Joseph A Carrese's research while affiliated with Johns Hopkins University and other places

Publications (78)

Article
Background While opioid use disorder (OUD) is prevalent, little is known about what patients with OUD in sustained remission think about the chronic disease model of OUD and their perspectives of the cause, course, and ongoing treatment needs of their OUD.Objective To (1) examine patient perceptions of the chronic disease model of addiction and dis...
Article
Full-text available
Background: The Scholarly Concentrations program was established at Johns Hopkins University School of Medicine in 2009 with the aim of instilling passion for scholarship. Objective: Our study aimed to determine whether the Scholarly Concentrations program achieves positive changes in medical student self-efficacy in conducting research and, if...
Article
Importance Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines. Objective To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients. Design, Setting, and P...
Article
Full-text available
Grateful patients provide substantial philanthropic funding for health care institutions, resulting in important societal benefits. Although grateful patient fundraising (GPFR) is widespread, it raises an array of ethical issues for patients, physicians, development professionals, and institutions. These issues have not been described comprehensive...
Article
Full-text available
Background Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding after stroke; however, PEG tubes placed in patients in whom death is imminent are considered non-beneficial. Aim We sought to determine whether placement of non-beneficial PEG tubes differs by race and sex. Design and setting/participants In this retros...
Data
Flow diagram indicating selection of the study population. *Not mutually exclusive. (TIF)
Data
Sensitivity analysis: Odds of PEG among stroke patients who died or were discharge to hospice within 14 days of admission (n = 32,560). (DOCX)
Data
Multivariable analysis for race and sex determinants of non-beneficial PEG placement after stroke. Sensitivity analysis including imputed data for race; n = 42,235. (DOCX)
Article
Objective: Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the "respect and dignity status" of an ICU. Design: A draft checklist based on previous work was iter...
Article
Purpose: The purpose of the study is to develop a brief index of patient and family experiences of respect in the intensive care unit (ICU). Materials and methods: We designed a questionnaire with 44 items representing 12 themes that emerged from prior in-depth interviews with ICU patients and families. After pilot testing, items with minimal va...
Article
Background: Though strong relationships between primary care providers (PCPs) and patients with addictive disease are essential for care, these relationships are often strained. Providers frequently have negative attitudes about treating these patients, in part due to the practical and psychosocial challenges that come with addictive disease. Resu...
Article
Full-text available
This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received...
Article
Despite wide recognition of the importance of treating patients with respect and dignity, little is known about what constitutes treatment in this regard. The intensive care unit (ICU) is a unique setting that can pose specific threats to treatment with respect and dignity owing to the critical state of patients, stress and anxiety amongst patients...
Article
Little is known about health care professionals' perceptions regarding what it means to treat patients and families with respect and dignity in the intensive care unit (ICU) setting. To address this gap, we conducted nine focus groups with different types of health care professionals (attending physicians, residents/fellows, nurses, social workers,...
Article
Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU....
Article
Treating patients and their family members with respect and dignity is a broadly accepted goal of health care. The work presented in this article is part of a larger project aimed at better understanding what constitutes treatment with respect and dignity in the ICU to improve the care that patients and family members receive in this regard. Direct...
Article
Full-text available
Purpose: Existing research shows that medical students experience high levels of distress. The purpose of this study was to understand how medical students experience doubt, and how doubt relates to distress. Methods: A mixed-methods study was conducted among first-year students at the Johns Hopkins University School of Medicine in June 2012. Stude...
Article
Full-text available
Effectively developing professionalism requires a programmatic view on how medical ethics and humanities should be incorporated into an educational continuum that begins in premedical studies, stretches across medical school and residency, and is sustained throughout one's practice. The Project to Rebalance and Integrate Medical Education National...
Article
Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize healt...
Article
Introduction and Purpose Ethics curricula are nearly universal in residency training programs, but the content and delivery methods are not well described, and there is still a relative paucity of literature evaluating the effect of ethics curricula. Several commentators have called for more ethics curriculum development at the postgraduate level,...
Article
Full-text available
Purpose: Existing research shows that medical students experience high levels of distress. The purpose of this study was to understand how medical students experience doubt, and how doubt relates to distress. Methods: A mixed-methods study was conducted among first-year students at the Johns Hopkins University School of Medicine in June 2012. Stude...
Article
Full-text available
Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three majo...
Article
A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents' personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives...
