Week Eight

Hi everyone! 

I hope all of you have enjoyed this experience, and that everything is coming together as we wrap up our Senior Projects in these final weeks! This week, my survey was officially sent out to the three sample groups of medical students. Although the process ended up being a really close call, I'm glad to have received responses from so many medical students! As the finishing touch to my project, I'll be meeting with Dr. Hartmark-Hill and University of Arizona's bio-statistician to analyze my data and its corresponding trends. 

I'm excited to see how the survey results turn out; hopefully my hypothesis that medical students practicing narrative medicine hold more value for patients and have better patient outcomes will be supported by the data. While I've been waiting for survey responses to trickle in, I've almost finished constructing my research paper. This has been an interesting challenge for my project in particular because the experiential results are so subjective. In the past, my academic research papers have been prominently objective with numerical data and graphs to support correlations and trends. Since narrative medicine is a field which is both subjective and objective, it's been a bit of an obstacle to find the right balance for a deliverable. 

After searching for previous academic papers on narrative medicine, I was able to form a structure for my paper that will include the numerical survey results, but rely heavily on experience-based data. As such, I've completed my abstract, background, introduction, and methodology sections with a focus on the workshops and lectures I participated in for training. Once I get my finalized data, I will finish up the results, discussion, and conclusion sections by integrating a social outlook into the numerical values. 

Aside from the paper, I've been working on my PowerPoint slides to reflect my study. I assure you progress is being made, but I'm realizing "Is this important?" and "Is this interesting?" are two questions with very different answers. 

It's exciting to see that after being the architect of my own study, I'll finally be able to hold tangible evidence in a field that is so new and still developing. Even though my Senior Project is close to an end, I feel that this can act as my launching point for an even more intricate study in college. It's been truly fascinating to see how much social perspectives can impact scientific procedures, and even more eye-opening to see how much we neglect that fact. I'm thankful to Dr. Hartmark-Hill and the physicians I was able to interact with for recognizing a hole in medicine that is often overlooked, and I admire their drive to re-humanize it. 

Thank you so much for checking in every week! 

Anivarya 

Week Seven

Welcome back! 

I hope the past week treated all of you well! Last week, I had the opportunity to shadow Dr. Pratt, an optometrist, in his private practice. During the work breaks, he exposed me to diagrams and models of the eye and followed that with techniques to understand the way vision works. Within the practice, vision care is their top priority, but by observing the physician-patient relationship, I got the sense that patient care is just as valuable to him. 

In comparing this shift to my previous ones, I found more room for implementing patient narration here because each appointment was so centered on how the patient is feeling, even if the visit was a simple annual checkup. At the beginning of each appointment, Dr. Pratt sat eye-level with the patient (a tip the UofA taught me to make patients feel comfortable), and asked if there was anything the patient wanted to address or ask before he began the examination. What I uncovered was that he used this to gear his own examination and vision care priorities, which not only left the patient more satisfied, but also allowed the doctor to offer better diagnosis and treatment. Throughout the procedure, Dr. Pratt was an active listener to patient storytelling whether that was related to their vision or not. Their willingness to share showed a form of trust he had created over the years with his patients, and it was exciting to see each patient leaving in a better mood than they came in. 

The rest of the week, I worked on finalizing my survey and making it official, especially focusing on the online version. Dr. Hartmark-Hill, my off-campus senior project adviser, introduced me to a software called Qualtrics which many researchers use for generating data and trends. I was able to form my own survey with a pre-programmed Likert Scale and set a sample size X value to equalize data. 
As promised in one of my first blog posts, the following are the questions my survey entails: 

1. Taking the time to ask a patient about their story is valuable to patient care (diagnosis, treatment, etc). 
Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

2. Taking the time to ask a patient about their story is valuable to patient outcomes (improvements in health, safety, etc). 
Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

3. Knowing the patient's story improves physician-patient relationships. 
Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

4. Knowing the patient's story makes clinical practice more enjoyable. 
Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

5. Knowing the patient's story can improve clinical team communication. 

Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

6. Asking a patient about their story makes it more likely for them to return to the clinic. 

Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

7. Better understanding one patient's story can increase awareness of the need to ask other patients about their story and consider unique factors influencing health in these other patients.
Strongly Agree   Agree   Neither agree or disagree   Disagree   Strongly Disagree

As always, thank you so much for reading, and best of luck to everyone as the year comes close to an end!!

