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General MSPress Announcements

“More Than a Diagnostic Code” Dr. C. Garrison Fathman, 2015 Commencement Address of the Washington University School of Medicine in St. Louis

Screen Shot 2015-08-26 at 7.47.02 PMThis week, Dr. C. Garrison Fathman’s 2015 commencement address at Washington University School of Medicine in St. Louis entitled, “More Than a Diagnostic Code” debuts via the Medical Commencement Archive.

Dr. Fathman is a Professor of Medicine in Immunology and Rheumatology at Stanford University School of Medicine. Dr. Fathman received his M.D. from Washington University in St. Louis in 1969, completed his residency at Mary Hitchcock Memorial Hospital in 1971 and his fellowship at Stanford University School of Medicine in 1973.

He is currently the Director of the Center for Clinical Immunology at Stanford and Division Chief of Immunology and Rheumatology, and a former President of the Clinical Immunology Society and the Federation of Clinical Immunology Societies.

Dr. Fathman’s primary research focus in molecular and cellular immunology continues to lead the way in discovering the mechanisms of T-cell anergy and the pathophysiology and immunotherapy of preclinical animal models of autoimmune disease.

Dr. Fathman begins his speech by recollecting a somewhat nerve-wracking situation in his medical school rotation and reflecting on the importance of remaining humble in the face of knowledge:

“…you have an abundance of knowledge gained over the years of study already committed to this profession, but a dearth of practical experience. It is critical that as you enter into practice, you maintain a sense of humility in your knowledge as you interact with your patient.”

He continues by describing the dramatic changes in medicine as technology surges to the forefront of patient care, and encourages students to interact with patients physically and emotionally instead of simply recording information into a computer:

“…you must remember that the more skilled you become, the more specialized you become, and the more dependent on technology you become, the easier it becomes to lose your humanity by discarding your compassion and connectivity with your patient. You must continually strive to maintain your compassion and connectivity with your patient. This will allow you to maintain your humanity.”

He closes by reminding student to embrace the uncertainty of science and the opportunities it opens:

“Trust the education you received at this internationally esteemed medical school to help you make the right probability-based decisions, but don’t stop learning; continuing education is a life long requirement of the medical profession.”

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General Lifestyle

Coffee

Coffee. A 6-letter word that I am sure soothes the souls of many medical students around the world, including my own. That dark, rich color. That tempting, invigorating smell. I honestly can’t imagine my mornings without that cup of coffee. A full cup of homemade Starbucks coffee with a dash of almond milk and some sort of sweet pastry- the ideal morning routine that gets me going. However, ever since my first day of medical school, it doesn’t just stop at that morning cup. There’s a lunchtime Starbucks run, maybe one after class at 5, and don’t forget those evening teas, which average around 40 mg of caffeine per 8 fluid ounces! Come on, how else do my professors expect me to keep up with my daily studies?!

An article written in Medical News Today, entitled “Coffee drinking habits may influence risk of mild cognitive impairment”, discusses a study that has opened my eyes to just how much of an influence our coffee drinking habits could have on us! Drinking coffee, an act we think is going to wake us up so we can study and retain more, is in fact doing the COMPLETE opposite. It is not exactly the act of drinking coffee that is detrimental to us, but the pattern in which we are doing so. The article presents a study presented in the Journal of Alzheimer’s Disease, following the drinking habits of people between the ages of 65 and 85. The results they discovered are truly amazing! As quoted by the article’s author, Honor Whiteman, the results of the study revealed that “cognitively normal participants whose coffee consumption increased over time were also around 1.5 times more likely to develop MCI than those whose coffee consumption remained stable – no more or less than one cup of coffee each day”. Furthermore, “participants who consistently drank a moderate amount of coffee – defined as one or two cups daily – were at lower risk of MCI compared with those who never or rarely consumed coffee”. Who knew changing the AMOUNT of caffeine one drinks over time could have such a major effect on one’s memory and cognitive abilities?

It is very interesting to me that if you just keep a consistent, stable, predictable amount of intake, coffee has not shown to be detrimental for the body. This just goes to show that too much of anything is simply not good for you. Even though the pool of subjects was older in this study, there is definite potential that the correlation found could apply to the younger population. Once we near that final exam, and we start upping our intake to two, then three, then four cups a day, that is when the damage might ensue. This is the point I wanted to highlight. Trust me, I understand at that moment, at 1:00am in the middle of the night, you feel like that warm, steaming cup of coffee is the only thing keeping you from having a meltdown and simply giving up. However, I just want to call to your attention the possibility that the change in our coffee drinking patterns could actually be hindering our cognitive abilities, instead of helping. Next time you go to your Mr. Coffee to make that 4th cup of the day, please step back, and think of another alternative that could wake you up and recharge your engines. Perhaps a quick run. Maybe a phone call to an old friend or family to change your mindset. These are all possible substitutes that could work, if given the chance, AND that do not have such destructive effects.

