Starting a Life in Medicine Around Inclusivity

 By Zoe Kornberg, writing from University of California, San Francisco

For new student orientation, I joined my first-year classmates on the Mission Bay campus for an intensive boot camp on the most widely applicable clinical procedure we will use as doctors: communication.

Dozens of faculty and staff members led the incoming class in a newly expanded diversity, bias, and inclusion training, which was developed in response to the past year’s events at UCSF and beyond. The deaths of Eric Garner and Michael Brown, among many others, at the hands of non-indicted police officers, have led to a surge of activism and awareness about racial inequality at all levels. This consciousness has led many to call for change in how black people and other disadvantaged populations are treated in health and healthcare by foregrounding issues ranging from microaggressions to community health disparities.

A Calling for Our Generation

Denise Davis, MD, the principal organizer of the two-day training, said, “Given the events in the United States in the past year, given the [White Coats for Black Lives] ‘die-in,’ given the school’s leadership retreat on race and inequality…it seemed natural to expand this part of the orientation, unlike any other medical school, to work on increasing diversity and reducing bias.”

Dean Talmadge King, Jr., MD, welcomed us into the school with a delightful speech about his life and advice for medical students. He quoted Maya Angelou’s famous line, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” I found myself thinking back to these words of wisdom during orientation, as it concisely sums up many of the communication skills we learned and practiced.

Catherine Lucey, MD, vice dean for education, gave an inspiring and memorable speech about being an intern at UCSF at the start of the HIV/AIDS epidemic in the 1980s. Lucey recounted how UCSF mounted a coordinated and multi-pronged attack against this devastating epidemic to discover the causative agent, treatment and prevention options, and a cure. While the fight against HIV and AIDS is not over, another affliction to people’s health has reached crisis levels: health inequities. Eliminating health inequities is the calling for our generation of UCSF physicians.

Language of Inclusivity

Out of the conversations that followed the deaths of Garner and Brown, UCSF medical students founded a national organization, White Coats for Black Lives (WC4BL), and organized a “die-in” at medical schools across the country to raise awareness about health inequities, especially across racial lines.

As a featured speaker, third-year medical student and WC4BL co-founder Sidra Bonner explained the importance of the subjective in the SOAP (subjective, objective, assessment, and plan) note, the basic format of a doctor’s written notes about an encounter with a patient. Typically, the subjective is the patient’s subjective account of his or her symptoms—the chief complaint. Bonner turned that idea upside down and placed the subjective role on the clinician to avoid bias and intolerance while communicating with the patient. The O, A, and P will be useless and even detrimental to the patient if the S is distorted by prejudice.

The class learned acronyms to help remember effective communication styles and watched faculty demonstrate both successful and unsuccessful interactions. We learned to use “FIFE” (function, ideas, fears, and expectations) as a guide when asking a patient open-ended questions about his or her perspective. For example, rather than asking a patient, “Do you think you have an infection?” ask “What do you think could be causing your symptoms?”

For several hours each day, over 150 students separated into groups of seven or eight to practice the communication methods and have the opportunity to give and receive constructive feedback—another critically important skill we will use in medical school. On the second day, the class watched a staged microaggression between two faculty members. The conversation was painful and awkward; we split up into our small groups to discuss what we had just witnessed. In my group, we pinpointed exactly which words and sentences used showed bias and why and discussed how a bystander to this conversation might interject appropriately.

First-year students, Hanna Burch and Alex Withers, appreciated the opportunity to break down into small groups. Burch said, “The small groups…gave us a chance to create a safe space for learning about racial bias and inclusion.” Withers expressed a similar sentiment, commenting, “I felt that all opinions were welcome in the discussion, regardless of the sensitivity of the topic, and all of us followed the mantra of ‘positive intent’ really sincerely.”

Some students have already experienced the benefits of learning about and practicing good communication habits. First-year student Jorge Mena did not expect to participate in such a comprehensive training in the first week of medical school. He said, “It has already had a tremendous impact on my daily life. I have recognized myself making quick judgments and slowed down.”