Anivarya

Week Six

Hi guys!

Hopefully everyone had some great learning opportunities this week, I know I did! On Monday, I attended one of the most inspiring lectures titled "Burning Shield: The Jason Schechterle Story". Since the keynote speaker was Jason Schechterle himself, the lecture was considered a patient panel in discussing Schechterle's story as a patient and victim of a fire. 

A former Phoenix cop, Schechterle was hit by a taxi going 115mph on a 30mph speed limit. Because of the speed and impact, Schechterle's car immediately went up in flames, and due to a "series of miracles" he survived 4th degree burns. He started the patient panel by addressing anatomical and technical components of medicine: removal of burned and disfigured tissue, pain from physical therapy, plastic surgeries worth over 4 million dollars, and transplants to cure his acquired blindness and deafness. But the significance in the telling of his story was how his health improved through a growing emotional strength. He discussed his experience with being disfigured and the toll that took on his wife and young children. Most insightful to me as a future clinician was his anecdotes of interactions with doctors because I learned that empathy is different for everyone. While some patients like to be nurtured throughout the process, others prefer to be given brutal honesty and find strength through that. This gave my understanding of narrative medicine some more depth because it's one thing to know that medicine needs humanity and empathy, but it's another to know that every patient has a different interpretation so as doctors, we must adjust our care accordingly. 

At the end of the week, I shadowed at the same pediatric urgent care, and even though it was only my second visit, it already felt like home! I took some time to discuss with the head pediatrician there, and she made me realize that because the setting of an urgent care calls for the quickest clinical visits, the system almost forces a limit on the patient-doctor relationship. Keeping this in mind, I noticed that in one visit a cultural belief prevented a mom from giving her child anything cold during a fever. The pediatrician was able to make a connection and explain that a popsicle or any other frozen product might actually be the best solution for instant relief. I admired that she was able to take into account the traditional belief and simply suggest, but not force, an alternative explanation. At the end of my shift, I even got to watch a kid getting stitches! It was amazing to witness the procedure of anesthetic numbing and suturing from so close up. 

Having experience in the clinic and in lectures preparing for clinic was remarkable and I'm excited to start collecting data from surveys soon, so check back in next week! Thank you for reading! 

Anivarya

Week Five

Hey everyone!

I hope all of you had a great week! At the beginning of my week, I attended the "Film and Medicine Series: Being Mortal" at UofA's downtown campus. During the session, we watched a documentary adaptation of Atul Gawande's Being Mortal, which is easily the most well-known book in the medical world. (Which is also why I read the book twice to try and level up to the physicians and doctoral professors on campus) At the completion of the documentary, the auditorium was opened up to a Socratic Seminar on physician experiences related to those discussed in the documentary as well as advice for practicing medical students on humanistic approaches to patient care.

For me, the big takeaway from the Film and Medicine Series was that, in the paradox of medicine being both extraordinary and less than ordinary, you can't always count on the doctor to lead the way, sometimes the patient has to do it. Gawande detailed a series of questions that allows the patient to take the lead and, as a result, feel more valued throughout their care. Although this documentary focused on more long-term relationships with cancer patients, these individualized questions allow patients to use the clinical environment for emotional and physical therapy. To give you a more concrete idea of this, here are the four major questions:

1. As a patient, what do you think of your illness? What do you think it is and what do you feel will be its effects?
2. What are your priorities and goals for these last months of your life?
3. What are you worries? What are your fears?
4. What are you willing to sacrifice and what are you not?

I later shadowed an urgent care pediatrician, where I observed patient doctor relationships and attempts, or lack thereof, of an empathetic approach to medicine. After meeting with patients suffering from conjunctivitis, a reaction to a spider bite, an ear infection, and strep throat, I noticed that because it was in an urgent care setting, there wasn't any interaction besides discussing a quick fix from a prescription. Each clinical visit was about 5 minutes and, although the tone of the doctor was very warm and amicable, no one was taking the time to understand where the patient was coming from and what exactly the patient or parents were dealing with. I think this was a really important learning experience for me because in order for me to know what narrative medicine, it's vital for me to know what it is not. This way I can build a foundation of humanism in medicine off of this differentiation.

Thank you for reading and check back in next week!

Anivarya

Week Four

Welcome back from Spring Break!

