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What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

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Having A Baby? Big Differences In Hospital Quality Across Massachusetts

If you’re one of the roughly 70,000 women who will give birth in Massachusetts this year, you may be planning to deliver at a hospital close to home or where your OB practices. But what you might not realize is that when it comes to childbirth, there are big differences in hospital quality across the state.

For example:

  • Your chance of having a Cesarean section is almost three times higher at some hospitals
  • While some hospitals allow you to schedule an early delivery even when it’s not medically necessary, other hospitals have stopped this practice because a baby’s brain, lungs and liver need the full 39 weeks to develop
  • Your chance of having an episiotomy — a surgical cut to enlarge the vaginal opening — ranges from 0 to 31 percent
  • Trying for a natural delivery after having had a C-section is encouraged at some hospitals but not offered at others
  • Three times as many women breastfeed their babies at some hospitals as compared to others

“The door you walk in will have a big impact” on what happens during and after childbirth, says Carol Sakala, director of programs at the nonprofit maternity quality group Childbirth Connection.

The hospital where women choose to deliver “absolutely matters,” says Dr. Neel Shah, an assistant professor of obstetrics at Harvard Medical School. Take C-section rates, Shah says. “In many ways, which hospital you go to is a bigger predictor of whether or not you’re going to get a C-section than your own risk or your own preferences.”

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Transgender Patients Create Their Own Networks Of ‘Safe’ Providers

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT organizations. (Jesse Costa/WBUR)

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT groups. (Jesse Costa/WBUR)

A nurse looked at the couple: a man of medium height with a large belly and a tall, thin woman. The nurse handed the woman a small paper cup and asked for a urine sample.

“Well, that’s not really going to work because my husband is the one who’s pregnant,” the woman said. Then Karl Surkan, a transgender man who teaches gender studies at MIT, took the cup.

“Well, then I guess I need a urine sample from you,” Surkan remembered the nurse saying to him.

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Other nurses and doctors might make the same mistake. Transgender men are pretty unusual in OB offices and maternity wards. The nurse in this case wasn’t hostile, Surkan said, just “not knowledgeable about the existence of masculine-looking people who are pregnant.”

Still, Surkan would give the nurse a low score on an online provider rating system he co-founded late last year — TransRecord.com. Transgender and genderfluid patients log in, name a provider, and respond to eight questions that identify a doctor, nurse or counselor as transgender friendly — or not.

“This is a population that is heavily medicalized,” Surkan said. From the pre-transition period, through a gender change, to potentially decades of hormone therapy, these patients will be frequent users of health care. Continue reading

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Mass. AG Shifts Health Care Costs Conversation To Behavioral Health

If you have ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy.

Now, that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. It takes stock of behavioral health benefits and the low health insurance pay rate for these services in Massachusetts. Healey is shifting the focus of her office’s health care cost report after several, under former Attorney General Martha Coakley, that highlighted the wide gaps between payments made to high- and low-cost hospitals.

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Healey says she’s changing gears because “it’s really important to look at the whole health of the patient.”

“We need to get to a place where we treat people who’ve got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones,” Healey says.

Seventy-nine percent of Massachusetts residents enrolled in MassHealth or ConnectorCare have coverage that separates general medical care from mental health and substance abuse. For members of commercial health plans. that number is much lower but still significant: 31 percent.  Healey’s report does not say that the separation is necessarily bad, but that the state needs a better system of sharing patient information between medical and behavioral health providers, and more coordination of care.

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Note From A Civilized City: Boston Parks To Offer Dispensers Of Free Sunscreen

Got sunscreen? A sunbather on the Boston Common, one of the city parks that will offer free dispensers of free sunscreen. (Alonso Javier Torres/ Flickr Creative Commons)

Got sunscreen? A sunbather on the Boston Common, one of the city parks that will offer dispensers of free sunscreen. (Alonso Javier Torres/ Flickr Creative Commons)

In winter, season of germs, we can turn for a squirt of protection to the multitudes of handy sanitizer dispensers that have cropped up everywhere over the last few years, from gyms to workplaces to public buildings.

And in summer, when the blue skies raise the risk of skin cancer, we here in the civilized city of Boston will now be able to turn to 30 dispensers of free sunscreen that are being installed in the central Boston Common and four other popular parks. They’re expected to be up by July 1.

“Skin cancer and melanoma are among the most prevalent cancers and they’re also among the most preventable,” says Matt O’Malley, the Boston city councilor who proposed the sunscreen initiative in April.

“So what we are doing in Boston is, we’re offering a service, we’re promoting public health and we’re reminding folks of the importance of sunscreen — at no cost to the taxpayer. It’s an incredibly wonderful initiative and I look forward to seeing it spreading across the country much like the way my freckles spread every summer.”

