Sunday, November 18, 2018

Dr. Saul A. Schwartz, Remembering My Dad 20 years after his passing

In an earlier article, I recounted my dad's passion for playing different sports in college: baseball, basketball and field and track.

Today,  I remember his passion for caring for his patients (which led, incidentally,  to his building one of the largest practices in the Bronx.)

His dedication to the sick was reflected in several ways. First he made house calls, going up and down flights of stairs. I should know as I would often accompany him-- carrying his doctor's bag. (at the time, he would charge $5 per house visit.) And he spent time getting to know each of his patients--patiently listening to all their complaints.

Well the word go around very quickly along the Grand Concourse and the East Tremont section of the Bronx about the doctor who makes house visits. Naturally, when the patients recovered, they flocked to his office at the Flat Iron Building located at 1882 Grand Concourse.

Here it was not unusual  for up to 40 patients to be waiting for a consult. I would ask dad why they didn't make appointments. His answer was: I would urge them to schedule appointments, but they simply come and who can stop them. Half would find seats in the waiting room and others would stand.

They did not mind waiting, sometimes up to two hours. Why?

Dad had  a special caring, empathetic, bedside manner that was infectious. He took time to hear their complaints, speak to them in Yiddish, German, or English. He did much to alleviate their worries and anxieties that often led to ulcerative colitis, his  specialty.

Dad, I am so grateful to have experienced the importance of taking the time to listen to each patient's story before making a diagnosis- a luxury rarely heard of in the practice of today's medicine.

You have inspired me to write a series of articles to examine the current crisis.

Wednesday, November 14, 2018

Medical Students turn to poetry discussions to share experiences and to develop empathy

In an earlier article I discussed the enlightened lead of the St. Andrews Medical School in giving every graduate a small portable book of poems, Tools of the Trade to accompany them on their rounds.

 Then in my most recent posting, I explained how reading and reciting poetry helps the reader-including the medical student/professional-- to deal with the complex of emotions that are not easily resolved by simple reading of prose.

The next obvious question is: how can medical educators work with their students to get them to express-- in a group setting--what it is they are experiencing when reading poems dealing with their daily contacts with their ailing patients?

St. Andrews has added a new direction: using the Tools of the Trade: Poems for new doctors  book of poems as a base, it has instituted a program called Poems for Doctors. First there is a blog which publishes these short poems. Then "video readings are made by medical professionals or  trainees who have chosen one poem for particular reasons or associations that they explain. Each reading provides a seed for informal discussion in a Facebook group managed by a group of highly experienced medics." (bold italics mine)

Contrast the St. Andrews informal discussion in a Facebook group with the following poetry centered program at Hadassah- Hebrew University Medical Center to "increase student's capacity for empathy and awareness of patients' narratives." Five 1-hour meetings were "held immediately following a teaching round, of seven to nine students with a facilitator doctor. At each meeting a poem reflecting the patient-caregiver relationship is discussed in order to encourage students to share their experiences." The results favored the students' empathetic identification with the patient (what it is like to be a patient). Read evaluation here.

 St. Andrews and Hadassah present differing models of how to  bring students together to share reactions to poetry. First they are alike in that each has an experienced faculty member who facilitates discussion. The former uses an informal discussion in a Facebook group  while the latter brings the students together in a face-to-face meeting held immediately following a teaching round.

Both schools are to be commended for their encouraging students to share their reactions to

The Hadassah method of having round table discussions, where students face each other --eye to eye --  is, perhaps, preferable because it done immediately after coming off the wards  when the emotions are still so fresh.

   Yet, on the other hand, the St. Andrews method of informal Facebook discussions may be more preferable mode for shy students who may be more reluctant to share their emotions in a 'live' setting.
They may be inhibited to share reactions in a setting where they have to view their peer's reactions such as facial expressions.

Besides St. Andrews and the Hadassah-Hebrew University Medical Center other medical schools such as Yale and Harvard are also taking the lead in including poetry as a means of fostering empathy.

In my next article, I will explore how medical schools are requiring art classes as well. So stay tuned in.


Wednesday, October 31, 2018

On the road to Relief from stress: How Poetry Works to make known the unknown, to make the impalpable palpable

In a recent article, I pledged to explore how the composition, recitation and listening to verse can alleviate the inevitable stress associated with the study and practice of medicine. In this context, I discussed Psalm 23.

So why, one might ask, is poetry more effective than prose in this regard?

