Courses

Please note that all courses are offered at Brown unless otherwise indicated.

Design + Health (BIOL 6518)

Course Coordinators (2014): Pranav Reddy and Abdul Wasey
Course Coordinator and Founder (2013): Ravi Sarpatwari
Faculty Advisor: Jay Baruch

Through its intrinsic presence in our daily life, design has the capacity to influence health and well-being. The act of design is a fundamental response to create solutions that enhance our way of life, and it has shaped the world around us—from the built environments we live and work in, to the streets and highways that connect us, to the tools and products we use. As a result, design affects our experiences and behaviors on a variety of different scales. By enlisting design to support human health, designers possess a potent tool to tackle complex healthcare issues that we face today.

As part of a developing partnership between AMS and the Rhode Island School of Design, this course seeks to inform a new method for health care problem solving by actively bringing together medical and design students. Innovative solutions often require a multi-disciplinary team to create strategies, concepts and prototypes. By identifying specific barriers and problems within the medical field, this course will encourage students to think beyond their realm of expertise and to collaborate amongst their peers to create tangible solutions that can positively impact health.

Aims:

• To increase awareness of the capacity of design to influence health
• To foster collaboration and effective communication among the health and design disciplines
• To encourage critical thinking, creativity, and innovative solutions to address clinical and public health issues
• To create tangible and implementable design solutions for medical problems

Objectives:
On completion of this course, students should be able to:

• Demonstrate an understanding of the influence of design on health
• Serve as informed advocates for improved health outcomes through design
• Effectively collaborate in an interdisciplinary setting
• Critically evaluate healthcare problems through the lens of design
• Appreciate the need for rigorous health research to support effective design interventions
• Engage in continued explorations in the relationship between design and health
• To create longitudinal design and medical collaboration groups that could resolve ongoing medical design issues

Diseases, Doctors, and Divas: Opera and Medicine

For over four centuries, opera with its extravagance and melodrama has acutely captured our evolving understanding of disease processes from tuberculosis in Puccini’s La Bohème to HIV/AIDS in Larson’s rock opera Rent. While opera serves to prepare audiences emotionally for their own inevitable demise through staging poignant stories of human disease and mortality, it has also instilled ongoing stereotypes and stigma with which we label both patients and their doctors. In this unique interdisciplinary course, faculty from the medical, music, and foreign language departments will facilitate active discussion of topics ranging from “Tuberculosis and the Opera Heroine” to "Orthopedic Disorders in Opera“ to "Wozzeck: A Study in Medical Ethics.” Drawing upon live performances, video clips, scientific and literary articles, this course provides students with an overview of the historical and contemporaneous understandings of diseases and the role of the physicians who treat them.

Goals and Objectives:

• Evaluate the rich illness narratives portrayed in a series of operas
• Construct meaning through thematic explorations across operas and make linkages to the doctor-patient relationship
• Examine preconceived notions of illness and how this impacts patients and the patient- physician relationship
• Explore how opera reflects societal perceptions of disease, and in turn shapes those perceptions

No Innocent Eye: Knowledge and Interpretation in Art and Medicine (BROWN BIOL3710M, RISD0730Y)

Instructor(s): Jay Baruch, Kelly Auerbach

See the article "Beyond Comfort Zones: an experiment in medical and art education"
Journal for Learning through the Arts, 8(1)

Practicing medicine and creating art are both informed by observation and perception, yet how artists and doctors view the world and their place in it might be quite different. By bringing two populations together – RISD students and Brown medical students – this highly interdisciplinary course will examine the ways art and medicine have overlapped and entwined historically, and still do today. Through selected readings, discussion and creative assignments, we will discover the many ways creative and imaginative skills are essential to the ‘art’ of medicine.

Team-taught by Kelli Auerbach (RISD English) and Dr. Jay Baruch (The Alpert Medical School), and with the help of guest speakers from both Brown and RISD, the course will examine a range of topics that will inform the work of both doctors and artists. Examples include: how both fields figure the body; the ethics and challenges of understanding and treating pain; the role of enhancement technologies on identity and authenticity; shifting conceptions of normalcy; madness; mistakes; medical photography and illustration; medicine and eroticism; contemporary artists’ explorations of health and illness, as well as fiction and poetry by doctors.

Students should expect significant writing, readings of creative and critical texts, lively discussion, and both individual and collaborative projects (written, visual, and/or performance).

