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Deborah Kasman

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I am a family physician, bioethicist, and mother. My interests are in the ethics of the provider-patient relationship, with a focus on the ethics of uncertainty, or 'not knowing' in clinical decisions, as well as support for healthy provider well being as an ethical issue. I enjoy painting, hiking and writing.
Phone: 206-724-6456

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Kathryn Hurlock

Manchester Metropolitan University

San Diego State University

École Normale Supérieure de Lyon

Yale University

Manchester Metropolitan University

FURG - Universidade Federal do Rio Grande

Tribhuvan University (IOM)

Alvernia University

Brandeis University

University of East London

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Papers by Deborah Kasman

Doctors Have Feelings Too

Annals of Internal Medicine, Aug 15, 1994

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

Journal of General Internal Medicine, 2007

BACKGROUND: Improving physician health and performance is critical to successfully meet the chall... more BACKGROUND: Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE: To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being.

An Ethics of Unknowing: Discerning Ethical Patient-Provider Interactions in Clinical Decision-Making

Narrative Inquiry in Bioethics, 2020

There is an irreducible amount of uncertainty in clinical decision-making. Both health care provi... more There is an irreducible amount of uncertainty in clinical decision-making. Both health care providers and patients experience anxiety elicited by clinical uncertainty, and this can lead to missed opportunities for healthy shared decision-making. In order to improve the patient-provider relationship and the ethical qualities of decision-making, the provider first needs to recognize where his/her "unknowing" exists. This article presents a model for a unique ethics of unknowing by identifying three levels at which the provider's knowledge or lack thereof impacts clinical decision-making. The model illuminates ethical choices that providers can make to promote healthy patient-provider relationships. The means by which an ethics of unknowing informs shared decision-making in patient care will be exemplified through a case study of one patient's encounters with several physicians while making difficult decisions throughout her breast cancer journey.

The Clinical Bioethicist’s Role: Should We Aim to Relieve Suffering?

Narrative Inquiry in Bioethics, 2016

Bioethics consultants arrive at their profession from a variety of prior experiences (e.g., as ph... more Bioethics consultants arrive at their profession from a variety of prior experiences (e.g., as physicians, nurses, or social workers), yet all clarify ethical issues in the care of patients. The integrated bioethicist’s role often extends beyond case consultations. This case presents a young person suffering a prolonged and gruesome end–of–life journey, which raised questions regarding the bioethicist’s role in alleviating suffering as part of the health care team. The case is used to illuminate forms of suffering experienced by patients, families, and health care providers. The question arises as to whether it is in the ethicist’s jurisdiction to alleviate suffering, and if the answer is “yes,” then whose suffering should be addressed? The discussion addresses one approach taken by an integrated bioethicist toward promoting delivery of ethical and compassionate care to the patient.

Literature and the arts in medical education

Family medicine, 2000

In this column, teachers who are currently using literary and artistic materials as part of their... more In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at

Communication between older women and physicians: Preliminary implications for satisfaction and intention to have mammography

Patient Education and Counseling, 2006

Objective: To explore the associations between physician communication styles and their older pat... more Objective: To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. Methods: This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n = 7) and their female patients aged 65 years and older (n = 56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. Results: The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as ''deep'', ''trusting'' and ''bonding'' were more satisfied with communication than women who rated physician communication as less trusting ( p = 0.03, 0.02 and 0.02, respectively). Conclusion: Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. Practice implications: Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

