Daniel J. Benor, MD            

…If you’re not part of the solution, you’re part of the problem.  There is no middle road…
         Oh Shinnah – Odyssey of a warrior woman
         In: Steven McFadden – Profiles in Wisdom

A remarkable programme has been available at the University of Louisville Medical School since 1980. It introduces entering freshmen to concepts and approaches which, surprisingly, are not presented in many conventional medical school curricula. Included are nutrition, exercise, relaxations (using music, art, song and Tai Chi), social support systems with peers and upper classpersons, health maintenance and disease prevention, time management and specific study skills for medical school, awareness of professionals’ liability to substance abuse, and more.

This programme addresses the tendency of doctors to overlook their own physical and emotional health needs.  Recent BBC television series have focused on the enormous strains encountered by student doctors.  Their many years of training demand long hours of study and service in hospitals and clinics, often exceeding 90 hours per week.  Few medical schools provide education in how to cope with such stresses.  It is little wonder that doctors have the highest rates of any professional group for depression, alcoholism, drug abuse and suicide.

The Louisville medical freshmen are invited through a letter included in their registration papers to this four day voluntary programme which immediately precedes the start of formal studies.  Over the past few years more than 90 percent have elected to participate, despite the extra investment in time and costs of lodging.

I was fortunate to be able to observe the programme for the class of 1997 (identified by their date of graduation from the four years of studies).

Second year students volunteer to be Health Tutors to groups of 10-15 freshmen.  The Tutors are one of the most effective of the spectrum of aids available in this programme.  In semi-formal panel discussions and in informal contacts they were very open in sharing their own anxieties and coping styles for dealing with the stresses of the gruelling course of medical studies.  It is sobering to hear that most students find that they have only a few hours in the week for activities not related directly to studies or to household chores for survival.  The Tutors described their individual preferences for relaxation, many mentioning physical exercise in some form.  The school has responded to this by making available an exercise room and a volleyball court, both very popular and heavily used.

  The Tutors meet with their groups daily during the programme and then regularly through the first year.  They are also available for consultation on professional and personal problems.

  Leah Dickstein, M.D., Professor in the Department of Psychiatry and Behavioral Sciences, and Associate Dean for Faculty and Student Advocacy, is the staff coordinator for the programme.  She has specialised in counselling students over many years and is very obviously a most caring and concerned person, ideally suited to this role.  She makes herself available to the students at any time, day or night, asking only that students not approach her with minor problems which might be addressed by other staff.

  Other faculty members volunteer to lecture, to supervise student groups, and to be available for consultation to students over school and personal problems.

  The caring, warmth and good humour of all participants set a very encouraging tone to four days devoted to stress prevention and management.

Doing is more impressive than talking about doing.  This is immediately demonstrated by the breakfast awaiting the anxious students who start to appear well before the 8am time set for this nutritional greeting.  Each day a series of healthy vegetarian (and occasional poultry) dishes are prepared under the supervision a nutritionist, Nancy Kupper, who manages the fine balance of being knowledgeable and informative while not sounding preachy.  For the first three days the second year Tutors are the chefs.  On the last day freshman volunteer for this task.  The gastronomic introduction is reinforced with a lecture on healthy diet, with emphasis on counting the fat units which contribute to atherosclerosis and hypertension, some of the major causes of illness and death in western society.

A hefty pile of papers and booklets is handed out upon registration.  

Prominent amongst these is a cookbook with many delicious vegetarian recipes and a table of fat contents of many common, store-bought items, including, of course, Kentucky fried chicken.

The red-covered MUSH (Medical Student Unauthorized Survival Handbook) outlines many of the points covered by the Tutors in their discussions.  It recommends study practices, note-taking services, recourses when encountering difficulties in studies, etc.  It also provides lists of popular local entertainment spots and ‘watering holes’.  This volume is re-edited yearly by graduating first year student volunteers as a legacy to the next class.

Steps to Good Health is another ring-bound handout which provides more formal information about medical school requirements and expectations, as well as student recourses should they have formal grievances. It has suggestions for relaxation and other approaches to health maintenance.

Dr Dickstein leads off the lectures, pointing out some of the contributions of nutrition to health and disease. It is sobering to realise that over 450 milligrams per day of caffeine actually interferes with learning. (One cup of drip coffee contains 100 mg.)  Other stresses are discussed.  Dr Dickstein repeatedly emphasizes the importance of relaxation time for emotional and intellectual refuelling in order to increase productivity. Catnaps are highly recommended.

School policies support the approach of the health awareness programme. Examination marks are given on a pass/fail basis.  Students are encouraged to cooperate in collaborative note-taking and studies and are discouraged from competition.  The motto, ‘P=MD’ (Pass = Medical Doctor), is repeatedly mentioned.  Several lecturers cited Bernie Siegel’s caveat that MD does not stand for Medical Deity.

