First Opinion is STAT’s platform for interesting, illuminating, and provocative articles about the life sciences writ large, written by biotech insiders, health care workers, researchers, and others.
To encourage robust, good-faith discussion about issues raised in First Opinion essays, STAT publishes selected Letters to the Editor received in response to them. You can submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.
The story
“The disappearance of empathetic touch in medicine,” by Alexa B. Kimball
The response
Reading Dr. Kimball’s First Opinion piece reminded me of the personal recollection of the extraordinary powers of empathic touch reported by the Scottish physician Archie Cochrane in his posthumous 1989 memoir “One Man’s Medicine.” Captured during the Battle of Crete in World War 2, he became a medical officer in the prisoner of war camp Stalag IV-A in Germany. Late one night a young Soviet prisoner was put in Cochrane’s ward:
“The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I examined him. He had obvious gross bilateral cavitation and severe pleural rub. I thought the latter was the cause of his pain and screaming. I had no morphine, just aspirin, which had no effect. I felt desperate. I knew very little Russian and there was no‐one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming, but the loneliness. It was a wonderful education about the care of the dying and I was ashamed of my misdiagnosis and kept the story secret.”
Cochrane later recalled that his wartime experiences made him acutely aware of the lack of hard evidence to guide choice of therapy. He went on to become a leading advocate of evidence-based medicine, the celebrated global Cochrane network being named after him. One wonders what he would make of the irony that, despite the existence of good scientific evidence for the benefits of touch, those benefits are now increasingly being set aside.
— Robert Matthews, Aston University
The story
“Dr. Glaucomflecken says NBC’s ‘St. Denis Medical’ makes medicine funny again,” by Will Flanary
The response
As a physician who used to write and perform stand-up comedy in New York City, I was very interested to read Dr. Flanary’s review of the comedy tropes in the new NBC sitcom “St. Denis Medical.” In this essay, he writes that “the comedy axiom of ‘don’t punch down’ is more true in health care than any other part of society” and that “any ridicule or snark directed from a health care professional toward a patient, even in a clear comedy setting, doesn’t come across as funny — it’s bullying.”
He’s not incorrect, but the most effective and memorable satires of medicine in literature from Samuel Shem (“The House of God,” which inspired “St. Elsewhere” and “Scrubs”) to Albert Camus to Louis-Ferdinand Céline focus their energies solely on illustrating who’s victimized in vicious bullying. About all of these writers and works would be “canceled” today for myriad reasons, but the art itself is better and more “impactful” for it. (To paraphrase Philip Roth, a non-physician who is among the greatest recent writers on chronic illness and infirmity, satire works best at its most selfish and self-focused and unflattering and vain: “I work, I’m on call. I’m like a doctor and it’s an emergency room, and I’m the emergency.”)
As doctors, we see way more pain than the average person. And we fail to speak truth to others’ pain at our expense if we pretend in our comedy that the bullying isn’t happening. If we comedians become afraid to be real moral witnesses for our audiences and portray the universal experience of unsolicited, undeserved bullying with the unsparing detail and tenderness and ridicule that it deserves — i.e., willing to direct our scalpels at others as well as ourselves for failing so many people — then we are not going to the “cringe” comedy that can unnerve and in its unforgettableness ultimately convert people to be better actors. As a victim of psychological bullying and moral injury as doctor and comedian, I know well the “painful lessons over the years about who to make fun of and how to make fun of them” that Flanary has learned. And I respect that he might want to use a lighter touch. I just want to remind audiences that there is also an audience for the comedy that goes to the jugular and restarts the heart. As physicians and comedians, we need not be heroes, but we definitely need not shy away from the humiliation and rage that are the source of the richest and most trenchant and devastating comedies about injustices in medicine. Medical comedy is a rich vein.
— Maureen Miller, M.D., M.P.H.
The story
“Pediatrics is becoming medicine’s largest skeleton crew,” by Jared E. Boyce and Faith Crittenden
The response
A well-written and important article. I believe that both general pediatricians and pediatric subspecialists are significantly under compensated. It was upsetting during my career to purchase vaccines and be reimbursed at cost or in some cases below cost. No business can survive under such conditions. If we want our best and brightest medical students to consider careers in pediatric medicine, compensation models must change. It is little wonder that medical students facing significant tuition loan debt are choosing more highly compensated specialties. especially those involved with performance of procedures. I have little confidence that the incoming administration will do much to address this issue considering to caliber of its nominees. Pediatricians must take a more active role!
— Philip Greenhill
The story
“An immigration fix to address the health care workforce crisis,” by Tom Price
The response
America’s health care workforce shortage is a well-known crisis, with over 85% of health care facilities lacking sufficient staff. While former Secretary Price’s account in “An immigration fix to address the healthcare workforce crisis” considers one aspect of this crisis, another downstream piece of the puzzle often overlooked is the shortage of health care educators. Demand for health care workers, such as nursing assistants and medical assistants, is expected to exceed 10 million by 2026. However, this same study projected that 6.5 million workers would leave these jobs while only 1.9 million new hires would replace them.
The difficulty in finding qualified instructors further exacerbates the shortage of qualified health care professionals. Currently, thousands of faculty positions are unfilled, limiting the ability to enroll enough students to fill the gaps in healthcare roles. Nursing schools alone face a 7.8% faculty vacancy rate, which has led to over 65,000 qualified applicants being turned away from nursing programs.
Similarly, in career and technical education programs for allied health professionals, 71% of directors report a shortage of instructors, contributing to fewer students entering health science fields. This scarcity of educators is shrinking the pipeline of possible future health care professionals.
To address this crisis, we need more than one innovative solution to support and grow the health care workforce, and that must include doing more to support our health care educators. Right now, there is a lack of resources available to encourage clinicians to transition to teaching roles, but grants, competitive salaries, and training opportunities could help entice practitioners to take on teaching. And we need better support for those already teaching, including tools like clinical simulation and educational technology to reduce burnout and improve teaching efficiency. While unlikely to pass this Congress, there is precedent legislation that aims to close the pay gap between clinical nurses and nurse educators. As incoming policymakers consider future options, they should consider a more comprehensive approach that would expand support for healthcare educators across all levels of education, including career and technical education programs and community colleges. Having qualified educators is key to training the next generation of health care professionals and policies set by the incoming Congress should reflect that if they hope to address the healthcare workforce crisis.
— Kathy Hunter, National Healthcareer Association
