Doctors Should Embrace the Ocean

Option 3.jpg

By: John (Teddy) Nohren, SKMC Class of 2018

“We are not students of some subject matter but students of problems. And problems may cut right across the borders of any subject matter or discipline.” –Karl Popper (1`).

Every day the mountain of knowledge and innovative ideas in various scientific fields grows with increasing speed and complexity. Much like organisms in the ocean, new devices and groundbreaking treatments are discovered every day. This rate of constant expansion demands interdisciplinary individuals to facilitate incorporative innovation. Overlap between fields has no limits. In fact, seemingly unconventional combinations have provided a multitude of discoveries that have changed the modern world as we know it! Two such fields are medicine and marine biology.

Marine life has provided many clues, tools, and unique compounds to medical research with the promise of more waiting to be discovered. Porifera (sponges), for instance, have been a resource of several chemicals undergoing various clinical investigations. Two examples, crambescidins and batzelladines, are organic compounds that have shown antiviral properties, the latter of which has the ability to inhibit HIV-1 envelope-mediated cell-cell fusion (2). Discodermalide, derived from a deep-sea sponge, has shown the ability to stabilize microtubules and is being developed for cancer treatments (3). Porifera aren’t the only marine life providing chemicals that could dramatically alter current treatment standards. A little higher up the food chain, sharks have been an animal of extensive research regarding potential therapeutics. For a while there was a belief that shark cartilage held a secret to cancer treatment. However, this ultimately has been disputed after drugs, such as Neovastat, showed no significant improvements during phase III clinical trials (4). Presently, sharks are able to provide models for cancers such as melanoma (5) and their immunoglobulins & T cell receptors are promising in the field of immunotherapeutics (6).

This brief foray into a handful of instances where sponges and sharks can play a role in medicine illustrates that there is a potential treasure trove of discoveries to advance the medical field in the vast, open sea. Physicians and other medical researchers who also have a personal passion for marine biology, as well as other natural sciences, may be in a unique position to be on the forefront of innovation by existing where two fields overlap.

 

References:

1.     Popper, K. (1962). Conjectures and refutations; the growth of scientific knowledge, (p. 88). New York, NY: Basic Books.

2.     Bewley, C., Ray, S., Cohen, F., Collins, S., & Overman, L. (2004). Inhibition of HIV-1 Envelope-Mediated Fusion by Synthetic Batzelladine Analogues. Journal of Natural Products, 67(8), 1319-1324.

3.     Kijjoa, A., & Sawangwong, P. (2004). Drugs and Cosmetics from the Sea. Marine Drugs, 2(2), 73-82.

4.     Falardeau, P., Champagne, P., Poyet, P., Hariton, C., & Dupont, [. (2001). Neovastat, a naturally occurring multifunctional antiangiogenic drug, in phase III clinical trials. Seminars in Oncology, 28(6), 620-625.

5.     Waldoch, J., Burke, S., Ramer, J., & Garner, M. (2010). Melanoma in the Skin of a Nurse Shark (Ginglymostoma cirratum). Journal of Zoo and Wildlife Medicine, 41(4), 729-731.

6.     Criscitiello, M. (2014). What the shark immune system can and cannot provide for the expanding design landscape of immunotherapy. Expert Opinion on Drug Discovery, 9(7), 725-739.

 

Adding Value Wisely: The Case for Economics as a Medical School Prerequisite

By: Nishant Pandya, SKMC Class of 2019

The health care system steadily faces increasing costs. Under its current trajectory, healthcare spending is projected to account for nearly 20% (approximately $5.5 Trillion) of the US GDP. $700 billion of this money is considered avoidable and unnecessary, including $325 billion of unwarranted use, $100 billion of provider inefficiency, and $50 billion of poor care coordination (1).  While unfortunately there is no silver bullet for this challenge, the health care system must attempt to reduce costs without compromising the quality of patient care. Without an unexpected new revenue source on the horizon, many healthcare leaders have started prioritizing high value care to address this issue (2). The concept is straightforward: for each dollar spent, healthcare teams are to focus on achieving the greatest health outcome. However, the challenge lies in developing this mindset in practicing health care professionals and medical students (2,3).

