The Pharos - Sample Articles and Poems
Article
links are to pdf files |
Editorial: "There is nothing more hostile than water turning into ice" And then there were eight “My medical school class is smaller now. Out of the ten of us who started in September, now there are eight. The cost of a career in medicine never felt so real.” Among medical students the prevalence of mental illness is 15-30%, three times higher than the rate of depression in either the general population or age-matched peers. Even more alarming is a report that the chance of dying by suicide is 70% higher for male physicians and 250-400% higher for female physicians compared to non-physicians. Untreated depression is a major concern in our professional community. Many in the medical profession continue to stigmatize mental illness and several organizational and regulatory barriers discourage physicians from seeking help. This essay discusses the recent experience of my medical school class and potential reasons physicians are reluctant to seek help. My university’s comprehensive plan for medical student wellbeing is presented as well as suggestions for practicing physicians and educators. The smirk My first rotation as a third-year student was in the colorful neighborhood known as "Boystown" in Chicago. Armed with my stethoscope, reflex hammer, tuning fork, and pocket book, I was eager to diagnose and save everyone. However, the people were not sick. What was the purpose of seeing the not-so-sick patients? I was beginning to doubt my patients and myself. Then, Jon walked in. Searching for God below the vocal cords It is Saturday, June 21, 2003, approximately 7:00 am. I am content, as I have managed to capture a few hours of uninterrupted sleep while on call. I am eager to leave—I was not supposed to take call last night, but the resident in charge had a family emergency and I was summoned to duty. Suddenly the speaker next to the head of my bed announces, “Attention, attention, code blue, pediatrics, admission entrance!” My first thoughts are “It can’t be real! It cannot be there. No one codes in the entrance to the hospital!” Poem - Path in the Afternoon Poem - Dance of the Student Doctor Poem - She Lay Quietly Poem - A Tribute to Medical Stereotypes |
Editorial: The American culture and health care Burial at sea Our ship was ten minutes out of port and my daughter, my niece, and I were in the lounge playing bingo. We were enjoying a tropical cruise. My sister-in-law, a nurse, approached suddenly and she appeared tense. “Karen needs you right away. The man in the cabin nextto yours is having a heart attack and he looks really bad.” A fragile web of understanding The personal reflection, “A Fragile Web of Understanding,” describes an encounter that the author, a diabetologist rounding in the medical intensive care unit, had with an individual who might be described at first glance as a “difficult patient.” The conversation that ensues reveals experiences and perspectives that are foreign to the doctor, and reveal the complex interplay between past and present experiences of racism, suspicion, and mistrust that frequently underlie and influence encounters between doctors and patients. The wayward eye Two years after cataract surgery to replace the lens in his left eye, the patient began exhibiting abnormal signs in his right eye. It began with ptosis of the right lid only that resolved over several days with warm compresses. He then noticed a painless deterioration of vision in that eye that progressed at an alarming rate over a week. It was accompanied by episodic diplopia that became nearly constant. Retinal examination showed no pathophysiological changes. Wear a red robe “Wear a Red Robe” explores the emotional response of a medical student to the news thather aunt has been diagnosed with terminal lung cancer. Poem - The Devourer of Things Poem - One of us Cartoon - Alpha-male giraffes have learned to get carotid ultrasound by age 17 Poem - Nine Holes Poem - Creation: Millennium 2000 Poem - Still, No Clue |
Editorial: An epiphany—requisite for all physicians Invaders from Mars, with commentary from Robbie Burns Medical students are generally idealistic. They enter the profession with dreams of relieving suffering, pushing back the frontiers of biomedical science and teaching the next generation to carry on these noble traditions. They often identify many members of the older generation as being jaded, greedy, insensitive, and self-centered, and usually vow to avoid this fate themselves. Despite these lofty intentions, each generation follows the one before in the gradual, imperceptible transition from idealism to cynicism. The explanation for the inability to prevent this inexorable mutation lies in the neurological concept of anosognosia, the denial of deficit. The only antidote is to recruit a reliable friend who, looking from the outside, does not suffer from anosognosia. Those of us who have such friends and are willing and able to see ourselves as others see us have a fighting chance to avoid the otherwise inevitable victory of the Invaders from Mars.
