The challenges of being a physician during the time of COVID-19 are nothing new to medical professionals said Kevin Churchwell, M.D., president and chief executive officer of Boston Children’s Hospital. The ongoing pandemic has increasingly brought those issues to light.
Churchwell delivered his remarks to faculty and staff of the UMKC School of Medicine as the keynote speaker for the annual Noback-Burton Lectureship held virtually on Dec. 9.
He outlined four particular challenges physicians have faced that include information overload, dealing with shift work, time commitment and finding an adequate work-life balance.
“I hope you realize that it’s not just in a time of COVID that these challenges are presented to us,” he said. “These are challenges that have faced us since the beginning of time. It’s really a challenge of how do we continue to see medicine as a profession.”
At the children’s hospital in Boston, Churchwell said, leaders have addressed the issues by creating the Boston Children’s Hospital academy for teaching education, innovation and scholarship. It is a program that explores how to help physicians, practitioners and residents with the information overload, while promoting excellence in innovation and offering mentorship and support to help with career development.
“No matter what, in the time of COVID or outside of COVID, I believe the issues that we’re facing now are the issues that we will continue to face,” Churchwell said. “The solution will be to start by treating medicine as a profession.”
The Noback-Burton Lecture series is endowed by James Riscoe, M.D., ’75, a member of the school’s third graduating class. Riscoe started the event in 2016 to honor Richardson K. Noback, M.D., the first dean of the School of Medicine, and the late Jerry Burton, M.D., ’73, a classmate who is recognized as the first graduate of the medical school.
Doctors have been around since the beginning of human civilization. But are they still necessary today?
John Lantos, M.D., director of the Bioethics Center at Children’s Mercy Kansas City Hospital, broached the subject on Dec. 10 as keynote speaker at the School of Medicine’s annual Noback-Burton Lectureship.
For much of early civilization, doctors offered little more than a caring bedside presence, Lantos said. Advanced medical science, however, changes the way people think about doctors and what they can do.
School of Medicine founding dean Richardson K. Noback, M.D., for whom the annual lectureship is named, once described the doctor as a morally responsible problem solver on behalf of people experiencing difficulty.
Lantos asked to imagine what would happen if artificial intelligence could be used to remove from doctors the moral responsibility of making decisions. Similarly, he asked, if algorithms can be developed to solve many of the problems that doctors use their minds to discern, will we still need doctors?
He quoted Eric Topol, noted cardiologist and former head of the Cleveland Clinic and Scripps Institute for Translational Research, with the answer.
“We will still need doctors to give the human touch,” Lantos said. “We still need doctors to provide empathy.”
Lantos said doctors still need to learn how to have difficult conversations with their patients. Where the tools to keep people alive were previously not available, doctors today can keep people alive while their bodies are failing.
“The result is that almost every decision about death is preceded by a decision made by doctors, patients and family members about when and whether to withhold or withdraw potentially life-prolonging medical treatment,” Lantos said. “That is a skill that doctors didn’t used to have, didn’t use to need. Now it is a crucial part of medicine.”
Patients still want their doctors to know them as individuals, Lantos said. And doctors, in many cases, want to know their patients as individuals.
“To imagine that we will always fail seems like it might be a pessimistic view, but it’s not,” Lantos said. “It doesn’t negate the remarkable achievements of medicine. It does, however, suggest that the role of the doctor has changed dramatically. Maybe the doctor’s expectations about the role and nature of their work no longer aligns with the work they actually do.”
The Noback-Burton Lectureship was established in 2016 to honor Noback, the school’s inaugural dean and Jerry Burton, M.D. ’73, who is recognized as the first graduate of the medical school.
Primary care specialties are facing an uphill battle for survival, said John Goodson, M.D., a primary care advocate.
Goodson, an associate professor of medicine at Harvard Medical School and primary care internist at Massachusetts General Hospital, delivered the UMKC School of Medicine’s annual William H. Goodson, Jr., M.D., Lectureship on Oct. 28. John Goodson is the son of William Goodson, who practiced internal medicine in the Kansas City area for more than 45 years.
“I’m really dedicated to the care of my patients,” Goodson said. “That’s what keeps me going in life. The balance of my life is patient care and I will do all that I can to save primary care. That’s why I have become an advocate.”
In 2015, John Goodson established the Cognitive Care Alliance to encourage improved compensation for generalist physicians and to help ensure a highly talented primary care work force for the nation’s future. The alliance has since grown to a force of nearly 109,000 physicians covering the spectrum of primary care specialties, Goodson said.
