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Syllabi: Health, Care, and Society I
INSTITUTION: Albany Medical College
PROGRAM CO-DIRECTORS: Wayne N. Shelton, Ph.D., Co-Director (email: wshelton@ccgateway.amc.edu);
Liva Jacoby, Ph.D., Co-Director (email: ljacoby@ccgateway.amc.edu)
ENROLLMENT: First-year Medicine; required
SEMESTER: 1999-2000
COURSE OBJECTIVES
A. Knowledge Areas
1. To recognize a set of characteristics that define the "good doctor" in a variety of challenging clinical settings.
2. To become aware of personal reactions and coping styles associated with human dissection and other clinical experiences.
3. To gain an understanding of the significant role of effective communication in providing good patient care.
4. To develop an understanding of the basic principles of medical ethics.
5. To develop an understanding of the historical background of informed consent and implications for patient care in the current healthcare setting.
6. To appreciate the diversity in cultural backgrounds of patients and its implications for care.
7. To develop a basic understanding of alternative and complimentary medicine and some of the reasons patients seek care in this area.
8. To gain a clearer perspective of aging in the US and the implications for patient care.
B. Skill Areas
1. To be able to formulate a set of professional obligations that students have to each other.
2. To develop the building blocks of effective communication in the physician-patient relationship.
3. To develop an ability in clinical ethics case analysis involving the application of basic principles of medical ethics to clinical medicine.
Course Organization
Health, Care and Society I is organized into twelve modules or major topic areas throughout the year. We will begin the year examining medical professionalism and in subsequent sessions draw out the implications for how a "good physician" would provide total care to patients. Accordingly, this course will introduce the students to some of the basic skills and knowledge areas in which the "good doctor" needs to be competent.
Module One The "Good Doctor" and Medical Professionalism
Module Two Entering into the Doctor-Patient Relationship
Module Three Human Dissection
Module Four Effective Communication and the Doctor-Patient Relationship
Module Five "The Good Doctor" and the Six Diseases
Module Six Medical Ethics
Module Seven Historical Background of Informed Consent
Module Eight Informed Consent and the Patient's Right to Self-Determination
Module Nine Cultural Diversity and Individual Autonomy
Module Ten Alternative and Complimentary Medicine
Module Eleven Aging in the US
Module Twelve The "Good Doctor" and the Total Patient - Application to the Six Diseases
Requirements
A. Assignment Schedule
Assignment #1 / Exam #1
Type: Human Dissection Material Covered: Modules 1-6
Length: 1-2 pages, typed, double-spaced Type: Take Home Essay
% of Total Grade: 10% % of Total Grade: 20%
Type of Grade: Pass-Fail Type of Grade: *High Pass-Pass-Fail
Due: 10-23-96 Due: 12-11-96
Assignment #2 / Exam #2
Type: Dax / Ethics Case Analysis Material Covered: Modules 7-12
Length: 1-2 pages, typed, double-spaced Type: Take Home Essay
% of Total Grade: 15% % of Total Grade: 20%
Type of Grade: *HighPass - Pass-Fail Type of Grade: *High Pass-Pass-Fail
Due: 1-24-97 Due: 5-19-97
Assignment #3
Type: The Moral Limits of Multiculturalism
Length: 2-3 pages, typed, double-spaced
% of Total Grade: 15%
Type of Grade: Pass- Fail
Due: 3-28-97
Assignment #4
Type: Why Patients Seek Alternative / Complimentary Care
Length: 2-3 pages, typed, double-spaced
% of Total Grade: 10%
Type of Grade: Pass- Fail
Due: 4-18-97
B. Attendance in Small Groups: 10% of Total Grade
Students who attend all small group sessions will be credited 10% of the course grade. One absence will mean half of the 10% will be taken off; a second absence will mean a loss of the entire 10%. Excused absences will be given in cases of illness or emergencies. An advance notification, in person or by phone, followed by a written excuse is expected.