When a Heart Stops

Annals of Internal Medicine, 1994

It was the summer of 1987 and the beginning of my last year of residency. Having easier rotations... more It was the summer of 1987 and the beginning of my last year of residency. Having easier rotations, I felt rested and wanted to earn some money. Northwest Emergency Physicians offered me a 24-hour shift at Moses Lake emergency room. It was a chance to earn good money and to travel to eastern Washington, the arid part of the state I had not seen since driving across the country 2 years earlier to begin my residency. Loving explorations, I accepted their offer. The night before the journey my mind swam in excited and apprehensive thoughts as the minutes sped by. What cases would I see? Was I fully trained for my work? What were the people like in rural Washington? Finally, I dozed off. Three a.m. arrived before I knew it. The lights of the city were low, and thick clouds covered the silent black Seattle sky. A cool breeze brushed my bare skin as I started my car and headed for the highway. I rolled the window down to wake up, rolled it up to warm up, and down again to feel alive and alert in the cold night air. After driving through mountain passes in total darkness, the soft rolling acres of farmland were a pleasant surprise in the morning light. Sprinklers filled the sky with a fine mist as cows grazed and tractors plowed. The Columbia River snaked through the countryside and I-90 stretched on forever. I arrived at the small rural hospital just before 7 a.m. The staff greeted me warmly and gave a quick tour of the ER. They showed me their fully equipped treatment room, where the supplies were stored, and how to fill out billing slips. The nurse asked if I was tired from the drive and said, It's usually quiet in the morning. Why don't you rest? I headed upstairs to the doctors' room for a nap. I was drifting off to sleep when the telephone rang. Get down here stat. We have a head injury. Click. I shoved on my shoes, popped in my contacts, and raced down the stairs to the treatment room. The scene was terrifying. One nurse pounded out chest compressions on a ghostly white boy while the respiratory technician squeezed the oxygen bag. I looked over my shoulder hoping to see another doctor. The hall was empty. I wanted to run away. The glaring hospital room with its whirring ventilator and anxious staff working on the boy filled me with dread. My heart and head began to pound. Page the pediatrician and the surgeon! I shouted. I placed my hand on the boy's cold wrist. I couldn't find a pulse. I came to my senses and started running his code. I had never resuscitated a child before. This blond-haired boy looked about ten or eleven. Franticdesperateto revive him, I placed the paddles on his chest. The monitor showed a flat line. Everyone back, I shouted and delivered the shock. His small body jerked. There still was no heart rhythm. Continue CPR, I commanded. I recharged. Everyone back, I said and delivered another shock. He jerked again. Still no life rhythm. Epinephrine, I yelled. I called for intubation. The respiratory technician looked at me as though I were crazy. As air was pressed into the boy's lungs, half of it bubbled out of a huge crack in his skull. What could be left of his brain? I had to do something! As I watched his chest move up and down with the breaths delivered, I decided to start an IV line. Unable to feel a femoral pulse, I placed a large-bore needle into his cold, pasty skin, searching for a vessel. My needle came back dry. Maybe a subclavian! The chest compressions stopped me. I looked at the boy's outstretched form, then at the nurses. Three faces stared back at me. The senior nurse shook her head. What's the use? I thought. I knew in my heart his soul had already left. You can stop now. Thank you for your help, I said. Everyone sighedexcept me. I felt a pain I had never known before. My chest felt empty, as if my own heart had stopped . I thought about his family. I had to tell his parents that their son was dead. Too late, the pediatrician came running in. She took one look at the boy, looked away, and left. She did not speak to me. She was gone, leaving me alone in this sterile room filled with antiseptic solutions. Finally, I asked for the story. There had been a car accident 20 miles away on I-90that long stretch of road that seemed so romantic to me earlier this morning. The same morning a family of five left Spokane on a trip with their two daughters in the back seat (wearing their seat belts) and their son on a mattress in the back of the van. Mom was driving while Dad slept in the passenger seat. The mother dozed. The van veered off the road and rolled over, throwing the boy from the van. His father ran to him and held him until a motorist stopped and sped them to the nearest hospital. The ER staff moved the boy, who had breathed his final breath in his father's arms, into the treatment room and began CPR. The child was dead on arrival, and resuscitation was a long-lost dream. Could another doctor have saved him? This was the first time in my experience that an unstable patient…

