D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Vol. 4 Issue 2 April 2015
Keeping the Human in Medical Humanities The term “medical humanities” is much like “medical sciences,” easy to recognize but difficult to define. Medical science is an amalgam of many things, biochemistry, microbiology, anatomy, physiology, but no one expects a physician to be a bench scientist in order to practice medicine. The name medical humanities is even more amorphous. It
originated in the 1960s in a religious context promoted by theologians and bioethicists as an effort to humanize medicine, which some thought had already started its pivot away from the patient and toward technology. It has since incorporated philosophy, anthropology, sociology, psychology, and the arts; music, literature, poetry, and drama. All of these fit well under a humanities classification, but the relationship to medicine is less obvious. People often call on it when trying to describe a perceived deficit in the persona of today’s physician, equating it with that special blend of bedside manner and clinical concern that evokes a Norman Rockwell image. That is not a fair comparison. There are generations of doctors who inspire confidence and trust, who make home visits on winter nights and bandage little boys who have fallen out of apple trees but have never been to an opera, never read a poem, and find the rendering of a coherent progress note painful. There are others, as real as the fictional television Dr. House who are gifted with a scintillating intellect and frightening diagnostic abilities, who play the guitar and piano, who hang out in art museums, yet demonstrate egregious behavior toward patients. Educators argue that studying the arts can transform the impersonal medical scientist into a compassionate, competent practitioner by rekindling the dying embers of empathy. They see unique opportunities to hone clinical abilities by exploiting the similar skills needed to read a literary manuscript and a patient. They suggest that there is an opportunity for young
Robert Thom, American 1915-1979 “Pasteur: The Chemist Who Transformed Medicine,” from “The History of Medicine” Courtesy the Collection of the University of Michigan Health System, Gift of Pfizer Inc., UMHS.32
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Points of View
morphed into information technology-supported pathways of clinical practice. The provision of medical care is highly dependent on several correct steps occurring in the right sequence at the right time, and clinical pathways help to systematize these steps in an appropriate manner by developing computer-based, comprehensive patient/disease specific care plans. Our hospital’s leadership has vigorously embraced clinical pathways for the most common illnesses seen at our center. A major concern with routine use of order sets and clinical pathways is that they limit clinicians’ ability to act independently, and their widespread adoption could lead to “cookbook medicine” by discouraging clinicians’ knowledge and understanding of the logic and evidence on which the recommendations are based. On the contrary, development
Learning Aspects of Pathways The emphasis on quality assurance, evidence-based medicine and clinical quality improvement that began in the late 1980s remained a focus of attention through the first decadeand-a-half of the new millennium and will hopefully continue for the foreseeable future. Regulatory bodies, Rajiv Dhand, MD, Chair professional societies and consumers of health care are stressing the need to standardize clinical practice across the spectrum of patient care. In this environment, guidelines for the management of specific disorders have proliferated and have progressively
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1
Cardiovascular Fellowship: First Step to the Next Level
Pictured from left to right: Dr. Dale Wortham, Program Director, with current cardiology fellows: Drs. Harry South, Steven Dolacky, Madhur Roberts, Moses Osoro, Umang Shah, and David Perkel
The Cardiovascular Diseases Fellowship at the University of Tennessee Graduate School of Medicine had its beginnings in 2006 when Dr. Tim Panella approached me about starting the fellowship. I had previously been the program director of a large cardiology fellowship at Walter Reed. Since I had not really contemplated being a program director again, I asked him to let me think it over and talk to my group. The group was somewhat split over the idea, so I asked Dr. Panella to address our group. Needless to say, University Cardiology decided to proceed. For approximately one year with much assistance from Patti Obenour, we designed the program from scratch. Our situation as a private practice group in a teaching institution was somewhat unique since our patients belonged to a specific cardiologist. This made structuring traditional fellowship activities like a consult service or CCU team somewhat problematic. I decided to seek advice from similar private practice groups with cardiology fellowships and was surprised that I could only find three of them. Patti and I spent the rest of 2006 designing the required rotations that we thought would fit our group’s culture. After receiving approval of the fellowship by the ACGME for two fellows per year for three years, we enrolled our first two fellows July 2007. Drs. Rubinder Ruby and Gayathri Baljepally were brave enough to enroll in our brand new program. We were lucky since they did a great job and set the tone for the program. Both were our first graduates in 2010, and since then we have had a total of ten graduates. Our academic achievements include the publication of 23 peer-reviewed articles, 4 book chapters, and 34 posters or abstracts. Our ABIM pass rate is 88%. Of our ten graduates, five have gone on to advanced programs in either interventional cardiology or electrophysiology. The other five are working as invasive cardiologists across the country. The feedback I get from the fellows is that they felt well prepared to practice cardiology. With the continuing assistance of the Program Coordinator, Pam Trentham, the fellowship has had been quite a success and has had a positive influence on University Cardiology and the Department of Medicine. We continually seek to improve the fellowship experience through a variety of ways, such as our annual reviews and the simulation center. My near term goals are to start an interventional fellowship and, hopefully soon to follow, electrophysiology. It is hard to believe it has been over nine years since the beginning of the cardiology fellowship. The quality of the fellows continues to be exceptional just like the faculty. This along with with the support and strength of the Department of Medicine helps to make us better and better.
