Syllabi: Hope and Suffering in the Doctor Patient Relationship

INSTITUTION: Stanford University School of Medicine

COURSE DIRECTORS: Dr. Elliott Wolfe (email: ewolfemd@stanford.edu), Dr. Audrey Shafer (email: ashafer@stanford.edu), Dr. Ernle Young (email: eyoung@leland.stanford.edu)

ENROLLMENT: 1st and 2nd year students; elective

SEMESTER: Winter Quarter 2001

COURSE DESCRIPTION:

In the spring of 1997, a series of meetings with Stanford medical students was held to identify physician skills which, although important to the art of healing, were felt to be many times overlooked in the medical training process. This course is an outgrowth of those efforts. The course is now being offered for the first time. Since it has been built on student input, you are always encouraged to let us know your opinion about any aspect of the course, large or small. We hope you find this course helpful and worthwhile. If you are going to attend, PLEASE register for it either as 1 or 2 units (see notes below). There is no final or homework. Any questions or comments can be addressed to the course directors or the TA. Thanks for coming!

LECTURE SCHEDULE

1. Hope and Suffering, Art and Healing: Patients Tell Their Stories

Wednesday, January 10, 2001

Lecturer: Cynthia Perlis, Director, UCSF Arts for Recovery

2. Palliative Care for Children

Wednesday, January 17, 2001

Lecturer: Harvey Cohen, M.D., Chief of Staff, Lucille Packard Children's Hospital and Nancy Contro, Director, Palliative Care, Lucille Packard Children's Hospital

3. The Role of Spirituality in Healing

(Lecture 1)

Wednesday, January 24, 2001

Lecturer: Chaplaincy Panel: C. George Fitzgerald, S.T.D., Director, Chaplaincy Service, Pastoral Associate, Memorial Church, Bruce Feldstein, M.D., Jewish and Interfaith Hospital Chaplain and John Hester, Roman Catholic Hospital Chaplain

4. Restitution In/On/With the Land

Wednesday, January 31, 2001

Lecturer: Topher Delaney, Landscape Architect, Specializing in Healing Gardens

5. Instilling Realistic Hope and Reducing Suffering for Cancer Patients

(Lecture 2)

Wednesday, February 7, 2001

Lecturers: David Spiegel, M.D., Professor of Psychiatry and Behavioral Sciences, Associate Chair Dept. of Psychiatry, Stanford University Medical Center

6. The Torment of Addiction and the Promise of Recovery

Wednesday, February 14, 2001

Lecturers: Barry Rosen, MD, Addictionalogist, Medical Director and CEO of Sequoia Alcohol and Drug Recovery Center, Chairman of the Board of the Legacy Foundation (a nonprofit harnessing community resources for prevention, treatment and recovery)

7. Literature and Writing: Selections and Reflections about Medicine

Wednesday, February 21, 2001

Lecturer: Audrey Shafer, MD, Associate Professor of Anesthesia, Stanford University School of Medicine, Staff Anesthesiologist, Veterans Affairs Palo Alto Health Care System

8. Student Panel on Hope and Suffering in the Patient.

Wednesday, February 28, 2001

Lecturer: Panel of medical student sharing their own experiences

9. IIllness and Death as Portrayed in Popular Culture

Wednesday, March 7, 2001

Possible lecturer: Elliott Wolfe, M.D., Associate Dean for Clinical Advising and Professional Development and Leah Bartsch, Medical Student

Experiential Component of Course (optional for an additional unit)

A. A. Observational Experience...

Medical students interested in participating in an observational experience for an additional unit may elect to do one or more of the following:

• Stanford University Hospital Chaplains - Spend one half-day with a chaplain as they go about caring for the emotional and spiritual needs of patients. Medical students will explore the varying roles which different belief systems and faith traditions play at the bedside.

• Menlo Park VA Hospice program - Spend the morning at the Menlo Park VA Hospice. Medical students will explore hope and suffering in the context of end of life care.

• Ethics Committee meeting - Attend an Ethics Committee meeting. Medical students will be introduced to the role of the ethics committee in the hospital's functioning and will observe how ethical issues are discussed in committee.

March 8, 2001 - 5:30-7:00 p.m. (location to be announced)

I. Introduction. A facilitated time for medical students to discuss their experience to date with the suffering of patients.

How will I, as a medical student respond to the suffering I see?

What aspects of patient suffering do I feel most unprepared to deal with?

What role has faith or religion played in my dealings with patients so far?

What was my reaction to seeing a patient suffer tremendously? To seeing a patient die? To seeing their family react? Was I overwhelmed? Was I numb? Was I afraid to show my own emotion? If you were with a chaplain: Why was the chaplain requested? By recognizing the patient's spiritual needs, what was the chaplain able to do for the patient? What was the chaplain not able to do? What did you learn? What do you take away from this experience?

What came up at the ethics committee meetings? How were the issues discussed? What is the role of an ethics committee in patient care? How do clinical ethicists work with physicians and patients?

SPIRITUALITY READINGS:

• Art for Recovery at UCSF Medical Center: Outreach (submitted by Cynthia Perlis)

• Art for Recovery at UCSF Medical Center: Breast Cancer Quilts Project (submitted by Cynthia Perlis)

• Symptoms and Suffering at the End of Life in Children with Cancer

• Understanding of Prognosis Among Parents of Children Who Died of Cancer: Impact on Treatment Goals and Integration of Palliative Care

• Immortality (submitted by Dr. Fitzgerald)

• Religious and Spiritual Case Reports on MEDLINE: A Systematic Analysis of Records from 1980 To 1996 (submitted by Dr. Fitzgerald)

• Energy Medicine (submitted by Dr. Fitzgerald)

• Sacred Sanctuary (submitted by Topher Delaney)

• Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer (submitted by Dr. Spiegel)

• A 43-year-old Woman Copes with Cancer (submitted by Dr. Spiegel)

• The Anesthesiologist and the Arts; Moonlight and Poo (submitted by Dr. Shafer)

• The Anesthesiologist and the Arts; The House of Pain (submitted by Dr. Shafer)

• Literature and Medicine: Contributions to Clinical Practice (submitted by Dr. Shafer)

• Eternity (submitted by Dr. Shafer)

• The Sick Wife (submitted by Dr. Shafer)

• Water (submitted by Dr. Shafer) 131

• Musee des Beaux Arts (submitted by Dr. Shafer)

• Spiritual Issues and Bioethics in the Intensive Care Unit: The Role of the Chaplain

• Religious Dimension of Dying and Death

• A Piece of My Mind; When You Come Into My Room

• The Language of Miracles: Ethical Challenges

• Religion and Spirituality in Medicine: Research and Education