Listen to Who's My Doctor on NPR's TED Radio Hour

Since my TEDMED talk on the importance of transparency in medicine was featured on TED.com last month, I have had an overwhelming number of responses. The majority were very positive. Hundreds of people encouraged us to keep going, and a lot wanted to know how they could participate: as transparent doctors and as patients. 

Many asked about how they could find a transparent doctor in their area. Our website is not robust enough for a geographical search function, and it contains a small fraction of the doctors who have signed the Total Transparency Manifesto. We are open to working with nonprofits and developers on improving Who’s My Doctor to make it more user-friendly.

In the meantime, Who’s My Doctor is fortunate to have captured the attention of someone who I’ve secretly admired for a long time: NPR radio host Guy Raz. You may have heard of Guy’s work as host of All Things Considered. Since March 2014, he has been the host of NPR’s TED Radio Hour. As a TED nerd and NPR faithful, I download these excellent podcasts every week. Some of my recent favorites have been the Source of Creativity featuring (among others) Sting and Overcoming.

I had the privilege of meeting Guy at TEDMED; he is as energetic and charismatic in person as he is on air. I was flattered when he invited me to be interviewed on TED Radio hour—but quite astounded and not a little bit embarrassed when he revealed that the topic of this session was “courage”. The other people interviewed in this episode are war journalist Janine Di Giovanni, human rights litigator Kimberley Motley, former CEO Margaret Heffernan.

TED Radio Hour: Courage

What we’ve done in Who’s My Doctor is important, but hardly courageous! Having been a patient and caregiver, I know how frightening it is to be in the position of extreme vulnerable, when you or a loved one are ill. Dealing with these stressful situations is what takes real courage; Who’s My Doctor is our attempt to level the playing field.

Whatever your thoughts are on transparency in medicine, I hope you will listen to Guy’s masterful interview, where he created a narrative out of my story and the stories of Janine, Kimberley, and Margaret. I look forward to your comments.

Life in an Urban ER

I wrote a piece for NPR about the patients we see in an urban ER, and how every day is a reminder that health doesn't exist in a vacuum.

 

Even in the time-limited setting of the ER, it's important for providers to understand where our patients live, work and play. It's these conversations that allow us to diagnose and treat the real causes of our patients' ills.

 

Why the ER Doctor Asks Patients What's Happening At Home

Thanks to everyone for reading, and in particular to the many people who pointed out the critical necessity of teamwork--with nurses, physician assistants, technicians, nurse practictioners, case managers, students, social workers, and many more. 

 

Indeed, it takes an entire team to provide true care. As people have commented on NPR's Facebook site, we in the ER rely on social workers--many of whom are overworked yet try so hard to help our patients. Whenever we as docs and nurses refer patients to social workers, they are always fantastic about helping us. It's critical for us frontline providers who see patients first to ask the tough questions and look beyond the "chief complaint" in order to know to involve the other members of our team.

 

I have been fortunate over the course of my training and career to learn from and work with many incredibly caring, highly compassionate, and superbly competent providers. It's also the community leaders and neighborhood organizations who provide care outside the walls of our institution, who are critical to the health of people. 

 

On this Thanksgiving weekend, I give them, and all of you, my unending gratitude and deep respect. Thank you.

Who’s My Doctor on TED.com!

I am thrilled that TED has picked up on Who’s My Doctor and our efforts to improve transparency in medicine. 

Click here for link to TED talk 

TED prohibits “selling from the stage” and apparently my call to action at the end was too much of a “sell”. Here is the intended conclusion of my original TEDMED talk.

"Radical transparency won’t be easy. There will be many critics, some who have ulterior motives and have something to hide, and others who are just scared of changing the status quo. But if it’s anywhere we can unlock our imaginations, any place where we dare to speak up, with anyone who can make the impossible a reality, it’s here at TEDMED, with all of you.

I call upon everyone here—anyone who will ever be a patient or family member of a patient—to sign the total transparency manifesto. I call upon doctors, nurses, physical therapists, nutritionists, and all healthcare providers to take off our white coats and show our patients who we are. 

