In the construction of knowledge, nothing is as important as what counts as evidence and what is discredited.
For example, the experience of Dr. Amy Forbes, Professor of History at Millsaps College and Associate Faculty at the Center for Bioethics and Medical Humanities, in the immediate aftermath of Katrina could readily be described as evidence of her capacity for unstinting public service at time of urgent, dire need. It could equally well help demonstrate how a historian may witness a cataclysmic event, perhaps even how such events can deepen scholarly engagement with historical research. However, the experience of Dr. Forbes, who served as a Red Cross volunteer among evacuees in Jackson following the storm, is unlikely to be as quickly mined for the deep immersion it provided into how people deploy language across the large and small events that must ceaselessly be bridged to support their lives.
Perhaps in science and medicine, we become a little too comfortable with how inclusion and exclusion should function. The tremendous capacities of the digital age and its tools - their very precision -represent a narrowing that is of great benefit in establishing and probing strict categories. This precision, however, may equally obscure the powerful impact of adjacent or overlapping contexts.
As a Red Cross volunteer, Dr. Forbes' decades of investigation into historical obstacles besetting communication made her keenly alert to the inability of many evacuated to Jackson to discuss their medical needs. Traumatized, their responses to queries instead centered on a repeated storytelling of their escape. The escape story predominated, even when the queries were backed up from, “Are you on insulin or any other routine treatment?” to “Do you have diabetes… asthma… kidney disease?” to “Do you take any medicine? Wear glasses?” During these conversations, representing the “escape” eclipsed the authorized responses to medical storytelling - “Yes, I take insulin…No, I don't wear glasses…” Such reports were absent, perhaps overshadowed, perhaps simply unavailable.
Dr. Forbes was uniquely positioned to observe and analyze this divergence. Her work since her undergraduate studies at Louisiana State University had been, first through modern languages and then through history, an examination of the definitions, cultures, and conversations by which we express alignment, difference, and vulnerability, particularly during periods of social and cultural upheaval. Her career-long investigations into historical obstacles to communication rendered her at once alert to the presence, among caregivers, but dearth, among survivors, of the authorized - here insufficient - narrative for describing illness, contagion, disaster, and demise, as well as any aspirations for succor and health. Whatever the medical need, escape was the thing, the material evidence around which urgently needed questions and answers had to be convened for the conversation to become meaningful.
In academic medicine and biomedical research we have for over a century roundly concurred: the findings from a study performed under rigorous conditions, reproduced by others under similarly rigorous conditions, and yielding similar findings across these domains, constitute strong evidence. For a half century now, findings from meta-reviews of data within established databases or in published reports have also furnished evidence that similarly invites, first, our inspection of these meta-analyses' methods, and with these reasonable, our confidence.
Rarely do non-historians think of history in terms of the painstaking collection of primary evidence - yet its research paradigm is just that, shaped and limited in a manner all too familiar to investigators from any discipline. As explained by Dr. Forbes, “In historical research, a question can only be asked if there are sources with which to answer it. That means there are some questions that cannot be asked.”
Human beings do not like limits, particularly those besetting their capacity to ask and answer the questions they consider meaningful and of far-reaching importance. Hence we develop an array of methods by which to refine, expand and answer the compelling questions of our historical and social epochs. But how does a historian contribute to developing these answers, often so demonstrable in hindsight, but so elusive at the moment and within the societies and cultures wherein they are most urgently needed?
“The pat answer,” according to Dr. Forbes, “is that a historian is someone who examines change over time. However dynamic the system, when a historian's questions are anchored to available sources, this examination seems to work to further our understanding of the social, cultural, and political contexts within which conflicts arise and communications responding to them are created in human life.”
Dr. Forbes' engagement in this examination began during her childhood in Baton Rouge, when the local public schools provided children with some study of French. Visits with New Orleans family made that city an ordinary place, an actual place, and prompted dismay at its depiction as a site for the consumption of fantasy-realism. In college, Forbes worked for a blues club opened by her father, where the performances by local musicians contrasted with “the schtick” that made music something to see, rather than hear. Alongside her growing understanding of the contrast between actual people and places and their portrayal within powerful stereotypes, Forbes read then-emerging historical scholarship on such practices as music, carnival, and ways of speaking - the conversations that are authorized, those that are excluded from authorized conversations (“silencing”) and those that acknowledge, circumvent and misdirect exclusion (for example, satire).
As a graduate student, first at the University of Georgia, then at Rutgers University, Dr. Forbes defined the concept that has informed her mature work: the examination of historical obstacles to communication. Since that time, her examinations have ranged from protest songs in the French Revolution, to satire in the July Revolution (1830 France), to scientific disputes about health and disease between Paris- and Philadelphia-trained physicians working in New Orleans during the early years of US medical education. The latter investigations in particular continued to evolve after her work among those evacuated after Katrina.
“New Orleans had long been described in terms of 'incurables', 'a soup of germs', 'how to survive the next epidemic…,' but as I worked in the aftermath of Katrina, parking behind the old Charity Hospital, my research about medicine, disasters, bodies, diseases took shape in earnest. The location of the speaker is always important in historical work - geographically, politically, socially, culturally. But in a disaster, a city itself becomes an interlocutor. People had fled with the lights on, and we watched as they went out over time.”
The evidence for Dr. Forbes' investigations is located in documents from ordinary, daily life - charts, letters, diaries, pamphlets, public archives, recorded lyrics, scientific reports, anecdotal and structured interviews, court records. In examining these data and formulating questions appropriate to their content and limits, Dr. Forbes does not seek to “put a fence around” communications. Instead, with this evidence, she investigates power relationships behind obviously linked and ostensibly disparate communications, examining “how they are placed in conversation with each other, and by whom…”
In her research, Dr. Forbes seeks above all to answer one question: “What happens when satire or any other approach that evades the authorized narrative goes wrong?”
