Published by
Stanford Medicine


Events, Medicine and Literature, Medicine and Society, Stanford News

Medical students and physicians share their writings on “becoming a real doctor”

Medical students and physicians share their writings on "becoming a real doctor"

louisewenreading_CROPPEDThe dilemma of being a medical student on clinical rounds who wants to help patients but can’t was captured by third-year student Raymond Deng in his essay “Performing Grief,” at a recent reading held by Stanford’s Medicine and the Muse Program and Pegasus Physician Writers group.

The event, titled “Becoming a Real Doctor: Writings on Medical Education and Training,” also featured a poetry reading by fourth-year medical student Lauren Pischel, a book excerpt by Cornell physician Matt McCarthy, MD, and essay readings by Emily Liu, a second-year medical student, and Louise Wen, MD.

The audience of medical students, physicians, residents, nurses and community members listened attentively as Deng described what it can feel like to be a medical student:

For a year or two, you will inch your way on the tightrope towards white-coated authority from diligently reproduced sham. What you lack in clinical knowledge, you will compensate for with the appropriate attire. Be meticulous. Put on your requisite, freshly-pressed white coat. Hang your stethoscope across the nape of your neck. Cram the pockets of your white coat so full of notes and reference guides that they sag. Ignore the nagging incongruence: the fact that you’re not a doctor but you look like one. You want to help patients, but will settle for watching… You will feel like a cardboard marionette, dancing to the steady rhythm of acting competent and acting ignorant of your acting.

For Wen, it was acting against the rules of eating in the area of clinical care that afforded her the opportunity to connect with her patient, Sara, on a personal level:

Hey doc, here’s a treat for you, I know you guys work hard… Here, try some Afghani bread.” She looks up, eager to connect, and my own yearning to know this women beyond her illness swells within my chest. I can recite numerous details and data points about her medical history and hospital course, but her life as a human being is a gaping void.”

Eating the homemade bread, with “the inside as soft as pillowy sponge cake,” led to a sharing of photographs of Afghanistan and a filling of the void for Wen.

Continue Reading »

Events, Medical Education, Medicine X, Stanford News

Learning from patients by walking in their shoes

Learning from patients by walking in their shoes

digital storytelling workshopWhere else but at a medical conference in Silicon Valley would you hear the term “empathy hack”? The concept of the empathy hack unites the acknowledged need for education geared toward fostering empathy in health-care providers with the innovative, disruptive mentality of the valley. The result is “One Day,” a pilot project led by Rice University’s Kristen Ostherr, PhD, and Roni Zeiger, MD and CEO of, who shared their hacking concept with attendees at a Stanford Medicine X | ED workshop yesterday.

The concept behind “One Day” is to pair a patient and a learner (a medical student, doctor, researcher, hospital administrator, or educator) and have the learner experience a day in the life of that patient, with everything that entails, including self-treatments and physical challenges caused by the patient’s illness.

The learner receives a “kit” containing materials that simulate the condition of the patient for the learner, i.e.  a thin straw and air pack to simulate a nebulizer used by patients with cystic fibrosis, or leg weights to be worn to simulate the drag caused on limbs by Parkinson’s disease.

Once patient and learner are matched, they agree on a form of communication for the day, with modalities including SMS Text, Facebook chat or texting with video, audio and photographs. The learner then follows the actions of the patients during the day, whether administrating nebulizer treatments or trying to negotiate crossing a street quickly with limbs that are weighed down.

After describing the project, Ostherr and Zieger asked attendees to brainstorm ideas for expanding this model to be used for other patient illnesses and experiences. Participants in the outdoor workshop were doctors, patients and medical educators, and their responses included chronic pain, diabetes, homelessness patients, and palliative care and end of life treatment. Caroline Okorie, MD, a Stanford pediatric pulmonologist, said she would like to see an exercise like this for teenagers dealing with CF: “They really have a unique issues, even in comparison to adults.”

A patient who has been dealing with chronic pain for years suggested that learners should deal with multiple challenges, as many patients do. “It may not just be that the pain is your back, that can lead to shoulder pain, or headaches, and all this happens at once.”

Zieger and Ostherr, who hope to bring the project to medical schools, emphasized the simplicity of the model: The kits cost approximately $30, and HIPPA concerns are handled by informed consent filled out by the patient participants. It’s small investment for the potentially-eye opening and revelatory experience of health-care providers walking in the shoes of a patient, even just for a day.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Kristen Ostherr and Roni Zeiger (both standing) courtesy of Stanford Medicine X

Medical Education, Stanford News

A nurse becomes a doctor

A nurse becomes a doctor


When I heard that first-year medical student Mariposa Garth-Pelly was a nurse, I had to meet her. I have extensive experience, sadly, with the critical role that nurses play on a health-care team, particularly during end-of-life care. There can be a communication and care gap between the physician and the patients’ families, and in my experience, nurses were often expert at bridging that gap. To have a nurse in medical school, I thought, could be a great learning experience for everyone.

