An NSS column that seeks to expose pre-health students to the intersection of medicine, ethics, law, and humanism. By looking to relevant opinion pieces in leading medical journals and crafting bite-sized summaries of recent debates in these spheres, it is our hope to spark interest and discussion to foster a deeper understanding of medicine.

Article Corner
Perspective and society pieces from reputed journals. Articles have been briefly summarized.

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Medical Education System

How Medical Education Is Missing the Bull’s-eye
DOI: 10.1056/NEJMp1915891
https://www.nejm.org/doi/full/10.1056/NEJMp1915891?query=TOC

The Cost of Applying to Medical School — A Barrier to Diversifying the Profession
DOI: 10.1056/NEJMp1906704
https://www.nejm.org/doi/full/10.1056/NEJMp1906704

This piece underscores the challenges that prospective medical students face not only when shouldering medical school tuition, but when taking on the cost of the application process itself. The authors specifically outline how the cost of medical education affects applicants from low-income backgrounds. The competitive process bears a hefty price tag at nearly every stage, from MCAT preparation resources and application fees to interview-related travel. These obstacles ultimately contribute to a pool of applicants in which low-income students, blacks, Hispanics, and American Indians are underrepresented. The authors recognize that efforts are being made to alleviate these financial burdens but suggest further action.

Health, Social Reform, and Medical Schools — The Training of American Physicians and the Dissenting Tradition
DOI: 10.1056/NEJMms1907237
https://www.nejm.org/doi/full/10.1056/NEJMms1907237

This piece summarizes efforts over the past century to fight discrimination and reform medical education to reflect a more inclusive conception of health. Two of the major organizations that led these efforts were the Association of Internes and Medical Students (AIMS) and the Student Health Organizations (SHO). These leaders of reform ultimately faltered in the face of societal expectations and political tides of the mid-20th century. However, the authors discuss the legacies that these organizations left, setting the stage for future activism efforts to combat challenges that persist in medicine today, including racism, elitism, and limited community outreach.

Patient-Physician Relationships

Last Song — Sharing Humanity while Maintaining Boundaries
DOI: 10.1056/NEJMp1907600
https://www.nejm.org/doi/full/10.1056/NEJMp1907600

Dr. Joshua Wales ruminates on his experience as a home palliative care physician, particularly when he was asked by an elderly patient to sing for her. He discusses his dilemma, wrestling with the complex boundaries between professionalism and individuality in the sphere of medicine. Ultimately, however, he concludes that the arts transcend the sometimes-uncomfortable nuances of personal anecdotes or life-stories. Rather, art forms such as film, music, and books help forge a deep, universal connection— one that underscores the “mutual humanity” of both patient and provider.

Healing as a Servant Instead of a Prophet
DOI: 10.1056/NEJMp1910439
https://www.nejm.org/doi/full/10.1056/NEJMp1910439?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

In this perspective piece, Dr. Lee reflects on a patient he saw in the emergency department. The teenager, J., had been seen by numerous physicians in the past, as they tried to pinpoint what his symptoms were attributable to. While gastrointestinal diseases often topped the list of possible diagnoses, Dr. Lee realized from his examination that the patient was likely suffering from something else. Invoking biblical analogy, Lee illustrates his decision to approach his patient not as a prophet, but a servant. In this capacity, he highlights the importance of gentle listening, guiding the patient along the path toward their diagnosis rather than simply “imposing third-party expertise.”

The Future of Care — Preserving the Patient–Physician Relationship
DOI: 10.1056/NEJMsr1912662
https://www.nejm.org/doi/full/10.1056/NEJMsr1912662

In this special report, Dr. John Noseworthy discusses modern medicine as a tug-of-war between the humanitarian underpinnings of the profession and health care as a business. To alleviate this tension, Noseworthy suggests re-focusing on the patient-physician relationship, which has always been the crux of medicine itself. Toward these ends, he recommends creating a system in which physicians are able to spend adequate time with patients who need extra attention, as well as supporting the work of coordinating physicians. It is his hope that these measures will not only grant physicians flexibility, but also alleviate the fragmentation of health care through collaboration, organization, and integration of care. Listing a myriad of action items, Noseworthy highlights his confidence that physicians can be health care leaders. He is optimistic that they will use their voices to advocate for patients, ultimately shaping a more sustainable health care system.