This “going wrong” can occur when figurative language, such as satire, is apprehended literally. It can arise when an authorized narrative excludes crucial questions that more circumspect responses attempt to address. In health care, such “going wrong” could occur by deeming a patient's response merely timid or polite, rather than as an attempt to gauge the health care provider's views on a sensitive topic.
At just under 3 million people, Mississippi's population is not large, and the stereotypes they contend with are rarely those of fantasy-realism. At UMMC, however, with its charge to support the complex health needs of Mississippi's people, Dr. Forbes' expertise is welcome. At the CBMH, we look forward to collaborating with her to identify and explore evidence of how perceived authority and personal autonomy can - whether jointly or at odds - influence how and when conversations are created, how they are placed within the contexts of other conversations, “who” we are and “how” we create the knowledge authorized as representing “what has been…”
The infrastructure on which we each and all rely can at some point be overwhelmed, despite our best efforts as stewards. In such times, Dr. Forbes' work may help us better understand ways by which wiser communications might be created and extended, primary evidence read and shared, and judgment and integrity better maintained to support a more just and healthy life when the claims of great precision do not yet serve, and greater inclusiveness is the goal.
A core value of the Center for Bioethics and Medical Humanities is the linking of humanities scholarship to health care and bioscience so as to strengthen UMMC clinical service, research, and educational practices. For this reason, the CBMH regularly works with Mississippi humanities scholars and students whom they identify as having a strong interest in medical ethics. For over five years, these faculty and students have participated in a range of projects, including an intensive, summer immersion experience in clinical ethics, the Frate Fellowship, and other focused efforts. Following college graduation or graduate school, a number of students have returned to UMMC to gain a greater exposure to the bioscience, frontline and policy practices they examined while participating in CBMH programs as undergraduates.
Two humanities scholars who have helped identify students are philosopher Patrick Hopkins, a core CBMH faculty member, and his Millsaps College colleague, historian Amy Wiese Forbes, the keynote speaker of our 2014 Medical Humanities conference. Dr. Forbes' scholarly background in studies of 19th century France while a graduate student at Rutgers University eventually led to research on the rise of medicine as a profession in Louisiana, and particularly New Orleans, after statehood. Her course, the History and Health of Medicine, prepares students to examine institutional practices and how they influence debates centered on concepts of individual rights and public welfare.
Similarly, Patrick Hopkins brings his research on contemporary topics in science, technology, law, and theology into his Millsaps course, Biomedical Ethics. Dr. Hopkins, who completed a University of Mississippi Masters' degree in Experimental Psychology and conducted research at the Yerkes Primate Research Center (Atlanta) prior to his doctoral work in Philosophy at Washington University (St. Louis), specializes in ethical theory, with a focus on applied ethics in the fields of science, technology, and medicine (STM), moral psychology, and neuroscience. Dr. Hopkins' courses have inspired a number of Millsaps students to participate in the CBMH Frate Fellowship since its inception in 2011.
For newly minted Millsaps graduate Sophie Lipman, however, Dr. Hopkins' course on Biomedical Ethics helped close a loop on that other dilemma undergraduates must engage: “What follows college?” Sophie completed a major in History, with a minor in Political Science and Philosophy, under the mentorship of Drs. Forbes and Hopkins, and will soon be headed to the University of Texas School of Law. Her interest in the intersections of Law and Biomedical Ethics was inspired by topics raised in Dr. Hopkins' course, and augmented through research completed for her senior thesis under the direction of Dr. Forbes.
That thesis, Religious Free Exercise and the Peculiar Plight of Nineteenth Century Mormons, allowed Sophie to examine and report on how the Bill of Rights, added as “…early 19th century Americans were beginning to put the lofty ideals of their newly ratified Constitution to the test,” led to the first federal level challenge of the First Amendment and the protection it offers for actions defined as religious observance. Sophie traces how challenges to the practice of polygamy, accepted after 1840 among adherents of the Church of Latter-Day Saints, resulted in 1879 in the first religious free exercise case to reach the Supreme Court, Reynolds v. United States. In her examination, Sophie notes that the rhetoric used in these arguments led to “…one of the first times that the notion of natural rights…” is discussed in a Supreme Court opinion, as well as “…the first time that Jefferson's powerful image of a 'wall of separation between church and state' was evoked.”
Sophie is excited to learn about Constitutional Law and the many other aspects of a legal education, but she is particularly excited to further her examinations of contemporary bioscience and health care, the ethical challenges arising in tandem with increasing technological facility in both arenas, and how these challenges are met with in the American legal system. Toward this end, she applied to programs having formal areas of study in biomedical ethics - and was accepted at both her first and second choices, Texas and Ann Arbor, respectively.
Along with her legal, historical, and philosophical interests, Sophie will bring to her work the perspective of a young woman born to a father from Britain and a mother from the US South. But don't jump to conclusions about what each parent's natal patrimony signifies with respect to attitudes: the truth might not conform well to stereotypes about either locale! Instead, Sophie emphasizes the passionate conviction, as well as differing views, that her parents contributed to her education during political and social discussions. These qualities taught her to give equal deference to both sides of any argument, to recognize that “lots of grey areas…” always exist within any topic of importance, and that evidence and clear argument are crucial to examining those areas. Thus Sophie ascribes to her family, as well as her coursework, her ability to understand without being dismissive. This quality will be critical to Sophie's entire study and practice of the law, but it will stand her in particularly good stead during any professional exposure to the ethical dilemmas now extant in bioscience and health care.