Option 2.jpg

Before implementing its High Value Care Training, the UNC Pediatrics Department Needs Assessment found that majority of the teaching faculty and residents did not feel confident in their abilities to deliver high value care and few had received any relevant instruction in the past. In hopes to bring change, the department used case base learning and guided lectures in a 5 part series to teach high value care through understanding benefits and harms, decreasing low benefit interventions, choosing high benefit interventions, customizing care according to patient values, and identifying system level opportunities to improve outcomes (5).

In one case study, the participants considered how to create a workup including tests for a patient with suspected pulmonary embolism. The group collectively ordered nine different tests, notably CT angiography, which costs $294.40 and D-Dimer assay which cost $65.88. A follow-up study analyzed the 22 CT angiograms that were ordered to “rule-out” pulmonary embolism (PE). For each patient, health records were provided to calculate their Wells’ Score, a probability scoring criteria used to diagnose likeliness of PE due to deep vein thrombosis. The calculated score indicates whether a patient is at high, moderate, or low likelihood for PE. The diagnostic algorithm advises high probability patients should have CT angiography performed while low probability patients should have a D-dimer assay performed (1).

Of the 22 CT angiograms that had been ordered, only 2 patients had PE. From the 20 other patients, 18 of those patients scored low likelihood on the Wells Score. Higher cost CT Angiography was unwisely ordered for patients whose risk for PE could have been equally measured by a lower cost D-Dimer assay. This case study hoped to highlight the overuse of imagining without initially checking pre-test probability and alternate low cost ways to rule out pulmonary embolism in patients (1).

While the training guided physicians through numerous “real-life” scenarios, participants admitted there would be challenges towards clinical implementation. They most frequently expressed difficulty changing habits, unawareness of every cost, and lack of support and instruction from administration (5). Even after the training, structural barriers exist that present challenges to changing the way practicing physicians approach their decision making by encouraging change at this stage in their career.

With this feedback in mind, the evidence points to the importance of introducing value based health care training early on in medical education. In 2012, the AAMC adopted the Do No Harm Project created at the University of Colorado. This initiative sought to develop clinical vignettes written by physicians to humanize concepts of medical overuse, over diagnosis, downstream harms and challenge the “more healthcare is better” culture (6).  Two anesthesiologists from Beth Israel Deaconess Medical Center studied over 73,000 low-risk surgeries and focused on pre-operative tests ordered to look for potential imaging overuse. The study found chest x-rays (CXR) were regularly ordered to assess risk for pulmonary complications. However, they found pre-operative CXRs rarely contained unexpected findings that would not be available in the patient’s medical history and physical exam. Furthermore, despite 20% of CXRs being abnormal, the imaging only influenced operative management in 3% of cases (6). This unnecessary imagining order added roughly $200-400 to the health care cost and rarely improved the patient outcome quality. This study stressed the importance to use all available sources of information and order tests wisely.

The conversation, however, is not one-sided. There is concern towards the increased focus medical students receive towards high value care. Johns Hopkins Medical Ethics Department believes that the welfare of the patient must remain the primary focus of the medical profession and overemphasizing cost saving burdens the risk of unintended consequences for the patient (7). For example, screening is an early detection tool that may allow for earlier treatment and potentially significantly reduced medical costs. All screening tests however are not equal. When a patient comes to a doctor with symptoms, a screening test offers a possibility of relief and explanation of an ailment. Screening asymptomatic healthy patients, however, is different. In 2012, the Clinical Journal of American Society of Nephrology faced this issue when exploring the merits of screening regularly for chronic kidney disease by regularly testing urine protein levels. At the core was the struggle between marginal cost and marginal benefit. By testing asymptotic patients, there is an opportunity to improve long term outcomes and prevent further progression of disease. However, there is also risk of false-positive screening that would unduly cause the patient anxiety or the risk of false-negative screening that would wrongly reassure the patient of their health. As of 2014, the National Kidney Foundation suggested a compromise in recommending healthcare professionals test asymptomatic patients who are at considered high risk (8). Debate still surrounds the merits of asymptomatic screening. It holds the potential to reduce healthcare costs and improve outcomes, but the screening itself may ignore hidden costs that burden the patient without full guarantee of benefit.