 I was enlightened by comments spoken by Rabbi Gidon Shoshan who declares in G-d's Poem that the text of the Torah (arguably the most read book in  both the original and in translation) "is not prose, but poetry. While prosaic writing is deliberate, detailed and thorough, poetry is concise, choice and laden with allusion. A poet does not write all that he wishes to communicate but, rather, uses the power of language and brevity to encapsulate, in limited words, all virtually unlimited ideas." (italics mine)

What he is saying is so profound. The poet, in my opinion, is a master of words. He chooses words that resonate with meaning, many meanings which allude to many ideas and so what he writes can be interpreted in many different ways.

King David praising the Lord with his Harp
Illustrator: Richard Andre, London, 1884

He is in tune with inner rhythms, that akin to music, can not be expressed in one note, but many notes. Recall that the psalms of David were composed to be sung to the accompaniment of the harp. The classic epics, such as the Iliad and the Odyssey were also written to be sung.

 And since we each have individual sensibilities,  each one of us as reader/listener can and will have our own unique response(s).

The poet, in my opinion, makes the unknowable knowable, the impalpable  palpable. He takes abstruse, complex ideas and feelings and chooses words and rhythms to share conflicts, paradoxes, ironies and emotional states--that are hard to articulate in simple prose.

To write in simple prose is limiting, dull and boring while poetry opens the mind and soul to multiple unlimited feelings and thoughts that need to be communicated.

This is why, reciting, understanding and discussing poetry lends itself to unraveling, the confusing-- often tormenting-- complex of emotions experienced by student medical professionals as they come in contact for the first time with real life threatening diseases afflicting their patients.

Indeed, before one can be an empathetic care-giver to those experiencing pain and suffering, one must first deal with one's own emotions.

In forthcoming article(s), I will explore how poetry discussions are helping to germinate the seeds of empathetic, humanistic medicine. 

Wednesday, October 24, 2018

Is Tuition Free Medical Education a true game changer?

(This discussion is a continuation of my earlier article, Tuition Free Medical Education: a potential game changer)

It is great news to learn that two Medical Schools are in the forefront of alleviating the financial burden that graduating doctors face.

 There will be much relief  from the stress-- psychological,  emotional and physical--  that nearly all medical school graduates now face to repay their massive student loans.

Yet much criticism has been leveled at the NYU Medical School plan to offer free tuition to all students regardless of need.

No doubt, this will alleviate the burden placed upon those students who have decided to enter the field of family medicine, a low- paying specialty in which the shortage of doctors will escalate into the tens of thousand in the next decade. These newly minted doctors will be able to focus more easily on their patients from the get go as they are free from debt.

But how about motivating other undecided students to enter these fields that will experience shortages?

Would it not be better to condition the awarding of  full scholarships to those students who commit to become primary care specialists (long live the 'GP')  and let the rest pay according to need?

On the other hand, the Columbia Physicians and Surgeons plan is more equitable in that it levels the field for all students. Given the fact, that there is plenty of assistance to cover all its medical students, those truly in great need receive a full scholarship and the rest get tuition grants according to family income.

After all, the latter group's families are in a position to contribute to their children's education.  So why shouldn't they pay their fair share?

Doesn't this sound fair and equitable?

Consider, that under the Columbia plan there are also no incentives to get student commitments for the primary care fields.

Looking to the future, there are several factors to keep in mind: first, these two medical schools have only just last year instituted these changes and it will perhaps take a decade or longer to evaluate results.

Secondly, Columbia and NYU represent just two of over 140 accredited Medical Schools across the country. (Perhaps the success of the these two programs will inspire other philanthropists and the
US government to fund scholarships to other medical schools)

And, finally, what influence and catalyst, if any, will these innovative programs provide in developing and training students to be patient-centered empathetic health care givers?

To follow and join this conversation, please tune in to my next series of articles.

Thursday, October 11, 2018

Tuition Free Medical Education: A potential game changer

In an earlier article, I focused on the many years of study-often over 18 years after High School-it takes for a pre-medical student to actually practice his specialty.

On Becoming a Physician: Pre-medical students 'shadowing'
a doctor as he makes his rounds

 At nearly age 40, he/she is now burdened with hundreds of thousands of dollars of crippling educational debt.

 This situation is the catalyst for several avenues of stress. First, the pressure to repay the loans forces many doctors to choose high-paying specialties-- when they would otherwise choose less lucrative ones such as practicing family medicine(primary care) in under-served communities.  This is a specialty whose shortages could total an alarming  35,000 by 2025 and even much more by 2030.