I’m taking the leap. This, today, is my pledge. Will you join me?"

The talk is here. I'd love to hear what you think.

On Caring for the Neglected 20%: People With Disabilities

In last month’s Health Affairs, I wrote a personal perspective about unequal treatment for patients with disabilities. Nearly 20% of the population in the U.S. have a disability; yet, teaching about care for people with disabilities is not a mandated part of the medical curriculum.

This is a deeply personal issue to me. As someone who grew up with a speech impediment, I am acutely aware of the prejudices and disparities that result from lack of knowledge.

I’m grateful to Health Affairs for publishing this article and producing the associated podcast. This has been nearly10 years in the making—thanks to my mentors and colleagues Dr. Fitzhugh Mullan and Dr. Audrey Young, among others, for encouraging me to write about my experiences. 

And I will be forever indebted to Professor Vivian Sisskin: a friend, mentor, supporter, cheerleader, and best speech therapist ever. This essay is dedicated to all those who are fighting to ensure equitable and accessible healthcare.

Link to Health Affairs article:

Condensed version in the Washington Post:

A Month of Conferences & Inspiration

My blog entries have been light over the last month in large part because of significant travel. In between clinical shifts in the ED and co-leading a fantastic cohort of GWU’s Residency Fellowship in Health Policy, I was fortunate to be invited to speak at several conferences in October. Here are some highlights:

In early October, I was honored to keynote the Centra Health Foundation annual gala in Lynchburg, VA to celebrate the work of several hundred volunteers, all of whom were either breast cancer survivors or family members of survivors. The event was moving and powerful; I thought of how proud my mother would be to hear me share her story with so many courageous and inspiring women.

Next was the 12^th Annual UC Davis Pre-Health Professions Conference in Davis, CA. Ten years ago, when I was the national president of the American Medical Student Association, I was approached by a student from a community college named Joubin Afshar who told me that he had started a conference for community college students who wanted information about the health professions. I attended the conference then, and was blown away by the drive and passion of these students. Nearly all were first generation college students, and for many, this was their first and only exposure to medical professionals.

Having been such a student myself, I vowed to return whenever possible. Last year and this year, I gave a keynote and led four workshops on leadership in medicine. Nearly 8,000 students attended the conference—many took overnight buses across California and even from the East Coast. It’s remarkable to see the work done by a small group of committed students. I wonder how many health professionals are where they are now because of the work of Joubin and his colleagues. (I also had the opportunity to see a friend and colleague, Dr. Davis Liu: an exceptional leader, thinker, and physician.)

My former Rhodes colleague who is now Chief Resident at Einstein Hospital in Philadelphia, Dr. Gary Huang, invited me to give Grand Rounds to the Departments of Internal Medicine and Emergency Medicine (pictured here with fellow Chief Resident and very kind physician Dr. Carlos Davila). I received many questions on what physician trainees can do to avoid burnout and deliver true patient-centered care. 

No answer I gave could have been as telling as the actions of Dr. Huang. As we were coming down the elevator, a woman in her fifties stopped us to ask directions to a particular surgeon’s office. I watched as Gary helped her figure out the name of the surgeon, led her to identify his location, then navigate her there. So many other people would have simply said, “I don’t know” and implied that it’s not their job to know, but not Gary. He took the time to help this woman in need, going far out of his way to do so. He didn’t do it to impress her or me (and I suspect he and his equally humble and caring wife Sherry would both be embarrassed by this blog post), but because it was the right thing to do. This action speaks volumes about the type of doctor he is, and answers the question that the residents asked: there may be many factors that make us disconnected from our patients, but it is within our abilities to treat patients as people, to value each person’s humanity, and to exemplify basic dignity and respect.

