By Dan Meyers | University Communications
There was this patient who relied on several HIV medications, Matt Wynia, MD, recalls. For a few months, too low on cash to afford co-pays of a few hundred dollars, she skipped the meds. Soon, she was hospitalized with AIDS-related pneumonia. The stay likely cost $50,000 or more, Wynia figures.
There are reasons to consider charging patients a drug co-pay, Wynia says, including giving patients some “skin in the game” around health care spending decision. But “this was medically and ethically wrong, and it was a terrible business decision, to charge her for meds that were keeping her out of the hospital.”
And there, in one quick example, is Wynia’s world – health care, policy and ethics.
Wynia now is diving deeper into that realm as the new director of the University of Colorado Center of Bioethics and Humanities. The center represents the commitment of the Anschutz Medical Campus to the human side of health care.
“You can’t disentangle the practice of medicine from human nature or the experience of getting sick or being well, doing well or doing poorly,” Wynia says. “Health humanities and bioethics are often about the experience of being a health professional or an ill person, about the experience of living in a community grappling with health issues.”
Wynia is bursting with questions: “How do you manage the care of people who need dialysis who are here illegally? How should we handle new cancer drugs that provide small marginal benefits but that are extremely expensive?”
Now he’s leading a center designed to pose and grapple with such questions.
Wynia, who began his Colorado job in April, will spend 40 percent of his time at CU until fully transitioning in summer of 2015, after one of his children graduates high school. Until then he’ll continue as director of patient and physician engagement at the American Medical Association in Chicago, where he is also a clinical assistant professor of medicine at the University of Chicago.
The bioethics center reports to Richard Krugman, MD, in his role as vice chancellor for health affairs for CU Denver | Anschutz Medical Campus.
“This center builds a bridge between the science of medicine and the lives of our patients,” Krugman says. “As teachers, researchers and clinicians, we are constantly focused on providing the best service to those in our care. This center will address ethics, integrity and professionalism to help improve the quality of care we provide.”
A specialist in infectious diseases, particularly AIDS, Wynia developed his interest in the intersection of medicine and ethics when he was an undergraduate at the University of Oregon. His majors were biology and philosophy. He was aiming for medical school. It’s not hard to see this one coming.
“For my undergraduate degree, I had to write a thesis,” Wynia recalls. “I started reading about bioethics and ended up writing about the topic of paternalism in medicine. Ever since, I've been fascinated by trying to understand the unique relationships between health professionals and the patients and communities we serve.”
Wynia says he’ll spend his first months in the CU job listening and learning, “creating a foundation” to build on. He’ll be looking at ways to engage not just the Anschutz campus but the broader community in discussions and presentations, a point he made in a recent interview on Colorado Public Radio.
Health care, meanwhile, is creating increasing need for that type of discourse.
- Providers are under pressure to both contain costs and demonstrate greater effectiveness, by reducing hospital readmissions, for example.
- CU is launching into the realm of personalized medicine. Peering into patients’ genetic make-up leads to both precision care and huge questions about privacy and how to responsibly handle the knowledge and data that will be available.
- Many health issues connect with broader forces such as economics, community and politics. Wynia cites obesity: “Whether you have a grocery store in your neighborhood matters, whether it’s safe to get out and exercise matters, advertisements in the community matter – and probably all of these matter more than traditional medical interventions to address obesity.”
“The issues at play are no longer just the types of issues that can be resolved with purely technical knowledge,” Wynia says. “They require weighing values, assessing priorities, and making decisions where there might not be one right answer for everyone.”
Then there’s the other part of the center’s title – “humanities.”
Wynia, the physician/philosopher, now oversees an art gallery and a forum in the Fulginiti Pavilion. All part of the mission, he says:
“Literature, art, music, film – all are ways of connecting with the experience of being in the health care environment. All convey the type of knowledge and understanding you can’t necessarily get from a textbook.”
Measuring success in this realm of health care education might seem challenging but Wynia is determined to do it.
“For the next year, which is a transition year for me, success will be the development of a clear shared vision for the work of the center and how it fits into the University and the larger community,” he says. “I'll be working closely with the deans of the schools, the center's Community Advisory Board, the core faculty and staff and other stakeholders, to make a plan for growth that makes sense to everyone.
“Part of that plan will include specific goals and metrics. I'm a big believer in measurement, even when what you are trying to measure might seem nebulous. For example, much of my research has focused on figuring out how to measure the ethical climate of health care organizations.”