Categories
Clinical Lifestyle Patient-Centered Care

Running Low and No Longer Running

I recently completed a rotation in endocrinology, and I learned valuable lessons about diabetes management in both the inpatient and outpatient setting. Today, I wanted to share a clinical pearl generally not discussed in lectures: Diabetic patients often gain weight because of the fear of hypoglycemia.

That’s right. The fear of hypoglycemia drives patients to eat a little more at meals. Let’s backtrack. Patients who have persistently elevated sugars are often started on insulin in addition to oral agents. Depending on their insulin regimen, patients may not eat enough after an insulin dose to prevent a drop in blood sugar. Patients who experience a hypoglycemic event try their best to prevent it from occurring again. This is understandable—fainting is scary and should not be taken lightly (pun intended).

The problem is that patients counteract this fear of hypoglycemia by either eating more after an insulin injection, or by exercising less. This impedes diabetes management. In addition to advising our diabetic patients to monitor their carbohydrate intake, we urge them to start some form of physical activity. Physical activity enhances the body’s insulin sensitivity—it gets to the core of the problem (insulin resistance) and improves overall cardiovascular health as well. But how can we encourage these lifestyle modifications if our patients are getting lightheaded after injections?

The answer: carbohydrate counting and education.

Not the answer: increasing insulin.

My attending explained that “increasing insulin” is actually what happens in some cases. For example, let’s say a patient named Sara comes in for her follow-up appointment and unknown to us, has “fear of hypoglycemia.” Sara brings her glucose meter, and the sugars are poorly controlled. Part of the reason for this poor control is secondary to a) eating more after an injection to prevent fainting and b) decreased physical activity to prevent fainting. Now, if we just treat her numbers, we would increase her insulin.

The lesson here is that one can’t just treat the number in medicine. Talking to the patient, even for a few minutes, will provide the story. Increasing the insulin perpetuates a viscous cycle, and breaking the cycle comes from better regimen management. Validating patient concerns about hypoglycemia and educating them on injecting based on carbohydrate intake is invaluable.

Photo Credit: Melissa Johnson

Categories
Clinical Emotion Public Health

The Day I Took off my White Coat

The man in scrubs stands in the middle of the room. He has a blood-filled syringe in one hand and hand-written lab notes on the back of an envelope in another. He scans the room, looking for someone or something. I follow his gaze. A young man is curled up in a ball on the floor, rocking himself back and forth while groaning in pain (gangrenous wound on leg). A man is throwing all his weight on his wife and yelling in pain (renal colic). A woman is holding a piece of red, soaked gauze tightly on the hand of her screaming 7-year-old son (amputated finger). An older woman in a wheelchair is drooling from one side of her mouth and has a drooping shoulder (stroke). A young man, handcuffed to a police officer, has circular marks around his neck and blood dripping from his mouth (suicide attempt with hanging and ingesting barbed wire). A young woman sits limply in a wheelchair, eyes rolled back, and blood on her clothes between her legs (severe anemia – abortion days prior). In this room no bigger than my mother’s walk-in closet, the suffering is palpable and audible, but the man in scrubs does not find what he is looking for, and begins to walk out. Before he reaches the door, an unconscious man is carried in to the room (antifreeze ingestion). Without missing a step, he reaches over and gives the man a rough sternal rub to wake him up, to no avail. He exits the room.

The man in scrubs is the sole medical resident in charge of the stabilization and triage of incoming patients at this Emergency Department situated in a Low and Middle Income country. As a visiting medical student, I am wearing a white coat, and although I should fit in, my general ignorance about the majority of relevant things makes me feel like an imposter. I shouldn’t be here. I shouldn’t be wearing this white coat.

‘You! You can help me!’ exclaims a woman in a wheelchair as she reaches towards me. Her face is covered, but somehow I know that she is in pain. Reluctantly, and with as much grace as a fish on land, I walk towards her. I walk towards her knowing that the only care I can provide is a hug, a tear, or a smile; the only prescription I can write is a kind word, and the only order I can put in is a prayer to the heavens.