The Johns Hopkins Ethics Department does not argue against the movement towards high value care nor is it complacent with where healthcare stands today. There is clear need to reduce costs, but the approach towards accomplishing this without harming patient care is its priority.  Ideally, Hopkins Ethics Department suggests putting greater emphasis towards teaching students to communicate costs of healthcare initially while introducing more complex concepts of value much later in training. This hopefully ensures a distinction that high value care is not synonymous with low cost care.

I understand the long term benefit of introducing students to high value care early in training, but I share the ethical concerns mentioned above. Ultimately, physicians are asked to uphold the Hippocratic Oath and care for patients. Medical education is fast paced and voluminous with the goal to ensure students meet a set of academic competencies. In its current structure, medical education often leaves insufficient time to properly introduce and teach important concepts, such as high value care. While vignettes and seminars can teach high value care in theory, it is a greater challenge to expect students to seamlessly integrate potentially new concepts into a clinical mindset without long term exposure and comfort with high value care.

Considering the challenges and shortcomings associated with a condensed curriculum of high value care, I suggest a two part method to introduce students to this style of thinking in a meaningful and efficacious manner earlier in their medical careers. The end goal is to expose students to the financial aspect of medicine through a longitudinal curriculum during their preclinical years. Specifically, showing how each step of a hospitalization including tests, orders, and medications sum towards the final cost of healthcare. Peeling back the curtain and showing how the conversion of healthcare services into healthcare costs allows students to incorporate the concept of cost into their clinical mindsets before they hold direct patient care responsibilities. While the primary part of this idea requires greater structural change, an immediate option for medical schools to consider is requiring Introductory Economics as a prerequisite for admission. If high value care is one of the primary initiatives in medicine, then requiring incoming students to be familiar with cursory economics may be just as efficacious towards accomplishing this goal as the basic and social sciences medical schools already require.

With healthcare spending becoming an increasingly important topic, medical schools will have to find a way to integrate the fundamentals behind high value care earlier in the curriculum. Students should be introduced to economics topics like cost vs. benefit analyses and how they apply to healthcare before they are treating patients. However, the updated curriculum should not ignore the patient’s well-being at the risk of these economic principles. Schools must find a way to incorporate and balance these overlapping values and they must do so quickly. 

 

Works Cited

  1. Swaroop, Bindu. “Introduction to High Value Care: Eliminating Healthcare Waste” Department of Medicine. University of California. 2016
  2. Rice, Lauren. "Health Care On a Budget: The Rise of Economic Dominance in Health Care Reform." (2012).
  3. Hillary, Wilson, et al. "Value based Healthcare." Advances in Management 9.1 (2016): 1.
  4. Porter, Michael E. "Value-based health care delivery." Annals of surgery 248.4 (2008): 503-509.
  5. Warthrop , Richard. "High Value Care In Practice and Education." The University of North Carolina. Pediatrics Department , 2014. Web. 28 Mar. 2017.
  6. Smetana, Gerald W. "The conundrum of unnecessary preoperative testing." JAMA internal medicine 175.8 (2015): 1359-1361.
  7. "Medical Ethicists Urge Caution in Teaching High-Value Care." Department of Ethics . Johns Hopkins University , 13 Dec. 2016. Web. 28 Mar. 2017.
  8. Kliger, Alan S. "Screening for CKD: A Pro and Con Debate." Clinical Journal of the American Society of Nephrology 9.11 (2014): 1987-1987.

Medical Aid in Dying: What My Dog Taught Me

He was sick, but it wasn’t like he was going to die anytime soon. A year ago, my dog Sierra sustained a neurological insult that left him delirious, unable to walk straight and almost entirely blind and deaf. Still, he enjoyed our loving touch, snuggling against my thigh as I watched a movie or falling asleep in my arms while being held. I struggled with these thoughts as the vet pushed the pink, fluid-filled syringe into his vein. He collapsed into my arms and let out a groan, as he had many times before. But this time, he did not get up.

