Author: themspress

Categories
disability Disability Issues Empathy Healthcare Disparities Medical Humanities Patient-Centered Care

Why as a society is difference viewed as unattractive?

Why as a society is difference viewed as unattractive?

By Lauren Higgins

 

Cherri (2022) The Adoration of the Golden Calf

 

The artefact I have selected is a lamb taxidermy called, ‘The Adoration of the Golden Calf, after Poussin’, which was created in 2022 by Ali Cherri and finished using wood, jesmonite and gold leaf.

The piece was commissioned in 2021 as part of the National Gallery Artist in Residence programme and sat within the Sainsbury wing of the art museum as part of the ‘If you prick us, do we not bleed?’ project.  This exhibition focused on historical pieces which had been vandalised when displayed, with Cherri assembling individual artworks to reflect the trauma of the original. This taxidermy of a lamb that died due to severe birth abnormalities, specifically relates to the Golden Calf depicted in the work of Poussin, which was destroyed with spray paint in 2011 (Wilson, 2011).

This unusual, alien-like figure immediately captured my interest, as it stood in high contrast to the beautifully depicted biblical scenes of the Renaissance paintings which surrounded it. Centred within the gallery, I also noticed that this artefact had caught the attention of large crowds, with many recoiling in disgust and horror at the physical appearance of the lamb. It has often been deemed human nature to be captivated and intrigued by the unknown or different, however the pure hatred that was directed towards this piece simply due to its distorted appearance shocked and outraged me. I, therefore, began to consider the animosity that individuals who suffer from noticeable deformities face, and the challenges of living in a society that doesn’t fully accept those who are atypical.

The distinct characteristics of the lamb also reminded me of the infamous Siamese conjoined twins. I thought about the struggles they must have encountered not only due to the disability itself, but also the unwanted views and opinions of society at the time.  I wondered whether after 100 years since their death if they would receive a similar reaction of repulsion which I witnessed being directed towards the abnormalities of this figure (Bahjat, 2018). Moreover, this sculpture encouraged me to reflect upon my own disability; the impact it has had on my life and the additional challenges I shall encounter as a medical student.

Throughout history, individuals deemed to be ‘medical oddities’, have been subject to curiosity from the public audience and even used as forms of entertainment for the so-called freak shows (Grande, 2010).  The exhibition of extraordinary bodies occurred across Europe and America during the Victorian period, whereby physical difference was seen as a profitable market (Durbach, 2012). Chang and Eng Bunker, credited as the original Siamese twins, were examples of individuals showcased around the world for paying audiences (Bahjat, 2018). The Bunker brothers were attached at the breastbone via a ‘small piece of cartilage’, but each had their own set of organs and body, allowing them to carry out the activities of a normal man (Bahjat, 2018).

At just the age of 17, the brothers’ peculiarities were identified as having ‘commercial potential’ by Robert Hunter, who proceeded to buy the boys from their mother in Thailand and exhibit them across the globe (Leonard, 2014). The idea that the Bunker brothers, and so many other individuals with physical deformities, were used as amusement for others is deeply saddening (Kattel, 2018). The humiliating and dehumanising nature of freak shows makes me consider the psychological implications patients with physical disabilities must endure due to the strain of unsolicited comments and community opinions.

Alongside the link to the Siamese twins, the structural deformity of the artefact reminded me of my own physical anomaly. I have an idiopathic form of scoliosis, which is the lateral deviation of the vertebral column without a known cause (Martin and Law, 2020, p.692). As a result, I have uneven hips and shoulders, poor posture, severe back pain/ discomfort, and lowered self-esteem due to an obvious hump-like structure caused by the posterior raising of my ribcage (kyphosis). Similarly, to the ‘freaks’ of the 19th century, I have personally been subject to wondering eyes, judgmental expressions, and hurtful remarks about my appearance when out in public (Grande, 2010). I, therefore, have experienced first-hand the damaging mental health consequences indirectly connected to my disability.

Although my scoliosis has posed many additional challenges in my life, I believe that having a disability as a medical professional may be advantageous in being able to effectively empathise with patients suffering from other long-term health issues. With disabled people aged between 16-64 reporting lowered well-being ratings on happiness; worthwhile and life satisfaction scores; and increased anxiety levels than non-disabled counterparts, the NHS is currently failing to provide adequate support to those with continuing health problems (Office for National Statistics, 2021). Hence, as a training doctor, I recognise that I will be in a privileged position to raise awareness about the psychological burden of lasting illness among my able-bodied colleagues and the general public. In doing so, I hope that healthcare workers will begin to take a holistic approach in viewing disability and think further than treating the body and look also to healing the mind.

The introduction of the Equality Act 2010, was a positive step into protecting people with disabilities from discrimination within the workplace and wider population, demonstrating the unquestionable progression society has made in accepting disability from the brazen Victorian freak shows. Such legislation introduced by the government has had an instrumental influence in encouraging people with disabilities into employment and societal activities (i.e., sports, community groups and higher education). For example, between 2013 – 2020, there was an increase of 8.1% in the proportion of disabled people in employment, with 2.6 million disabled women and 1.8 million disabled men working, demonstrating the constructive role of such parliamentary bills (Powell, 2021). Although the apparent improvements, the uneducated reactions I witnessed towards the lamb’s defects, along with my own experiences, would suggest that even in the 21st century, disabled people are inevitably going to be made to feel unsafe by the minority who still view difference as ugly.