In the meanwhile, Sophie looks forward to learning more about the structured rhetoric that inspires legal debate, even when - perhaps especially when - the topics under review are fraught with controversy and challenge. She relishes the deliberate and pointed usage that renders legal argument both creative and “a breath of fresh air…” in such debates. We at the CBMH deeply appreciate her enthusiasm for exploring the challenges and dilemmas of biomedical ethics during her legal formation, strongly encourage her desire to apply what she learns from that exploration as an ethical, informed, and creative legal mind, and look forward in a few years - we hope! - to welcoming her home, too.
As Program Administrator for the Clinical and Population Division of the newly launched Mississippi Center for Obesity Research (MCOR), Emma Willoughby's day will include a great deal of careful listening and reporting to help advance MCOR missions, aimed at a better understanding of the current obesity epidemic, locally, nationally, and globally. MCOR studies, which will include clinical, epigenetic and sociocultural research, currently target the clinical management and treatment of obesity, seek effective prevention in early childhood through improved education policy, and explore obesity's physiological effects and comorbidities. Through this work, the COR will contribute to better access to good nutrition in Mississippi, assist Mississippians in more effectively maintaining a healthy weight, develop collaborative networks that can reduce or eliminate food insecurity and advance viable pathways through which to obtain and prepare fresh, nourishing, satisfying Mississippi meals.
Emma's formal interest in food and nutrition began during her undergraduate years at the University of Mississippi. Through coursework in Sociology and Anthropology, she examined social determinants that could negatively impact health, among them food insecurity, food system politics, and disparities. With a matter-of-fact sense of initiative, Emma and fellow student c-director Jillian Cowart requested in 2014 to meet with Dr. Dan Jones at the Chancellor's Office about initiating a food project, the Real Food Rebels, to help bring local, sustainably- sourced food into campus dining halls.
Only well after the meeting did Emma learn that Dr. Jones, having investigated similar initiatives at other campuses, was far more than not inclined to grant the two students permission to proceed; he was quite prepared to deny that permission owing to the confrontational strategies of similar campus efforts. However, the two petitioners' shared nutritional objectives with those programs did not extend to their strategy, which differed vastly. The approach presented by Emma and Jillian for the Oxford campus was vastly different and involved collaborations with the effort's many stakeholders, as well as a healthy dollop of diplomacy. Thus, to his surprise, Dr. Jones found himself concurring that the proposal suggested by Emma and Jillian indeed offered a viable means of effecting important shifts toward campus and community health. By the end of the meeting, Emma and Jillian had gained permission to form a collaborative, “real food working group.” Across her senior year in college, Emma participated in this effort by directing the University of Mississippi On-campus Food Bank.
Emma's undergraduate education also included the first hand study of health care practices, dilemmas and policy considerations as a 2013 Fellow of the CBMH Summer Bioethics Fellowship (SBF). Through the SBF, Emma and four other undergraduates had the opportunity to directly observe and discuss with UMMC faculty mentors the impact of health care policy and decision-making on the care of individual patients. We like to think that this experience was a pivotal factor in Emma's choice to earn a Masters of Science in International Health Policy at the London School of Economics and Political Science. With that completed this past fall, Emma returned to UMMC to join the Center for Obesity research efforts led by Dr. Jones.
Emma's Masters' studies were particularly germane to her MCOR work. Dedicated to her parents and “those at home across the pond in need of holistic health care” (Willoughby, 2015, p. ii), her thesis examined how theoretical approaches from behavioral economics and medical sociology fare in improving adherence to recommended Type 2 Diabetes (DM2) treatment routines. The often asymptomatic nature of DM2 can prevent “…patients from recognizing the importance of continuing their treatment regimen, especially changes in diet and exercise habits” (2015, p. 35). In a recent discussion with Dr. Caroline Compretta, CBMH anthropologist and Assistant Professor in the Department of Preventive Medicine, Emma explained her findings on the importance of gaining patient perspectives on their experiences of chronic illness, rather than relying on assumptions based on theoretical and political constructs from Behavioral Economics.
Citing 21st century research and policy reports, Emma noted that focusing only on a patient's adherence or nonadherence to prescribed regimens fails to account for negotiations of identity that occur as the patient incorporates illness and experiments with responses to it (2015, p. 29). Behavioral theories do acknowledge the vast trajectories such responses can take. However, they all too often still propose incentives to encourage treatment compliance that hinge on normed views of rational self-interest, whether or not these views are shared by a particular patient.
Caroline and Emma concurred that to achieve effective, patient-centered care, an understanding of economic constraints, socio-cultural contexts and systems of belief concerning health and illness are critical. This understanding can help caregivers partner with patients as they establish and work toward achieving health goals, whether by managing chronic illness, maintaining progress toward a healthy weight, and/or developing and instilling cross-generational that can support lifelong health and reduce incursions to it.
As a young woman from Ocean Springs who learned early about the life and force of ponds, Emma is in home waters again, and we are glad to have her back.
The Schwartz Center has since 1999 “honored outstanding healthcare providers, who display extraordinary devotion and compassion in caring for patients and families.” On November 18th, 2015, however, the University of Mississippi Medical Center's Dr. Rick Boyte received the Inaugural Schwartz Center National Compassionate Caregiver of the Year Award. The award was presented by the award-winning physician author Dr. Atul Gawande, who also addressed the audience of 2,000 caregivers and healthcare executives at the Annual Kennth B. Schwartz Compassionate Healthcare Dinner in Boston.
Dr. Boyte, a pediatric palliative and critical care physician, as well as a core faculty member in the Center for Bioethics and Medical Humanities, is himself a physician writer who has been instrumental in efforts to promote writing among healthcare practitioners at UMMC. Today we write to congratulate him on his award, his work on behalf of his patients and their families, and his next chapter!
