Category: Reflection

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
Clinical Emotion General Humour Lifestyle Literature Medical Humanities Narrative Reflection

On Playing Doctor

An excerpt from “Playing Doctor: Part Two: Residency”

By: John Lawrence, MD

As was her habit, she [the surgical chief resident] had called to check in with a surgical nurse to see how each of her patients was doing. They were discussing each patient when the nurse stopped to mention that there was a code team outside a room on the sixth floor with a collapsed patient.

My girlfriend quickly realized that it was one of her patient’s rooms, then raced back to the hospital, sprinted up six flights of stairs, and dashed onto the sixth floor, where she encountered a chaotic group of people surrounding one of her patients lying unconscious in the hallway.

The internal medicine residents and attending physician running the code were about to shock the unconscious patient because he had no pulse. As we’ve discussed previously, no pulse is bad.

Suddenly, in the middle of their efforts, and much to everybody’s surprise, the 5’1” surgery chief ran up, injected herself into their midst, ordered them to stop, and demanded a pair of scissors.

Nobody moved. The internal medicine attending exploded, wondering who the hell she was and what she was doing. It was his medicine team in charge of the code, and this patient had no pulse. Protocol was shouting for an immediate electric shock to the stalled heart.

Paying little or no attention to his barrage of questions, she grabbed a pair of scissors and now, to everyone’s complete and utter shock, cut open the patient right through the surgery wound on his abdomen.

Let me recap in case you don’t quite appreciate what’s going on: she cut open a person’s abdomen in the middle of the hospital hallway—and then stuck her hand inside the patient!

When the chairman of surgery came racing down the hall, he found his chief resident on the floor wearing a full-length skirt, with her arm deep inside an unconscious patient, asking, “Is there a pulse yet?”

The furious medical attending was shouting, “What are you doing? Are you crazy? What are you doing?”

And she kept calmly asking the nurse, over the barrage of shouts and chaos, “Do you have a pulse yet?”

Suddenly the nurse announced, “We’re getting a pulse!”

Which immediately quieted everyone.

Being an astute surgeon, she remembered thinking that the patient’s splenic artery had appeared weak when they operated on him. She correctly guessed that the weakened artery had started bleeding, and that his collapsing in the hallway was due to his rapidly losing blood internally. She had clamped the patient’s aorta against his spine with her hand to stop any further blood loss.

From the sixth-floor hallway the patient was rushed to the O.R. with my girlfriend riding on top of the gurney, pressing her hand against his aorta, keeping the guy from bleeding to death.

She then performed the surgery to complete saving his life.

The guy took a while to recover. Being deprived of blood to the brain had its detriments; when he awoke, he was convinced the 5’1” blond surgeon in the room was his daughter. When he was informed that no, she wasn’t his daughter, he apologized, “Sorry, you must be my nurse.” That comment, one she heard all too frequently, did not go over well.

To put this somewhat crazy event into perspective, within a day or two, the story became the stuff of legends told throughout surgical residencies across the country—and this was before social media sites existed to virally immortalize kitten videos.

Opening a patient in the hallway and using her hands inside the guy to save his life? This feat, treated by her as nothing more than a routine surgical moment, was akin to knocking a grand slam homerun in the ninth inning of the World Series in game seven to win the game—well, something like that. It’s what little kid wannabe surgeons would dream of if they cultivated a sense of creativity.

And to be fair, I thought it was an exciting episode, but she was always running off to save lives as a surgeon. The moment however, that finally put this accomplishment into perspective for me occurred when I was having dinner with her brother, the ace of aces surgeon, along with several other all-star surgical resident friends. This was a few weeks later, and without her present.

Eventually their surgery discussions (because that is pretty much all that this group of surgeons discuss when stuck together: surgery, ultra-marathon running, and more surgery) turned to loudly bantering back and forth about the whole event.

They boisterously argued about how much better they would have handled the whole situation, and wished they had been there to save the day instead of her:

“You dream of something like that going down.”

“Can you imagine being that lucky?”

“Should have been me.”

“Oh man, I would pay to have something like that happen.”

