Refusing Medical Treatment: An SPH Panel Discussion

Over the last two years, I have really enjoyed developing and chairing the SPH Jewish Student Association.  It has been an honor to be able to meet wonderful and enthusiastic people who are excited to be involved in the Jewish community at school. I hope that the group continues to grow and strengthen over the next few years and continues to serve the Jewish student population at the University of Michigan School of Public Health.

Students in La Briut enjoying a homemade Shabbat dinner.

Earlier this semester, the Jewish Student Association held a panelist event at U-M SPH.  Professor Ed Goldman, Professor Peter Jacobson, Rabbi Seth Winberg, and Rabbi Kim Blumenthal were panelists.  The evening took a lot of coordination, but it was well worth it. Below is an article I wrote about the event for the Detroit Jewish News. Thank you to the Detroit Jewish News for allowing me to share this on the SPH Student Life Blog.

When I started my master’s of public health degree at the University of Michigan, I noticed that the Jewish students were well represented in the School of Public Health, but did not find a venue within the school to bring us together.

So I decided to form a student organization called La Briut (Hebrew for “to your health”), which has about 30 members. La Briut fosters community among Jewish students of all backgrounds in the school and creates a space to explore health-related issues that affect the Jewish population at large. Since its inception last year, we have organized a number of social, religious, and educational activities together. We recently sponsored a panel about refusing medical treatment.

Ed Goldman, professor of health management and policy at the School of Public Health, opened the discussion with anecdotes about cases involving the refusal of treatment on religious grounds. For instance, what steps should be taken when a Jehovah’s Witness’ child needs a blood transfusion and his parents will not consent to the procedure? He described receiving calls from doctors at 2 or 3 in the morning asking for his advice on these matters.

Professor Peter Jacobson, also from the department of health management and policy, addressed the conscience legislation recently proposed in Michigan. The legislation, which didn’t pass, would have given healthcare providers freedom to refuse to treat a patient if it violated the provider’s moral and religious principles.  Conscience clauses usually relate to issues such as abortion, contraception, and stem cell-based treatments.  In Jacobson’s view, health providers have a duty to fulfill a patient’s legal medical needs, irrespective of their personal position on the issue.

Two rabbis added the Jewish perspective on refusal of treatment. Rabbi Seth Winberg of U-M Hillel explained that today the standard view is that the Jewish tradition of saving life above all limits patient autonomy, and “consequently, a patient would be required to accept medical treatment.”

But he then cited several precedents that challenge such a view, suggesting that there may be reasons for a patient to refuse medical treatment—if, for example, the treatment is experimental or too risky.

Rabbi Kim Blumenthal from Beth Israel Congregation of Ann Arbor shared some of her experiences of counseling congregants.  Her take on the matter was simple: If someone comes to her seeking advice about a difficult decision, she sees her main role as comforting the individual and then guiding him or her through the process of making a decision.

Each viewpoint was unique, nuanced, and interesting.  I do a lot of thinking in my public health courses, but this panel pushed me to think in a different way.  It was provocative and stimulating, and I got the sense that the speakers were enjoying the experience as much as the students. I left the event understanding that we had only begun to delve into this topic and to wrestle with its many intricacies and uncertainties.

Mind The Gap. The Science Gap That Is.

This semester I joined the ranks of School of Public Health students before who have contributed to the Communicating Science Through Social Media course with Dr. Andrew Maynard.  In the class, students sign up for the daunting, yet exciting task of composing 10 science blogs in 10 weeks on the Mind The Science Gap (MTSG) site. No weeks off and no room for dropping the ball.

The process of developing a readable, interesting, and informative blog began with selecting a captivating topic that would (hopefully) appeal to readers—and to myself, the writer.  If I wasn’t interested, chances are it would show through.

I used the course as an opportunity to delve into topics such as alcohol and pregnancy, shingles, and Adderall use among

Image courtesy of photopin.com

college students.  One of my classmates cleverly said that for her, the class offered a kind of “choose your own adventure” experience.  She was spot on; each of us was responsible for choosing the direction our blogs took.  Some MTSG bloggers even used an investigative style, uncovering relevant research along with readers as the post progressed.

No matter the approach, each MTSGer this semester was able to establish a certain narrative style and audience. For anyone who enjoys writing (or wants to learn how to enjoy writing) and pouring through scientific research, I highly recommend this class. I’ve really learned a lot about my interests in the field.  I’ve also learned how to tighten my writing and focus in on only the most significant details.

I want to share my final post of the semester from the class, which looks into the  “flow experience” and some of its health implications.  In these final weeks of my graduate school career, I have been thinking a lot about what makes me happy and what kinds of activities most engage and absorb me. As such, the notion of flow has become particularly interesting and relevant to me. I hope you enjoy reading.

Ann Arbor Folk Festival

Danielle

On Friday night I was a volunteer usher at Ann Arbor’s 36^th Annual Folk Festival.

