I am the Director of the Center for Bioethics at Brigham and Women’s Hospital, associate physician in the Jen Center for Primary Care at BWH, and Associate Professor of Medicine and Global Health and Social Medicine at Harvard Medical School (HMS). The Center for Bioethics is the umbrella for ethics at BWH and I am responsible for oversight of our clinical ethics consultation service, ethics education for housestaff, hospital policy development, and bioethics research. I spend my effort engaged in clinical and research ethics consultation, teaching medical students and housestaff, practicing primary care medicine, and normative and empirical research in bioethics.
My primary areas of research interest are ethical issues in genetics, physician-patient communication, and medical education. In collaboration with BWH OurGenes, OurHealth, OurCommunity I am involved in a study of patient attitudes toward disclosure of genetic research results. I am also engaged in a population-based study of attitudes toward whole genome sequencing, an NIH funded study of the impact of disclosing whole genome sequencing results to patients in primary care and cardiology and an NIH funded study of the impact of direct to consumer genetic testing.
Physician-patient communication is a long-standing interest of mine. I continue to build on my previous research in this area that looked at communication during bedside rounds. Within the broad area of physician-patient communication, I have primarily focused on communication about preferences at the end of life. I was the senior author on an interventional study to improve the completion of advance directives among primary care patients. This study was the basis for a systems wide intervention to improve the completion of advance directives among primary care practices affiliated with Partners Community Healthcare, Inc. I have also completed two manuscripts on communication about advance care planning using video technology. In these studies we found that the use of video images of a patient with advanced dementia compared with a verbal narrative of advanced dementia had a significant impact on subjects’ preferences for end of life care. We also found that health literacy, not race, was a predictor of subjects’ end of life care preferences. I am currently involved in an NIH funded study assessing how best to prepare family members of seriously ill patients for medical decision-making.
My research in medical education focuses on understanding students’ and residents’ experience with the medical hierarchy. We recently adapted and are validating a scale to assess moral courage among healthcare providers. We are studying the likelihood of residents’ speaking up in clinical situations that pose a threat to patient safety and medical professionalism.
My research applies the analytical approach of philosophy and the methods of biostatistics and clinical epidemiology to ethical questions in medicine. Analyzing the conceptual issues that underlie the empirical questions complements my empirical research. In this way, the normative implications of the research are, from the outset, incorporated into the empirical research. Illuminating a theoretical foundation allows me to give depth and sophistication to the formulation of the empirical research.
I currently teach a first year HMS required course in medical ethics and professionalism. This one-semester course meets weekly for two hours. I also teach in the Introduction to the Professions for first year students and the HMS 4th year Capstone Course. I have previously taught the elective introductory medical ethics course to first year HMS students, served as a tutor for a cohort of students in Patient Doctor III, and supplemented students’ education in medical ethics during a summer seminar. I have also taught in the BWH internal medicine residency’s humanistic curriculum and participated in educational sessions for medical students, nurses, physicians, and house staff about medical ethics. I have also developed and continue to teach a research ethics curriculum for fellows in the Harvard Clinical Scholars Program. I have also developed a case based ethics education program for housestaff in clinical departments at BWH and I actively mentor medical students, housestaff and fellows interested in bioethics research. I chair the Advisory Committee on Medical Humanities for the HMS Scholars in Medicine Program, the Ethics Committee of the Society of General Internal Medicine, and the Ethics Advisory Board of the Framingham Heart study.
In my role as a primary care physician, clinical ethics consultant and medical educator, I am an active participant in the creation of a hospital culture that fosters the ethical practice of medicine. Through my research on the ethical dimensions of incorporating genetics into clinical medicine and my research on physician-patient communication, I have become a national leader in the field of bioethics.