All the young surgeons agreed that this was their medical wet dream, being the rebellious action hero, on center stage, in such a grand case, in the middle of the hospital, no less, calmly saving a life in front of everyone with attending physicians yelling at you.

Then there was a moment of silence, total quiet as everyone reflected on the event…

“But you know what?” her brother finally said, looking around at everyone, then shaking his head and chuckling, “I never would have had the balls to do it.”

And every single surgeon around the table slowly nodded their head in agreement—they wouldn’t have either.

True hero.

Playing Doctor: Part Two: Residency is a medical memoir full of laugh-out-loud tales, born from chaotic, disjointed, and frightening nights on hospital wards during John Lawrence’s medical training and time as a junior doctor. Equal parts heartfelt, self-deprecating humor, and irreverent storytelling, John takes us along for the ride as he tracks his transformation from uncertain, head injured, liberal-arts student to intern, resident and then medical doctor.

Categories
General Global Health Healthcare Disparities Innovation Public Health Reflection

A Call to Action: The Unified Front of #Students_Against_COVID

Beyond borders, beyond languages, and beyond our differences students across the world have united with a common purpose to serve and create a positive impact. With over 1000 students comprising more than 90+ countries, #Students_Against_COVID, a grassroots movement has served as the cornerstone for creation, purpose, fulfillment and fostered collaborations throughout the world allowing students to join forces in the fight against the COVID-19 pandemic.

#Students_Against_COVID Volunteers, Friends & Family

The Power of Technology

The Spanish Flu or the 1918 pandemic over 100 years ago, vastly differs from the COVID-19 pandemic due to the availability of technology. Since then, there have been many advancements with new medical equipment and instruments to care for patients. Many cures for diseases or drugs that were impossible decades ago are now a reality due to the hard work and diligence of researchers in finding answers to the centuries’ old medical mysteries. During the Spanish flu pandemic, scientists could hardly imagine elucidating the nucleotide makeup of the virus, but with the advent of polymerase chain reaction (PCR) half a century later, in today’s technological landscape, within 2 weeks of a global emergency scientists were able to determine the sequence of the coronavirus genome. Within seconds, a text message from South Africa is transferred via the internet to Canada, and as such the spread of information and misinformation has appeared to be an added pandemic, namely the infodemic of the century.

Objectives of SAC, the Grassroots Movement

One of the core objectives of SAC in tackling the infodemic and the pandemic, has been to disseminate trustworthy information as quickly as possible and in as many languages to reach minorities, villages and people far away. From Pashto in Afghanistan, Turkish in Turkey, German in Austria, Hausa in West Africa, Yoruba in Nigeria to Lugada, the most prestigious language in Uganda, “the Pearl of Africa”, students have translated different COVID-19 campaigns.

Social Media Campaigns Translated

The objective of the Global Health & Social Media Team has been to echo public health guidelines to stop the transmission of the infectious disease and to encourage those with symptoms of COVID-19 to seek medical assistance. Despite the socio-economic challenges for many without access to the internet, the major global health challenges the international community face will require an integrated, interdisciplinary approach addressing the political, cultural, legal, biological, and medical issues. Therefore acknowledging the role of technology in tackling the ongoing pandemic the team aims to eliminate avoidable disease, disability and death, while serving as an avenue of health promotion and disease prevention.

Blood Donations Campaign

As such, important values, such as altruism, service in times of crisis, and solidarity with people around the world offered the chance, or opportunity of a lifetime to participate in the fight of this historic pandemic. Stemming from leadership’s most fundamental element to create a difference in the lives of others SAC therefore provided students with a platform to unleash their creativity and innovation necessary to navigate a crisis and to emerge from it healthy.” by Leah Sarah Peer

Additionally, with increased reliance on virtual platforms for connection and socializing, telehealth technologies for consultations, counseling sessions and physical examinations, physicians have been able to continue providing care while maintaining social distance. Similarly, educational institutions have transitioned to online remote learning where students and professors meet over interactive technologies such as Zoom and Google Meets for lectures. Medical students especially have had their clerk-ships suspended without direct patient contact while others have graduated early to serve as front-line clinicians. In this manner, technology has defied space and time, as it has not only exposed the fragility of humanity but also proved that technology is an integral part of our future evolution.

