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Syllabi: Health, Care, and Society II
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: Second-year Medicine; required
SEMESTER: 1999-2000
Course Overview
"Health, Care and Society" reflects the commitment of Albany Medical College to provide medical students with the educational training to become excellent physicians in a complex health care environment. This course will explore the broader, non-technical aspects of illness and disease around which the physician and patient must forge an effective relationship. The overall goal is to promote self-awareness, and an understanding of the complexities around the patient's illness experience.
There are two basic, complimentary perspectives of this course. One is a social science perspective which examines the psychosocial and behavioral, cultural and societal factors that influence the physician-patient relationship. The other is the perspective of philosophical and clinical ethics which develops in students the ability to apply a method of case analysis to serious ethical dilemmas that arise in the course of patient care. As much as possible we will integrate these perspectives with topics that are being addressed in other themes, particularly CCCS.
Table of Contents
Topic Topic Page No.
1. Course Objectives
2. Course Organization 2
3. Requirements 3
4. Introduction Session 5
5. Module One The Patient and the Illness Experience 6
6. Module Two On Death and Dying 8
7. Module Three Spirituality and Illness 10
8. Module Four The Team Approach to Care 11
9. Module Five Medical Ethics Revisited 12
10. Module Six Resource Allocation 14
11. Module Seven Managed Care 17
12. Module Eight The Social Political Responsibility of the Physician 19
13. Module Nine Current Bioethical Issues in Society 20
Course Objectives
A. Knowledge Areas
1. To develop a perspective integrating the multifaceted aspects of a patient's life into the process of medical decision-making.
2. To develop an awareness of aspects of caring for patients with life-threatening illness.
3. To develop a perspective of the complex needs of patients and a multi-disciplinary approach in satisfactorily addressing those needs.
4. To expand the understanding of the basic principles of medical ethics.
5. To develop a familiarity with key macro-level health care issues in society.
6. To develop a familiarity with some of the central medical ethical dilemmas in contemporary society.
B. Skill Areas
1. To be able to assess the psychosocial dimensions of a patient's illness.
2. To be able to utilize a method of ethics case analysis elucidating the basic principles of medical ethics, and their application to clinical medicine.
3. To be able to participate in decision making regarding the rationing and allocation of health care resources.
Course Organization
Health, Care and Society II is organized into nine modules or major topic areas throughout the year. Modules One-Five will explore the multiple aspects of the physician-patient relationship; Modules Six and Seven will engage the students in some of the macro level policy areas which affect the practice and delivery of health care; and, Modules Eight and Nine will conclude the year by examining some of the central medical ethical issues in contemporary US society.
Module One The Patient and the Illness Experience
Module Two On Death and Dying
Module Three Spirituality and Illness
Module Four The Team Approach to Care
Module Five Medical Ethics Revisited
Module Six Resource Allocation
Module Seven Managed Care
Module Eight The Social and Political Responsibility of the Physician
Module Nine Current Bioethical Issues in Society
Requirements
A. Assignment/Exam Schedule
Assignment #1 / Exam #1
Type: Patient Case Study Material Covered: Modules 1-5
Length: 1-2 pages, typed, double -spaced Type: Take home - short essay
% of Total Grade: 10% % of Total Grade: 20%
Type of Grade: Pass - Fail Type of Grade: *High Pass-Pass-Fail
Due: September 4, 1996 Date: December 18, 1996
Assignment #2 / Exam #2
An Exploration of Curing and Material Covered: Modules 7-9
Caring in Medicine. Type: In-class, short answer & short essay
Length: 2-3 pages, typed, double spaced Grade: 20%
Grade: 10% Type of Grade: *High Pass-Pass-Fail
Type of Grade: Pass - Fail Date: April 17, 1997
Due: October 23, 1996
Assignment #3
Type: Book Review of Strangers at the Bedside
Length: 2-3 pages, typed, double-spaced
% of Total Grade: 15%
Type of Grade: *High Pass-Pass-Fail
Due: January 22, 1997
Assignment #4
Type: Disease Groups Ranking: Group Project
Length: 7-8 pages per group, typed, double-spaced
% of Total Grade: 15%
Type of Grade: Pass - Fail
Due: February 26, 1997
B. Final 10% of Total Grade: Attendance in Small Groups
C. Requirements for Passing the Course: 80%
D. Due Date Policy
Assignments are to be handed in on the due dates listed above. Delays will be accepted with a valid excuse presented in person or over the phone prior to or on the due date.