Goodson said three issues are key to maintaining a strong primary care workforce: training medical students who enter primary care specialties; practice reform, including such things as infrastructure, support, team building and health information technology; and, ultimately, attaining parity of compensation for primary care physicians.
“The healthcare economy is not a free economy by any stretch of the imagination,” Goodson said. “We spend $3 trillion on health care. It’s a huge jobs program and there are many problems. Our job is to ensure that our work is appropriately compensated within this gigantic environment.”
While the complexity of the primary care specialties has increased, he noted that interest in primary care has decreased throughout the years. Goodson said he isn’t sure anyone has the perfect answer, but that the problem is understandable when one compares the compensation for primary care physicians to other specialists who earn much higher salaries.
He called for changes in the way service codes used for billing and reimbursement are defined and valued. Goodson said the playing field is tilted with too few primary care specialists included on the panel of health care professionals that determine those service codes and their values.
“We need to defend the cognitive capabilities of our professions,” Goodson said.
This was the 30th year of the annual lectureship. A group of family, patients, colleagues and friends established the William H. Goodson, Jr., M.D., Lectureship in 1987 to honor his many contributions to the field of medicine in the community. Each year, noted speakers offer scholarly perspectives and information related to internal medicine to current and future practitioners.
All across the country, medical schools are experiencing the same thing, according to John Mahoney, M.D., M.S., associate dean for medical education at the University of Pittsburgh School of Medicine. National organizations such as the American Medical Association and other outside forces are converging to promote new ideas and changes to what medical education looks like.
On Jan. 15, Mahoney presented at the School of Medicine as the first speaker in the Dean’s Visiting Professor Lecture Series. In his remarks, he shared thoughts on today’s medical education making broad changes in curriculums on a national scale.
“There are enough forces now calling on medical education, the house of medicine, to look at ourselves critically and understand, are we doing the best possible job for our students and for the country, that it really has been put upon us to take a look at ourselves and ask ourselves before someone else asks us, ‘how are we doing,’ ” Mahoney said.
A leader in curriculum advancement, Mahoney has been instrumental in updating how his school provides medical education. He had a part in designing Pittsburgh’s integrated medical clerkships. He is also recognized for spearheading methodology and content changes that have enhanced the curriculum and has developed innovations in simulation, public health preparedness and technology.
All of that is part of the nationwide push for innovations in medical education to meet today’s health-care needs. These changes are expected to help better train medical students to meet not only the current demands, but the future challenges of a changing health-care system.
An issue impeding such progress, Mahoney said, is the factor of the unknown. With impending change of leadership at the national level and the possibility of changes in health-care laws, Mahoney pointed out that no one knows for certain where the country’s health-care industry is headed financially or philosophically.
“Curricular change is very difficult if you don’t know where you are going,” he said.
Change will be a continuous process, and Mahoney outlined a number of factors that will play into the evolution of medical education.
He presented steps for medical school leaders to take in updating their curriculum with educators looking at and understanding the desired outcomes of their curriculum. Additionally, they must be willing to learn from others and be open to new and different ideas.
“Everything around us is changing. Medical education has to change, too,” said Mahoney. “If I know where I want to go, and understand the desired outcomes, I stand a chance of getting there.”
UMKC School of Medicine Dean Steven Kanter, M.D., established the Dean’s Visiting Professor Lecture Series to bring distinguished speakers to the school. The new program explores important issues in academic medicine and health care.
“This gives us an opportunity to interact with someone who has expertise in the area of academic medicine. We can talk about new ideas, share best practices, discuss common problems,” Kanter said in introducing the lecture series and Mahoney, his long-time colleague. “It is also opportunity for prominent members of the academic medicine community to learn about us and the great things that are happening at the UMKC School of Medicine and the health sciences campus here.”
An expert in disaster management and science who responded to the Ebola outbreak in Liberia said the disease had essentially been eradicated there.
Thomas Kirsch, M.D., M.P.H., director of the Center for Refugee and Disaster Response and an associate professor of emergency medicine at Johns Hopkins University, traveled to Monrovia, the Liberian capital, to work in an emergency operations center during the crisis late last year. He presented the W. Kendall McNabney, M.D., Lecture at the School of Medicine on April 30.
The largest Ebola outbreak ever recorded primarily affected the West African countries of Liberia, Sierra Leone and Guinea. More than 10,000 people died, according to the World Health Organization. “We went from a small, isolated outbreak of a very scary disease, that is a horrible way to die, that has a mortality rate of up to 90 percent, to this massive outbreak, which clearly caught the attention of the world,” Kirsch explained.