Intellectual pursuits outside of medicine are encouraged. A librarian archivist briefly reviewed some of the local history of Louisville. A marvellous lecture on physicians as artists and an art show featuring works of physicians illustrated this avenue for relaxation. First prize at the show was awarded for a violin built by a doctor who was enchanted by this instrument when his girlfriend took him to his first concert a few years earlier.  

Joel Elkes, M.D., Emeritus Professor of Psychiatry, is the co-founder of the Health Awareness Program. Though he was unable to participate in it personally this year, his presence was felt – particularly through presentations of the Arts in Medicine faculty.  It is most difficult to do justice to the experiential presentations of these vibrantly alive people.

Adam Blatner, M.D. is the only psychiatrist in the U.S. specialising in psychodrama.  He playfully introduced ‘The Talk Show Host Game’ with Dr Dickstein, in which one of a pair is designated interviewer and the other is free to be anyone or anything s/he wishes to be.  The interviewers get to ask questions, and the guests must answer truthfully about themselves while maintaining their chosen identity.  Imagine a two-ton truck or a refrigerator being interviewed!  This was but one of the many opportunities for students to get to know each other.

Alice Cash, PhD, Coordinator of Music Therapy services, had students toning and explained and demonstrated the differences between this and chanting.

While emphasizing the positive and preventive sides of health care, the programme also encouraged open discussion of difficulties which might challenge medical students.

The dangers of alcoholism were highlighted with a film based on a true life story of a physician who slid into using drink too heavily as a stress reliever – ending in a divorce and professional censure.  Several doctors who had overcome alcohol and substance abuse problems spoke openly of their struggles and mentioned the sorts of help which are available to doctors who find themselves in such difficulties.

The problems of people with AIDS and the adjustments of homosexuals in the medical professions were discussed by people who were dealing with these themselves.

Rev Kelley Milstead Woggon, a Baptist minister who is also a psychologist specialising in perinatal support groups, discussed aspects of faith which are relevant to doctors.  She highlighted the World Health Organisation’s definition of health as the complete state of physical, mental, emotional and social wellbeing – not only the absence of disease.  Here was the clear voice of a healer who championed caring over curing and who pointed out that death is not an enemy.
 
I found it personally jarring to have this lecture on healing followed by two discussions of campus security and safety issues.  These are necessary because the hospital is located in a high crime area.  Perhaps this unfortunate superimposition was an artifact of scheduling arrangements.  Perhaps the bracketing of the anxiety-provoking with the spiritual and relaxing was intentional, as the municipal and campus police were followed by an experiential demonstration of Tai Chi.  This Oriental form of exercise has been shown in China to be highly effective in preventing and treating numerous illnesses.

Issues of ethics along with professional and personal attitudes were discussed throughout the four days of the programme.  I found it highly instructive to view a film on subtle sexual prejudices, in which attitudes normally expressed towards women were demonstrated towards men.  For example, a hospital Consultant greeted two female doctors by their professional titles and surnames, while patronisingly addressing the male doctors by their first names.  I hadn’t been aware of how insidiously pervasive these subtle sexual prejudices can be.

It was encouraging to find that women made up close to half of the Louisville Medical School class.  Dr Dickstein emphasized that students should not tolerate stresses of sexual harrassment and pointed out the official recourses available to them should they encounter this.

Stress prevention through exercise was heavily emphasized through a lecture on relaxation therapy and through invitations to participate in daily athletics activities, including outdoors games and sports at several picnics.  Several afternoons during the programme were left open for the students’ relaxations of choice.

Support groups for exceptional students (older, coming from non-science backgrounds, married, having handicapped family members, etc.), for students’ spouses and for children are excellent stress prevention and management resources provided as part of the programme.  Here again the student Tutors were most helpful, demonstrating through their own successful experiences that it is possible to deal successfully with the stresses of medical school.  Picture to yourself, for instance, a single mother of one or two or three children dealing with the burdens of medical training.  I am personally in awe of these dedicated folk who find the ways to meet the demands of family life while putting in such long hours in studies.  The school also provides tutoring for the exceptional students and for other students who find a particular subject difficult to master.

Why, you might ask, would the editor of this Newsletter invest so much time and effort in travelling to such a distant place and, more relevant, share such detailed information on these pages?  If health care is to include more healing, doctors are a potential resource to provide this.  Readers of this Newsletter might consider how to introduce more healing into conventional medical settings, few of which begin to approach the comprehensive programme available in Louisville.
 
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Copyright © Daniel J. Benor, M.D. 1993 Reprinted with permission of the author P.O. Box 76 Bellmawr, NJ 08099 www.WholisticHealingResearch.com    [email protected]