Half of the assignment grade will be taken off the first day an assignment is late, and 25% for each of the following two days. Please communicate with Drs. Jacoby (X5466) and Shelton (X6423) or Cheryl Lussier, office secretary (X6082).
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 #3 and both exams.
2. Passes on #1, #2, #4.
3. Attendance in all small groups.
F. 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.)
3. David Rothman, Strangers at the Bedside, Basic Books, 1991.
Note: Throughout the syllabus, the reading assignments from the two first required texts will be stated by using the letters in parentheses as listed above.
INTRODUCTION
August 14, 1996
In the first meeting we 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 Patient and the Illness Experience
Session One
August 21, 1996
Patienthood: Personal Illness Narratives
Objective: To gain insight into the distinction between illness and disease through patients' personal accounts.
Format: Guest / Large Group
Reading: D. Reiser and A. Schroder, "Reactions to Illness", Chapter 4 in Patient Interviewing: The Human Dimension , (Williams & Wilkins Company, 1980).
A. Kleinman, "Conflicting Explanatory Models in the Care of the Chronically Ill", Chapter 7 in The Illness Narratives , (Basic Books, 1988).
Session Two
August 28, 1996
Psychosocial Assessments of Patients
Objective: To learn how to incorporate a psychosocial assessment into clinical medicine.
Format: Guest / Large Group
Reading: A. Kleinman, " The Personal and Social Meaning of Illness", Chapter 2 in The Illness Narratives , (Basic Books, 1988).
J. Lipowski, "Psychosocial Aspects of Disease", Chapter 2, in Humanistic Health Care, Turner & Mapa (eds.), (Health Administration Publishers, 1988).
Session Three
September 4, 1996
The Meaning of Illness: Discussion of Patient Case Studies
Objective: To define the biopsychosocial model of care.
Format: Small group sessions
Reading: M. Nagai-Jacobson, and M.A. Burkhardt, "Viewing Persons as Stories: A Perspective for Holistic Care", Alternative Therapies , Vol. 2, No. 4, July 1996.
G. Engel, "The Clinical Application of the Biopsychosocial Model", American Journal of Psychiatry, Vol., 137. No.5, May 1980.
MODULE TWO
Death and Dying
Session One
September 11, 1996
On Dying and Death
Objective: To increase awareness of attitudes toward dying and death in the context of US culture and medical care.
Format: Guest / Large Group
Reading: D. Callahan, "Frustrated Mastery - The Cultural Context of Death in America", Western Journal of Medicine, Vol. 163, 1995.
J. McCue, "The Naturalness of Dying", JAMA, Vol. 273, No. 13, April 5, 1995.
Session Two
September 18, 1996
The Physician's Perspective On Caring For The Dying Patient
Objective: To gain an understanding of how caring for dying patients impacts the physician from a personal and emotional point of view.
To consider coping strategies in making the transition from cure to comfort care.
Format: Guest / Large Group
Reading: S. Nuland, "Hope and the Cancer Patient", Chapter 11 in How We
Die , (Alfred A. Knopf , 1994).
Session Three
September 25, 1996
Meeting The Patient's Needs in Life Threatening Illness
Objective: To gain a better awareness from patients who face a life-threatening condition about the importance of having care and support from his or her physician.
Format: Small Groups
Reading: E. Bushkin, "Signposts of Survivorship", Oncology Nursing Forum, Vol. 20, No. 6, 1993.
A. Trillin, "Of Dragons and Garden Peas", NEJM, Vol. 304., No. 12, March 19, 1987.
E. Hansot, "A Letter From A Patient's Daughter", Annals of Internal Medicine, Vol. 125, No. 2. July 15, 1996.
R. Carver, "My Death", in On Doctoring, R. Reynolds and J. Stone (eds.), Simmon and Schuster, 1991).
MODULE THREE
Spirituality and Illness
Session One
October 2, 1996
What Is Spirtuality And What Is Its Relationship to Illness?
Objective: To develop a clearer understanding of the meaning of spirituality and its significance in managing the care of patients.
Format: Guests / Large Group
Reading: E. Cassell, "The Nature of Suffering and the Goals of Medicine", Chapter 3 in Humanistic Health Care, J. Turner and J. Mapa, (eds), (Health Administration Press, 1988).
D. McKee and J. Chapple, "Spirituality and Medical Practice", The Journal of Family Practice, Vol. 35, No. 2, 1992.
Session Two
October 9, 1996
Spirituality And The Clinician
Objective: To discuss and reflect on one's own personal approaches to spirituality and the implications for personal and professional development
Format: Large Group
Reading: L. Dossey, "Holistic Health: A Critique", Chapter XI in Beyond Illness, (New Science Library, 1984).
