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The Concept of the Self in Medicine

Purpose

Undeniably, the most important thing to a person is their sense of self, which refers to who we are and what makes us this way.  It consists of our beliefs, our passions, and our personalities, among other factors that are more external, such as where we live.  One place that this seems to take a backseat, however, is in the case of medical treatment.  Suddenly we are nothing but a name on a chart that is made up of the sum of our illnesses, our individuality and who we are, now left undefined. More often than not, the only version of the self that is cared for by doctors is our physiological make-up, and this is where we reach a fundamental problem in our ways of biomedicine; doctors don’t care enough about their patients on an individualized, empathetical level. My research revolved around ethics and the personal narratives of patients and doctors, to analyze the patient-doctor relationship, and the concept of the self in medicine.

The Project

My research was targeted towards crafting a course that could be used to teach undergraduate pre-med students, or students going into another aspect of medicine, about the humanitarian sphere of medicine. 

Course Syllabus

When it comes to being the carrier of a disease, we exchange our label of person for another p-word: patient. The purpose of this course is to examine the various relationships in medicine, revolving around patients, doctors, and humanity as a whole. Medicine has become an environment where individuality has been broken down, the self stripped away, in an effort to make treatment more efficient. However, it has become counterproductive; though more patients are able to be seen daily, a lack of empathy and understanding is leaving treatment subpar, the ever-important relationship between patients and their doctors dwindling down to nothing. This course will examine the place of the self in medicine, both the good and the bad, as well as researching the concept of ethics and doctoral responsibility. To do so, multiple articles, patient/doctor narratives, and other forms of prose will be closely analyzed to determine whether the importance of personage should be reevaluated in the medical sphere.

 

COURSE OBJECTIVES

  1. To examine personal narratives of patients and doctors, as well as researchers, to determine the importance of the self in Western medicine. In turn, throughout the course, students will develop their own concept of the level of self that is permissible.

  2. Allow students to actively interact with the humanitarian sphere of medicine and treatment through assignments targeted towards critically thinking about the self in medicine.

  3. Examining the past and present of ethics in medicine, utilizing current events to jumpstart the discussion of a possible reevaluation.

  4. Cultivate research and writing skills through multiple discussion board posts and other writing assignments.

  5. Encourage a relationship between patient narratives and their medicinal qualities, bridging the gap between the humanitarian and scientific sides of Western medicine.

 

ORGANIZATION OF COURSE CONTENT

This course is organized thematically, with the various articles and texts being arranged into four categories: “The Self in Medicine,” “Ethics in Medicine,” “The Self as a Hinderance,” and “The Self as Healing.” Each category is also broken up into weekly subcategories pertaining to that specific concept.

 

REQUIRED TEXTS

Atul Gawande, Being Mortal: Medicine and What Matters in the End (Picador, paperback reprint edition, 2017) ISBN-13: 9781250076229

G.E. R Lloyd, ed. Hippocratic Writings (Penguin, Revised Ed., 1984) ISBN 978-0140444513

Audre Lorde, The Cancer Journals: Special Edition (Aunt Lute Books, 2nd edition, 1997) ISBN-13 : 978-1879960510

Kathy Charmaz, Good Days, Bad Days: The Self and Chronic Illness in Time (Rutgers University Press, Reissue edition, 1993) ISBN-13 : 978-0813519678

Paul Kalanithi, When Breath Becomes Air (Random House, 1st edition, 2016) ISBN-13 : 978-0812988406

*Links to additional readings can be found on our course site

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GRADING POLICY

Weekly Discussion Board post and replies                          10%

Participation                                                               10%

Additional Assignments                                                 20%

Midterm Paper                                                                  25%

Midterm Revision                                                                5%                            

Final Paper                                                                       30%

Grading Scale

A+ = 97-100%
A = 94-96%
A- = 90-93%

B+ = 85-89%
B = 80-84%

C+ = 75-79%
C = 70-74%

D+ = 65-69%
D = 60-64%

F = 59% and Below

 

CLASS POLICIES

  • Attend all classes fully prepared to discuss the readings assigned for the day. If you must be absent, it is your responsibility to turn in any assignments due that day, and for getting the notes you missed from a fellow student.

  • Perform close readings of the texts, including annotations and notes, so that you are prepared to speak in class.

  • Complete Discussion Boards posts (250-500 words) by class time. Late posts, without good reason, will not be counted.

    • Respond to two other students by the end of the week (minimum 100 words)

  • Writing Assignments (details provided separately) should be completed by midnight on the day that they are due.

