The International Journal of Whole Person Care
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The patient as teacher-learnings about becoming a good physician from senior medical students
Get PDFFor 15 years, in fourth-year clerkships in Family Medicine / Underserved Health Care, the author, a core clerkship faculty member, meets with 8-12 students at the beginning and end of their monthly rotation. Students reflect on and write goals in four areas, including Primary Care, Teaching, and Working with Underserved Communities. A key goal is the fourth. Students reflect on their training, especially third year, as a ‘socialization’ process where they may have learned some good habits, but also some behaviors that may have felt like survival, that are not congruent with the physician they aspired to become.
In a safe and supportive learning environment, at the Student-Run Free Clinic, where time and reimbursement are not the drivers, the students grow in self-awareness as physicians, healers, and teachers.
In the final session, each student also shares a meaningful story about a patient who will sit on their shoulder throughout their career and gently remind them about the physician they are becoming. Each student then identifies the essence of the patient’s teaching. Another student takes notes. The students co-create, in a facilitated and supportive environment, a set of teachings. One student reads them aloud and sends them to the group. The specific teachings, in the students’ own words, are about listening, to being present, to thoroughness, to asking open-ended questions, to exploring the social determinants of health, to learning from our errors, to taking the extra minute, and many others. More than 1200 students have participated in this activity, with consistent positive feedback.
Peer support for adolescent girls living with scoliosis: finding a digital community
Get PDFIntroduction : Scoliosis in a condition where a curve develops in the spine. Adolescent girls affected by scoliosis are significantly more likely to require treatment such as bracing or surgery than their male counterparts. Curvy Girls is a peer support group for adolescent girls with scoliosis that allows them to engage with each other in a safe environment.
Objectives : This study endeavours to explore the experiences of adolescent girls living with scoliosis who are Curvy Girls members and understand how this peer support group has affected their experience.
Approach : Sixteen participants were recruited through a senior board member of Curvy Girls. Data was gathered through semi-structured interviews with open-ended questions, transcribed verbatim, and analyzed using an applied philosophical hermeneutic approach, a practice of uncovering insights from transformational conversation.
Findings : We found that the participants’ sense of belonging to Curvy Girls did not depend on their level of involvement with the group. Whether they were leaders in their in-person local group, or simply following the organization on social media, seeing themselves represented allowed the participants to feel like they belonged to the group.
Future Directions : These findings may help clinicians, healthcare professionals, and peer support organisations deepen their understanding of the perspectives of this specific population. This transformed understanding could lead to the instauration of care and services that are better adapted to this population’s needs, resulting in lessening the burden of the condition on the individual and their support system.
 
Aging, care and dependency in multimorbidity: how relationships affect elderly women’s homecare and health service use
Get PDFRelationships are multidimensional, and we know little about the facets of relationships in the way elderly patients’ with multimorbidity utilise homecare and health services. Gerontology literatures emphasize the importance of place of care, inequalities, availability of health services and affordability. However, the diversity of relationships and associated dependency in elderly care remain underassessed.
A qualitative study involving a demographic survey and interviews was conducted to explore relationship experiences of elderly women with multimorbidity in homecare and health services utilization. Civil Surgeon of Sylhet District in Bangladesh was contacted to recruit participants for the study, and this resulted in 33 interviews [11 staff and 22 elderly women with multimorbidity]. Three domains of Axel Honneth’s Theory of Recognition and Misrecognition [i.e. intimate, community and legal relationships] were used to underpin the study findings. Data was analysed using critical thematic discourse method. Four themes were emerged: nature of caregiving involved; intimate affairs [marital marginalization, and parent-children-in law dynamics]; alienation in peer-relationships and neighbourhood [siblings’ overlook, neighbourhood challenges, and gender inequality in interactions]; and legal connections [ignorance of rights, and missed communication]. A marginalization in family relationships, together with poor peer supports and a misrecognition from service providers, resulted in a lack of care for elderly women with multimorbidity.