I hope everyone enjoyed their time off! Last Saturday was my first day as a member of the Humans of SHOW program in the SHOW Clinic, and I had such a heartwarming experience interacting with homeless patients. For the rest of this week, I dedicated my time to analyzing works of the renowned physician-writer, Atul Gawande.

At the SHOW Clinic, I was welcomed by UofA, ASU, and NAU medical students and immediately became a part of the community there. After partnering with a student photographer, I interviewed four of the patients experiencing homelessness, in which the questions were geared towards an open and comfortable narration of their story - their path towards homelessness, their emotions and understanding of their current situation, and what they hope to fulfill in the future. In interacting with them, we uncovered that even within the category of "homeless", each individual was unique because of their background and goals, and this drew ties with the purpose of narrative medicine in that each patient is unique even if the illness is categorized under one.

I was intrigued by the stories of each of the four patients and humbled by their optimistic perspective on life despite their struggles. Due to patient confidentiality, I'm not allowed to release names of the patients I interviewed, but fortunately they did sign a consent for me to share their story in hopes to change people's misconceptions of homelessness. The first I interviewed was a woman suffering from epilepsy and domestic violence from her former husband. She pointed out that her loving husband getting a brain tumor, and as a result, becoming violent towards her and her daughter, in complement with her epileptic episodes, was all truly unexpected. After opening up to us, she began crying and even hugged us because her goal is to help others understand that homelessness isn't the result of unstable backgrounds or misconduct in actions. Her words showed us that homelessness is a temporary situation that happens to the person affected, and each person has tried and will continue to try their hardest to come out of the situation. I then interviewed a Navajo man who had been in and out of jail three times due to misconceptions regarding his ethnicity, and when asked about his daughters, began crying in hopes to use the resources at SHOW to stabilize and provide for his children. After a short snack break, (although we really weren't able to eat anything after listening to their stories of suffering) we interviewed a man who was relatively hesitant to speak as well as a religiously devout woman who stated that she wasn't homeless because she had a permanent home in heaven and that she was simply in a "transition state here at SHOW".

Although each individual's background and future outlook was unique, the one thing that was consistent was that they were truly thankful for the care they were receiving at the clinic. What seemed to us as almost an impossible style of living was one they cherished and wanted to utilize as a foundation for their dedication towards a future purpose.

Somehow, this one day was much more substantial than the six days of reading I did, but why not lighten the mood with a brief description of Atul Gawande's work. Gawande sheds a new light on medicine by introducing its paradox of being both extraordinary and less than ordinary. By tying in the importance of humanities and patient stories, he discusses that as much as medicine is advancing and saves life after life, medicine is essentially a trial and error process because physicians can't know the right way to treat a person since each is so physiologically and psychologically different.

In my next blog, I will talk more about this complex analysis of the practice of medicine because turns out Atul Gawande even has a movie!

Thank you so much for reading!

Anivarya

Week Three

Hi everyone!

Hopefully, all of you had a wonderful week. As for me, I finally got to set foot on the University of Arizona College of Medicine campus and familiarize myself with the involvement of the Narrative Medicine department!

On Wednesday morning, I had the opportunity to shadow Dr. Hartmark-Hill in her "Visiting Professorship" meaning with Dr. Beyda, the head of UofA's Bioethics and Medical Humanism department. The meeting started off with scheduling of various narrative medicine events as a way to continue promoting patient stories in the local medical community, and this segwayed into discussion of narrative medicine at an international level. It was pretty cool to see that a physician all the way in Venezuela chose University of Arizona to get professional medical training because of its focus of humanities in medicine and value of patient stories.

After the meeting, Dr. Hartmark-Hill gave me a tour of the campus, and I was truly mesmerized by the medicinal and anatomical canvas paintings hung up on the walls. Although the campus isn't dedicated to narrative medicine, there is definitely a strong influence of the simplae presence of medical humanities and narrative medicine programs in the building.

We later attended a medical humanities writer's group, which was hosted by two authors who used creative writing as an emotional outlet for their experiences in the medical world. The collaboration was called "True Stories: Exercises to Pull Meaning from Memories, Part I", and the authors Amy Silverman and Paul Rubin set up a workshop followed by a telling of their own story. Listening to their development as writers through the power of medicine was really inspiring; Ms. Silverman wrote on the story of science and love in coping with her daughter's down syndrome and Mr. Rubin writes through the interaction and bonds formed when a diversity of people share an equally diverse set of stories.