MODULE FOUR
Illness and the Team Approach
Session One
October 16, 1996
A Demonstration of the Team Approach
Objective: To become familiar with how a multi-disciplinary health care team approaches patient care.
Format: Large Groups
Reading: N. Coyle and J. Ingram, " The Role of the Health Care Team and Case Study", Section VII in Caring for the Dying, The American Board of Internal Medicine, Education Resource Document, Vol. 67, No. 5, 1992.
C. Fagin, "Collaboration Between Nurses and Physicians: No Longer a
Choice", Academic Medicine, Vol. 67, No. 5, 1992.
Session Two
October 23, 1996
What Happens When Team Communication Breaks Down? -
Origins of Clinical / Ethical Dilemmas
Objective: To become familiar with problems that may arise when
health care professionals fail to use an effective team approach.
Format: Small Groups
Reading: P. Pearson, "The Interdisciplinary Team Process or the Professional Towers of Babel", Developmental Medicine and Child Neurology, Vol. 25, 1983.
MODULE FIVE
Medical Ethics Revisited
Session One
October 30, 1996
Physicians' Roundtable on Medical Ethics
Objective: To develop a sense from a panel of seasoned physicians of how ethical issues in medicine have evolved over the past thirty years in the United States.
Format: Guests / Large Group
Reading: D. Rothman, Strangers at the Bedside, (Basic Books, 1991).
Session Two
November 6, 1996
Subjectivity vs. Objectivity in Ethical Analysis
Objective: To develop greater clarity about the application of ethical principles to various scenarios that are not subject to personal opinion.
Format: Large Group
Reading: E.H. Lowey, "Theoretical Considerations", Chapter 2 in Textbook
of Health Care Ethics, (Plenum, 1996).
Session Three
November 13, 1996
Ethics Focus Groups
Objective: To be able to apply the 4 Boxes of case analysis to a case which presents ethical issues in the clinical setting.
Format: Small Groups
Reading: J. S. & W., Clinical Ethics, (Mc-Graw- Hill, Inc., 1992).
Session Four
November 20, 1996
Ethics Case Conference
Objective: To develop an understanding of how an ethical conflict develops in the clinical setting and how it may be resolved
Format: Large Group
Reading: J. S. & W., Clinical Ethics, (Mc-Graw- Hill, Inc., 1992).
NOVEMBER 27, 1996
NO CLASS
December 4, 1996
End of Semester Wrap-Up
Objective: To be able to integrate the topics covered so far, in preparation for the take home exam.
(Exams will be handed out)
Format: Small Groups
DECEMBER 18, 1996
EXAMS DUE
No Class
MODULE SIX
The US Health Care System and Resource Allocation
Session One
January 8, 1997
A Brief Overview of the US Health Care System
Objective: To gain a basic understanding of the important developments in health care since WW II.
Format: Dr. Martin Strossberg / Large Group
Reading: K. Grumbach and T. Bodenheimer, "The Organization of Health Care", JAMA, 273, No.2, January 11, 1995.
Session Three
January 15, 1997
Exercises in Health Care Resource Allocation
Objective: To develop an appreciation of the process in which difficult allocation decisions must be made.
Format: Dr. Martin Strossberg and Robert Baker / Large Group
Reading: A. & S., N. Daniels, "Is the Oregon Rationing Plan Fair?"
pp. 633-640.
D. Eddy, "Principles for Making Difficult Decisions in Difficult Times", JAMA, Vol. 271, No.22, June 8, 1994.
Session Two
January 22, 1997
Should There Be Universal Health Care Coverage?
Objective: To seriously reflect upon and refine one's own perspective about
health care as a basic human right.
Format: Small Groups
Reading: A. & S., D. Brock and N. Daniels, "Ethical Foundation of Health Care Reform", pp. 593 - 606.
T. Bodenheimer and K. Grumbach, " Health Care in Three Nations", Chapter 13 in Understanding Health Policy, (Appleton and Lange,1995).
MODULE SEVEN
Managed Care
Session One
January 29, 1997
The Structure And Operation Of A Managed Care Organization
Objective: To become familiar with the organization and operation of a local HMO.
Format: Dr. J. Salkowe / Large Group
Reading: S.J. Williams and P.R. Torrens, "Managed Care: Restructuring the System", Chapter 13 in Introduction to Health Services, S.J. Williams and P.R. Torrens (eds.), (Delmar Publishers, 1993).