In August, the Center for Bioethics and Medical Humanities conducted the BaFa' BaFa' Simulation for all new dental and medical students during their 2015 orientation. The goal of the BaFa' BaFa' Simulation is to foster an appreciation of cultural diversity through an interactive and exciting activity that requires participants to cooperate using new cultural norms. During the simulation, students divide into two imaginary cultures, learn how to participate in their new groups, and engage the other culture despite having no prior knowledge of the other group. Afterward, students gather for an in-depth discussion of the exercise and its relevance for healthcare professionals. The experience helps participants recognize the myriad ways biases are incorporated into everyday practices, fosters positive communication, and supports an appreciation of difference. This experiential learning opportunity allows students to not only have fun, but also to learn valuable tools needed to work in multidisciplinary teams and in culturally diverse healthcare environments.
Anna Grace Stout
The five 2015 fellows set to gather in late June to begin the Center for Bioethics and Medical Humanities' Summer Bioethics Fellowship will follow four prior groups that have observed, experienced and debated a broad spectrum of the bioethical dilemmas that can and do arise on the front lines of medical and health care service, education, research and policy.
The fellowship, limited each year to a small cohort of fellows to minimize intrusiveness as they and their docents take part in clinical rounds, provides undergraduates with an opportunity to learn about and reflect on healthcare practices. It is not passive learning, however; fellows debate the health and health care impact of practices they have seen in small groups and special seminars with UMMC faculty and guest professors. Each SBF cohort quickly engages the fundamentals of principalism, including autonomy, beneficence, nonmaleficence, and justice, alongside probing deontological and utilitarian approaches to such topics as advances in and limitations of population research, transplantation, healthcare law, critical thinking and moral judgment, public health, dual loyalty, religion and spirituality, biomedical research and its funding, Institutional Review Boards (IRB) and Institutional Animal Care and Use Committees (IACUC), public health, mental health, and critical intersections of health and health care with humanities and arts disciplines.
These topics represent ambitious goals for a month, but they are only intermediate achievements, in actuality, for the fellowship. Its overarching objective is to provide fellows with an exposure to the complexities of contemporary health care that will enable them to contribute productively, through the myriad disciplines and fields they will engage, to the improvement of systems for supporting and sustaining health, for delivering effective, patient-centered care, and for confronting with compassion, equilibrium and justice the ethical challenges that human susceptibility to injury and illness inevitably present.
During summer 2015, to celebrate the Summer Bioethics Fellowship's fifth year, we will detail some of the achievements of former SBF fellows. To begin this series, we will introduce Anna Grace Stout, one of the CBMH's 2014 fellows. Anna Grace cites her participation in the CBMH fellowship last summer as pivotal to her inclusion in a group of 5 students, out of 107 applicants nationwide, now pursuing the Mayo Clinic's Summer Bioethics Research program.
"We had to write a cover letter," explained Anna Grace, en route to Minnesota. "I outlined what we did in the fellowship, and I believe my experience at UMMC is what caught their eye."
There would be many things to catch the reviewers' attention, actually, beginning with Anna Grace's major in Public Policy Leadership and two minors, one in Chemistry and one in Biology. They might also have noticed her enthusiasm, after participating as a fellow in the CBMH summer 2014 Poverty Simulation, for bringing that experience back with her to Oxford. Despite the often daunting nature of progress between enthusiasm and accomplishment, Anna Grace was able to develop and propose her concept, gain funding for purchase of the simulation kit in a short amount of time - and the University of Mississippi Poverty Simulation is now scheduled for implementation on October 3, 2015.
Perhaps it was just this grit and willingness to bring something important back to her student community that prompted one of Anna Grace's Public Policy professors, Dr. Eric Weber, himself a recipient of the Mississippi Humanities Council 2015 Public Humanities Scholar Award, to point her toward the Mayo Research program.
With her phone interview's discussions of the CBMH Summer Bioethics Fellowship and acceptance to the Mayo Clinic's Summer Bioethics Research program relegated to the past academic year, Anna Grace is excited now to turn her attention toward the two qualitative research projects in which she will soon be participating. The first will involve focus groups and health care groups aimed at helping bereaved mothers to cope with lactation management post-infant mortality. The second will consist of focus groups with healthcare workers on the many ethical implications of prenatal genetic diagnoses, and consequent communications with the pregnant patients.
When asked to cast an eye backwards to last summer, though, so as to offer any advice to the incoming fellows, Anna Grace did not hesitate. "It is a fantastic experience, and the mentors put a lot of work into developing and organizing the fellowship. Read that huge binder - reading it is well worth the time; it makes a difference. Take advantage of all of the opportunities that are presented to you."
The Center for Bioethics and Medical Humanities had the honor of participating in the 17th annual meeting of The Southern Association for the History of Medicine and Science (SAHMS) held in Jackson, Miss., on March 12-14, 2015. Center Director, Dr. Ralph Didlake, moderated a session on "Bioethics in 20th Century Health Care" which included a paper entitled "Religious Refusals of Treatment by Adolescent Patients," delivered by CBMH affiliate faculty member Jonathan Will, JD, of Mississippi College School of Law. Dr. Didlake also presented a paper in a session focused on 18th and 19th century medicine describing the center's ongoing work to archive materials from Centenary College School of Medicine, which operated in Brandon Springs, Miss., from 1841 to 1844.
Health care discussions now routinely occur across print, broadcast and digital media, including real-time interactive sources. These discussions both serve the public good by disseminating ongoing developments in knowledge about health, injury, and disease, and proliferate questionable facts, opinions, and beliefs that must be addressed by all of us in health care and bioscience research. The 2015 Tatum Lecture, Medicine and the Media, to be held at noon in room R354 on April 7, 2015, will focus on the impact of media discussions and representations of health, disease, the impact of illness, and approaches to prevention and treatment. This lecture, held annually as a memorial to and in honor of the pioneering work of Dr. Nancy O'Neal Tatum in establishing the first formal medical ethics program at UMMC, supports careful reflection on dilemmas confronted in the delivery of patient-centered care.