 

In conclusion, the artefact identifies and represents the exploitation of vulnerable individuals with deformities and highlights the dangerous way humans react to things that they are unfamiliar with. I observed how most of the responses to this piece within the gallery, were profoundly negative, and I have come to believe that this reaction of repugnance is reflective of the poor treatment of disabled people within today’s society. This piece has led to me uncovering the failures of the healthcare system in the past to protect individuals most at risk from mistreatment and has opened my eyes to the challenges I may encounter during my medical career in terms of counteracting negative public perception of disabilities.

Although legislation introduced by the government aims to pave the way for a more optimistic future whereby disabled people are not faced with judgment and prejudice, such discrimination is rooted within British history, and thus I appreciate it will take time to fully shift public opinion. I, therefore, hope in the future as a medical student, I can educate those around me about the damaging consequences of ignorance towards difference, and support those who face maltreatment because they do not fit into the idealistic prototype pushed by society.

Reference list-

Bahjat, M. (2018) Chang and Eng Bunker (1811-1874). Available at: https://embryo.asu.edu/pages/chang-and-eng-bunker-1811-1874 (Accessed: 13 April 2022).

Cherri, A. (2022) The Adoration of the Golden Calf, after Poussin [taxidermy] The National Gallery, London (Viewed: 11 April 2022).

Durbach, N. (2012) ‘Skin Wonders’: Body Worlds and the Victorian Freak Show’, Journal of the History of Medicine and Allied Sciences, 69(1), pp. 38-67. Available at: https://doi.org/10.1093/jhmas/jrs035

Equality Act 2010, c. 1. Available at: https://www.legislation.gov.uk/ukpga/2010/15/part/11/chapter/1 (Accessed: 13 April 2022).

Grande, L. (2010) ‘Strange and Bizarre: The History of Freak Shows’, Things said
and done. Available at: https://thingssaidanddone.wordpress.com/2010/09/26/strange-and-bizarre-the-history-of-freak-shows/ (Accessed: 12 April 2022).

Kattel, P. (2018) ‘Conjoined Twins’, Journal of Nepal Medical Association, 56(211), pp.708-710. Available at: https://www.jnma.com.np/jnma/index.php/jnma/article/view/3526/2764 (Accessed: 12 April 2022).

Leonard, T. (2014) ‘How the original Siamese twins had 21 children by two sisters… while sharing one (reinforced) bed’, The Daily Mail, 7 November. Available at: https://www.dailymail.co.uk/news/article-2825888/How-original-Siamese-twins-21-children-two-sisters-sharing-one-reinforced-bed.html (Accessed: 13 April 2022).

Martin, E. and Law, J. (eds) (2020) Concise Medical Dictionary. 10th edn. Oxford: Oxford University Press.

Office for National Statistics (2021) Outcomes for disabled people in the UK: 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/outcomesfordisabledpeopleintheuk/2020 (Accessed: 27 April 2022).

Powell, A. (2021) Disabled people in employment. (House of Commons Library briefing paper 7540). Available at: https://researchbriefings.files.parliament.uk/documents/CBP-7540/CBP-7540.pdf (Accessed: 13 April 2022).

Wilson, C. (2011) ‘Man held after Poussin painting is vandalised at National Gallery’, The Guardian, 17 July. Available at: https://www.theguardian.com/uk/2011/jul/17/poussin-attack-national-gallery (Accessed: 12 April 2022).

Categories
Emotion Empathy General Reflection Women's Health

In the Face of Loss: A Medical Student’s Journey Through Devastation and Discovery

By Melissa Bonano

Amidst the flurry of activity in a busy emergency department, an urgent call cut through the chaos, leading me to a profound realization about my path in medicine. “There’s a patient actively miscarrying in the restroom,” the message crackled with urgency and distress. Instantly, my focus sharpened as I grasped the gravity of the situation. A nurse, visibly shaken, relayed that a woman, bleeding heavily at 14 weeks into her pregnancy, required immediate assistance. In that moment, a wave of recognition washed over me—I had encountered this patient during triage.

Racing to her side, I found her standing over the toilet, clutching a fetus in her hand, tears streaming uncontrollably down her face. With the nurse momentarily frozen in the doorway, I was alone. The reality of the situation crashed over me as I realized I was the only one there to provide immediate support. Her heart-wrenching plea, “Can you help him?” pierced through the chaos, and I knew I had to deliver the heartbreaking truth.

A storm of thoughts swirled in my mind. How do you convey the finality of such a profound loss when you are unprepared? Despite lectures and TV portrayals, nothing had truly prepared me for this moment. As a medical student, all my training and knowledge suddenly felt inadequate in the face of such raw grief. As I crouched beside her, my arm wrapped around her shoulders for support, I summoned every ounce of compassion and clarity I could muster. I gently conveyed the harsh reality that there was nothing more we could do for the baby, softly explaining that it was too early in her pregnancy for him to survive. She nodded in understanding, her breaths interspersed with sobs. I cradled her baby in my hand as I guided her into a wheelchair, engulfed by a wave of helplessness. Her cries, the most gut-wrenching I had ever heard, reverberated around me. Witnessing her grief was agonizing; my words felt feeble in the face of such profound loss.