I came to medical school to gain the skills that I need to better care for my neighbors, to share moments of humanity, of suffering and healing with my neighbors, to be meaningfully curious – to ask and answer questions that benefit my neighbors and our community, and to use medicine as a platform to implement meaningful social change. The irony is, I see none of that now; all I can do is stand defeated as I watch my neighbors suffer. I watch because I don’t have the money to cover the 15 pounds admission fee for every patient that is turned away at the door of the ED. I watch because I don’t know whether that comatose child who was just intubated is in trouble because his stomach is inflating instead of his lungs. I watch because I don’t know if that medical student just injured that woman’s radial nerve while trying to get an arterial blood sample.

With tears in my eyes, I fumble out of my white coat and head for the exit. I’m done watching, I tell myself. I’m done watching and I’m ready to learn. I’m ready to learn how to care for the suffering. I’m ready to be a part of the change I want to see in the world. As the door of the ED closed behind me, I managed to catch a final peek of the chaotic scene, as if to tell myself, ‘I will return when I’m ready.’

Looking back, I wish I had kept my white coat on, even if just to care with a tear, heal with a kind word, and pray for the well-being of my neighbors.

Photo Credit: Alex Proimos

Categories
Clinical Emotion Empathy Humanistic Psychology Reflection

The Enigma of Empathy

“My mother says I’m a piece of shit.” My 18-year old patient sits at the head of a conference table, her face stony with resolve. The members of her care team are surrounding her. She asks, “Why do you all care about me when I don’t even care about myself? That’s just weird.” Her resolve crumbles and tears begin rolling down her cheeks.

The attending physician stares at her before responding. “We don’t know you,” she says. “But we do care about you. You’re right-it’s a weird concept.”

It took this exchange-during my final year of medical school-for me to fully grasp the unusual nature of the empathy that we have for our patients. As medical students, most of us have described ourselves as empathetic or compassionate at some point. But I’ll wager that most of what we know about empathy comes from close relationships, be they with friends, family members, or even repeat clinic patients. It’s not difficult to understand how these established relationships could be colored with empathy. After all, these are relationships that we usually choose to have, or at least, choose to continue having, and in many cases, they’re relationships of mutual benefit.

As medical students, much of our experience is gained on the inpatient units in the hospital, with patients who are thrust into our service. While it is possible that the relationships we have with those who are closest to us serve as templates for empathy, the relationships that we develop with our hospitalized patients are different in several ways. First, we do not choose these relationships. Generally, patients are assigned to us regardless of our desire to have them as patients. Part of being a physician in training implies consent to treat patients. Another reason why our relationships with patients are unique is that we rarely can choose to terminate a relationship with a patient who we are treating. Finally, the relationship between the hospitalized patient and the doctor is not mutual. Hospitalized patients cannot and should not offer any direct benefits to their treatment team. My relationship to this 18-year old patient fit all the aforementioned parameters: I did not choose her as my patient, I could not stop my service to her, and I enjoyed no direct benefit from her as my patient. And yet, even accepting the above as true, even recognizing that I had only known this person for 48 hours at the time of this discussion, my empathy for her was not any less genuine than my empathy for my best friend or closest family member.

Does being a physician mean that we are forced to have empathy for near-complete strangers? Or does it mean that the people who choose this profession are characterized by an ability to freely give empathy to those who cross our path?

Interestingly, the word “empathy” did not reach the English language until 1909. Derived from the German word “einfuhlung” (or “feeling into”), it has been a continually enigmatic concept that has eluded any simplistic definition. Philosophers have described empathy as a central emotive descriptor that characterizes the feeling one has when they recognize the human spirit in another.[1] Even neuroscientists have taken up the job of trying to define empathy, noting that mirror neurons, which are neurons that fire when one living creature acts and then observes the same action in another living creature, may play a role in the development of empathy.[2]

Reflecting on my patient’s remarks has given me serious cause to contemplate what empathy means to me as a soon-to-be physician. While I can speak only for myself, I think the thing that makes me different is not my capacity to give empathy, but my desire to foster relationships with my patients. Even though my relationship with that patient may have been only days old, the quality of that relationship and therefore my ability to feel empathetic towards her, is a direct reflection of my desire to have that relationship. While I did not choose the patient, I chose to get up that day and practice medicine, and empathetic medicine is the only kind of medicine I know how to practice.

