Brian Carter, M.D., an international expert in neonatal intensive care outcomes, medical bioethics and pediatric palliative care presented the 25th annual William T. Sirridge, M.D., Medical Humanities Lecture on March 28 at the School of Medicine.
An author of three textbooks on neonatal intensive care and palliative care, Carter shared his observations of how physicians can help parents deal the reality of a young child facing life-altering challenges.
He talked about helping them learn to adjust and accommodate the realities of a child’s condition that they can’t change.
He said parents and family of children in a NICU typically are fearful and anxious, maybe even desperate as they realize their dreams for their children are being shattered. He said parents go through a process of grasping the situation, trying to understand what decisions need to be made, who can help make them, and understanding all the facts they need to learn.
“If all I’m doing is providing more information and not tending to where they are in the process, they’ll be stuck,” Carter said. “They need to move forward. We need to recognize where they are in the process as we speak to them and try to usher them through.”
Carter joined the School of Medicine and Children’s Mercy Hospital in 2012 as a Professor of Pediatrics and Bioethics. He serves as co-director of the Children’s Mercy Bioethics Center’s Pediatric Bioethics Certificate Course and practices at Children’s Mercy Hospital as a neonatologist.
The recipient of numerous NIH grants, he has published extensively in the areas of neonatology, neonatal intensive care, palliative care, and bioethics.
He said that while clinicians in the NICU have the benefit of experience and understanding the outcomes of children in intensive care, they need to be cognizant of the needs of parents and families of these children.
“Let’s move away from information overload,” he said. “We ourselves need to sit down with the family and find out where they’re at, if they need someone to help them move forward.”
The Sirridge Office of Medical Humanities is currently seeking submissions for a new edition of the medical humanities magazine, The Human Factor.
The magazine recognizes the important connection between medicine and the arts and their significant roles in strengthening physician-patient relationships. It also supports the “art” of medicine by showcasing creative works and sharing human experiences.
School of Medicine students, faculty and alumni are encouraged to submit original, unpublished essays, poems, short stories, drawings, photography and other art work. Past issues also have included shared experiences from classes, field trips and concerts.
The submission deadline for the next issue is April 30. Submissions should be sent to the Sirridge Office at 2411 Holmes St., Kansas City, MO 64108, Attn: Sarah McKee, or emailed to firstname.lastname@example.org.
Medical students are invited by the Office of Medical Humanities to submit abstracts for a poster presentation on March 26 at the School of Medicine’s Osler Society Spring Event.
Abstracts should be no longer than one page and should mirror the content of your poster. It should begin with the complete title, the names of all coauthors, and the corresponding author’s mailing address, telephone number, and e-mail address. Authors and coauthors will be asked to give a short poster presentation. If a large number of entries are received, not all will present.
Abstracts should be sent by e-mail to Steven D. Waldman, M.D., J.D., associate dean and chair of medical humanities and bioethics, at email@example.com later than March 1, 2019. Poster guidelines and template will be sent once the poster abstract has been received.
The theme for this year’s UMKC William Osler Poster Presentation isThe Quotable Osler. Sir William Osler was one of the most prolific authors of his time, producing more than 1,600 writings including “The Principles and Practice of Medicine,” considered to be one of the first comprehensive textbooks of modern medicine. One hundred years after his death, his pronouncements on medical issues are still considered good medicine and are often quoted to illustrate the right way to care for patients.
Students should feel free to pick their favorite or least favorite Osler quote and opine on it, draw it, paint it, sculpt it, photograph it, sing it, act it, dance it, or present whatever strikes your fancy. Be Creative Because Everything Osler Is Fair Game.
Former UMKC School of Medicine docent and Humanities Department namesake William T. Sirridge, M.D., was a master at connecting with patients, including in their final days.
So it was fitting that this year’s medical humanities lecture endowed in Sirridge’s name was titled “How to Conduct a Good Death.” Gary Salzman, M.D., a 1980 graduate of the School of Medicine, delivered the lecture March 22.
“William Sirridge was my docent and mentor and taught me many things not published in books,” said Salzman, himself a faculty member, docent and Truman Medical Center physician since 1985.
Sharing a half dozen stories about patients at the end of their lives, Salzman told the lessons he had learned from Sirridge and how they had played out in his career. The most important lesson focused on how to connect with patients.
“As we bring more and more technology into medicine, we become less and less able to connect with patients,” said Salzman. “Connecting with patients is as important today as it was 40 years ago when I was in medical school.”
Salzman first told two stories of how, as a student, he had failed miserably in dealing with a patient’s death. In one case, he was ill prepared and “got it all wrong” telling a woman over the phone that her mother had just died at the hospital.
In the other case, he had prepared a case for presentation by examining a woman with a classic case of scleroderma, studying the medical literature on the woman’s dire condition and working up a detailed treatment plan. But he had left out the human element, and was unaware that Sirridge had already tried the recommended treatments – which all failed. Instead, Salzman learned Sirridge was helping the patient and her three daughters take the necessary steps for the woman to die peacefully at home.