After settling her into her room, I remained by her side, determined to offer whatever comfort and support I could in her darkest hour. Despite my reassurances, her pain was palpable, an all-consuming sorrow that left me feeling powerless. My aspiration to heal seemed futile against the magnitude of her suffering. A part of me longed to stay, to be her anchor through this harrowing ordeal, but another part of me, the novice, wanted to escape, to avoid ever facing something so heartbreaking again.

As she was eventually transferred to the labor and delivery floor, I made my way back to the bustling ER that seemed unchanged, indifferent to the storm I had just weathered at this mother’s side. I sat back at my computer, staring blankly at the list of patients waiting to be seen when a hand gently landed on my shoulder. My preceptor stood beside me, his presence a silent acknowledgment of my turmoil. Without looking me in the eye, without asking a single question, he said, “Take 5 minutes.”

Take 5 minutes. Take 5 minutes to reflect on what it means to be a doctor. Take 5 minutes to absorb this rude awakening of what can unfold on any given day. Take 5 minutes to understand that despite the overwhelming difficulty of what I had just experienced, it was precisely what I was here to do—to stand beside those in their moments of greatest need. As I walked out into the quiet of the ambulance bay, a profound realization dawned on me. Despite its unconventional and heart-wrenching nature, I felt a deep, undeniable call to be there for every mother who needed me. It was on that day, amidst the sorrow and the struggle, that I found my true calling—to be an obstetrician and gynecologist, dedicated to supporting and caring for those who need it most.

Categories
Healthcare Cost Healthcare Disparities Innovation Technology

The Transformative Power of Telehealth: A New Era in Modern Healthcare

By Dipti Shah

Introduction:

Telehealth has rapidly evolved from a supplementary healthcare service into a vital component of the modern healthcare system. Spurred by the COVID-19 pandemic, its adoption has skyrocketed, offering a glimpse into a future where healthcare is more accessible, efficient, and patient-centered. This article explores the profound impact of telehealth on expanding access to care, improving cost-effectiveness, and the challenges that remain for its widespread implementation.

Expanding Access to Care:

Telehealth’s most significant advantage lies in its ability to extend healthcare access to populations previously underserved. For rural communities, where access to specialized care is often limited, telehealth has marked improvements in health outcomes. A 2021 study published in The Journal of Rural Health found that telehealth reduced the need for travel to urban centers for specialist consultations by approximately 30%, bridging the gap in healthcare access for rural populations. Additionally, telehealth has been particularly beneficial for individuals with mobility challenges and chronic conditions.

For example, a study by Doraiswamy et al. (2022) highlighted a 30% increase in healthcare utilization among patients with mobility impairments, leading to better management of chronic conditions such as diabetes and COPD. Furthermore, telehealth’s convenience has significantly increased patient adherence to treatment plans. During the COVID-19 pandemic, the American Medical Association reported a 35% increase in telehealth visits for chronic disease management, underscoring its role in enhancing long-term health management and improving overall patient outcomes. These examples demonstrate how telehealth effectively bridges access gaps, supports diverse patient needs, and fosters improved health outcomes across various populations.

Cost-Effectiveness and Efficiency:

Telehealth is not only improving access but also contributing to cost savings within the healthcare system. By reducing the need for in-person visits, telehealth decreases transportation costs, time off work, and other associated expenses. Additionally, telehealth can help to alleviate the burden on emergency services by offering an alternative for non-emergency consultations, leading to a more efficient allocation of healthcare resources.

A 2022 study published in Health Affairs estimated that telehealth could save the U.S. healthcare system over $10 billion annually. These savings are primarily attributed to the reduction in unnecessary hospital visits and the optimization of care delivery processes. As healthcare costs continue to rise, telehealth presents a viable solution for enhancing efficiency while maintaining high-quality care.

Challenges and Considerations:

Despite its many benefits, telehealth faces challenges that must be addressed to ensure equitable access. The digital divide, characterized by disparities in access to technology and reliable internet, poses a significant barrier to widespread telehealth adoption. Low-income households, elderly populations, and those in remote areas are particularly vulnerable to this divide, limiting their ability to benefit from telehealth services.

Regulatory and reimbursement challenges also hinder the full integration of telehealth into the healthcare system. While the pandemic prompted temporary regulatory relaxations, permanent solutions are needed to sustain telehealth’s growth. Policymakers are currently working to streamline these regulations and improve reimbursement policies, but continued efforts are essential for long-term success.

Conclusion:

Telehealth represents a transformative shift in healthcare, with the potential to make care more accessible, cost-effective, and patient-centered. As the evidence in favor of telehealth continues to grow, it is imperative that healthcare systems and policymakers work together to address the challenges and fully integrate telehealth into the continuum of care. By doing so, we can ensure that the progress made during the pandemic is not just temporary but forms the foundation of a more resilient and equitable healthcare system.