[1] https://plato.stanford.edu/entries/empathy/

[2] https://www.ncbi.nlm.nih.gov/pubmed/18793090

Photo Credit: Sean MacEntee

Categories
The Medical Commencement Archive

“A Good Job”: Dr. Elizabeth Dreesen, 2017 Commencement Address of the University of North Carolina School of Medicine

I am pleased to present this week’s Commencement Archive piece: Dr. Elizabeth Dreesen’s keynote address at the 2017 University of North Carolina School of Medicine Commencement.

Dr. Dreesen grew up in a Navy family. Before earning her M.D. at Harvard Medical School, she completed a B.A. in History and African Studies from Boston University after spending a year at the University of Nairobi. After a year as an Obstetrics and Gynecology intern, she elected to train in General Surgery and graduated from the New England Deaconess residency program in 1994. She pursued further training in Surgical Critical Care at the University of Maryland Shock Trauma Center. After training, Dr. Dreesen and her husband started a rural General Surgery practice in western North Carolina. Dr. Dreesen has been at the University of North Carolina since 2006 and currently serves as the Chief of the Division of General and Acute Care Surgery there. She is known for her many years as a column writer for the Raleigh News and Observer, exploring experiences and issues in the world of medicine.

 

“Medicine isn’t just a good job, it’s a great job. It’s a complicated, bloody, hilarious, exhausting, inspiring job that will challenge you every day for the rest of your life. And jobs don’t get any better than that!”

What a unique set of adjectives to describe a job! When you think about it, few professions accommodate such diversity. We are truly blessed and privileged. Dr. Dreesen continues, discussing the features of this amazing career:

  • Dress comfortably—“At any given moment in medicine, somebody could throw up on you. So, as a group we dress respectably, but nothing too fancy.”
  • Excellent coworkers—“You’ll have coworkers who will amaze you.”
  • Enormous variety—“Every day is different in medicine, because every day you will meet a patient who surprises you… The breadth and variety of human experience will enrich you every day.”

Dr. Dreesen provides a unique perspective. We often view physicians as patient advocates and leaders in their field, however we may not fully appreciate the role they can play in their communities.

“In my own case, medicine made me a pillar of the community, a leader in my town. I’d been kind of an outsider through college and medical school – the protestor demographic. I was picketing the Dean’s office over my school’s labor policies, arguing with the administration about curriculum.”

As physicians we are privileged with a voice and a podium to make meaningful change. We should not shy away from these opportunities.

Finally, Dr. Dreesen echoes what I believe to be the most fulfilling reason that medicine is a “good” job.

““[Good jobs] change who you are, how you see yourself, and how others see you…In fact, a good job, a really good job, your new good job is one in which you have the opportunity to do moral good. And that is not an opportunity that every job affords.”

Photo Credit: Hamza Butt

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/299/315

Categories
General Patient-Centered Care The Medical Commencement Archive

“Becoming Healers”: Dr. Jonathan LaPook, 2017 Commencement Address of Quinnipiac University School of Medicine

I am pleased to present this week’s Commencement Archive piece: Dr. Jonathan LaPook’s keynote address at the 2017 Quinnipiac University School of Medicine Commencement.

Dr. Jonathan LaPook is the Chief Medical Correspondent for CBS news and has served in this role since 2006. A board-certified physician in internal medicine and gastroenterology, he is also a Professor of Medicine at NYU Langone Medical Center. He attended medical school at Columbia College of Physicians and Surgeons, and completed an internal medicine residency and a gastroenterology fellowship at the New York-Presbyterian Hospital/Columbia University Medical Center. Dr. LaPook has received two Emmy awards for his work in 2012 and 2013 covering the national drug shortage and Boston Marathon bombings, respectively.

 

While Dr. LaPook is accustomed to speaking in front of crowds and cameras, this particular speech was a first for him.   With great pride and humility, he addressed the very first graduating class of Quinnipiac University School of Medicine. While the event was new to everyone involved, the message Dr. LaPook delivered stems from his diverse experiences as both a physician and journalist.

