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Doctors Serving People

Doctors Serving People: Restoring Humanism to Medicine through Student Community Service

Edward J. Eckenfels
Copyright Date: 2008
Published by: Rutgers University Press
Pages: 240
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  • Book Info
    Doctors Serving People
    Book Description:

    Today's physicians are medical scientists, drilled in the basics of physiology, anatomy, genetics, and chemistry. They learn how to crunch data, interpret scans, and see the human form as a set of separate organs and systems in some stage of disease. Missing from their training is a holistic portrait of the patient as a person and as a member of a community. Yet a humanistic passion and desire to help people often are the attributes that compel a student toward a career in medicine. So what happens along the way to tarnish that idealism? Can a new approach to medical education make a difference?Doctors Serving Peopleis just such a prescriptive. While a professor at Rush Medical College in Chicago, Edward J. Eckenfels helped initiate and direct a student-driven program in which student doctors worked in the poor, urban communities during medical school, voluntarily and without academic credit. In addition to their core curriculum and clinical rotations, students served the social and health needs of diverse and disadvantaged populations. Now more than ten years old, the program serves as an example for other medical schools throughout the country. Its story provides a working model of how to reform medical education in America.

    eISBN: 978-0-8135-4509-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Foreword
    (pp. vii-xii)
    Joseph F. OʹDonnell

    Early on in my position as Dean of Student Affairs at Dartmouth Medical School, I was asked to bring a group of our medical students to meet with Dr. Robert Coles over breakfast. Dr. Coles, the noted author and child psychiatrist, professor of medicine and humanities at Harvard, and recipient of the Pulitzer Prize for his work in documenting the experiences of those children first involved in the integration of the schools in the South, was giving Dartmouth’s fall convocation speech that day. Dr. Coles and I lingered after the breakfast meeting with the students and talked about our dreams...

  4. Acknowledgments
    (pp. xiii-xvi)
  5. Introduction: Humanism in the Time of Technocracy
    (pp. 1-11)

    To paraphrase the great American Revolutionary hero Thomas Paine, these are times that try the soul of American medicine.¹ Cost estimates of $2.2 trillion and rising, at least 45 million people uninsured at any given time, and mounting dissatisfaction with the quality of care received have made the existing crisis in medicine increasingly alarming. Added to the rapidly expanding list of medicine’s woes are a growing physician shortage (or maldistribution and overspecialization); a leveling-off of minority admissions to medical school; a steady decline in medical school graduates seeking a career in primary care; proposed higher premiums for Medicare beneficiaries; a...

  6. Chapter 1 The Emergence of the Rush Community Service Initiatives Program
    (pp. 12-29)

    The impetus for launching the Rush Community Service Initiatives Program came from a first-year course in community health I taught in the late 1980s. The primary aim of the course was simply to get the students outside the walls of the academic health center and into the vast cultural diversity of Chicago’s neighborhoods and communities. The course was a logistical nightmare. Since the majority of transportation to and from the various sites was by car, and students lived all over the city (a large number in the hip North Side neighborhoods), the scheduling for both the students and the sites...

  7. Chapter 2 Clinics Serving the Poor and Homeless
    (pp. 30-64)

    Although the four clinics serving the poor and homeless shared the common theme of learning from giving service to the underserved and disadvantaged, each one had its own pattern of what these experiences meant to the RCSIP participants and the people they served. The different geographic areas, the unique history of each community, the broad sociocultural variations, and the social order of each clinic or shelter provided settings in which an understanding of the human element of giving care went far beyond simply learning medical procedures and technical skills. In what follows I try to capture the essence of what...

  8. Chapter 3 The New Faces of AIDS
    (pp. 65-78)

    In 1991 I attended a two-day symposium on AIDS at the New York Academy of Medicine. I got an academic rate at a boutique hotel across the street from the Metropolitan Museum of Art on Fifth Avenue. It was a beautiful late summer day, so I decided to walk along Central Park to the academy. Everything was still in bloom, the air was fresh and clear, the sun warm and comfortable; it was one of those perfect days you wish could last forever, but at the same time you know summer is almost gone. Bicyclers glided under the parkway bridges;...

  9. Chapter 4 Community-Based Grassroots Programs
    (pp. 79-95)

    There are two RCSIP programs that are essentially grassroots in nature. One began at Henry Horner Homes, a Chicago Housing Authority project on the Near West Side, and the other at Casa Guatemala, in the Uptown community area on the Far North Side.

