The Humanities and Social Sciences in Medicine

INSTITUTION: Oregon Health Sciences University

INSTRUCTOR: Martin Donohoe, M.D. email:martin.donohoe@verizon.net

ENROLLMENT: fourth and fifth year medical students, MPH and M.D./Ph.D. students.

SEMESTER: March 2001

Monday-Friday, 8am-12pm
COURSE OBJECTIVES:

This seminar-type elective will focus on the role of the humanities and social sciences in clinical medicine, public health, and health policy. Students will meet for 4 hours each morning. Issues in public health and sociocultural medicine will be examined, including: substance abuse, race and health care, family and gun violence, occupational and environmental medicine, poverty and homelessness, mental illness, alternative medicine, the pharmaceutical industry, immigration and public health, disabilities and stigmatization, the health effects of war, art and medicine, and the history of medicine in America and at OHSU. Most days will begin with group discussion of works of literature (novels, short stories, essays, and poems). Guest instructors (with backgrounds in the history of medicine, medical anthropology, philosophy, literature, and ethics) will join the group to lecture and facilitate discussion. Readings from historical texts and contemporary medical journals will supplement the literary offerings.

Students will need to spend approximately 2-3 hours per day working outside of class. They will be expected to read and discuss the literature and journal articles, and to prepare 2-3 brief oral presentations (using articles provided by the course director or accessed via Medline). This is a full-time, 4 unit course. It is possible to gain 5 or 6 units by doing one or both of the following, each for one unit: 1) an 8-10 page paper on a subject in the social sciences and humanities; 2) a clinical project of approx 4 hrs per week that in some way touches on the humanities and social sciences. These could form the basis of a publication depending on student time and interest. Students should not take any other rotation simultaneously. There will be no clinical responsibilities or "call" during the course. There are no prerequisites. Students who took IM 705B (Literature, Medicine and Public Health) will see a few updated sessions, but the vast majority of material will be new. Grading is pass/fail, based on participation in discussions and quality of presentations.
COURSE OUTLINE:

Monday, 1/29/2001

8:30am-9am: Course Intro (Martin Donohoe)

9am-12pm:

Contemporary Issues in Women’s Health Care: Violence Against Women, Rape, Teen Pregnancy, The Family, Child Care, Sexual Harassment, Historical and Contemporary Ideals of Beauty, Female Genital Mutilation, and International Human Rights Abuses (Martin Donohoe)

Donohoe M. Contemporary Issues in Women’s Health Care (Handout).

Tuesday, 1/30/2001

9am-10am: Minimata Disease: The Photography of W Eugene Smith (Martin Donohoe)

Land Mines (Martin Donohoe)

10am-11am:

Dancing Faeries and Popular Delusions in the Middle Ages; Links with Multiple Chemical Sensitivity (Loren Pankratz)

No readings.

11am-12pm: Munchausen Syndrome By Proxy (Loren Pankratz)

Pankratz L. Munchausen syndrome by proxy 1997 (case study).

Wednesday, 1/31/2001

NO CLASS - Work on History of Medicine papers and student talks

Thursday, 2/1/2001

8am-10am: The Development of the Starr-Edwards Heart Valve (Annette Mathews)

Handout 10am-12pm: Human Health and the Environment (Martin Donohoe)

Webster D. Inside the $10 billion black market in endangered animals. NY Times Mag 1997 (Feb 16):26-33, 49, 53, 61.

Donohoe M. Handout: "The Health Consequences of Environmental Degradation and Social Injustice"

Friday, 1/2/2001

8am-9am: Community Oriented Primary Care - "Here Comes Another Burnside Bum" (Neil Rendelman)

Link BG, Phelan J. Social conditions as fundamental causes of disease. J Hlth & Soc Behav 1995 (extra issue):80-94.

Rendelman N, Feldstein A. Occupational injuries among urban recyclers. J Occup Envir Med 1997;39(7):672-5.

9am-10am: Student Presentations

10am-11am: Mandatory Reporting of Alcoholics in the Emergency Room (Room 11D-03) Carol Bonnono

Videotape from Dateline, NBC TV.

The Cost of Alcohol-Related Traffic Crash Injuries: Fact Sheet, MADD, 1989.

Liu S, Siegel PZ, Brewer RD, Mokdad AH, Sleet DA, Serdula M. Prevalence of alcohol-impaired driving: results from a national self-reported survey of health behaviors. JAMA 1997;277:122-5.

Chang G, Astrachan B, Weil U, Bryant K. Reporting alcohol-impaired drivers: results from a national survey of emergency physicians. Ann Emerg Med 1992;21:284-90.

How an Idea becomes Law: A Simplified Version of the Oregon Legislative Process.