I said goodbye and left him to join my parents standing in the waiting room. My father looked up at me, “Is it done?” I nodded, and suddenly, we all broke into tears. We embraced each other and talked about what a good dog he was. We told each other it was the right thing to do, that it was time. But was it? Why now?

I couldn’t help but think we were being selfish. Objectively, nothing much had changed since his suspected stroke, albeit he was undoubtedly more of a burden. We were constantly cleaning up after him, redirecting him when he got caught in a corner and paying for vet visits and medications. But the bottom line was that he still found enjoyment in life. Was the choice to put him down for our wellbeing or for his?

Health professionals and loved ones struggle with these same questions when caring for those nearing the end of life. Sierra’s decline came at a poignant time, one in which many are fighting for the right to choose death in the face of terminal illness or suffering. Currently, five states allow those with a terminal illness and a prognosis of less than six months to end their life with the help of a physician, also known as “medical aid in dying.” Canada legalized physician-assisted death in 2016, joining a small number of countries that have laws enabling this practice.

The principle behind these laws is relatively simple. People want to die with dignity, and in the process of fighting for the right to do so, they’ve ironically improved end-of-life care. As a free nation that claims to be a leader in health care, why have we not adopted this practice? While poking fun at “the land of the free,” Jim Jeffries, an Australian comedian known for his outsider political commentary, pointed out that “assisted suicide for the sick … is the biggest freedom of them all.”

Opposition to physician-assisted death comes from both the public and from within the medical profession itself. Deeply rooted societal ideals, values and norms fuel the debate. From day one, physicians take an oath to “do no harm.” Common sense tells us that healthcare professionals are supposed to help heal the sick, not to “help” them die. Furthermore, for some patients, taking one’s life goes against their religious values and/or our fundamental values as human beings. Also, many families find that loved ones nearing the end of life are often incapable of making well informed decisions due to fear, depression or the effects of disease on their mind. And so we choose life, even when death seems so near.

Despite the moral controversy, attempts have been made at giving patients the right to take control of their own death in the United States. Numerous court cases have brought the legality of this practice into light culminating in the 2006 Supreme Court case Gonzales v. Oregon. Under this ruling, the federal government failed to prohibit physicians in Oregon from prescribing drugs to help patients die, opening the door for states to legalize medical aid in dying. Organizations such as the Death with Dignity National Center have taken it upon themselves to both educate the public on end-of-life options and to advocate for physician-assisted death. Even so, there has been little done to legalize this practice in federal law.

Lawmakers took a step in the right direction during discussions about health care reform and the implementation of the Affordable Care Act (ACA). The misleadingly-termed “death panels” were a way to incentivize physicians to have discussions about end-of-life care with their patients. Unfortunately, this section of the ACA was thrown out due to political controversy. Finally, in 2015, the Centers for Medicare and Medicaid services approved regulations that allow qualified healthcare professionals to be reimbursed for providing advance care planning to patients. Still, moral and legal barriers persist, preventing patients from making the decision that is right for them.

Looking back, I am grateful that Sierra left us when he did. Choosing to put him down was not easy, but afterwards, I came to an important realization. By choosing death at that moment, we determined when, where and how he died. We chose a period when our family was home together so that we could spend quality time with each other in his last moments. This pronounced the end of our living relationship, giving us a sense of completion. We made sure that he died with us, in a peaceful environment, around those he loved instead of alone on the kitchen floor. He was able to leave the world peacefully and quietly without the suffering of a drawn out painful death that would taint our memory of his long and happy life. Sometimes, I wonder if the groan he let out at the end was a sigh of relief, a goodbye or even a thank you.