Session Two
February 5, 1997
The Philosophy of Managed Care
Objective: To develop an understanding of the philosophical underpinnings and essential goals of managed care.
Format: Dr. J. Chessare / Large Group
Reading: J.K. Iglehardt, "Physicians and the Growth of Managed Care", NEJM, Vol. 331, No. 17, October 27, 1994.
J. Sabin, "Clinical Skills for the 1990's: Six Lessons from HMO Practice", Hospital and Community Psychiatry, Vol. 42, No. 6, June 1991.
Session Three
February 12, 1997
Managed Care, Ethical Issues and the Physician-Patient Relationship
Objective: To become better prepared for the challenges posed to the physician- patient relationship by managed care.
Format: Guest / Large Group
Reading: J. Balint, and W. Shelton, "Regaining the Initiative", JAMA, Vol. 275, No. 11, March 20, 1996.
J. LaPuma and D. Schiedermayer, "Ethical Issues in Managed Care and Managed Competition: Problems and Promises", in The Physician's Guide to Managed Care, (D.B. Nash, ed.), (Aspen Publishers, 1994).
A. & S., "The HMO Physician's Duty to Cut Cost", pp. 116.
Session Four
February 19, 1997
Resource Allocation: Application to Ranking of Diseases
Objective: To discuss and clarify the assignment and to reach a consensus on the ranking of diseases.
Format: Small Groups
Reading: T. Bodenheimer and K. Grumbach, "Medical Ethics and the Rationing of Health Care" in Understanding Health Policy, (Appleton & Lange, 1995).
MODULE EIGHT
The Social and Political Responsibility of the Physician
Session One
February 26, 1997
Helping Those Lacking Access to Health Care -
What is the Physician's Responsibility?
Objective: To learn about the work of a local physician who donates his time doing surgical procedures for children in Russia.
Format: Guest / Large Group
Reading: Crandall, S., et. al., "Medical Students' Attitudes Toward Providing Care for the Underserved", JAMA, Vol.269, No. 19, 1993.
Session Two
March 5, 1997
Student Debate On The Scope Of Physician Responsibility
Objective: To refine one's understanding of and views about the range of the physician's responsibility to become involved in health care issues that go beyond caring for individual patients.
Format: Student Debating Teams / Small Groups
Reading: R.C. Wesley and V. Sidel, "Gun Violence - A Call for Physical Activism: Lessons From the Struggle to Ban Weapons of Mass Destruction", Medicine & Global Survival, No. 1, June 1994.
MODULE NINE
Current Bioethical Issues in Society
Session One
March 12, 1997
Ethical Issues In Genetic Research, Testing, and Screening
Objective: To become familiar with ethical issues in clinical practice which grow out of recent work in the human genome project.
Format: Guest / Large Group
Reading: A. & S., T.H. Murray," Issues in Human Genetics", pp. 479-512.
Session Two
March 19, 1997
The Abortion Debate
Objective: To become familiar with the arguments on both sides of the abortion debate and to understand their implications for clinical practice.
Format: Guest / Large Group Debate
Reading: A. & S., D. Callahan, "The Abortion Debate: Can This Chronic Public Illness Be Cured?", pp. 369-376.
Session Three
March 26, 1997
Physician Assisted Suicide and Euthanasia
Objective: To develop an understanding of the ethical issues related to physician assisted suicide and euthanasia.
Format: Guests / Large Group
Reading: A. & S., T. Quill, "Death and Dignity: A Case of Individualized Decision Making", pp. 292-295.
A. & S., D. Brock, A. & S. "Voluntary Active Euthanasia", pp. 295-309.
A. & S., D. Callahan, "When Self-Determination Runs Amok", pp.310 -314.
APRIL 2, 1997
NO CLASS
Session Four
April 9, 1997
The Problem of Medical Futility
Objective: To understand the conflicts posed by medical futility and to consider strategies on how to handle such conflicts in patient care management.
Format: Small Groups
Reading: A. & S., B. Steinbock, "The Lakeberg Siamese Twins: When is Treatment Futile?", pp. 276-280.
A. & S., S. M. Miles, "Informed Demand of `Non-Beneficial' Medical Treatment", pp. 277-280.
A. & S., S.L. Schneiderman, N. and Jecker, A. Jonsen, "Medical Futility: Its Meaning and Ethical Implications", pp. 281-288.
A. & S., D. Brock, A. & S., "Voluntary Active Euthanasia", pp. 295-309.
FINAL EXAM IN CLASS
APRIL 16, 1997