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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
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
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