First-year student Ugomma Eze’s favorite parts of the orientation occurred when “the speakers, facilitators, and students shared their personal stories about how they grew up and what experiences shaped them. [These stories] demonstrated the importance of diversity in medicine.” First-year student Jordan Spatz felt that by hosting this orientation, UCSF showed it truly prioritizes diversity, remarking that it was “such an important topic for our medical education and sets a tone of inclusion for our medical education and beyond.”

 http://medschool.ucsf.edu/features/starting-life-medicine-around-inclusivity

Another Urban Legend? The Middle Ages Were the “Dark Ages”

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By David J. Theroux  •  Saturday April 11, 2015 9:28 PM PDT  • 

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As the culture wars intensify in America, let’s consider some of the roots of these contentious conflicts.

With the “Age of Enlightenment” of the 17th and 18th centuries, a “modern” narrative was invented to explain the history of the West, the wider world, and humankind’s place in the universe. This narrative claimed that liberty, democracy, republicanism and religious tolerance could only be achieved through an “Enlightenment project” of secularism taking control of both the public square and the commanding heights of society and that the abandonment of metaphysics and religious tradition were essential for human progress. Proponents of this narrative then included Denis Diderot, Voltaire, Jean-Jacques Rousseau, Edward Gibbon, and David Hume, and in the 19th century such writers as John Draper and Andrew Dickson White. With some exceptions, this worldview came to dominate western elite and popular thinking. However many historians have since increasingly challenged this narrative as fundamentally fallacious. Such historians as J.G.A. Pocock, Dale Van Kley, Derek Beales, and Jonathan Israel have discarded the claim of an exclusively secular “Enlightenment” and shown that there have been multiple and far more causal Enlightenments, based in various Catholic, Protestant and Jewish traditions. In addition and since the 1970s, historians of science Ronald L. Numbers, David V. Lindberg, and James R. Moore have refuted the erroneous and indeed propagandistic, secular claims of Draper and White that Christianity and science are adversarial.

Indeed, it has been these religious traditions that were primarily responsible for the revolutionary economic, legal, technological, and cultural changes that have uplifted the West, and that such changes began well before the 17th century. Sociologist Rodney Stark has shown that it was the Judeo-Christian tradition that produced all aspects of progress in the West, including the ideas of objective morality and truth, free-market capitalism, reason and science, natural law, individual liberty and the abolition of slavery and infanticide, civic virtue, and the rule of law. (Among his many notable books are The Victory of Reason, The Triumph of Christianity, How the West Won, and For the Glory of God.)

In “The Secular Theocracy,” I have also discussed the “Enlightenment project”‘s hypocritical and intolerant crusade that “exalts a sovereign and powerful state that pervades all of life and compels obedience not just to its mandates but to the secular nationalism of the Zeitgeist itself, for which the populace is forced to conform to and fund.”

Stark and others have further shown that the “secular Enlightenment” narrative rests upon numerous historical falsehoods that today are still taken for granted and commonly taught in schools. The following video discusses one such fallacy—why the Middle Ages were not the “Dark Ages,” including the “urban legend” that people then believed in a Flat Earth:

http://blog.independent.org/2015/04/11/another-urban-legend-were-the-middle-ages-really-the-dark-ages/

Forgotten Civil War atrocities bred more carnage

George Orwell wrote in 1945 that “the nationalist not only does not disapprove of atrocities committed by his own side, but he has a remarkable capacity for not even hearing about them.” The same moral myopia has carried over to most Americans’ understanding of the Civil War. While popular historians have recently canonized the war as a practically holy crusade to free the slaves, in reality civilians were intentionally targeted and brutalized in the final year of the war.

The most dramatic forgotten atrocity in the Civil War occurred 150 years ago when Union Gen. Philip Sheridan unleashed a hundred-mile swath of flames in the Shenandoah Valley that left vast numbers of women and children tottering towards starvation. Unfortunately, the burning of the Shenandoah Valley has been largely forgotten, foreshadowing how subsequent brutal military operations would also vanish into the Memory Hole.

In August 1864, supreme Union commander Ulysses S. Grant ordered Sheridan to “do all the damage to railroads and crops you can…. If the war is to last another year, we want the Shenandoah Valley to remain a barren waste.” Grant said that Sheridan’s troops should “eat out Virginia clear and clean as far as they go, so that crows flying over it for the balance of the season will have to carry their provender with them.” Sheridan set to the task with vehemence, declaring that “the people must be left nothing but their eyes to weep with over the war” and promised that when he was finished, the valley “from Winchester to Staunton will have but little in it for man or beast.”

