Classes in Health Care Activism

Published

MD students can now take these courses. I'd like yo see nursing students taking them too!

December 2, 2003

Medical Students Go Beyond Books to Learn About Activism

By SHARON LERNER

he already knows how to read an EKG. And she was taught to measure blood pressure three years ago. But in her fourth year of medical school, Hilda Fernandez is learning how to quantify hope.

One of a growing number of medical students taking courses in social activism, Ms. Fernandez is trying to move beyond the straightforward science that has occupied so much of her time during her professional education.

As her final project for the class, she is trying to gauge the optimism of the Latino patients she treats before and after she educates them about diabetes.

"It's not just the hemoglobin that's important, but how we're able to improve their life outlook," Ms. Fernandez said. "That way I could show that the program is worth funding."

Far removed from the rote memorization so often required of medical students, such complicated social, political and practical advocacy issues are creeping into medical curriculums across the country.

Ms. Fernandez is enrolled in "Research-Based Health Activism" at the Montefiore Medical Center in the Bronx, a class that draws budding doctors from all over the country. For a month they focus exclusively on creating change in both patients' lives and in health policy.

Over the past six years, similar courses have been introduced at several medical schools, including Case Western Reserve University, the University of North Carolina and the University of Pennsylvania.

Doctors were tackling policy issues long before Howard Dean became a presidential candidate. They have influenced everything from hospital practice to global politics.

For instance, Dr. Ignaz Semmelweis, a 19th-century Viennese obstetrician, campaigned to get his colleagues to wash their hands after realizing that physicians were spreading puerperal fever among patients.

Dr. Rudolf Virchow, a contemporary of Semmelweis's, railed against poverty and told his fellow doctors, "If medicine is to fulfill her great task then she must enter the political and social life."

And the advocacy group International Physicians for the Prevention of Nuclear War won the Nobel Peace Prize in 1985 for working to abolish nuclear weapons.

Students in the health activism course in the Bronx hear from many of today's physician advocates, including Dr. Oliver Fein, a vocal supporter of a single-payer health care system, and Dr. Bertrand Bell, an internist who led a successful campaign to limit medical residents' hours in New York State.

Classes focus on the way economics, business and government policy affect the practice of medicine, with lectures on treating the uninsured, dealing with Medicare, creating advocacy organizations and using scientific findings to lobby.

To Dr. Peter Lurie, a physician who has helped plan many of these new courses, such policy-oriented work goes hand in hand with the practice of medicine.

"Physicians are inherently activists," said Dr. Lurie, who works for the health research branch of the consumer advocacy group Public Citizen.

"These are people who say, `I'm going to do everything I can about a patient's condition,' " he said. "What we're doing is bringing that instinctual activism all doctors have to the social arena."

In order to have sway among their colleagues-and earn medical school credit-advocating for social change involves more than chanting and protesting, of course. Participants in the activism courses organize and, in most cases, conduct research studies relating to issues that trouble them. And, if the data they collect strengthen their case, students are encouraged to try to influence public opinion.

David Herszenson, a fourth-year medical student at the University of Wisconsin who enrolled in the course in the Bronx, hopes that the research he is doing for class will ultimately help lower health care costs. Mr. Herszenson is researching the effect of marketing campaigns for brand-name drugs.

"You see patients all the time wanting to know about some drug they've heard about in an ad," says Mr. Herszenson, 27. "But the ads direct them to the newest most expensive therapy, which isn't always the best."

If his findings support his contention that pharmaceutical marketing unnecessarily increases drug costs, he plans to include them in a pamphlet that will urge patients to "ask your doctor about cheaper generic alternatives," which he will then distribute in doctors' offices.

Other student projects have already yielded results outside the classroom. In a similar course Dr. Lurie of Public Citizen taught to undergraduates at the University of Michigan in 1997, three student projects were published in peer-reviewed medical journals. Dr. Lurie helped arrange a news conference to highlight the work of one team, which compared cigarette package labels in the United States and in developing countries.

While some students seem intent on changing the world with ambitious projects tackling international tobacco sales, homelessness and other major problems, others hone their advocacy efforts on changing the world of medicine.

Tania Thomas and Scott Heysell, two students in the Bronx course, for instance, are aiming their hunger campaign at physicians, a group they say is mostly unaware of the problem.

"Maybe a pediatrician will ask if a child is a picky eater, but they don't ask, `Does your child get three meals a day?' " Ms. Thomas said. "It's a real disconnect."

In response, the two students are creating a resource book so doctors can direct their patients to food stamp offices and emergency food pantries.

With numerous forms to fill out, patients to see and other important problems to look out for, many doctors probably will not find the time to use the resource book. But the latest group of medical students advocating various causes is hopeful that some will manage to insert pressing social issues into their practices-just as the students themselves have squeezed a course on social issues into their own grueling schedules.

For Ms. Fernandez, who came from California to take the activism course, the effort was worthwhile.

"Medical students tend to want to do just straight studying because there's this strong interest in being a great student," she said. "But we're not going to be professional students for the rest of our lives, we're going to be physicians. I think if you just bury your head in the science books, you're missing out on a huge aspect of medicine."

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