In the wake of Katrina: An update on the Louisiana State University School of Medicine in New Orleans August 29, 2006, marked the one-year anniversary of Hurricane Katrina’s arrival along the Gulf Coast. Its epic devastation has been well chronicled, and the city of New Orleans continues to rebuild its infrastructure, including its homes, neighborhoods, schools, and healthcare system. The losses were enormous and did not spare the academic medical institutions, which had to sustain their multiple missions of research, healthcare, student teaching, and postgraduate training. Posthumous letters Written as letters between the cadaver and the medical student dissecting her, this piece chronicles the student's reflections as he procures more from anatomy lab than knowledge of human structure and comfort with death. A key theme is uncertainty. The romantic intentions of the body donor are in stark contract to the realities of being a specimen, and this dichotomy is crucial to the student's realization that medicine and life are not about scrutinizing to the point of certainty, but instead learning to wield life's uncertainty as an asset. The student experiences a transformation as he realizes through his cathartic recounting of the brutal realities of dissection that he is capable of the decisive, courageous actions that medical practice requires, and that his cadaver's intention, which he once perceived as grandiose, were accurate. Mentoring: Nurturing clinician and physician scientists in an academic career Career mentoring for clinical and physician-scientist faculty in particular should be planned and offered by an academic medical department. While often considered to be helpful, the effectiveness of mentoring should be more rigorously assessed to find out how well it meets the needs and expectations of faculty, especially younger members. Faculty who serve as mentors may need better preparation and more incentives to improve this service. As the emphasis of the mentoring changes during a person's career, different advice must be devised and offered. For example, in the early phase, research success (obtaining and maintaining grant support) is very important; in mid-stage, administrative or other career options compete with continued research, and clinical and educational activities; and in the later period, finishing up and retirement strategies surface. Mentoring must remain flexible, pertinent, and sensitive to provide good help throughout the whole academic career. Unintentional fraud: An oxymoron? Fraud in medical research is being uncovered with increasing frequency. Most cases involve intentional fabrication of data or manipulation of results. Although intentional fraud is in many cases unavoidable, as it involves complex psychological forces, unintentional fraud is preventable. Researchers, especially those relying on others' work, should undergo significant training in prevention of this serious consequence. The faculty dining room Lunch time means different things to different people. Some virtuously do without lunch altogether, pretending that this somehow both contributes to health and bolsters the ego, while freeing up time for other things. Some choose to eat in the hospital cafeteria, partaking of the customary sumptuous delicacies. Poem - Byte Poem - Harvest
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Editorial: Well, death's been here for a long time Consumer-driven health care: Implications for the physician/patient relationship In the United States, we continue to struggle with the elusive health care goals of quality, affordability, and accessibility. The newest health care financing and delivery experiment is the consumer-driven model, which seeks to financially empower and thereby encourage (in many cases, actually force) individuals to exercise much more choice and control regarding the details of their own health care. This emerging paradigm presents a number of significant implications for changes in the future role of physicians within the physician/patient relationship. This article outlines some of the most salient of these potential implications. Commentary: Health Savings accounts—the avoidance of solution A trip to Philadelphia "You don't know me, Dr. Fritts," the man on the phone said, "but my colleagues and I know a good deal about you, and in the light of what we know, we believe you are uniquely qualified for a job we need to fill." The gym Dr. Hostler, an academic pediatrician with sixty-six year old knees hobbled by degenerative arthritis, runs the numbers in a humorous description of her predawn experiences at the gym struggling to postpone the inevitable joint replacement surgery and, maybe even, retrieve one more summer on the tennis court. Three times a week at four o’clock in the morning she works out with a twenty-three year old trainer seeking counsel about his marriage, honeymoon, first home and possible conversion to Judaism. Success is defined by faint praise from the