Author Archives: Kirsten Ostherr

History of Medical Records Systems from 19th to 21st century on Connexions

Guest post by Olivia Bannergraphics5

I’ve just posted A History of Medical Records on Connexions (a Rice University-based repository for online learning modules). By showing medical record systems from the nineteenth century through the present, this project illustrates how the physician/patient encounter has been recorded, and the accompanying text begins to tease out what we can learn from the forms such records have taken.

When we teach about the history of medicine, students often take it for granted that medical records sit outside of history: that it is obvious what a hospital or a doctor would want to measure and record about their patients. Yet that information has changed over time, and what a hospital or a doctor selects as significant enough to record tells us much about the needs of medical institutions as well as what goes on within the physician-patient encounter. In addition, the format for those records has undergone constant transformations due to the introduction of new technologies, or changes in institutional needs, etc., and their format reveals much about medical practice.

The project is still in progress, and the materials I have been able to gather have been limited by what archives have saved (and medical records, seen as the stuff of bureaucracy, are often not considered important for the historical record) as well as by concerns about privacy. Materials from Los Angeles and Boston archives will be added in future months. Nevertheless, what is included here will help us all learn more about the history of medicine as it moved from the analog to the digital age.

Louis Pasteur Visits Medical Futures Lab

Portrait of Louis Pasteur

Way back in 1895, a French physician by the name of M. Jeanne attempted to persuade his fellow doctors that big changes were coming to the field of medicine. As he wrote in the Concours Médical,

“It may not be too soon to look ahead into the future that the scientific revolution, brought about by the beneficent discoveries of the illustrious Pasteur and his school, has in store for the medical profession. […] Diagnosis, that primordial element of our art, will soon no longer be able to do without the microscope, bacteriological or chemical analysis, cultures, inoculations, in a word everything that may give our clinical judgments absolutely precise data. […] Let us go back to school, and prepare the ground for an evolution, if we are to avoid a revolution.” 

We’re using Bruno Latour’s The Pasteurization of France (1984) – the source of the quote –  in my graduate seminar, “Emergent Media: Technologies, Networks, Culture” at Rice University. Our focus is on the complex interplay between the emergence of new media technologies in different historical periods (past, present and future), the networks of commerce and creativity that fuel and arise from these innovations, and the cultural productions that result. While much of our reading looks forward at digital interfaces, we can learn a lot about contemporary evolutions and revolutions by looking back – and the bacteriological revolution was about as disruptive as they get. But the key point is that it was a revolution that came from outside of medicine, and it only gained momentum through an accumulation of forces, including professionals and the lay public, who all felt they shared a common goal.

In one hundred years, will we have a Louis Pasteur of digital medicine? Will the eventual embrace of digital tools seem as obvious then as the embrace of bacteriology seems to us now?

Latour argues that physicians in France finally joined the Pasteurians only after the development of the diptheria serum, which required the doctors’ services to diagnose the disease. By devising a serum that treated but did not prevent disease, the Pasteur group allowed doctors to keep their jobs and get on the bacteriology bandwagon without losing face. What will be the magic serum that allows medicine to join the digital revolution? Self-tracking? Personalized genomics? 3-D printing? Whatever it is, history tells us that it will only take over by making itself seem inevitable.

 

Transmedia Hackathon @ OEDK!

OEDKEarlier this week the Medical Futures Lab parachuted into Matthew Wettergreen’s class in the Oshman Engineering Design Kitchen at Rice University to run a two-day transmedia hackathon inside a summer engineering design course. Our goal: explore how the visual and narrative representation of problems shapes our ability to find solutions to those problems. Students engaged in a series of experiments using different communication and representational tools to develop their understanding of how the form of representation for a problem shapes the way we analyze and solve that problem. By exploring with different tools, students saw different dimensions of their problems, which included doctor-patient communication about a variety of complex subjects, including risks & benefits of genome sequencing, end-of-life conversations, and talking about socially uncomfortable topics.