At the Urgent Matters Conference during the American College of Emergency Physicians meeting in Chicago, Dr. Jesse Pines expanded upon these themes. The other presenters (including my former attending at Brigham and now MGH Vice Chair, Dr. Ali Raja) and I spoke about how patient-centeredness and better communication can reduce overtreatment, improve patient safety, and transform care. The response was much better than expected, in no little part due to the amazing tweeting capabilities of one Dr. Seth Trueger (aka @MDAware).

Then it was on to Nijmegen, the Netherlands, where Corine Jansen (pictured), Jennie Grau, and their team organized the first-ever listening conference in healthcare. Initially, when my husband heard that I was speaking at listening conference, he laughed—isn’t it an oxymoron? And I have to say that I didn’t initially understand what a listening conference was really about (though the International Listening Association has a long history of hosting these conferences, and cosponsored this one).

The moment I showed up, though, I got it. Patients, family members, doctors, nurses—they shared their stories. They were powerful and unforgettable; indeed, as one participant commented, “the shortest distance between people is a story.” I heard a doctor speak about how he and his fellow neurologists assumed that their patients with Parkinson’s disease cared most about memory and managing their tremors. But when they listened—really listened—to their patients, they heard that what mattered most to them was sleep and sex. So they changed the entire medical encounter so that it wasn’t just about medication management, but also hired a sex and sleep therapist. Corine, Jennie, your team at REShape (where I took the photo with the best message ever): hats off to you for a fantastic conference and to the tremendous individuals I had the pleasure of meeting there.

This week, it is off to Grantmakers in Health Conference in DC then American Cancer Society in San Jose, CA. I hope to contribute more substantive blog posts soon; please write if there are particular topics you would like to see.

More on OpenNotes & Surprising Results of What Doctors Think

Recently, I wrote on NPR’s Shots Blog about the movement towards open medical records and the pioneering work of OpenNotes by Dr. Tom Delbanco and Jan Walker. Here’s an excellent RWJF podcast about why they decided getting health care providers to share their notes with patients, and where their work is headed next. 

Here’s a hint: what if the 3 million patients who now have access to their clinician’s notes could co-write notes with their providers?

I'll add another thought: what if we go beyond written medical records, and patients wish to have audio- or video-tapes of their doctors' visits?

Patient advocates have responded very positively to the OpenNotes concept. I was curious about what doctors think of it and other movements to transparency. Emily Peters from Doximity was kind enough to help me with an informal poll of Doximity users (doctors who register to be on their site). We asked 3 questions and asked doctors to use a 1-5 scale, 1 being not at all likely to 5 being very likely. We received 113 responses:

(Please note that I have no financial with Doximity, and this poll is not meant to be a scientific study.)

I’d love to know what you think about this. Do the data surprise you? What do you think about open medical records, and patient-initiated requests to audiotape/videotape their medical encounters?

Innovations in “Upstream” Care

My last blog was on how today’s medical system fails by not addressing the real needs of our patients and their communities. Here, I highlight three projects that take such an “upstream” approach to healthcare:

Doctors can give prescriptions for medications, but why not a prescription for healthy foods and safer housing? Health Leads employs young people (usually college graduates interested in careers in health) to be advocates who assist doctors in clinics and ERs in connecting patients with community resources. They help with everything from food assistance to job training to legal counseling. They help to “fill” the other prescriptions that people need to achieve better health.

Recognizing that black males have significant health disparities and that outreach and education must start in the community, Project Brotherhood was conceived from a simple idea: give patients free haircuts, and use barber shops as a place to screen and counsel on illnesses such as high blood pressure and STI prevention. Its model of multidisciplinary, culturally competent care incorporates other aspects of social support, including on fatherhood and job support.

 The New York Times just published a story about an “EMS Corps” in East Oakland that specifically recruits at-risk youth and train them to be emergency medical technicians. They provide mentorship for young men who come from backgrounds of poverty and violence, and train them to become professionals who will serve their communities. As the story cites, these men are taught that they aren’t the problem—they are the solution.

These are only some of the some of the many innovations occurring around the country. We need far more interventions that go beyond “band aid” care. In the words of public health doctor Rishi Manchanda (whose recent TED talk I highly recommend), we must change our entire approach to healthcare, away from simply treating the effects of illnesses to targeting interventions to where people live, work, and play—where health really begins.