This article was written by Jeffrey Henstenburg, SKMC Class of 2018

Recognizing Historical Trauma’s Role in Cross-Cultural Psychiatry

As a first-generation Singaporean American, I sometimes think about the stark contrast in richness between the age-old historical narratives of Asian countries and of acculturated Asian Americans. Identifying more with the latter, I realize how the absence of an inspiring historical narrative among us has left some of my second and third-generation peers susceptible to internalized prejudice and reduced self-esteem. My parents, even as immigrants, may have an unconscious boost to resilience from feeling tied to a Chinese historical-cultural tradition with millennia of achievement. Yet, many of my Asian American peers, who only remember life in the states, are unaware of positive role models and absorb their own stereotyped misrepresentations in media and literature. Collective historical identity obviously need not define a person; however, it can subtly erode at one’s mental wellbeing. 

Stress resulting from historical consciousness is by no means isolated to Asian Americans. In Black Skin, White Masks (1952), Frantz Fanon described psychiatric stresses specific to citizens of African ancestry in the West at the time. He noted how collective memory of African culture and achievement had long disappeared, but historical trauma and cruel portrayal by media within the “mother country” insidiously ravaged one’s self-esteem. Even today, even ignoring ongoing injustices that cause stress, it should surprise none that repeatedly hearing, starting from elementary school, about the horrific enslavement of and discrimination towards one’s ancestors could contribute to mental trauma. 

Joy DeGruy proposed a term for the results of such historical trauma: “post-traumatic slave syndrome” (PTSS). According to DeGruy, and which may seem intuitive, a collective memory of centuries of slavery, Jim Crow laws, and unwarranted mass incarceration aggravates maladaptive behaviors among many African Americans. Acute racism against African Americans has subsided markedly since the last century, but widespread sentiments of being victimized persist despite this reduced context of racism. Older generations, who experienced and vividly remember acute racism, may indoctrinate their children into anti-authority cynicism and aggression. Despite policy and sociology’s roles in perpetuating PTSS, there exists an enormous opportunity for psychiatrists to help patients identify and defuse their maladaptive mechanisms. 

At times, psychological impacts of historical consciousness are so strong that cultures have well-established terms for them. Such terms abound today for Korea, which historically had little power to resist brutal interference from militaristic giants. Connecting all this to psychiatry, palja denotes a sort of fatalistic, helpless attitude: an acceptance of lack of control over one’s life’s course that stems from folk memory of both those invasions and the historical caste system that dictated individual Korean status. Even more prominent, han describes an unresolved, distress-inducing—often strong enough to elicit somatic pain—and collective feeling of unjust victimization among Koreans, to this day. A lifelong internalization of memories of unavenged foreign humiliation no doubt contributes immensely. 

All of these examples relate to Arthur Kleinman’s term “cross-cultural psychiatry,” which first described a tendency towards somatization of depression among patients of native Chinese cultural background. Fanon’s observations, PTSS, and han could be categorized into a new 

“collective history-bound” subfield within cross-cultural psychiatry. Much of psychiatry and, especially, psychoanalysis tries to alleviate latent tension in part by bringing buried, uncontemplated stressors into conscious processing. These stressors arise not only from a person’s life events, or events involving their close friends and family, but also from their ethno-cultural community. Discussing historical traumas relevant to an entire culture could benefit certain patients. 

A more immediate priority, however, is public awareness of cross-cultural psychiatry. In 2016, some psychiatric morbidities allotted the greatest federal funding for research included acquired cognitive impairment ($1.132 billion) and depression ($410 million). Few would argue against such conditions receiving major attention in research, due to their conspicuousness and universality across demographic lines. Yet, mental stress arising from historical collective memory, even if a culture-specific source of burden, receives very little attention from American psychiatric research. 

The gap in research funding for cross-cultural psychology has two causes. First, the US is relatively young among civilizations. In turn, the dominant historical narrative we do have about our last 241 years almost close-mindedly emanates optimism. The national narrative is easily replete with heroic George Washingtons and Abraham Lincolns and achievements like our contribution towards an Allied victory in both world wars. However, it may not show a rounded picture with darker undertones, such as fairly recent, extensive de facto racism as depicted by Fanon. Thus, researchers may not perceive historical consciousness as a stressor. 

