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General

“Where There Are Challenges, There Is Huge Opportunity” Dr. Paul Klotman, 2015 Commencement Address of the Baylor College of Medicine

This week, Dr. Paul Klotman’s 2015 Commencement Speech at the Baylor College of Medicine entitled, “Where There Are Challenges, There Is Huge Opportunity” debuts via the Medical Student Press.
Dr. Paul Klotman began serving as President and CEO of Baylor College of Medicine in 2010. He
received his Bachelor’s degree in 1972 from the University of Michigan and his M.D. from Indiana University in 1976. He completed his medicine and nephrology training at Duke University Medical Center. In 2001, he was selected to be the Chair of the Samuel Bronfman Department of Medicine of the Mount Sinai School of Medicine. The BCM Board of Trustees named him as the school’s new President in July of 2010.

Dr. Klotman’s research has been a blend of both basic and clinical research in molecular virology and AIDS pathogenesis. He developed the first small animal model of HIV-associated nephropathy using transgenic techniques. He is on the editorial boards of journals in both the United States and in Europe and he has served on and chaired numerous study sections including those from the NIH, the American Heart Association, the National Kidney Foundation, and the VA research service.

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At Baylor College of Medicine, he oversees the only private health science university in the Greater Southwest, with research funding of nearly $400 million. The medical school is ranked as one of the top 20 for research by U.S. News & World Report and first among all Texas colleges, universities and medical schools in federal funding for research and development.

 

Dr. Klotman begins his address by jumping right into the topic of ethical consequences when medical expenses influences treatment options:

“How do we measure it and how do we make sure we do the right thing even if it costs more? …All this sounds good but unless we deal with the costs of intervention and the costs of end of life care, we will struggle to bend the cost curve significantly.”

He further discusses the continued issue of the uninsured poor, despite government and local changes, and the graduates’ role in being catalysts of improving the opportunities that the underserved have in attaining medical care:

“But where there are challenges, there is huge opportunity. And the opportunities in health care have never been greater. Whether it’s new approaches to the discovery of drugs, transformational technologies to expand access to or delivery of care, or novel ways to approach the health of populations, the opportunity to innovate and transform has never been more apparent.”

Click here to read Dr. Klotman’s full speech.

Categories
Emotion Reflection

The Power Of Crying

Last week, we started a class called “Death and Dying” (doesn’t it sound fun?).  Jokes aside, this class is a valuable component of the medical school curriculum. Physicians deal with death on a regular basis—some every day, and others every hour. During one of our discussions about a patient, a small tear rolled down my cheek. I quickly wiped it away in embarrassment, pinched myself to “get my act together,” and hoped no one had seen. Later that day, I wondered what would have happened if another student had seen me almost cry? Would their opinion of me change?

I am a “crier.” Not when I am faced with my own struggles, but when those I love go through happy or sad times, that’s when the waterworks kick in. This has me worried. I know that crying is seen as a sign of weakness. Some would even call it unprofessional, and I can’t blame them. Our profession teaches us to set personal and emotional problems aside. But what happens when our profession is the cause of these emotions?

A recent discussion we had in class answered my questions. It turns out that crying is okay. Of course, this does not mean we should break down every time a patient has to spend an extra day in the ED, but it does mean we can be vulnerable in a highly professional setting. One of the pediatric oncologists shared a special patient experience with us. She had always shied away from crying in front of her patients. However, one day after a family had received especially disheartening news, she unintentionally teared up in the clinic room. This was well received by the patient’s family—the patient’s mother told her, “It let me know you cared.” From that point on, the physician’s relationship with the family was altered—an unbreakable, unspeakable bond was formed.

This alleviated a few of my fears concerning the display of raw emotion. We are in a profession where humans care for other humans. It is natural to cry. In fact, we become physicians because we deeply care and love others. Showing this empathy is not a sign of weakness—it is a sign of power.

Yet, there are some important points to remember about crying. Though releasing a few tears is okay, you cannot become a mascara-stained mess.

  1. Your tears have to come naturally. These tears are symbols of your love and devotion. They signify your raw, genuine emotion. Don’t cry to make yourself closer to a family.
  2. You still need to be strong for your patients and their families. You want to be able to process and deliver information to them in a calm, collected way.
  3. You do not want to cry and then have your patients feel they have to comfort you. You are their robust pillar of support! They should be leaning on you for guidance and comfort—not the other way around.
All in all, I am happy to have realized that watery eyes in the clinic will not make me a pariah. Crying, like all aspects of medicine, has to be motivated by your candid empathy. Only then can it be powerful.
Featured image:
A Single Tear by Lauren C
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General Mentorship MSPress Announcements

“Going Forth with Compassion” Dr. Ruth Lawrence, 2015 Commencement Address of the University of Rochester School of Medicine

This week, Dr. Ruth Lawrence’s 2015 commencement speech at the University of Rochester School of Medicine and Dentistry entitled, “Going Forth with Compassion,” debuts the Medical Commencement Archive. This address was a personal favorite to read and a great reminder for those of us still studying in our medical school caves, as well as those starting their life in residency.