Women’s Health Team

A Spark of Creativity & Innovation

With more free time for students, as the usual commutes to school, scheduling of classes and extracurricular in person activities were all cancelled they were able to invest in themselves and even develop new hobbies. Within SAC, it was evident that despite the negative impacts on medical education, these exceptional times represented opportunities for change. Such an example is that of the Clinical Resources Team, that curated a database of clinical resources for health professionals to access COVID-19 & medical information. This volunteer experience among many highlighted the value of non-graded elective courses in furthering student’s knowledge while allowing them to participate in a movement greater than themselves. As such, important values, such as altruism, service in times of crisis, and solidarity with people around the world offered the chance, or opportunity of a lifetime to participate in the fight of this historic pandemic. Stemming from leadership’s most fundamental element to create a difference in the lives of others SAC therefore provided students with a platform to unleash their creativity and innovation necessary to navigate a crisis and to emerge from it healthy.

Besides making a difference, SAC provided a sense of community where friends soon became family. In isolation many were reminded of our collective values and collective history, emphasizing society at large rather than individual self-interest.

The Mental Health Team sparked the beginning of students inspiring one another, of sharing their own stories as well as becoming listeners as a crisis naturally triggers a range of physiological and psychological responses that are heightened under lock-down. The earlier trauma and abuse students faced often resurfaced as the lost sense of normalcy triggered grief with feelings of denial, anger and depression.

Women’s Health Team Activities

Bearing the consequences in mind, the Women’s Health Team of SAC drafted up a list of domestic violence hotlines per country for individuals afflicted by domestic violence. To them, having access to these resources during quarantine was vital and therefore have further created campaigns on sexual health, reproductive rights, maternal health and “The Period Project”, all aiming to raise awareness for the challenges girls and young women are faced with. Passionate about women’s health, to commemorate international breastfeeding week, educational material was prepared celebrating womanhood while promoting access to skilled breastfeeding counseling. 

Advocating for Vulnerable Populations

Nonetheless, the #Students_Against_COVID community rarely sleeps and while students are taking care of themselves, and those around them, they are also actively advocating for vulnerable populations.

The Asylum Seeker’s & Refugees initiative within SAC aims to raise awareness about the predicament of minorities by creating infographics, and posters. Furthermore, underway is the curation of a database of World Organizations & Charities for donations so that donors have access to places where their funds are needed and may be used wisely. In a catastrophe such as that presently in Lebanon, the database gathers recognized Lebanese Non-Governmental Organizations (NGOs) providing humanitarian aid and emergency relief.

https://twitter.com/zohaasghar16/status/1294311683150815232?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1294311683150815232%7Ctwgr%5E%7Ctwcon%5Es1_c10&ref_url=https%3A%2F%2Fwww.voicesofyouth.org%2Fnode%2F25666
Co-Leads of the Asylum Seekers & Refugees Initiative Shedding Light on the Yemen Humanitarian Crisis

Additionally, bearing in mind the challenges of the COVID-19 pandemic, the team recognizes the plight of refugees suffering from human rights violations. Whether  forced to leave their homes, their communities and their families, to find safety in another country, the Asylum Seekers & Refugees Team within SAC abides by the Universal Declaration of Human Rights (UDHR) to assure all human beings are treated with respect and dignity. Since, by definition, refugees are not protected by their governments, the international community steps in to ensure the individual’s rights and physical safety while monitoring and promoting respect for refugee rights. Although the newest edition to #Students_Against_COVID family, the team’s aim is to strengthen and broaden public information, education and involve members of the civil society in refugee, asylum seekers and migrants protection.

Asylum Seekers & Refugees Initiative Team’s Showcase Saturday

Reflecting on the Past Year & Moving Forward

Recognized for it’s positive contributions internationally, #Students_Against_COVID was awarded the Pollination Project grant, won 1st place in the DICE Foundation COVID-19 Innovation Challenge, as well as the 2021 CUGH Pulitzer Prize for Highest Impact Project, Video Submission.

