Ralph Didlake, M.D., F.A.C.S.
Associate Vice Chancellor for Academic Affairs
Director, Center for Bioethics and Medical Humanities
The uncharacteristic duration of cold weather across this past Mississippi winter was more than matched by the energetic participation of students, providers, faculty, staff, and yes – even administrators! – in a series of educational corollaries to UMMC’s service, education, and research missions. This participation was especially noteworthy for its transprofessional character and signaled an increased understanding within UMMC that the responsibilities entrusted by Mississippians to its academic medical center depend upon an informed understanding of the challenges to and contributions of all.
This recognition, easy in principle, can fade in the crush of daily health care and research obligations. Instead, we rely on a sharp focus on skills and resources, premium among them time. Meeting our respective duties routinely leaves but rare opportunity for sharing the contexts of our knowledge transprofessionally. Even within one’s own mandated training forums, the iPAD charting of HIPPA protected information can prove quite tempting, can it not?
More is required within an academic medical center than answering to the immediate. The exercise of high standards across departmental and divisional missions requires a depth of understanding as to how each of our efforts cohere with our partners in health care service, education, and research. The responses of our peers, patients, transdisciplinary team members, and others may strongly influence, or even determine, the outcomes of our own efforts.
January to March 2014 abounded in opportunities for members of the UMMC community to consider such contexts – and many UMMC community members rose to the occasion to participate in them. Present and historical challenges arising from a wide range of sources, their impact on achieving crucial standards, and moments occasioned by them frankly marked by patchy understanding, faulty communications, and consequent suffering were reviewed and discussed among seasoned and emerging members of the UMMC community.
In January, the 2014 Common Read examined Sheri Fink’s Pulitzer prize-winning, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, in two back-to-back sessions sponsored by the Office of Multi-Cultural Affairs and led by Jonathan Wilson, UMMC’s Director of Disaster Management and Emergency Services. Mr. Wilson provided an overview of UMMC and statewide disaster preparations and responses, along with the overall stabilities to withstand and vulnerabilities to disaster of our institution and our state, prior to opening the discussion. A lively, transprofessional audience contributed its experiences of triage and decision-making across Mississippi and Louisiana during Katrina, with thoughtful debate on the many ethical implications of urgent decisions made under extreme pressures of time and resources. The session closed with a table-top disaster exercise that asked participants to recognize the nature of an approaching disaster, how best its effects might be met and curtailed, and where systems and resources for responding well to it might be overwhelmed.
In March, fifty transprofessional UMMC students joined a group of one hundred from September 2013 in augmenting their coursework by an Entergy-sponsored, Center for Bioethics and Medical Humanities implementation of the Poverty Simulation Experience. Research supporting the development of the Poverty Simulation Experience was conducted in Jefferson County, Missouri by the Missouri Association for Community Action. Its community advocates and researchers accompanied actual families as they navigated the caregiving and financial demands of managing a household with insufficient resources. Based on their findings, they produced a simulation experience designed to “sensitize participants to the realities faced by low-income people.” Amani Bailey, MA, MPH, the CBMH Education Administrator, looks forward to expanding this program so as to explore in greater depth how insights into the escalating tensions associated with insufficient income can be used to improve clinical care. In welcoming students to the Poverty Simulation Experience, Ms. Bailey cautions at its outset, “This is a simulation. It is not a game.”
The 2014 Humanities in Medicine lecture, Doctors and dueling: Establishing Medical Authority in French New Orleans, was delivered by historian Amy Weiss Forbes, Director of European Studies and Professor of History at Millsaps College. Dr. Forbes’ talk outlined the divisions in 19th century American medicine, including a rather circumspect view of approaches to evidence-based outcomes, including duels to defend professional reputation. The role of reputation in establishing the legitimacy of 19th century medical practitioners, and the rhetorical and discursive practices involved in upholding that reputation, were examined across that century’s repeated outbreaks of yellow fever. Along with tales of recourse to arms to rebut, among other things, charges of “empiricism,” Forbes contrasted established and emergent concepts of physician legitimacy among New Orleans French-speaking physicians of differing generations, francophone physicians and the English-speaking ones who followed Louisiana’s admission to the union, two theoretical training models (Parisian and the U.S. northeast), rhetorical approaches associated with the city and the provinces, and the use of argument in substantiating evidentiary claims. Hierarchies of language, race, religion, specialization, and the regard of patients were also crucial in concepts of physician authority, and while their aspect may differ vastly from ours, they serve as a caution against becoming overly comfortable with evidence and authority as they support our own assumptions.
April began with the 2014 Tatum Lecture, honoring the contributions of Dr. Nancy Tatum to Mississippi health care, including her pioneering work to establish UMMC’s first formal program of medical ethics. A Family Medicine physician, Dr. Tatum first joined her father in a Petal, Mississippi practice until his death, then trained in Medical Ethics at Vanderbilt and joined the UMMC Department of Family Medicine faculty, where she was an outstanding physician, teacher, and advocate. In her memory, this year’s lecture featured a panel presentation on a topic replete with the rich ethical features that she would point us toward: The Value of Genetic Information. Ethical issues surrounding genetic information were explored by Dr. Patrick Hopkins of Millsaps’ Department of Philosophy, who provided philosophical and legal contexts for what aspects of genetic information can and cannot be owned, Dr. James Wilson, who provided a researcher’s perspective on the trajectory of access to genetic information, and what this information may and does not entail, and Pediatric Genetic Counselors Holly Zimmerman and Laura Hendon, who spoke of dilemmas in dealing with what genetic information does and does not provide in terms of potential interventions, as well as troubling ethical dilemmas that can arise in practice as genetic evaluations become increasingly incorporated into clinical practice.
From March to May, however, UMMC students, from all UMMC schools, were invited to enter the dialogue – and twenty-one students did,, reflecting on their experience of the 2013-2014 academic year in the inaugural Writes…of spring contest. Using a range of forms, they answered the following questions: Where did you begin? Where are you now? What did you discover about yourself, health, illness, healthcare, biomedical sciences, and Mississippi collaborations toward better health? How have your initial expectations and aspirations for your discipline fared across the material you have encountered in your studies? What have you particularly learned from peers in your own discipline or in others on campus?. The contest was completed May 1st, and was followed by judging by Dr. Rick Boyte of Pediatric Palliative Care, Amani Bailey of the Center for Bioethics and Medical Humanities, Laura Weeks now owner of Lorelei Books in Vicksburg, but formerly an ICU nurse, and Dr. Ann Steinecke of the Association of American Medical Colleges, who holds a PhD in American Literature. Will Berlin received first prize, Leslie Davis and Andrea McLaughlin tied for second, and third went to Allison Pace.
In an earlier message, I mentioned that “the outcomes of health care rely on a profound understanding of sheer matter, the spirit of function, the dynamics at play upon, within, and surrounding the body. Patients tell you, in honed precision, the world they know. Use every means at your disposal to be able to hear it.”
Attending to that voice is urgent. But the insights of mentors, peers, and those you are educating can also spell the difference between standard of care and outstanding care. Transdisciplinary forums are as vital to the service and research missions of an academic medical center as they are to its educational mission. It is in the actual sharing of knowledge that the most important characteristics of team cohesion are based.
As critical as the knowledge of one’s own role within health care delivery and research is, that knowledge alone is insufficient. You are invited to suggest topics for future discussions, to participate in something outside your pressing interests. You are invited to join in respectfully when others have taken such an initiative. It is not just your presence in other forums that matters, although it does. It is your future grasp, when time narrows to an instant, and you must judge.
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