tight-assed physical therapist, advice-seeking about second childhoods from the early morning crones and progression to one hundred pounds on the horizontal leg press. Saved by AΩA A man whose temple-hair was becoming gray bragged to me recently that he had graduated MD at Ohio State in 1990. He was momentarily nonplussed when I told him that I had received my MD degree at Western Reserve University in 1935. His eyes mirrored the spinning of his mental calculator. That long-ago day, so difficult for him to imagine, is engraved in my memory. I hope the occasion of graduation is a precious day to remember for all physicians. It is more than a once-in-a-lifetime event for each of us. For me it represented both achievement and challenge. Everything that preceded it made the achievement all the more unforgettable. The challenge was how I was to get home to California from Cleveland after graduation. Poem - The Man Who Raised Nightingales Poem - Tiger Swallowtail Poem - An Inconclusive Autopsy |
Editorial: Endangered species Danse macabre: Poverty, social status, and health Disparities in health status and in life expectancy are striking features of the American health landscape, and of the landscapes of other developed countries as well. To some extent these differences can be related to variations in the incidence of disease, access to health care, health-adverse personal habits, violence, and other factors, but deep societal forces appear to be important determinants as well, and in fact may, in many instances, be primary. Socioeconomic status is prominent among these, and has been tied not only to life expectancy but to health trajectory across the lifespan in a variety of studies over more than 150 years, despite changes in health care systems and disease patterns, and in the fact of deepening understanding of the biology of disease and the effectiveness of clinical interventions. Similarly, education, gender, race and other individual characteristics have powerful health impacts. The mechanisms whereby poverty and social status and other group or individual pressures translate into shorter and sicker lives present a rich set of considerations bearing on vulnerability to disease, mechanisms of adaptation to social and environmental circumstances, and psychosocial issues. Knowing my body This personal essay describes the conflict within a bulimic medical student. The student’s knowledge of the anatomy and physiology of the human body is contrasted with her disordered thinking and behavior as she binges and purges. This essay explores the themes of the opposition of knowledge and emotion and the discrepancy between the exterior surface of a medical student and her internal mental illness. Of hospital advertising truths, half truths, and the academic medical center Direct-to-consumer advertising by academic medical centers (AMCs) is an increasingly used approach to compete for patients. Prior to the rise of managed care, AMCs’ competitive efforts were directed primarily toward persuading physicians in private practice to refer patients to their hospitals and clinics. Potential patients were never viewed as influencing hospital choice. No one disputes that academic centers have an obligation to succeed financially. But aiming ads at healthy consumers through print and broadcast media to increase business is new, and it entails risks. Moreover, if empowered and informed consumerism is the goal, it cannot be achieved through sound bytes in advertisements. If AMCs want to have an impact in competing for patients, they need to take a hard look at themselves. Commentary: Of truths, half truths, and less than half truths on the road to health Poem – To the end of her life Poem – Warm nights in Oaxaca Poem – A Rigid Mind Sprouts No New Crops |
From amusement to anger: Samuel Clemens’s shifting attitude toward patent medicine Samuel Clemens had a lifelong relationship with patent medicines. He ingested them as a child (sometimes against his will), wrote about them, and even encouraged his brother to market his own brand. A review of his public and personal writings throughout his lifetime demonstrates that he underwent a progressive evolution in his attitude toward the patent medicine industry. Clemens could use his humor as either a gentle gift or as a sharp weapon. He treated patent medicine fairly gently in his earlier writings, and even in his later reminiscences about his early days in Hannibal, but his later writings became far more caustic and exhibited an increasing level of anger and contempt toward patent medicine’s deceitful methods. Ramshackle lopsided research This essay tells the story of two randomized placebo-controlled clinical trials of the use of vitamin C to ameliorate or prevent the common cold. Young physician investigators designed and carried out these studies in 1973 and 1974 among children in two elementary boarding schools served by Public Health Service clinics on the Navajo Reservation. The investigators proceeded with a great deal of enthusiasm, but very little financial support. In the first study, they found that vitamin C supplements appeared to ameliorate upper respiratory symptoms and decrease total days of morbidity. In the second, larger study, the supplements were ineffective. Both programs generated great support among parents, children, and teachers in the Navajo communities. While the results of the first investigation were widely touted innational media, the negative findings that followed a year later were largely ignored. Poem – Irritable Bowel Poem – Presbycusis