Article
To identify the perceived roles and responsibilities of clinicians during care transitions of older adults. Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated. An acute care hospital, a skilled nursing facility, two community-...
Article
Full-text available
Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.
Article
Background: Philanthropic contributions to academic medical centers from grateful patients support research, patient care, education, and capital projects. The goal of this study was to identify the ethical concerns associated with philanthropic gifts from grateful patients. Methods: A qualitative study design was selected. Investigators conduct...
Article
Background Philanthropic contributions to academic medical centers from grateful patients can be transformative. This study set out to identify features that are thought to be associated with success in grateful patient philantropy.
Article
This qualitative study explored perspectives of primary care providers and patients in challenging relationships. In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S. academic center. Providers identified patients with whom they had ongoing "challenging relationships," and we interviewed t...
Article
Full-text available
Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US. To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care. Focus group study. Dis...
Article
Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.e. ordinary ethics issues commonly faced) that internal medical residents encounter in their out-patient clinic and determined whether teaching about these issues occurred during f...
Article
The number of women in academic medicine has steadily increased, although gender parity still does not exist and women leave academics at somewhat higher rates than men. The authors investigated the reasons why women leave careers in academic medicine. Semistructured, one-on-one interviews were conducted in 2007-2008 with 20 women physicians who ha...
Article
Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audi...
Article
The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a me...
Article
To describe the ethics issues that pediatric residents encounter during routine care in an outpatient teaching clinic. Qualitative study including in-depth interviews with pediatric residents and direct observation of interactions between preceptors and residents in a pediatric teaching clinic. The Johns Hopkins Harriet Lane Pediatric Primary Care...
Article
Context: Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and...
Article
Full-text available
This qualitative study examined the experiences and perspectives of caregivers of homebound elderly patients. We performed in-depth, semistructured interviews with 22 caregivers (average age 59 years) of homebound elderly patients and analyzed them to determine major themes. The homebound patients were part of a house call program of a US academic...
Article
To determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals. Mailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses. Two hundred and fourteen providers completed the survey (55% response rate). Eight discrete sources of distress were identified fo...
Article
Full-text available
To use a natural experiment to identify patient factors associated with the decision to follow one's primary care provider (PCP) to a more distant location after the closure of a medical practice. Case-control study. Eight months after the closure of a practice in Dundalk, Maryland, we randomly selected 140 patients older than 60 years from each of...
Article
Evidence-based medicine (EBM) is important in training doctors for high-quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM. The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consist...
Article
Previous studies about resident well-being have focused on negative aspects of well-being. We conducted this study to explore residents' conceptions of well-being and how it affects their work. One investigator conducted semi-structured interviews with residents at two hospitals during February-June 2005. Through random sampling stratified by progr...
Article
Burnout is high among clinicians and may relate to loss of "meaning" in patient care. We sought to develop and validate a measure of "personal meaning" that practitioners derive from patient care. As part of a larger study of well-being among genetics professionals, we conducted three focus groups of clinical genetics professionals: physicians, nur...
Article
The closure of a primary care practice and the relocation of the physicians and staff to a new office forced patients to decide whether to follow their primary care physicians (PCP) or to transfer their care elsewhere. This study explores the perspectives of the older patients affected by this change. Qualitative study. Two lists of patients older...
Article
The genesis of this article was a conversation between the authors: M.I., a senior faculty member, and J.C., his primary care doctor and a midcareer faculty member. It addresses the challenges facing physicians today as they struggle to strike the proper balance between career and personal life; it also addresses the potential toll to oneself and l...
Article
The long-term impact of faculty development programmes (FDPs) is poorly understood, and most assessments of them have been quantitative in nature. This study aimed to use qualitative methods to better understand the long-term impact of an FDP in teaching skills (FDP/TS). A survey was carried out in July 2002 of the 242 faculty members and fellows w...
Article
Previous quantitative studies about doctor well-being have focused primarily on negative well-being, such as burnout. We conducted this study to understand residents' perspectives on well-being. We conducted 45-minute interviews with residents from 9 residencies at 2 academic hospitals in Baltimore, Maryland. From February to June 2005, we approach...
Article
Key points: 1. Historically, medical ethics focused on the proper conduct of physicians as members of a profession. 2. Bioethics has emerged as a distinct field over the past several decades and has a broader scope than traditional medical ethics. The field of bioethics includes research ethics, public health ethics, organizational ethics, and cli...