    In 1935 as a building block of the New Deal, President Franklin D. Roosevelt and Congress created the Works Progress Administration, later called the Works Project Administration (WPA), for the primary purpose of getting the unemployed victims of the Great Depression back to work. Besides building national parks, bridges, and new highways and supporting major works of...

  10. Chapter 5 The Community Today, Tomorrow the World
    (pp. 96-107)

    In the 1990s the United States, like the rest of the industrialized world, was going global, and cultural diversity was becoming the norm. The new global perspective was finding its way into health care and medicine: The AIDS pandemic does not stop at the border; people carrying contagious diseases can be in a country thousands of miles away in ten hours. The potential of telemedicine for transmitting medical information via computer networks was emerging. There was a new spirit of cooperation among scientists and clinicians worldwide. And there was already a group, Médecins sans frontières, or Doctors without Borders, dedicated...

  11. Chapter 6 Looking for Meaning
    (pp. 108-117)

    Since RCSIP emerged spontaneously, evolving rapidly out of student enthusiasm, it was impossible to prepare any truly systematic evaluation scheme in advance. Yet the questions that are most frequently asked are about evaluation—what kind of controls, if any, were used, what were the outcomes, what measurements were used, what statistical methods were applied—that is, the standard questions found in formal grant proposals that, by definition, impose a specific protocol for program evaluation. Program efficacy is judged on measurable outcomes. The types and numbers of services rendered can be classified and counted and thus are quantifiable. Participants’ actions and...

  12. Chapter 7 Empirical Estimates of Patients and Clients Served
    (pp. 118-125)

    The task of accounting for those people served by RCSIP is an interesting one. First, on the basis of my decision to limit and discuss in detail four very different and particularly revealing types of programs, I excluded a number of other activities that were just as important to the participants and the people they served. Second, for this assessment I have included all twenty-four programs that had been undertaken during the decade of the 1990s (see table 1). Third, there was no way to keep track of every individual seen in the twenty-four projects that ran between three and...

  13. Chapter 8 The Learning and Development of the Students
    (pp. 126-132)

    When the fifth class with RCSIP representation graduated in 1994, it was possible to try to measure what, if any, effect participation was having on the students’ academic performance. The total number of students who graduated in the five-year period 1990–1994 was 565, of which 176 (31 percent) participated at some level in RCSIP, despite RCSIP being still in its first stage of growth. The real participation explosion began in the second half of the 1990s. Furthermore, because the main thrust of this book is on the genesis of RCSIP, I felt I needed to tell the story of...

  14. Chapter 9 Nurturing Idealism, Advancing Humanism, and Planning Reform
    (pp. 133-160)

    It is time to put what I have said so far into some kind of overarching framework. The four pillars of RCSIP—student initiated, student run, voluntary, and extracurricular—are the sine qua non of the program. An analysis of what constitutes RCSIP during its first decade must necessarily be concerned with an equation embracing at least four major elements: service, learning, values, and community. The biomedical side of the equation is already an established fixture in the formal medical school curriculum.

    RCSIP students and faculty provided health care to thousands of poor members of ethnic minority groups living in...

  15. Chapter 10 A Personal Reflection: The Staying Power of the Call of Service
    (pp. 161-172)

    In March 2000, I was asked to make a presentation on “humanitarianism” at the Ninth International Health in Medical Education Conference in Vancouver, British Columbia. My session was one of four scheduled for this time slot, after lunch on the second day of the conference. Much to my surprise, the room was packed, primarily with medical students from across the United States and Canada. Although I had prepared some material based on my involvement with the Health of the Public program and my discussions with Fred Hafferty on the culture of medical education, I knew my best way of engaging...

  16. Appendix A Sources of Funding for RCSIP
    (pp. 173-173)
  17. Appendix B Guidelines for Maintaining Safety and Security
    (pp. 174-175)
  18. Appendix C Publications and Presentations of RCSIP Participants
    (pp. 176-180)
  19. Appendix D The Social Medicine, Community Health, and Human Rights Curriculum
    (pp. 181-186)
  20. Notes
    (pp. 187-192)
  21. Bibliography
    (pp. 193-200)
  22. Index
    (pp. 201-216)
  23. Back Matter
    (pp. 217-218)