Book Review: In Shock by Rana Awdish, MD

This May at the Cleveland Clinic Patient Experience Summit , I had the opportunity to hear a mind-blowing talk by a physician named Dr Rana Awdish. Her story was a personal account of how she literally died at her own hospital, losing her entire blood volume into her abdomen due to a ruptured liver tumor. Pregnant at the time, she lost the baby. She continued with her journey of pain, suffering, recovery, and healing while the audience sat pin drop silent, tears and sobbing audible. Her experiences as a patient transformed her understanding of medicine and how it should in actuality be practiced; with compassion, with empathy, and through making space for suffering and vulnerability. Needless to say, I couldn't wait to dive in to the pages of her book. Here's my review. 

Dr. Awdish tears down the walls housing her personal experiences as a doctor turned patient. She masterfully guides the reader through multiple vantage points: as a doctor expecting a child, to the loss of a child and her own “death”, to miraculous survival, painful determined recovery, multiple set backs, surgeries, and medical emergencies, with victories and profound revelations throughout.  You will need to put the book down to dry the tears that fall out of pure sympathy. The reader will experience complete disbelief that a single person could possibly endure such devastation, pain, and grief.  The story captivates with a raw authenticity, transporting the reader through a broad spectrum of emotions the reader couldn’t possibly be prepared to experience: disbelief, grief, devastation, sadness, victory, joy, and true hope.  Dr. Awdish’s deep inner reflections are juxtaposed with her seemingly endless battle for life, providing a thought-provoking framework for redefining the terms patient experience, patient engagement, doctor satisfaction, and the meaning of true healthcare. There is no doubt that medical education must be refreshed after experiencing this harrowing account.

Readers will undoubtedly leave this book permanently changed and rocked to the core. In Shock professes a convincing perspective on the need for compassion and human connection in medicine.  Dr. Awdish makes a clear case for the need for more empathy for doctors, patients, and their carepartners. She is a visionary enlightened by her profound experiences as a patient. This should be required reading by every medical and nursing student, every hospital administrator, technician, and staff member. There isn’t a single person who wouldn’t benefit from reading In Shock and experiencing the consequent opening of the soul first-hand. 

My (REJECTED) Letter to the Editor

          As a researcher, I can fully appreciate the review process and recognize that there is simply only so much space allotted in any given journal. My recent submission was a Letter to the Editor of the New England Journal of Medicine (NEJM) regarding a perspective “Saying Goodbye to Lectures in Medical School- Paradigm Shift or Passing Fad?” by Schwartzstein et al, on alternatives to traditional teaching formats in medical school.  Given the elite status of the NEJM, I wasn’t entirely surprised to receive a rejection. Perhaps my simple little opinion wasn’t written in cream-of-the-crop style. The more concerning alternative is that the submission was rejected because it was not representative of the masses of submissions received or the popular vote. Perhaps no one else feels strongly about incorporating patients and care partners in the design and delivery of medical education. I find this gravely alarming.

            Revising the manner in which knowledge is delivered, i.e., virtually, in Q&A sessions, flipped classrooms, augmented reality, etc., addresses only part of the issue of sustained learning in medical trainees. It is important to incorporate the power and influence of storytelling to enhance the medical education experience. It is important for curated curricula to foster life-long learning not only in students, but also in the medical experts responsible for shaping young minds.  Current medical curricula offer learning as a 1 way street with information being disseminated from professors to students. Medical education is missing patient and care partner stories and experiences. More on that here: http://www.kevinmd.com/blog/2017/07/every-medical-student-needs-hear-patient-caregiver-stories.html

            Here’s my formal rejection from NEJM in response to my submission below. Does anyone else believe in the power of incorporating patient and care partner stories to enhance medical education?

Dear Dr. Cordovano,

I am sorry that we will not be able to publish your recent letter to the editor regarding the Schwartzstein article of 17-Aug-2017.  The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received.  Many worthwhile communications must be declined for lack of space.

Thank you for your interest in the Journal.

Sincerely,

XXXXXXXX Editor

 

(Original Submission) To the Editor,

It was disappointing Schwartzstein et al. (Aug 17 issue)1 did not include patients and care partners in the design, development, and delivery of medical education. Students are only learning part of the story from cadavers and medical experts at respective institutions. We must foster the creation of curricula that are not only engaging, thought provoking, and evidence-based, but also unite patients and physicians, promote shared-decision making2, and delivery of compassionate care. Patients and care partners bring an authentic breathe of experience and perspective3 that textbooks and medical experts cannot impart or convey. It’s time to invest in participatory medicine and welcome patients and care partners to share their experiences living with disease significantly earlier into the careers of medical trainees. This model offers a unique opportunity to foster interactive, collaborative learning for all involved: medical trainees, seasoned medical experts, and patients and care partners. A change in the culture of medical education is more profound than revising curricula alone.

References:

1.     Schwartzstein R, Roberts D. Saying Goodbye to Lectures in Medical School- Paradigm Shift or Passing Fad? N Engl J Med 2017; 377: 605-607

2.     Barry M, Edgman-Levitan S. Shared Decision Making- The Pinnacle of Patient-Centered Care. N Engl J Med 2012; 366: 780-781

3.     Awdish R. A View from the Edge. N Eng J Med 2017; 376: 7-9