Article
Honoring patients' wishes becomes difficult when doing so threatens their well-being. In this article, the case of a hospitalized elderly woman is presented. The patient, ready for discharge, insists on returning home, yet she is bedbound and lacks adequate social support and financial resources to manage safely. The medical team, troubled by this...
Article
Full-text available
Focus groups stratified by race and socioeconomic status were used to examine obese women's experiences with weight-loss methods. Six themes emerged: failure of weight maintenance, use of psychological and spiritual approaches, role of family influences and societal expectations, role of African American subculture, method affordability, and racial...
Article
Thesis--University of Missouri, Kansas City, 1975. Microfilm. Ann Arbor, Mich. : Xerox University Microfilms, 1976. For soprano, chamber ensemble and pre-recorded tape. Words by Beverly Shroyer; text based on Plato's Allegory of the Cave. Includes notes on music and text. 1. Prologue.--2. The cave.--3. The ascent.--4. The return.
Article
Self-doctoring is providing oneself care normally delivered by a professional caregiver. Expert authors warn physicians not to self-doctor, yet cross-sectional studies document that physicians frequently do. Explanations for this disparity remain speculative. To better understand the circumstances when physicians did and did not doctor themselves a...
Conference Paper
Background Self-doctoring is providing oneself care normally delivered by a professional caregiver. Expert authors warn physicians not to self-doctor, yet cross-sectional studies document that. physicians frequently do. Explanations for this disparity remain speculative. Objective To better understand the circumstances when physicians did and did n...
Article
Medical learners look to role models to better understand the values, attitudes, behaviors, and ethics of the medical profession. This study examined issues related to physicians serving as role models for diverse medical learners. Between September and November 2000, in-depth semi-structured 30-minute interviews were conducted with 29 highly regar...
Article
Role modelling is an effective teaching method in medical education. We sought to better understand role modelling by examining the insights of respected physician role models. We conducted 30-minute in-depth interviews with 29 highly regarded role models at 2 large teaching hospitals. We coded the transcripts independently, and compared our coding...
Article
Full-text available
To understand how elderly patients think about and approach future illness and the end of life. Qualitative study conducted 1997-9. Physician housecall programme affiliated to US university. 20 chronically ill housebound patients aged over 75 years who could participate in an interview. Participants identified through purposive and random sampling....
Article
Professional development in medicine includes the acquisition of values and attitudes which are fundamental to the role of the physician. Little is known about which values and attitudes attending physicians emphasize in their teaching of medical trainees to help them develop professionally. To determine the values and attitudes which attending phy...
Article
Full-text available
A physician's effectiveness depends on good communication, and cognitive and technical skills used with wisdom, compassion, and integrity. Attaining the last attributes requires growth in awareness and management of one's feelings, attitudes, beliefs, and life experiences. Yet, little empiric research has been done on physicians' personal growth. T...
Article
Physicians play a critical role in controlling resource use in medicine. This paper describes an innovative, interdisciplinary conference that teaches housestaff and medical students about resource and information management in the hospital setting. The objectives are to help foster communication between physicians and other members of the health c...
Article
Several challenging ethical issues have been associated with the shift to managed healthcare in the United States. Our objective was to develop, implement, and evaluate a curriculum designed to help physicians identify and examine ethical issues encountered in the managed care setting. The curriculum was developed during a year-long workshop at Joh...
Article
Practicing medicine well requires recognizing the breadth of human experience and attending to the psychological and sociocultural dimensions of patients as well as their physical needs. Central to the concerns of anthropology are the shared beliefs and values expressed in social practices and traditions that give meaning to everyday life. The rele...
Article
Cultural differences between doctors and their patients are common and may have important implications for the clinical encounter. For example, some Navajo patients may regard advance care planning discussions to be a violation of their traditional values. To learn from Navajo informants a culturally competent approach for discussing negative infor...
Article
To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives. Focused ethnography. Navajo Indian reservation in northeast Arizona. Thirty-four Navajo informants, including patients, biomedical health care providers, and traditional healers. Informan...
Article
Objective. —To understand the Navajo perspective regarding the discussion of negative information and to consider the limitations of dominant Western bioethical perspectives.Design. —Focused ethnography.Setting. —Navajo Indian reservation in northeast Arizona.Participants. —Thirty-four Navajo informants, including patients, biomedical health ca...