The following day, I was able to sit in on my first medical student lecture! I actually wasn't aware this was a big deal, but I was told that first graduate-level lectures are a milestone, so there's that. My first lecture was on cardiomyopathy, and this covered the different forms of cardiac diseases and their corresponding treatments and prognoses. One thing that stood out to me was that each disease and patient was treated as almost a two-dimensional object, and the options for treatment were simply categorized in "drugs", "devices", or "cardiac transplant". Although the medical student curriculum was offering professional education on the heart, I felt that there was a lack of depth and realization that each patient has differing symptoms based on their story as a person. However, the second lecture was called "Heart Sounds with Harvey", and right from the title I could guess that this would be interactive and offer characterization to each patient. This lecture was a case-study, so each patient was treated as a unique case, and each heart rhythm was associated with a patient story regarding their racial background or age. Here, the medical student education was certainly integrating the humanistic approach to medicine, and I noticed that the students were a lot more interested and were able to better apply their knowledge towards becoming a physician. 

I'm really glad that I was able to be a part of a medical community that views medicine in social and emotional context because, it's hard to describe objectively, but there really is a difference in their attitudes towards clinical practices and the overlap between professionalism and humanism. Thank you for reading such a long post!

I will be taking next week off for my Spring Break, but I look forward to sharing my experiences with you the Friday after next! 


Anivarya

Week Two

Welcome back! 

I hope these past few days have treated you well! This week, I've been working on completing a very lengthy Institutional Review Board (IRB) Application. First lesson I learned: When they say the IRB is not for people younger than graduate students, they're undoubtedly right. Although paperwork for the IRB was unlike any other set of forms I've seen, it was a remarkable learning experience for me. 

The particular form that I needed to complete was the F200: Application for Human Research. When a study uses human subjects as a part of their research, the Institutional Review Board is required to approve the study to ensure the protection of each human subjects' health and privacy rights. It's fascinating to see that something as simple as conducting a survey comes with so much liability. 

To better understand what the F200 entails, here's a quick run through of the application. The first section was the background, which mirrored my Introductory Post in this blog in explaining what narrative medicine is and its significance. Within the second section of purpose, I discussed the two direct purposes, two specific aims, two objectives, and the primary and secondary endpoints of the research. The following series of sections focused on compiling key words and adequate questions for the Likert scale survey. Once approved, I'll release my official survey questions on this blog!

Along with this survey, I was required to create two consent forms as well. One was a general consent form and the other was a consent to participate in research; both addressed potential concerns of the subjects (which, in this study are the medical students). Each consent form requires the human subject to read and then sign their rights to privacy and voluntary action, potential costs and risks, and potential benefits of the study. 

After "briefly describing" (with a not-so-brief 650 word minimum!) the study population, subject recruitment process, research procedures, settings, costs and risks, benefits, and provisional protection and confidentiality of data, I was required to explain the research investigation in "lay summary". Funny thing is, this was by far the most difficult part of the entire application. According to research investigators, the guideline for being specified as "lay" is 10th grade reading level, but since this includes 10th graders of all backgrounds, it's surprising to see how much the writing style has to change to meet that. If I'm honest, I spent a solid 2.5 hours on making my lay summary from "15th grade" (I didn't even know that was a thing) to 10th grade level. 

Although there were a lot of tedious applications and forms to fill out, I was personally fascinated by this process. I mean, who would've thought that a 2 minute survey would take over 15 hours of paperwork?! There are so many minute details that are often overlooked when it comes to dealing with human subjects, and as someone who plans on pursuing research at university and medicine in the future, this has been an amazing learning opportunity for me. 

As always, thanks for reading and please check in next week! 

Anivarya 

Week One

Hi guys! 

I hope everyone had a great week! Over the course of the last few days, I have been working on (surprise, surprise) passing yet another string of tests and quizzes to become certified for conducting clinical surveys. But in all honesty, it's been pretty fun!

In order to interact with patients and physicians in a clinical setting, I've been taking training courses and assessments for CITI, HIPAA, and SHOW. 

Before I begin detailing my experience with each, I just wanted to give a quick side note about my research question. Turns out being in high school (in combination with being under 18) results in complications with directly surveying patients, so my study has evolved to a slightly different approach to narrative medicine. As such, my new research question is: How does storytelling impact a clinician's experience in patient care? In hindsight, this is actually a wonderful opportunity for me because there already exists some research on the effects of storytelling on patient health and relationships; however, almost no investigations study the effect that storytelling has on clinicians in their ability to diagnose and improve treatments for their patients. 