Understanding the complexities of elderly women’s relationships may assist in policy making with better attention to their health and well-being support needs. Staff training on building relationships, and counselling services for family and relatives are essential to improve the quality of care for the women.
 
Training interprofessional faculty in humanism and professionalism: a qualitative analysis of what is most important
Get PDFIntroduction: The capacity of healthcare professionals to work collaboratively influences faculty and trainees’ professional identity formation, well-being, and care quality. Part of a multi-institutional project*, we created the Faculty Fellowship for Leaders in Humanistic Interprofessional Education at Boston Children’s Hospital/ Harvard Medical School. We aimed to foster trusting relationships, reflective abilities, collaboration skills, and work together to promote humanistic values within learning environments. Objective: To examine the impact of the faculty fellowship from participants’ reports of “the most important thing learned”.
Methods: We studied participants’ reflections after each of 16 1½ hour fellowship sessions. Curriculum content included: highly functioning teams, advanced team formation, diversity/inclusion, values, wellbeing/renewal/burnout, appreciative inquiry, narrative reflection, and others. Responses to “What was the most important thing you learned?” were analyzed qualitatively using a positivistic deductive approach.
Results: Participants completed 136 reflections over 16 sessions–77% response rate (136/176). Cohort was 91% female; mean age 52.6 (range 32-65); mean years since completion of highest degree 21.4; 64% held doctorates, 36% master’s degrees. 46% were physicians, 27% nurses, 18% social workers, 9% psychologists. 27% participated previously in a learning experience focusing on interprofessional education, collaboration or practice.
Most important learning included: Relational capacities/ Use of self in relationships 96/131 (73%); Attention to values 46/131 (35%); Reflection/ Self-awareness 44/131 (34%); Fostering humanistic learning environments 21/131 (16%).
Discussion: Results revealed the importance of enhancing relational capacities and use of self in relationships including handling emotions; attention to values; reflection/self-awareness and recognition of assumptions; and fostering humanistic learning environments. These topics should receive more emphasis in interprofessional faculty development programs and may help identify teaching priorities.
*Supported in part by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as PI; Dr. Rider as site PI)
Ngununggula: The story of a cancer care team for aboriginal people
Get PDFIn Dharawal Country in regional New South Wales, a small and powerful team provides cancer prevention, screening, support and care for Australian Aboriginal people, their families and communities.
In keeping with Aboriginal practices and values, their uniquely holistic approach encompasses everything from food security and finding childcare, to support at diagnosis, surgical, radiation or chemo treatment, through to holding funerals, facilitating yarning groups, and Ceremony for survivors of cancer and their carers.
The team created a manual for Aboriginal Health Workers, and other staff of Aboriginal Community Controlled Health Services, together with training webinars, and modules. The program is also designed for Aboriginal Liaison Officers and Palliative Care Workers who work in hospitals.
The book and the training modules are called Ngununggula. The name, from the Gundungurra language, means working and walking together.
“We’ll make ourselves available to anyone that wants to tread this path because we know all the pitfalls. We’ve learned them. We’ve tripped and had to climb out of them again. Anyone that wants the shortcuts—more learning, less pain—here they are. We want to share and help. I want the message to get out all over the place. I want to share the resources, to support anyone else who wants to run programs or build a team like we do.” Kyla Wynn, Counsellor/Co-ordinator Cancer Care Team, Illawarra Aboriginal Medical Service.
Partners include: Aboriginal Health and Medical Research Council, Illawarra Aboriginal Medical Service, University of Sydney, University of Wollongong, Menzies School of Health Research
Caring for patients near the end-of-life at Mayo Clinic: a narrative
Get PDFI’m a palliative care and hospice doctor focusing my clinical care on families near the end of life. It has been a great privilege to be welcomed to the bedside of so many seriously ill and dying patients to care for them and their families. Pursuing geriatrics and palliative care were not always met with welcome sentiments from my peers. “You’re going to take care of sick and dying patients.” “It is so depressing.” My experience is that geriatrics and palliative care are a little like peeking through the old skeletal keyhole into a living room. You have to get up real close to peek inside and if you dare to go through and enter in, a whole new world opens. It is often a sacred space. A space for a team of professionals caring together.
