"Lost in Translation" by MSIH first year blogger Rebecca Siegel

A few days ago, when I was walking home for class, a man asked me for directions in Russian. I know that he was asking for directions, not because my Russian was sufficient to decipher his intention but because he was pointing to a tattered map. From what I could tell, he was looking to get to the post office, which was pretty much a straight.

I tried to communicate that it was straight ahead in every way I could. I attempted in Hebrew. I attempted in English. I made a line with my finger on his map. I mimed a person walking forward and finding a post office.

Nothing worked and with each attempt he looked progressively more frustrated. I also felt frustrated because I knew what he was going through and I was powerless to help. I too was a stranger in a strange place. I knew exactly what it was like to say the simplest thing over and over again and not see a look of understanding on the face of the person that I was talking to.

            To me, this is one of the greatest assets of going to medical school in a foreign country. The very fact that we know what it is like to struggle with being able to communicate and understand basic things is what is going to make us good doctors. Not understanding is hard.

            So here’s to my classmates who have known the true horror of taking a bite of a would-be-delicious breakfast parfait, only to find they had purchased sour cream and not yogurt at the grocery store.

My very resilient classmates who have double, triple and quadruple checked the bus map, only to find they were now farther from their destination then they started.

Together, we have learned intimately what it means to need help and lack the words to ask for it.

My peers and I represent a class of physicians who will understand that it is not the responsibility of a patient to communicate in ways a physician can understand. It is on the doctor to hear a patient’s explanation and figure it out.

"Clown College" by MSIH first year blogger Rebecca Siegel

           On Wednesday evening at 3:47, a typical first medical student rummages through her backpack, to prepare for her next class. She sits in the break room on the sixth floor of the internal medicine building at Soroka hospital. She takes out a biochemistry textbook and put it’s on the floor beside her backpack. She takes out some highlighters, flash cards, and a binder full of printed out slides from immunology lectures. She still hasn’t found what she is looking for. She pulls out a tutu and then continues to rummage until she finds a Santa hat.  “Finally”, she mumbles. It’s time for class. 

Welcome to medical clowning. Meet Dr. Amnon Raviv, the only self-proclaimed only personal in the world to have a PHD in medical clowning. He is a clown, a real-word superhero, and the instructor of this very special course. He is a human sigh-of-relief for people battling serious illnesses all of the country. On any given day he can be found in an oncology ward, belting out an upbeat western style song about colon cancer, or in the surgery wing, helping a 5-year-old boy make a list of what dreams he would like to have during surgery (before summoning in the anesthesiologist and reading the list of dream-demands aloud).

As we leave the class three hours later, I feel a little overwhelmed by how lucky we are to have Dr. Raviv. We are students of empathy and active listening. We are tutu clad care takers. And for three hours every week, we are allowed to reclaim some of the idealism that made us want to practice medicine in the first place.

       It’s time to practice. One student is the patient, one is the doctor and one is the clown. Dr. Raviv tells us that the patient is a small child who is getting a shot, but feels quite scared. The clown tries to make bird noises and funny faces in order to distract the child from the shot. Dr. Raviv stops the exercise.“ The child is afraid of the shot”, Raviv explains “and you’re not going to help by ignoring the shot.”   They try again, only this time the clown jokes about the shot. He pretends to give it to the nurse, to himself, even to the wall. “Better”, Dr. Raviv says. Slowly we are starting to understand. 

"A Guide through Dissonance: 2015 Physician's Oath Ceremony," by MSIH first year blogger Jay Berkes

MSIH Physician's Oath Ceremony 2015

The fact of medicine as an institution has not been lost on any that have passed through its doors. The least of which are first year medical students, whose ambitions of practicing medicine have not yet been co-opted by the demanding processes of the education and the career. Our view of medicine is still one of reverence, the ideals of which don’t just sit propped on one mountain to be climbed, but on peaks and in valleys throughout an entire range of challenges. They remain there, revered, and in places of importance because we are the type that enjoys challenge.

A good challenge, though, must be accompanied by its goal. Or some reminder of its goal. For me, this reality was the highlight of the master’s degree I completed shortly before coming to Israel. I studied business administration, the result of which is a ticket to business ownership or organizational management in some form. In one class we discussed whether or not management was a true profession, bound by a code of conduct, a license to operate, a professional governing body, a foundational education, and a duty to serve. These requirements are necessary to generate a fairly explicit agreement with society, one in which the members of a profession will exercise trust and control in the provision of their service, maintaining equity within that societal agreement. Of course, the field of management isn’t bound by these requirements. So do they not have a place within a societal agreement? Of course they do, and in the absence of a professional governing body or a license to operate they must rely solely on their education and their duty to serve. Those two things, and especially that duty to serve, become the daily reminder of the daily challenges offered in management.

So where does that leave me, three months into my medical education, still wrapped in the importance of the pursuit of becoming a physician? And what is the guiding reminder of that goal?

First and foremost, I hold onto that duty to serve, a fundamental part of my interest in medicine, and a fundamental part of my future profession. And while that should be enough, the rigors of the educational process provide more than enough distraction from the foundation. Every pursuit of knowledge is wrought with that dissonance, the dichotomous fight between awareness and ignorance. Awareness to the details of root memorization, creative processing, and the larger end goal of application. Ignorance to the discomfort of effort, in the trenches of detail and the finality of that big picture. The difficult realization, of course, is that merely surviving such dissonance isn’t enough. Surviving on the merit of scientific knowledge, and graded application, will produce competence, and at the every least it will have produced a physician that has succeeded in entering into that fairly explicit societal agreement (complete with licensure, a code of conduct, and the acceptance of a professional governing body). But a code of conduct is not an oath, and medical competence is not the only goal. Something else is needed.  

At MSIH and Ben Gurion University, like hundreds of institutions around the world, we take a Physician’s Oath at the start of our medical studies to guide us on a path through that dissonance. With Dr. Shimon Glick, a founding member of BGU’s Faculty of Medicine and a leader in the practice of medical humanism and medical ethics, we learned that this oath and this ceremony is in place to bear on us the responsibilities and duties, and not just rights, of medicine. Started over 40 years ago, at this school, this practice aimed to make “change agents” of the BGU’s first medical students, working to upgrade the medical care and health of patients and communities, from the very start¹. 

For those of us that have chosen a foreign country to enter into a difficult profession, with a focus on a discipline (Global Health) that is not widely understood, the Physician’s Oath is a guiding hand, a statement of our duty to serve, and a reminder to be agents of change for the benefit of our patients and our communities.

I’ll use it as my guide when the dissonance gets too loud.

Reference:

1.      Glick, S. M. (2003). White coat ceremonies—another commentary. Journal of Medical Ethics, 29(6), 367–368. http://doi.org/10.1136/jme.29.6.367