2530 Midterm

"Redefining the Practice of Medicine" Dr. Goldman (TED talk)

-Elements of modern medicine culture create an environment that stands in the way of healing: pride and competitiveness of physicians out of med school and hospital systems, fear of failure, cost of healthcare and physicians needing to make money, unrealistic expectations of perfection, no time for self-care, and no space to admit mistakes to learn from them and teach others -White Coat Black Art -Reminds us of other challenges- owning our humanity & admitting our mistakes

Jenner

-Eradication of smallpox -Father of immunology

Hippocrates

-Father of environmental medicine, explored the relationship between human health and the natural environment -3 goals: alleviate a patient's suffering, reduce the severity of illness, recognize and refrain from treating the untreatable (do no harm)

"What Doctors Worry About" Dr. Gawande (TED talk)

-Find where your failures are -Devise Solutions- checklists -Implement solutions (like checklists) with help from everyone with humility, discipline, and teamwork. -creating systems that work with pit crews and not cowboys) -Talks about cost and medicine -Autonomy WAS our highest value, now we need to build on discipline, teamwork and humility -"Making systems work"

Herophilus

-First anatomist -Placed consciousness in the brain and not the heart -First to describe two parts to the brain (cerebrum and cerebellum) -Determined what nerves do: convey movement from brain to limbs -Found that arteries and veins were different (arteries 6x thicker) -Linked beating of heart to the pulse -First to describe male and female urogenital organs

Soranus

-First in birthing techniques/Father of obstetrics -How to handle a breech birth -First biography of Hippocrates -First to write of psychiatric problems: depression/mania -Raised the 'art of differential diagnosis' to a new level

Eristratus

-First physiologist -Advanced the 'art' of surgery in his day -First to understand the heart was a pump -Came closer than any other person (for nearly 2000 years) to understanding blood flow & circulation (via capillaries)

Al-Rhazes

-First to offer ideas that 'blind belief' in the absolute truths of religion inspires fanaticism and hatred -All are equal -Differentiated between measles and smallpox (counter to the doctrine of Galen) -Provided excellent details of many diseases -First to classify animal vs. vegetable vs. mineral -Wrote a book of medicine for the 'common man' -Father of pediatrics and ophthalmology -Wrote extensive textbook of medicine used in European medical schools for hundreds of years

Weyer

-First to put mental health on the table -Father of psychology -Father of psychiatry -Fought for those who didn't have a voice

Varro

-First to recognize 'germs' may exist -Idea for germ theory of disease -Invisible minute creatures

Harvey

-Heart as the center of health -Circulation of blood (by the numbers) -Moved beyond qualitative description of heart and gave quantitative information -Inspired scientists/physicians to use experimentation to ask 'how' things worked (more so than why)

Galen

-Paralyzed medical progress for nearly fifteen hundred years -Nerve function of spinal nerves due to his severing the spinal cord -The function of arteries -The fact that the heart was reason for the pulse and blood flowed from the heart to the periphery

"Patch Adams" (film)

-Patch learned he wanted medicine to not look like the dean and doctor in the mental hospital (ego standing in the way of patient care) -Found healing through laughter, energy, interaction, caring, listening -Stressed not to fear death but accept it as part of the process -Students were pushed to learn from a book (instead of patients), created cold and paternalistic relationships (referred to patients by illness and not name), pushed to become machines who don't make mistakes

"A Doctor's Touch" Dr. Verghese (TED talk)

-Patients need attention that is apparent to them, and he suggests touch and physical examinations to achieve this -There is a "virtue of examination" -Patient care is a ritual, hallmarked by importance, catharsis, necessity, and a relationship

Paracelsus

-Pioneered use of chemicals and minerals in medicine -Sickness and health in the body relied on the harmony of man (microcosm) and nature (macrocosm) -Certain illnesses of the body had chemical remedies that could cure them -Major contributions to toxicology (poisoning of body from outside the body) and psychotherapy -Doctors should treat rich and poor alike -Each disease has a unique cause and cure -Chemistry must be used to create pure and potent drugs

"Art of Medicine" Dr. Braverman (video on Art of Analysis program at Yale)