Guest: Narrative Medicine & Inside Stories

I am delighted to host a guest blog by writer and narrative medicine specialist Annie Robinson, who describes her journey with storytelling.

On a warm June afternoon, clustered around picnic tables, cradled in the mountains of the Berkshires in western Massachusetts, eight medical students from around the world began telling one another their stories. They were among approximately 40 students invited to participate in a weeklong intensive program run by AMSA for medical students interested in integrative medicine called LEAPS. As a graduate student of Narrative Medicine at Columbia University, I was asked to help facilitate the program.

Over iced tea and dark chocolate, they spoke of heartbreak and grief and divorce, of exam-stress and isolation and fear. They also shared brilliant visions of innovative approaches to medical care, and their aspirations to foster intimate relationships with their fellow medical students, their families and friends, and their patients. I listened with rapt attention as they described how, from personal struggles, conviction and vision were born for their careers as caregivers. I shivered, on that muggy summer day, knowing I was in the presence of my tribe. 

I was raised to revere the power of storytelling, which has been a critical component in how I have navigated my way through the world. It proved particularly useful when I entered the healthcare system in my early adolescence. I have spent over half of my life now as a patient, grappling with illnesses and issues of embodiment. In large part, it has been by speaking my struggles aloud that I have been able to heal. Telling my stories has allowed me to harness the power of the dark times to create connections and attain insight. 

As I sat there at LEAPS, witnessing medical students experiencing what I myself had experienced time and again–that relationships and wisdom come from baring one’s soul – I began to envision a way to enable more students to engage in this powerful narrative process. The seeds for my oral narratives podcast project Inside Stories: Medical Student Experiences were planted. I wanted to hear more student stories about the path to medicine, about struggles and triumphs, roadblocks and dreams. Through sharing over the course of that week, the students gained clarity and catharsis, and many remain in touch to this day. 

Inside Stories emerged from those conversations with LEAPS students. The idea was to develop a podcast platform that would enable medical students anywhere to both voice and listen to stories about medical student experience. Inside Stories’ mission is “to provide a means of personal healing, self-realization and empowerment through the sharing and receiving of personal stories, as well as to cultivate community among students in the often isolating medical school environment.” The interview process involves recording stories from current medical students, remotely or in-person. Recruitment has been done via word-of-mouth, social media platforms, and at medical humanities conferences. Student participants comprise a diverse demographic of men and women from all four years of medical school, of various races and nationalities, interested in medical fields ranging from OB/GYN to pediatrics to gastroenterology and many more. 

The topics addressed are vast. Hannah spoke about the challenges of navigating in medical school while being a mother. Petra reflected on how her spiritual path informs the challenges being a medical student. Katie discussed the encouragement she gained from finding her mentor. Leah shared how writing poetry aided her personal healing. Samar described how self-care practices helped her get through school. Angie talked about how her Syrian heritage drove her motivation to become a physician. Hieu shared his experiences as a community health worker in Uganda propelled his motivation to combat structural violence. Carlton described his motivation to pursue medicine in the South, to offer the African-American community a provider with whom they can identify.

    

To date, over 40 students have participated in the project. One participant reflected: “At first I was intimidated at the prospect of sharing my deepest feelings to a public audience, especially because I had never verbalized these feelings and in general I am a very private person. Ultimately, I'm glad I committed myself to this project and am proud to have my message out in the open.” Another described how sharing felt validating: “It made it seem real - everything that I had been through.”

I hope that by listening to the accounts of the courageous, insightful students whose stories constitute this project, others will follow suit and be inspired to share the personal stories at the heart of their journeys through the world of medicine.

If you or someone you know might be interested in telling their story about their experience in medical school, or if you have further questions about Inside Stories, please contact Annie and visit this website and on Twitter @Inside_Stories.

Should Patients Have Total Access to Their Medical Records?