Bio:

Dipti Shah holds a master’s in physical therapy and has over 10 years of experience in the field. She is passionate about integrating innovative healthcare solutions, such as telehealth, to improve patient outcomes and accessibility. Dipti’s insights are informed by her extensive clinical experience and commitment to advancing modern healthcare practices.

References:

  1. The Journal of Rural Health. “Telehealth’s Role in Rural Healthcare Access.” 2021.
  2. American Medical Association. “The Rise of Telehealth During the COVID-19 Pandemic.” 2021.
  3. Health Affairs. “Telehealth and Its Potential for Cost Savings in U.S. Healthcare.” 2022.
  4. American Telemedicine Association. “Policy and Regulatory Considerations for Telehealth.” 2023.
  5. The Nielsen Company. “The Role of Telehealth in the Modern Healthcare Landscape.” 2022.
Categories
Global Health Healthcare Disparities Medical Humanities Public Health

Medical Students as Advocates for Change

At a time when demand for advocacy is high, opportunities for medical students to develop these skills is waning. In the midst of the COVID-19 pandemic, advocating for those less fortunate is not just the duty of medical professionals’ but the correct action of any human being. 

With a long and deep rooted tradition in medicine, advocacy calls upon physicians to speak up on behalf of patients, the vulnerable and those in dire need of assistance. Due to the respect physicians have as leaders of society, and of the trust individuals have in the medical system, they are able to influence policies that benefit their patients and the healthcare system.

Therefore, as students-in-training, when given the opportunity to advocate for our patients, and positively affect interactions in medicine, these occasions ought to be seized particularly if we want to change the landscape of disparities and injustices that are rampant in America. By encouraging medical students to engage in advocacy efforts, the concept of physicians as advocates becomes a step closer to normalization as well as their humanity strengthened when engaging with the medical system outside of their usual role. 

Given the lack of awareness, or an unrealistic view of the difficulties, and interactions that prevent a successful physician-patient relationship, medical students need to be empowered with advocacy skills to create physicians who are capable of treating diverse populations such as refugees, the homeless, and other disadvantaged patient groups.

As a result of the COVID-19 pandemic, movements such as #Students_Against_COVID, Students vs Pandemics, and a Coronavirus Global Awareness Magazine have been born. These times of chaos have proved to be the fruit of innovation sprouted by the desire to serve and rise above obstacles. Besides these efforts, medical students seeing the need for personal protective equipment (PPE) created a Non-Profit Organization, MedSupply Drive which gathered medical students across America uniting in the collection of equipment required for professionals to protect themselves while serving on the front-lines. 

Other students passionate about advocacy have had to seek extra-curricular positions in the International Federation of Medical Students (IFMSA), American Medical Student Association (AMSA), American Medical Women’s Association (AMWA), Australian Medical Student Association (AMSA), Asian Medical Students Association International (AMSA International) and American Medical Association (AMA) to raise their voices for tangible and effective change. They have organized campaigns on the Affordable Care Act, MedVote, Global Gag Rule, contraception, and gun safety among others. The Global Health Committee, the AIDS Advocacy Network as well as numerous LGBT+ Communities have also met with senators and representatives to discuss important state and national bills affecting health care. 

In Canada, students have formed a coalition known as the Medical Student Response Team where they’ve created an app to efficiently distribute community support during the pandemic. Such responsibilities involve assistance at the homeless shelter, collecting grocery items for the elderly or virtual storytelling opportunities for children. Others have come up with ways to create ventilators for vulnerable populations in Yemen, Syria and Afghanistan. Medical students foreseeing the problems afflicting indigenous populations sought indigenous translators to translate COVID-19 related information into their local languages for dissemination and understanding in order to keep themselves safe.

As a result of the anti-black attitudes and of racism prevalent in our societies, students have stepped up to educate citizens through the sharing of books, websites and videos to learn more about the issues prevalent in society. Medical student, Malone Mukwenda from the United Kingdom took it upon himself to co-author a textbook, Mind the Gap, a clinical handbook of signs and symptoms in black and brown skin. This book was inspired by the lack of racial diversity in medicine as medical dermatology textbooks failed to adequately educate physicians on conditions affecting those of non-white skin. Other student initiatives have been propelled by the desire to fight the information epidemic where misinformation about COVID-19 has been spread across Latin America. Extremely dangerous and perpetrated by those taking advantage of peoples’ confusion, and fear, COVID Demystified, a group of senior undergraduate students, graduate students and early-career scientists from universities across North America have come together to bring research on COVID19 to the people. This stems from their desire to make science accessible to all, therefore the information presented in their posts are all from peer-reviewed, published studies in reputable journals. 

While support of experiential learning in advocacy is needed, much work is to be done if evidence-based advocacy training is to become readily accessible to current and future health professionals nationwide. Even though advocacy takes many forms, occurring at multiple levels of engagement such as individual, local and national, all are valuable. At an individual level for example, physicians advocate for timely diagnostic tests and regionally for groups of patients seeking funding from a health provider. At a system level, physicians advocate for activities to improve the overall health and well-being of populations and globally encourage international support for health related environmental protection. 

