Friday Morning Seminar - April 30 with Dan Dohan and Iman Roushdy - Shared screen with speaker view
Seth Donal Hannah
Mary-Jo, this is the best slide ever
Fortin Sylvie
Many thanks for the talk - Sorry to leave before the second paper and discussion. All the best…
Lesley Sharp
Thanks so much for yet another wonderful seminar. I have to leave early for another meeting! Thanks for a thoughtful and thought provoking talk.
Byron Good
You mentioned Jaswant. Did she want to talk?
i had only personal reflections in the care of my own child on an hematology oncology ward and the need for advocacy that become a parent positioning : as long as one doesn’t challenge the oncology : eg. at that time : pain medication was strongly discouraged and resisted for young children : bone marrow interventions standardly done with no anesthethic etc because “they will become addicts if we give pain meds” so “care” not just the agenda of the protocol have to be reciprocities which only go forward if care teams are able to include “listening” in these open ways that iman and dan suggest
Arlene Katz
thank you antonio for your eloquent, moving comments…it captures so much of what matters…
Annabelle Slingerland
From both sides of the bed experiences as a doctor and a trauma surgery patient over last year: There is definitely a need for including not just social determinants but the importance and experience what it would mean for the outcome both for patient doctor surgeon and hospital to buy into not just knowing but also understanding and implementing it. It might even reduce misdiagnoses, unusual delays, claims and hence quality of life and focus on original aim. But cross talk and mixing as you do with these webinars subsequently introduced in the curriculum but also in the hands on training might be the first step.
Dan Dohan (he/him)
Koenig, Christopher J., Evelyn Y. Ho, Laura Trupin, and Daniel Dohan. 2015. “An Exploratory Typology of Provider Responses That Encourage and Discourage Conversation about Complementary and Integrative Medicine during Routine Oncology Visits.” Patient Education and Counseling 98(7):857–63. doi: 10.1016/j.pec.2015.02.018.
Dan Dohan (he/him)
Sharing this ms in response to Eric’s earlier comments.
Thanks—another zoom calls
Annabelle Slingerland
Doctors surgeons are more and more trained as part of societal shifts in general on mistrust of defensive medicine that might explain their reactions Antonio, they even select patients (un)consciously and they are not kept on the job to be nice is the conundrum. Dr Cooley, the famous cardiac Texas Heart Institute surgeon in the 70s had Dr Hall to communicate for him that style still sips through
Seth Donal Hannah
Ha Ha, I’m going to have to update how I’ve been teaching that chapter in Medicine, Rationality, and Experience
Michael M. J. Fischer
Dan and Iman — many thanks for terrific presentations — I need to get on another call
Emma Seevak
As someone in the midst of applying to medical school — I’m really curious how the changing anatomy curricula will shape medical students’ development of the medical gaze. I’ve seen several schools boast that they no longer teach anatomy with a cadaver, and instead use virtual reality or computer simulations.
Dan Dohan (he/him)
I have been involved in teaching medical students for 10 years and have been struck by the persistence of the medical gaze even as anatomy lab has ended.
David Sternman
what can be said about the forms of "VALUE" which are not part of the institutional metrics, such as the value of a patient not returning for further care?
David Sternman
The institution will not operate on those metrics
Michael Nathan (he/him/his)
@Emma: I think there's a lot of variation. It's been a few years since I asked our HMS students, but I think it still is the same. They observe some prosections (faculty doing a focused dissection of the shoulder, for instance), and some text and visual education. I don't think there's any expectation for them to know the entirety of human anatomy in the way I had in the 1980s.
Seth Donal Hannah
Another anecdote: Shelly had to break the news to her staff at her two primary care clinics, that they must increase the number of patients each doctor has to see each day to 23 immediately. Previous number was 21. She faced all out revolt from the doctors, the MA’s and the Nurses, who thought it was completely impossible and that it reflects a complete lack of regard for the quality of care that they will be able to provide. Despite this new rule coming from upper management, they all blacked Shelly (the Administrative Manager) for the change, as if she was somehow doing this to them irrationally or unfairly. Her Physician in Charge, who knew very well that this was all coming from upper management, stood by silently while Shelly got yelled at by everyone for an hour.