    • Assignment guidelines will be found in our class site

 

ATTENDANCE POLICY

This course has an attendance requirement, in keeping with Departmental/Literature Program norms and guidelines. There is no distinction between “excused” and “unexcused” absences: whether you notify me beforehand or not; whether it is due to illness, or unforeseen emergency, or family responsibilities; or simply because you are too tired; or because of athletic events, you have to accept the consequences of your absence. For each absence without make-up work, after the fourth, however, your final grade will be lowered by a third (e.g., from B to B- to C+, and so on).

I will take attendance almost every class session.

 

SCHEDULE

Section One: The Self in Medicine

Week One - Where it Began: Reading the Original Medical Records Part I

Read: Psychology Today – “What is the Self?”

        Hippocratic Writings – Epidemics Book I

Week Two - Where it Began: Reading the Original Medical Records Part II

Read: Hippocratic Writings – Epidemics Book III

Assignment: Discussion Post One + Responses

Week Three - Personage VS Patientage: What we give up to Receive Treatment

Read: NCBI – “Identity and Psychological Ownership in Chronic Illness and Disease State”

        My Heart Sisters – “The Loss of the ‘Self’ in Chronic Illness is What Really Hurts”

        The Mighty – “When you fear You’ve lost Yourself to your Chronic Illness”

Assignment: Discussion Post Two + Responses

 

Section Two: Ethics in Medicine

Week Four – What are the Ethics of Medicine?

Read: Hippocratic Writings – The Oath

         AAPS – “Various Physician Oaths”

        Journal of the Royal Society of Medicine – “’First do no Harm’ – A Clear Line in Law and Medical Ethics"

Assignment: Assignment One – Bioethics and Medicine

Week Five – Ethics in Medical Research

Read: Smithsonian Magazine – “In need of Cadavers, 19th-Century Medical Students Raided Baltimore’s Graves”

        History – “Tuskegee Experiment: The Infamous Syphilis Study”

Assignment: Discussion Post Three + Responses

Week Six – The History of Surgery

Read: The Yale Journal of Medicine – “Body Snatching: A Grave Medical Problem”

Assignment: Assignment Two – Virtual Museum Tours

Week Seven – When Ethics Become Complicated: COVID-19

Read: The New England Journal of Medicine – “Facing Covid-19 in Italy – Ethics, Logistics, and Therapeutics on the Epidemics”

        NPR – “US Hospitals Prepare Guidelines for who gets Care Amid Corona Virus Surge”

        BMC Critical Care – “…the Italian Perspective During the COVID-19 Epidemic”

        Minnesota Department of Health – “Ethical Framework to Allocate Remdesivir in the COVID-19 Pandemic”

Week Eight – Midterm

Assignment: Midterm Paper

 

Section Three: The Self as a Hinderance

Week Nine – Doctors are People Too

Reading: The Atlantic – “Doctor’s Tell all – and it’s Bad”

            NCBI – “Culture of Blame – An Ongoing Burden for Doctors and Patient Safety”

Assignment: Discussion Post Four + Responses

Week Ten – When Treatment Becomes Harm

Reading: Being Mortal

            The Cancer Journals

            AP News – “When to give up: Treatment or Comfort for Late-Stage Cancer?”

Assignment: Discussion Post Five + Responses

 

Section Four: The Self as Healing

Week Eleven – Doctors and the Concept of Empathy

Read: frontiers in Behavioral Neuroscience – “Why Empathy has a Beneficial Impact on Others in Medicine: Unifying Theories”

        Patient EngagementHIT – “Understanding Physician Empathy, how it Impacts Patient Care”

        NCBI – “What is Clinical Empathy?”

Assignment: Discussion Post Six + Responses

Week Twelve – The People Behind the Patients

Read: Good Days, Bad Days: The Self and Chronic Illness in Time

        When Breath Becomes Air

         Journal of Clinical Nursing – "Seeing the Person Behind the Patient: Enhancing the care of Older People Using a Biographical Approach"

         DUKE Center for Personalized Healthcare – "The Importance of Physician-Patient Relationships Communication and Trust in Health Care"

         AMA Journal of Ethic – "They Are People First, Then Patients"

         NCBI – "Knowing the Patient as an Individual"

         Cambridge University Press – "The secret is out: Patients are People with Feelings that matter"

Week Thirteen – Wrapping Up

Assignment: Final Paper

Click here for Assignment Guidelines

Click here to go to the Archive for additional readings

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