From letter writing, social media campaigns, to one on one discussions with authority figures, advocacy techniques and strategies may vary. When speaking publicly, physicians should be clear when their comments are made in a personal capacity or on behalf of a third party and while many physicians are skilled advocates, these abilities are not natural for all physicians. Most often, advocacy is then a learned skill developed over time .

As healthcare providers and leaders, physicians can help improve and sustain the health systems by approaching issues with transparency, professionalism and integrity. Through informed perspectives and the use of evidence-based facts to help persuade others, now more than ever will patients continue to look to their doctor as a trusted source for healthcare information and support. Consequently, advocacy efforts will only increase in importance as the rise in injustice, neglect and falling economies continue and although advocacy’s definition in healthcare is evolving, physicians may show leadership by remaining engaged, committed and seeking to advance their viewpoints in a professional appropriate manner; for then only may they truly serve humanity before anything else. 

Written by,

Leah Sarah Peer

Categories
General

Announcement: Hiatus October 2018 to February 2019

Dear Readers,

The MSPress Blog is on hiatus from October 10, 2018 to February 10, 2019.

If you are interested in contributing to The MSPress Blog or are interested in joining our team, please email journal@themspress.org to request an application.

Thank you!

Sincerely,

The MSPress Team

Categories
The Medical Commencement Archive

“An Invitation To Learn” – Dr. Jeremy Sugarman, NY Medical College 2018 Commencement

Dr. Sugarman gives a speech rich with advice by sharing three life experience stories. These are very unique ethical situations that can serve to provide helpful guidance to freshly anointed doctors when they face similar dilemmas or challenges down the line.

In his first story, Dr. Sugarman discusses the 1993 revelation that the US government had supported a series of radiation studies on its citizens without consent during the Cold War era in order to determine possible after effects from potential nuclear fallout. Physicians and scientists helped conduct over 400 radiation experiments on unaware subjects. Dr. Sugarman served on President Clinton’s Advisory Committee on Human Radiation Experiments to investigate wrongdoings and who may have been harmed. From this first story, he provides the following advice: “It is far too easy to be caught up in the rush to uncover the latest scientific truths. All of us, regardless of our professional careers, need to be alert to the interests of those who are subjected to science. Similarly, we all need to be vigilant regarding the temptations of big data due to the potential tradeoffs between enhanced knowledge and individual harms and wrongs, such as violating privacy. In addition, we need to be alert to what is driving the science that we do. Scientists and policy makers in particular must ask who is funding or supporting our work and for what purposes?”

In his second story, Dr. Sugarman speaks about his time on the Maryland Stem Cell Research Commission. There was a fellow commissioner named John Kellermann who was determined that stem cells were the solution to completely curing his Parkinson disease. This intense hope for a cure took priority over John’s personal, political, and ideological beliefs. Dr. Sugarman reminds graduating medical students “to not inflate the very natural hopes of people who are sick. An experimental approach that helps cure a mouse and be scientifically fascinating may never help cure a human…recognize the distinctions between treatment and cure. These differences matter. Anyone who is in anyway involved with the care of patients needs to be sensitive to them. Finally, the contemporary practice of delivering untested and unproven interventions that exploit this hope for cure are unethical and don’t in any way comport with the ethical obligations of beneficence inherent to the health professions.”

The final story that Dr. Sugarman shares is about his time serving abroad in Tanzania, which had widespread TB and HIV at the time. He also recounts a case when he suspected pericardial effusion in a patient. However, limited resources prevented diagnosis through imaging, and in the end, Dr. Sugarman performed a gutsy, blind pericardiocentesis that succeeded. “Working in Tanzania taught me many things that are of importance for your careers, regardless of whether you will be engaged with public health practice, a clinical role, or policy making. First, we respect one another by honoring appropriate cultural norms. For example, in the US we shake hands firmly and quickly; in Tanzania we hold hands gently and for long periods of time; in other cultures we kiss or bow or wai. Second, it is possible to engage patients in their care, even in desperate circumstances. Third, for clinicians, medicine is not only about knowledge but also about laboring. Aristotle considered medicine a techne, a skill or an art. And a skill needs to be practiced to be perfected.

…Please realize your degree is an invitation to learn. Stay alert for the lessons that will accompany your work. Welcome unlikely experiences. Welcome unlikely teachers. And welcome the ethical challenges in your work. Congratulations and all the best in the future.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/340

About Dr. Sugarman:

Jeremy Sugarman, MD, MPH, MA is the Harvey M. Meyerhoff Professor of Bioethics and Medicine, professor of medicine, professor of Health Policy and Management, and deputy director
for medicine of the Berman Institute of Bioethics at the Johns Hopkins University. He is an internationally recognized leader in the field of biomedical ethics with particular expertise in
applying empirical methods and evidence-based standards for evaluating and analyzing bioethical issues. His contributions to both medical ethics and policy include his work on the ethics of
informed consent, umbilical cord blood banking, stem cell research, international HIV prevention research, global health and research oversight.

