StudenTalk is a selection of Student Scene columns, arranged by theme, from Harvard Medical School's online magazine WebWeekly.
BECOMING A DOCTOR
On
Becoming a Doctor—and a Mother
Ellen Rothman: The journey
toward motherhood has been much more roundabout and problematic than
the path toward medical practice. “Pregnancy was the first deadline
that I ever missed.”
The
Mirror of Medical Training
Alisa Land: Choosing a specialty is
the last great challenge of medical school, a time when students
envision a professional identity largely from their third-year
clinical experiences. The process of making a choice would be less
problematic, though, if the medical content of each field were the
primary basis for decision-making. The marked variation in
remuneration, practice culture, and professional lifestyle may
distort the final choices.
Learning
to Grieve for Each Death
Alisa Land: During third-year
rotations, the author looked for balance between clinical competence
and compassionate care, particularly in terminal cases. Ultimately,
competence and compassion were never truly at odds.
The
Language of Medicine
Alisa Land: When doctors speak to
patients, their use of language often reinforces either a connection
or separation. Separation can be minimized if the doctor appreciates
the patient's situation and strives for a shared language by avoiding
medical jargon.
Family
Medicine Broadens Foundation of Medical Training
Tarayn
Grizzard: Doing a rotation in a community clinic gave the author a
deeper perspective on the importance of family medicine training for
any future medical practice.
Learning
the Healer’s Art
Annemarie Stroustrup Smith and Mauro
Zappaterra: A pilot course, the Healer’s Art, which began in January
2003, explored the human side of care-giving. The elective was
wonderfully effective in its focus on the power of storytelling to
reacquaint physicians in training with their deeper and fuller selves.
How a Doctor Builds a
Family
Alisa Land: On her OB/GYN rotation, the author
discovered some of the medical and emotional trials—and deep
satisfactions—on the doctor's side of childbirth. But taking part in
the birth of someone else's family raised issues around not having
her own.
A Promise of
Care
Alisa Land: As part of a humanitarian mission to Rwanda
after the genocide in 1994, the author witnessed extremes of
suffering. The experience influenced her decision to become a doctor,
capable of bringing material comfort to those in need.
Re-centering the Patient in
Clinical Education
Tarayn Grizzard: For some students, the
prospect of a fifth year in medical school is a way to delay the overwork,
red tape, and growing emotional disconnectedness from patients that
they are apt to experience as residents. Though students may be
committed to patient care, in the hospital during medical and
residency training, they are increasingly more likely to deal in
indirect patient management.
A Primary Dilemma for
Underrepresented Minorities
Tarayn Grizzard: The author points
out that some medical students who are members of underrepresented
minority groups are in a bind. On the one hand, they feel pressure to
go into primary care because an increase in minority practitioners
may alleviate some of the health care disparities that minority
patients face. On the other hand, specialties outside of primary care
lack minority practitioners to serve as role models for upcoming
minority medical students. She suggests that more minority students
may need to gravitate away from primary care.
Creating a Life? Fertility and
Postgraduate Medical Education
Tarayn Grizzard: Juggling
career and child-bearing is especially difficult for young doctors.
Might residency programs institute changes to better balance the two
tracks?
OUTREACH
Med Students
Take Environmental Concerns to Washington
Christine Pace: The author and eight fellow students from HMS joined others
in Washington, D.C., to explore ways that physicians can counter environmental
threats to their patients. The students, part of Students for Environmental
Awareness in Medicine, also presented a petition on the environment and human
health to their senators and representatives.
English as an Instrument for
Care
Janice Jin: For the author, teaching English to a group
of Asian immigrant women was a lesson in empowerment.
Respecting Navajo Medicine May
Collide with Preserving It
Ellen Rothman: In her second year
as a physician on the Navajo Reservation, the author witnessed the
tension between the private, sacred performance of traditional
practices and the desire to breach that sanctity to convey sacred
ways more broadly to successive generations. Even the non-Navajo have
a stake in the struggle, she says.
Listening In on
Terror
Davin Quinn: While transcribing taped interviews of
Cambodian refugees who had suffered under Pol Pot in the late 1970s,
the author witnessed the salutary effect of oral history.
Somehow, Providing Care Across
Cultures
Ellen Rothman: In practicing on the Navajo
Reservation in Arizona, the author faces frequent barriers to care
delivery. Communication can be a problem, but underlying this are
conflicting expectations between patient and doctor.
CULTURAL COMPETENCE
Community Celebrates a Child's First Laugh
Ellen Rothman: A robust half giggle from the author's daughter Macy recently drew Navajo community members to the baby's First Laugh Ceremony.
Crossing
Cultural Barriers One Patient at a Time
Tarayn Grizzard: The
author has found that consistently exploring aspects of lifestyle and
personal history that may have a bearing on the patient's illness is
an effective way to bridge cultural divides.
‘Fat Bias’: A Barrier to the
Treatment of Obesity
Tarayn Grizzard: Some scholars call bias
against obese people the last socially acceptable form of prejudice.