Medicine and the Media will highlight three disciplinary perspectives concerning the influence of media examinations of health and disease through a panel discussion of the assumptions and dilemmas that can arise through various media interactions among health-care professionals, established media outlets, blogs, and real-time digital forums engaged by the public, individuals and other interested parties. The panel of experts, which will represent front-line medicine, broadcast reporting, and public relations, will include UMMC Professor of Pediatrics Dr. Hannah Gay, WLBT's news anchor Stephanie Bell Flynt, and UMMC's Chief of Public Affairs Tom Fortner.
Dr. Gay recently learned that a career-long effort to pursue the highest standard of quality care for her patients can garner attention, wanted or not, as a national media icon. Thrust into such a role when one of her patients experienced a critically important period of functional cure from HIV as a result of Dr. Gay's proactive efforts, UMMC's most famous pediatrician will discuss how such unexpected attention places important burdens on a physician with respect to ensuring accuracy in health-care communications, upholding patient privacy and reporting health-care outcomes to support the public health and good of the entire community. She will be joined by Stephanie Bell Flynt, a veteran television broadcast journalist whose work has been recognized by the Association of Health Care Journalists. In addition to detailing the responsibilities, skills and ethics of trained journalists in ensuring that the public remains aware of new developments in health care and research, Ms. Flynt will also help address the developed strategies in print and broadcast media for engaging health literacy concerns by language to bridge "fine print" that might otherwise be ignored to a potential "big picture." Thus, she can provide information on how media strategies for working with "the story" might be redirected for use in patient communications by frontline health-care providers. Finally, UMMC's own Tom Fortner will contribute to the discussion by explaining how institutional public relations efforts within academic medical centers at home and across the country strive also to link research and service findings with a story that can communicate wide-ranging developments in care, local implementations of such findings, local instances that illustrate them, and specific services that can be accessed - and how to do so - by individuals and communities within each institution's areas of service.
By considering discrepancies between media and medical depictions of healthy function across the life cycle, the natural history of a disease, abbreviated lay definitions of medical concepts, and media summaries of approaches to care, the 2015 Tatum Lecture will help further thoughtful conversations within UMMC on the public media and digital technology platforms that now put health knowledge - or obfuscation thereof - easily within reach. By examining dilemmas associated with the impact of media focus on specific health topics for research and reporting, media vs. medical authority in public understanding of health and illness, and real-time, real-life contests between these disparate sources of focus and authority in patient decision-making, the 2015 Tatum Lecture will further the spirit of ethical investigations that characterized the contributions of Dr. Nancy O'Neal Tatum throughout the years of her practice as a family medicine physician in Petal and as a medical ethicist and faculty in Family Medicine at UMMC. By generating discussions on how Medicine and the Media might jointly better communicate medical realities, alongside novel treatments, the 2015 Tatum Lecture seeks to extend and enrich Dr. Tatum's legacy for patients and providers throughout Mississippi.
The 2015 UMMC Common Reading project, co-sponsored by the School of Medicine and the Center for Bioethics and Medical Humanities will feature "Men We Reaped" by Mississippi author Jessmyn Ward. This annual event, now in its fourth year, is intended to highlight the many dimensions of diversity and to remind us how good literature can help us explore complex human problems.
For this year, we chose something hard, challenging, even controversial. The book examines the deaths of five African-American men in the author's life in a raw and unflinching way. This work was chosen in part because we, as the community of UMMC caregivers, have an obligation to take on hard or uncomfortable topics that cause us to reach for deep understandings of the individuals for whom we provide care, or whom we study, or whom we educate. Selecting this book is not without risk. If read superficially, this book can reinforce negative racial and cultural stereotypes, even perpetuate long-standing prejudice and bias. Read more closely however, this book is about loss and grief, the cyclic frustrations of poverty, mental illness, chronic health issues and under investment in education. A thoughtful reading unmasks a story of Mississippi, of Mississippians, of the social, economic and cultural contexts in which we live, in which we become patients, and how these facts complicate our care and contribute to variances and disparities in outcome.
Our challenge is to give this excellent, but difficult book a close, reflective reading and use it both as a corrective lens through which to see others and as a mirror in which to see ourselves. Please join us at noon Wednesday, Feb. 25, in Room R354 for an open discussion.
Biomedical illustrations are used in teaching and research to communicate information that even "being there" cannot always convey. A line slightly contoured, highlighted, weighted, or shadowed - neither the perfect line of a computer, nor the unimpeded "capture" possible with a handy smartphone - is able to elucidate and communicate information about anatomy and physiology in a manner rarely otherwise achieved. But to produce lines that can communicate requires an ability to look at something, visualize it and put it on paper.
To create such lines, Michael Schenk of Biomedical Illustrations at UMMC, pursued both a full pre-med curriculum and a course of studies in art as an undergraduate, followed by a master's program at Georgia Regents University in Augusta, one of six biomedical illustrations programs in the U.S. and Canada. His graduate studies included coursework in the initial two years of medical school alongside medical students, a series of summer internships that put him in such sites as surgical theaters and pathology labs, and extensive study of the communication of complex concepts through art.
"If you don't know your anatomy," he states, "you won't know how to remove the extraneous, the liquid for instance, so as to render the illustration better."
Schenk's work at UMMC began with an interview with Dr. James Hardy among packed boxes; the pioneer surgeon's work was in transition. This past summer, however, Schenk's UMMC collections of biomedical drawings and sketches were unpacked, examined and archived by two School of Medicine students, Lauren Williamson and Jedd Audry.