Michael Nathan (he/him/his)
@Dan: I agree the medical gaze still develops, but our current residents and students seem far more humanistic, and the gaze seems more inclusive of the subjectivity of the patient than in the past. I was recently on the teaching service, and have been impressed by the disappearance of negative comments about patients as objects (dismissive talk has clearly decreased).
Seth Donal Hannah
Blamed, not blacked
Dan Dohan (he/him)
@mike: absolutely.
Dan Dohan (he/him)
The students now typically push faculty in these regards.
Emma Seevak
That’s really interesting — thank you for your responses. Do you think that the changes in anatomy curricula are connected to the declining emphasis on physical exams?
Seth Donal Hannah
I see this passion in my pre-med students. So many of them are flocking to grab a minor in Global Health, precisely because they care so much about the social side of medicine and for equity issues
Dan Dohan (he/him)
@Emma — as Iman is indicating I think there is tremendous variation in different specialities and practices. It is quite local, in my experience, and thus makes it quite challenging to choose a specialty and career track.
Michael Nathan (he/him/his)
@ Emma: I think that's complex. It may be more that the decrease in importance of anatomy is a result of a changing gaze that is more technologic that also results in decreased dominance of physical exam.
Annabelle Slingerland
There was definitely a shift to speak up to faculty but the question is how while students run through the course of medicine they melt in with the system or they remain their fresh and renewed in put and how can we stimulate and nurture that and how can social medicine had a worthwhile place?
Annabelle Slingerland
rhetorical question
Dan Dohan (he/him)
Also: maintaining an anatomy lab and obtaining cadavers has become incredibly expensive. At least at UCSF, cost-cutting was a significant motivation. This should not come as a surprise to anyone on this call...
Michael Nathan (he/him/his)
@Dan...Great point!
Tony V Pham
great presentation! have to head out. thanks.
Seth Donal Hannah
Thanks everyone, I have to go also. See you all next week!
Thanks for these such interesting and intellectually stimulating talks and great Q&A!
Annabelle Slingerland
There have been cuts in medicine- health care, education and security/ police forces indeed but also these moves can be reversed
Michael Nathan (he/him/his)
@Annabelle: I think there's huge variation in medical schools and residencies at least across the US. There are schools that have so privileged social awareness that they've changed to culture of the hospitals, medical school, and university (Indiana and UVa come to mind). For us, the presence of Partners in Health and DGHSM draws a group of students that are highly aware prior to entering HMS. A few years ago I taught a pod of 6 students, and 4 of them had either started health care related NGOs in resource poor settings or were involved in care delivery and social science research in similar settings.
Eric Jacobson
Happy birthday Mary-Jo!
thank you so much
Emma Seevak
The way they pitch virtual anatomy to prospective students is focused on efficiency: “dissecting a real cadaver is inefficient and you’ll learn what you need to know faster through VR.” — I think this might connect to other shifting emphases within medicine as well.
Dan Dohan (he/him)
Kellogg, Katherine C. 2011. Challenging Operations: Medical Reform and Resistance in Surgery. Chicago: University of Chicago Press.
Dan Dohan (he/him)
Weinberg, Dana Beth. 2003. Code Green : Money-Driven Hospitals and the Dismantling of Nursing. Ithaca, N.Y.: ILR Press.
Dan Dohan (he/him)
These 2 make fascinating bookends
Michael Nathan (he/him/his)
@Emma...THat's very interesting. Are you taking field notes as you apply?
Emma Seevak
I have been taking lots of notes but haven’t been thinking of them as field notes…. I like that idea
Dan Dohan (he/him)
@Emma: I could put you in touch with Melissa as she goes through this same process.
Michael Nathan (he/him/his)
Emma, you'll have a broader view of variations in schools than any of us!
Lissie Wahl
I find biomedical corporate legalese defines protocol; healthcare itself may be done by the provider - increasingly overloaded complying with protocol - and/or nurses, interpreters, and others able and willing to follow up and know the patient more deeply.
very interesting and emotional points. thank you. I am now having to leave but very much hope all this gets into print.
Mary Jo DelVecchio Good
Thanks for joining Akile
Lissie Wahl
Protocol responds to economics and other political ecologic pressures, not always to what a patient requires to improve or manage his healthcare
Dan Dohan (he/him)
I’m sorry…I have to leave. Thank you all!
Mary Jo DelVecchio Good
Thanks so Much DAN