Second, there is a lack of diversity among academicians. Trends at any academic center will likely be influenced by issues its researchers feel most aware of. More ethno-cultural diversity among research psychiatrists would likely lead to increased academic interest in the impact of culture on mental health. Inadequate representation in academic psychiatry alienates ethnic groups that have unique culture-bound and minority status-related psychiatric stressors. Hence, advocates for psychiatry and other mental health care training programs should intensify thir current academic diversity initiatives. When demographic diversity among trainees may not be easily obtained, more psychiatry residency programs should adopt training initiatives surrounding culture-bound mental illness, such as those that at Yale and George Washington University. Furthermore, more programs could train all residents to show awareness of and sensitively screen for history-bound conditions such as PTSS and han, especially in and near large cities. 

Finally, cross-cultural psychiatry as a whole deserves stronger advertising among medical students and psychiatry residents. Long-term solutions include the addition of several pertinent lectures to medical school curricula and the creation of clinical rotations in cross-cultural psychiatry. Immediately, psychiatry clerkship preceptors could encourage trainees, when giving psychiatric evaluations among diverse patients, to ask about cross-cultural concerns. Advocates can also write and speak about cross-cultural psychiatry’s relevance not only to academic centers, but also to community practice. In turn, more attention can be paid by psychiatrists to distress specifically related to historical trauma. 

Identifying with one’s cultural history may enhance resilience but may also generate distress. A traumatic collective history can certainly aggravate the latter, justifying a greater awareness of historical narrative’s effect on mental health when evaluating diverse patients. Mental health advocates can promote awareness of and encourage research on culture-bound psychiatric stressors. In turn, by also acknowledging the limited attention thus far on historical trauma’s role as a stressor, we can promote a new “collective history-bound” field of discussion within psychiatry. Such a field would help psychotherapy patients transcend trauma from not only their individual pasts, but also from a far larger collective past. 

This article was written by Richard Zhang, Sidney Kimmel Medical College Class of 2020

 

The Case for Spirituality and Medicine

Effective medicine requires developing meaningful relationships with patients. As students, we are taught to start conversations with patients with open-ended questions. Without a simple "yes" or "no" for an answer, the patient shares their story and is able to decide what is important to tell the physician. Clinicians can then ask follow up questions to fill in any gaps in the patient's narrative. Not only is this efficient in terms of diagnosing and treating the patient, but it also facilitates an environment of trust. The patient’s concerns are easily conveyed to the physician and the physician can focus their therapy based on this conversation. Although this is an excellent technique, including spiritual histories could enhance the standard patient interview.

Readily focusing on patient values, spiritual histories allow patients and physicians to connect on a deeper level. They also facilitate planning of advance directives, end of life care, and other spiritually-sensitive medical treatments. By talking about spirituality, patients are able to share, in their own words and in a way that they can understand most, what gives their lives meaning and how this can be applied during difficult times. Physicians have a spiritual role in terms of caring for others and physicians could use this role to their advantage by acknowledging it and using it during patient care.

One method that can be used by residents and physicians to take a spiritual history includes the HOPE acronym:

H: Source of meaning, hope, strength, and connection

O: Organized religion

P: Personal spirituality and practices

E: End of life issues and how spirituality affects medical care

For example, in terms of “H: Source of meaning, hope, strength, and connection”, a physician could ask, “What are the sources of hope in your life?” Alternatively, one could ask, “I understand that religion and spirituality can help people find strength and meaning in their lives; is this true for you?” This step in the spiritual history opens the door to the rest of the questions. If the answer is yes, then the physician could ask about “O: organized religion.” When asking about organized religion, a physician should ask how important the patient’s spirituality is to him or her and what role it has in his or her life.