Categories
The Medical Commencement Archive

“Collaboration and Curiosity” – Dr. Huda Zoghbi, University of Massachusetts 2018 Commencement

Dr. Zoghbi delves into her speech by stating “regardless of your individual path to this day, there is one thing I can predict about your future: it won’t be what you expect.” Then, she proceeds to share a moving account of her journey through life and medicine interweaved with four main points of advice on how to handle the unexpected. A major encompassing theme is to be open to and appreciative of the human relationships formed during one’s path in the medical field, especially during times of hardship.

“First, have a plan, but be flexible within that plan. There will be storms in the ocean that is your life and you have to learn to surf each wave as it comes. My drive to be a physician was strong, and that kept me going to medical school through four years, two countries, and one war. But the people close to me—my mentors Ralph, Marv, and Art, and my husband William—helped me see more clearly what it was that I really wanted to do. They taught me and they helped me to listen to that little voice inside that so often gets drowned out by the noise of obligations and the fear of leaving a well-trodden path. Listen to that inner voice.

Second, listen to other people, too. Listen to your patients and their families. The single biggest complaint I hear from people about healthcare nowadays is that their physician or nurse is looking at a screen instead of at them. We all want to make a difference in peoples’ lives, but sometimes the best thing we can offer our patients is our respectful attention. Thinking back to the first girls I saw with Rett, why were so many diagnosed with cerebral palsy, a diagnosis that would have been apparent at birth, when the girls were perfectly healthy the first year of life? The diagnosis didn’t fit; only a physician who didn’t trust the parents and didn’t trust their own eyes would try to make it fit. Or, thinking back to SCA1, why would each generation of a family develop more severe disease at an earlier age than their parents’ generation? Now we know the answer is a dynamic mutation, but at the time it was a puzzle. Pay attention to the reality in front of you, not the rules and models you learned in school. In 20 years, much of what you learned here will no longer be valid—so keep an open mind, and you might be one of the people who brings forth new knowledge to share with others.

Third, develop resilience. We are not born with patience, and perseverance doesn’t come into play until we meet circumstances in which it is possible to give up. Resilience is like a muscle. Hard times are never fun, but they’re the way we develop character.

Fourth and most important, cherish your relationships. You will have noticed that at each crucial juncture in my life there have been people who gave me opportunities. Meharry Medical College was willing to break the rules to let me transfer in mid-stream. My mentors and my patients opened my eyes and then opened their hearts to me. My collaborators and my trainees have made my career a joy. My husband William, who is a cardiologist with his own demanding career, has made our home a stress-free zone and helped me raise two beautiful children. Many other people have had a profound influence on me, and I have tried to honor their gifts by being generous in turn. I believe with all my heart that my strong relationships have enabled me to achieve the success and the happiness I’ve reached in my life.

As you reflect on your own paths, I am sure you can identify those who helped you get to this point. If there are fewer such people than you would like, then make it a goal to strengthen your relationships. Choose friends and loved ones who will help you become more resilient, pay closer attention, and listen to your own best self.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/339

About Dr. Huda Zoghbi

Huda Zoghbi is the Ralph D. Feigin Professor of Pediatrics at Baylor College of Medicine, where she is also professor of Neuroscience and Molecular and Human Genetics. She has been an Investigator with the Howard Hughes Medical Institute since 1996. She is also the founding Director of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital. Zoghbi’s interest is in understanding healthy brain development as well as what goes awry in specific neurological conditions. She has published seminal work on the cause and pathogenesis of Rett syndrome and late-onset neurodegenerative diseases, and has trained many scientists and physician-scientists and is a member of several professional organizations and boards. She has been elected to the National Academy of Medicine, the National Academy of Sciences, and the American Academy of Arts and Sciences. Among Dr. Zoghbi’s recent honors are the Pearl Meister Greengard Prize from Rockefeller University, the March of Dimes Prize in Developmental Biology, the Shaw Prize in Life Science and Medicine, the Breakthrough Prize in Life Sciences, Canada Gairdner International Prize, and Honorary Doctor of Science degrees from Harvard University and from the University of Massachusetts Medical School.

Categories
The Medical Commencement Archive

“The Chapters to Come” – Dr. Carl Nathan, Weill Cornell Graduate School of Medical Sciences 2018 Commencement

Dr. Carl Nathan kept his speech short and sweet during the 2018 Weill Cornell Graduate School of Medical Sciences Commencement. Dr. Nathan was trained in internal medicine and oncology at Mass General Hospital, the National Cancer Institute and Yale before becoming a staff member at the Weill Cornell Graduate School of Medical Sciences. He has been a distinguished professor at Cornell University for over 3 decades, and current R.A. Rees Pritchett Professor and chairman of the Department of Microbiology and Immunology.

Dr. Carl Nathan makes his speech all about the impact the MD graduates have had on the people around them, including their parents, friends, and professors, and the impact they will have on the future of the medical field:

“You have given us new knowledge from your own minds and hands. You have given us fresh evidence that the prospects for scientific discovery are limitless. You’ve shown us that being the first to see something reproducible or to explain something mysterious brings as much joy and fulfilment as when van Leeuwenhoek first saw “wee beasties” through a microscope and Marie Curie discovered radium and thought of using it to treat cancer.