Because people lived in a state that had seceded from the Union, Sheridan acted as if they had automatically forfeited their property, if not their lives. Along an almost 100-mile stretch the sky was blackened with smoke as his troops burned crops, barns, mills and homes.

War against civilians

Some Union soldiers were aghast at their marching orders. A Pennsylvania cavalryman lamented at the end of the fiery spree, “We burnt some sixty houses and all most of the barns, hay, grain and corn in the shocks for fifty miles [south of] Strasburg…. It was a hard-looking sight to see the women and children turned out of doors at this season of the year.” An Ohio major wrote in his diary that the burning “does not seem real soldierly work. We ought to enlist a force of scoundrels for such work.” A newspaper correspondent embedded with Sheridan’s army reported, “Hundreds of nearly starving people are going North … not half the inhabitants of the valley can subsist on it in its present condition.”

After one of Sheridan’s favorite aides was shot by Confederate soldiers, Sheridan ordered his troops to burn all houses within a five-mile radius. After many outlying houses had been torched, the small town at the center — Dayton — was spared after a federal officer disobeyed Sheridan’s order. The homes and barns of Mennonites — a peaceful sect that opposed slavery and secession — were especially hard hit by that crackdown, according to a 1909 history of Mennonites in America.

By the end of Sheridan’s campaign the former “breadbasket of the Confederacy” could no longer even feed the women and children remaining there. In his three-volume Civil War history, Shelby Foote noted that an English traveler in 1865 “found the Valley standing empty as a moor.” The population of Warren County, Virginia, where I grew up, fell by 11 percent during the 1860s thanks in part to Sheridan’s depredations.

Historian Walter Fleming, in his classic 1919 study, The Sequel to Appomattox, quoted one bedeviled local farmer: “From Harper’s Ferry to New Market, which is about eighty miles, the country was almost a desert…. The barns were all burned; chimneys standing without houses, and houses standing without roof, or door, or window.” John Heatwole, author of The Burning: Sheridan’s Devastation of the Shenandoah Valley (1998), concluded, “The civilian population of the Valley was affected to a greater extent than was the populace of any other region during the war, including those in the path of Sherman’s infamous march to the sea in Georgia.”

Unfortunately, given the chaos of the era at the end of the Civil War and its immediate aftermath, there are no reliable statistics on the number of women, children, and other civilians who perished thanks to “the burning.”

Abraham Lincoln congratulated Sheridan in a letter on Oct. 22, 1864: “With great pleasure I tender to you and your brave army the thanks of the nation and my own personal admiration and gratitude for the month’s operation in the Shenandoah Valley.” The year before, in his Gettysburg Address, Lincoln had justified the Civil War to preserve a “government by consent.” But, as Massachusetts abolitionist Lysander Spooner retorted, “The only idea … ever manifested as to what is a government of consent, is this — that it is one to which everybody must consent, or be shot.”

Some defenders of the Union military tactics insist that there was no intent to harshly punish civilians. But, after three years of a bloody stalemate, the Lincoln administration had adapted a total-war mindset to scourge the South into submission. As Sheridan was finishing his fiery campaign, Gen. William Sherman wrote to Grant that “until we can repopulate Georgia, it is useless to occupy it, but the utter destruction of its roads, houses, and people will cripple their military resources.” Sherman had previously telegrammed Washington that “there is a class of people — men, women, and children — who must be killed or banished before you can hope for peace and order.” Lincoln also congratulated Sherman for a campaign that sowed devastation far and wide.

The carnage inflicted by Sheridan, Sherman, and other northern commanders made the South’s postwar recovery far slower and multiplied the misery of both white and black survivors. Connecticut College professor Jim Downs’s recent book, Sick from Freedom, exposes how the chaotic situation during and after the war contributed to the deaths of hundreds of thousands of freed slaves.

Afterward

Ironically, a war that stemmed in large part from the blunders and follies of politicians on both sides of the Potomac resulted in a vast expansion of the political class’s presumption of power. An 1875 American Law Review article noted, “The late war left the average American politician with a powerful desire to acquire property from other people without paying for it.”