C. Due Date Policy
Assignments will be expected on the due dates. An assignment one day late will mean loss of half credit for the assignment; two days late will mean no credit for the assignment. As with absences, if it is necessary to turn an assignment in late you must notify us in advance by phone or in person. If you have an emergency, of course you will be given extra time.
D. Requirements for Passing the Course: 80%
E. *Qualification for a Letter of Commendation
A student will qualify for a Letter of Commendation for the course if he or she meets the following three conditions:
1. high passes on assignment #2 and both exams.
2. passes on #1, #3, and #4.
3. Attendance in all small groups.
Required Texts
1. John D. Arras and Bonnie Steinbock, eds., Ethical Issues in Modern Medicine, Mayfield
Publishing Company, 1995. (A. & S.)
2. Albert Jonsen, Mark Siegler, and William Winslade, Clinical Ethics, McGraw-Hill, Inc., 1992. (J. S. & W.)
Note: Throughout the Syllabus, the reading assignments from the required texts will be stated by using the letters in parentheses for the above two texts.
HCS I SYLLABUS
1996-1997
INTRODUCTION
September 4, 1996
In the first meeting Dr. Shelton and Dr. Jacoby will go over the goals and objectives of the course. All of the assignments throughout the year will be described so that there is a clear understanding of what is expected from each student. We will describe the philosophy of the course and its relevance to medical practice.
MODULE ONE
THE "GOOD DOCTOR"
AND
MEDICAL PROFESSIONALISM
Session One
9-11-96
Entering the Medical Profession
Objective: To bring into focus the relationship between personal values and aspirations and those of the medical profession
Format: Small Groups
Readings: 1. P.R. Lee, "Changes in the Scope and Responsibility of Medicine", Mayo Clin. Proc., 67: 876-878, 1992.
2. J. Racy, "Professionalism: Sane and Insane", J. Clin Psychiatry, 51:4, pp.138-140, April, 1990.
3. A. & S., Hippocratic Oath, p. 54.
4. W. Olsler , "Aphorisms" in On Doctoring, R. Reynolds and J. Stone, (eds.), pp. 30-33, Simon & Shuster, 1995.
Session Two
9-18-96
How Do We Define the Medical Profession
Objectives: To clarify the meaning of a profession and professionalism and how they relate to the practice of medicine
To understand the relationship between values and behavior in medical students and in physicians
Format: Guest Physician / Large Group
Readings: 1. J. C. Jennings, "Responsibility for Integrity Lies First With Students", JAMA, Vol. 266, No. 17, pp. 2452 & 2458, November 6, 1991.
2. J. Dwyer, "Primun Non Tacere: An Ethics of Speaking Up", Hastings Center Report 24, No. 1, 1994.
Session Three
9-25-96
The "Good Doctor"
Objective: To be able to articulate basic characteristics of the "Good Doctor" in light of current changes in healthcare
Format: Guest Physician / Large Group
Readings: 1. "Shattuck Lecture---Healing And Heroism", NEJM, Vol. 322, pp. 1540-1548, May 24, 1990.
MODULE TWO
ENTERING INTO THE DOCTOR-PATIENT RELATIONSHIP
Session One
10-2-96
Understanding the Patient's Perspective
Objectives: To develop an understanding of the impact of the doctor-patient relationship in the process of providing care.
To clarify the essential elements of the physician-patient relationship
Format: Two Patients / Large Group
Readings: 1. S. Kaplan, et. al., "Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease". Medical Care, Vol. 27, No. 3, Supplement, pp. S110-S127, March 1989.
Session Two
10-9-96
Models of the Doctor-Patient Relationship
Objective: To develop an understanding of the various models of the physician-patient relationship and their application to various settings.
Format: Guest Physician / Large Group
Readings: 1. M. Siegler, "The Physician-Patient Accommodation", Arch Intern Med, Vol. 142, pp. 1899-1902, Oct. 1982.
2. T. Szasz and M. Hollander, "A Contribution to the Philosophy of Medicine: The Basic Models of the Doctor-Patient Relationships". Arch Intern Med, Vol. 97, pp. 585-592, 1956.
