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.