#Students_Against_COVID Global Health Program
Besides these accomplishments, currently in the works and set to launch late spring to early summer 2021, is the creation of a unique, Global Health Program: An interdisciplinary Overview. It’s aim is to cultivate a better understanding of Global Health amidst the COVID-19 pandemic and the program hopes to connect global health enthusiasts from around the globe, introducing students and young professionals to critical global health issues and ways to address or solve them.
Happy New Year 2021 – A Recap & Reflection of the Movement

As the crisis evolves, compassionate leadership entails the unified efforts of changemakers championing science in both local and international theaters. Although words may not adequately serve to express the work and dedication of this virtual agora, pushing boundaries to inspire, help and motivate people is at the centre of the #Students_Against_COVID movement!

To join SAC or to become a part of this ever expanding network of motivated youth, check out our website, find us on Instagram, Twitter, Facebook, LinkedIn, and Youtube.

About the Author

Leah Sarah Peer is a medical student at Saint James School of Medicine in Chicago and a graduate of Concordia University, Specialization in Biology, Minor in Human Rights in Montreal, Quebec, Canada. As a Core-Facilitator within Students_Against_COVID, Leah aims to foster belonging and inclusion to unify the movement and compassionately strives to empower others to make a difference.

Categories
Community Service Emotion Empathy Global Health Healthcare Disparities Innovation Medical Humanities Patient-Centered Care Public Health Reflection

Beyond Medicine: The Peer Med Podcast, Serving Humanity !

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.” – Voltaire

The covid-19 pandemic has claimed millions of lives, shut down economies, restricted movement and stretched our healthcare systems to the edge; but despite this time of destruction, Peer Med, a podcast dedicated to serving humanity was born! Established as a platform for creation, innovation and above all a platform for unity.

A student-led initiative of the Peer Medical Foundation, the Peer Med podcast intertwines medicine, an ever changing science of diagnosis and treatment, with conversations about issues in healthcare where lives are on the line. Due to the fashionable focus of medical education on biology, pathology and disease there has been a reduced emphasis on the social determinants of health. As such physicians lack an empathetic character understanding the human aspect of medicine and in this, fail to communicate effectively rendering patients dissatisfied with care.

Seeing the need for more fruitful discussions, the Peer Med Podcast provides listeners with a more nuanced interpretation encouraging health professionals to look beyond medicine and into the experiences, values and beliefs of patients to assure a successful therapeutic relationship. It serves as a reminder of the importance of self-determination, beneficence, non-maleficence and justice as medicine naturally exposes health professionals to the darker side of human existence. The podcast explores these themes by delving into the underbelly of life where homelessness, drug addiction, abuse, trauma, and death are brought to the surface of conversations. It takes the already prevalent cases of strokes, pneumonia, heart attacks, fractures, and miscarriages from the everyday scenarios in emergency rooms plaguing our species and encourages a more humane outlook amidst all conflict and chaos.

“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”

– Voltaire

Founded on March 24th at the start of the COVID-19 pandemic, Peer Med is dedicated to humanity and the millions of people worldwide without access to education, health and water, sanitation and hygiene (WASH) services. The podcast aims to inspire, engage and promote action to solve challenges in global health, human rights and medicine. Acknowledging that the delivery of healthcare requires a team effort, the podcast invites everyone from clinicians, advocates, economists and even comedians to delve into the subjects of medicine. While peer-reviewed information is important, not all valuable work belongs in an academic journal. In order to strengthen health systems a multidisciplinary set of perspectives is required to teach and inspire people. Therefore, Peer Med encourages dialogue so that all listeners may raise their voices advocating for humanity.

Ensuring Peer Med is truly a global podcast is the goal but despite the best intentions to ensure inclusivity, barriers in terms of gender, language, and access prevent this from happening. To tackle the problem, Peer Med aspires to invite speakers from all corners of the world, not only to assure equitable representation but to also gain advice on how to empower those in low-and-middle-income-countries (LMIC) so that their voices may be heard. In serving humanity, Peer Med is completely free and available on a variety of platforms aiming to leave listeners refreshed, empowered and motivated to effect change. These can be heard from a mobile phone, shared via social media, or played for a friend. The conversations will leave listeners burning with a flame in their hearts to do their utmost on life’s quest to serve humanity.

