Longer looks: A Nobel for the economist behind the National Resident Matching Program; Helping Charlie end his life

Oct 19 2012

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New Republic: Economics In Action: The Life-Changing, Nobel-Winning Work Of Al Roth
A noted economist at Harvard, (Al) Roth was responsible for algorithms that matched medical students with their residency programs, children with their schools in Boston, and more recently, compatible kidney donors and transplant patients in paired donations. ... Roth's influence is anything but theoretical. His effects on society are far-reaching, touching many lives, including those of the tens of thousands of new doctors who seek their first job in the field each year. Each March, Roth's algorithm runs on the National Resident Matching Program's computer, taking the ordered lists of preferences for residency programs submitted by graduating medical students, and the ranking of candidates submitted by hospitals, and assigns the best-possible match for each. Despite this, Roth probably remained unrecognizable to most physicians whose lives his work deeply touched. ... On Monday, Roth awoke to the news that he and Lloyd Shapley (whose work provided the basis for Roth's models) had been named recipients of the Nobel Prize in economics (Brian Eule, 10/16).

Health Affairs: Physician-Assisted Death Is Illegal In Most States, So My Patient Made Another Choice
Charles-;Charlie, as I came to know him-;greeted me at the door wearing only his boxer shorts and a full head of tousled white hair. ... My first impression was of an aged Abraham Lincoln: strong and gangly, dignified despite the boxers, with a mischievous smile. ... in his nineties, Charlie had debilitating back and leg pain from severe spinal stenosis, a condition that compressed his spinal cord and nerves. It caused his walking to be so unstable that he was prone to falls. ... (After a serious fall) Charlie was absolutely unwilling to go to the hospital or to consider any intervention that might prolong his life. He informed his wife and me that he was ready to die. He wanted to know what his options were. Could I provide a medication that would end things quickly? ... I explained to Charlie that in New York State, no doctor could legally take an active part in helping him end his life, and that included providing a lethal dose of medication. If he was determined to let this event end his life, he could stop eating and drinking, in which case it might take as long as seven to ten days before he passed away (Dr. David Muller, October 2012).

The New York Times: The Doctor Can See You Now. Really, Right Now.
Often the worst part of a visit to the doctor isn't the awkward hospital gown, needle sticks or embarrassing physical exams -; it's the drawn-out wait, camped out in the reception room in the company of sick patients and old magazines. During a particularly long wait to see his dermatologist, Parker Oks, 18, thought there had to be a better way. ... That realization led Mr. Oks to create Appointment Status, a Web site devoted to improving appointment efficiency and providing patients with information to avoid long waits. ... It's one of several innovations meant to help patients. While many digital developments -; electronic medical records and mobile medical encyclopedias -; have streamlined doctors' work, new tools for patients are starting to hit cellphones and the Internet offering help in keeping track of medications, recording heart rate and glucose levels and managing personal and family medical history, among other tasks (Karen Borrow, 10/15).

Wired Magazine: Empowering Patients Through Design
Michael Graves lost his ability to walk in 2003 when a sinus infection infiltrated his nervous system, impairing his spinal cord. As he learned to navigate the world from his wheelchair, Graves noticed that places meant to empower patients, like rehab centers and hospitals, weren't. He felt powerless in rehab when he couldn't reach the faucet to brush his teeth or the outlet to plug in his shaver. Everything about the room was designed for people who could stand. Since then, the award-winning architect has been on a mission to revamp hospital furnishings and living spaces so they fit the patients, families and medical staff who use them. "I decided that since I was a designer, and architect and a patient, I have the credentials to do this," Graves said. ... Although a patient-centered approach might seem obvious, "very few people have stopped to think what effect the built environment is having," John Kouletsis, chief architect of the Kaiser Permanente Health Care Innovation Center in Oakland, California, told Wired in an interview last week (Daniela Hernandez, 10/15).

The Atlantic: Keeping the 'Mentally Incompetent' From Voting
Roberta Blomster, 37, lives in a suburb with her parents and sister outside of St. Paul, MN, where she interns with Congressman Keith Ellison's campaign and testifies at her state capital on behalf of people with disabilities. During her free time she knits and spends time with her family and their two dogs. Doctors have diagnosed her with mild mental retardation and epilepsy, and she is under limited guardianship, meaning that her mother manages her health and financial decisions. The decision about whether to vote, however, is hers alone -- a reality that might be different if she lived in another state. She gets her news from the local paper, television and social media. "It feels wonderful knowing that I'm able to make informed decisions about who I'm voting for," she says. "It's a very satisfying feeling knowing that you're making a difference." About 30 states and the District of Columbia have laws in their constitutions that can limit people with mental disabilities from voting if they have been ruled "mentally incapacitated," or incompetent, by a court. ... People with mental disabilities or patients who are receiving psychiatric treatment do not automatically lose their eligibility to vote in any state (Kimberly Leonard, 10/17).