In the last two
decades, many changes have occurred in our medical system as scientists,
doctors, and patients have explored how the mind-body-spirit connection
influences our physical and emotional health. But to truly improve
healthcare, more attention is also being paid to this system’s starting
gate—medical education.
“We’re now trying to encourage students who want to be
physicians,” says Pali Delevitt, education coordinator for the
Duke Center for Integrative Medicine,
“to follow one golden rule: Physician, heal thyself.
“Forget the old model of the doctor who used to smoke while telling his
patients not to smoke,” explains Delevitt, “or the overweight doctor
advising his patients to go on a diet. It’s about walking your talk, and
being authentic. The foundation for becoming a physician starts with knowing
yourself, and knowing how to take care of yourself, so that you become a
model of wholeness and wellness for your patients.”
Delevitt tells this story to emphasize her point: “A
mother came to the Hindu leader
Mahatma Gandhi and said, ‘Gandhiji, tell my
child to stop eating sugar.’ Gandhi responded, ‘Come back in three days.’
The mother was puzzled but she went away for three days. She returned and
once again pleaded, ‘Gandhiji, please tell my child to stop eating sugar.’
He looked at the child and said ‘Stop eating sugar.’ Then the mother asked
why it took him three days to give this instruction to her child. He
replied, ‘Three days ago I was still eating sugar.’ ”
In any role of leadership, especially the doctor-patient relationship, says
Delevitt, you need to model the behavior you’re espousing. For this reason,
she is trying to motivate medical schools to pay more attention to how
students retain their own health. The fact is, she says, under the present
system many medical students do not take care of themselves. Moreover, some
medical schools, with their rigorous, hectic schedules, tend to discourage
students from pursuing a healthy lifestyle.
“It’s instilled in us not to lead a healthy lifestyle,” observes medical
student Jodi Sherman. “If you sleep, if you eat right, if you exercise, it’s
assumed you’re neglecting your patients.”
Another student, Mara Merritt adds, “In many ways we’re talking about the
work ethic. In the US, we believe the harder we work, the more successful
we’ll be. We think people who don’t work hard are lazy. The longer the hours
you work, the more respect you get. Medical students are taught that if they
don’t work those long hours, they’re not learning. Yet if your body and mind
need sleep, you can’t learn. You’re just getting by, and this changes the
way you feel about your patients. You begin to resent your patients.”
These comments by students worry Delevitt. During the last ten years, as an
adjunct faculty professor, she has taught at different medical schools and
medical conferences around the US. “As I travel around the country, what I
keep hearing from medical students are remarks such as, ‘I feel like I’m
losing my soul.’ How much are students shutting down at a time when their
spirit should be opening up? That’s not what medical education should be
about. It should be about nurturing, sustaining, and awakening the soul as
we go through medical education. As soon as students walk in the door of
medical school, they need to be given the message from the faculty, and from
everybody involved, that being a whole human being is the bottom line. This
is the challenge for students: Are you being honest and real with yourself,
so that you can be honest and real with other people–especially your
patients? Are you modeling wholeness, modeling wellness, modeling a
lifestyle?”
Provocative questions. As with any idealistic concept,
the reality road is rocky, and anybody who tries to trek such a rough road
needs guidance. Delevitt is offering guidance: She has initiated an
innovative one-month elective course called The Global Medicine Education
Program for senior students from medical schools around the country. The
first session of this ongoing program, sponsored by private grants, and
fully accredited by the
University of Florida College of Medicine,
was offered in collaboration with the
American Medical Student Association (AMSA),
a national medical student-led organization. Another team partner was the
Institute of Noetic Sciences (IONS). Both IONS and AMSA are interested in
transforming the culture of medicine from its present focus on technology to
a more humanistic, life-affirming outlook.
