Treating the human body like a machine has served western medicine well, but the solutions are simple when machines finally can’t be fixed anymore. Not so much when a mother of three lapses into a coma with no living will, or a medical procedure will cost a man his entire month’s income.
Furman University Philosophy Professor Carmela Epright, Ph.D., who has dedicated 23 years to the study of medical ethics, wishes she could say that after the rigors of medical school, doctors were as prepared as they could possibly be to handle those and other complex situations. She can’t. What she will say, with great enthusiasm, is they would be better at their jobs if they had participated in The Medicine Program, the University’s longtime collaboration with the Greenville Health System.
The Medicine Program provides students a unique opportunity to examine difficult moral questions through Epright’s Medical Ethics class, a Medical Sociology class taught by program co-founder Kristy Maher, Ph.D., and possibly unmatched undergraduate access to doctors, patients, and treatment facilities called Field Work in Medicine.
“To our knowledge, there’s nothing like it in the country,” Epright, who came to Furman in 1999 because of the program, said. “Lots of places teach medical ethics and medical sociology . . . but we take them into the hospital.”
Now-retired Furman philosophy professor Doug MacDonald, Ph.D., approached Maher with the idea of the interdisciplinary partnership, and two decades later more than 200 students, not all of whom became or even planned to become doctors, have been the beneficiaries. Program participants must apply a year in advance, and sometimes as many as 60 candidates vie for 20 slots.
The reward if they’re selected is access to emergency rooms, psychiatric wards, intensive care units, and other sensitive areas as they observe medical professionals doing their jobs.
Dr. Brian Ohning, a neonatologist, has been guiding students through the GHS children’s hospital neonatal intensive care unit for 15 years. Furman won his cooperation and respect early on.
“They’re set up well by Furman and the faculty to ask probing questions and get something useful out of it,” he said. “Whether they go into medicine or not, that’s really irrelevant. It’s that they’re opened up to a different set of questions, ethics, and issues they hadn’t even considered before, much less that they’d have to deal with.”
And Ohning doesn’t shield them from many tough realities. They’re the point.
“It’s one thing to read in a textbook about withdrawal support and medical futility, but it’s another thing to be in the background when I’m discussing this with parents and extended family who are grieving and trying to deal with this difficult decision,” he said. “So it brings in the poignancy of these decisions that are discussed rather dryly in class.”
Kate Causey ’16, who participated in the most recent program, will certainly never forget many of the things she saw.
“On Tuesdays, we shadowed in the GHS emergency room,” she said. “Just seeing the homeless people and the drug addiction and alcohol addiction— the emergency room is kind of a dumping ground for that—it brought to light a lot of other problems.”
Robbie Shoenleben is a manager in the GHS’s department of psychiatry and behavioral medicine. That’s exactly the outcome he hoped for when he agreed to volunteer himself and his staff to participate.
“This just isn’t about going into medicine and treating the physical issues. Students need to be aware of the mental-health issues and how that can affect a person’s overall health,” he said. “It’s time-consuming for me; it’s time-consuming for my staff. But everyone here believes that we need to get people who are interested in medicine early in their careers, and let them know about treating the whole person.”
The Medicine Program celebrated its 20th anniversary on Feb. 29 with dinner at The University of South Carolina School of Medicine’s Greenville Memorial Medical Campus which was attended by Furman President Elizabeth Davis, Ph.D., GHS president and chief executive officer Mike Riordan, and Jerry Youkey, M.D., GHS’s executive vice president of medical and academic affairs and dean of the USC School of Medicine Greenville.
Also in attendance were a number of past students who participated in the program, Furman alumni who are now doctors in the area or in medical school, Furman faculty, and several GHS doctors and administrators.
Epright says she starts planning rotations, which send the students out in pairs, more than a year in advance, and she knows how fortunate Furman is to have the cooperation of GHS.