Garth-Pelly says she had not seen herself in that way. “I didn’t come to medical school to be an advocate or spokesperson for nurses, but I am surprised at how little discussion there is about nurses and other health-care professionals,” she told me. “I see that a big part of learning to be a doctor is learning how to work within that team, and I have been lucky enough to see some amazing physicians who empower all members of the team as they lead. That approach ultimately results in the best care for the patient.”

A graduate of Brown University, Garth-Pelly decided to go to nursing school after working in West Africa for a public health organization. “I wanted to gain practical, clinical skills that could directly benefit the people I was trying to help,” she explained. After two years as a nurse, most recently at the Palo Alto Veteran’s Administration hospital, Garth-Pelly realized she wanted to play a larger role in the “trajectory of care” of patients by becoming a physician. “It was a tough decision, because medical school is a huge commitment, but I am happy I made the decision to come to Stanford,” she said.

Although she came to medical school with a particular interest in end-of-life care, Garth-Pelly realizes she may have the opportunity, and challenge, of bringing attention to an issue that can be problematic in patient care. “Even the Joint Commission, which regulates compliance issues for hospitals, recognizes that there needs to be improved communication among caregivers,” she said. “It seems the full scope of what nurses do is not always fully appreciated, or even realized, by many doctors. I think it would be beneficial to devote even a day in medical school to what the professionals who are not wearing the white coats do.”

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: “This reinforced why I went into nursing”: The story of two nurses who resuscitated plane passenger and Nursing: The need to make a difference
Photo, of Garth-Pelly and her father, by Sam Kim. (Charles Garth drove his motorcycle for six hours to make to his daughter’s white coat and stethoscope ceremony on time.)

Medical Education, Medical Schools, Medicine and Society, Stanford News

Engaging with art to improve clinical skills

Engaging with art to improve clinical skills

med students looking at paintingThe scene: A group of medical students huddled around the iconic Robert Frank photograph Car Accident – U.S. 66, Between Winslow and Flagstaff, Arizona in the Cantor Center for the Visual Arts. They’re being led through an observation exercise by Sarah Naftalis, a doctoral student in art and art history at Stanford, as part of an innovative new medical school course supported by the Bioethics and Medical Humanities Scholarly Concentration.

Naftalis asks students what they see as she gestures to the photograph, which appears to have as its focal point four people standing out in a field, looking at something under a blanket on the ground. Several students note the people, the odd lumpiness of the blanket and the reduced horizon. Second year medical student Sam Cartmell says, “Well there may be more than four people,” and points to an odd contour at the shoulder of the lone female in the photograph. Cartmell’s observation sparks a lively debate, as his fellow students take turns looking closely at the work, seeking to discern what Cartmell has seen.

The concept behind this class is so important. If medical students can grasp these observation skills, it will really serve them well in their residencies and beyond.

That moment, explains Naftalis, illustrates the “productive ambiguities of art,” as well as the benefit of engaged close looking without “rushing to assign meaning to what we see.”

The practice of engaged close looking as a means to improve observational skills is a key goal of the course, which includes gallery sessions facilitated by doctoral students from the Department of Art and Art History at Stanford paired with a clinical correlate hour where School of Medicine faculty members applied the lessons of the art gallery portion to the clinical setting. Physicians from family medicine, orthopedics, dermatology, pathology and anesthesiology led discussions on a range of topics including narrative, body in motion, skin and tone, and death.

“The thematic organization was meant to inspire conversation across disciplines, by putting two takes on a similar theme in proximity to each other for two hours,” explains art history doctoral student Yinshi Lerman-Tan, who helped develop the course. “Bringing medicine into the space of the museum was a great aspect of the course – simply allowing different bodies of knowledge to exist under one roof. The medical students would sometimes use clinical vocabulary or concepts to describe works in the gallery, making for an interesting range of language in our discussions.”

Cartmell said one important take away for him from the course, which is called “The Art of Observation: Enhancing Clinical Skills Through Visual Analysis,” was learning to observe without jumping to interpretation. “I was surprised at how strong the impulse was to interpret the work, before I had actually observed the entire piece,” he says. The exercises the instructors led us through, describing what we saw objectively without commentary, really forced me to slow down and really see what was in front of me, without jumping to conclusions or interpretation.”

Continue Reading »

Medical Education, Medical Schools, Stanford News

Stanford Medicine Music Network brings together healers, musicians and music lovers

Stanford Medicine Music Network brings together healers, musicians and music lovers

sarahkenricMore than 100 physicians, students and members of the Stanford community gathered last week at the Li Ka Shing Center for Learning and Knowledge for the inaugural concert of the Stanford Medicine Music Network.