The Global Medicine Education Program, held on the IONS campus this past
spring, embodied this vision by presenting students with a personal and
integrative approach to healing and healthcare, one that honors both science
and the human spirit. In addition, by providing time and support for
personal reflection and contemplation, students were encouraged to develop
self-care skills, and experience transformative changes in their own daily
lives.
“We hope,” says Delevitt, “that this program will inspire a new direction in
medical education.”
Offering a Holistic Framework
During the month-long program, the students lived together, ate together,
worked together, and played together. This gave them time to get to know
each other, and to hear and debate different viewpoints. As students
discussed their experience in medical school, nearly all of them mentioned
feeling wounded by the medical education system. However, student Chrissie
Ott acknowledged that although she, too, had undergone negative experiences
in medical school, it was crucial to remember this point: “The people who
created difficulties for us in medical school are made of the same stuff as
us. They’ve gone through the same trials. They came to medical school with
hopes and dreams to create a better world. If their light got blown out, it
wasn’t because they chose to do so; it wasn’t their fault. It wasn’t because
this is how they wanted it to be. It is simply because they were not given
the tools to create a better place.”
The Global Medicine Education Program was deliberately designed to provide
new tools to approach healing from a more holistic perspective. In
particular, students were introduced to the philosophy, principles, and
practices of some of the world’s major healing traditions in fields such as
homeopathy, Chinese medicine, acupuncture, and ayurvedic medicine. The
information they received was not intended to train them as experts in any
one area, but the courses did help students gain knowledge and understanding
of both the value and limitations of holistic healing practices.
“The idea is for students to be more aware of what these different healing
systems offer when they become physicians,” explains Delevitt, “but the
deeper question is: ‘What
is Healing?’ Whether one is studying healing from the point of view of an
acupuncturist or from the perspective of a biochemist, to inquire into the
nature of healing is ultimately the same journey—to explore the nature of
our humanity, and of our spiritual consciousness.”
Joji Suzuki, a student in the program, decided to participate so he could
get an introduction to the different global healing traditions. “But more
than that, I wanted to learn about the art of medicine, not necessarily the
techniques of medicine. There are many different ways we can practice, but
there’s an underlying art that transcends the actual techniques, and that’s
where healing comes in. Anybody can give an antibiotic shot to somebody
else, but that’s not necessarily practicing healing. You might be practicing
a technique, not necessarily practicing the art. I think what we’re doing is
learning what it means to heal. I think that’s the core issue of what we’re
trying to do for each other and, hopefully, for our patients in the future.”
The faculty of physicians and mentors were chosen because of their
commitment to working with students. Mitchell Krucoff, a cardiologist at
Duke University Medical Center, offered a class titled “Spirituality in
Healing.” For more than a decade, he has been involved in clinical research
programs (supported in part by IONS) that examine not only the physiological
issues of heart disease, but also the emotional and spiritual issues.
There's
an underlying art that transcends technique, and that's where healing comes
in.
“In cardiology, and in every practice,” he says, “sooner or later we
encounter a patient who is extremely sick, and who you are quite sure is
going to die—but the person lives. Almost invariably, when you look around
the hospital room, you find pictures of a newly born grandchild, or a
religious icon, or a loving family member. As a practitioner, you find
yourself thinking that this person has a link to a vital force that kept
them alive, even though the physiological indicators were pointing to death.
Unfortunately, the reverse also occurs. You have a young, relatively healthy
person who comes in for a routine diagnostic test, and he or she dies. It’s
not unusual to find that the patient was alone, or depressed, or both. We
don’t yet understand the complex reasons behind why some people survive and
why some don’t, but it’s clear we need to explore this aspect of the human
spirit and its role in health and illness. This doesn’t mean rejecting the
technologies that students learn in medical school, but we need to augment
that information, because we are recognizing it’s not only the gadgets and
drugs that make a person well.”
Suzuki, after attending Mitchell Krucoff’s session, offered this response:
“I realize our bodies and minds are not just machines that we need to fix.
We have to look at the whole human—mental life, social life, spirit, soul.