Dr. LawrenceDr. Ruth A. Lawrence, MD, is a graduate of Antioch College and the University of Rochester School of Medicine and Dentistry. She is a pediatrician, clinical toxicologist and neonatologist. She is Professor of Pediatrics and Obstetrics and Gynecology at the University of Rochester School of Medicine and Medical Director of both the Ruth A. Lawrence Poison and Drug Information Center and of the Breastfeeding and Human Lactation Study Center. She became the Director of the Poison Center at the University of Rochester in 1958 and wrote on the management of household poisonings with Dr. Robert Haggerty, Chair of the Department of Pediatrics and former Director of the Boston Poison Center. She has been a member of the New York State Association of Poison Centers since its founding and has served as its President twice. In 2002, Dr. Lawrence received the Life Time Achievement Award from the American Academy of Clinical Toxicology.

Dr. Lawrence begins her speech with the almost-intimidating reality of graduating from medical school:

“You are about to embark on the most challenging year ever.  Medical school pales by comparison because before you were the student, you were there to learn but it was someone else’s responsibility.  In a few weeks, you will be the doctor of record, what you do may save a life, solve a problem, or change the course of an illness.”

She reminds the class that despite the advances in technology, treatment plans and hospital protocols, and despite the efficiency of a quick reference to “Google,” nothing will ever replace the significance of simply listening to your patient and being compassionate.

“The key to being a good doctor is to really care about your patient.  The science will come and go, but the best doctors understand people, REAL people, and are good communicators. Listen when patients talk, listen completely.”

Dr. Lawrence concluded by reciting a short quote:

The purpose in life is not to be happy, it is to matter

To be productive and responsible

To be honorable

To be dedicated to goals higher than self

To have it make some difference that you lived at all.

Click here to enjoy Dr. Lawrence’s full address.

Categories
General Opinion

You don’t belong here; are you even a real doctor?

Disclaimer: This is written with the sole purpose of increasing awareness.

Rare things are valuable.  They stand out.  They generate intrigue.  However, they can also make people apprehensive.

There is a misconception that naturopathic doctors are quacks who couldn’t get into “real” medical school, and don’t know what they’re talking about. But there is a big difference between naturopaths (online certification) and naturopathic doctors (four years at an accredited institution). At age 23 I had been to nearly 20 different MDs and was ingesting 10 different medications each day until I saw a naturopathic doctor (ND) who turned everything around. Not only did my health change, my career choice did as well.

Naturopathic Medicine is a distinct primary health care profession that combines natural healing techniques with modern science.  It is a whole-person approach tailored to each patient and focuses on finding the root cause of the health issue. NDs are well versed in treating chronic illnesses and emphasize preventative medicine, but can also aid in acute care. By combining natural healing methods with modern scientific principles and technology, naturopathic medicine genuinely embodies modern integrated health care.

There is a time and place for everything. NDs are trained to know when referral or higher intervention is needed. It is time to erase the battle lines because the “us versus them” mindset is not beneficial to patients. Furthermore, MDs and NDs are more similar than it may seem.

We all have the same ability to heal and treat our patients. Although the manner in which we go about treating our patients may be different, we are all trained in basic and clinical sciences, including biochemistry, anatomy, physiology, pharmacology, and even minor surgery. NDs have additional training in nutrition, botanical medicine, and counseling, while MDs have added training in pharmacology and more clerkship hours. Both cohorts complete clinical training and take board examinations in order to become licensed professionals.

We have similar struggles. We sit through hours of classes only to go home and study until we fall asleep. We sacrifice our social lives for our scrubs. We are more up to date on the latest neuroanatomy YouTube videos than we are on episodes of Game of Thrones. We go home at the end of the day smelling like dead bodies and bodily fluids.

But aside from these things, we have the same end goal. We are all detectives, trained to combine history, lab tests, imaging and physical examinations to understand the patient. While NDs typically don’t advocate drugs at the first sign of trouble, we are still trained to prescribe them.

There is an underlying assumption that only pharmaceuticals are “real” medicine, while nutrition, exercise, and lifestyle interventions are “fake” medicine. In actuality, real medicine is whatever works, and the most important aspects of patient care are things that cannot be quantified or measured, but can instead be conveyed and experienced.

Partnerships require a lot of work. Nonetheless, patients need and deserve the services of both MDs and NDs.  Therefore, we should work to understand and respect each other’s profession.  Our skills complement each other and by working together our patients will receive the greatest benefit.

Featured image:
Apple for Health – Apple with Stethoscope by Wellness GM

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General MSPress Announcements

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

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

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

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

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

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

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

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

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

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

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

Categories
General Lifestyle

Coffee

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

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

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

Featured image:
cup of coffee by cactusbeetroot

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MSPress Announcements

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

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

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

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

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

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

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

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

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

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

Categories
General Reflection

Can Empathy Be Taught?

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

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

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

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

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

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

Featured image:
empathy by Sean MacEntee

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General MSPress Announcements

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

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

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

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

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

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

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

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

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

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

 

Categories
Lifestyle Narrative Reflection

Lonely in a Room Full of People

Stock phrases:

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

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

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

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

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

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

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

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

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

Featured Image:
Humanity by Kevin Dooley