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

• Physician mistakes

• Impaired physicians

• Physician fraud

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)

Stigmatization

John Updike

“From the Journal of a Leper.”

Am J Dermatopathol 1982;4(2):137-42

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

martindonohoe@phsj.org