Values@MUSC
A Newsletter of the Institute of Human Values in Health Care at the Medical University of South Carolina
                                                                                                                                
Inside this Issue:

• Special Article:  Interdisciplinary Approaches to Medicine

• Director's Views: A Message From Robert M. Sade, M.D.

• Health Policy Update: New Guidelines for the Treatment of Pain in South Carolina

• Calendar & Events

Volume 1, Issue 1, Fall   1999                                        www.values.musc.edu

Special Article

Interdisciplinary Approaches to Medicine
by Robert. H. Blank, Ph.D.

   Traditionally, medical training contained little content from other disciplines. In recent years, the advent of biomedical ethics and the creation of medical humanities programs has added other perspectives though usually these have taken on a secondary role and not been highly integrated into medical training. More importantly, most of these endeavors tend themselves to be rather narrow and focused on several disciplines, eg. philosophy, literature, or other humanities, at the exclusion of a genuine interdisciplinary approach. As will be argued here, this context is not unique to medical training, though it produces special problems for the education of physicians who will be faced with life and death decisions.

   In much simpler times, Plato and other classical thinkers were able to master the known areas of knowledge and engage in true interdisciplinary dialogue. A more complicated world however requires specialization in minute dimensions of the world, thus making a Plato impossible in our times. As a result, disciplines and subspecialties within those disciplines have become the focus of activity. Each of these disciplines, carved from the total, develop unique perspectives and concurrently establish turfs to defend from interlopers from outside. The resulting divisions over time have become quite rigid. As a result, calls for interdisciplinary perspectives are often perceived with skepticism and seen as threats. Moreover, in academic settings where tenure and budgets are largely department based, there are often insurmountable logistical problems in teaching interdisciplinary courses and faculty members who do so are frequently disadvantaged.

   Interdisciplinary journals, likewise, tend not to enjoy the prestige accorded to top disciplinary journals. Instead of being rewarded for their insight, faculty members who publish in journals outside their own discipline, often find themselves being criticized or even penalized. As a result faculty members with interdisciplinary teaching and research interests often must volunteer for such teaching beyond their "normal," ie., department, load and make sure they also publish in acceptable disciplinary journals as well. Fortunately these distractions have not stopped many dedicated scholars and teachers from many disciplines to push for a more integrated view of the world and work at bridging the disciplines.

   Interdisciplinary teaching/research is especially problematic in medical training because medicine itself has become so segmented and specialized. As one rotates among the units it is clear to see priorities, perspectives, and even language change. Although there is some essential communication across specialties, seldom does this appear to be sufficient to produce an interdisciplinary environment, rather one set of experts getting needed information from another set of experts. Given the high demands on physicians just to keep up with their own specialties, it is understandable that first priority is there, but in the end it makes continued interdisciplinary education improbable.

   The problem of interdisciplinary education in medicine is compounded significantly if the term is expanded to include traditional disciplines outside of health care, particularly the humanities and social sciences. This of course cuts both ways—in fact most social science and humanities scholars are less likely to appreciate medical science than vice-versa. The insular views of these disciplines have produced barriers that make real communication amongst themselves, much less medicine and the biological sciences difficult at best. This also makes it difficult to develop meaningful interdisciplinary programs for medical education. At least physicians have some shared experience in medical school that can be drawn upon and they live in the world and thus have some knowledge of other disciplines.

   The Interdisciplinary Fellowship Program at the Medical University of South Carolina (MUSC) is an attempt to bridge some of the canyons dividing disciplines by bringing into the clinical setting persons trained in a range of non-medical professions. The purpose is twofold, first to expose these medical novices to the context and perspectives of a medical university, and second to expose the medical community to persons trained in an array of other fields all of whom are especially interested in health care. As noted above, this is no easy task because of the in built biases and backgrounds on all sides.