The dispensers being installed in Boston parks (Courtesy of the Melanoma Foundation of New England)

The dispensers being installed in Boston parks (Courtesy Melanoma Foundation of New England)

The idea for dispensers sprang, he says, from a medical student who argued that installing them was a growing practice, including at Hershey Park in Pennsylvania. But no major city has adopted it as a citywide initiative, O’Malley says — until now.

If the pilot project with 30 initial sunscreen dispensers works out well, he says, the plan is to extend the dispensers to all the city’s playgrounds and parks — more than 200 of them.

The dispensers cost between $100 and $200, O’Malley says, so the ultimate price tag could be close to $50,000 — but not to the taxpayers. The dispensers are a public-private partnership including the Melanoma Foundation of New England and Make Big Change, both organizations that fight skin cancer. The foundation is covering the cost of the dispensers, according to a press release, and Making Big Change provides the dispenser units; it has also been placing them in New Hampshire beaches and parks.

So how might Bostonians respond to the new dispensers? Continue reading

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Those Who Worked On Mass. Law Cheer As Supreme Court Upholds Obamacare Subsidies

Jessica Ellis, right, with "yay 4 ACA" sign, and other supporters of the Affordable Care Act, react with cheers as the opinion for health care is reported outside of the Supreme Court Thursday. The court upheld the nationwide tax subsidies under President Obama's health care overhaul. (Jacquelyn Martin/AP)

Supporters of the Affordable Care Act react with cheers as the opinion for health care is reported outside of the Supreme Court Thursday. The court upheld the nationwide tax subsidies under President Obama’s health care overhaul. (Jacquelyn Martin/AP)

Obamacare supporters everywhere are celebrating a win from the U.S. Supreme Court. With a 6-3 vote, the court decided Thursday that Americans who buy coverage through health care exchanges run by the federal government can continue to receive subsidies.

None of the 119,962 Massachusetts residents who have health insurance that is subsidized by the government were at risk for losing coverage based on the ruling. That’s because the commonwealth has a state-run health insurance shopping website, the Massachusetts Health Connector. The case before the high court only dealt with people who buy insurance through the federal health insurance exchange.

But many in Massachusetts had a close personal or professional interest in this case.

“I am very relieved that affordable care can continue nationwide. It’s made a huge difference in Massachusetts,” said Faith Perry, who joined the Greater Boston Interfaith Organization through the Church of the Covenant in Boston.

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Medical Marijuana Is Now For Sale In Mass.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

There’s another milestone in the storied history of Salem. On Wednesday, the state’s first dispensary for medical marijuana opened on the ground floor of a former factory here, a few blocks off a busy thoroughfare. Continue reading

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Baker Announces Plan To Combat Opioid Addiction Epidemic

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

One person living in Plymouth County will die today from an overdose of heroin or another opiate. Gov. Charlie Baker says that sobering average, from just one county, offers a glimpse into the opioid epidemic that rages through every community in Massachusetts.

To combat this epidemic, Baker released a plan of attack. It includes 65 recommendations, drawn from a task force of experts who heard from 1,100 people this winter and spring, many of whom crowded into public hearings to tell their stories.

“Opioid addiction is a health care issue that knows no boundaries across age, race, class or demographics,” Baker said during a press conference Monday. “From the Berkshires, to Boston, to Cape Cod, too many people have heart-wrenching stories of loved ones or friends who have battled with addiction and in some cases lost their lives. Opioid abuse is stealing the livelihood of our children, our siblings, relatives and friends, one person at a time.”

The recommendations include more education for doctors, young people, those at risk for addiction and their family members about the dangers of pain killers. The state will look to add 100 treatment and recovery beds by this time next year. Pharmacists will be required to add pain prescriptions to a statewide database within 24 hours, much more quickly than the current seven days, which Massachusetts is working to connect to databases in other states.

“This is a complicated issue so there’s not going to be a simple fix,” said Health and Human Services Secretary Marylou Sudders.

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For Salem Dispensary, Mass. Issues One-Time Waiver From Marijuana Safety Tests

Massachusetts’ first medical marijuana dispensary will be allowed to open, but for limited sales, while the state reviews safety standards.

Marijuana grown so far tests for lead higher than allowed in Massachusetts, and the state says labs are not equipped to test for seven of 18 restricted pesticides. But the Baker administration will let Alternative Therapy Group, a proposed dispensary in Salem, open as long as it limits each patient to 4.23 ounces and instructs patients to consume no more than two grams a day.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

“Patients have waited to access marijuana for medical purposes for far too long,” Gov. Charlie Baker said in a statement. “This waiver will allow industry laboratories a little more time to reach full operation while providing safe amounts of medical marijuana for qualifying patients who need it.” Continue reading

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