The bias is widespread, existing even in the health care field. A
damaging irony of this prejudice among health care providers is that
it impedes effective obesity treatment.
Words: The Most Potent
Drug
Renee Hsia: Experience on rotations has heightened the
author's appreciation of patient-doctor communication and the
critical translation services that support it. She argues that the
understanding that might come from this dialogue, with the help of
translation if necessary, is too often devalued by data from
technology-based tests.
CONDUCTING RESEARCH
A Laureate’s Lesson: Ideas
Outshine Data
Jan Schmollinger: After translating a 1908 paper
by German Nobelist Paul Ehrlich, the author awoke to the scientist's
penetrating vision and the danger that data may clutter observation
and insight.
A S.L.I.M. Chance for the
Evolution of Lab Research
Alex Carter: The author has seen the
future, and it is “Slim”—as in Scientific Laboratory Information
Manager. Will it be knocking on your lab door soon?
PROFESSIONAL ISSUES
AIDS and Isolation Among the Navajo
Ellen Rothman: On the Navajo reservation in Arizona, the author and her fellow
clinicians see few patients with HIV and AIDS. She observes that for these
patients, community support may be hard to come by.
Failing Elders Weigh Heavily on Reservation Families
Ellen Rothman: On the Navajo reservation, the demands of life increase the
burden of caring for elders whose health is declining. The author sees many
of these patients and deals with the hardships their families endure.
Letting
Nurses Take the Lead in Teaching Hands-on Care
Tarayn
Grizzard: While working on a hospital's postpartum floor, the author
learned more about provider-to-patient care from nurses than she ever
did from doctors. She suggests that medical students should have
greater exposure to nursing in their medical training.
House
Fire Exposes Gaps in Care
Ellen Rothman: On the Navajo
Reservation where she practices, the author has noticed that
sometimes poverty is mistaken for cultural preservation. Sometimes
the consequences are tragic.
Physicians
Lead Sexual Health Education in Chile
Tarayn Grizzard:
Community activism by Chilean physicians has led to a new and highly
effective program for adolescent sexual health education. Similar
activism on the part of U.S. doctors might boost community health as
well as the medical profession.
In
Chronic Care, Perhaps the Provider Should Call the
Patient
Erica Seiguer: The author interviews a patient who is
part of a Robert Wood Johnson Foundation program to improve patient
care. The patient's core message is that if the system is to be
redesigned, the perspective of patients with chronic needs must be
considered.
Vaccines:
Who Should Pay and for What?
Erica Seiguer: Drawing on an
Institute of Medicine report on the U.S. system for financing
vaccines, the author discusses the instability of the system and
recommendations for strengthening it.
Doctor
Sees Culture of Overweight Among the Navajo
Ellen Rothman:
Practicing on the Navajo Reservation in Arizona, the author sees an
alarming trend of overweight among children. Few people in the
community seem to consider it a problem, however, even though, by age
60, nearly one in three adults develops type 2 diabetes, a disease
associated with obesity.
When
Patients Think the Doctor Knows Best
Tarayn Grizzard: As a
summer intern at a clinic in Santiago, Chile, the author noticed a
greater acceptance of physician authority than she typically observes
back home. She thinks it is based on patients' trust, their belief
that the doctor has their best interests in mind.
Group
Gives Enabling Support
Ellen Rothman: On the Navajo
Reservation, attendees of the first group meeting for people with
spinal cord injuries said there was only one thing wrong: the meeting
was too short.
A
Quandary in Caring for Alcoholic Patients
Ellen Rothman:
Practicing in Arizona on the Navajo Reservation, the author
frequently deals with alcoholic patients. Their patterns of alcohol
abuse differ from those of patients at other sites where she has
worked. Unfortunately, effective treatment is particularly elusive.
Bad
Outcomes: A Backdrop for Good Medicine
Ellen Rothman : The
author tells the story of a missed diagnosis. Knowing that the best
medicine is not perfect does not make the mistake any easier to
accept.
Belly Pain and the Health Care
Market
Renee Hsia: The author has a friend who was temporarily
uninsured when she was struck by abdominal pain that would not goaway.
Her dilemma—wait it out or pay for care—gives a view into the
defects of the health care marketplace.
Clinical Exam Scores May
Predict Future Performance on Boards
A study led by Steven
Simon supports the early use of Objective Structured Clinical
Examinations—OSCEs—as instruments for education and evaluation in
medical schools.
Healing Touch of a Troubled
Mind
Alisa Land: Before entering medical school, the author
worked as a therapist for troubled children in New York City. Yet she
began her psychiatry rotation with some doubts about her ability to
help her patients. What she had forgotten was the patients' ability
to help themselves and one another, as well as the health care
provider.
Treating Patients One at a
Time
Sean Amos: Since many people are having trouble affording
the medications they should take, it is tempting to consider how
doctors might put prescriptions into priority to identify the one
best drug for an entire population. But keying in on the individual
patient rather than a drug hierarchy is a better way to go.
top
|