   The Interdisciplinary Fellowship Program has the added effect of exposing the Fellows themselves to the disciplines of the other Fellows. Persons trained in law, bioethics, sociology, political science, economics, and communications are likely to find wide variation in the views they each bring to the Fellowship and experience an opportunity to better understand the interdisciplinary dynamics of health care. The wide diversity of the Fellows surprised many of the residents and attendings who expected a single and largely critical appraisal of what they were doing. Instead they found often-conflicting views, again indicating the complexity of medical decision making. To the extent that the Program engenders communication among all the medical and non-medical disciplines involved, it represents a step toward better understanding of what is needed to strengthen this context.

   The Interdisciplinary Fellowship Program itself, of course, cannot transform either the way medicine is practiced or how it’s viewed by those scholars outside medicine. Disciplinary boundaries are too engrained to give way easily to more enlightened interdisciplinary approaches. However, for those who believe that the solution to increasingly complicated social issues and personal problems lies in multifaceted approaches that transcend any single discipline, fellowships of this type are most encouraging because they signal a willingness to explore new ways to resolve these problems—ways that depend on a broadened dialogue among persons trained formally in medicine and those trained outside but with a strong interest in contributing to a sound health care system.

Robert H. Blank, Ph. D. is a 1999 visiting fellow at the Institute of Human Values in Health Care at the Medical University of South Carolina.  To learn more about this program, click here.  Professor Blank is currently Professor and Chair of Political Science at the University of Canterbury in Christchurch, New Zealand.

 

Director's Views

   Welcome to the first issue of the Institute's newsletter. We intend to use the newsletter to facilitate communication between our Institute faculty, fellows and former fellows, and all who are interested in our work. The beginnings you see here are the product of two former fellows. Bob Blank, who wrote the opening article, is Professor of Political Science at University of Canterbury in New Zealand. He was an Interdisciplinary Fellow in 1999, and writes of his understanding of the value of interdisciplinary scholarship.

   Jason Arnold, another 1999 fellow, has degrees in both law and public health. With this background, his major interest is in bioethics. He has taken the initiative to create this newsletter, so any expressions of appreciation should go to him. Besides taking responsibility for the entire production, he also wrote the update on health policy. He has previously worked in the area of pain policy, and will publish on this site soon a monograph surveying intractable pain policy in the United States.

   We plan to publish a variety of papers written by our faculty and fellows on this site. Jason's will be the first to appear.

   We hope you enjoy this, the first edition of Values@MUSC. We also hope that you will take this opportunity to visit our Web site at <www.musc.edu/humanvalues>. If you have any thoughts about the newsletter or Web site and how they might better serve our mission or you would like to submit an item, please contact Lynn G. Bailes at values@musc.edu

Sincerely,
Robert M. Sade, M.D.
Director

Editor's Note: The Institute of Human Values in Health Care was created by Robert M. Sade, M.D., as an intercampus and interdisciplinary group of scholars and professional committed to advancement of ethics and health policy. To learn more about the Institute, click here.

 

Health Policy Update

New Guidelines for the Use of Controlled Substances in the Treatment of Pain
by Jason F. Arnold, J.D., M.P.H.

   Patients who suffer from acute or chronic pain have a right to appropriate and effective pain relief, according to a policy document recently adopted by the State Board of Medical Examiners of South Carolina. The policy document, Guidelines for the Use of Controlled Substances for the Treatment of Pain, is designed to assist physicians in improving public access to appropriate and effective pain relief.

   One reason often cited for lack of adequate pain treatment is that physicians fear investigation or sanction by state medical boards for prescribing large doses of opioids in treating chronic pain. According to James R. Winn, M.D., executive vice president for the Federation of State Medical Boards, "guidelines such as those developed by the Federation will help to alleviate this perception and ultimately reduce unnecessary patient suffering."

   The guidelines, developed in 1998 by the Federation of State Medical Boards of the United States, have received widespread support from organizations such as the National Association of State Controlled Substance Agencies, the American Academy of Pain Medicine, and the American Pain Society.  To develop the model guidelines, the Federation consulted with a work group comprised of experts in the field of pain management and representatives from the medical regulatory community.

   All physicians should become knowledgeable about effective methods of pain treatment and, as such, are strongly encouraged to read the Board’s Guidelines for the Use of Controlled Substances for the Treatment of Pain. To receive a free copy of the guidelines, please visit our web site at <www.values.musc.edu>. Physicians are referred to the Physicians Manual of the U.S. Drug Enforcement Administration for specific rules governing controlled substances as well as applicable state regulations.

