By Ana Santos-Carvalho and Carolina Lebre, edited by Andrew S. Cale Excessive use of technical jargon can be a significant barrier to…
Patient input is critical to the advancement of patient care. In this post graduate student Michael Liesen showcases Dr. Paul Musey’s research which focuses on improving mental health interventions in the ER. This post was written in partnership with Dr. Krista Longtin’s advance science and research communication writing course at IUPUI. –JAS
“The only way out is through, and the only way through is together.” This quote, which is adapted from Robert Frost’s Servant of Servants, is likely one you may have read or heard, and if you email Dr. Paul Musey you will see it at the bottom of his email. Dr. Musey is an emergency medicine clinician and ER doctor practicing medicine and conducting clinical research at Indiana University School of Medicine. The original quote from Robert Frost is “The best way out is always through.” Dr. Musey uses an expanded adaption of this quote that claims the only way through is together. Dr. Musey’s research is a partnership, whether it is with the mentor who helped him start, his colleagues who help him conduct the research or even with the patients he is treating. These partnerships make it very clear that together is Dr. Musey’s way through.
Dr. Musey was born and raised in Atlanta, Georgia. He attended Atlanta institutions Georgia State University for his undergraduate education and Emory University for medical school. So how was it that this lifelong Braves and Falcons fan found himself in Indianapolis, a city he had only previously “flew over to get to Chicago”? Dr. Musey came to learn and conduct research. He was paired up with his research mentor, Dr. Aaron Carroll. Through this mentorship, Dr. Musey spent time talking to both child patients and their parents. He learned from these conversations how to design research projects for outcomes centered on the patients.
Dr. Musey said this was the first time he had ever asked the patients for their input and how to make it better for them. “It was something very novel to me… and something I didn’t shy away from in my future research.”
Dr. Musey uses these skills when conducting research in his current area of interest; psychological contributors to common complaints in the ER. These “contributors” are things like anxiety and depression and the common complaint is most often chest pain. These contributors go undiagnosed many times, and this leads to a cycle of patients coming back to the ER and leaving without getting what they needed. Dr. Musey’s research hopes to change this outcome and find ways for healthcare providers to recognize and reach these patients.
This phenomenon is something I witnessed as an EMT. These patients were often known as frequent flyers, and many EMTs thought this was a waste of resources because there was not a physical reason for the symptoms. This attitude and the general social stigma on mental health is what Dr. Musey is up against.
Of course, this is only one aspect of the many challenges faced doing mental health research. In the ER, the doctor often has a one-time interaction with the patient. Getting patients to commit to something that requires follow-ups is more difficult in the ER than research involving chronic diseases that require regular visits. Another challenge is that many folks do not understand that things going on in your head can have a physical effect on your health. Even if they do understand, people do not want to talk about these kinds of problems due to the stigma on mental health. This leads to issues not only for people getting the care they need but also makes it difficult for Dr. Musey and his staff to enroll them in a study. Dr. Musey said that the group that they have the hardest time reaching is black males. He suspects there are many reasons why this is the case including social stigma on mental health and a lack of communication about mental health in many communities.
So how does one face these challenges and reach all communities? The answer is together. While Dr. Musey was finishing up his project with Dr. Carroll he met Dr. Jill Connors, a faculty member in the Department of Surgery. She was looking for a project and had a background in patient engagement. Leading up to the start of the project they had monthly meetings with a focus group of patients in a conference room of the faculty office building.
These patient partners would contribute their perspective and knowledge. The patients were also asked to answer the question “How do we do better?”
These patient discussions won the Patient-Center Outcomes Research Institute (PCORI) Award. Dr. Musey relies on Dr. Connors to manage much of the engagement with the patient partners. He even says, “Had I not relied on her expertise, and her tenacity, at creating relationships and fostering them, my research would not be where it is now.”
Another way to reach people and groups who haven’t been heard yet was a decline survey. This idea was simply used to ask patients why they do not want to participate. Dr. Musey and Dr. Connors wanted to take the information gathered from this survey to their patient partners and come up with new approaches and new ways to reach people. This survey has faced challenges on a few different levels. Some patients are not interested in any part of participation including filling out a survey. Another group of patients, in an attempt to be polite, never give the staff a firm participation answer, neither declining nor agreeing. Both of these groups aren’t being heard, unfortunately.
The necessity and effectiveness of this partnership approach with patients can be seen in The Story of “Mary”. Dr. Musey said that Mary had been going to the ER with chest pain but repeatedly was told nothing is wrong. This led Mary to continue to come into the ER with chest pain. It wasn’t until an ER doctor sat down with her and told her that this chest pain might be due to the anxiety she was feeling that it clicked. Dr. Musey went on to say that doctor was able to connect Mary to proper resources.
Mary’s story and countless other stories are why Dr. Musey believes a new approach is needed for patients in the ER. He hopes to come up with objective mental health screening methods and to connect patients with proper services in the ER. Dr. Musey hopes objective methods can help fight the stigma against mental health and encourage people to get help for a condition that affects every aspect of their life. In the end, Dr. Musey has shown the only way to continue this fight through will be together with mentors, colleagues, and patients.
Edited by Jennifer Shutter, Indiana University School of Medicine.