Mixed Messages on Campus

The past two months have been my first time working in the hospital, as a third-year medical student in my Internal Medicine clerkship. It’s been exciting not only to see how medicine works but to be a part of the action! It really is striking to see the dramatic increases in proficiency and confidence with each stage of the training. From junior student to acting intern to intern to resident to chief resident and eventually to attending, each year brings both more responsibility and more competence. Importantly, physicians-in-training also get very efficient in seeking out and communicating information. Just like SBM editors read widely and blog prolifically whereas I struggle to put together one post a month, experienced clinicians have responsibility for dozens of patients at a time whereas I feebly tag along with one or two each day. Watching my elders on the medical team, I feel excited about how much smarter and more effective I will become as I progress through my training.

Anyway, I want to share an interesting sight in my hospital last month. There were three 3-foot posters on tripods prominently displayed in the hospital lobby, in the cafeteria, and in other public places. The first one read:

STAY HEALTHY! Avoid The Flu! FREE FLU VACCINES FOR STAFF. [dates, times, locations]

I have been quite impressed with infection control, both at the Veterans’ Affairs hospital where I spent one month and at my campus hospital. The VA screens every single inpatient for MRSA nasal colonization and if positive enforces contact precautions. Both hospitals have ubiquitous hand sanitizer dispensers, of course, and twice in my two months I’ve been told “thanks for washing your hands” by a passing infection control monitor. We had a great lecture for Grand Rounds recently about the national and local epidemics of pandemic H1N1 and how our hospital is dealing with it. Dr. Crislip will be happy to hear that I saw my resident put on a respirator mask before interviewing a coughing patient in the ED. Everyone is also very sensitive to the risk of nosocomial infections from indwelling catheters and such, and I gather that the vigilance is increased recently because Medicare et al have decided not to pay for care related to certain avoidable adverse outcomes. Incentives work!

Yesterday a classroom of a dozen other students and I were asked how many of us would get the flu shot were it not required by the school. I was sad that not all hands went up, that not all of my classmates considered it a professional duty given our contact with immunocompromised patients, and that one even voiced the concern that the H1N1 vaccine was “rushed to market.” I was heartened, however, when that person’s neighbor quickly turned around to deny the “rushed” misconception with an explanation, and another student joked that we should fear the shot because Glenn Beck says the government is evil. I chimed in that Bill Maher was worried about toxins.

Back to the posters. Next to the flu poster was the following advertisement:

The Institute of Complementary & Alternative Medicine presents The Safe Use of Herbal Medicine
In attending this lecture, you will learn about:
* the use of herbal medicine in clinical practice
* areas of benefit, caution and risk
* the top ten botanicals in American use today, including indications, adverse effects, and drug interactions.

This component of the 2009-2010 Wellness Lecture Series is presented by a guest speaker whose credentials are “RN, AHG.” Although the above description may sound reasonable, I was immediately nervous because the sponsoring CAM Institute has a dubious track record. Each year one of its well-advertised lectures is about homeopathy, for example, with posters even in front of the pharmacy our patients use. The director of the CAM Institute conducts clinical research on QiGong. How can I trust them on a plausible topic when they demonstrate equal enthusiasm for farfetched ones?

The third poster was the one that really broke my heart. It advertised the “Holistic Series” offered this autumn by the School of Nursing. Listed were four day-long sessions:

* Reiki: Certification in Level 1 Attunement
* Holistic Nursing
* Nursing in Herbal Medicine
* Aromatherapy for the Healthcare Provider

Holistic nursing? I know some terrific nurses, and the implication that they don’t “treat the whole patient” or whatever is at least as ridiculous as that accusation is leveled at physicians. (Orac recently wrote about a similar example of CAM promoted by nurses.) Just like “Wellness” apparently now includes homeopathy and herbalism, it seems that “Holistic” means using Reiki and aromatherapy. I guess those words don’t mean what I think they mean.

Posters like these anger me primarily because they are positioned to be seen by as many patients as possible. My hospital’s patient population is not the typical CAM crowd (i.e., white and wealthy). Our typical patients have few resources and little science education, and they trust us as one of the few sources of care accessible to them. I believe that such promotion of “unconventional” CAM philosophies does our patients a disservice. It is hard enough for healthcare providers to teach patients how to manage their complex chronic diseases like diabetes and AIDS without having magical thinking encouraged on the hospital grounds. Fine if you want to fight over the merits of QiGong in the halls of academia, but presenting homeopathy to the public as a noncontroversial treatment option seems wrong to me.