The immediate task undertaken by Williamson and Audry involved sorting the Schenk sketches and drawings by discipline - no small task for a collection of its size. The individual items that the students worked with included free sketches on tracing paper, copy paper, watercolors, carbon dust, pen-and-ink, and layers produced to show surgical procedures. The students were tested in their medical knowledge, as they had to identify the subject of every drawing in order to catalog and archive it.
Williamson and Audry described it this way: "There were representations of Schwanomas, craniotomies, even laporoscopic panoramas, one might say, of complicated surgeries, as well as surgical manuals to review and catalogue." Their efforts permitted them to explore academic archives, the Hardy catalogues, earlier editions of Arthur Guyton's textbook, and the many contributions of other physicians whose efforts greatly contributed to the medical center, to School of Medicine educational goals and standards, and to the continuous development of a philosophy for guiding health care education across disciplines.
However, when asked about the value of a detailed examination of items in the collection, Williamson and Audry did not dwell on the past. Without a moment's hesitation, they replied, "It was great for our future knowledge," one chiming in as the other left off.
"There was a story in every picture."
"It was a great opportunity to kind of flesh out the story within the picture…"
Audry later described "an image which stood out (that) involved the trapping of the anterior inferior cerebellar artery before it could distribute blood to the cerebellum. This reminded me of a trigeminal neuralgia patient whom I saw in clinic. Although a different kind of entrapment (dealing with nerves), in looking at the AICA entrapment, it kind of hit me: This surgery had been done on a real person that had presented with real pain and discomfort. It was a life-saver to them, and it was interesting to see a clinical presentation that gave life to the medical artwork. Lauren and I were constantly reminded that the beauty of Michael Schenk's work is in its ability to show students, surgeons, physicians, nurses, and others in the medical field not only the techniques and procedures in medicine, but also the intricacy of the human body."
In closing his description, Audry quoted a poster in the Biomedical Illustration offices: "Draw what can't be seen. Watch what's never been done. And tell thousands about it without saying a word."
Williamson similarly described the sleuthing that was part of the students' summer. "One of the more difficult image series that we had to identify was found in the ENT box. The anatomy is very complex, and some of the drawings were finely detailed surgical images. One in particular involved a nine step operation that had no explanation or labeled anatomy. Luckily, Jedd had shadowed neurosurgeons throughout the summer and knew it was a craniotomy (for which a bone flap is temporarily removed from the skull to access the brain). But there are so many different approaches, such as frontotemporal, parietal, and suboccipital, that we needed additional information to fully identify all nine images. This involved searching the online library catalog and scanning the bookshelves for ENT surgical texts. I found one that did step-by-step instructions on craniotomies, from which I learned that we were working with a frontotemporal approach. It took us about two hours to identify just nine images, but it was well worth the effort. And we could not have done this without our recent neuroanatomy class, Jedd's hands-on knowledge in the OR, and my knowledge of the library resources (Pubmed, Up-to-Date, and the catalog)."
"And now we have this collection of medical drawings that are very well annotated."
"We hope it becomes a future resource for medical practitioners."
There is every reason to expect that the students' hope will be realized. As Schenk explains it, a well done pen-and-ink drawing, for example, can be scanned at high resolution, the resulting huge file transferred to a software program such as Illustrator, then streamlined, converted to vector, and sent around the world. When printed, it will look like a pen-and-ink drawing.
But to achieve that result, to avoid a stagnant pane, to realize instead an image's communicative potential, the placement of each line is defining. The work of Williamson and Audry, and their excitement in brief moments and phrases describing it, confirms that a line well placed can both yield a biomedical landscape and its context - and invite its viewer to probe and discover each.
On October 16, 2014, the Center for Bioethics and Medical Humanities (CBMH) hosted the Mississippi Humanities Council's (MHC) fall meeting at UMMC. The CBMH works regularly with the Council to employ humanities approaches to knowledge and its assessment and dissemination to help strengthen health care professionalism, research, advocacy and patient outcomes.
The meeting included a tour of key sites on the UMMC campus that comprise architectural "archives" of our history as an institution. Some of the sites visited included the surgical room where Dr. James Hardy performed the first heart transplant, the Emergency Room where civil rights leader Medger Evers, transported by private car to UMMC because no ambulance would respond to the call, passed away after being shot, and the bank of nearly adjacent bathrooms and dining rooms that bear further witness to the demonstrable facts of segregation. The tour began at the original entrance to the hospital and continued to the new adult hospital, symbolizing a move towards a healthier future for all Mississippians.
Details on our current CBMH-MHC collaborative effort, Food: for Thought, for Life, can be accessed from the home page of the CBMH website.
The most recent UMMC Poverty Simulation was held from 9 a.m.-noon Thursday, Oct. 9, 2014, in the UMMC Student Union.
Our next Poverty Simulation will be held from 9 a.m.-noon Wednesday, Feb. 11, 2015.
The Poverty Simulation, developed by the Missouri Association for Community Action, is a tool designed to educate participants about the day-to-day realities of living with a shortage of resources and an abundance of stress.
Participants were each assigned a role to assume during the four 15-minute "weeks" during which the simulation takes place. The participants' challenge is to end the "month" having met all of their obligations - financial, familial and social. The simulation takes approximately three hours to complete.
The Center for Bioethics and Medical Humanities brings the Poverty Simulation to the University of Mississippi Medical Center to sensitize our students - future practitioners - to the challenges that some of their patients may experience in addition to being in ill health. It is our hope that the simulation will serve to inform and shape the way the future health-care providers of Mississippi deliver care. The simulation is also open to UMMC faculty and staff, our stakeholders and interested members of the community. Please e-mail Amani Bailey with any questions you may have.