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| Old
Medicine in a New World Trang La, MD, MBA |
| After a two-month student elective at Cho Ray Hospital in Ho Chi Minh City, Vietnam, medical student Trang La provides a first-hand account of her experiences and adventures in her native country. Shifting between life inside and outside the hospital, Trang captures the chaos that typifies life and work in Ho Chi Minh City through gripping anecdotes and colorful descriptions of the environment. In many ways, the scene at Cho Ray Hospital is a microcosm of greater Vietnam: densely populated, underdeveloped, and hindered by a stifling bureaucracy. Though the picture may appear bleak, shreds of hope are emerging in the form of a new generation focused more on markets and music than the military, and a dedicated corps of young physicians transitioning into the realm of modern hospital medicine. |
| Poem
- The Listening Art Arvey I. Rogers, MD |
| Poem
- Anthropologist on Venus Lauren Rusk, PhD |
| The
universal efficacy of the generic glazed donut Phil Granchi |
| Several recent studies outline the poor nutritional value of donuts. To the contrary, anecdotal evidence from diverse fields suggests that donuts may have intrinsic and poorly understood properties that elevate them above their current classification as mere foodstuff. Furthermore, identifiable patterns of usage emerge upon meta-analysis of donuts in social and industrial settings. These factors, relative to possible health care applications of donuts, are discussed. |
| Poem
- Céleste Albaret burns the Cahiers Noirs Manuel Martinez-Maldonado, MD |
| Poem
- Arrhythmia Myron F. Weiner, MD |
| In
the eye of the storm: Charity Hospital and Hurricane Katrina Fred A. Lopez, M.D. |
| The epic devastation rendered by Hurricane Katrina, which made landfall along the Gulf Coast of the United States on Monday, August 29, 2005, has been well-documented. Many New Orleanians were unable to escape the storm’s fury and had to ride the hurricane out in the city. These included patients and physicians in New Orleans’ historic downtown Charity Hospital, which has long served the healthcare needs of the city’s indigent patients. Until the hospital’s complete evacuation on Friday, September 2, more than 1,000 people were stranded in unbearable conditions: hot, hungry, and desperate for the rescue that sometimes seemed as if it would never arrive. The author provides a thought-provoking personal account of the challenges encountered at Charity Hospital before, during, and after the storm. |
| Finding
balance Colin K.L. Phoon, M.Phil., M.D. |
| Many physicians sacrifice their own personal interests for the sake of work and family. In this essay, I argue that kindling such interests need not be viewed as a selfish endeavor, but rather benefits one's self, family, and patients. |
| Poem
- Fireflies Urias A. Almagro, M.D. |
| A
case of glimmering gloom Katherine L. Wisner, M.D., M.S., Mark Bostridge, M.A. (Oxon), and Philip A. Mackowiak, M.D. |
| This patient, perhaps history's most famous invalid, was confined to bed for almost three decades with insomnia, anorexia, nausea, irritability, and depression. Since her death almost a century ago, historians and biographers have argued over the etiology of her illness. Some have suggested that it was an extraordinarily protracted case of brucellosis acquired during her service in the Crimea, others that it was simply a form of neurosis steeped in self-pity. Who was this famous patient, and what diagnosis best explains the full spectrum of her strange illness? |
| AMA's
program for the twenty-first century J. James Rohack, M.D., John H. Armstrong, M.D., Duane M. Cady, M.D., Edward L. Langston, M.D., Nancy H. Nielsen, M.D., ,Ph.D., and Donald J. Palmisano, M.D., J.D. |
| This year marks a milestone in the 158-year history of the American Medical Association. After several years of research and analysis, the AMA is rolling out a series of action programs that will be more responsive to what physicians tell us they need... |
| Sunday
morning rounds when the Baptist Church Choir came through Richard I. Haddy, M.D., and Theresa B. Haddy, M.D. |
Problem
solving: A story for medical educators |
| Sports
physicals Dean A. Blumberg, M.D. |
| Supplemental
oxygen Daniel M. Becker, M.D., M.P.H., M.F.A. |
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| Beijing