Educating for Professionalism

Academic Medicine, 2003

The practice of medicine triggers a broad range of feelings and emotions that are a challenge to ... more The practice of medicine triggers a broad range of feelings and emotions that are a challenge to manage, including despair, frustration, anger, and elation. 1,2 Yet, physicians are being asked to attain ''emotional intelligence ,'' 3,4 defined as the means to perceive and express emotion and regulate emotions in self and others. Competencies required to become emotionally intelligent include understanding one's own emotions, knowing and using appropriate words for feelings, and developing insight and empathy into emotions of others. 5,6 Emotionally intelligent physicians facilitate improved patient satisfaction 7 and respond empathetically to emotions of patients. 8,9 Physicians who capably manage their emotions are also more likely to avoid depression and burnout, 10 steer clear of ABSTRACT Purpose. To assess day-today emotions and the experiences that trigger these emotions for medical trainees in hospital settings. The overarching goal was to illuminate training experiences that affect professional behaviors of physicians. Method. This qualitative study, conducted April-June 2000, used semistructured, open-ended interviews, observations by a non-participant, and a self-report task at two inpatient services (internal medicine and pediatrics) at different hospitals within a single academic institution in the northwestern United States. Twelve team members, including medical students, interns, residents, and attendings, were invited to participate. Ten completed all aspects of the study. Interviews were conducted before and after a one-week period of nonparticipant observations and self-report tasks. The authors grouped emotional experiences into ''positive'' or ''difficult'' emotions. Data were analyzed for coherent themes using grounded theory and content analysis. Results. Positive emotions included gratitude, happiness, compassion, pride, and relief, and were triggered by connections with patients and colleagues, receiving recognition for one's labors, learning, being a part of modern medicine, and receiving emotional support from others. Difficult emotions included anxiety, guilt, sadness, anger, and shame and were triggered by uncertainty, powerlessness, responsibility, liability, lack of respect, and a difference in values. Tragedy and patients' suffering was the only trigger to elicit both positive (compassion) and difficult (sadness) emotions. Conclusion. This study identified common and important emotions experienced by medical trainees and the common triggers for these emotions. Understanding trainees' experiences of uncertainty, powerlessness, differing values, and lack of respect can guide education program designs and reforms to create an environment that fosters professional growth.

Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education

Journal of Medical Humanities, 2006

Personal, creative writing as a process for reflection on patient care and socialization into med... more Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being-are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.

The Work of ASBH's Clinical Ethics Consultation Affairs Committee: Development Processes Behind Our Educational Materials

The Journal of clinical ethics, 2018

The authors of this article are previous or current members of the Clinical Ethics Consultation A... more The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work.

Doctor, are you listening?" A writing and reflection workshop

Family medicine, 2004

Editor’s Note: In this column, teachers who are currently using literary and artistic materials a... more Editor’s Note: In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at University of California, Irvine, Department of Family Medicine, 101 City Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714456-7984. [email protected].

The right to know--but at what cost?

This case scenario, submitted by the patient’s son, brings up three interesting ethical questions... more This case scenario, submitted by the patient’s son, brings up three interesting ethical questions. The first question involves whether it is ever ethically justifiable to withhold information from patients, and if so, under what circumstances? The second question is: who decides whether invasive medical procedures should be offered to a given patient? The last question is: does the patient have a right to determine his own health care?

When is medical treatment futile? A guide for students, residents, and physicians

A difficult ethical conundrum in clinical medicine is determining when to withdraw or withhold tr... more A difficult ethical conundrum in clinical medicine is determining when to withdraw or withhold treatments deemed medically futile. These decisions are particularly complex when physicians have less experience with these discussions, when families and providers disagree about benefits from treatment, and when cultural disparities are involved in misunderstandings. This paper elucidates the concept of "medical futility," demonstrates the application of futility to practical patient care decisions, and suggests means for physicians to negotiate transitions from aggressive treatment to comfort care with patients and their families. Ultimately, respect of persons and beneficent approaches can lead to ethically and morally viable solutions.

Writing to Heal Thyself: Physician as Person & Person as Physician

Journal for Learning through the Arts

Socialization in medical training: Exploring "lifelong curiosity" and a "community of support

The American Journal of Bioethics, Feb 1, 2004

Doctor, are you listening?" A writing and reflection workshop

Family medicine, 2004

... Listening to Self and Others Participants are paired up to read their newly created lists to ... more

The right to know--but at what cost?

American family physician, 2004

Physicians' feelings: toward a balance in medical education

Western Journal of Medicine, 2001

Socialization in Medical Training: Exploring "Lifelong Curiosity" and a "Community of Support

The American Journal of Bioethics, 2004

Knowledge as Power: The Impact of Normativity on Epistemology

The American Journal of Bioethics, 2003

Doctors Have Feelings Too

Annals of Internal Medicine, Aug 15, 1994

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

Journal of General Internal Medicine, 2007

BACKGROUND: Improving physician health and performance is critical to successfully meet the chall... more BACKGROUND: Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE: To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being.