MODULE THREE
HUMAN DISSECTION
Session One
10-16-96
Understanding the Experience of Dissection
Objective: To reflect upon and discuss personal reactions to human dissection
Format: Large Group
Readings: 1. D. Reiser and A. Schroder, "Becoming a Doctor", chapter two in Patient Interviewing, pp. 21-27, Williams and Wilkins, 1980.
Session Two
10-23-96
Sharing Experiences of Dissection
Objective: To understand the relevance of the experience of dissection in developing personal coping strategies in the clinical setting.
Format: Small Groups
Readings: 1. N. Gustavson, "The Effect of Human Dissection on First-Year Students and Implications for the Doctor-Patient Relationship", Journal of Medical Education, Vol. 63, pp. 62-64, January 1988.
MODULE FOUR
EFFECTIVE COMMUNICATION
AND
THE DOCTOR-PATIENT RELATIONSHIP
Session One
10-30-96
Framing The Physician-Patient Relationship
Objective: To understand the importance of effective communication in the development of the physician-patient relationship
Format: Patient and Physician / Large Group
Readings: 1. D. Matthews, et.al. "Making "Connexions": Enhancing the Therapeutic Potential of Patient Clinician Relationships, Annals of Internal Medicine, Vol. 118, No. 12, pp. 973-977, June, 1993.
2. V. Francis, et.al. "Gaps in Doctor-Patient Communication", NEJM, Vol. 280, No. 10, pp. 535-540, March 6, 1969.
Session Two
11-6-96
Examining Patient/Family/Physician Communication in Critical Care Settings
Objective: To be able to critically assess communication styles in the clinical care setting
Format: Physician / Film / Large Group
Readings: 1. S. Cohen-Cole and J. Bird, "Function 1: Gathering Data to Understand the Patient" and "Function 2: Building Rapport and Responding to Patient's Emotions, (Relationship Skills)", Chapters three and four in S. A. Cohen- Cole, The Medical Interview: The Three-Function Approach, Mosby Yearbook, 1991.
Session Three
11-13-96
Role Playing Exercises: Barriers to Communication
Objective: To develop better awareness about the barriers to effective communication during the management of a serious disease and how those barriers might be overcome
Format: Small Groups
Readings: 1. T. Quill, "Barriers to Effective Communication", Chapter 8 in The Medical Interview: Clinical Care, Education and Research, M. Lipkin, et. al., (eds.), 1995. Session Four
11/19/96
Communication And The Physician's Search For Meaning
Objective: To develop an appreciation for how effective communication with patients can be meaningful to physicians
Format: Physician / Large Group
Readings: 1. A. Suchman, et. al., "The Role of the Medical Interview in the Physician's Search for Meaning", Chapter 30 in The Medical Interview: Clinical Care, Education and Research, Mack Lipkin et. al. (eds.), Braum and Brinkin, 1995.
No Class
11-27-96
MODULE FIVE
THE "GOOD DOCTOR" AND THE SIX DISEASES
Session One
12-4-96
Take Home Exam to be Handed Out
Objective: To apply what has been learned so far regarding the characteristics and skills of the "good doctor" to cases from the six diseases
Format: Small Groups
Readings: 1. J. S. & W., "Preferences of Patients", Chapter two, pp. 37-85. (For Module Six)
12-11-96
Exams Due
(No Class)
MODULE SIX
MEDICAL ETHICS
Session One
1-8-97
A Method of Ethical Case Analysis
Objectives: To understand the principles of biomedical ethics and to become familiar with a method of ethical case analysis
Format: Large Group
Readings: 1. J. S. & W., "Quality of Life", Chapter three, pp. 85-120.
Session Two
1-15-97
The "Dax" Case
Objectives: To be become familiar with the changes in context of medical ethical decision making during the past 25 years. To develop a basic appreciation of a real live ethical dilemma.
Format: Film / Large Group
Readings: 1. A. & S. "Assessing Decision-Making Capacity", Part 2, Section 2, pp. 185-202.
