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UC Davis Puts 'Humanity' in Medical School Curriculum

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(Sacramento, CA)
Thursday, December 15, 2011

Physicians face an array of ethical conundrums, particularly in end of life situations.


PATIENT: Maybe you can just give enough medicine so I can sleep.

DOCTOR: I'll write for a sleeping pill for tonight.

PATIENT: Just something that will let me sleep, for good…

This video is based on a real medical case involving a leukemia patient. Isabel Jameson has been responding to chemotherapy, but now is in the emergency room with a bowel obstruction and is hesitant about getting the surgery that might save her life.

PATIENT: "I'm sick I'm tired, I'm just asking for something that will…

1213_PB_doctoring3DOCTOR: Ms. Jameson? I can't help you commit suicide. And it's comments like that make me wonder whether it's your depression speaking instead of you…"

Her doctor must decide whether Jameson's mental state leaves her fit to make her own health decisions. The case is being used to teach med students here at the UC Davis doctoring program how to communicate, how to be ethical, and how to make good clinical decisions.

WILKES: One of the things about doctoring is that there are occasions where there are clearly right answers, but there are often situations where there is no right answer.

Dr. Michael Wilkes started the "doctoring program" 20 years ago at UCLA. Now he leads it at UC Davis.

He says future doctors need to be taught how to bring humanity to patient care. He says working in medicine, even as a student, can be stressful and de-humanizing. It requires long hours, little sleep, and a lot of exams.

WILKES: We're trying to preserve their humanity and reinforce the fact that patients aren't the enemy, patients are what we're here for, and we've entered this caring profession because we really want to take care of them, and to do that we need to be  partners not have them be the adversaries.

1213_PB_Doctoring2He says the goal is to make future doctors more cost-conscious, prevention-focused, and patient-centered.

Dr. Wilkes shows the videos in the classroom, where they're only part of the program. First he meets with med school professors to coach them through the curriculum. Then the professors break out to teach students in small groups. There are many ethical discussions.

STUDENT: What is a depression that is so severe that you lack capacity and what is, you're depressed but you still have capacity. You know, I don't know how you tease that out.

Then they bring in the actors. The students get to practice their people skills in real life scenarios with mock patients.
ACTOR: I'm pretty much interested in my test results...
STUDENT: In your test results?
ACTOR: Yeah, and the mammogram.
In this case, the med students' goal is to convince the patient to plan for her care if she's later unable to.  
STUDENT: In case your health were to deteriorate, have you ever heard of an advance directive or thought about it?
Dr. Wilkes calls a time out.
WILKES: From your perspective, how are things going here?
A lot of questions come up.
STUDENT: "Generally accepted health care standards? I'm not really sure what that means exactly"
And new revelations.
1213_PB_Doctoring4STUDENT: "I think that's something that as doctors we struggle with all that time, we don't know for certain how something is going to turn out.."
Another question from the day's lesson: How can a provider offer choices to a patient with limited health literacy?  Wilkes says he hopes the program skills will prep these future doctors for upcoming health reform. The problem is, communication is limited in a 15-minute patient visit.
WILKES:"Where we fall down, is that the health care system hasn't been structured to allow doctors the time to do, and engage with those sorts of processes."
Since the start of the program 20 years ago, more than 30 medical schools have adopted aspects of the program. But Wilkes says that's not enough.
WILKES: "I think it's worrisome that the majority of medical schools haven't approached this, and are still using multiple choice tests and lectures and not paying attention to who the doctor is as a person."

Wilkes says it's hard to measure how better communication might lead to better health, but he says you'll probably see more satisfied patients.

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