Featured image:
cup of coffee by cactusbeetroot

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MSPress Announcements

“Building a People-Centered Health Care System” Dr. Richard Gilfillan, 2015 Commencement Address of Georgetown University School of Medicine

This week, Dr. Richard Gilfillan’s 2015 commencement speech at Georgetown University School of Medicine entitled, “Building a People-Centered Health Care System” debuts on the Medical Commencement Archive.

Screen Shot 2015-08-14 at 10.16.35 PMDr. Gilfillan has been a leader in U.S. health care for over 25 years, developing organizations to deliver stronger health outcomes. Gilfillan began his career as a family medicine physician and later became a medical director and a chief medical officer. He earned his undergraduate and medical degrees from Georgetown University and an MBA from the Wharton School of the University of Pennsylvania.

He launched and became the first director of the Center for Medicare and Medicaid Innovation (CMMI) in 2010 and worked with payers and providers to develop innovative models for improving patient care and reducing costs.

He is currently the President and CEO of Trinity Health, the $13.5 billion Catholic health system that serves communities in 21 states with 86 hospitals, 126 continuing care facilities and home health and hospice programs that provide more than 2.2 million visits annually.

Dr. Gilfillan’s speech revolves around the idea of innovating opportunities for bringing health care to as many people as possible in the country.

“Taking the perspective of a person or family being cared for in our system we ask ourselves how would we choose priorities, design the lab, or set visiting hours sensibly? We integrate the resulting ideas into our conversation. Doing this significantly expands our thinking and will lead to better decisions.”

He concludes by advising the graduating class to incorporate five principles into their daily encounters with patients and hospital staff:

“Be humble. Be curious. Be bold.Laugh a lot, enjoy your work, and celebrate your team.And remember that listening well to your patients is the starting point of great patient care.”

Read Dr. Gilfillan’s speech and the rest of the Archive here: The Medical Commencement Archive

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General Reflection

Can Empathy Be Taught?

As medical students, we are taught to examine patients, recognize symptoms, and treat diagnoses. We get lost in the sea of differential diagnoses and worries of exams. I always worried that I’ll never remember all the important facts, that I’ll miss an important sign or symptom or forget an essential part of treatment in an emergency situation. When I faced my real-life patients, I realized that I was indeed not ready. Surprisingly though, it wasn’t the lack of theoretical or practical knowledge that worried me anymore, but the fact that each patient required a different approach. Some patients are serious and to the point, others are full of witty remarks about not only their condition, but all sorts of topics. Some don’t want to know much about what’s happening to them, while others have countless questions. Their behavior might be a part of their usual personality, or it could be changed because they have found themselves in a new, often scary situation. I wanted to, had to, understand why each of my patients acted and thought the way they did, so that I could adapt my manner, make them more comfortable, find out more information, and finally, earn their trust.

In observing my seniors, doctors with years or decades of experience, I have noticed their style of communication with patients comes from every part of the spectrum. Some are empathetic and communicative, dedicating a large portion of their time to their patients; others are introverted, avoid communication with patients at all costs, or can even be patronizing and show little understanding.

In the past, medical education focused primarily on academic knowledge and practical skills. Today, however, the importance of doctors’ communication skills has obviously been recognized and integrated in our education. But can empathy be taught?

We can learn to shake a patient’s hand, to ask for permission before examining them, to perform other small actions that take little effort but make our patients much more comfortable. In order to better understand our patients, to get them to open up more easily and reveal parts of their medical history they would otherwise conceal, to treat them in the most individual manner possible, we need to empathize with them. I’ve seen my colleagues to whom this comes naturally, but I’ve also seen others whose attempts at empathy take a lot of effort and energy.

Because I am at the very beginning of my medical career, I realize my point of view might be naive. Still, at this point I believe I should focus on each patient. I should empathize and understand each individual fully before attempting to tend to his or her troubles, however much energy that takes. I am also worried about the possibility that this ability can be lost. I often wonder if the more reserved senior doctors have always been that way, or if their energy and will to empathize have been lost after seeing innumerable patients.

I don’t know if empathy can be taught in classes, but I do believe everyone can develop it. Unfortunately, I think the ability to empathize can also be lost. Ultimately, this social dimension of medicine remains different for each health professional, and their ability or will to empathize remains their choice, depending on how they choose to integrate their theoretical knowledge and experience with their personality.

Featured image:
empathy by Sean MacEntee

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General MSPress Announcements

“The Compassionate Physician Discoverer” Dr. Barry Coller, 2015 Commencement Address of the Northwestern University Feinberg School of Medicine

This week, Dr. Barry Coller’s 2015 commencement speech at Northwestern University Feinberg School of Medicine entitled, “The Compassionate Physician Discoverer” debuts via the Medical Commencement Archive.