You’ve given us reassurance that no matter our inadequacies as teachers, your brilliance and resourcefulness let you absorb exponentially growing amounts of information with no sign of a limit to what the prepared mind can master.

Finally, in a troubled time, you’ve proven again that science is a form of communication that sifts fake from real and connects rather than divides, that creates a community transcending region, religion and origin. Many of you took precious hours from your pressured lives to share that message with children in the city around you.

What will you go on to give the world from your coming positions in colleges, universities, biotech, pharma, other businesses, foundations or public service?

You will help shed light on the unknown. Help cure disease. Help make cures accessible to those in need. Some of you will help create wealth. Help see that wealth distributed fairly. Help teach those who come up after you.

All of you can help defend the role of apolitical reason and scientific evidence in civic life and public policy. Help save this earth, its peoples and the diverse forms of life with which we share our climate, oceans, forests and fields.

The diploma you are about to receive is a symbol of the power you’ve proved that you have. Go use your power wisely. Then come back and tell us what you’ve done. Like your parents, partners, family and friends, your teachers and advisors are proud of the stories you are writing with your lives. All of us are eager to hear the chapters to come. ”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/334

About Dr. Nathan

Carl Nathan, MD is R.A. Rees Pritchett Professor and chairman of the Department of Microbiology and Immunology at Weill Cornell Medical College. After graduation from Harvard College and Harvard Medical School, he trained in internal medicine and oncology at Massachusetts General Hospital, the National Cancer Institute and Yale before joining the faculty of The Rockefeller University from 1977-1986. At Cornell since 1986, he has served as Stanton Griffis Distinguished Professor of Medicine, founding director of the Tri-Institutional MD-PhD Program, senior associate dean for research and acting dean. For eighteen years he co-chaired the Program in Immunology and Microbial Pathogenesis at Weill Graduate School of Medical Sciences of Cornell University, where he is now the dean. Nathan led the planning team for the Tri-Institutional Therapeutics Discovery Institute and is a now a member of its Board of Directors. Tri-I TDI is a not-for-profit corporation owned by Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center and The Rockefeller University. Nathan is a member of the National Academy of Sciences, the National Academy of Medicine and the American Academy of Arts and Sciences, a Fellow of the American Academy of Microbiology, associate scientific director of the Cancer Research Institute, a governor of the Tres Cantos Open Lab Foundation and on the scientific advisory boards of the Global Alliance for TB Drug Development, the American Asthma Foundation and the Rita Allen Foundation. He is a member of the national Pfizer Therapeutic Areas Scientific Advisory Panel and the Lurie Prize jury. He served for ten years on the scientific advisory board of the Cambridge Institute for Medical Research and the Board of Trustees of the Hospital for Special Surgery, where he chaired the Research Committee. He has been an editor of the Journal of Experimental Medicine since 1981 and presently serves as co-chair of its editorial board as well as on the editorial boards of the Proceedings of the National Academy of Sciences and Science Translational Medicine. He was awarded the Robert Koch Prize in 2009 for his work on tuberculosis, the Anthony Cerami Award in Translational Medicine in 2013 and the Milstein Award of the International Interferon and Cytokine Society in 2016.

Nathan is a member of the Bill and Melinda Gates Foundation’s TB Drug Accelerator and Principal Investigator of the NIH-funded Tri-Institutional TB Research Unit. His research deals with the immunological and biochemical basis of host defense. He established that lymphocyte products activate macrophages, that interferon-gamma is a major macrophage activating factor, and that mechanisms of macrophage antimicrobial activity include induction of the respiratory burst and inducible nitric oxide synthase (iNOS). He and his colleagues purified, cloned, knocked out and characterized iNOS biochemically and functionally, discovered the cofactor role of tetrahydrobiopterin in NOS’s and introduced iNOS as a therapeutic target. Although iNOS helps the host control Mycobacterium tuberculosis (Mtb), the leading cause of death from bacterial infection, Mtb resists sterilization by host immunity. Nathan’s lab now focuses on the biochemical basis of this resistance. Genetic and chemical screens have identified enzymes that Mtb requires to survive during non-replicative states, including the mycobacterial proteasome. His group is identifying compounds that kill non-replicating bacteria while exploring new collaborative models between academia and industry to help invigorate antibiotic research and development.

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The Medical Commencement Archive

“A Moral Compass” – Dr. Howard Bauchner, University of Texas Health Science Center McGovern School of Medicine at Houston 2018 Commencement

This week’s commencement speech is by Dr. Howard Bauchner, who spoke at the University of Texas McGovern School of Medicine in Houston, TX. Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA® and The JAMA Network® in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003-2011).

Dr. Bauchner focuses his speech on the morality of being a physician and ethical challenges one must face. He starts by emphasizing the trust patients will place on the graduating medical students: “What I want to focus on is the need to find a moral compass in your life as a physician. I cherish being a physician. Many patients trust us with their lives – thankfully we are no longer seen as a gods – and that is a good thing – but many many patients want us to help them with some of the most difficult and emotional decisions in their lives – how to care for a sick child, how to help a failing parent, what test or procedure should they have for themselves, and of course among the most difficult decisions – care at the end of life. This is your future as a physician, embrace it – and feel the privilege that it is to be so intimately involved in the life of another individual.”