In continuation with the certification trainings, I would like to discuss the types of questions in and significance of each. 

Collaborative Institutional Training Initiative (CITI): The goal of CITI is to ensure public trust, integrity, and quality in research. Under the University of Arizona College of Medicine branch, I was able to take the Social and Behavioral Research Investigators (HSR) course which covered lessons in healthcare ethics, federal research regulations, risk of assessment, human subjects in research, and privacy or confidentiality protections. I was particularly interested by the modules "Research with Children", "Research with Prisoners", and "Research with International Minorities" because it's so fascinating to see that in healthcare, each individual is valued for their unique contribution to the patient world. 

Health Insurance Portability and Accountability (HIPAA) Training: The purpose of HIPAA is to secure privacy while maintaining efficiency in portability of patient information. HIPAA training is meant for higher-degree physicians running a private practice and graduate students practicing for medicine, so admittedly this was a bit more challenging to comprehend. Essentially, I was able to learn what PHI (individually identifiable health information) is and the uses and disclosure procedures of it. I personally really liked the "special circumstances" section which included medical scenarios in law enforcement, decedent and familial records, and military and national intelligence activities because this showed how complex the interdisciplinary nature of practicing medicine truly is. 

Student Health Outreach for Wellness (SHOW) Clinical Orientation: The SHOW training was relatively simplistic and the goal is to take a holistic approach in providing a safe environment to patients experiencing homelessness in the community. I was introduced to SHOW-specific clinic flow and the different codes which are universal in hospital and clinical settings: code red for fire, code yellow for a bomb threat, code blue for cardiac arrest, code gray for security alert, and code orange for hazardous material incident. (Definitely realized the colors of the rainbow aren't so peaceful anymore)

Overall, taking these orientations and assessments (fun fact: I got straight A's) was an unforgettable experience. I'm so glad to already feel like I'm a part of the medical community that I strive to be in as a physician. Now that I'm officially certified to interact with patients, doctors, and medical students, I'm looking forward to beginning my interview and survey process soon! 

Thank you so much for reading! Please check in next Friday for my weekly update! 

Anivarya

Introductory Post

Hi everyone!

I will be updating this blog with my experience of patient and physician interactions on a weekly basis, but for now, here is a quick introduction to what my senior project on narrative medicine will entail. 

Before I discuss the specifics of my study, let me address the big question: What even is "narrative medicine"? Founded by Dr. Rita Charon of Columbia University, narrative medicine is an effort to re-humanize medicine by integrating storytelling into clinical practices. Recent studies show that the therapeutic process of forming a bond with a physician, through open conversation of one's background and emotions, can improve patient health. Psychologists have found that narrating an experience allows the patient to voice a disruption and smoothly find its place alongside all other life events. 

As someone who is passionate about medicine and the process of storytelling through creative writing, narrative medicine is the perfect discipline for me to combine my interests. 

As such, the research questions for my investigation are:
1. How does storytelling impact the physical health of patients? 

2. How does storytelling impact the relationship between a patient and her doctor?

In order to collect data for this study, I will be developing a scoring scale to measure both qualitative and quantitative responses from patients regarding their experience of sharing a piece of their life story with their respective physicians. Before giving out this survey in a clinical setting, I will be collaborating with Dr. Hartmark Hill to complete an Institutional Review Board (IRB) application to ensure that all questions adhere to ethical guidelines when using human subjects for research. 

I'm excited to spend my time at the SHOW Clinic to survey patients and participate in projects such as Humans of Show, as well as at the University of Arizona College of Medicine to perform data analysis and literature research. 

Current health practices are so focused on treating patients by prescribing drugs or invasive procedures, that the emotional value of the patient is being sacrificed. In today's fast-paced society, medical technology and antibiotics are advancing, but these are only curing the superficial health of a patient. Sharing a story is such a simple thing to add to health practices, and if it can make such a large impact on health and relationships, it can serve as a breakthrough in non-invasive treatments. 

Once I begin my research, I will be back with some more in-depth information, pictures, and potentially excerpts from patient narratives, so please check in every week! Thanks for reading! 

Anivarya