• For a more complete analysis and copy of the guidelines, please click here. The Institute of Human Values in Health Care at the Medical University of South Carolina is currently working on ways to raise public awareness of a patient’s right to effective pain relief, which includes developing resources physicians may use to educate patients about medical board expectations regarding appropriate pain management. These tools should be available by the end of the year. For more information, contact the program office at (843) 792-5278. Any specific legal or medical questions about the recently adopted model guidelines should be directed to Mr. Aaron Kolozski, JD,  Executive Director, South Carolina State Medical Board at (803) 896-4500.

Interdisciplinary Fellowship

          Applications for 1999 - 2000 Now Being Accepted

   The Institute of Human Values in Health Care at the Medical University of South Carolina (MUSC) invites applications for its third annual Interdisciplinary Fellowship. The Program is designed to provide non-clinical professionals who work in health related fields (e.g., law, government, economics, sociology, philosophy, journalism, religion, and history) with first-hand exposure to and involvement with intensive inpatient and ambulatory care of the critically ill within a major academic medical center. The fellowship runs from January 10 through May 26, 2000. To encourage the widest range of applicants, no eligibility limits are placed on the educational and professional backgrounds of individuals who may apply. We particularly seek non-clinical professionals who are mid-career, who would benefit from an enriching clinical experience, and who would provide MUSC residents and students with perspectives from their own disciplines. Stipends for the program are available for a limited number of fellows. To receive application information, please contact: Robert M. Sade, M.D., Director, Institute of Human Values in Health Care, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 409, PO Box 250612, Charleston, SC 29425; (843) 792-5278; (843) 792-8286 (fax); values@musc.edu; www.values.musc.edu/.

1999 Application

Applications must be postmarked by October 15, 1999. Applications for the fellowship starting in January 2001 are also welcome. Completed applications should be submitted to Jason F. Arnold, J.D., M.P.H., Director, Interdisciplinary Fellowship.

 

 

Newsbriefs

          Robert M. Sade, M.D.: New Responsibilities
          Dr. Sade, Director, Institute of Human Values in Health Care, was elected as
          speaker of the house of the South Carolina Medical Association (SCMA) this year.
          The medical association composed of nearly 6,000 physicians, is the voice of the
          medical profession in South Carolina. Its purpose is to support the efforts of South
          Carolina physicians providing quality medical care and promoting good health for
          all citizens of the state, as well as to represent and serve the interests of those physicians.
         
          Dr. Sade also was recently appointed Medical Director of the South Carolina Organ
          Procurement Agency, the procurement organization for this state. He has been an
          active participant as a surgeon on the procurement side of transplantation for several
          years, and has had an interest in transplantation policy for nearly ten years.
         
          To e-mail Dr. Sade, Click here.

         
         
          December
         
          December 6
          Moral Challenges in Rural Health Care
          Greenville, NC
          The Conference is designed to identify and address the distinctive moral issues faced
          by health care professionals and institutions in rural states.  It will be held at the Monroe
          AHEC Conference Center (East Carolina University) and is designed for health care
          professionals and students from a variety of disciplines, including medicine, nursing, health
          care administration, social work, and allied health sciences.
          Contact: gperry@brody.med.ecu.edu

          Other Upcoming Conferences

          May 2000

          May 11-12, 2000
          Human Genome Project: Science, Law and Social Change in the 21st Century
          Cambridge, Massachusetts.
          For more information, please contact ASLME by phone at (617) 262-4990.
          E-mail: info@aslme.org
         
         
          September 2000

          September, 2000
          Pitts Memorial Lectureship in Medical Ethics
          Charleston, South Carolina
          The Institute of Human Values in Health Care is pleased to announce plans for the
          seventh annual Pitts Memorial Lectureship in Medical Ethics to be held at the Medical
          University of South Carolina.  Please check back later for more information about this
          upcoming event.  To learn more about Dr. Pitts, click here

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