(Vol. 6, No. 40)

Learning about medicine is a lifelong endeavor whether you’re a patient, a doctor, a caregiver, a hospital administrator or, perhaps, even an insurance company executive. In today’s Grand Rounds, we’ve an array of eleven perspectives that, directly or indirectly, bear on the suggested theme of education.

If there’s a motif that emerged unsolicited this week, it’s empathy, a term highlighted in the titles of two submitted posts:

In Glass Hospital, Dr. John Schumann considers what motivates health care workers in a thoughtful post, Finding Empathy. Schumann, an internist and medical educator at the University of Chicago, suggests that doctors and nurses need to re-encounter and re-engage with empathy to continually find meaning in their work.

Bedside Manner, a blog out of Boston’s Kenneth B. Schwartz Center, offers an article on ‘Boosting’ Empathy through Continuing Medical Education. Here, director Julie Rosen writes on newly-published data on the value of post-graduate, interdisciplinary sessions where clinicians discuss psychosocial and emotional aspects of patient care.

Near empathy lies the concept of interpersonal connectedness. In that vein, several of this week’s essays consider the essential and sometimes close (or not-so-close) relationships that form between patients and their doctors, between physician-educators and doctors-in-training, and between scientists who study particular disorders and the public that depends on their work:

In How Can I Explain it to You? The Life of a Grad Student With Lupus, a young woman (20-something, as self-described) blogs anonymously about her experiences as a person with systemic lupus erythematosus. Her latest post, it’s supposed to be a ‘doctor-patient’ not ‘doctor-disease’ relationship bemoans the lack of attention given to empathy (yes, it’s here too!) and patients’ lives in medical education. “Don’t test only the science,” she recommends.

Dr. Kimberly Manning is a medical educator at Atlanta’s Grady Memorial Hospital. In the ACP Hospitalist she considers the transience of some relationships, and permanence of others, formed between faculty and junior doctors passing through that public hospital’s residency training program. Her post, “Life at Grady: A clinician-educator reflects” included some lovely verse. After reading those lines, I couldn’t resist trying to find out more on Aleksandra Lachut, a poet previously unfamiliar to me.

A recent Health Business Blog offering weighs in on the emotional and healing value of connectedness among patients. In a transcript of his Podcast interview with LaChance Publishing President Victor Starsia, HBB author David E. Williams reveals why Debra LaChance founded the Healing Project. This non-profit organization provides support and education for people with breast cancer and other chronic or life-threatening diseases. It encourages patients’ sharing of stories through a book series, Voices Of.

In his wrenching Medicine vs. Religion: My Brother’s Keeper Revisited, Dr. Alan Dappen considers the predicament of a severely anemic woman who refused treatment for many years based on her firmly-held religious views. Drawing on his own, personal experiences with a brother whose faith-based ideals led him to decline care, Dr. Dappen persuaded the patient to accept medical help. This and related posts by can be found on Better Health.

A scientific sort of connection is espoused by Walter Jessen, Ph.D., who edits and writes at Highlight Health. In his early-June post on The 2010 NF Conference – Connecting the Public with the Research, he anticipated the research presentations at a meeting on neurofibromatosis (NF) sponsored by the Children’s Tumor Foundation. Although conference attendance was restricted to researchers, the foundation decided to provide information and updates to the public through a video and blog. What I liked best was the video, in which Dr. Kim Hunter-Schaedle explains the significance of the NF conference theme: “Back to the Future.”

Moving on, toward a most practical aspect of medical education, the ever-anonymous and Happy Hospitalist tells us in Difficult Foley Catheter Insertion. I Got To Watch The Cath Man In Action how glad he was to absorb, first-hand, details on the intricacies of placing a Foley the right way. (As someone who’s, um, had quite a few surgeries and subsequent catheters, I cannot exaggerate the significance I assign to this type of specialized knowledge.)

Going further in a pragmatic direction, Louise Norris advises patients and doctors to “think twice” before CT scans in her post Radiation Exposure from Medical Testing. She and her husband own Insurance Shoppers Inc., provider of the Colorado Health Insurance Insider blog. Of interest, Norris advocates a radiation medical record that would track a patient’s total exposure to imaging radiation over a lifetime. Health insurance companies could help patients, she suggests, by reducing their risk through the approval review process for imaging studies. “If an ultrasound could be used instead of an x-ray, or an x-ray instead of a CT scan, we could be saving money as well as preventing future cancers,” she writes.

My favorite title of the week comes from InsureBlogs Bob Vineyard, CLU (that’s Chartered Life Underwriter, just in case you’re wondering as I was). In his Mission Accomplished! post, Vineyard rails on the consequences of Romneycare including a primary care physician shortage. One lesson from the Massachusetts experience is that there will be an even greater demand for primary care physicians under Obamacare. As he sees it, the question for today’s aspiring physicians is whether or not to take advantage of that opportunity.

Finally, and coming full circle, the ACP Internist submitted a post authored by none other than Glass Hospital’s Dr. Schumann. This one’s called Cholesterol: validation of the self. Here, he questions the merit of an established and perhaps over-valued concept in medicine, that of lowering cholesterol.

It seems to me, the notion of challenging old assumptions is a terrific lesson with which to end any catalog of essays on education.

Lots to think about –

Many thanks to all who contributed to this week’s Grand Rounds!


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