Dr. LaPook discusses the semipermeable membrane—or as he puts it, an emotional wall—that lies between us (as physicians) and the patient. One must be mindful of the emotional balance that exists, and this, according to Dr. LaPook, is the first and last challenge of the art of healing.

“It starts with a decision about the emotional wall we all build between ourselves and our patients. Constructing it is tricky. You don’t want to make it too thin and porous, because that can be emotionally devastating. But you don’t want to make it too thick and impervious, because then you miss out on all the good stuff, the precious moments when you connect with a patient as a person. I treasure the time an elderly patient showed up for an office visit on a beautiful spring day, and I wheeled her over to the Central Park Zoo to watch the sea lions. No medicine I have ever prescribed has had a more powerful therapeutic response. Everybody has to find a comfort level. For me, erring on the side of “too empathetic” is the way to go. Patients pick up on it, and if they feel you really care, they’re more likely to open up to you.”

 

“When we’re watching a movie and an important moment is about to happen, how do we know?”

Unfortunately, when caring for sick patients, other than a few beeps on the monitor, important moments don’t come with dramatic music or close-ups. There is no camera-pan to direct our attention to informative, meaningful information. We are both privileged and burdened with this responsibility of seeking out and interpreting information in order to make informed decisions.

“Well, in life, there’s no close-up and there’s no change of music. You have to play the soundtrack in your own head. You have to control the zoom button yourself. You must catch that moment when the patient—consciously or unconsciously—tells you what’s the matter. You need to get them to open up to you as one human being to another. And they will not do that unless they know they are talking to a human being!”

As Dr. LaPook continues, he begins to discuss his career in journalism and its implications on his medical practice. In particular, covering global health crises has shaped his ability to communicate oftentimes complex medical information to a broad audience.

“The key is taking complex topics and presenting them in simple, accessible terms. Communicating clearly—and succinctly—is an important skill. Work on it.”

Dr. LaPook summarizes with a single piece of advice.

“Be comfortable with uncertainty. If you’ve been practicing medicine for five years and you think you have all the answers, you’re in the wrong profession.”

Although patients may expect us to have all the answers, we must not burden ourselves with this expectation. Medicine is an art, not a calculation. Physicians consume diverse clinical data not necessarily to find an answer but rather to justify a decision.

Dr. LaPook sends the graduating class out with a final message.

“What’s going to distinguish you as true healers is the way you embrace humility, compassion, and empathy. Turn away from the computer screen and look your patient straight in the eyes. Understand the extraordinary importance of listening. And realize that even when you don’t have the answer for a patient in need, you can still help—with a sympathetic ear, a reassuring touch of the hand, and by sticking by them, through sickness and health.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/297/314

Categories
Innovation Lecture

Drinking from a Fire Hydrant: Musings on Active Learning in Medical School

Almost everyone has seen a doctor at some point in their lives. Yet, for most, what actually goes on in medical school remains a mystery. Chances are that if you’re reading this, you have experienced the delightful experience that is medical school. Sleeping in late, eating well, and relaxing with friends and family on the weekend are just a few of the joys that we medical students get to experience. Just kidding. Medical school, as most of us know, is beyond challenging. At my school, faculty members fondly liken the medical school experience to drinking from a fire hydrant. As medical students, our pre-clinical days are comprised of hours and hours of lectures and power points. Then, when class is all over, we get to top off the day with several additional hours of studying. It’s challenging, it’s overwhelming, and at times, it seems downright impossible.

Part of what makes medical school such a unique challenge is the fact that medicine is a tactile discipline and yet, pre-clinical education is traditionally taught in a classroom setting. In response to this dichotomy, the University of Vermont’s Larner College of Medicine recently made headlines by announcing that it would become the first public American medical school to completely eliminate lectures from its curriculum, joining private Case Western Reserve University School of Medicine in Ohio (https://www.washingtonpost.com/news/to-your-health/wp/2017/07/29/medical-school-without-the-sage-on-a-stage/?utm_term=.6847516c2b31.) This change, which is expected to be fully implemented by the year 2019, comes in response to concern that the traditional lecture format does not promote knowledge retention and instead relies on “passive” learning where the learner is not actively engaged in their education. To draw an analogy, passive learning is like being fed while active learning requires learners to pick up the fork to feed themselves.