It serves as a reminder of the importance of self-determination, beneficence, non-maleficence and justice as medicine naturally exposes health professionals to the darker side of human existence. The podcast explores these themes by delving into the underbelly of life where homelessness, drug addiction, abuse, trauma, and death are brought to the surface of conversations. It takes the already prevalent cases of strokes, pneumonia, heart attacks, fractures, and miscarriages from the everyday scenarios in emergency rooms plaguing our species and encourages a more humane outlook amidst all conflict and chaos.

Leah Sarah Peer

The support for the podcast has been humbling as love has poured in from around the globe. So many are keen on sharing their stories and this speaks volumes to the passion of the podcasts’ guests, their enthusiasm and commitment to mankind. Some have included a world renowned speaker and human rights champion, a Brooklyn-based singer, songwriter, teacher and PhD candidate in Comparative Literature, a range of student initiatives – Meet the Need Montreal, Helping Hands, to Non-profit Organizations such as Med Supply Drive and so many more.

World-Renowned Humanitarian & Neuroscientist, Abhijit Naskar

If there is something the COVID-19 pandemic has taught us, it’s the power of community and compassionate care’s strength in uniting us across the world. Peer Med hopes to serve as a medium for inspiration, for reflection, and invites people from across the healthcare spectrum to come together committed and dedicated to serve humanity.

To listen to Peer Med, visit Spotify, Apple Podcasts. To read about the individual episodes visit the website for more.

Categories
Empathy General Medical Humanities Opinion Reflection

Visual Arts as a Window to Diagnosis and Care

With the rapid advancement of knowledge and technology in medicine, physicians alienate themselves from the core purpose of their profession. A grounding in the humanities as well as a strong foundational basis understanding the medical sciences is required to establish well-rounded physicians. Art inspires medical students and physicians to observe detail they otherwise wouldn’t. With patients in the emergency room, before any physician-patient interaction can occur, the sounds of bilateral crackles, the sight of neck muscles contracting and of the nostrils flaring indicate a patient in respiratory distress. This very detail in observation is needed for split-second decisions of utmost importance in the emergency theatre.

Art is the projection of our experiences, memories and has the power to record reality and fantasy. These altogether add to the artistic memory of an artist and allow them to add adaptations based on their life’s observations. Artists have captured the human body through the pursuit of conveying human experience, of the human’s appearances, shapes, and sounds all reflecting their state of health. Artists must see the details of a picture and reproduce it, and only once they’ve mastered observational art can they move on to more abstract forms conveying emotions of the real world.

When dissections were forbidden centuries ago, artists together with doctors snuck out to examine human corpses for a closer look. This was important for them to accurately reproduce representations as they not only had to know the inner workings of the human body just as physicians did but they needed the eye for their artistic creation. Unfortunately, today the acquisition of life-drawing skills has lost its traditional importance due to increased demands for the more conceptual art forms.

In medicine, observational skills provide insight into a patient’s problem.  From observing, not only do we see it as is but we recognize patterns, are able to analyze context and make connections. Despite knowing everything about a disease or illness, learning how to see pathologies, and diagnostic criteria is important to avoid missing all the signs. The four steps of physical examination are inspection, percussion, auscultation and palpation. Inspection or observation is often overlooked but is so crucial to patient care and treatment as is to the creation of art.

The artwork of Piero di Cosimo, A Satyr Mourning over a Nymph (1495) depicts a young woman killed accidentally during a deer hunt by a spear. Upon analysis of the painting and deep observation, evident is that there is no spear wound but instead the women’s arms are covered with long cuts as if acting in self defense from her assailant. Her left hand additionally is placed in position with her wrist flexed and fingers curling inwards known as “waiter’s tip”. Fundamentally at large, di Cosimo used the girl’s corpse as a model and because as an artist he had no understanding of medicine and injury, he portrayed exactly what he saw. Unintentionally, he captured the girl’s true injuries dictating to a medical practitioner the likely theory of the young woman’s actual cause of death.