2. E. Rosenberg & D. Karides, "An Interview With Dax Cowart", JAMA, Vol. 272, No. 9, September 7, 1994.
Session Three
1-22-97
Analysis of Dax Case
Objectives: To be able to analyze an ethical dilemma and to reach a reasoned conclusion
Format: Small Groups
Readings: 1. A. & S., B. Miller, "Autonomy and the Refusal of Lifesaving Treatment",
Part 2, Section 2, pp. 202-211.
MODULE SEVEN
HISTORICAL BACKGROUND OF INFORMED CONSENT
Session One*
1-29-97
Nazi Medicine
(Two Hours)
Objectives: To develop an appreciation for some of the key historical events leading to the emergence of the doctrine of informed consent
Format: Dr. Micheal Franzblau / Large Group
Readings: 1. "The Ethical and Legal Implications of Informed Consent in the Patient- Practitioner Relationship". The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions, Vol. 1, pp. 1-9, 1982.
2. "Medical Ethics Under National Socialism", Encyclopedia of Bioethics, W. Reich, (ed). The Free Press, pp. 1015-1020, 1978.
3. A. C. Ivy, "Nazi War Crimes of a Medical Nature". Bioethics, R. Edwards, and G. Graber (eds). Harcourt Brace Javonovich, 1988.
* We will have a special guest at this session. Please be sure to be present.
Session Two
2-5-97
Experimentation and Informed Consent in the US
Objectives: To develop an understanding of what happened during the Tuskegee Experiments
Format: Film / Large Group
Readings: 1. H. K. Beecher, "Ethics and Clinical Research", NEJM, 274, No. 24, pp. 1354-60, June 1966.
Session Three
2/12/97
Discussing Personal Reactions
Objectives: To grapple with the difficult questions and issues that arise out of the previous two sessions, on informed consent
Format: Small Groups
Readings: 1. "The Gilded Age of Research", Chapter three in Strangers at the Bedside, D. Rothman. Basic Books, pp. 51-69, 1991.
MODULE EIGHT
INFORMED CONSENT
AND
THE PATIENT'S RIGHT TO SELF-DETERMINATION
Session One
2-19-97
Patient Autonomy and Models of Obtaining Informed Consent
Objectives: To understand the significance of patient autonomy and the legal and moral basis of informed consent
To become sensitive to the barriers in obtaining informed consent in physician- patient encounters
Format: Guest / Large Group
Readings: 1. T. Beauchanp and L. McCullough, "The Management of Medical Information: Legal and Moral Requirements of Informed Voluntary Consent". Medical Ethics The Moral Responsibilities of Physicians, pp. 63-78, Prentice Hall, Inc., 1984.
Session Two
2-26-97
Advance Directives
Objectives: To appreciate the significance and role of living wills and healthcare proxies in end of life decision making.
Format: Guest/Large Group
Readings: 1. A. & S., "The Health Care Proxy and the Living Will". Part 2, Section 3, pp. 212-217, and "In the Matter of Claire C. Conroy". Part 2, Section 3, pp. 222-232.
MODULE NINE
CULTURAL DIVERSITY AND INDIVIDUAL AUTONOMY
Session One
3-5-97
Aging and Death in Three Cultures
Objective: To recognize cultural and ethnic differences in patient populations.
Format: Video/Large Group
Readings: 1. E. Berlin and W. Fowkes, "A Teaching Framework for Cross-cultural Health Care". The Western Journal of Medicine, 139, 6, pp. 934-938.
Dec. 1983.
Session Two
3-12-97
Discussion of Cultural Differences
Objectives: To be able to identify and discuss in an informed manner three cultural approaches to aging and death
Format: Small Groups
Readings: 1. J. Muller, "Cross-cultural Medicine; A Decade Later: Ethical Dilemmas in Cross-cultural Context, A Chinese Example". Western Journal of Medicine, No. 157, pp. 323-327, Sept. 1992.
2. J. Klessig, "Cross-cultural Medicine; A Decade Later: The Effect of Values and Culture on Life-Support Decisions, Western Journal of Medicine, No. 157, pp. 316-322, Sept. 1992.