These are the aspects that cannot be ignored, yet somehow in Western
medicine we're forgetting this.”
Above all, students were urged to remember that to be healers, they have to
begin by healing themselves. Delevitt’s own experience as a cancer survivor
provides a powerful example. “At some point in your life,” she tells
students, “someone close to you, or even you, will face disease or trauma.
Whether we are in the role of a physician or in the role of a patient, we’re
all human beings trying to understand the essence of healing. How do I heal
and awaken to a new level of understanding of who I am, and who I am in
relationship to everyone else?
“One of the reasons for this program,” she emphasizes, “is to tap into the
innate wisdom of each individual. It’s not just shoving external information
down the pipes. It’s about allowing each person to access his or her own
innate wisdom and understanding of where healing comes from. Then our
knowledge and our wisdom merge to impact not just our patients, but every
life we touch. Everything we do is an act of healing and an act of spiritual
awakening.”
Physician, Heal Thyself—
Physician, Know Thyself
A portion of the curriculum was taught through experiential learning
sessions, and all the classes were self-reflective. And because the main
objective of this program was for students to learn not only how to take
care of others, but also how to take care of themselves, the schedule was
specifically designed to include movement and exercise opportunities, time
in nature, and time to relax. In addition, students learned how to plan and
prepare nutritionally balanced meals, and there were even support sessions
to discuss emotions and process concerns.
“In most medical school classes,” says Krucoff, “students are lined up in
rows, facing forward. You basically get lists of things you need to memorize
from the teacher, and some concepts you need to glue together. But during
this program, the students sat in a circle on the floor, with awareness of
each other, as well as of the teacher. The faculty invited open-minded
critical thinking. Education in this format is a different kind of process—a
knowledge-gaining process that’s interpersonal and involves the student’s
spirit.”
“The majority of medical schools,” notes Allen Neims, a former dean of the
University of Florida School of Medicine, “have elective classes to
introduce students to acupuncture and other health techniques. Some schools
have experimented with short retreats, and almost every school offers
programs for professional development. When I mention The Global Medicine
program, people often say, ‘We offer a program like that.’ I don’t mean to
belittle what they offer, but their programs don’t seem to come from the
heart. Our purpose is to discover the heart in all healing.”
Mike Hsu, one of the students, agrees. “At my school, the sharing is almost
exclusively about the sharing of research conclusions and knowledge—but
nothing from the heart. Occasionally you’ll get an attendee who will open up
to his or her residents and medical students, but usually it’s all about
facts, knowledge, and protocols. Yet the reason we are doing medicine is to
build a connection with our patients. That’s where we learn our life lesson.
The more you can create the heart connection, the better you are as a
person, as a healer.”
The question remains, though: Can the type of program that Delevitt created
really make a difference in students’ lives?
Students
become aware of how heart and soul play a role in sickness and in health.
Mara Merritt, who has played a significant role in the American Medical
Student Association (AMSA), believes emphatically that it can. “As medical
students, we are so ripe, so hungry. We’ve spent so much time being the
nameless medical student in the white coat who wants to please others.
Sometimes all it takes is a moment to make a difference in a person’s
outlook. Anyone who has had an epiphany knows that something that happens in
a split second can affect the rest of your life. In that mode of thinking,
four weeks is a long time to create this space to change how we think and
act towards our own health.
“When we start medical school,” continues Merritt, “most of us have a strong
sense of self; medical school is a steady process of disempowerment. There’s
a feeling that as medical students, and even as residents, we’re expendable.
If you express discontent, there are hundreds of people waiting for your
spot. It’s very silencing.”
Questioning Ethics
Ironically, Merritt was asked to be the student director of The Global
Medicine Education Program, and in this role she was specifically encouraged
to express her views so that other students would be equally honest. At one
point in the program, the conversation turned to ethics and integrity.