A new construct: mindful procedural touch
Get PDFTraditionally, touch in health care has been classified as either functional or expressive. Yet, this nomenclature denies the reality that all touch is expressive, and touch that is purely functional may express objectification. The dilemma lies in expressing care while respecting patient boundaries, especially during intimate touch. Mindfulness offers a solution to this dilemma. Mindful touch—being present to the sensations of touch while connecting to an intention of care—allows the health care professional to convey care during functional touch while enjoying the benefits of person to person connection
A gamified sleep intervention for veterans: an overview
Get PDFA good night’s sleep is well known to be imperative for maintaining one’s overall wellness. Yet, about half of Canadian adults struggle with falling asleep or maintaining sleep. The impacts of insufficient sleep are wide-ranging, from physiological correlates such as diabetes to mental correlates such as depression. Effective treatments for sleep-related issues exist: for example, online interventions for insomnia have been found to be effective.
As a medicine and a health psychology student at, respectively, Sherbrooke University and McGill University, we worked on the MissionVAV health promotion program during the COVID-19 pandemic, providing free gamified interventions for Canadian Veterans and their families. Over the course of several online interventions related to physical health, we observed that a large proportion of our participants were dissatisfied with their sleep. Consequently, we have developed an 8-week online sleep intervention to address this primordial element of primary prevention.
The intervention aims to better our participants’ sleep through providing weekly readings on the following topics: age-related changes in sleep, proper sleep hygiene, varied relaxation techniques as well as the relationship between sleep and chronic pain, menopause, shift work, rumination, exercise and light. To promote healthy sleep hygiene habits, daily self-assessment questions are provided and are incentivized through points and storytelling. Furthermore, health coaches trained in sleep medicine follow participants throughout their journey to provide support and reinforcement. Ultimately, the intervention aims to shed light on the importance of sleep within preventative medicine, tackling it systematically in an engaging, gamified fashion
Harnessing the power of gate control: interventions for procedural pain and anxiety
Get PDFMedical and dental procedures present a minefield of opportunities for pain and anxiety. Many procedures for diagnosis, treatment, and palliation are performed either without comfort measures at all or with sedation/anesthesia. Yet, there are many ways of decreasing patients’ procedural pain and anxiety and of increasing physical and psychological comfort.
Gate control theory explains how we can close the gate on pain transmission (and minimize opening the gate) through non-pharmacological means. An exploration of several bottom-up and top-down interventions will be discussed including breathing, mindfulness, gradual exposure, non-pain stimuli, distraction, touch, and postoperative communications. Interventions will be illustrated with pictures and short videos in the dental setting
Engaging healthcare providers and patients on climate action through physical, emotional and social wellness
Get PDFAccording to the World Health Organization, the health challenges from climate change are many and varied including: Malnutrition due to lack of quality food access. Mental health challenges in addition to severe socioeconomic challenges, through the loss of homes, jobs and needed social connections due to extreme events. Acute illness and the risk of water-borne diseases associated with lack of access to clean water. The increased risk of vector-borne diseases with warmer temperatures. Chronic illnesses associated with heat stress and pollution. Death from cardiovascular and respiratory disease, particularly among vulnerable people as temperatures rise to extreme levels.
Both healthcare providers and patients must be engaged on climate change and action. While several medical training institutions are exploring opportunities to embed climate change and health education into their curricula, of importance are the holistic strategies to engage patients on climate action. The challenges are complex, and the data is overwhelming. Patients may not fully comprehend the personal implications of climate change and as citizens, may not understand their role in climate action.
We suggest through the creation of a sustainable living mindset based on wellness, it is possible for healthcare providers to create a personal and emotional connection to climate action. The results from workshops with older adults are shared in this paper, demonstrating how the link to physical, emotional and social wellness, can encourage behavior change with respect to dietary and consumption practices as well as increased connection to and protection of greenspaces for health and well-being.