Morning Gerald S. Lazarus, M.D. |
| China is undergoing enormous change as it takes its place as a world leader. The physician-patient relationship has been compromised over the past decade, as evidenced by increasing dissatisfaction among patients and physicians. The issues responsible for this concerning trend are quite complex and surprisingly relevant to medicine in the United States. The dynamics shaping these changes may include: economic constraints, evolution of an entrepreneurial consumer society, policital reform, changes in societal values, and an impossibly short time frame for change. These issues are presented and analyzed from the unique personal experiences of a Westerner who lived and work in health care policy in China for three years. |
| Demon,
quack, scientist, or saint: Depictions of doctoring in the operatic
literature Todd A. Florin |
| A musical work, like other art forms, is a mirror and window into the cultural ideas and anxieties of the period in which it was written. During the first half of the nineteenth century, medical practitioners were the subject of critique, satire, and occasionally admiration, in popular culture. In particular, the operatic repertoire offers a diverse range of literary and musical representations of physicians. The four operas explored in this paper-L'Elisir d'Amore by Donizetti, Wozzeck by Berg, Les Contes d'Hoffmann by Offenbach, and La Traviata by Verdi-have libretti written during the first half of the nineteenth century. Although the texts were written within 40 years of each other, each work presents a different portrayal of the medical practitioner. To understand the diversity of these popular perceptions, this paper examines the physician character in each opera, and analyzes the musical devices that reinforce and enhance the text. |
| What
do we mean by "the art of medicine"? Hunter Groninger, M.D. |
| Since the time of Hippocrates, ideas about the nature of art have been inextricably linked to various definitions and descriptions of clinical practice. "The art of medicine" is a phrase and concept that has endured several thousand years and is widely employed in medical literature today. However, its meaning varies among authors, suggesting that the relationship between "art" and "medicine" is still in great flux and may signify very different ideas for different clinicians. |
| A Medline keyword search for the phrase "art of medicine" discovers 235 entries since 1965. This article examines common themes in contemporary uses of the phrase, while considering the historical connection between art and medicine. The author suggests that such themes may point to a tenable, albeit broad, definition of the phrase that carries considerable weight in helping caregivers to define what clinical medicine has evolved to become. |
| The
workup, or Where is Champollion when we need him? Faith T. Fitzgerald, M.D. |
| Poem
- Out Shane Neilson, M.D. |
Renal colic on an African cliff while searching for smallpox The power of touch in clinical medicine Physical touch is one of the most effective acts of doctoring. However, as technological advances in medicine continue, the use of touch in medicine is at risk. Physicians need to recognize the diverse and powerful aspects of touch, and medical educators need to develop educational strategies that inform students of its importance in patient care, as well as its appropriate use. Here, literary works and case narratives offer descriptions that emphasize the importance of touch in medicine and its capacity for healing.
An untimely illness: Dr. Osler calls upon a future first lady
A philosophical basis for medical education The philosophical foundations of modern science are insufficient as the basis of a balanced medical curriculum. The meaning and truth value of many statements made by medical teachers and doctors cannot be assessed by empirical standards of verifiability and fasifiability. The time-honored judgment that doctors are both scientists and artists suggests that the traditional "art of medicine" is an essential philosophical component of the medical curriculum. An examination of the program of general learning (humanitas) of our medical predecessors demonstrates that the terms liberal arts and philosophy have meanings that diverge widely from modern thought, yet remain essential components of a doctor's pre-medical education. Traditionally, music has been what in modern thought is called a basic science for medical education. The metaphysical proposition that the world is organized proportionately, and therefore harmoniously, suggested to medical teachers before the modern era that the doctor's role is to cooperate with nature to restore each patient's harmonic mean by corrections of imbalances among bodily and spiritual elements. The philosophical foundation of medical education inherited from the ancient world complements admirably the principles of modern philosophy of science as the twin cornerstones of a general medical education.