Reporting Intoxicated Drivers, ORS 676.260-676.280. Oregon Association of Hospitals and Health Systems - Member Legal Services.

11am-12pm: Commissioning Public Bioethics (Room 11D-03) Patricia Backlar

National Bioethics Advisory Commission Executive Summaries on: Human Stem Cell Research, Rockville, Maryland, September 1999.

Capacity Report, Rockville, Maryland, December 1998.

Monday, 2/5/2001

8am-9am: Student Presentations

9am-10am: History of Medicine Lecture: Boerhave and Aunbrugger (Pete Sullivan)

Handout

10am-10:30am: Student Presentation

10:30am-12pm: Psychiatry and the Law: War Criminals (Landy Sparr)

Sparr L. The Interface of Psychiatry and the Law at the International War Crimes Tribunal: Diminished Responsibility or Perpetuation of Undiminished Confusion? pp. 6-20.

Tuesday, 2/6/2001

9am-10am: Student Presentations

10am-11am: Challenges of Treating Hematologic Disease in the Developing World (Tom Deloughery)

Chandy M. Management of Hematological Diseases: Socio-Economic Aspects. Hematology 1999:73-76. Williams JA, Marina N, et al. Developing a pediatric hematology/oncology partnership program (PHOPP) in El Salvador. Abstract

11am-12pm: Physician-Physician Relationships (Steven Jones)

Lowenstein J. The Midnight Meal.

Wednesday, 2/7/2001

8:10am-9am: Doctors in fiction - are they real? Do we know them? (Jack McAnulty)

Chapter 6 from Run with the Horseman, by Ferrol Sams (New York: Viking-Penguin, 1982).

9am-10am: Oregon’s Assisted Suicide Law - Ethical, Legal, and Clinical Aspects (Susan Tolle)

Lee MA, Tolle SW. Oregon’s assisted suicide vote: the silver lining. Ann Int Med 1996;124:267-9.

Lee MA, Nelson HD, Tilden VP, Ganzini L, Schmidt TA, Tolle SW. Legalizing assisted suicide - views of physicians in Oregon. N Engl J Med 1996;334:310-5.

10am-12pm: Leonard DaVinci’s Anatomical Drawings (June Ferar) Thursday, 2/8/2001

8am-10am: Narrative ethics for clinicians (Merilee D. Karr)

Karr MD. Of Mice and Women, a ten-minute play. 1998

Karr MD. Development notes from journal for the play Of Mice and Women, 1999

Wedekind A, Seebeck T, et al. MHC - dependent mate preferences in humans. Royal Society 1995:245-49.

10am-11am: (Hatfield, Room 11D-03) Health Consequences of Tobacco/The Tobacco Industry (Martin Donohoe)

11am-12pm: (Hatfield, Room 11D-03) Health Issues of Migrant and Seasonal Farm Workers (Eric Hanson)

Handout: Hanson E. The Health Issues of Migrant and Seasonal Farm Workers Friday, 2/9/2001

8am-5:15pm: Northwest Society of General Internal Medicine Conference (Oregon Medical Association)

Monday, 2/12/2001

8am-9am: The Limits of the Doctor-Patient Relationship (Martin Donohoe)

"To Respond Always," by Douglas R. Mailman, from M Lacombe (ed.), On Being a Doctor (Philadelphia: American College of Physicians, 1995).

"The Consultation," by Richard Selzer.

9am-10am: Ethical Considerations of Complementary and Alternative Medicine in Western Medical Settings (Karen Adams)

Handout

10am-11am: Physician Moral Diversity and Conscientious Objection in the Provision of Abortion Services (Karen Adams)

Meyers C, Woods RD. An obligation to provide abortion services: what happens when physicians refuse? J Med Ethics 1996;22:115-120.

Lazarus ES. Politicizing abortion: personal morality and professional responsibility of residents training in the United States. Soc Sci Med 1997;44(9):1417-1423.

Cole HM. Legal interventions during pregnancy: Court-ordered medical treatments and legal penalties for potentially harmful behavior by pregnant women. JAMA 1990;264(20):2663-2670.

11am-12pm: The Physician Faces Illness (Miles Edwards)

Edwards MJ. Facing life-threatening illnesses. The Pharos. Summer 1997.

Edwards MJ, Garland M, et al. Medicine’s essential patient-centered ethic. The Pharos. Fall 1999.

Tuesday, 2/13/2001

8am-9am: Dept. of Medicine Grand Rounds, OHSU Hospital 8B-60

Urine Trouble: Practical, Legal and Ethical Issues Surrounding Mandatory Physician Drug Testing (Martin Donohoe) Donohoe MT. Urine Trouble: Practical, Legal and Ethical Issues Surrounding Mandatory Physician Drug Testing (Handout).