“We’re really grateful that the Greenville Health System has supported us. Lots of places wouldn’t have done it, and the doctors have been fabulous,” Epright said. “They have more and more things that they’re required to do.”
Causey, a math major, has no intention of attending medical school, but the classes will be valuable to her nonetheless.
“I still am interested in public health, and I think it gave me an incredible view of the American healthcare system, where it’s working and even more so, where it is not,” she said. “I think that will be of great benefit to me.”
In fact, it already has been.
“We saw some end-of-life situations where physicians and families faced the issue of when to provide care and when to stop providing care, and how a patient can best make their wishes known,” she said. “I ended up going home over Thanksgiving break and filling out the healthcare power of attorney with my parents and my living will.”
Dr. Arianna Shirk ’02 (formerly Arianna McLain), now practicing in Kijabe, Kenya, knew she wanted to live in Africa since she was 5. What she didn’t know was how deeply The Medicine Program would influence her worldview.
“When I took the class I didn’t understand a urinary tract infection or a heart attack, but I could look at the dynamics of the family and I could look at how things were affecting the families separate from medicine,” she said. “So it started me thinking that way before I ever had the skills to think about the medicine. It made everything intertwined from day one, which was an incredible gift.”
And one Shirk appreciates every day as she faces a different set of problems in East Africa. Astronomical healthcare costs are a major issue in America but nothing compared to the hardship they put on people there.
“Today working in Kenya and working with the resources that I have I have to look at both of those things almost first before I can look at the medicine. What I can do medically is not always the most important thing,” she said. “Literally most of my families live on $800 a year right now, and that’s a family that has a lot. A lot of my families live on somewhere between $30 and $40 a month, so every test I order, everything I do, every day they stay in the hospital means they can’t feed their other children, they can’t pay their rent, they can’t plant their crops.”
Dr. TJ Seneker ’07— it stands for Tennessee James, and, no, there are no periods—is a family medicine doctor in Burnsville, N.C., a small town north of Asheville near Mount Mitchell. Rural areas suffer from a chronic shortage of physicians for a variety of reasons, and while Seneker didn’t say his experience with the Program directly resulted in him choosing this less glamorous career path, he did credit it, as well as his philosophy degree, for helping him see through a different lens.
“For me, it helped focus my interest,” Seneker said. “With medicine, you can get caught up on the science aspect and just fixing medical problems and forget about all the other ethics issues or sociological issues that actually play a large part into peoples’ health. It helped prioritize that as a component.”
Epright is also a clinical professor of neuropsychiatry and behavioral sciences at the USC Medical School and serves as a clinical ethicist and ethics consultant. Her experience has convinced her that the American healthcare system would be better if more emphasis was placed on the subject.
“It’s a failing because we don’t see ethical questions as part of medicine until they are so bad that you’re suddenly embroiled in the middle of them,” she said. “Medical students don’t get access to medical ethics and medical sociology questions like this.’”
Seneker, who attended the East Tennessee State Quillen College of Medicine, agrees.
“The program at Furman was way more intensive and well-rounded in training in sociology and ethics than anything I’ve experienced in the rest of my training,” Seneker said. “There are a lot of things that medical education has to juggle beyond just making competent doctors, but I think (ethics is) a pretty important one.”
“I went to Wake Forest for medical school, and they tried (to teach ethics). They did,” Shirk added. “But I didn’t have to study for those classes. I had to study for what the heart does when it doesn’t work correctly. And so it’s really, really difficult for them to show you what the balance should be before you’re in the middle of it.”
Shirk says her experience at Furman has been “fundamental to the way” she practices medicine. Maher, whose research focuses on access to healthcare and health disparities, couldn’t have asked for more when she agreed to work with MacDonald, and to her it’s a testament to the opportunities Furman provides.
“I feel like the program is the embodiment of liberal arts and engaged learning,” she said. “It’s the thing that Furman says that it does is in this one program. We just need to let people know.
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