“Medical education,” acknowledges Merritt, “tends to promote dishonesty in
many ways. For instance, when a doctor and a medical student walk into a
patient’s room, the attending doctor often says, ‘This is Dr Merritt.’ Does
a student confront the doctor, and say ‘I’m not a doctor. I’m a student’? Or
does the student keep silent and pretend they know more than they really do?
“Another common occurrence in the third and fourth year of medical school is
that students are asked to do procedures they’ve never done before, without
asking for consent from the patient. As medical students, many of us have
done things we don’t feel good about. But, ultimately, how do we learn to
become strong enough to stand on our ethical ground? It’s about giving us
the courage to know what is right and to face those consequences. Sometimes
in a hospital that means you’ll be asked to leave your residency; sometimes
it means you’ll get a hideous evaluation that affects the rest of your
career. Yet as long as we maintain the secrecy, it’s perpetuated. The only
way to break the silence is to start speaking the truth.
“People argue that the system has worked for nearly a hundred years,” adds
Merritt, “so why should we change it now? I think we are just reaching that
point where there’s a consensus that change is desperately needed.”
The Global Education faculty said that they, too, feel a change in the
medical education system is crucial. Wendy Kohatsu is an assistant professor
in a family practice residency program at East Tennessee State University,
where the goal is to foster a more holistic environment. At one time, she
also pursued a two-year fellowship in integrative medicine with Andrew Weil,
a well-known physician and spokesman regarding the need to transform the
medical system.
With this background, she offers her own perspective of medical education.
“The present system was built on the paradigm that the harder you work, the
better physician you become. It’s a punitive type of system. Why would you
want to have that kind of attitude in healing? It doesn’t make sense, and
we’re starting to see the system fall apart. On multiple surveys, many
physicians say they wouldn’t ever choose to go into medicine again. In my
opinion, medicine has lost its soul, but when you participate in programs
like this, you realize you can actually reclaim the soul of medicine. It’s
empowering. If all we did in medical school was teach students how to take
care of themselves, and how to listen with a compassionate heart to
themselves as well as to patients, we would change the face of medicine.
It’s time to remember the altruistic reason why most people chose to be
physicians.”
Allen Neims, who was one of the physician faculty mentors, offers another
viewpoint. “I don’t consider the Global Education program revolutionary; I
consider it evolutionary. Often you prevent change from occurring (or make
it harder to achieve results) when you label other people ‘the enemy.’ This
suddenly creates two camps. I don’t think this helps. Medical faculty really
want their patients to be better. I see us as being able to work gently
within the medical system in an evolutionary way to help it heal itself.
These students are the ones who can do it. I sincerely wish to approach this
whole thing from a position of love and forgiveness.”
As for the students, they see themselves as pioneers, and this work as a
start of a global movement, similar to the peace movement and the
environmental movement. To them, the underlying intent is the same: It’s
about changing one’s consciousness, becoming more aware of how the heart and
soul play a role in our lives, our environment, our world—in sickness and in
health.
“Healthcare,” says Sherman, “is an integral part of society, and we have the
power to accomplish true transformation.”
“There’s a worldwide shift in consciousness going on right now, and this is
a powerful piece of it,” says Ott. “As trained physicians, we have the
cultural authority to legitimize that movement.”
When Delevitt initiated her Global Medicine Program, she wrote this
statement: “It is our intention for students to take what they have learned
from Global Medicine and its multidisciplinary perspective and disseminate
it back into their community. They will be the teachers and the leaders,
either directly or indirectly, who will help reshape both medical education
and health-care delivery.” It seems many students are willing to make
Delevitt’s vision a reality.
For further information about The Global Medicine
Education Program,
see
www.globalmedicineeducation.org
or contact Pali Delevitt at 919-967-2630.
GAIL BERNICE HOLLAND is an associate editor of IONS Review. She is
the author of A Call for Connection: Solutions for Creating a Whole
New Culture, available as an e-book at
www.CyclopsMedia.com.
Contact:
gbauthor@noetic.org