Historical Perspectives

Insight Medicine Lacks — The Continuing Relevance of Henrietta Lacks
DOI: 10.1056/NEJMp1905346
https://www.nejm.org/doi/10.1056/NEJMp1905346

Shakkaura Kemet reflects on an experience she and her mother had at an oncology appointment. Drawing parallels between her mother’s experience with vaginal cancer and the story of Henrietta Lacks, Kemet brings attention to the challenges that black women face in the clinical setting. Kemet highlights the relevance of Lacks’ experience decades later, particularly in the context of clinical trials, race in medicine, and a physician’s duty to treat each patient as a human being.

Sir William Osler (1849–1919) — The Uses of History and the Singular Beneficence of Medicine
DOI: 10.1056/NEJMp1911601
https://www.nejm.org/doi/full/10.1056/NEJMp1911601

Drs. Bryan and Podolsky give readers a glimpse into the life of one of the most influential physicians in American history. Sir William Osler famously viewed medicine as a profession characterized by “singular beneficence.” In their piece, Bryan and Podolsky discuss Osler’s reverence for the history of medicine. Osler viewed his predecessors with a sense of pride, harnessing medicine’s past to nurture solidarity and progress during his time. However, the authors also outline how Osler’s views evolved throughout his life. By analyzing the outlooks of both Osler and his contemporaries, Bryan and Podolsky frame the future of medicine in a historical context.

Ethics and Humanism

Fun
DOI: 10.1056/NEJMp1909360
https://www.nejm.org/doi/full/10.1056/NEJMp1909360

Dr. Colaianni reflects upon an experience she had in the OR as a medical student. During a particularly heartbreaking surgery, Colaianni was forced to realize what it means for a physician to find excitement in their work while recognizing the suffering that patients experience. Now, having pursued a fellowship in surgery for cancer, Colaianni discusses how she deals with the struggle between enjoying her work while realizing its inherent connection to human pain.

Why Is a Cow? Curiosity, Tweetorials, and the Return to Why
DOI: 10.1056/NEJMp1906790
https://www.nejm.org/doi/full/10.1056/NEJMp1906790

Inspired by his 4-year-old daughter’s boundless curiosity, Dr. Breu contemplates the importance of “why.” He contends that medical training often places value on the “what” questions—the facts—without always emphasizing the reason for them. Rediscovering his love of “why,” Dr. Breu posted a tweetorial to explain why a particular medical phenomenon takes place. Through his experience with Twitter, Breu brings to light the power of social media to nurture curiosity among the medical community, bringing trainees and physicians together in a flexible, engaging dialogue.

Unsteady Thoughts — Telling the Truth of Psychosis
DOI: 10.1056/NEJMp1905350
https://www.nejm.org/doi/full/10.1056/NEJMp1905350

Dr. Ann Conn tells the heartbreaking story of her sons, both of whom suffered from psychotic bipolar disorder. Conn reveals how even as a trained neurologist, the details of her sons’ personal experiences shook her. As she describes her experience as a mother, watching mental illness eventually drive both her children to suicide, she conveys how much there remains to be learned about the brain. Reflecting on the heart-wrenching journeys of her sons through their treatments and ultimately grieving their loss, Conn discusses her active support for scientific efforts to understand mental disorders from a biological standpoint.

Altruism in Extremis — The Evolving Ethics of Organ Donation
DOI: 10.1056/NEJMp2000048
https://www.nejm.org/doi/full/10.1056/NEJMp2000048

In this perspective piece, Dr. Rosenbaum introduces the experience of patient W.B., who was diagnosed with ALS. Understanding the prognosis of his condition, W.B. decided that he wanted to donate his organs, in order to save lives. Rosenbaum discusses the particulars of W.B.’s case and the legal barriers that ultimately prevented him from donating. Broadening the scope to include cases such as euthanasia and neurologic injury, Dr. Rosenbaum more generally discusses the ethical and legal framework that guides organ donations. Citing renowned bioethicists, Rosenbaum sheds light on the departure from a paternalistic approach to medicine. There are experts in the field who feel that patients, not just the medical community, should be able to contribute to conversations regarding bioethical decisions.