Georg Büchner's Woyzeck: A tragic example of human experimentation without informed consent
David H. Solomon, M.D. Commentary
Medicine in art: Looking at "The Doctor" There are many representations of medical themes in art, and a number of portrayals of physicians. Perhaps the most famous of these is "The Doctor," a Victorian painting by Luke Fildes. It hangs in the Tate Gallery, London.
The history of hysteria
PERSPECTIVES "The Doctor" |
Disease and Destiny and the postcard from Athens Commentary: Medical history without medicine
William Carlos Williams, M.D.: Lessons for physicians from his life and writings This paper introduces the life and literary works of physician-author William Carlos Williams (1883-1963). Williams trained in pediatrics and obstetrics, practiced full-time, and wrote voluminously. In his stories, he portrayed the variety of individuals he met in the clinic and on home visits; recounted many of the frustrations, setbacks, and failures that he experienced as a small town physician; and described his encounters with poverty and other social ills, non-paying and non-compliant patients, unethical doctors, and monolithic, unsympathetic bureaucracies. Through his writing, he achieved a catharsis and, he believed, improved his ability to communicate with his patients. Many of Williams' concerns continue to affect today's physicians, and his observations and advice possess immense value for those interested in ethics and humanism in medicine.
Everyday amnesia: The curious effects of a common drug Versed (midazolam) belongs to a class of drugs called the benzodiazepines, drugs which are well known for their sedative, anti-anxiety and memory-blocking effects. Versed's anti-anxiety effect is arguably its most clinically useful attribute; however, the amnesia it produces certainly is its most striking feature. Under the influence of Versed, patients become powerless and vulnerable. They are in a state of diminished inhibition and judgement. And they will not likely remember much, if anything, about their experiences on Versed. While Versed may render patients remarkably vulnerable and potentially leave imprints invisible to the conscious mind, its utility in the clinical setting is undeniable, its effects clearly beneficial. Used properly, Versed can dissolve the tension and discomfort of hospital visits and contribute to the efficiency and ease of modern medicine.
Is there magic in tropical rain?
A medical student's review of the British National Health Service (PDF) Great Britain's National Health Service (NHS) was examined from the perspective of an American medical student. The NHS is a government financed health system that provides health care to all people in Britain regardless of their ability to pay. Its history, evolution and current operations are influenced by politics and the media. Universal access to care in the NHS is limited by waiting lists and the NHS is stretched to its capacity, creating roadblocks to effective patient care. Its commitment to the entire lifespan of a patient gives the NHS incentive to invest in preventive medicine. However, its totality of responsibility accentuates the moral dilemma of balancing what is best for an individual and what is best for society given limited resources. In light of its many differences, the NHS has similar health outcomes to the US health care system, with the exception of Britain's lower infant mortality rate. Commentary
Guidance for the doctor's physician child
PERSPECTIVES How life imitates baseball |
Autumn 2000 |
| Affirmative action in medical school admissions: Minority underrepresentation in medicine Lois W. Choi |
Spring 2000 |
| "The good and the bad dying indiscriminately": The Athenian plague reconsidered Eric Michael David |
Winter 2000 |
Death of a nation: The AIDS crisis in Zimbabwe Angelical conjunction: Religion, reason, and inoculation in Boston, 1721–1722 |
Summer 1999 |
The curative paradigm in medical education: Striking a balance between caring and curing Walking through the valley of the shadow of death: A student's perspective on death and the medical profession |