The law says yes. Prior to 1996, patients had to sue to see their own records. Since HIPAA—the Health Insurance Portability and Accountability Act—patients are guaranteed by law to have access to their records. However, the process for getting medical records is often so cumbersome that people don’t look at them, and usually not well after their medical visit.

In my medical training, I learned that the medical record is a tool for doctors to communicate with each other. But could it be harnessed as a collaborative tool for patients?

When Patients Read What Their Doctors Write

My latest NPR article discusses ongoing national experiments to provide open access to patients not only of their test results, but also their doctor’s notes. Participating doctors were initially opposed to the concept, but the results from the experiment have been striking:

·      80% of patients who saw their records reported better understanding of their medical condition and said they were in better control of their health;

·      Two-thirds reported that they were better at sticking with their prescriptions;

·      99% percent of the patients wanted OpenNotes to continue

When patients see their records, there's more trust and more accuracy. But that doesn’t mean that OpenNotes is a panacea. There are new controversies that are arising. I address them in this article, and also on Weekend Edition. Listen here for the interview with legendary journalist Linda Wertheimer.

What do you think? Should patients have full access to what their doctors write about them?

Open Payments: Will Transparency Hurt Or Help Patients?

Today, I was interviewed on CBS This Morning about whether the government’s Open Payments website should be delayed. This is part of the Physician Payment Sunshine Act that will provide public access to payments made to physicians by pharmaceutical and medical device companies.

Over the years, I have become increasingly concerned about the harmful effects of financial conflicts of interest on patient care. Dozens of studies have shown that financial relationships between doctors and drug/medical device companies influence physician prescription practices.

My research on patient-centered care also shows that patients are concerned about these potential conflicts of interest and how they may affect their care. Our patients deserve to know how their doctors are paid and whether this may affect them. The Sunshine Act will provide much-needed, critical tools for increasing transparency and accountability, and will help exert pressure to prevent inappropriate financial relationships between doctors and industry in the future.

The Open Payments website that will display the payments to doctors has already been delayed by more than a year. Now, in light of some technical problems, physician groups including the American Medical Association are arguing that there should be another six-month waiting period. While it is important to provide doctors an opportunity to review and dispute payments to them, this should not delay timely release of physician payments data to the public.

The American Medical Association argues that inaccurate information could undermine trust. If physicians want to improve trust, they can take a proactive approach and begin conversations with patients. They can send out an email or letter clarifying their affiliations with drug companies. They can participate in Who’s My Doctor and explain their philosophy publicly, online. They can have one-on-one conversations with those who have questions. Such openness will only improve the doctor-patient relationship, improve trust, and increase accountability.

For those doctors who truly are ashamed of their payment history, perhaps they can reevaluate their financial relationships. As former Supreme Court Justice William O. Douglas said, “Sunlight is the best disinfectant.” The sunlight is available now. Physicians and patients alike should embrace it, now.

Parts of this post were part of an open letter I sent to Ms. Marilyn Tavenner, CMS administrator, on May 27^th 2014 with the subject of “Revision of a currently approved collection; Title of Information Collection: Registration, Attestation, Dispute & Resolution, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495).”

Going Beyond “Band Aid” Care

When I was a medical student, I worked with an NGO in Rwanda to provide medical care to women with HIV. Nearly all had witnessed their family members murdered during the genocide, and many became afflicted with HIV as a result of rape. Our initial focus was on getting antiretroviral therapy to these women, but we quickly realized that while it was important for them to have access to medications, they couldn’t be healthy unless they also had enough food to eat. They couldn’t stay safe unless they had shelter. They couldn’t be well unless we addressed their psychological trauma.

As an emergency physician working in inner city ERs in St. Louis, Boston, and D.C., I see this same problem every day. My 8-year old patient, Kami, comes in wheezing and short of breath. She has asthma, and two years ago, she lost her inhaler. She and two brothers are staying with her mother’s cousin; lots of people smoke in the house; and she’s missed several days of school. I can give her a breathing treatment and prescribe an inhaler, but how do I help her achieve good health?