“P: personal spirituality and practices,” has two sides. One side focuses on the patient’s beliefs independent from an organized religion or the patient’s belief in God and what that relationship looks like. The other, and equally valuable, side looks at the patient’s spiritual practices, such as prayer, meditation, or other practices that helps the patient find motivation and comfort throughout the day. Finally, as it especially pertains to medical practice, a physician should address “E: end of life issues and how spirituality affects medical care.” For example, a physician can ask the patient if there are any spiritual restrictions health care professionals should know about, such as dietary restrictions, that could change the patient’s treatment plan.

So what can physicians do after they have received this information? There are many different options depending on the circumstances and patient’s desires. Firstly, the physician can take no further action with this information if that is what is desired. Even if no further action is taken, the patient will feel a connection with the physician after speaking about his or her spirituality and the physician will gain a better understanding of the patient’s values and what they find meaningful in life. On the other hand, if desired, the physician can incorporate the patient’s spirituality into the patient’s health care. For example, if a patient is dealing with anxiety related to his or her illness, the physician can try to encourage the patient to use spiritual practices such as prayer or meditation to get through difficult times. A physician could also help find resources that the patient could use to find motivation during an illness, such as speaking with a spiritual leader or spirituality-focused support groups.

Incorporating a spiritual history into patient care is important because not only does it open the dialogue, but it also creates a safe space for discussion. This helps to create a meaningful relationship between the physician and the patient that can facilitate trust. In addition, the spiritual history helps the physician to understand where the patient’s desires and values come from. This enables them to be advocates for their patients by making sure that the care that the patient is receiving is in line with his or her values and motivations in life. Considering these advantages, the argument can be made that a spiritual history can be a valuable add-on to a medical history that helps to create a trusting environment between the patient and the physician where open dialogue can be facilitated, patient concerns can be addressed, and care that aligns with the patient’s beliefs can be offered.

This article was written by Michelle Evans, Sidney Kimmel Medical College Class of 2019

 

References:

(1) http://www.aafp.org/afp/2001/0101/p81.html

(2) https://www.psychologytoday.com/sites/default/files/attachments/52072/apt-taking-spiritualhistory-may-07.pdf

(3) https://depts.washington.edu/bioethx/topics/spirit.html

The Case For Needle Exchanges

The Case For Needle Exchanges

Needle exchanges are organizations that allow injection drug users to receive free or reduced cost hypodermic needles with no prescription. To the dissenters, the first word that comes to mind when discussing these programs is “enabling.” It is often hard to define the line between support and collusion, but the best way to do so is to look at the overall pros vs the cons.

The Virtue of Patience: Medical School Admissions & The Waitlist

The Virtue of Patience: Medical School Admissions & The Waitlist

For patients, actually being patient can be the most difficult part of receiving healthcare. For some, this ends in the waiting room, but others, unfortunately, anxiously await insurance approval, test results, surgery, transplants, and sometimes—even death. The list of things patients wait for is long, but in medicine, patients aren’t the only ones who need patience.

Can Physicians Also Be Political Advocates?

Can Physicians Also Be Political Advocates?

As medical students, we are torn: can we express political opinions? Will it affect my residency application? Will future patients see it and decide to seek out a second opinion with a physician who is opinion-less on political issues? We take an oath to be inclusive, to treat everyone equally regardless of race, gender or religion. How do we defend that oath but still remain neutral?

Doubting Modern Medicine through Memes

Doubting Modern Medicine through Memes

Conspiracy theorists like the “anti-vaxxers” spread a dangerous strain of anti-intellectualism, and their efforts are rewarded by outbreaks of previously obsolete diseases (and preventable deaths). We need to analyze and fully understand their methods.

Deep Freeze: Why residency programs should pay for trainees’ egg freezing

Deep Freeze: Why residency programs should pay for trainees’ egg freezing

As women make up more of the physician workforce, it’s becoming more evident that women in their training years are also in their prime reproductive years. And residency programs need to recognize that.

High-Yield Lecture Hacks for Professors

High-Yield Lecture Hacks for Professors

The former high school teacher in me says there is room for improvement in medical school pedagogy. In fact, I have noticed some high-yield and easy-to-implement teaching “hacks” that would improve overall instructional practice and student understanding if they were consistently instituted by each professor during every lecture.