A Satyr mourning over a Nymph by Piero di Cosimo
https://www.nationalgallery.org.uk/paintings/piero-di-cosimo-a-satyr-mourning-over-a-nymph

Appreciation for paintings by physicians even reveal medical diagnoses given the structural facial characteristic changes that occur in different diseases. The Old Woman by Quinten Massys depicted an exaggerated ugliness due to the pattern of facial deformations; bossing forehead, prominent cheekbones, enlarged maxilla and increased distance between the mouth and nose all consistent with leonine faces of Paget’s disease stemming from accelerated bone remodeling. Another example is that of Peter Paul Rubens, The Three Graces, displaying symptoms of benign hyper-mobility syndrome, an autosomal dominant disease. Scoliosis of the spine, a positive Trendelenburg sign and double jointedness as well as lax upper eyelids is evident in the artists painting.

Fascinating nonetheless is that the medical diagnoses in both paintings were unknown to doctors at that time. Paget’s Disease and benign hyper-mobility syndrome were discovered just a couple years ago while these paintings existed long before them. 

Compared to artists however, doctors have stopped putting their skill of inspection into practice and with all the expensive tests available to help doctors make diagnoses, the necessity of individual, physician observation has decreased. Thus raises a question, will the dependence on tests rather than investigation through the senses define the future of medicine?

As medical students, this urges us to hold true to the art of observation. Technological advances were directed to improve patient care and not impede the physician-patient relationship. The personal touch of a doctor and the direct communication through movement, and language has been lost. Remembering the feelings of our patients allows us as future physicians to be mindful that no patient manifests the same way despite presenting with the same disease. Neither are patients aware of the manifestations of disease and overtime naturally adapt to the abnormal posture, gait, and lifestyle changes often overlooking the skin changes, mood or weight fluctuations.

When doctors are trained to “see”, observe and infer from signs alone a basic diagnosis, will they understand the whole human being. Therefore, arts education in medicine helps humanize science and connect medical theory into the patient’s journey. In analyzing art pieces, students are able to connect clinical skills and improve their ability to reason with the physiology and pathophysiology of the human body from visual clues alone causing them to become more emotionally attuned to their patients and aware of their own biases as physicians.

The skills of observation requires improvement and practice from physicians to both diagnose and understand the underlying concerns of a patient. Only when doctors have mastered the art of observation and trained their eyes to truly see, will they ultimately return to a world of greater human connection in medical practice.

References
McKie R. The fine art of medical diagnosis. The Observer. 2011 September 11;Culture. 
Berger L. By Observing Art, Med Students Learn Art of Observation. NY Times. 2001 January 2;Health
Christopher Cook. A Grotesque Old Woman. BMJ 2009;339:b2940
Dequeker J. Benign familial hypermobility syndrome and Trendelenburg sign in a painting “The Three Graces” by Peter Paul Rubens (1577–1640). Annals of the Rheumatic Diseases 2001 September 01;60(9):894-­‐895.
Pecoskie T. Improving patient care with art. The Spec. 2010 December 2;Local. https://www.mcgill.ca/library/files/library/susan_ge_art__medicine.pdf

Categories
Emotion General Medical Humanities Opinion Reflection

Wallflower

Wallflower by Janie Cao
Edited by Mary Abramczuk

Two Novembers ago, I decided to try painting again. At that point, I had been studying medicine for a little over 2 years. After browsing YouTube’s collection of painting tutorials, I found one that seemed realistic for me. It was a still life of roses.

There's a common saying--  "stop and smell the roses." Have you heard of it? It suggests a world that is riddled with roses. I wish that was the world we lived in.

In those years being surrounded by scientific medicine, I think I was learning this: sometimes by the time you arrive, the roses have all been picked. Then it's up to you to create beauty, again, from the ashes.