The sea change was clear even before the war ended. Sherman had telegraphed the War Department in 1863, “The United States has the right, and … the … power, to penetrate to every part of the national domain. We will remove and destroy every obstacle — if need be, take every life, every acre of land, every particle of property, everything that to us seems proper.” Lincoln liked Sherman’s letter so much that he declared that it should be published.

After the Civil War, politicians and many historians consecrated the conflict and its grisly tactics were consigned to oblivion. The habit of sweeping abusive policies under the rug also permeated post–Civil War policy towards the Indians (Sheridan famously declared that “the only good Indian is a dead Indian”) and the suppression of Filipino insurgents after the Spanish-American War. Later historians sometimes downplayed U.S. military tactics in World War II that killed vast numbers of German and Japanese civilians.

The same pattern is repeating with the Vietnam War. The Pentagon is launching a major effort to commemorate its 50th anniversary — an effort that is being widely denounced as a whitewash. The New York Times noted that the Pentagon’s official website on the war “referred to the 1968 My Lai massacre, in which American troops killed hundreds of Vietnamese civilians, as the My Lai Incident.” That particular line was amended but the website will definitely not be including the verdict of David Hackworth, a retired colonel and the most decorated officer in the Army: “Vietnam was an atrocity from the get-go…. There were hundreds of My Lais. You got your card punched by the numbers of bodies you counted.”

The failure to recognize how wars routinely spawn pervasive brutality and collateral deaths lowers Americans’ resistance to new conflicts that promise to make the world safe for democracy, or rid the world of evil, or achieve other lofty-sounding goals. For instance, the Obama administration sold its bombing of Libya as a self-evident triumph of good over a vile despot; instead, chaos reigns. As the administration ramps up bombing in Syria and Iraq, both its rhetoric and its tactics echo prior U.S. misfires. The proclaimed intentions of U.S. bombing campaigns are far more important than their accuracy. And the presumption of collective guilt of everyone in a geographical area exonerates current military leaders the same way it exonerated Sheridan’s 1864 torching of Mennonite homes.

Since 1864, no prudent American should have expected this nation’s wars to have happy or uplifting endings. Unfortunately, as long as the spotlight is kept off atrocities, most citizens will continue to underestimate the odds that wars will spawn debacles and injustices that return to haunt us.

SOURCE

Father Charles E. Coughlin



Father Coughlin first took to the airwaves in 1926, broadcasting weekly sermons over the radio. By the early 1930s the content of his broadcasts had shifted from theology to economics and politics. Just as the rest of the nation was obsessed by matters economic and political in the aftermath of the Depression, so too was Father Coughlin. Coughlin had a well-developed theory of what he termed "social justice," predicated on monetary "reforms." He began as an early Roosevelt supporter, coining a famous expression, that the nation's choice was between "Roosevelt or ruin." Later in the 1930s he turned against FDR and became one of the president's harshest critics. His program of "social justice" was a very radical challenge to capitalism and to many of the political institutions of his day.

Father Coughlin was an early and passionate supporter of President Roosevelt, since he viewed FDR as a radical social reformer like himself. Roosevelt's rhetoric during his inaugural address implicitly promised to "drive the money changers from the temple." This was music to Coughlin's ears since a core part of his own message was monetary reform. Roosevelt's early monetary policy seemed to fulfill this promise and so Coughlin viewed him as the savior of the nation. But when FDR failed to follow-on with additional radical reforms, Coughlin turned against him. By 1936, he would support a third-party candidacy against FDR's reelection bid and would even say this of Roosevelt:

"The great betrayer and liar, Franklin D. Roosevelt, who promised to drive the money changers from the temple, had succeeded [only] in driving the farmers from their homesteads and the citizens from their homes in the cities. . . I ask you to purge the man who claims to be a Democrat, from the Democratic Party, and I mean Franklin Double-Crossing Roosevelt."

Father Coughlin's influence on Depression-era America was enormous. Millions of Americans listened to his weekly radio broadcast. At the height of his popularity, one-third of the nation was tuned into his weekly broadcasts. In the early 1930s, Coughlin was, arguably, one of the most influential men in America. Although his core message was one of economic populism, his sermons also included attacks on prominent Jewish figures--attacks that many people considered evidence of anti-Semitism. His broadcasts became increasingly controversial for this reason, and in 1940 his superiors in the Catholic Church forced him to stop his broadcasts and return to his work as a parish priest.

http://www.ssa.gov/history/cough.html