During the event, Lloyd Minor, MD, dean of the medical school, told the audience, “It is so gratifying to be here this evening, and to see that musicians in the medical community have a means to continue to play and perform.” Music was a big part of Minor’s life in medical school and he played the cello in a musical trio that played at various events during that time.

The network was launched last year after Minor and Steve Goodman, MD, PhD, associate dean for research and translational science, discovered they both attended a 1976 cello performance by Yo-Yo Ma, who was then a student at Harvard. The shared memory inspired them to establish a musical home for the medical community. They joined forces with Audrey Shafer, MD, professor of anesthesiology and director of the Medicine and Muse Program, and Ben Robison, a medical student and professional violinist, and created the Stanford Medicine Music Network (SMMN, pronounced “summon”).

Among the goals of the network are to connect musicians for group practices, organize chamber music and string quartet groups and stage performances at Stanford and in the surrounding community in an effort to contribute to healthy communities.

The concert featured classical and contemporary music as well as a special gift presentation by Charles Prober, MD, senior associate dean of medical education, thanking medical student Kenric Tam and his parents, Carol and Kingsang, for their generous donation of a grand piano. The piano, which will reside outside Paul Berg Hall, will be available for events and members of the Stanford Medicine community to play.

As the program ended, Goodman noted in his concluding remarks that the word “summon” describes multiple aspects of what the network represents. “As musicians, we are summoned to perform, and this in turn summons those who care to listen,” he said. “As physicians and medical students, many of us are answering a summons we felt to care for others, and I think keeping music in our lives allows us to do a better job of that.”

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”“Deconstructed Pain:” Medicine meets fine artsStanford network launched to connect musicians, music lovers and What physicians can learn from musicians

Events, Medicine and Literature, Stanford News

"Deconstructed Pain:" Medicine meets fine arts

"Deconstructed Pain:" Medicine meets fine arts

Gernod_Weis_Oel_auf_Leinwand_150x200_1995Stanford’s medical school is just steps away from Stanford’s arts corridor, home to the Cantor Art Museum and the newly opened Anderson Collection at Stanford. This proximity results in a cathartic intersection between the arts and medicine, a connection captured by two recent events sponsored by Stanford’s Medicine & the Muse Program in Medical Humanities and the Arts.

The first event featured doctors and medical students reading poems they had written that were inspired by the paintings in the Anderson Collection at Stanford. The poetry reading included a performance by Stanford’s Musicians in Residence, the St. Lawrence String Quartet.

The second event, a gallery talk titled Honoring the Ghosts, celebrated Veteran’s Day by exploring the relationship between war trauma and art, through the paintings of the late Frank Lobdell, a World War II veteran and Stanford emeritus professor. The gallery talk, the first to take place in the Anderson Collection at Stanford, was an interdisciplinary event sponsored by Medicine & the Muse, the Stanford Arts Institute and the Anderson Collection. The event drew an overflow crowd, including World War II Veteran Genero Felice, Stanford student veteran Steven Barg and his wife, Shannon, also a veteran and Stanford physican John Scandling, MD, who majored in art history as an undergraduate.

The talk was introduced by Alexandar Nemerov of Stanford’s Art & Art History Department. Nemerov’s father, Howard Nemerov, was a World War II veteran who wrote about his war experiences, eventually winning a Pulitzer Prize for poetry. The audience listened intently as Sarah Naftalis, a doctoral student in Art & Art History, described Lobdell’s horrific World War II experiences: Part of a liberating party for the concentration camps in Germany, Lobdell’s unit came upon a burned barn full of concentration camp victims the Nazis did not want to be freed.

That experience influenced Lobdell’s work, and indeed, he stated that he worked out his war trauma “on the canvas.”

War trauma was also explored in the art, poetry and music event, when Hans Steiner, MD, used Jackson Pollack’s Lucifer as inspiration for his poem dedicated to his relatives killed in World War II.

Continue Reading »

Events, Medicine and Society, Stanford News

On death and dying: A discussion of "giving news that no family members want to hear"

On death and dying: A discussion of "giving news that no family members want to hear"

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including “Lost in Translation”:

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk… You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care,” Feldstein responded. “And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

Continue Reading »

Medicine and Society, Stanford News

Man on a mission: Working to help veterans who have lost limbs

Man on a mission: Working to help veterans who have lost limbs

vet - smallerThe student riding the Segway stands out on the bicycle-laden Stanford campus. His short hair and erect bearing suggest he is a veteran. The prosthetic legs that extend from his torso to the Segway stand confirm it.

