistant clinical professor of medicine, he previously was co-director of the medicine consult<\/span><\/span> and co-management<\/span><\/span> service at University Hospital and now serves as UTHSCSA\u2019s associate program director for the internal medicine residency program.<\/p>\n

Dr. Moreland\u2019s question this morning is typical of his teaching, says Bret Simon, PhD, an educational development specialist and assistant professor with<\/span><\/span> the division of hospital medicine at UTHSCSA.<\/p>\n

\u201cHe\u2019s very good at using questions to teach, promoting reflection rather than simply telling the student what to do,\u201d Dr. Simon explains.<\/p>\n

Why Medicine?<\/p>\n

Chris Moreland\u2019s parents discovered their son was deaf at age two, by which time he had acquired very few spoken words. After multiple visits to healthcare professionals, a physician finally identified his deafness. The family then embarked on a bimodal approach to his education, using both signed and spoken English. He learned ASL in college. As a result, he communicates through a variety of channels: ASL with interpreters Agan and Keri Richardson, speech reading, and spoken English. When examining patients, he uses an electronic stethoscope that interfaces with his cochlear implant.<\/p>\n

Medicine was not Dr. Moreland\u2019s first academic choice.<\/p>\n

\u201cI went into college thinking I wanted to do computer science,\u201d he says, speaking of his undergraduate studies at the University of Texas in Austin. When he realized computers were not for him, he switched his major to theater arts, continuing an interest he had had in high school. After that, research seemed appealing, and he became a research assistant in a lab in the Department of Anthropology. Finally, after shadowing a number of physicians, his interest in medical science was stimulated.<\/p>\n

\u201cMedicine,\u201d he says, \u201cbecame a nice culmination of everything I was interested in doing.\u201d From computer science, he learned to appreciate an understanding of algorithms; from theater arts came the ability to understand where people are coming from; and from his link with research in linguistics and anthropology came the contribution of problem solving and methodology.<\/p>\n

Fearless Communicator<\/p>\n

Dr. Moreland says his deafness presents no impediments to his practice of medicine. \u201cI grew up working with interpreters, so I\u2019m used to that process,\u201d he says. \u201cIt forces you to become less inhibited about what you\u2019re doing. People have questions [\u2018who is that other person in the room?\u2019], and you learn how to handle those questions quickly, without interfering with communication in order to advance the work.\u201d<\/p>\n

When Dr. Moreland started his clinical rotations as a third-year medical student, he grappled with the best way to introduce himself and his interpreter to patients. His first attempt at explaining the interpretive process \u201cwent on for quite a while\u201d and was too much information. \u201cIt ended up overwhelming the patient,\u201d he says.<\/p>\n

The next time he chose not to introduce the interpreter but<\/span><\/span> to simply address the patient directly. \u201cThat didn\u2019t work either, because the patient\u2019s eyes kept wandering to that other person in the room.\u201d<\/p>\n

Finally, \u201cI realized that it wasn\u2019t about me,\u201d he says. \u201cIt was about the patient.\u201d So he simply shortened the introduction to himself and the interpreter and asked the patients how they were doing.<\/p>\n

\u201cOnce I became more professional about the situation, the more positive and patient-centered it became, and it went well.\u201d He says he\u2019s had no negative experiences since then, at least not related to his deafness. He approaches each new patient interaction proactively, and he and his interpreters become part of the flow of care.<\/p>\n

Teaching\u2019s Missing Pieces<\/p>\n

As illustrated with<\/span><\/span> his first question, Dr. Moreland intends for his trainees to learn to think globally about their patients.<\/p>\n

\u201cAlthough rote information has its role,\u201d he explains later in the conference room, \u201cI\u2019m always afraid of overemphasizing it. When I trained in medical school, we didn\u2019t learn that much about communication skills and teamwork. We talked a lot about information<\/span><\/span> we use as physicians\u2014the mechanism of disease, the drugs we use.<\/p>\n

\u201cWhat I try to emphasize with trainees is, what skills in communication, teamwork, and self-education can we develop so that we can use those skills continuously throughout our practice?\u201d<\/p>\n

Dr. Moreland takes setting resident-generated learning goals seriously, says Dr. Simon, for which he and trainees give him high marks.<\/p>\n

\u201cHe is very supportive and encourages us to make our own management decisions,\u201d Dr. Victor says. \u201cThough, of course, he will let us know if something is likely the wrong choice, usually by discussing it first.\u201d<\/p>\n

Patrick S. Romano, MD, MPH, professor of general medicine and pediatrics and former director of the Primary Care Outcomes Research (PCOR) faculty development program at the University of California Davis, where Dr. Moreland was a resident and then a fellow, found his trainee was always \u201cvery thoughtful and conscientious, presenting different ways of looking at problems and asking the right questions. And, of course, that\u2019s what we look for in teachers: people who know how to ask the right questions, because, then, of course, they are able to answer students\u2019 questions.\u201d<\/p>\n

Transformational and Inspirational<\/p>\n

For many of Dr. Moreland\u2019s colleagues and trainees, working with him has been their first exposure to a hearing-impaired physician. Richard L. Kravitz, MD, MSPH, professor and co-vice chair of research in the department of medicine at UC Davis, supervised Dr. Moreland during his residency and later during his PCOR fellowship. The American Disabilities Act-mandated interpreter for Dr. Moreland introduced a \u201cchange in standard operating procedure,\u201d Dr. Kravitz notes. \u201cNone of us knew what to expect when he came onboard<\/span><\/span> the residency program. But, very quickly, any unease was put to rest because he was just so talented.\u201d<\/p>\n