Although the University of Vermont and Case Western Reserve University seem to be the only two institutions whose medical schools have committed to becoming completely lecture-free, it’s interesting to realize that other schools have moved towards a more active learning format as well. In my school, the College of Osteopathic Medicine of the Pacific (COMP) , students pick their own small groups. These small student-led groups meet several times a month and work together to complete assignments and discuss scenarios that are based upon real clinical scenarios. Northwestern University’s Feinberg School of Medicine is one of several schools that employs a problem based learning curriculum, and in 2015, Harvard Medical School also restructured their curriculum to become more problem-based. Ultimately, medical school curriculums exist on a spectrum from passive to active curriculum styles and the continuum seems to be shifting to favor active learning styles at many medical institutions.

Moving away from a traditional lecture setting certainly presents its own unique challenges that affect learning. The non-lecture curriculum requires more self-reliance on the part of the students, who must teach themselves new material. The small groups used at COMP, for example, are completely student-led. A faculty member may pop in for a few minutes to make sure that the group is running smoothly, but often these faculty members are not experts in the subject matter at hand and are present to deal more with administrative issues than to teach content.  It also means that students are required to participate in groups, whereas many schools may have optional attendance for lectures. Perhaps the biggest challenge of the active learning curriculum, however, is the necessity for different personalities to work together to achieve a common goal. The traditional classroom setting involves one teacher who employs a specific style to reach multiple students. In the active learning curriculum, small groups are often used, in which each member has a different personality. Students in these groups must work together, sometimes despite personality differences, to master the curriculum and achieve common goals. Although the group setting closely resembles the team-based approach taken in most healthcare settings, it can undoubtedly be frustrating, especially for someone like myself who tends to be more introverted and likes to study on his/her own. In my personal experience, the members of my small group were incredibly supportive and had a variety of strengths, yet there were many days when I couldn’t wait to return to the comfort of my own room to be able to really learn the material myself. Sometimes trying to learn unfamiliar concepts with others was a distraction, and despite the best of intentions, small group was like the blind leading the blind when we were all confused on certain concepts. There were some times that the small group felt comforting, like someone holding my hand, and other times when it felt too overwhelming, like someone pressing my face up against that proverbial fire hydrant. Ultimately, I felt like the combination of both lectures and small groups was actually more dynamic than relying solely on one or the other. While the University of Vermont and Case Western Reserve University have both made the bold move to abstain from lectures altogether, they join the company of many medical schools, both allopathic and osteopathic, that have recognized the importance of active learning for the medical school curriculum. Let me know what alternatives your medical school offers to traditional lecture-style learning!

Categories
General The Medical Commencement Archive

“Cat’s Feet”: Dr. Donald Berwick, 2017 Commencement Address of the Dartmouth School of Medicine

This week, the Commencement Archive is pleased to publish Dr. Donald Berwick’s address to the Dartmouth School of Medicine Class of 2017, titled Cat’s Feet.

Donald M. Berwick, MD, MPP, FRCP, is President Emeritus and Senior Fellow of the Institute for Healthcare Improvement. A pediatrician by background, Dr. Berwick has served on the faculty of the Harvard Medical School and Harvard School of Public Health, and on the staffs of Boston’s Children’s Hospital Medical Center, Massachusetts General Hospital, and the Brigham and Women’s Hospital. He has also served as Vice Chair of the US Preventive Services Task Force, the first “Independent Member” of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality. He additionally served two terms on the Institute of Medicine’s (IOM’s) Governing Council, was a member of the IOM’s Global Health Board, and served on President Clinton’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry.

Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by Her Majesty, Queen Elizabeth II, in recognition of his work with the British National Health Service. Dr. Berwick is the author of over 160 scientific articles and six books. He currently serves as Lecturer in the Department of Health Care Policy at Harvard Medical School.