Over the last year, I’ve seen 19-year old Byron in the ER three times. The first time, he was stabbed on the arm. It was a superficial cut; he received some stitches. The second time, he got in a fight and broke his hand. I gave him a splint and sent him home. The third time, he was shot twice in the abdomen. I stabilized him and sent him to the operating room. I wonder when he will be back for another violent injury. Is there a better way to help him than to patch him up, piece by piece?

Then there’s Josephine, a 38-year old single mother of four. She was told four years ago that she has cervical cancer. Between her three part-time jobs and taking care of her children, she had no time to see a doctor. Her boss threatened to fire her if she left in the middle of the day. She tried to call a specialist, but they wouldn't take her insurance. By the time she comes to the ER, her cancer had spread to her intestines and her lung. We set her up for treatment, but what does it say about our society that her disease had to progress this far?

Our healthcare system is good at providing short-term fixes for problems. We pride ourselves in having the most advanced technologies in the world. We can provide this excellent care for the few hours the patient is with us in the ER, hospital, or clinic—but then the patient is on her own and back to the same problems, 24 hours a day, 365 days a year. Numerous studies have shown that it’s where we live, learn, work, and play that have a far greater impact on our well-being than the treatment delivered in a hospital.

I chose to be an emergency physician because I want to provide excellent care to everyone, regardless of ability to pay. We in the ER provide a necessary service, but it’s far from being sufficient. We need comprehensive strategies that promote health and target problems “upstream”. We need to recognize that health does not exist in a vacuum, that it is intimately tied to issues such as literacy, employment, transportation, crime, and poverty. An MRI here, a prescription there—these are Band-Aids, not lasting solutions. Our communities need innovative approaches to pressing issues like homelessness, drug addiction, obesity, and lack of mental health services.

The sage Dr. Patch Adams said that if we treat the disease, we lose; if we treat the patient, we win. To help the patient, we must also address the health of the community.

Over the next several blogs, I will be exploring interventions that show promise in addressing the needs of the patient and their community. I welcome your ideas and suggestions.

TEDMED!

This week, TEDMED announced its final speakers for the dual San Francisco-Washington, D.C. event. 

 

TEDMED 2014

I am excited and honored to be part of this list, along with a phenomenal group of healthcare leaders & entrepreneurs including Abraham Verghese, Thomas Goetz, Danielle Ofri, Betsy Nabel, and many more.

My talk will be on radical transparency in medicine. More to come soon--and please join us at the Kennedy Center in September!

Guest Post: In a Patient’s Death, My Life Found New Purpose

I am delighted to host this guest blog from Dr. Eric Bing, physician and professor of global health. We share a passion for fighting disparities in health, a passion is deeply rooted in personal experience, and that comes through in this poignant essay.

 

I was a Harvard-educated physician yet I couldn’t save a patient from an easily preventable disease. In her death, my life found new purpose.

Her name was Lorraine. She was abandoned when she was just six weeks old—left alone in a dark building on a cold winter’s morning. Wrapped in only a soiled blanket, she had nothing to soothe her cries. She might have died if not for those cries, for someone heard her and carried the tiny body to the infant’s grandmother. In Philadelphia in the 1930s, neighbors knew everything about each other, and the existence of this child was not a secret. Her grandmother took her in. She had already raised 15 children of her own, so what was one more? 

As a little girl, Lorraine grew up fast. Even with her sharp mind, like many black girls at that time, she had little money and even fewer opportunities. She slept in the crawl space under her grandmother’s stairs. When she was 12, Lorraine began working as a domestic servant, cleaning houses and caring for children not much younger than herself. She later dropped out of school, and while still a teenager began having babies of her own. 

She was so busy taking care of others that when she began having light, occasional vaginal bleeding, she ignored it.  She had already gone through menopause so this was nothing to worry about. But over time the light bleeding became heavy and the occasional occurrence became alarmingly frequent. After an anxious trip to the doctor, tests confirmed that she had cervical cancer, caused by the human papilloma virus she had acquired years earlier.