This course will allow both art and medical students to consider topics and foster skills not necessarily covered in art and medical school curriculums, but which will be invaluable in the actual practice of doctoring, the professional and personal growth of physicians, and the deepening of more finely nuanced knowledge and practice for artists.

Pragmatic Medical Humanities (BROWN HMN1970V)

Instructor(s): Jay Baruch

The question, “What is medical humanities?” has flummoxed the very experts who ardently argue for it’s importance to medical education and the professional and personal growth of health care providers. Rafael Campo, esteemed poet and physician, wrote in a JAMA essay that “no concept of the ‘medical humanities’ compels, caught somewhere between manifesto, mushiness, and marketing lingo.”

Individual persons harbor different meanings for the term, invest it with different values and goals. I believe humanities is elemental to the act of caring for patients. To fully respond to the sick and injured, one must not only attend to disease and physical damage, but appreciate the impact and meanings of illness and impairment. Through stories we tell ourselves and share with others, knowledge is constructed, experience is interpreted and we work towards shaping what we consider “right” and “good.”

Caring for the sick and injured is becoming an increasingly complex endeavor requiring more than clinical and technical expertise in a disorganized and unruly health care system. It requires creativity, sensitivity and imagination. The sciences don’t address the big, human questions that arise when patients face suffering and death, or prepare physicians to examine their own values, frailties, and capacity for compassion and tolerance. The medical humanities provides tools for fostering critical thinking skills, encourages respect for different and differing opinions, nurtures passion and curiosity, and fosters cross disciplinary discourse.

Medical humanities, regardless of definition, should be pragmatic. It should prove useful at the bedside as well as serve as a method of inquiry, a lens through which one’s moral imagination is given the necessary breadth and focus to successfully wrestle with complex and messy issues and ultimately respond in a thoughtful manner. Why is this important? The writer/physician William Carlos Williams once said, “...it is your response to the ethical questions that will make you what you are.” In fact, the word “Ethics” shares roots with the greek word for character, ethos. The medical humanities scholar Kathryn Montgomery wrote: “Ethics is practical knowledge, forged experientially and honed on circumstance...in narrative, inquiry is inseparable from explanation, narrators and audiences must test the sources of our stories, compare versions, and sustain an healthy skepticism about answers. Thus, narrative represents the conditions of moral discourse, even as it is the principal medium of that discourse.”

The interdisciplinary nature of medical humanities, engaging in conversations with persons who possess different expertise, different knowledge and different approaches to knowing, provides opportunities for examination and insight unavailable elsewhere.

During this seminar, students will investigate alternative meanings, interpretations and purposes embedded in the term “medical humanities.” They will develop their own personal relationship to this term, this field of study, and it’s utility as a tool for understanding and responding to the profound experiences of clinical medicine, illness and health.

Pain, Medicine, and Society (BROWN HMAN2970E)

Instructor(s): Jay Baruch, Christine Montross, Michael Steinberg, PhD

“To have pain is to have certainty, to listen to pain is to have doubt.”
Elaine Scarry

Pain is a mystery, an elusive, dancing ghost unlike anything else a physician treats. The roots of pain can’t be dissected, located on a CT scan, quantified through lab work. Associated with, or a manifestation of, certain diseases and injuries, pain is ultimately modulated and given significance by the mind. Shaped by the patient’s experience, pain must be validated and given legitimacy by health care providers before it can be understood and effectively treated.
Defining pain has proven to be a challenging endeavor, one that seems to substantiate the mystery rather than adding clarification. It has been said that definition isn’t the way to begin learning about pain, but rather “to explore the ways in which it tends to get away from us.”

Pain has been described as a state of crisis. Modern medicine, with a Western, technocratic world-view, misrepresents pain as purely a medical problem, the creation of anatomy and physiology, and ignores the experience of pain as phenomena of the mind, shaped by historical, cultural, and psychosocial factors 1 .

Translating a pain story can prove problematic when pain’s profound voicelessness is ephemeral, subjective, and defies categorization. The medical model, with its focus on objectification and identification, seems a deficient process through which to address meaning, and it ignores the relationship between pain and suffering.

Pain is soul destroying. Patients may be located in the doctor’s office or hospital room, but lost in their pain. Pain shadows their every move, disrupting lives at a basic level, affecting relationships, job performance, and the ability to think and reflect clearly. Pain eventually hijacks individuals from who they once were, taking away their self-identity, autonomy, and capacity to control their present and future. Pain can become their identity. Pain can be terribly isolating. Sometimes pain can only be identified indirectly, by attending to silences and metaphors, focusing on visual expressions and inconsistent stories.