An Ethics of Unknowing: Discerning Ethical Patient-Provider Interactions in Clinical Decision-Making

Narrative Inquiry in Bioethics, 2020

There is an irreducible amount of uncertainty in clinical decision-making. Both health care provi... more There is an irreducible amount of uncertainty in clinical decision-making. Both health care providers and patients experience anxiety elicited by clinical uncertainty, and this can lead to missed opportunities for healthy shared decision-making. In order to improve the patient-provider relationship and the ethical qualities of decision-making, the provider first needs to recognize where his/her "unknowing" exists. This article presents a model for a unique ethics of unknowing by identifying three levels at which the provider's knowledge or lack thereof impacts clinical decision-making. The model illuminates ethical choices that providers can make to promote healthy patient-provider relationships. The means by which an ethics of unknowing informs shared decision-making in patient care will be exemplified through a case study of one patient's encounters with several physicians while making difficult decisions throughout her breast cancer journey.

The Clinical Bioethicist’s Role: Should We Aim to Relieve Suffering?

Narrative Inquiry in Bioethics, 2016

Bioethics consultants arrive at their profession from a variety of prior experiences (e.g., as ph... more Bioethics consultants arrive at their profession from a variety of prior experiences (e.g., as physicians, nurses, or social workers), yet all clarify ethical issues in the care of patients. The integrated bioethicist’s role often extends beyond case consultations. This case presents a young person suffering a prolonged and gruesome end–of–life journey, which raised questions regarding the bioethicist’s role in alleviating suffering as part of the health care team. The case is used to illuminate forms of suffering experienced by patients, families, and health care providers. The question arises as to whether it is in the ethicist’s jurisdiction to alleviate suffering, and if the answer is “yes,” then whose suffering should be addressed? The discussion addresses one approach taken by an integrated bioethicist toward promoting delivery of ethical and compassionate care to the patient.

Literature and the arts in medical education

Family medicine, 2000

In this column, teachers who are currently using literary and artistic materials as part of their... more In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at

Communication between older women and physicians: Preliminary implications for satisfaction and intention to have mammography

Patient Education and Counseling, 2006

Objective: To explore the associations between physician communication styles and their older pat... more Objective: To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. Methods: This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n = 7) and their female patients aged 65 years and older (n = 56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. Results: The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as ''deep'', ''trusting'' and ''bonding'' were more satisfied with communication than women who rated physician communication as less trusting ( p = 0.03, 0.02 and 0.02, respectively). Conclusion: Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. Practice implications: Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

