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
Interview Lifestyle

Residency Interview Tips for a Virtual Cycle!

Virtual interviews are in full swing for medical school, residency, and fellowship applicants. Here are some tips to make the most of your interviews. Wishing you all the best!

Making a good virtual impression:

In the virtual format, your first impression is not your firm handshake or tailored suit. It will be the quality of your internet, audio, and video! Make sure you are well prepared to stand out. Here are some supplies you may consider for Zoom interviews. Although these are just suggestions, we recognize that many individuals face financial barriers that may limit access to technology:

  1. Audio: Headphones with a microphone (prevents reverb from your computer audio), consider noise reducing microphones to block out any background noise.
  2. Lighting: A bright lamp or ring light placed in front of you so your face is well lit. May consider having it higher than eye level so you are not squinting and looking directly into the bright light.
  3. Video: Webcam with 1080p quality (can consider buying an external webcam which will have much better quality than a laptop webcam).
  4. Reliable internet 
    1. You may check your internet speed by typing “internet speed test” into Google. 
    2. Consider a wifi extender if you must be far away from your main router. It will expand the reach of your internet to parts of the building that may not get good service, and prevents lag for a seamless interview.
    3. Have a backup internet and computer option if things go wrong– can use your phone’s mobile hotspot in case you lose your main wifi connection. Borrowing or using a backup ipad, laptop, or desktop computer can also be helpful if your computer breaks down suddenly.
  5. Background: 
    1. A chair that does NOT swivel (so it’s not distracting).
    2. Put your setup against a white or neutral background (can use removable wallpaper or a blanket if you don’t have this available). 
    3. May also consider an interesting and professional background item like a bookshelf, fun painting, plants, or your favorite photos can make for a great conversation starter and highlight your hobbies! 
    4. If you have your bedroom as a background, make sure it is clean and spotless.
      1. Tape something by your camera to remind you to make eye contact with the camera while speaking.
      2. Download and test the interview platform beforehand (Zoom, WebEx, etc).

Answering Questions: 

Prepare a GREAT answer to each of the following questions:

  1. Tell me about yourself
  2. Why this specialty
  3. Why this school
  4. Strengths and weaknesses
  5. Interesting/challenging patient case
  6. Behavioral: 
    1. Time you failed
    2. a mistake you made
    3. working on teams, being a leader
    4. dealing with a conflict
  7. What do you do for fun?
  8. A short spiel about EVERY activity on your application, what you did, and what you learned from it. 
  9. Be able to talk intelligently about any research including your role, the hypothesis, analyses, results, and conclusion.
  10. Any questions for me?

Staying organized for interview invites!

You will be getting a LOT of emails. 

  1. Make a calendar where you are writing down dates of all interview invites as you schedule them so you can quickly glance if you get a new invitation and so you don’t double book yourself. Can sync your calendars across different platforms (ie Outlook to Gmail/google to iOS).
  2. Have a separate email account just for your interviews that will spam you with notifications so you are very unlikely to miss anything.
  3. Be professional and cordial in all emails that you send to the program coordinator, residents, etc.
  4. Here are all the ways you can get a notification about an interview invite:
    1. Text messages (set up forwarding in gmail to your phone number)
    2. Email notifications (enable notifications on your phone)
    3. Email forwarding to your main/school account
    4. Desktop notifications
  5. Here are the major platforms for scheduling interview invites
    1. Thalamus
    2. ERAS (noreply@aamc.org)
    3. Interview Broker
    4. Direct emails from the program coordinator

Best of luck!

Categories
Global Health Healthcare Disparities Medical Humanities Public Health

Medical Students as Advocates for Change

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

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

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

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

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

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

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

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

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

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

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

Written by,

Leah Sarah Peer

Categories
General

Announcement: Hiatus October 2018 to February 2019

Dear Readers,

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

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

Thank you!

Sincerely,

The MSPress Team

Categories
The Medical Commencement Archive

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

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

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

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

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

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

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

About Dr. Sugarman:

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

Categories
The Medical Commencement Archive

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

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

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

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

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

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

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

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

About Dr. Huda Zoghbi

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

Categories
The Medical Commencement Archive

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

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

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

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

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

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

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

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

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

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

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

About Dr. Nathan

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

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

Categories
The Medical Commencement Archive

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

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

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

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

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

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

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

About Dr. Bauchner

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

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The Medical Commencement Archive

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

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

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

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

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

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

 

About Dr. Robert Witzburg

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

 

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The Medical Commencement Archive

“Dallas Needs You”: Mayor Mike Rawlings, UT Southwestern Medical School 2018 Commencement

This week’s commencement speech is by Mayor Mike Rawlings, who spoke to the UT Southwestern Medical School 2018 Commencement. Mike Rawlings is the 61st mayor of Dallas and the longest-serving mayor in more than 45 years. During his time in office, he has focused on spurring economic development in the long-overlooked southern portion of Dallas through his GrowSouth initiative, improving public education, combating poverty and domestic violence, developing parks, elevating the city’s international profile and turning Dallas into a top destination for artists, young professionals, families and corporations.

Mayor Mike Rawlings starts off his speech by talking about UT Southwestern’s importance to the city of Dallas and his personal interactions with the physician leaders of UTSW. He makes a plea to the graduates to stay in the Dallas metroplex to help the growing community continue to flourish.

Mr. Rawlings then talks about the recent events that shattered the Dallas community such as the police shootings during the Black Lives Matter protest in 2016 and the Ebola scare in 2014, and how it took the strength of heroic medical professions to get through these events. One such hero was UTSW’s very own trauma surgeon, Dr. Brain Williams: “…5 of our officers were ambushed and killed during a Black Lives Matter protest. I saw the best of medicine that night. One of the lead trauma surgeons treating our officers at Parkland was Dr. Brian Williams, a black man who lives in Dallas and in the wake of that awful day spoke powerfully about the fear that he has experienced as a black man interacting with police officers – but he added that he of course would never have allowed his personal feelings to in any way impact the way that he cared for those officers. That night he was a doctor first, an advocate second. But he used his platform as a trauma surgeon who had worked to save our officers as an opportunity to speak in a raw and honest way about social justice… and that has continued in the years since the July 7 shootings.”

Mayor Rawlings then goes into a conversation about the importance of the personal interactions the graduating students will encounter throughout their professional medical careers, and draws from the work and thoughts of Martin Buber, a Jewish Theologian. He encourages the graduates to change their personal interactions from an “I – IT relationship” to an” I – THOU relationship” to recognize the divinity within ourselves and the divinity of others so that deeper relationships can be formed.

Mike Rawlings concludes his speech with a call to action for the graduates to realize their higher calling in life: “These are all personal choices each of you will have to make. Will you fulfill your calling? If so, what will it be? And how will you interact with your patients? Can you be conveyors of science and hope at the same time? I know you will make the right decisions. You are smart enough, you’ve been taught by the best, and you are lucky. I’m betting on you. And so is our city. Thank you for allowing me to celebrate this day with you.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/327