Our fifth Summer Bioethics Fellowship came to a close Aug. 1, 2014. We reluctantly said good-bye to our six fellows who had been with us since June 30. This fellowship, a collaboration between the CBMH, Millsaps College and the Department of Philosophy and Religion at the University of Mississippi, began in 2009, and is a five-week immersion experience exposing students to many ethical, social and cultural issues associated with modern health care and bioscience research.
In addition to being the largest fellowship class yet, several new events were added to this year's program content. New to the fellowship this year was a visit with Dr. Gloria Perry, chief medical officer of the Mississippi Department of Corrections who shared information on the topic of dual loyalty in correctional medicine. This theme was continued by another new addition, Dr. Leslie McKenzie, associate professor of Emergency Medicine at UMMC and an active-duty officer in the Mississippi Army National Guard. Another new experience for our students was a tour of the SIM Center conducted by its medical director, Dr. Anna Lerant.
Also added as a discussant this year was Dr. Peyton McElroy, affiliated scholar at Millsaps College and affiliate faculty for the CBMH who met with students to discuss the philosophy of film. This discussion provided an excellent base for viewing films assigned over the course of the fellowship. Dr. McElroy holds degrees in philosophy from Stanford University as well as a master's in philosophy of religion from Yale Divinity School and is also experienced in theater, having served as theater director for plays in Boston and New York. Other new topics added this year included a medical anthropology discussion, led by Caroline Compretta, PhD, QEP Post-Doctoral Fellow at the CBMH, and a discussion of war and health facilitated by Dr. Libby Spence, professor in UMMC's School of Health Related Professions.
In total, the students met with 44 expert docents and discussants, completed and reviewed 56 readings, and viewed and analyzed 13 films. They successfully distilled their experiences and observations into essays on a focused bioethics topic. This year's group was bright, engaged and at times challenging. In other words, exactly what one wants developing scholars to be. A perfect example is Anya Kremer, a rising senior in the Honors College at the University of Mississippi who introduced a new film documentary to the group and led a discussion about contextualizing a patient's illness. The film, "Tanaquil LeClercq - Afternoon of a Faun," is based on the life of a ballet dancer who was stricken with polio at the height of her career. Anya, herself a dancer, amplified this discussion with her own artwork as well as exceptional insight.
Our Summer Bioethics students were included, for the first time, as participants in the summer session of the CBMH Poverty Simulation. This simulation experience is a collaboration with Entergy Corp. and is designed to educate participants about the day-to-day realities of living with a shortage of resources and an abundance of stress. It has proven to have a profound effect on all who take part.
As these students return to school to resume their traditional studies, we are certain that their summer experiences will change the way they approach their studies, their careers and the world. It was a pleasure to have had them this year. We at the Center for Bioethics and Medical Humanities wish each of them much success in the years to come.
On June 30, the Center for Bioethics welcomed members of the 2014 Summer Bioethics Fellowship. The fellowship, now in its fifth year, is a five-week immersion experience exposing students to many ethical, social and cultural issues associated with modern health care. This year's fellowship of six is the center's largest to date.They are Joseph Maxwell, Anya Kremer and Anna Grace Stout from the University of Mississippi, Merrilee Bufkin and Charles Stevens from Millsaps, and Amir Khadivi from the University of Chicago.
During this fellowship experience, the students will attend sessions conducted by 44 discussants and docents, visit various clinics and attend Weekly Fetal Conference. In addition, they are assigned selected readings from biomedical literature and view films that serve as the basis for weekly discussions.
To date, the students have toured the animal lab facilities as well as the Simulation Center, have seen the Dialysis Unit at the Jackson Medical Mall, attended Mortality/Morbidity Conference and met with the director of the Institutional Review Board. Additional experiences included a visit to the Tissue Bank, and accompanying rounds in the Pediatric Palliative Care unit at Batson Children's Hospital. A trip to the Mississippi State Hospital at Whitfield was the highlight of their second week of the fellowship.
Sessions during the fellowship cover a broad spectrum of topics for the students: religion and spirituality, literature and medicine, allocation of scarce medical resources, organ transplantation, confidentiality, dual loyalty in both military and correctional medicine, public health policy, genetics, medical anthropology and cosmetic procedures, to name a few.
Many other exciting events are scheduled before the fellowship concludes Aug. 1. The students will meet with Dr. Gloria Perry, chief medical officer, Mississippi Department of Corrections; participate in the UMMC Poverty Simulation; visit the UMMC Center for Telehealth; and view several films of Dr. James Hardy's surgeries performed at UMMC.
It is the ultimate goal of this fellowship to produce a population of humanities scholars versed in the human aspects of medical care and bioscience research. Our hope is that these scholars can bring the skills of their respective disciplines to a better understanding of how people experience health, injury and illness.
Selection of the prize winners was done by four reviewers, each with experience in health care education, a love of literature, and a current or former engagement with literary scholarship, poetics, essays, and/or reviews. Two further readers from the Center for Bioethics and Medical Humanities served as "tie breakers" - or tried to! First place was awarded to Will Berlin for Before, a poem that moves its reader through the strengths and fragilities encountered in initial clinical experiences and "the fierce magic it takes to live." The unbreakable tie for second place went to Leslie Davis for her reflective poem Where You Are and to Andrea McLaughlin for her good-humored, light verse rendition of This Chaos they Call, "Nursing School. Third place went to Allison Pace for her reflective essay, A Year of Firsts.
The book prize, a copy of William Carlos Williams' The Doctor Stories, was selected for its literary quality and eye witness documentation of the health care assumptions, practices, and relationships prevailing over the course of Williams' lifetime (1883-1963). His Paterson, NJ, medical practice is portrayed in these studies and poems through clinics, hospitals and house calls, but most importantly through vignettes - not always flattering and some outright objectionable - of William's interactions with those who sought care. All local, some would arrive through world wars, the Great Migration, revolutions; all 20th century, many would be affected by the Great Depression, or benefit by the advent of discoveries that would lead to astonishing changes in our approach to illness, health and health care, changes that continue to unfold. Robert Coles (b 1929), who introduces this volume and the Williams who observed to a medical student "There's nothing like a difficult patient to show us ourselves," finds in Williams professional renderings the following caution:
Coles goes on to state that, "Presumptuousness and self-importance are the wounds this life imposes upon those privy to the wounds of others. The busy capable doctor, well aware of all the burdens he must carry, and not in the least inclined to shirk his duties, may stumble badly in those small moral moments that constantly press upon him or her - the nature of a hello or good-bye, the tone of voice as a question is asked or answered, the private thoughts one has, and the effect they have on our face, our hands as they do their work, our posture, our gait. (xiii)"
These words apply to health care providers in every discipline, and the submissions to Writes … of spring showed that our students try diligently to heed them.
Finally, the awards were made only a few hours after word of the passing of Maya Angelou (1928-2014). In honor of her contributions within American letters and art, and in recognition of her immense influence on literary forms by which to examine the histories we live, the Book Awards began with a reading of the first stanzas of Maya Angelou's Still I Rise, followed by an excerpt from Theories of Time and Space by Mississippi and U.S. poet laureate Natasha Tretheway.
The Center for Bioethics and Medical Humanities would again like to congratulate each student who participated in the 2014 launch of Writes … of spring for picking up the mandate of Williams, Coles, Angelou, Tretheway, and uncountable others to intervene on behalf of healing through the reflective exercise of their profession. We look forward to reading more work by all of these students - and you?!
The Center for Bioethics and Medical Humanities is pleased to introduce Dr. Caroline Compretta, our Quality Enhancement Plan (QEP) Post-doctoral Fellow. A graduate of Millsaps College, Dr. Compretta received her master’s and doctoral degrees in Cultural Anthropology at the University of Kentucky, Lexington, where she investigated the complex and contested relationships between service providers and recipients in faith-based social service programming.
Her doctoral research examined the contradictions and commonalities in providers’ conceptualizations and implementations of services and the lived realities of participating children and families. In view of agency struggles to meet the needs of children and families, her research showed that giving voice to service populations, especially children who are rarely considered in the creation and provision of services, helped to identify areas for service development and collaboration. Her work advocates listening to clients’ voices so service professionals can construct more responsive programs given their knowledge about the everyday issues clients face. In addition to her research interests, Dr. Compretta brings to CBMH an expertise in qualitative methodologies. As an anthropologist, she conducts structured analyses using techniques such as interviewing, focus groups, surveys, and “participant observation,” a method that allows a researcher to immerse herself in the participant community to gain first-hand knowledge about research issues. The analyzed data generated from these and other qualitative methods helps to create a holistic understanding of social dynamics in order to affect social change. Dr. Compretta’s work at CBMH will focus on issues of engagement as a means to work toward the improvement of patient outcomes. She plans to investigate engagement as it relates to the communicative dynamics within interdisciplinary healthcare teams, between patients/families and practitioners, in patients’ cultural and spiritual practices that affect health, and between practitioners and the wider community. Dr. Compretta will apply her knowledge and skills to examine how people within healthcare communities can create more effective responses to patients’ medical and sociocultural needs through communication and understanding. In so doing, her work will help to improve the quality of care at UMMC.
Topics important to national health care education and policy discussions on both physician retention and the declining interest in rural and primary care practices provided the focus for original investigations by Therese L. Sison (M3) and Khang Dang (M2), respectively, of the UMMC School of Medicine. The students, who have worked with the Center for Bioethics and Medical Humanities since their M1 year, continue to evaluate and interpret data on physician management of professional grief (Sison) and on election to practice in Mississippi (Dang).
Coping patterns for professional encounters with grief comprise an important skill set for physicians and other clinical caregivers. To examine these patterns among resident UMMC physicians, Sison modified a survey instrument jointly designed by Kenneth J. Doka, professor of gerontology at the College of New Rochelle (NY), as well as a senior consultant to the Hospice Foundation of America, and Terry L. Martin, associate professor of Psychology and Thanatology at Hood College (MD). Their metric delineates grief patterns into "instrumental'" (modulation through problem solving), "intuitive" (modulation through demonstration), and "blended" approaches.
Sison piloted her modified metric in a survey of 281 residents from a range of UMMC specialties to identify the patterns most frequently used to manage professional grief. A blended grief pattern was seen for most of the residents surveyed. However, statistically significant differences were observed in a number of areas. Among the most interesting for further investigation, one comparison showed that respondents in primary care specialties had significantly higher instrumental scores (p ≤ 0.001) than their colleagues in non-primary care specialties. Policy discussions about the election to practice in a Mississippi practice after completing UMMC medical training helped prompt Dang's interest in medical graduate specialty selection and practice locale. This pilot retrospective study was conducted as the initial segment of an effort to develop useful models for predicting both election to practice in the state and specialty selection among graduating UMMC School of Medicine Students. For this work, Dang examined demographic data for 1,056 students and for 1,599 residents at UMMC to identify patterns and policies that positively correlated with the election to practice in Mississippi between 2002 and 2012. Dang's study results showed that the election to practice in Mississippi was positively correlated with primary care residencies (more female than male physicians), a Mississippi origin and/or family in Mississippi, a dedication to primary care medicine, and a Mississippi undergraduate education. Sison and Dang hope that their work will contribute to policy and education efforts that will ultimately help improve physician satisfaction and retention, and thereby improve standard of care for patients throughout Mississippi.
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