“He looked over his glasses and said to me, ‘Salzman, do you know how to conduct a good death?’ ”
After those two instances, Salzman said, he dedicated himself to listening, watching and learning from Sirridge and other veteran physicians. He saw that Sirridge’s skill at connecting with patients had three parts:
Physical touch. A gentle hand on a patient’s arm could be “more powerful than morphine.”
Common interests. Finding and sharing commonalities with some humor mixed in.
Direct and honest conversation.
As Salzman practiced and applied those principals over the years with dying patients and their family members, he began to learn how to conduct a good death, and to pass his lessons on to colleagues, residents and students.
Salzman recounted his education and evolution through cases that took him from trying to do too much for dying patients, to pushing too hard for removing life support. He told of one patient who, after being taken off life support, woke up, looked at him and said, “I need a beer!”
He found equilibrium by listening deeply, respecting patient and family wishes, and then doing his best to find a balanced course of action.
In one case, a hospice patient who recently reunited with his estranged spouse desperately wanted to live and have more time. Salzman, though skeptical, went with the man’s wishes and got him out of hospice and back home with a portable breathing unit. “Eight years later, he still sings my praises as the man who saved his life,” Salzman said. “I just listened to his wishes.”
And for patients “who want you to do everything,” Salzman said, “I tell them, ‘Let’s do everything that will help you, and nothing that will hurt you.’ ” Through that lens, he said, appropriate individual plans can be worked out for each patient.
Salzman closed with a case in which a sixth-year student got to know a patient with severe pulmonary fibrosis and her daughter. They were having trouble letting go even though the patient’s essential life-support mask, not meant for long-term continuous use, was causing her more and more pain and skin deterioration. Eventually, the student was able to describe what would happen if life support was removed, and what medicines would be used so the woman could die comfortably. Eventually, they agreed to remove the mask, and the mother died in peace.
“The student told me she determined the best way to connect with this family was to sit quietly, to just be present while watching television. So she watched ‘Ellen’ with them, most afternoons for two weeks.” Salzman praised the student on her outstanding work
“I told the student that I had a story that I wanted to tell her. It is about a man she never met but influenced her education. It is a story of my docent, William T. Sirridge, and a question he asked me a long time ago: ‘Do you know how to conduct a good death?’”
The lessons Dr. Sirridge taught on connecting with patients and conducting a good death learned by Salzman are now being passed on to current students. And, according to Salzman, these students will carry on, teaching these skills to their students and continuing the legacy of Dr. Sirridge long after his death.
Several trends in health care make the practice of compassionate medicine more difficult, but integrating the humanities into medical education can help produce more-caring physicians, Arno Kumagai, M.D., said at the second annual Noback-Burton Lecture.
“The first question is, What kind of doctors are we trying to create?” Kumagai asked in his April 28 lecture at the UMKC School of Medicine, titled “Ways of Seeing, Ways of Knowing: A Role for the Humanities in Medical Education.”
Kumagai, vice chair for education in the Department of Medicine at the University of Toronto, argued that medical education should be moral education, promoting justice, compassion and “development of the empathic self.”
He said the rising emphasis on patient-centered care was welcome—and needed to counter current challenges and developments including:
Rapid technological change, which despite its possible benefits can be hard to keep up with and disruptive.
Turning medicine into a commodity and patients into customers. Conveyor belt medicine and measures of “productivity” work against the best care, Kumagai said.
The standardization of medical education. Though a wide range of essential skills must be imparted to every student, individuality and fresh and varied ways to see and engage with patients should be nurtured rather than sacrificed.
The ubiquity of electronic medical records, leading to typing into a computer crowding out human interaction, especially during a 15-minute conveyor belt style appointment.
Especially given these developments, Kumagai said, how do medical schools educate future physicians to best provide patient-centered care?
Integrating the humanities into the curriculum is certainly part of the answer, but moreover Kumagai argued for using the many ways that the humanities and art can get people to open their perception and see and know their patients and the world differently.
As an example, he said it had built empathy, and shown students the power of other people’s stories, to match medical students with patients with chronic conditions, and have them really get to know those patients. Valuable lessons come from such “deep listening and dialogue,” Kumagai said, and can keep doctors from seeing patients as their illnesses and not whole people.
“We often forget that at the heart of medicine lies the interaction we have with someone who suffers … a sacred space in which people become different than they are, including ourselves,” Kumagai said. “Medicine is ultimately the opportunity to bear witness to the mystery, tragedy and wonder of being human. And it is our duty as physicians not to look at this as extra. This humanism, humanities, is at the core of medicine. It is not an extra.”
This was the second year for the lecture series, endowed by James Riscoe, M.D. ’75, a member of the school’s third graduating class. Riscoe said he started the event to honor Richardson K. Noback, M.D., the first dean of the School of Medicine, and Jerry Burton, M.D. ’73, a classmate who is recognized as the first graduate of the medical school.