Session Three
3-19-97
Role Playing and Cultural Diversity
Objectives: To better understand the potential for cultural biases in the clinical setting
Format: Guests/Large Group
Readings: 1. A. Kraut, "Healers and Strangers", JAMA, Vol. 263, No13, April 4, 1990.
Suggested Readings: A. Walker, "Posessing the Secret of Joy", Pocket Books, 1992.
Session Four
3-26-97
The Moral Boundaries of Multiculturalism
Objectives: To reflect upon the boundaries of respect for a cultural practice that may pose harm for a minor
Format: Small Groups
Readings: 1. N. Jecker, J. Carrese, and R. Pearlman, "Caring for Patients in Cross- Cultural Settings". Hastings Center Report, 25, No. 1, pp. 6-14, 1995.
2. V. Michel, "Factoring Ethnic and Racial Differences into Bioethics Decision Making", Generations, Vol. XVIII, No. 4, Winter 1994.
3. R. Schwartz, "Multiculturalism, Medicine, and the Limits of Autonomy: The Practice of Female Circumcision", Cambridge Quarterly of Healthcare Ethics, 431-441, 1994.
MODULE TEN
ALTERNATIVE AND COMPLIMENTARY MEDICINE
Session One
4-2-97
What is Medical Science?
Objective: To better understand the nature the of scientific method in evaluating the efficacy of treatment options
Format: Guest / Large Group
Readings: 1. M. Kottow, "Classical Medicine v. Alternative Medical Practices", Journal of Medical Ethics, Vol. 18, pp. 18-22, 1992.
VACATION
4-9-97
Session Two
4-16-97
(Two Hours)
Alternative and Complimentary Healthcare
Objectives: To become familiar with selected types of alternative/complimentary methods in healthcare and to understand the role of these methods in today's healthcare system
Format: Alternative Care Providers / Small Groups
Readings: 1. D. Eisenberg, et. al,. "Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use", NEJM, Vol. 328, No. 4, January 28, 1993.
2. J. Callahan, "Studying the Alternatives". New Age Journal, pp. 83-90, January/February, 1995.
MODULE ELEVEN
AGING IN THE US
Session One
4-23-97
Myths About Aging
Objective: To recognize some common beliefs and myths about aging and the elderly in the US
Format: Film / Large Group
Readings: 1. K. Daychtwald, "The Aging of America: Overview". Chapter One in Wellness and Health Promotion for the Elderly, Aspen Publishers, Inc., 1986.
2. J. Sokolovsky, "Images of Aging: A Cross-Cultural Perspective". Generations Journal of American Society on Aging, pp. 51-54, Spring/Summer 93.
Session Two
4-30-97
The Aging Patient and the Physician
Objective: To integrate the perspectives and skills of the previous modules toward the task of caring for the aged patient
Format:
Readings: 1. R. Butler, "Dispelling Ageism: The Cross-Cutting Intervention", Generations, Journal of the American Society on Aging, pp. 75-78, Spring/Summer 93.
2. N. Reichel, "Essential Principles in the Care of the Elderly", Chapter one in Care of the Elderly, (W. Reichel, (ed.). Williams and Wilkins, 1995.
Session Three
5-7-97
Aging and the Limits of Medicine
Objective: To be able to elucidate some arguments surrounding the question "too old for health care"?
Format: Small Groups
Readings: 1. A. & S., D. Callahan, "Aging and the Ends of Medicine". Part 6, Section 2, pp. 622-628.
2. A. & S., C. Cassel, "The Limits of Setting Limits". Part 6, Section 2, pp. 629-633.
MODULE TWELVE
THE "GOOD DOCTOR" AND THE TOTAL PATIENT:
APPLICATION TO THE SIX DISEASES
Session One
5-14-97
Exams will be handed out
Objective: To apply the concepts of the "good doctor" and the total patient to case studies from the six diseases
Format: Small Groups
Turn In Final Exam
5-19-96