9am-9:30am: Discussion of Physician Drug Testing (Martin Donohoe)

9:30am-10am: Student Presentation

10am-11am: Pastoral Care (Jim Berry)

Moyer FS. Pastoral care in the hospital. J Pastoral Care 1989:XLIII(2):171-83.

11am-11:30am: Mandatory Reporting Laws and Doctor-Patient Confidentiality: Domestic Violence, Alcoholics in the ER, Infectious Diseases, Violent Crimes, Substance-Abusing Pregnant Women, etc. (Martin Donohoe)

Hyman A, Schillinger D, Lo B. Laws mandating reporting of domestic violence: do they promote patient well-being? JAMA 1995;273:1781-1787.

11:30am-12pm: Student Presentation

Wednesday, 2/14/2001

8am-10am: Extending Access to Everyone in Oregon: Public Forum with Reflections (Michael Garland) Trigger Items for Discussion (please fill out before coming to class)

Kitzhaber J. "State of the State" address (1/21/00)

Data from "Uninsured in Oregon, 1998"

Project diagrams

"A Ritual to Read to Each Other" by William Stafford.

"Aunt Mabel" by William Stafford.

10am-12pm: William Styron and Depression (Peter Hatcher)

Excerpt from William Styron’s Darkness Visible.

Thursday, 2/15/2001

8am-9am: Immigration and Health Care/California’s Proposition 187/Latino Health Care (Martin Donohoe)

Lacombe MA. Gordian knot. Am J Med 1993;94:76-76.

Evans CA. Immigrants and health care: mounting problems. Ann Int Med 1995;122:309-310.

Flaskerud JH, Kim S. Health problems of Asian and Latino immigrants. Nursing Clinics of North America1999;34(2):359-380.

Donohoe M. Handout on Latino health care.

9am-10am: The Controversy over Oral Contraceptives and Thrombosis (Leon Speroff)

Speroff L. Oral contraceptives and thrombosis. 1998

10am-11am: Race and Health Care (Martin Donohoe)

"The Sky is Gray," by Earnest J Gaines, from Marion Gray Secundy (ed.), Trials, Tribulations and Celebrations: African-American Perspectives on Health, Illness, Aging and Loss (Yarmouth, ME: Intercultural Press, 1992).

Brandt AM. Racism and research: the case of the Tuskegee Syphilis Study. Hastings Center Report 1978;8(6):21-29.

Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Publ Hlth 1997;87:1773-1778.

Questionnaire: Research or Racism? Harper’s Magazine 1997 (Sept):18.

Jury Rigging Laid Bare. Harper’s Magazine 1997 (June):23-24.

11am-12pm: Ethical Issues Related to Conjoined Twins (Martin Donohoe)

Handouts: Court-Ordered Separation of Conjoined Twins

Handouts: Ethical and Moral Thinking/Analysis from Michael Garland

Friday, 2/16/2001

8am-9am: Law/Psychiatry/Deinstitutionalization/Abuse of Psychiatry (Joe Bloom)

"Introduction: The Shame of the Streets," from RJ Isaac and VC Armat.

Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill (New York: The Free Press, 1990).

Handouts on forensic psychiatry

9am-10am: The History of Infant Nutrition and Breast Feeding vs. Formula in the Third World (Oliver Massengale)

Radbill SX. Infant feeding through the ages. Clin Ped 1981;613-21.

Anderson GC. Science brought to mothering (review of Mothers and Medicine: A Social History of Infant Feeding, 1890-1950, by Rima Apple). Science 1989;244:843-5.

Short SED. History in the medical curriculum: A clinical perspective. JAMA 1982;248:79-81.

10am-10:30am: Break

10:30am-12:00pm (Hatfield Bldg, Room 11D03)

Monday, 2/19/2001

NO CLASS - Holiday

Tuesday, 2/20/2001

8am-9:30am: Domestic Violence (Hatfield, Room 11D-03) - Christina Nicolaidis

Videotape: "The Voices of Survivors: Domestic Violence Survivors Educate Physicians"

9:30am-11am: The Pharmaceutical Industry/Academia-Industry Relationships (Martin Donohoe)

Donohoe M. The Pharmaceutical Industry.

11am-12pm: Adolescence / Sexuality (Martin Donohoe)

"If They Knew Yvonne," by Andre Dubus (from the North American Review). Warner DL, Boles J, Goldsmith J, Hatcher RA. Disclosure of condom breakage to sexual partners. JAMA 1997;278:291-2.

"The Christian Fright," from Harper’s Magazine 1997(Oct):20-3.