When a Heart Stops

Annals of Internal Medicine, 1994

It was the summer of 1987 and the beginning of my last year of residency. Having easier rotations... more It was the summer of 1987 and the beginning of my last year of residency. Having easier rotations, I felt rested and wanted to earn some money. Northwest Emergency Physicians offered me a 24-hour shift at Moses Lake emergency room. It was a chance to earn good money and to travel to eastern Washington, the arid part of the state I had not seen since driving across the country 2 years earlier to begin my residency. Loving explorations, I accepted their offer. The night before the journey my mind swam in excited and apprehensive thoughts as the minutes sped by. What cases would I see? Was I fully trained for my work? What were the people like in rural Washington? Finally, I dozed off. Three a.m. arrived before I knew it. The lights of the city were low, and thick clouds covered the silent black Seattle sky. A cool breeze brushed my bare skin as I started my car and headed for the highway. I rolled the window down to wake up, rolled it up to warm up, and down again to feel alive and alert in the cold night air. After driving through mountain passes in total darkness, the soft rolling acres of farmland were a pleasant surprise in the morning light. Sprinklers filled the sky with a fine mist as cows grazed and tractors plowed. The Columbia River snaked through the countryside and I-90 stretched on forever. I arrived at the small rural hospital just before 7 a.m. The staff greeted me warmly and gave a quick tour of the ER. They showed me their fully equipped treatment room, where the supplies were stored, and how to fill out billing slips. The nurse asked if I was tired from the drive and said, It's usually quiet in the morning. Why don't you rest? I headed upstairs to the doctors' room for a nap. I was drifting off to sleep when the telephone rang. Get down here stat. We have a head injury. Click. I shoved on my shoes, popped in my contacts, and raced down the stairs to the treatment room. The scene was terrifying. One nurse pounded out chest compressions on a ghostly white boy while the respiratory technician squeezed the oxygen bag. I looked over my shoulder hoping to see another doctor. The hall was empty. I wanted to run away. The glaring hospital room with its whirring ventilator and anxious staff working on the boy filled me with dread. My heart and head began to pound. Page the pediatrician and the surgeon! I shouted. I placed my hand on the boy's cold wrist. I couldn't find a pulse. I came to my senses and started running his code. I had never resuscitated a child before. This blond-haired boy looked about ten or eleven. Franticdesperateto revive him, I placed the paddles on his chest. The monitor showed a flat line. Everyone back, I shouted and delivered the shock. His small body jerked. There still was no heart rhythm. Continue CPR, I commanded. I recharged. Everyone back, I said and delivered another shock. He jerked again. Still no life rhythm. Epinephrine, I yelled. I called for intubation. The respiratory technician looked at me as though I were crazy. As air was pressed into the boy's lungs, half of it bubbled out of a huge crack in his skull. What could be left of his brain? I had to do something! As I watched his chest move up and down with the breaths delivered, I decided to start an IV line. Unable to feel a femoral pulse, I placed a large-bore needle into his cold, pasty skin, searching for a vessel. My needle came back dry. Maybe a subclavian! The chest compressions stopped me. I looked at the boy's outstretched form, then at the nurses. Three faces stared back at me. The senior nurse shook her head. What's the use? I thought. I knew in my heart his soul had already left. You can stop now. Thank you for your help, I said. Everyone sighedexcept me. I felt a pain I had never known before. My chest felt empty, as if my own heart had stopped . I thought about his family. I had to tell his parents that their son was dead. Too late, the pediatrician came running in. She took one look at the boy, looked away, and left. She did not speak to me. She was gone, leaving me alone in this sterile room filled with antiseptic solutions. Finally, I asked for the story. There had been a car accident 20 miles away on I-90that long stretch of road that seemed so romantic to me earlier this morning. The same morning a family of five left Spokane on a trip with their two daughters in the back seat (wearing their seat belts) and their son on a mattress in the back of the van. Mom was driving while Dad slept in the passenger seat. The mother dozed. The van veered off the road and rolled over, throwing the boy from the van. His father ran to him and held him until a motorist stopped and sped them to the nearest hospital. The ER staff moved the boy, who had breathed his final breath in his father's arms, into the treatment room and began CPR. The child was dead on arrival, and resuscitation was a long-lost dream. Could another doctor have saved him? This was the first time in my experience that an unstable patient…

Educating for Professionalism

Academic Medicine, 2003

The practice of medicine triggers a broad range of feelings and emotions that are a challenge to ... more The practice of medicine triggers a broad range of feelings and emotions that are a challenge to manage, including despair, frustration, anger, and elation. 1,2 Yet, physicians are being asked to attain ''emotional intelligence ,'' 3,4 defined as the means to perceive and express emotion and regulate emotions in self and others. Competencies required to become emotionally intelligent include understanding one's own emotions, knowing and using appropriate words for feelings, and developing insight and empathy into emotions of others. 5,6 Emotionally intelligent physicians facilitate improved patient satisfaction 7 and respond empathetically to emotions of patients. 8,9 Physicians who capably manage their emotions are also more likely to avoid depression and burnout, 10 steer clear of ABSTRACT Purpose. To assess day-today emotions and the experiences that trigger these emotions for medical trainees in hospital settings. The overarching goal was to illuminate training experiences that affect professional behaviors of physicians. Method. This qualitative study, conducted April-June 2000, used semistructured, open-ended interviews, observations by a non-participant, and a self-report task at two inpatient services (internal medicine and pediatrics) at different hospitals within a single academic institution in the northwestern United States. Twelve team members, including medical students, interns, residents, and attendings, were invited to participate. Ten completed all aspects of the study. Interviews were conducted before and after a one-week period of nonparticipant observations and self-report tasks. The authors grouped emotional experiences into ''positive'' or ''difficult'' emotions. Data were analyzed for coherent themes using grounded theory and content analysis. Results. Positive emotions included gratitude, happiness, compassion, pride, and relief, and were triggered by connections with patients and colleagues, receiving recognition for one's labors, learning, being a part of modern medicine, and receiving emotional support from others. Difficult emotions included anxiety, guilt, sadness, anger, and shame and were triggered by uncertainty, powerlessness, responsibility, liability, lack of respect, and a difference in values. Tragedy and patients' suffering was the only trigger to elicit both positive (compassion) and difficult (sadness) emotions. Conclusion. This study identified common and important emotions experienced by medical trainees and the common triggers for these emotions. Understanding trainees' experiences of uncertainty, powerlessness, differing values, and lack of respect can guide education program designs and reforms to create an environment that fosters professional growth.

Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education

Journal of Medical Humanities, 2006

Personal, creative writing as a process for reflection on patient care and socialization into med... more Personal, creative writing as a process for reflection on patient care and socialization into medicine ("reflective writing") has important potential uses in educating medical students and residents. Based on the authors' experiences with a range of writing activities in academic medical settings, this article sets forth a conceptual model for considering the processes and effects of such writing. The first phase (writing) is individual and solitary, consisting of personal reflection and creation. Here, introspection and imagination guide learners from loss of certainty to reclaiming a personal voice; identifying the patient's voice; acknowledging simultaneously valid yet often conflicting perspectives; and recognizing and responding to the range of emotions triggered in patient care. The next phase (small-group reading and discussion) is public and communal, where sharing one's writing results in acknowledging vulnerability, risk-taking, and self-disclosure. Listening to others' writing becomes an exercise in mindfulness and presence, including witnessing suffering and confusion experienced by others. Specific pedagogical goals in three arenas-professional development, patient care and practitioner well-being-are linked to the writing/reading/listening process. The intent of presenting this model is to help frame future intellectual inquiry and investigation into this innovative pedagogical modality.

The Work of ASBH's Clinical Ethics Consultation Affairs Committee: Development Processes Behind Our Educational Materials

The Journal of clinical ethics, 2018

The authors of this article are previous or current members of the Clinical Ethics Consultation A... more The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work.

Doctor, are you listening?" A writing and reflection workshop

Family medicine, 2004

Editor’s Note: In this column, teachers who are currently using literary and artistic materials a... more Editor’s Note: In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and speculate about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at University of California, Irvine, Department of Family Medicine, 101 City Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714456-7984. [email protected].

The right to know--but at what cost?

This case scenario, submitted by the patient’s son, brings up three interesting ethical questions... more This case scenario, submitted by the patient’s son, brings up three interesting ethical questions. The first question involves whether it is ever ethically justifiable to withhold information from patients, and if so, under what circumstances? The second question is: who decides whether invasive medical procedures should be offered to a given patient? The last question is: does the patient have a right to determine his own health care?

When is medical treatment futile? A guide for students, residents, and physicians

A difficult ethical conundrum in clinical medicine is determining when to withdraw or withhold tr... more A difficult ethical conundrum in clinical medicine is determining when to withdraw or withhold treatments deemed medically futile. These decisions are particularly complex when physicians have less experience with these discussions, when families and providers disagree about benefits from treatment, and when cultural disparities are involved in misunderstandings. This paper elucidates the concept of "medical futility," demonstrates the application of futility to practical patient care decisions, and suggests means for physicians to negotiate transitions from aggressive treatment to comfort care with patients and their families. Ultimately, respect of persons and beneficent approaches can lead to ethically and morally viable solutions.

Writing to Heal Thyself: Physician as Person & Person as Physician

Journal for Learning through the Arts

Socialization in medical training: Exploring "lifelong curiosity" and a "community of support

The American Journal of Bioethics, Feb 1, 2004

Doctor, are you listening?" A writing and reflection workshop

Family medicine, 2004

... Listening to Self and Others Participants are paired up to read their newly created lists to ... more

The right to know--but at what cost?

American family physician, 2004

Physicians' feelings: toward a balance in medical education

Western Journal of Medicine, 2001

Socialization in Medical Training: Exploring "Lifelong Curiosity" and a "Community of Support

The American Journal of Bioethics, 2004

Knowledge as Power: The Impact of Normativity on Epistemology

The American Journal of Bioethics, 2003