Keeping the Human in Medical Humanities
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learners to vicariously explore cultural, moral and ethical dilemmas before facing them in reality. In addition to preparing students of medicine for life, the humanities can also provide an escape. While we still teach that the patient will give us the diagnosis if we listen long enough, we are forced to limit appointment times. We preach social justice but cannot afford to treat the uninsured, teach pain management but not how to recognize suffering…the humanities can be a hiding place. William Osler, MD, said, “Nothing will sustain you more potently in your humdrum routine…than the power to recognize the true poetry of life---the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief.” Celebrate the humdrum at the Medical Humanities Conference hosted by Dr. Mendola. Listen for the poetry of the commonplace at Literary Rounds, hosted by Donna Doyle, Poet-in-Residence in the medical library. Encourage every student of medicine to see the suffering person within their unique context. Hear their story and find meaning in it. Act on their behalf. That’s the definition of Medical Humanities. 2
Faculty Announcements We are pleased to announce that Rajiv Dhand, MD, has been appointed to the position of Associate Dean of Clinical Affairs. In this position, Dr. Dhand will manage clinical services of the Graduate School of Medicine, including the UT Internal Medicine and OB/GYN Center (residents’ clinics). Dr. Dhand will continue to serve as Chairman of the Department of Medicine. Two new faculty members have been appointed to the Department of Medicine. Julie Monahan, DO, has joined our faculty as Clinical Assistant Professor. She has been practicing with Faculty Internal Medicine, Turkey Creek. Joseph Peeden, MD, has joined the faculty as Clinical Assistant Professor and Medical Student Clerkship Director for Pediatrics. Dr. Peeden also has special expertise in genetics.
Rajiv Dhand, MD
Dr. Peeden
Julie Monahan, DO
Kendra’s Treats “I decided I wanted to be a doctor after reading an article about geneticists in Newsweek magazine when I was in 3rd or 4th grade,” explained Dr. Kendra Black, PGY-2. “The dream evolved from there, with my eventual landing in internal medicine. I love the patients and the variety of internal medicine,” she explains of her medical career. She grew up in Jamestown, TN, and went to ETSU for undergraduate studies, majoring in biology with a minor in humanities. Dr. Black has another love that rivals medicine, however. She maintains a cooking and baking blog, “Kendra’s Treats,” as a hobby to “help keep me balanced.” She grew up cooking and baking with her mom, and her “skills really took off” during undergrad as she studied Food Network, read cookbooks and followed food blogs. Kendrastreats.com came to fruition during her second year of medical school “as a way to document my culinary journey and as an online recipe box.” The blog has evolved from mostly desserts into a variety of foods. “What’s on the blog is a direct representation of what’s happening in my kitchen,” explains Kendra. Friends, family, neighbors, and coworkers (hers and her husband’s) are beneficiaries of her “experiments” as she will bake and cook for “whoever I can pawn food off on.” Dr. Black’s other hobbies including running and road races “because I have to balance out my love of food somehow!” She enjoys hiking, being outdoors, traveling and photography (food and otherwise) as well as reading. Eventually, Kendra plans to practice outpatient primary care medicine.
Points of View continued from page 1 of clinical pathways could provide an educational opportunity by involving a large number of stakeholders and by incorporating the recommendations into the teaching curriculum as is being done in the medicine department. Using a strong evidence base for development of the pathways also requires them to be continually updated and reviewed so that they reflect state-of-the-art care for patients. Thus, uniform adoption of clinical pathways is having a tangible impact on the quality of patient care provided at our institution. It is heartening to note that members of the medicine department at all levels, under the leadership of Drs. Julia Van Zyl and Mark Rasnake, both of whom are faculty members in the department, are enthusiastically promoting the implementation of this key initiative. 3
CME Opportunities - Mark Your Calendars! The 3rd Annual Medicine CME Conference, offering 11 hours of CME credit, will be held April 17-18 at the Holiday Inn World’s Fair Site. We hope you can join us for this informative event.
Department of Medicine Grand Rounds 8:00 - 9:00 a.m. Morrison’s Conference Center University of Tennessee Medical Center, Knoxville Approved for AMA Credit 4-14-15 Cystic Fibrosis Bruce Ludwig, MD 5-12-15 Neurologic Paraneoplastic Syndromes Steven Rider, MD 5-26-15 Research Past and Present Mitch Goldman, MD 6-9-15 Annual Research Presentation by Department of Medicine Residents and Fellows
Guest Speaker, Dr. Mark D. Okusa We were delighted to have a guest speaker for our Grand Rounds on March 10, 2015. Mark D. Okusa, MD, presented “Changing Paradigms of Acute Kidney Injury: From Mechanism to Management.” He also gave the March 10th Research Seminar, “Targeting Immune Mechanisms for Therapies of Acute Kidney Injury.” Dr. Okusa is Chief, Division of Nephrology, and Director of the Center for Immunity, Inflammation and Regenerative Medicine at the University of Virginia School of Medicine, Charlottesville, VA. Dr. Mark D. Okusa
Presentations, Publications, Awards Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.
In Touch
Volume 4, Issue 2: April 2015 Publishers James Neutens, PhD, Dean Rajiv Dhand, MD, Chair, Department of Medicine Associate Dean Editor Ronald Lands, MD Administrative Director Susan Burchfield, CAP-OM Contributors Susan Burchfield Rajiv Dhand, MD Christen Fleming, MD Kandi Hodges Ronald Lands, MD Jane Obenour Design J Squared Graphics In Touch is produced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities. Contact Us In Touch University of Tennessee Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck. edu/internalmed/main.cfm
Thank You For Your Support For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the information in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.
Stay In Touch! Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you! 4
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