 

Dr. Berwick delivers a powerful speech covering historic writings, poetry, and personal anecdotes. The ultimate message he conveys is choice, and our preparedness to make a decision.

The title of Dr. Berwick’s speech is Cat’s Feet, a phrase which he introduces in a poem by Carl Sandburg:

 

The fog comes

on little cat’s feet.

 

It sits looking

over harbor and city

on silent haunches

and then moves on.

 

He continues to discuss the poem and its portrayal of the unexpected choices we are faced with throughout our careers.

“The fog comes on little cat’s feet. Maybe you think of ethical choices as arriving with a brass band: Carton at the guillotine, Joan of Arc at the stake, or Martin Luther King and John Lewis on the Edmond Pettis Bridge. Moments of fame and drama “Here I am: Ethics.” Forget that. For you, me, most of us, the choices that matter come in unannounced, on little cat’s feet, silent in arrival and gone almost before we notice. You will have the same choice…Whether it will come tomorrow or next week or next year, I cannot say; but it will come. And it won’t come once. It will come again, and again, and again, always on cat’s feet, suddenly, too suddenly for you wing it. So, don’t wing it. Get prepared. Decide in advance.

As Dr. Berwick continues, he addresses an important question: what will be your self-identity as a doctor? Physicians must balance personal heroism with interdependency. In other words, we will have opportunities to be heroic, to act, and to take matters into our own hands. Dr. Berwick argues that we cannot and should not act alone. Rather, there is a greater “need for teamwork, generosity, and deference to others.” Dr. Berwick recommends to “not ask what you do; ask what you are part of. Ask, “Who depends on me, and how am I doing in their eyes?”

Dr. Berwick reflects on the evolution of ethical values appreciated in healthcare. Now more than ever, physicians have an immense ethical duty.

“If we be healers, then the time has ended when the tasks we shoulder stop at the door of an office, the threshold of an operating room, or the front gate of a hospital. We must engage in the rescue of a society, and of a political context, that has forgotten to heal. That has become our job too. Professional silence in the face of social injustice is wrong.”

Unlike some of the other pieces in this commencement archive issue, Dr. Berwick’s is marked with a tone of gravity and weightiness. He goes beyond our duty as physicians and calls on our responsibilities as individuals in society. The message is serious, sincere, and thought-provoking. I encourage all to consider his words closely.

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/294/311

Categories
Clinical General Public Health

Medical Residents: A Dream Career Can Be Yours If You “Choose Sleep”: Dr. Ilene Rosen, President of the American Academy of Sleep Medicine

Now is the time that many medical residents are considering future plans, and hopefully giving thought to a sleep medicine fellowship. The truth is, we need you. Millions of Americans suffer from chronic sleep disease, and now more than ever there is an increasing demand for sleep physicians. As awareness of sleep health increases, millions of new patients will be seeking evaluations from sleep physicians.

Sleep medicine is an intriguing field with long-term growth potential and the opportunity to have a positive effect on the health of a huge population of patients. By diagnosing and treating sleep disorders, you can directly improve patients’ health and quality of life. In addition, because sleep is still a relatively young field, many research questions still exist. These questions can lead to involvement in cutting-edge basic, translational, and clinical research.

As a new sleep medicine physician, you may have the opportunity to practice in diverse settings. Opportunities abound in teaching hospitals, community hospitals, and independent sleep centers, allowing you to cultivate a work schedule that best fits your lifestyle. In addition, you can expect a call schedule that is quite manageable, as trained technologists at an accredited sleep center monitor most overnight sleep studies, and patients often self-administer their own sleep studies at home.

Another great thing about sleep medicine is the constant collaboration. As a sleep specialist, you will work closely with physicians from other disciplines and lead sleep teams of other health care providers – including nurses, physician assistants, psychologists and technologists. You may find many opportunities to collaborate with multidisciplinary teams, treating patients in coordinated efforts using the latest technology. I think you will find these collaborations eye-opening and educational.

So, the choice is yours and the options are plentiful to pursue your dream career, just as I did. There are 83 sleep medicine fellowship training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Learn more at www.ChooseSleep.org.

