Nikhil Barot: Research and Contributions to UCLA and Beyond
Nikhil Barot is an Assistant Clinical Professor of Medicine at the University of California, Los Angeles (UCLA), and a physician at Olive View-UCLA Medical Center. His work spans clinical practice, research, and education, contributing to advancements in patient care, medical knowledge, and the training of future physicians.
Clinical Practice and Patient Care
Dr. Barot's involvement in direct patient care is evident through his work at Olive View-UCLA Medical Center. The Ambulatory Medicine curriculum, a longitudinal, progressive educational program across the three-year residency, benefits from his expertise. His contributions extend to addressing contemporary health challenges, such as the opioid crisis. The Bridge Clinic, designed for patients with opioid use disorder, offers a chance for follow-up with a provider to prescribe medication-assisted therapy in order to manage opioid dependence.
Dr. Barot likely played a role in managing patients during public health emergencies. For example, during the early stages of the COVID-19 pandemic, L.A. County Department of Public Health (DPH) declared a local public health emergency with six new cases in the county. The State of California also declared a state of emergency with the first related death in the state. Updated PPE recommendations from CDC and DPH were issued.
He is also dedicated to addressing the needs of vulnerable patient populations, including unrepresented patients. A retrospective review of deidentified bioethics logs over a 2-year period was conducted after the implementation of an Unrepresented Patient Committee policy. There was a substantial increase in unrepresented consult requests from an average of 2 requests per year before 2015 to 23 requests in 2015 and 20 requests in 2016. The committee meetings were convened on average within 4.8 days of a consult request in 2015 and within 5.8 days in 2016.
Research Contributions
Dr. Barot's research interests are broad, encompassing various aspects of internal medicine and related fields. His research contributions include:
Read also: UCLA vs. Illinois: Basketball History
- Pulmonary Hypertension: Kahn M, Seo JY, Kyung SR, Barot N. Bosutinib-induced pulmonary arterial hypertension in a patient with chronic myelogenous leukemia. Abstract published in: American Journal of Respiratory and Critical Care Medicine. 2020;201:A3775. Poster presentation & abstract published in: American Thoracic Society International Conference 2020; Philadelphia, PA; May 2020. DOI: 10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a3775
- COVID-19 Related Research: Wong JI, Sadek R, Mehrabani A, Koppula A, Soverow J. Echocardiographic Characteristics, Cardiovascular Factors, And Disease-directed Therapy Do Not Explain Differences In Covid-19 Related Hispanic Outcomes. American Heart Association Scientific Sessions 2021. Virtual.
- Silicosis: Loui H, Nguyen J.H., Fazio J.C., Kamangar N., and N. Barot. Silicosis: A Rare Cause of Endobronchial Lesions (abstract). Am J Respir Crit Care Med 2024;209:A5984.
- Teaching Skills: Kahn M, Suthar L. How to Teach the Teacher: Using Lesson Plans to Build Residents’ Teaching Skills, Workshop Presentation at Alliance for Academic Internal Medicine, Denver, CO, October 2019. National.
These publications and presentations demonstrate Dr. Barot's active engagement in research and his commitment to advancing medical knowledge.
Medical Decision-Making and Patient Autonomy
One of Dr. Barot's articles, originally published on Cancer Focus in May 2017, delves into the complexities of informed consent and shared decision-making in medicine. The article reflects on the evolution of the doctor-patient relationship, moving from a paternalistic model to one of informed consent and, more recently, shared decision-making.
The Evolution of Informed Consent
The article begins by recounting a personal anecdote about the author's grandfather, Bapu, who underwent coronary artery bypass graft surgery in the early 1980s. The author reflects on how different the medical landscape was at that time, noting that doctors were less likely to engage patients in detailed discussions about their conditions and treatment options.
The author then discusses the landmark court case of Salgo v Stanford in 1957, which marked a turning point in the legal recognition of patients' rights to be informed about their medical care. The court ruled that Mr. Salgo was not properly informed of the risks of the procedure and therefore was justified in holding his doctors responsible for the outcome.
The Limits of Informed Consent
The author argues that informed consent, while essential, has its limits. It isn’t always ideal to treat the patient as a consumer in the decision-making process. The author cites a paper by Cathy Charles and colleagues, who argued that the informed consent model can leave the physician outside the decision-making process, limiting their role to one of information transfer.
Read also: Navigating Tech Breadth at UCLA
Shared Decision-Making and Libertarian Paternalism
The author advocates for a shared decision-making model, which seeks to balance the perspectives of both the patient and the physician. Even this model has its costs. In a 2006 study vetting it, titled “What Is the Impact of Shared Decision Making on Treatment and Outcomes for Older Women With Breast Cancer?”, Jeanne Mandelblatt and colleagues note that, in the context of breast cancer treatment, patients who more or less made decisions with their doctors (as measured by their scaled responses to statements like, “My surgeon asked me about my worries about breast cancer”) were more likely to receive recommended adjuvant (secondary to initial) treatment, and to have greater short-term satisfaction. However, they also reported that their breast cancer was more burdensome.
The author also explores the concept of libertarian paternalism, introduced by Richard Thaler and Cass Sunstein, which suggests that it is acceptable for healthcare providers to "nudge" patients toward decisions that are in their best interest, while still respecting their freedom of choice. For example, take the policy of “presumed consent.” There is a several-fold higher chance that people will donate their organs when they die if they are automatically opted-in to this choice. They still retain the freedom to opt-out of donating, but the architecture of the choice is altered to favor the greater public good.
Balancing Paternalism and Autonomy
The author concludes by sharing a personal experience of "nudging" an elderly patient with a lung mass against a biopsy, believing it was the safest option for her. The author acknowledges the potential for manipulation but argues that it is sometimes necessary to guide patients toward a safer harbor, while still honoring their autonomy.
Educational Contributions
As an Assistant Clinical Professor of Medicine at UCLA, Dr. Barot is actively involved in medical education. The Ambulatory Medicine curriculum is a longitudinal, progressive educational program across the three-year residency. He likely contributes to the training of medical students, residents, and fellows, sharing his knowledge and expertise to shape the next generation of physicians.
Read also: Understanding UCLA Counselors
tags: #nikhil #barot #ucla #research