A frustrating aspect is my sense that many students and faculty think it’s silly but not worth getting upset over. Indeed, when you’re facing a pandemic flu, it may seem a waste of time to fret over the vocal minority of “energy healing” believers, provided of course that they don’t explicitly discourage real treatments. Switching from “alternative” to “complementary/integrative” truly was a brilliant move by the CAM proponents.

See photos of the posters here.

Posted in: Science and Medicine

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9 thoughts on “Mixed Messages on Campus

  1. Kausik Datta says:

    Oh, good post, Tim! (Even if it is once a month – as you lament!) :)

    I completely empathize with you. At my hospital (a BIG name one as some of you may recall), while I have not seen posters, but there are prominently placed large flat-screen TV monitors, that continuously display various messages and advertisements for the hospital. These monitors are everywhere, from the patients’ waiting rooms to cafeterias, to common walking intersections and so forth. Every so often, there would be messages from the “Center for Wellness” or something of that sort, and the contents of those messages are – well, cringeworthy…

    This no longer surprises me considering that almost of all of the top hospitals in the US have established centers that dole out a hefty dose of woo to willing patients, in form of “integrative medicine” (On this, let me reference my post earlier this month).

    I concur with you one hundred percent that unbridled promotion of CAM philosophies to the unsuspecting and the gullible at large is doing a huge disservice to myriads of patients out there looking for a cure of their ailments. Which is why the current concerted effort on undermining science and evidence in medicine (that David wrote about) scares the hell out of me, when I try to put myself in the position of those patients.

    On one hand, the insurance companies gouge the patients because ostensibly they try to save their own money. Just this morning I was reminded of the woman whose coverage was dropped because she had donated her kidney to her son, and her lack of a kidney was construed by the insurance company to be a ‘preexisting condition’. And on the other hand, despite everything, millions and millions of dollars are being spent on promoting quackery and nonsense like CAM, and now, if the bill passes the Senate, insurers will be forced to pay for CAM therapy sessions.

    Sometimes I fear my head would explode.

  2. weing says:

    I think holistic medicine should be viewed as Voltaire viewed medicine in his day. Nature cures, the holistic practitioner simply there to entertain the patient.

  3. Arnold T Pants says:

    1. Have a good time on the wards. I too am immensely enjoying my third year.

    2. It is frustrating to be at a hospital that serves a poor and underserved population and see the BS that people are conned into spending money on. One of my favorites is “special” bottled water for mixing baby formula. It felt nice to tell a mom, trying to do right by her adorable baby, that it’s a load of bunk.

  4. Newcoaster says:

    Welcome to the wards, fellow Tim. I enjoy your posts as they remind me of my own med school and residency adventures back in the 90’s.

    Unfortunately those of us who speak up about woo are too rare, and shruggies are the rule in clinical and hospital practice. Nobody wants to make waves or upset woo sympathetic colleagues. In my hospital I ‘came out of the closet’ as a sCAM skeptic when Healing Touch was proposed as a hospital based treatment, by a team of doctors and nurses!

    I felt very alone in public meetings against it, only a couple other doctors spoke out against it, but many people would come up afterwards and say they agreed. I’m proud to tell you that I single handedly kept HT and Reiki out of our little rural hospital, and we have no official woo, though the nurses still do HT secretly.

  5. Dr Benway says:

    The 1980s were better, Newcoaster. The wall of science that once EXPEEEELD!! nonsense from academic medicine was first breached somewhere between the mid-1980s and the early 1990s.

    There’s a second Flexner report coming out. Don’t get your hopes up. The guy directing the project has a divinity degree and leiks integrative medicine.

  6. MBoaz says:

    Great article Tim. I too find it maddening that this dichotomy goes unnoticed by the majority of health care providers.

  7. The mixed messages were jarring in my training as a massage therapist. On the one hand, we were told that were learning “medical” massage, and we aspired to master orthopedic assessment techniques and best management practices for many pain problems and injuries. On the other hand, most instructors showed an appalling ignorance of science, and routinely promoted implausible interventions with full credulous conviction. It was impossible to get through a day there without getting a mental dissonance headache!

  8. yeahsurewhatever says:

    RN, AHG

    I assume that stands for Registered Nurse who Also Huffs Glue.

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