I had seen Dan Berschinski one day on campus and asked Tim Hsia, student president of the Military Connected Network, if he could introduce me. Berschinski, I learned, had just finished his first year at the Stanford Graduate School of Business – and he’s on a mission. As was highlighted in a CBS News story last fall, he’s at Stanford to learn how to grow his current business into a thriving enterprise, hopefully one that employs veterans with disabilities.

Ever since he woke up in Walter Reed National Military Medical Center after having his legs blown off by an improvised explosive device (IED) in Afghanistan, the West Point graduate has been thinking of ways to help veterans.

“Look, I was an officer,” he told me recently. “I couldn’t sit there feeling sorry for myself. My soldiers were still in Afghanistan, still getting killed. And the hospital was full of guys with injuries as bad or worse than mine.” Berschinski was sitting with me at a campus cafe, his Segway and cane propped against the door. The fact that he’s able to walk on his prosthetic legs is a miracle, although, he said with a small laugh, his doctors were hesitant to use that word. “Let’s just say that nobody with my injury has ever walked out of Walter Reed,” he said, hands firmly placed on his thighs.

Berschinski’s right prosthetic leg attaches to his hip – there was nothing left of his leg to salvage. On his left side, he must force the portion of his thigh that is left into a sleeve. He explained this all to me matter-of-factly. In fact, Berschinski is quick to point out that he feels lucky. Pointing to his left hand, which is missing a finger and is marked by a large portion of a skin graft, he said, “Hey, they were able to save this hand. If they hadn’t, I would be a triple amputee.” Shaking his head, Dan continued, “Those guys have it rough.”

The use of IEDs and the length of the wars in Iraq and Afghanistan mean that there are veteran amputees in numbers not seen since the Civil War. But in a society where only less than 1 percent of the population participated in those wars, these veterans are somewhat invisible. Berschinski is out to change that by raising the visibility of veterans who have lost limbs. In addition, he wants to shine light on civilian amputees, particularly children, who often cannot afford prosthetics. He serves on the board of the Amputee Coalition, using what he describes as this “new change in my life” to help others who he believes aren’t as fortunate as he. “I have the advantage of being cared for by the government. I have access to cutting edge prosthetic limbs and care. Most people don’t have that.”

Asked if he has advice for current medical students who might be treating patients who have lost limbs, he was quick to answer. “Yes. Your optimism, and your support are critical. Yes, the medical skills are important. But you have to understand that patients are looking to you for hope. And don’t ever underestimate the willpower of your patients. Certainly don’t give up on them.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Battling hearing loss on and off the battlefield and Stanford graduates partner with clinics in developing countries to test low-cost prosthetic
Photo courtesy of Dan Berschinski

Events, Mental Health, Stanford News

A campus-wide call to pause and reflect

A campus-wide call to pause and reflect

contemplation by designA friend once said to me in her warm Virginia drawl, “You know Jacqueline, there is a whole other world  on the other side of STOP.” I found out how correct she was when a severe back injury forced me to stop my hectic, stress-filled schedule. It was a tough way to learn a valuable lesson, but I wouldn’t change those pain-filled days given what they taught me about the importance of getting off the merry-go-round of activities that I thought I had to do.

On Friday, those in the Stanford community will be given a glimpse of that world on the other side of STOP without injury, by participating in the Carillon Concert and Quiet Contemplation. Everyone on campus is invited to gather at 11:30 AM for a Carillion Bell concert, a chance to relax, do some tai chai, win some raffle prizes, and most of all STOP and contemplate. Attendees are encouraged to bring a mat and a desire to “take a chill pill” as my children would say.

And for our far-away readers: You, too, are encouraged to, in the words of the event organizers, “pause, reflect and take time to unwind.”

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Medicine and Society, Stanford News

Stanford network launched to connect musicians, music lovers

Stanford network launched to connect musicians, music lovers

Minor playing celloThis week marks the launch of the Stanford Medicine Music Network, an online meeting place for musicians in the Stanford health-care community looking to share their love of music. An e-mail invitation went out yesterday from SMMN (pronounced “summon”) co-founders, asking for musicians and music lovers to join in to build community and provide opportunities for other musicians to play and perform with them.

The goal of the network is for musicians to eventually perform in the surrounding communities, particularly in schools and nursing homes where music has been cut back or is not available. There’s more about SMMN in this Inside Stanford Medicine story.

Jacqueline Genovese is assistant director of the Arts, Humanities, and Medicine Program within the Stanford Center for Biomedical Ethics.

Previously: Intersection of arts and medicine a benefit to both, report finds, What physicians can learn from musicians, More than medicine: Medical students embrace their artistic passions through unique program, The benefits of the arts to both patient and practitioner and Stanford neurologist rocks out for science
Photo of Lloyd Minor, MD, dean of the School of Medicine, by Mark Hanlon

Stanford Medicine Resources: