teaching activism in medical education: goals, topics and the use of literature martin donohoe, md,...
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Teaching Activism in Medical Education: Goals, Topics and
The Use of LiteratureMartin Donohoe, MD, FACP
Harvey Cushing
“A physician is obligated to consider more than a diseased organ, more even than the whole man. He must view the man in his world.”
Rudolph Virchow
“Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”
Issues in Teaching Activism
• Students– Highly motivated– Negative attitudinal changes / cynicism
• Faculty
• Curricular Time
• Institutional Support
Goals
• Educate students and residents about social justice issues
• Promote activist-oriented research and writing
Goals
• Translate knowledge into practice through volunteerism and service
• Encourage lifelong learning
• Heal schism between medicine and public health
Issues
• Access to care
• Racial, sexual and SES discrepancies in outcomes
• The effects of poverty on health
Issues
• Corporatization of academic and clinical medicine
• The role of the pharmaceutical industry– Drug promotion and advertising– Drug pricing
• Conflicts of interest– Balancing responsibilities to self, patients,
insurers, colleagues, and community
Issues
• Women’s rights issues:– Violence against women– Teen pregnancy– Female genital mutilation– Political, legal, and educational
marginalization– Sexual harrassment
Issues
• Homelessness
• Substance abuse
• Tobacco industry
• Privacy:– Genetic testing– Drug testing
Issues
• Human subject experimentation– Nazis, Japan’s Unit 731– Tuskegee Syphilis Study– Willowbrook Hepatitis Experiments– Henry Beecher– U.S. government-sponsored radiation
experiments– Nuremberg Code, Helsinki Conventions
Issues
• Human Subject Experimentation - Contemporary Issues:– Special populations (e.g., prisoners, cultural
minorities, the mentally ill– Internationalization of research– Use of placebo controls– The role of for-profit IRBs– cloning
Issues
• Environmental degradation– Overpopulation– Air and water pollution– Deforestation– Global warming– Unsustainable agricultural and fishing
practices– Species loss
Issues
• Environmental degradation – social justice contributors:– Overconsumption (“affluenza”)– Maldistribution of wealth– Rise of the corporation– Third World debt crisis– Human rights abuses
Issues
• War and Militarism:
– Weapons of mass destruction– Diversion of economic resources and
intellectual capital– Prejudice/hate crimes– Erosion of civil liberties
The Role of Literature
• Vicarious experience
• Explore diverse philosophies
• Promotes empathy, critical thinking, flexibility, non-dogmatism, self-knowledge
• Encourages creative thinking
• Allows for group discussion/debate
Why Use Literature
• Encourage appreciation of non-medical literature
• Develop reading, analytical, speaking and writing skills
• Promote ethical thinking (narrative ethics)
• Identification with doctor authors (e.g., Keats, Chekhov, Maugham, Williams)
Homelessness
Doris Lessing
“An Old Woman and Her Cat”
From the Doris Lessing Reader (New York: Knopf, 1988)
Conflicting Responsibilities of Physicians
Pearl S. Buck
“The Enemy”
In Far and Near: Stories of Japan, China, and America (New York: The John Day Company, 1934)
Race and Access to Care
Ernest J Gaines
“The Sky is Gray”
in Gray, Marion Secundy, ed. Trials,Tribulations, and Celebrations: African American Perspectives on Health, Illness, Aging and Loss. Yarmouth, Maine: Intercultural Press, 1992
Poverty
• Orwell, George. How the Poor Die. In Sonia Orwell and Ian Angus, eds. The Collected Essays, Journalism and Letter of George Orwell, IV; In Front of Your Nose, 1945-1950. New York: Harcourt, Brace and World, Inc: pp.223-233.
• Checkhov, Anton. Letter to AF Koni, January 26, 1891, Letter to AS Survivor, March 9, 1890. In Norman Cousins, ed. The Physician in Literature Philadelphia: WB Saunders, 1982.
• Eighner, Lars. Phlebitis: At the Public Hospital. In Travels with Lizbeth. New York: St. Martin’s Press, 1993.
Domestic Violence
Michael LaCombe
“Playing God”
In LaCombe M, ed. On Being a Doctor. Philadelphia: American College of Physicians, 1994
Human Subject Experimentation / Human Rights Abuses
Shusaku Endo
The Sea and Poison
(New York: Taplinger Publishing Co., 1972)
Mental Illness
Anton Chekhov
Ward Number Six
in Chekhov A. Seven short novels (New York: Bantam, 1976)
Single Motherhood / The Welfare System
Grace Paley
“An Interest in Life”
In We are the Stories We Tell: The Best Short Stories by North American Women since 1945, Wendy Martin, ed. (New York: Pantheon Books, 1990)
“Activist” Journals
• American Journal of Public Health
• Public Citizen’s Health Letter
• PNHP Newsletter
• Mother Jones
• Harpers
• Z Magazine
• Hightower Lowdown
“Activist” Journals
• Rachel’s Environmental Weekly
• Sierra
• The Amicus Journal
• Bulletin of Atomic Scientists
• Multinational Monitor
• Some articles in NEJM, JAMA, JGIM, SSM, others
Rudolph Virchow
• “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.”
Contact Information
Public Health and Social Justice Website
http://www.phsj.org