For visitors, Dr. Moreland seamlessly addresses his hearing impairment and makes sure that everyone on the team is following the discussion. Luci<\/span><\/span> K. Leykum<\/span><\/span>, MD, MBA, MSc, hospital medicine division chief and associate dean for clinical affairs at UTHSCSA, says that Dr. Moreland has brought \u201ca lot of positive energy to the group\u2014and in ways I would not have expected.\u201d She praised his talents as both a clinician and teacher.<\/p>\n

John G. Rees, DBA, RN, patient care coordinator in the 5th Acute Care Unit, says that Dr. Moreland immediately \u201cblended\u201d with the staff on<\/span><\/span> his service. \u201cThe rapport<\/span><\/span> was perfect,\u201d he adds.<\/p>\n

Robert L. Talbert, PharmD, the SmithKline Centennial Professor of Pharmacy at the College of Pharmacy at the University of Texas at Austin, often participates in teaching rounds. Dr. Moreland, he says, \u201chas an excellent fund of knowledge; he\u2019s very rational and evidence-based in<\/span><\/span> decisions he makes. He\u2019s exactly what a physician should be.\u201d<\/p>\n

Watching interpreters Agan and Richardson during group meetings, Dr. Leykum<\/span><\/span> believes, has influenced their group dynamics. \u201cOn a subtle level, having Chris in the group has made us more aware of how we interact with each other.\u201d<\/p>\n

Nilam<\/span><\/span> Soni, MD, FHM associate professor in the department of medicine and leader of ultrasound education, has noticed that he has become attuned to Dr. Moreland\u2019s way of communicating and often does not need the interpreters to decipher the conversation between them. Working with Dr. Moreland has given Dr. Soni \u201ca better understanding of how to communicate effectively with patients that have difficulty hearing.\u201d<\/p>\n

After working with Dr. Moreland at UC Davis, Dr. Kravitz observed that employing physicians with hearing impairment or other disabilities brings additional benefits to the institution. Dr. Moreland\u2019s presence \u201cprobably raised the level of understanding of the entire internal medicine staff, because it demonstrated that a disability is what you make of it,\u201d he says. \u201cOne recognizes how porous the barriers are, provided that people with disabilities are supported appropriately. In that way, Chris was inspiring, and may have changed the way some of us look at this specific disability that he had, but also other disabilities.\u201d<\/p>\n

A bigger picture, indeed.<\/p>\n

Gretchen Henkel is a freelance writer in California.<\/p>\n

SOURCE:<\/p>\n

http:\/\/www.the-hospitalist.org\/details\/article\/6443271\/Deaf_Hospitalist_Focuses_on_Teaching_Co-Management_Patient-Centered_Care.html<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Deaf Hospitalist Focuses on Teaching, Co-Management, Patient-Centered Care From: The Hospitalist, August 2014 Hospitalist team leader, educator Christopher Moreland, MD, MPH, FACP, has changed how peers regard doctors with disabilities by Gretchen Henkel What\u2019s the bigger picture here? “What\u2019s the…<\/p>\n

Read more →<\/a><\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[2],"tags":[22459,22267,4621,23,22456,22455,24,22457,162,40,5038,22460,19779,22461,12248,22458],"class_list":["post-28759","post","type-post","status-publish","format-standard","hentry","category-deaf-news","tag-adrienne-victor","tag-american-disabilities-act","tag-article","tag-asl","tag-christopher-moreland","tag-christopher-moreland-md-mph-facp","tag-deaf","tag-gretchen-henkel","tag-hospital","tag-interpreter","tag-md","tag-robert-l-talbert","tag-todd-agan","tag-university-of-california-davis","tag-university-of-texas-health-science-center","tag-uthscsa"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p752R-7tR","jetpack-related-posts":[{"id":14566,"url":"https:\/\/deafnetwork.com\/wordpress\/blog\/2011\/06\/02\/tsd-graduation-6211-seniors-take-center-stage\/","url_meta":{"origin":28759,"position":0},"title":"TSD Graduation – 6\/2\/11 Seniors Take Center Stage","author":"Grant Laird Jr","date":"June 2, 2011","format":false,"excerpt":"TEXAS SCHOOL FOR THE DEAF PRESS RELEASE Contact: Keena Miller Phone: 512-462-5328, cell: 512-658-4444 Email: Keena.miller@tsd.state.tx.us FOR RELEASE JUNE 2, 2011 WITH SCHOOL OUT, SENIORS TAKE CENTER STAGE INSPIRED BY DEAF M.D., 2011 GRADUATING CLASS CELEBRATES ACHIEVEMENTS Austin, Texas \u2013 June 4, 2010 Today at the Texas School for the\u2026","rel":"","context":"In "General"","block_context":{"text":"General","link":"https:\/\/deafnetwork.com\/wordpress\/blog\/category\/deaf-news\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":45037,"url":"https:\/\/deafnetwork.com\/wordpress\/blog\/2024\/04\/26\/governor-abbott-appoints-three-to-governing-board-of-the-tsd\/","url_meta":{"origin":28759,"position":1},"title":"Governor Abbott Appoints Three To Governing Board Of The TSD","author":"Grant Laird Jr","date":"April 26, 2024","format":false,"excerpt":"Governor Abbott Appoints Three To Governing Board Of The Texas School For The Deaf April 25, 2024 | Austin, Texas | Appointment Governor Greg Abbott has reappointed Christopher Moreland, M.D. and Shawn P. 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