When he arrived in Liberia, Kirsch said he expected to find himself in a “zombie apocalypse.” Instead, he found that life in Monrovia was relatively normal. Shops were open, and people were going about their daily lives.
But there were washing stations with bleach solution in front of every building. Also, hand shakes and other forms of touching were forbidden, which Kirsch found disorienting. “Try to go through life like that,” he said. “It’s very odd, it’s very disturbing. But that’s the way people lived there.”
Kirsch was modest and stressed that the focus of his efforts in Liberia was on public health and that he did not provide clinical care. “I was a bureaucrat,” he said.
The United States spent hundreds millions of dollars and deployed troops to Liberia, a historical ally, when estimates suggested failure to act would result in 1 million people in West Africa becoming infected. But the disease was on the wane before the military opened its first treatment center. “Clearly, it was not the Ebola treatment beds that turned this epidemic,” Kirsch said.
What had changed was people’s behavior, Kirsch said. In addition to hand washing stations, isolating the sick and safer burial practices helped to bring the disease under control. “When a first spike occurs in your community, and you watch your neighbors vomiting on the street and dying, you change your behavior,” Kirsch said.
Kirsch said the competence of the political leaders and public health officials in Liberia was key to the social mobilization and education efforts. While there have been no known community transmissions in 80 days, a Liberian woman’s infection was confirmed in March. It is believed she contracted Ebola from unprotected sex with a man who survived the virus. The virus has been found in the semen of some men who have recovered from the infection. “This disease is now endemic in West Africa,” Kirsch said.
Kirsch, however, sounded optimistic that an Ebola vaccine would be developed eventually. “Ebola is a stupid little virus,” he said. “It’s not HIV.”
Music and medicine have always gone hand in hand, said Lisa Wong, M.D., during her “Medicine and Music” lecture at the School of Medicine on June 5.
“In fact, Apollo was not only the god of sun, truth and healing, but he was also a musician,” she said.
The Sirridge Office of Medical Humanities and Bioethics invited Wong, associate professor of pediatrics at Harvard Medical School and a pediatrician with Milton Pediatrics in Boston, to share her experience with the healing power of music. A trained musician since age 4, Wong is the author
of Scales to Scalpels: Doctors Who Practice the Healing Arts of Music and Medicine, which tells the story of the volunteer musicians from the Boston medical community who comprise the Longwood Symphony Orchestra.
Wong grew up in Hawaii and attended Punahou School for kindergarten through twelfth grade. Punahou boasts graduates who are musically inclined and have gone on to win Tony awards and to be the president of the United States, Barrack Obama. After graduating from Harvard, Wong attended NYU Medical School where she found colleagues who were also artists. Since then, she has been able to incorporate music into her daily life and career and was president of the Longwood Symphony Orchestra for 20 years.
During her interactive lecture, Wong discussed the power of music and its role in medicine and healing.
“Learning music is similar to medical training,” she said. “Is it music or medicine when you’re evaluating data, looking at a piece of music or a lab sheet – looking for patterns.”
She has traveled the world with various volunteer efforts, including El Sistema, a music-for-social-change program in Venezuela.
“I always knew I wanted to take care of children through music,” Wong said.
Wong met her husband, Lynn Chang, professor at the Boston Conservatory and world renown violinist, while an undergraduate student at Harvard. Chang told the School of Medicine audience his story of performing during the 2010 Nobel Peace Prize Ceremony and played “Jasmine Flower,” which he performed at the ceremony honoring Liu Xiaobo. He also explained the power music can have for a community. At the time of the 2010 ceremony, the Chinese government did not allow any Chinese citizens to attend the ceremony.
Xiaobo was an advocate of political reform and human rights in China and was publically critical of the Chinese communist regime. He was a prominent figure during the Tiananmen Square protests, calling for peaceful negotiations between students and the government. Xiaobo was famously absent for the Nobel Peace Prize Ceremony, as he was still imprisoned by the Chinese government, and his medal and diploma were displayed on an empty chair.
In the past, “Jasmine Flower” served as an anthem for the Chinese people, Chang said, and after he played it at the ceremony, it was banned for three years in China. But, Chang said, it had a profound effect on those who learned it was played for Xiaobo, bringing the sense of camaraderie back among the people.
Music is used in many ways. At each Nobel Prize ceremony, music is played to highlight its significance. Wong said the best kind of music is that played from the heart. The Longwood Symphony Orchestra is full of those, she said, who play with compassion.
“There aren’t a lot of business orchestras or law orchestras,” she said. “But there’s something about music and medicine that brings us together.”