Lorraine’s life was once again in danger, but this time from an easily preventable disease.

Cervical cancer can be diagnosed in its earliest stages by a simple Pap smear. In developing countries where Pap smears are too expensive, it is being diagnosed using a few drops of vinegar or prevented in girls with a simple vaccination. And it can be treated at an early stage by freezing lesions off, like a wart. But in order for early care and treatment to work, you must not only have access to care, you must use it. And like many women, she did not do that; the needs of others always came first.

By the time her cancer was diagnosed, it had already spread throughout her pelvis. From there it would move to her liver, bones, and lungs before spreading to her brain and taking her life.

I cared for Lorraine until the day she died, however she had cared for me from the day I was born.

Lorraine was my mother. And her death from an easily preventable disease changed my life.

I was a psychiatrist in Los Angeles when my mother died in 1999. Today I am the senior fellow and founding director of global health at the George W. Bush Institute in Dallas and the founding director of the Center for Global Health Impact at Southern Methodist University.

At the Bush Institute, I helped launch, Pink Ribbon Red Ribbon, an innovative public private partnership to combat cervical and breast cancer in Africa and Latin America by increasing access to cancer prevention and treatment. In developing countries, where Pap smears are too expensive, cervical cancer can be diagnosed by putting a few drops of vinegar on the cervix, which is then examined under a lamp. Lesions appear white and can be treated at an early stage by freezing them off.

A recent study from India showed that this simple vinegar test that costs less than $1 can reduce deaths by nearly one-third. There are also inexpensive vaccines that can prevent the viral infection entirely. We can defeat cervical cancer now in simple, cost-effective ways.

The challenge is access.  In Pharmacy on a Bicycle:  Innovative Solutions for Global Health and Poverty, Rice University business professor Marc J. Epstein and I show how even access to care barriers can lowered in developing countries for many diseases, by shifting care to lower-cost providers, focusing on efficiencies, strengthening existing systems and by stimulating partnerships among governments, businesses, nonprofits, entrepreneurs and women of all ages. And, as my mother's death taught me, we must mobilize women to recognize their risk and realize that by protecting their health, they can live to protect the ones they love.

As my mother lay dying in her home in North Carolina, her house was once again full— with people who had been helped and touched by her over the decades. My mother had scoffed at the notion of filling a funeral home with flowers for the dead. "Give me my roses while I can smell them," she had said.  So people obeyed, coming to bid farewell while she could still hear them.

Despite the steady stream of people at her bedside, she fretted in her final days about what she saw as her lack of accomplishment and lasting impact: She was intelligent but uneducated. She was courageous yet lived in fear. She had done nothing with her life, she felt. She had not fulfilled her life's mission.

When she was finished reliving what she thought was a string of disappointments, I began to re-tell her life story—not as she understood it—but as I saw and experienced it as her youngest son.

I told her that I believed that her life's mission was to unleash passion and purpose in the lives of those she touched. Not only had she raised five children who went on to careers in business, education and medicine; she had applied her quick mind, hearty laugh and steel backbone to helping anyone she came across who was in need.

She taught us that love is what creates a family. She helped us see that a good heart must be coupled with hard work in order to succeed. Those that she had helped were now helping others, and they would in turn help others, and they, still others. Through others, her spirit would live on, continuing to change the world.

As we spoke, I could see a shift occurring within her as she sat there quietly. Softly, a warm smile filled her face, as though she was looking in the mirror and for the first time loved the woman she saw. 

My mother died in my arms, leaving the world far more peacefully than she entered it. In her death, my life found new purpose.

Eric G. Bing is the co-author of "Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty" and senior fellow of global health at the George W. Bush Institute. He is also a professor global health at Southern Methodist University and founding director of the Center for Global Health Impact.

A version of this article originally appeared in the LA Times, June 23, 2013, as A cancer that need not kill, by Eric G. Bing.  It is reprinted here with permission of the publisher.