The financial stress has further ramifications once our doctor begins to see patients.

Unwittingly or wittingly, our caregiver is, in many specialties, forced to sacrifice a leisurely in- depth doctor/ patient relationship (refer to The Model of Empathetic Medicine : The Way it Was) in favor of short cursory visits in order to see as many patients as possible per hour.

Now comes an eye-opening series of events, perhaps a game changer.

Recently, both NYU Medical School and Columbia Physicians and Surgeons have announced programs to offer (a) free tuition to all students regardless of need (in the case of NYU) and (b) full tuition scholarships  to those in greatest financial need, while others would get only grants, not loans, to make up their need (in the case of Columbia).

Tune in to my next article which will answer the question whether offering 'free' tuition is really a boon to ameliorating the crises facing traditional medicine today.

Sunday, September 23, 2018

Thomas Edison Rest Stop is Closed: Finding Comfort in New Jersey Two Years after my Sister's Passing

The Thomas Edison Rest Stop along the 
New Jersey Turnpike is closed for Renovations

Just a short two years ago, I was on my way driving down the New Jersey Turnpike to Southern New Jersey for the funeral of my sister Marilyn. 

Then, I passed many Rest Stops along the way including the Thomas Edison pictured above.

This year I was doubly sadly in shock on my way down the NJ Turnpike-- to spend Shabbat in a warm caring community to gain comfort and healing for sister Marilyn...

She was so abruptly taken from our family by a metastatic lung cancer. 

I  was preparing to exit the ramp to heed the call of nature and  quaff some Starbucks at the service area named for our  famous luminary (aka the 'Wizard of Menlo Park', NJ ) and, lo and behold, there appeared a sign declaring that this area had closed. 

It seemed so final to me, as if a light had been extinguished, sudden, unanticipated--reminiscent of the final days of Marilyn's precious life.  

Thomas Edison Library courtesy of Wikimedia  Commons  

(I had visited The Thomas Edison National Historic Park in West Orange, NJ many times and found Glenmont,- the family estate home-, his laboratories and his library fully intact as they were when he was still alive.)

This story, however, does have a happy ending.....

 It does lighten up. 

My weekend near Philadelphia was replete with much healing and uplifting of my spirit and that of my departed sister.

 My hosts made me feel at home for the second year in a row and the Synagogue provided me the opportunity to recite many kaddishes (memorial prayers) for her.

I even read a Mishna in her honor. 

When I returned home,  I googled the area and much to my de-light learned that the stop is temporarily closed for renovations and will reopen soon.



Friday, August 31, 2018

Stressed out medical professional trainees/students? There's a quiet poetic (R)evolution in the air

For five  earlier articles depicting how the medical arts have devolved, scroll through my blogs beginning with the seminal one entitled Crises in the Medical Arts: Returning Medicine to Patient Centered Care Giving.

The links between the healing arts and poetry are well known.

The Statute of Apollo Outside the National Academy of Athens
Apollo was recognized as the god of healing, poetry, music, truth,
the sun and light and much more  

 For instance,  poets including  John Keats, William Carlos Williams and Oliver Wendell Holmes, Sr.  all received medical education.

The composition, recitation and listening to verse is known to release pent up feelings of angst, sadness, sorrow and depression--making it much easier to deal with these stressful feelings. (this subject to be explored in a forthcoming article)

Perhaps one  of the most calming and stress- relieving poems  is Psalm 23 which begins with:
"The Lord is my shepherd I shall not want."

The verse soothes all those who are  stressed through life's  travails  with its lovely images such as  being lead beside still waters and being guided on the right paths,  though we walk through the valley of the shadow of death. 

So it comes as no surprise that poetry would be a tonic for the  proverbially overworked medical trainee.

Kudos to the pioneering steps of St. Andrews Medical School (founded in. 1413) that acknowledges the healing benefits of poetry and the practice of humanistic medicine.

Tools of the Trade is a pocket size 
book of collected poems for doctors, It is
small enough to pull out and read when needed
photo from the Scottish Poetry Library.

Each year, each of the circa 900 Scottish medical school graduates receives "Tools of the Trade: Poems for new Doctors."  It's a small volume, less than 100 pages--thus easily potable.

According to a recent Wall Street Journal article, "the poems are grouped into five themes designed to help young physicians: looking after yourself, looking after others, beginnings,  being with illness and endings."

May this project, though in its infancy, continue to blossom and spread the seeds of empathetic humanistic medicine.