Wallflower by Janie Cao // 11.24.2016

PC: TonalLuminosity

Categories
Emotion General Global Health Healthcare Disparities Interview Narrative Reflection

Out There: Part 1 (An Interview Series)

Trimbekshwar Temple
Out There: Part 1

By Janie Cao
Edited by Mary Abramczuk


I met Thanos Rossopoulos through a community service leadership program. As with almost everyone I’ve met, I stereotyped him at first glance (subconsciously, of course). I thought that he was going to be like most other first-year medical students I’d met before—smart, hardworking, and…pretty fresh from college. And guess what? I was only mostly right.

The first time I heard him share his story, we were at a group dinner. I was sitting too far away to hear everything but at the perfect distance to want more. He said something about ‘7 gap years,’ the oil and gas industry, and living in India. That was enough to nag at my curiosity, so I unashamedly asked for an encore. He graciously obliged.

Like many people in their early twenties, Thanos wasn’t quite sure what he wanted to do with his life when college graduation arrived too soon. He remembered that at the time, he’d just wanted to do something exciting, something risky, something “radical.” So when they offered him an engineering job that would put him in the oil rigs of India for one and a half years, he said yes. There, for the first time in his life, Thanos stared into the glare of deprivation. Not really what he wanted, but perhaps what he really needed.

Growing up in Orange County, California, he had been raised in a privileged “bubble,” as he called his sheltered childhood. But he didn’t know how sheltered he was until he stepped foot into India, where he saw mansions and slums coexisting side by side, all in broad daylight. “It took India to force me to face inequality,” Thanos reflected, “and it didn’t sit with me well.” What he made sound like ‘just a slightly uncomfortable feeling’ was in fact the beginning of a tenacious zeal to alleviate human suffering. He was a tad modest.

The impact of those years in India manifested powerfully after he returned home. Whereas in the past, he did not even know to look for inequality, now that was all he could see around him. So, what did Thanos do next? What would you have done?

To be continued…

--------------------------------------
Photo Caption: "...Taking a stroll in the morning before my shift on the oil rig. If you look closely out in the distance you see the top part of the oil rig I worked on behind the trees. This was from a small village called Radhapur in the state of West Bengal. Very beautiful place." -Thanos Rossopoulos
Categories
Emotion Empathy Narrative Poetry Reflection

When Love Gives Way to Lies

When Love Gives Way to Lies
By Janie Cao
Edited by Shaun Webb
One evening on my way back from a hospital shift, I saw a woman staggering along the street. Half walking… half falling… It looked like she was trying to get back home after spending some time at the nearby bar.

I didn’t know how I was supposed to respond as an almost-doctor. But it didn’t feel quite right to just leave her be, especially when she was drunk and in the dark, all alone.

By the time I drove to her, she was already in the parking lot of her apartment complex. I got out anyways, just to say “Hi.”

I remember when she turned and looked at me. She paused. And in those moments of silence, I saw heartache.  There was also sadness, anger, and a pain that would leave marks. It didn’t matter that she didn’t know me enough to trust me. There was too much hurt to hide. As I watched her eyes, I remember wanting so much to stop her from feeling that night.

Finally, she chuckled and smiled bitterly. “My husband…” she said. Then she gave me a kiss goodbye.

She never finished her sentence, but I wonder if it had something to do with this: that when a husband hurts his wife, and love gives way to lies, it can simply be called life. I went home after, and cried.

----
based on a true story

Photo credit: Bernard Laguerre



		


	


	

		
		


			

		


		
	


	






	



	


		
			

				Categories
				

					Emotion General Literature Palliative Care Poetry Reflection Spirituality				

			


			
Smiling Rust

		


			

		


		
	





	


		


			
		


	


	
	


		


			
Smiling Rust
By Janie Cao
Edited by Mary Abramczuk


My grandpa used to be a particular quirky smile.

He was once a certain amused sigh.


But nowadays, at visits I pay

He’s a bag of dust— hidden behind marble and rust.


On those days, I am truly glad

That I believe in more than what passes the eye.


-----------------------------
Photo credit:lavagirl66


		


	


	

		
		


			

		


		
	


	






	



	


		
			

				Categories
				

					Clinical General Healthcare Costs Opinion Patient-Centered Care Reflection				

			


			
Excellent, good, or fair? How accurately can patient satisfaction surveys measure quality of care?