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Peter Killoran started things off with a narrative medicine + EMR re-design warm-up exercise, routed through two classics: IOM’s To Err is Human (1999) and Edward Tufte’s Visual Display of Quantitative Information (1992). We spent a lot of time talking about the role of storytelling in design, and then these incredible students went about prototyping (in about 90 minutes) consumer-facing EHRs that could also be useful to clinicians. The beauty of the non-expert approach was definitely on display, as these young creatives weren’t hampered by all the restrictive protocol (HIPPA, can you hear me?) and instead could concentrate on the core message: get the patient’s story into the EMR.

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Later in the day, Allison Hunter ran the group through some eye-opening visual arts exercises in flow-charts and mood-boards. The next morning, I launched the group into a session on doing things with words. We did exercises on metaphor, simile, and analogy, both textual and visual. We also worked on point-of-view as a critical dimension of design. After a final session on storyboarding with Allison, students were tasked with a problem to solve using a set of tools (written, visual, moving image, audio), and at the end of the hackathon they presented their experience of experimenting and identifying which tool best helped them develop a solution to the problem.

This was a laboratory designed to generate ideas and strategy for the Medical Media Arts Hub, and my big take-homes included affirmation (again) that collaboration across difference is truly critical to engineering design, to medical problem-solving, and to tackling the wicked problems of the world; that art+engineering+storytelling is the answer to many problems; and that listening to future users’ needs is everything. Mind-expanding experience, and fun to boot. Next time, we’re taking it public, so stay tuned – we’ll be seeking local “wicked problems” to tackle soon!

Angelina Jolie: Teaching Medicine through Literature

mastectomy tatooGuest post by Olivia Banner

I’ve been thinking a lot about Angelina Jolie’s New York Times op-ed (“My Medical Choice”) because I include a section on breast cancer when I teach Literature and Medicine for pre-med students. In her piece, Jolie reveals that she underwent a double mastectomy after testing for the BRCA1 gene; she had reconstruction and implants too.

In my class, we read poet Audre Lorde’s Cancer Journals: she too underwent a double mastectomy but had no follow-up surgeries, and she criticizes the assumption that every woman will immediately want reconstructive work and implants. Lorde recounts a visit by a health care worker, who assumed Lorde would want implants and who encouraged Lorde – for the sake of her emotional heatlh – to get them. Lorde refuses the treatment, and she is very clear that within that encouragement lurks a culture that values women according to their desirability, and that assumes a woman’s emotional health will be influenced by how well she fits into cultural norms for appearance. Lorde’s story often surprises my students: many of them too assume all post-mastectomy women must want implants.

It is especially interesting to hear students respond to the health care worker’s visit, as they come to terms with what this scene reveals: many medical professionals have internalized this way of valuing women, and such encouragement reinforces cultural expectations for bodies, without actually addressing real health concerns (such as the high rate of complications after reconstruction and implant surgeries).

Many people called Jolie’s revelation brave: for some people there was bravery in undergoing the arduous surgeries themselves; for other people, it was brave of a woman whose career depends partly on her breasts to reveal that she’d had them removed. Yet perhaps the even braver choice would have been, like Lorde, to refuse reconstructive surgery and implants. To what extent, I wonder, did Jolie’s physicians encourage her this decision? This may seem a silly question — again, after all, her career has been built on her physical attributes. But it’s an important question for women generally. (A follow-up article in the New York Times stated that in fact many women feel pressured by physicians to get larger implants.

One of the issues I ask students to examine throughout our Literature and Medicine course is whether certain assumptions that we’re socialized into — assumptions regarding norms of appearance and behavior — might make it hard for them, once they’re physicians, to see the alternatives to standard treatments that patients might wish to pursue.

We examine how people make art out of their post-mastectomy bodies, through chest tattooing and other visual works, so that students can consider other ways to conceive what makes a body beautiful. What else should we be looking at?

Millennial Medicine symposium videos are up!

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Marc Triola’s talk featured NYU’s Virtual Anatomy Lab

All of the fabulous talks from our speakers at Millennial Medicine are now up on the Medical Futures Lab website under a new tab called “Videos.” Check them out, let us know what you think, and stay tuned for more as yet unseen content from that event in the weeks and months to come.

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