-Program beginning at Yale that encouraged medical students who analyze and interpret visual art pieces to encourage and develop more detailed observational skills of patients -Art brings humanity together and connects us -Excellent health care workers are observant and pay attention -Like an artist, we notice what is right before our eyes

"Empathy: The Human Connection to Patient Care" The Cleveland Clinic

-Showed various patients in the hospital with thought bubbles above their heads -Worries about things like 'how will I pay for this appointment', 'I'm scared', 'I don't understand' -Emphasizes that physicians don't always know what their patient is thinking and they need to have empathy when interacting with patients -Using art in film to help us 'sense' in medicine

"The Doctor" (film)

Doctors of time were neglectful of their patients' feelings... In this film, Jack learns what it is like to be the patient in the patient physician relationship... He discovers first hand several details which open his eyes to what his past patients have gone through.

"To Isaiah"

Dr. Berwick's fundamental message in "To Isaiah" was one of caution. Although we are taught to treat and "cure" with the healing art of medicine, there is no use in healing a person of physical illness if we do not care about the whole person and what they are going through personally. Isaiah was a patient who he saw over a period of time who was "cured of leukemia [yet] died of hopelessness". It is not just our job to treat the sick, but also to stand up for all those who do not have a voice in the politics of human health in America. We must be "healers of the miseries [we] did not cause" and stop hiding behind neutrality.

"A Story I Hope Ends up being True..."

Dr. Wendy Stead is an infectious disease specialist who visited with a patient named Tom. She talks with him at length about children, his job, and his friends. Although she eventually talks with him about the treatment plan, when she leaves he thanks her for "coming and talking with me". This meant more to him in that moment-to be treated like a person. "Even when we don't have the answers, we should still go into the room...While modern medicine was failing both of us, he treated me as a human, not as a doctor, and led us to that place where the power to heal remained."

"Just Like You" Keb Mo (music video)

Music is used to relate to the human experience, and this song serves to connect and unite people

"The Healer's Art" Dr. Remen (NBC news story)

-"Healing is evoking from people - their resource, their innate strength, their capacity to respond to the challenge of their disease" -She developed a program for med students that taught and encouraged listening, openness, and their presence in the moment

Al-Nafis

-'Radical new understanding' and description of how blood is oxygenated is the first by some 300 years (disproved invisible pores Galen believed in)

"Embedded Arts" Worthen (video about art motivating PT with trackers on limbs)

-Arts used to inspire, to motivate patients to complete their therapy by creating a visual -Patients can see movements and time goes by faster -Patients work harder because they want to see darker colors -Speeds up recovery

Vesalius

-Dissection -Learn things with your own senses -Found more than 200 discrepancies in Galen's work -Significant detail of the human brain (rete mirabile) -Femur was straight and not curved, no invisible holes in heart's septum -Galen's work described animals, not humans -Wrote anatomy textbook

"Our Hour: Cancer Research through a Dance Community" Chang (OSU dance group expressing cancer)

Arts used to relate to human experience by expressing the story of cancer and its challenges through dance

"The Good Physician"

The art of medicine is an intense awareness of the human condition. It is spiritual and elusive. What then, makes the difference between a good and an average physician? Good doctors are compassionate and curious, but how can we actually measure these traits?" The main example in this article is when Dr. Bhadula saw Mrs. K, asked her all these questions and thought she had mastered the "diabetic visit". However, Dr. S went in after her and got way more information from her in less time. She had lacked something that Mrs. K needed in order to really open up. "What we cannot measure objectively, we cannot reproduce or learn with certainty and must instead acquire individually by experience. We create curriculums, post surveys, attend workshops, all in the hope that we might understand the formulaic success of exemplary physicians... The flaw inherent in this pursuit is that when it comes to physician-hood, we cannot render unto science that which is not due to science." The art of medicine is unique to each doctor and only developed through self-reflection.

"Learning to Breathe"

The author of "Learning to Breathe"(Elizabeth Levin) did not choose to either connect fully with her patient or to create an emotional separation. Through the mindfulness based techniques she learned in her class, she was able to breathe through the emotions she was feeling while discussing taking the woman off life support, and did not cry or add to the family's burden.