Categories
The Medical Commencement Archive

“Creating Your Legacy”: Dr. Carol Nadelson, 2017 Commencement Address of the University of Rochester School of Medicine and Dentistry

This week we have the pleasure of hearing from Dr. Carol Nadelson, who delivered her speech titled “Creating Your Legacy” at the University of Rochester School of Medicine and Dentistry 2017 commencement.

In 1985, Dr. Nadelson became the first female president of the American Psychiatric Association. She was also the first female editor-in-chief of the APA Press, and the first director of Partners Office for Women’s Careers at Brigham and Women’s Hospital, where she continues as the director today. As a Harvard Medical School psychiatrist and Brigham and Women’s Hospital expert on promoting academic medical careers for women, she has had a major influence on the lives of women in medicine by advocating for mental health resources and by leading the office for the professional development, career planning, and mentoring of female hospital staff.

Dr. Nadelson was elected to the Alpha Omega Alpha medical honor society at the University of Rochester Medical School in 1961. From 1979 to 1993, she served as vice chair of the Department of Psychiatry at the New England Medical Center in Boston. She became a clinical professor of psychiatry at Harvard Medical School in 1995. In 1985, Dr. Nadelson received the Elizabeth Blackwell Award for “contributions to the cause of women in the field of medicine” and in 2002, she was honored with the Alexandra Symonds Award for sustained high-level contributions to the field of psychiatry and leadership in advancing women’s health. She currently serves as president and CEO of the American Psychiatric Association Press, president of the Association for Academic Psychiatry, and president of the Group for Advancement of Psychiatry.

 

The road to practicing medicine is arduous, and few will deny this fact.  For Dr. Carol Nadelson—a female in the 1950’s—the dream of a career in medicine seemed unachievable.  Giving up on this dream, however, was not an option for Dr. Nadelson.

“Most people, including my parents, thought that there were other, more reasonable careers for women. But I was determined……What did I learn from it? To accept challenges, find role models and support, and persist in pursuing my dream. While the threat of imminent failure was always on my mind, I had to learn to believe in myself. “

Throughout medical school we are required to memorize an infinite amount of information. We are exposed to brilliant professors who are capable of helping us with this task, and simultaneously inspiring us. For Dr. Nadelson, however, the most informative and inspiring teachers were her patients.

“Most important was what I learned from my patients. They taught me to listen and to care for them. It wasn’t only a physical exam, a procedure or a new medication; they needed me to understand them, be honest with them, and help them come to terms with their pain, loneliness and fear. They needed to trust that I would commit myself to helping them; they needed caring and hope. Their needs could not be met in short, hurried and impersonal exchanges, nor if I were absorbed with filling out forms, more recently looking away from them to a computer screen.“

Dr. Nadelson closes with a reminder that we are entering the most noble of careers, a career without bounds, and with unlimited opportunities to apply the skills and knowledge base we have developed.

“As I welcome you into this compassionate and honorable profession, always remember that it is a privilege to be accepted into the lives of your patients and to serve them. At every age in our history, being a physician has been demanding, but at this time you face unique obstacles and challenges. You have the opportunity, indeed the mandate, to create a legacy that builds from the past and leads to a better future for medicine, for yourselves and for your patients. Congratulations!”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/293/310

Categories
Public Health The Medical Commencement Archive

“Circles of Compassion”: Dr. Kinari Webb, 2017 Commencement Address of Yale School of Medicine

This week, the Commencement Archive features Dr. Kinari Webb’s speech titled “Circles of Compassion.” She delivered the keynote address at the 2017 Yale School of Medicine Commencement.

Kinari Webb, M.D. is the founder of Health In Harmony, an organization that establishes links between the health of humans, ecosystems, and the planet in order to solve problems of poverty, poor health, and environmental destruction. During a life-changing experience in Indonesia studying orangutans, Dr. Webb encountered not only a beautiful and threatened natural environment, but also the dire health needs of the people surrounding the National Park. After her experience in Indonesia, Dr. Webb decided to become a physician and return to Indonesia to work together with local communities to improve their health and preserve their natural environment.