Screen Shot 2015-08-13 at 3.07.39 PMDr. Coller is a respected educator and a leader in hematological research. He graduated from Columbia College in 1966, received his M.D. from New York University School of Medicine in 1970 and completed his residency in internal medicine at Bellevue Hospital and advanced training in hematology and clinical pathology at the National Institute of Health. He is currently the David Rockefeller Professor of Medicine, the Head of Laboratory of Blood and Vascular Biology, Physician-in-Chief of The Rockefeller University Hospital, and Vice President for Medical Affairs at The Rockefeller University. He also serves as the founding Director of the Rockefeller University Center for Clinical and Translational Science. Dr. Coller’s research interests have focused on hemostasis and thrombosis, in particular platelet physiology. He helped developed abciximab which, to date, has treated over five million patients – I’m sure we’ve all heard that drug in pharmacology many times!

Dr. Coller began his address by reflecting upon, what he believes, are the two pillars of medicine: science and humanism.

“The expert physician has a comprehensive and deep scientific understanding of the causes of illness and the rational basis of disease prevention and therapy; the compassionate physician applies that knowledge with sensitivity to the unique needs and circumstances of a single complex individual.”

He further explains that medical humanism has five core elements: the preciousness of human life, respecting and protecting a patient’s dignity, celebrating human diversity, sympathetic appreciation of the complexity of the human condition and lastly, a commitment to social justice, universal access to medical care, and global responsibility.

Of course, a leader in research will not fail to emphasize the importance of furthering science:

“…I appeal to each of you to be a medical discoverer by which I mean applying the scientific method to address a health need… you live in an age of ever faster technologic change, much of which meets the criterion of disruptive innovation, wherein new technology does not simply improve on previous technology, but forces radical transformation.”

At the end of his speech, Dr. Coller concludes with this piece of wisdom:

“Art, literature, poetry, theater, and cinema help you keep the patient’s perspective before your eyes, but nothing is as good as really listening to your own patients, sympathetically hearing their life story, and learning what they have teach you. And nothing is as rewarding.”

 

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Lifestyle Narrative Reflection

Lonely in a Room Full of People

Stock phrases:

“Hey mon, you alright?”
“You have a blessed day.”
“How is your morning walk pretty ladies?”
“Yeah mon, no worries. Everything alright.”

These ‘stock phrases’ are just a few of the things I heard each and every day while staying in Negril, Jamaica. I travelled to the island to take a short vacation and attend a destination wedding this past month. While on the island, I was pleasantly greeted by the local Jamaicans any time I left the bed and breakfast I stayed at. I was surprised at first at how friendly the locals were – I had heard from friends to be cautious of the crime in Jamaica. Nevertheless, I always responded to the locals, asking them how they were.

A few days into my trip I was with a Jamaican driver named Patcha, headed to another part of the island. I chatted with Patcha for quite a while. I asked him about his culture – his views on marriage, money, economy, etc. He was open and never held anything back. I mentioned to him how friendly I thought the Jamaicans all were. He kind of chuckled and asked if that was out of the ordinary for me. I told him America was different.

I went on to tell him that I am guilty of being unfriendly at times; not intentionally, but just by habit. He didn’t quite understand. I told him how common it is in America to be walking in a hallway or down a street with one other person and for neither of them to say hello to one another. Some people even say they feel lonely in a room full of people. He burst out laughing.

I started laughing too. Why do we do this? What stops us from just initiating a conversation with others? He asked why this is so. I started thinking and said, “Maybe it is because Americans are too stressed. We forget about other people because we are kind of on a mission each day.” Patcha responded, “Us Jamaicans are stressed too, we need to have food on the table every night.” I bit my tongue remembering Patcha had told me earlier that many Jamaicans live in poverty. He told me workers at some of the larger all-inclusive resorts on the island make only about ten US dollars a day and smaller establishments tend not to pay their workers on time or abuse their power over their employees in other ways.

Clearly, stress is a problem in Jamaica just as it is in America. So why is it only in the US where we insist on emotionally walling ourselves off? Why do we stray away from human contact when it is so easy to make a connection with another human? I couldn’t give Patcha an answer. I have been a shy person for the majority of my life, but by no means am I scared to strike up a conversation with anyone. When I returned to the United States I noticed myself falling into old habits, just politely smiling at the person next to me in line for coffee, but never saying hi or asking the how their day is going.

I wanted to write this blog post to hold myself accountable and also challenge my readers to break the silence. Say hello to strangers. Dare yourself to give someone a compliment. Make yourself more human.

As future medical professionals, part of our responsibility is to make our patients comfortable. I will count this challenge as daily practice for my career. I’ve seen many doctors put on a positive attitude for their patients, only to find them miserable when engaging in other social interactions. What makes a stranger in the grocery store any different from a patient in the hospital?