		


			

		


		
	





	


		


			
		


	


	
	


		


			
Last week I had my semiannual dentist appointment. Right after I stepped out the door, I received an email: Dental Office – Patient Satisfaction Survey. Hi, thank you for visiting the dental office. Please take a minute to complete the survey…. Was it a déjà vu? Didn’t I just fill this out recently? Oh wait no. That was for the hygienist? Or was it for that new periodontist? Maybe it was my other specialists?


So besides rating my favorite restaurants and shops on Yelp and Google, now my clinics and insurance companies also want to know how I would rate my doctors– how splendid!


To my surprise, when I clicked the link, the questions were trickier than I expected. According to the email title, it seemed like the survey was about my dentist, but 75% of the questions were about the clinic itself: Waiting time in reception area, appointment phone call answering friendliness, waiting room neatness, office decoration….(Wait…my dentist is responsible for decoration? Great, let’s talk about changing the interior lighting and repainting the wall at the next appointment). As I was filling out the questionnaires, my head started to spin with my own questions: It was a normal checkup appointment, will “fair” be good enough? But I remembered I had given the hygienist an “excellent,” and honestly I couldn’t tell which one was better…oh boy! How are they going to use my answers? Who will be reading my survey responses? Who will be affected by my answers?


To me, it’s difficult to judge the doctors’ performance fairly. I can measure a finance manager by his portfolio performance, a designer by how many designs have been ordered, and a lawyer by how many lawsuits she has won. But judging a doctor is more like judging a piece of artwork: there’s a lot of subjectivity. How do I know Dr. ABC is better than Dr. XYZ? By my test result? Or by the number of medications they prescribe? Like with my dental visit, I couldn’t really tell the difference between that cleaning from the previous ones. Interestingly, some physician groups use patient satisfaction surveys to allocate bonuses [1]. That would make the weight of responsibility seem heavier; I would hate to find out that my dentist lost his Christmas bonus because of my thoughtless answers.


Needless to say, it’s difficult for management to evaluate every department and employee in a large organization. I truly hope that upper management does not blindly rely on this “big data” to determine a doctor’s career path. I would very much like my doctor to focus on my health, instead of for him or her to be driven by monetary incentives and to act as a salesperson. If the survey data is used for allocating the budget, perhaps the survey needs to be transparent about how the clinic is going to use the result: “This survey is for quality training purposes only” or “this survey is for determining the best doctor of the month and who gets the nearest parking spot.” I suspect that knowing the purpose of the survey helps the respondent think twice before jotting down comments or complaints. It might motivate patients to actually finish the survey (I would very much like to meet the saintly soul who is able to finish 30 ambiguous questions without losing their temper). Also, I would like to suggest that since we are giving patients such power, perhaps we can give some power to the physicians too and allow them to rate their patients (like how Airbnb and Uber lets hosts/drivers grade their guests/riders).


Surveys and ratings can be important sources of information. If I need to find a new doctor or specialist, the first thing I do is go on Yelp and sort the list by how many stars they have. Some industries routinely rely on survey systems to improve their customers’ experiences [2].


I understand that the idea behind patient satisfaction surveys is to encourage more communication. But at the end of the day, I believe that the doctor and the patient should have a strong mutual trust that enables them to communicate and give feedback freely and respectfully, without needing to rely on 30 ambiguous survey questions.


 


Reference:


    

  1. White, B. (1999, January 01). Measuring Patient Satisfaction: How to Do It and Why to Bother. Retrieved April 17, 2018, from https://www.aafp.org/fpm/1999/0100/p40.html
    2. 

  2. Columbus, L. (2018, April 22). “The State of Digital Business Transformation, 2018.” Retrieved April 25, 2018, from https://www.forbes.com/sites/louiscolumbus/2018/04/22/the-state-of-digital-business-transformation-2018/#761f84535883
    3. 







Edited by Shaun Webb


Photo credit: Steve Harris


Special thanks to Blog Associate Editor, Janie Cao, for some last-minute content revisions


To learn more about the author, please visit her website here