After graduating from Yale University School of Medicine with honors, Dr. Webb completed her residency in Family Medicine at Contra Costa Regional Medical Center in Martinez, California. Dr. Webb founded Health In Harmony in 2005 to support the combined human and environmental work that she planned in Indonesia. After a year of traveling around Indonesia looking for the best site for this program, Dr. Webb co-founded the ASRI program in West Kalimantan Indonesia with Hotlin Ompusunggu and Antonia Gorog. Dr. Webb currently splits her time between Indonesia and the U.S.

 

Dr. Webb did not take the typical path towards a career in medicine. She went—as she simply puts it—“against the grain.” Despite excelling as a top student at a top-tier medical school, she was drawn back to Indonesia, where she previously studied orangutans as an undergraduate. This time, however, she returned with a much greater vision: using medical approaches to improve the health of humans and the planet.

Dr. Webb argues that our medical knowledge base and clinical skills are applicable to all species:

“I first came to know just how profoundly lucky I was during the year that I spent deep in the rain forest of Borneo when I was 21. I discovered there that people were often forced to cut down rain forest trees in order to pay for health care. I found myself feeling angry and deeply sad that such an injustice was occurring in the world. After residency I founded a non-profit called Health In Harmony and I have spent the last twelve years working on this issue. You may not have thought of your stethoscope as a tool to help heal the lungs of the earth – otherwise known as the rain forest – but it turns out it can be.

Your medical skills have all kinds of unexpected powers and I want to argue that we actually all need to become planet doctors. We are at an unprecedented time in the 4.6 billion year history of the planet: this is the time when a species that actually has the capacity to understand what it is doing is dramatically altering life on earth. And the health of our planet is the greatest threat to your patients’ health that they are likely to face over your career. Without a stable climate, enough drinkable water, food to eat, and healthy air you will have a very hard time keeping your patients well.”

Before I finished reading Dr. Webb’s speech, I found myself on her organization’s website, out of sheer curiosity. Health In Harmony is unique because of its dual efforts to promote environmental and healthcare reform in rural, impoverished communities across the globe. From training organic farmers to establishing tuberculosis treatment programs, the organization substantiates the role of “planet doctors”, one of whom Dr. Webb considers herself.

As Dr. Webb continues in her speech, she discusses the steps necessary to further a career as a physician, which she refers to as “Circles of Compassion.” The first circle emphasizes self-care. Regardless of the direction a career takes you, Dr. Webb argues that you are the most important patient.

“The first circle is caring for yourself. Most of you are about to go into indentured servitude, so this isn’t going to be easy. I remember massive sleep deprivation, feeling pushed beyond the limits of my skills, terrified I’d make a mistake, and being right in the middle of profoundly traumatic experiences. I encourage you to prioritize taking time to soothe and care for your body and soul even in the midst of all that. In my own journey of personal and spiritual growth, I have found help in faith communities, meditation, time with loved ones, therapy, and maybe most especially, being in nature. There might be nothing better for healing the soul.”

Dr. Webb’s next circle of compassion underscores the care we provide to patients:

“As a doctor, the second circle of compassion beyond you and your family is caring for your patients – both their physical well-being and their capacity to be their fullest selves. In Borneo, when we hire medical staff, we are looking for people who know they don’t know everything, who will be life-long learners, and most especially we want providers who will care for their patients as though they were their own family.”

Dr. Webb leaves the audience with the following concluding remarks:

“I wish to leave you with three key points:

First, don’t be afraid to take the road less traveled – or as my classmate Margaret Bourdeaux used to say: the deer path less traveled. The expectation superhighway is hard to resist but if you can see it all laid out in front of you, it likely isn’t your path. And this earth needs all of us to do whatever we are most passionate about – even if your deer path leads you to beautiful North Dakota.

Second, compassion matters. It starts with you, it spreads to those around you, and then to the whole planet.

Third, I encourage you to ask yourself: “Am I willing to be one of the sacred planetary healers that the earth so greatly needs?”

Congratulations again on this amazing accomplishment. May you go forth and heal!”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/291/308