Article
Full-text available
A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross-cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

Citations

... However, Africa's vaccination drive has confronted numerous challenges, including resource constraints as well as vaccine access and hesitancy, with South Africa at the end of the fifth wave of the pandemic in this second quarter of the year. This reality, therefore, has necessitated continued use of nonpharmaceutical prevention and control of the COVID-19 infection measures, such as wearing of face coverings and physical distancing, in an effort to save lives and livelihoods, while preserving the health and safety of health care practitioners and their patients and students (Beach et al., 2020;WHO, 2022;Wieten, Burgart, & Cho, 2020), with these regulations very recently (June 2022) having been completely scrapped by the South African National Department of Health. The implementation of these measures has presented challenges to the provision of services within the scope of practice of the speech-language and hearing (SLH) professions, including clinical practice, teaching and training, as well as research . ...
... While some hospitals affirm these fundraising efforts are necessary, for example, to defray costs for uninsured patients, growing evidence suggests the practice infringes on patient trust (4,5). A 2019 survey demonstrated the universal extent of public disapproval: 85.8% of the general public disapproves of physicians discussing donating with patients if the patient has not brought it up, 91.5% disapprove of physicians providing patient names to hospital fundraising staff without patients' permission, 90.1% disapprove of hospital development staff performing wealth screening using publicly available data, and 83.2% agree that physicians discussing donating with patients may interfere with the patientphysician relationship (5). ...
... This program increased student self-efficacy in research, which also increased satisfaction with scholarly activities and likelihood of pursuing academic medicine in the future. 5 Many medical universities have adopted similar programs to provide opportunities for medical students to invest time in research endeavors. [5][6][7] A clear benefit of these research programs included the potential for forming positive mentor-mentee relationships. ...
... Unfortunately, although GPPs are a common practice at hospitals, ethical guidelines and published reports of individual hospital experiences regarding GPPs are rare. A survey on a convenience sample of 13 major academic hospitals found none of the institutions had guidelines for ethical considerations (17). Moreover, the limited literature that shows the successes of grateful patient fundraising is not without flaws. ...
... For stroke patients who have difficulty maintaining an open airway or who require prolonged mechanical ventilation, tracheostomy in the US is commonly performed 6-14 days after stroke onset (14,15), with increasing numbers over the past two decades (14). Rates of life-sustaining interventions are higher in minority patients than white patients (16), including PEG (17,18) and tracheostomy (18). ...
... These forms of suffering often co-occur across care settings (e.g. intensive care, Carrese et al., 2017;primary care, Levinson et al., 2000) and countries (Lown et al., 2017;Martin and Dixon-Woods, 2014). All these forms of suffering are exacerbated during novel pandemics like COVID-19 where the diseases are deadly, disabling and poorly understood. ...
... For example, our findings on students' emphasis on the abundance of material and grades are consistent with prior research on the pre-clinical years [23]. Findings here are also in alignment with past research showing that students are often crippled with self-doubt in the form of imposter syndrome and other feelings of inadequacy [31]. Unlike the Coping Reservoir Model, however, we did not identify mentorship as a prevalent theme in first year students' experiences. ...
... Critical sickness is a disease that has an abrupt start, is severe, is quickly changing, and is unintentional, resulting in lasting repercussions [1]. The clinical needs for treating and caring for critically sick patients are exceedingly high. ...
... Numerous interpersonal subjective factors may be involved in presentations and interpretations of risks and benefits, related to contexts and dynamic interactions of doctors and patients. Doctors who become patients have received some attention, primarily focusing on single, anecdotal reports13141516, and issues of self-doctoring [17,18]. Anecdotally, they have been forced to experience medical care from a different position, and thus come to see aspects of medicine from another perspective in ways that challenge their preconceived beliefs and expectations. ...
... However, healthcare providers frequently hold negative and stigmatising views toward patients who do not use medications as prescribed, especially those labelled as 'addicts' ( Picco et al., 2021a ). Studies have shown that healthcare professionals may view these patients as challenging to treat due to complex psychosocial issues, hold the opinion that patients are responsible for their 'issues', and that their care impedes the care of other 'legitimate' patients ( Press, Zornberg, Geller, Carrese, & Fingerhood, 2016 ). Unsurprisingly, these attitudes can make people who use unusual amounts of monitored medicines feel inadequate, unwelcome and misunderstood by their provider, resulting in tense clinical relationships and disengagement with health care systems ( Press et al., 2016 ;Ray et al., 2013 ). ...