I hope this short story will help readers see that sometimes we all need a reality check. Whatever the reason is, our culture is heading down a path of loneliness, instead of solidarity. Let’s all take responsibility for this and make changes to unite one another.

Featured Image:
Humanity by Kevin Dooley

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MSPress Announcements

“Declaring an Affirmation of Commitment” Dr. Robert Folberg, 2015 Commencement Address of the Oakland University Beaumont School of Medicine

Screen Shot 2015-08-01 at 11.01.57 AMVolume 2 of the Medical Commencement Archive comes from Dr. Robert Folberg at Oakland University Beaumont School of Medicine’s charter class’ commencement. Dr. Folberg’s address, Declaring an Affirmation of Commitment, reflects not on the definition of being a good physician, but on being a good human being. Dr. Folberg is the Founding Dean of OUWB, as well as the Chief Academic Officer at William Beaumont Hospital. As a proud student of OUWB myself, I couldn’t help but debut this year’s Archive with my university’s Dean – a man who has never failed to give mini-motivational speeches in the hallway before exams and is always happy to attend and support student organization events.

Dr. Folberg revolves his speech around two questions: what do I want to do, and who do I want to be? Although to some, those two questions may inspire the same answer, Dr. Folberg stresses that the second question embodies a commitment beyond profession.

To answer the second question – who do I want to be – requires training, practice, and commitment. You were invited to come to OUWB because you excelled academically and because you provided evidence to us of experiences and attributes that predicted you would become physicians who are empathetic, compassionate, and engaged.

He continues by emphasizing the Declaration of Geneva, an oath that each study took upon receiving their first white coat. Each class at OUWB has the opportunity to make unique additions to the Declaraton of Geneva, reflecting upon the promises they hope to fulfill throughout their careers.

You recognize that we all have conscious and even unconscious biases that, if unchecked, could compromise our ability to practice medicine. How could we allow our biases to interfere with the practice of medicine if everyone has infinite value?

At the end of his speech, Dr. Folberg quotes an original line from the Declaration of Geneva: “I will give to my teachers the respect and gratitude that is their due,” and humbly titled each student as his new teachers in the profession of medicine.

Frequently, stymied by a case that challenges my abilities, I turn to my younger colleagues for help, and often, these are the very individuals who were my students. In a very real sense, I owe to them, my students, the respect and gratitude that is their due.

Volume 2 of the Medical Commencement Archive has a fantastic line-up this year! A new speech will be published each Friday.

Visit the Medical Commencement Archive

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Lifestyle Reflection

The Hypocritical Oath

Taking the Hippocratic Oath is a rite of passage. Before any physician enters Exam Room 1, he recites these words, written by Hippocrates centuries ago. These words are powerful; so powerful that they are treated as more than just words. These words represent a physician’s love and devotion to his patients.

No matter how stressful this field can be, I have always seen physicians set these words—the oath—as their standard. As physicians (or budding physicians, in our case), we tell others to fill their bodies with nourishment and to practice a variety of healthy habits. But, the question remains: do we treat our own bodies the same way?

As a public health major, I’m all about “prevention.” My special interest is the prevention of chronic disease. Whenever I go home, I am the first to scrutinize my parents’ pantry—making sure their ketchup is devoid of high fructose corn syrup and that their fridge is filled with raw food. When I talk to my friends or relatives, I push them to exercise because “it really only takes thirty minutes of your day, and you’ll feel amazing afterwards!”

Basically, I play the pushy health coach. But is this health coach all talk and no walk?

Sadly, I don’t always abide by the values I preach. Even though I know I should be drinking water equivalent to half my body weight in ounces, I generally don’t. Well, why not? Sometimes I don’t make it a priority, and other times I forget. Many patients probably experience a similar scenario. Likewise, I often see my fellow classmates put academics above their health at school. I can be guilty of this too.

When I started thinking about our habits, I was hard on myself and my peers. As healthcare practitioners, our own health should never be placed on the backburner. More importantly, I don’t like the idea of telling my patients to do A, B, and C if I can’t do A or B or C myself. It just doesn’t seem very reasonable. I’ve come to the conclusion that there are two ways I can approach this in the future:

  1. Practice what I preach
    OR
  2. Preach with empathy

I’ve realized it’s okay to push those I love to be better, even if I’m far from that point myself. But this conversation should be accompanied by a discussion on health barriers. It’s hard to get your limp legs out of a warm bed in the morning, but what will help you rip off the covers and jump on the treadmill? Sleeping with your sports bra on? Placing your alarm farther away from the nightstand? We all know what “healthy” looks like; what we don’t always know is how to achieve it. I want to share my own obstacles with patients while also discussing theirs.

Bottom line: I don’t have to be perfect to offer health advice…I just need to be compassionate.

Featured image:
The road to health by Sarah Joy