INSTRUCTOR: Gary M. Lande, M.D.

SEMESTER: Spring

LOCATION: The WWAMI Medical Education Program
at Montana State University, Leon Johnson Hall

TIME: 12:00 Noon

DATES OF CLASSES: 1/25, 2/8, 3/1, 4/6, 4/27

Throughout history, man has served as storyteller in order to pass on knowledge and experience. These stories express universal themes, many of which deal with psychological issues and, beyond entertainment, offer healing and psychological insights. Film has become the most powerful rhetorical device in human history. By suspending our disbelief in a film, we can often see experience from a different perspective and explore new options. Some films give us personal models that help to determine whether various outcomes are positive or negative in reference to our own lives.

The course will focus on films that explore the role of the doctor-patient relationship as related to illness in modern health care. Selected films will be used to develop a vision of physicians as healers. The doctor-patient relationship will be examined from the viewpoints of the patient, family, and physician. This doctor-patient relationship is at the heart of medicine, where a suffering and worried patient seeks help with a problem from a competent, informed physician who will offer help and care. All patients have emotional reactions to their illnesses which physicians must relate and this person-to-person relationship, set in the midst of growing scientific ability, must be mixed with kindness, interest, caring, accessibility, availability, trust, equality, honesty, communication, and compassion. Ways to synthesize knowledge, technology, and science, without losing the ability to relate, will be stressed. Readings prior to each film will be suggested in order to facilitate discussion.

Syllabus

Suggested Readings for General Course Material

This is a list of relevant readings, any of which will enhance this course and our discussions at any point during the course. I am also posting specific recommendations in the schedule below that will be helpful for each specific session.

Session One (January 25)

Screening: The Doctor

Based on the book A Taste of My Own Medicine, by Ed Rosembaum, M.D., Surgeon Jack McKee (William Hurt) warns his residents, "There is a danger in becoming too involved with your patients." "Get in, fix it, get out." Dr. McKee is an extraordinary surgeon who becomes an extraordinary person once he experiences firsthand what it's like being an ordinary patient as he experiences his brand of cold impersonal professionalism and the price we all pay for a physician's lack of empathy and relationship. (Several of the characters are actual doctors and nurses.)

Director: Randa Haines
Actors: William Hurt, Mandy Patinkin, Christine Lahti, Elizabeth Perkins
Year: 1991
Studio: Disney

Articles
Books
Poetry
Web Sites

I would highly recommend that you see Patch Adams (which is playing at the Ellen Theater: 17 W. Main, 586-6044) as a reference point for discussion for our first class.

 

Student's Opportunity in the Hospital from The Care of the Patient Francis W. Peabody, M.D. Here, for instance, is a poor fellow who has just been jolted to the hospital in an ambulance. A string of questions about himself and his family have been fired at him, his valuables and even his clothes have been taken away from him, and he is wheeled into the ward on a truck, miserable, scared, defenseless and, in his nakedness, unable to run away. He is lifted into a bed, becomes conscious of the fact that he is the center of interest in the ward, wishes that he had stayed at home among friends, and just as he is beginning to take stock of his surroundings, finds that a thermometer is being stuck under his tongue. It is all strange and new, and he wonders what is going to happen next. The next thing that does happen is that a man in a long white coat sits down by his bedside, and starts to talk to him. Now it happens that according to our system of clinical instruction that man is usually a medical student. Do you see what an opportunity you have? The foundation of your whole relation with that patient is laid in those first few minutes of contact, just as happens in private practice. Here is a worried, lonely, suffering man, and if you begin by approaching him with sympathy, tact, and consideration, you get his confidence and he becomes your patient. Interns and visiting physicians may come and go, and the hierarchy gives them a precedence; but if you make the most of your opportunities he will regard you as his personal physician, and all the rest as mere consultants. Of course, you must not drop him after you have taken the history and made your physical examination. Once your relationship with him has been established, you must foster it by every means. Watch his condition closely and he will see that you are alert professionally. Take time to have little talks with him&emdash;and these talks need not always be about his symptoms. Remember that you want to know him as a man, and this means you must know about his family and friends, his work and his play. What kind of a person is he&emdash;cheerful, depressed, introspective, careless, conscientious, mentally keen or dull? Look out for all the little incidental things that you can do for his comfort. These, too, are a part of "the care of the patient." Some of them will fall technically in the field of "nursing" but you will always be profoundly grateful for any nursing technic that you have acquired. It is worth your while to get the nurse to teach you the right way to feed a patient, change the bed, or give a bed pan. Do you know the practical tricks that make a dyspneic patient comfortable? Assume some responsibility for these apparently minor points and you will find that it is when you are doing some such friendly service, rather than when you are a formal questioner, that the patient suddenly starts to unburden himself, and a flood of light is thrown on the situation.   The Care of the Patient Francis W. Peabody, M.D. JAMA Vol.88, pp.877-882, March 19, 1927

 

Session Two (February 8)

Screening: First Do No Harm

Meryl Streep stars as a mother determined to find a cure for her ailing son. Lori Reimuller (Streep) manages to hold a part-time job, maintain a hectic but happy household and care for her three children, Mark, Lynne and Robbie. Her life is dramatically changed when her youngest son is diagnosed with a serious seizures. While Robbie's condition quickly worsens, and his visits to the hospital become more frequent, Lori finds herself administering dozens of prescribed medications to the boy which only make him restless, hyperactive and sometimes scarily catatonic. As Lori and her husband focus all their attention on Robbie's condition, the couple finds their once happy family spiraling into a world of emotional and financial despair. Mounting medical bills and lack of insurance even force the Reimullers to take their son to a local county hospital, giving up the highly specialized treatment Robbie needs to live. And in one final devastating setback, the family must move out of their home as they can no longer afford their house payments. Desperate, and with no relief in sight, Lori finally realizes that Robbie and the rest of her shattered family will never survive if she doesn't take the crisis into her own hands. Worried that Robbie may not survive through many more seizures, the concerned mother soon takes her son's treatment into her own hands, searching for anything -- any hope -- any unconventional medical answer that might make Robbie healthy again.

Readings
Web Sites

Session Three (March 1)

Screening: Lorenzo's Oil

Readings

Session Four (Tuesday,April 6)

Screening: Whose Life Is It Anyway?

Readings and Web Sites

Session Five (Tuesday,April 27)

Screening: My Life

Readings and Web Sites

• Readings
• Film and Healing
• Gary M. Lande, M.D.