He discusses the ongoing ethical issues facing the medical community such as high healthcare and drug costs, special interest groups that place the wellbeing of patients second, and difficulty of decision-making at the individual level vs the population level. He tells the graduates that they will have to face new ethical challenges with the advancement of technology, and must play the role of patient advocate.

To demonstrate the difficulty of managing such ethical issues, Dr. Bauchner shares a personal story of struggle: “I want to tell you a story of my own ethical failing – one that has haunted to me to this day.  I was attending on the wards at BMC – the old Boston City Hospital – and after days of caring for a child with pneumonia who was not getting better, and me resisting the idea of a repeat CxR, the child developed sepsis.  I was notified in the early morning hours at home, his temperature was 104, his WBC had increased to 35K, and a repeat chest CxR showed a large pleural effusion – likely an empyema.  He was whisked off to surgery, the effusion was drained, he was intubated, started on pressors for hypotension, and broad-spectrum antibiotics to cover the suspected bacteria.  I arrived the next morning – immediately went to the ICU – by this time his BP had stabilized, he had responded to the antibiotics, and was about to be extubated.  His parents came up to me and profusely thanked me for saving their child’s life – I stumbled – mentally and vocally – what should I say.  And to this day I feel ashamed, ashamed that I did not say what I should have, but you do not understand – it was my decisions that made your child so sick.

You will face many decisions – perhaps not quite as dramatic as this – that will affect your lives and the lives of your patients.  When do you speak up and when do you remain silent.  The colleague who does too many tests; the health care system that purchases practices so they can charge higher prices for care; the insurance company that blocks appropriate care; the pharmaceutical and device industries that charge prices in the US that are 5 and sometimes 10 times more than anywhere else in the world; and most importantly end of life decisions that you will make with patients and will be influenced by your own religious, cultural, and personal experiences.  You are likely to confront some but not all of these issue next year as a first year resident, but most will find their way into your professional life at some time.  There is no need to wrestle with all of them, since that can be overwhelming, but it is important to understand that these are ethical issues that demand and require much thought and reflection.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/332

About Dr. Bauchner

Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA® and The JAMA Network® in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003-2011). At BUSM he was Vice-Chair of Research for the  Department of Pediatrics and Chief, Division of General Pediatrics. He is a member of the National Academy of Medicine (formerly the Institute of Medicine) and an honorary fellow of the Royal College of Paediatrics and Child Health, United Kingdom.

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The Medical Commencement Archive

“Looking Back and Looking Forward” – Dr. Robert Witzburg, Boston University School of Medicine 2018 Commencement

As a faculty member of the Boston University School of Medicine for over 30 years and current Associate Dean and Director of Admissions, Dr. Witzburg had heard his share of commencement speeches. However, most of those speeches were less-than-memorable. Even when Senator John Kerry came to speak, Dr. Witzburg could hardly recollect the content of his address. Thus, rather than telling the graduating BA-MD class of the BUSM, Dr. Witzburg posed a riddle for them to ponder: “Why am I here today?”

He goes on to ask each new MD to seek out the answer from within – not to look for help from teachers, mentors, or classmates. “Only you can discover your own uniquely personal answer to this riddle. Only you can dig down deep inside, where you keep your most treasured dreams, where you nurture your most lofty goals, where you drop your guard, look in your internal mirror, and face unafraid who you are and who you hope to be.”

Dr. Witzburg ends his speech with what it means to be a BUSM trained physician: “we advance our science with integrity and that we care for our patients with dignity, with compassion, and with respect simply because it is the right thing to do”.

“If you carry this with you into your future as physicians I am quite certain, that you will end your careers as I end mine – believing that you have done well by doing good, taking delight in the fact that you have never had an uninteresting day, nor gone home without having learned something new, and that your work has been, not a burden, but one of the greatest gifts of your life.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/331

 

About Dr. Robert Witzburg

Dr. Witzburg is Professor of Medicine as well as Associate Dean and Director of Admissions at Boston University School of Medicine (BUSM)—a position he has held since 2002. A 1973 graduate of Tufts University, Dr Witzburg received his M.D. from Boston University School of Medicine in 1977. He completed his internship, residency and chief residency in Medicine at Boston City Hospital, and is board certified in Internal Medicine and Geriatrics. Dr. Witzburg has served the Boston community as Training Program Director and Associate Chief of Medicine at Boston City Hospital for 12 years and then as Associate Chief Medical Officer at Boston Medical Center and as the first Medical Director of the Boston Medical Center HealthNet Plan. He was the first Chief of the Section of Community Medicine at Boston Medical Center and Boston University School of Medicine, serving in that capacity and as Vice Chair of the Department of Medicine from 1997-2002. Dr. Witzburg was also a founder, President, and Medical Director of the Neighborhood Health Plan, a community health center-based HMO focused on enhancing the quality and scope of health care services available to vulnerable populations.