Pain is embedded with moral implications. Are physicians even listening to the pain story, or are diagnostic and biological considerations trumping what the patient wants heard. What ought to be expected from physicians and caregivers when, as Arthur Frank said, “One of our most difficult duties as human beings is to listen to the voices of those who suffer.”
Ultimately, pain demands a response. Easing and relieving pain is an elemental human endeavor. Adults know they can often ease the pain of a child with a gentle rub, a kiss, a held hand, and yet, pain is universally undertreated in medicine. Studies over the past twenty years demonstrate little, if any, improvement in this endeavor. Regulatory bodies trumpeted the undertreatment of pain as a massive public health problem, a challenge that is complicated by the epidemic abuse patterns of prescription narcotic medications. Insensitive or inadequate attention to pain can devalue the patient’s experience, cause further isolation, push the person deeper into the dark shadows. For a profession that pledges to “do no harm,” the undertreatment of pain, or oligoanalgesia, borders on egregious ethical conduct 2 3 .
In this seminar, we take on the big question of pain as a truly interdisciplinary enterprise, drawing on the rich and varied faculty of Brown University and Alpert Medical School. We will examine acute and chronic pain, physical and psychic pain, individual and collective, social pain. We will also consider the nature of suffering; why certain people might find value, even solace, in pain and suffering; representations of pain in literature, art, and music; shifting conceptions of pain and suffering across cultural, ethnic and religious communities. We’ll examine the actual and perceived barriers to effective treatment of pain. Most importantly, we aim to foster sensitivity and impart tools that will improve our understanding and treatment of individuals of pain.
The seminar will attempt to engage question associated with both medical and humanistic education, including:

1. why pain can be so difficult to understand and treat.
2. multiple meanings meanings of pain, the consequences of uncontrolled pain and the importance of pain in our lives.
3. barriers to pain assessment and management
4. benefits of interdisciplinary investigation into complex problems.

Humanities as Medical Instruments (BIOL3710A)

Instructor(s):Kevin Liou, Jay Baruch

“To write prescriptions is easy, but to come to an understanding with people is hard.”
Franz Kafka, A Country Doctor

Much medical training is about information and knowledge and less about traveling the more difficult path of feeling…it’s crucial for doctors to stay with the feeling, listen feelingly, and not turn away from the pain and suffering in patients and themselves. There is one shining difference between knowledge and understanding: We doctors may forget knowledge, but we never forget what we understand. We understand through feeling.
Samuel Shem, “Fiction as Resistance”

The work of medicine is a complex endeavor that requires more than simply scientific knowledge and technical expertise. The sciences can give us tools to examine the anatomy and physiology of patients and the biochemical mechanisms of diseases, but they cannot help us feel the pain of others, or give us insight into human suffering. Scientific knowledge alone cannot teach us how to interpret the stories of patients, how to respond to their experiences, or how to make sense of their illnesses. To care for sick, we must turn to the humanities to gain a deeper, more nuanced understanding of how we live and suffer. In this interdisciplinary elective, students will have the opportunity to explore the pragmatic value of the humanities in medical practice and education.

Through the diverse lens of art, poetry, literature, graphic novels, comics, music, film, and performing arts, second-year medical students will acquire the clinical skills to translate their scientific knowledge into effective, compassionate care. They will also serve as teaching fellows for Integrated Clinical Arts, a series of interactive, humanities-based workshops designed to strengthen the clinical skills of first-year medical students, deepen their capacity for empathy, imagination, and creativity in medical practice, and foster new ways of thinking about medical issues.

Goals

1. Examine how the humanities provide essential, pragmatic tools for the work of medicine
2. Formulate and apply an interdisciplinary approach to medical education that strengthens the clinical skills of medical students and deepens their capacity for empathy, imagination, and creativity in medical practice
3. Promote new, diverse ways of thinking about medicine through collaboration with the humanities, arts, and sciences
4. Discover and develop one’s “voice” by teaching and mentoring fellow students

1	Morris DM: The Culture of Pain University of California Press, 1991.
2	Cherney NI, Catane R: Professional negligence in the management of cancer pain. Cancer 1995;76:2181.
3	Johnson SH: Relieving unnecessary treatable pain for the sake of human dignity. Journal of Law, Medicine, and Ethics 2001;29:1112.