Wednesday, 2/21/2001 (Bring 5 copies of history of medicine paper today)

8am-9:30am: Poetry and Healing (Lisa Wiener)

9:30-10:30am: Child Abuse: Impact on Children and Families (Arlene Ritzen and Pam Crowe)

10:30-11am: Student Presentations

11am-12pm:

10:30am-12pm: Death and Dying/DNR - Ethical Issues (Martin Donohoe)

Kennedy AL. The Gift. Ann Intern Med 1996;125:513.

Kahlil Gibran (1993). The Prophet. New York: Alfred .A. Knopf

D.J. Enright (1983). The Oxford Book of Death. Oxford, New York: Oxford University Press, "The Venerable Bebe" , Ecclesiastical History of the English People; "An Essay on Man" by Alexander Pope (1688-1744); "Holy Sonnets" by Donne; "On the fear of Death" by William Hazlitt (1778-1830); "Do not go gentle into that good night" by Dylan Thomas (1914-1953); "The Royal Way" by Andre Malraux (1901-1976); " Maxims" by La Rochefoucald (1613-1680); "Getting Even" by Woody Allen (b. 1935); "Pensees" by Blaise Pascal (1623-1662); " In Memoriam A.H.H." by Alfred Lord Tennyson (1809-1892).

Anon. It’s Over Debbie. JAMA 1988;259:272.

Thursday, 2/22/2001

8am-9am: Origins of critical care units (Alan Barker)

9am-10am: Man in Extreme Environments (Gary Rischitelli)

10am-11:30am: (Hatfield, Room 11D-03) The ethical, cultural, and clinical aspects of caring for gypsies (Barbara Glidewell)

Maas, P. (1975). King of the Gypsies. New York: Viking Press.

Suthterland, A. (1975). Gypsises: The hidden Americans. London: Tavistock Publications.

Sway, M. (1988). Familiar strangers. Urbana, IL: University of Illinois Press.

Thomas, JD. (1985). Gypsies and American Medical Care. Medicine 102:842-45.

Gypsy culture protocol at OHSU - instructor to bring

In Search of History: The Curse on the Gypsy (video from the History Channel)

11:30am-12pm: Student Presentation

Farewell Readings:

Dillard A. The wreck of time: taking our country’s measure. Harper*s Magazine 1998 (Jan):51-6.

Pastor Niemoller, First they came for the Jews…

Work, from Gibran K. The Prophet (New York: Alfred A Knopf, 1923)

Anonymous. Desiderata (1692).

Crawshaw R, Rogers DE, Pellegrino ED, et. al. Patient-physician covenant. JAMA 1995;273:1553.

Kornrich WJ. An old horse. JAMA 1989;262:2902.

Kleinman LC. Health care in crisis: a proposed role for the individual physician as advocate. JAMA 1991;265:1991-2.


8am-9am: Charles Dotter and the History of Interventional Radiology at OHSU Misty Paine Handout 9am-10:30am: Medical/Hospital Waste (Health Care without Harm) John Krotchko Greening Hospitals Chapter 2: Medical Waste Treatment. Greening Hospitals Chapter 3: Mountains of Medwaste. 10:30am-12pm: Discussion of Students’ History of Medicine Papers Martin Donohoe Catch-up and Evaluations Martin Donohoe

Farewell Readings:

Dillard A. The wreck of time: taking our country’s measure. Harper*s Magazine 1998 (Jan):51-6.

Pastor Niemoller, First they came for the Jews…

Work, from Gibran K. The Prophet (New York: Alfred A Knopf, 1923)

Anonymous. Desiderata (1692).

Crawshaw R, Rogers DE, Pellegrino ED, et. al. Patient-physician covenant. JAMA 1995;273:1553.

Kornrich WJ. An old horse. JAMA 1989;262:2902.

Kleinman LC. Health care in crisis: a proposed role for the individual physician as advocate. JAMA 1991;265:1991-2.


 


Potential Student Presentation Topics

medical student abuse

medical marriages, divorces, pregnancy during medical training

abortion / fertility - epidemiology

substance abuse policies

early discharge of mothers and newborns - data and policy

suicide

impaired physicians

physician fraud

culturally-defined illnesses

injury prevention - fires, helmets, etc.

auto safety

corporate welfare

literacy and health care

other countries’ health care systems - e.g., Canada, UK, Australia, Japan, Germany, Russia, etc.

child abuse

corporal punishment

capital punishment

torture / PTSD

vivisection

historical and cultural aspects of obesity and eating disorders

farming and health

breast feeding - international aspects of infant nutrition

diseases in history - e.g., plague, etc.

famous figures in the history of medicine, nursing, dentistry, and public health

history of contraception or childbirth

malpractice

space medicine

childhood lead poisoning

medical aspects of adoption

refugees

sex education in the schools

polygraph testing

funerary rituals and attitudes toward death historically or in other cultures

humor in medicine

architecture and the modern hospital

other…