I wasn’t familiar with any of the artists in the line-up, but I’m a big fan of folk and indie music and knew it would be an awesome experience.  After being disappointed to find out that the show was completely sold out, I spoke with my friend who said she was ushering.  Well apparently, the Folk Festival is so popular that there was even competition to be an usher! I was put on an “usher waitlist” and had to wait to see if there would be an opening before the event.  It really shows the rich support among the Ann Arbor community for the Arc, which is a non-profit that presents folk, roots, and ethnic music.

A few days before the show the coordinator emailed me saying there was a spot for me.

Friday ended up being a snowy day with piles of slush along the edges of the sidewalks.  I trudged through the snow in the most efficient way possible toward Hill Auditorium, where all the ushers were meeting before the start of the show.  The staff explained the layout of the building, the rules that patrons must follow during the concert, and our role as ushers.  They placed us at different levels and sections of Hill auditorium, which I realized is quite giant and also quite beautiful.  Since I have never ushered before and do not frequently attend concerts, I found myself getting slightly nervous about my impending ushering duties.  But I figured I would be all right and all the concert-goers would probably find their seats just fine even if I happened to misguide them.  When the first people arrived, I realized ushering was even kind of fun—and also a pretty good work out (something akin to being on the stair stepper).

Colin Hay, a well-known Scottish-Australian musician and actor, was the evening’s MC.  To open the show, he joked that he had always wanted to hang out with Bob Dylan—“not sing with him, but grab a bite to eat or get a beer with him”.  Along with his lighthearted humor throughout the evening, Hay brought his brilliant, organic voice to the stage.

One of the show’s highlights was Rodriguez, who is a native Detroiter.  His songs, many of which have influential and politically charged lyrics, became popular in South Africa and several other countries as political anthems.  He did not gain success in the United States until a 2012 documentary about him called “Searching for Sugar Man” won notice at the Sundance Film Festival. The 70-something told the audience that the secret to life was to “breathe in and breathe out”. I have to say that that was very well played.

Among my favorite performances was Delta Rae, a band of six friends (three of whom are siblings) from North Carolina.

I also really enjoyed Trampled By Turtles, a band of six instrumentalists from Minnesota who are simply unbelievable to watch.

After being almost moved to tears by the talent at this year’s Folk Festival, I told my friend, “I only want to go to folk music concerts from now on.” I now have several new artists to listen to and love.

Guest Post: New Year, New You

Reva Berman graduated from the department of Health Behavior and Health Education at U-M SPH in 2012. She recently decided to put her MPH and health communication skills to use in her personal life by starting a blog in which she shares her thoughts and experiences living with Type 1 Diabetes.

Reva Berman

During my time in college, I used to dread Januarys at the gym. As someone who regularly frequented the gym between and after classes, I had figured out the best times to go when it was relatively empty and I could use the machines I wanted without having to wait for them. I developed a schedule and could usually count on completing my workout routine without interruption or delays.

That is until January came around.

Suddenly the gym became filled with people whose New Year’s resolution was to get in shape, lose weight, and work out more often. Instead of being able to jump on my usual machine, I now had to wait in line for the first available one. Don’t get me wrong, I love that people had suddenly decided to become healthier, I just wished that they didn’t all decide at the same time. By mid March however, the gym had mostly returned to its previous occupancy.

What happened? Pretty simple to figure out. By March, most of the people who were driven by their New Year’s resolutions to become healthier had begun to lose their motivation and eventually returned to their typical schedules. This phenomenon happens every year for all sorts of behaviors. Perhaps you begin the year with the intention to eat healthier, to cut back on smoking or drinking, to gamble less, save more money, to exercise more, the list goes on and on. But as each of us can probably attest to, many New Year’s resolutions go unfulfilled. I know many of mine have.

With the New Year right around the corner, I started to think about why. Why do so many of us fail at keeping our resolutions, especially when we are so motivated in the beginning? There are many reasons why this may happen, but I identified 3 major areas that I believe are critical components to any successful New Year’s resolution.

1. Scope

One of the biggest problems is that people set goals that are too lofty. Perhaps ideally you want to lose 20 pounds in the New Year, but that task can be daunting and overwhelming, especially if in the first few months you’ve only lost a few pounds. With such a large goal, it is easy to become discouraged in the beginning and not follow through. It’s important that your resolution is realistic. Saying that you want to lose 2 pounds a month may seem more surmountable than to lose 20 pounds. Even though you are setting a goal for the whole year, it becomes more manageable if you can break it into smaller monthly or even weekly goals. If you want to quit smoking or dipping this year, perhaps you begin by picking a number to cut back by each week. Setting these smaller goals can help make your overall resolution more attainable.

2. Concreteness

This brings us to the second problem. Resolutions need to be specific. What does it mean to exercise more or to eat healthier? The more specific and concrete a resolution is, the easier it is to follow through. Perhaps exercising more means doing at least 30 minutes of moderate cardio, 4 days a week. Eating healthier may mean incorporating at least one serving of fruits or vegetables into every meal. You want to save more money this year? How? Does that mean cutting back on the number of times you go out to eat? Does it mean spending less on clothes or electronics? Saying to yourself that you will only go out to eat twice a week gives you a concrete task to adhere to rather than an abstract objective.

3. Preparation

Without this third aspect, your resolution is doomed from the beginning, however many people do not spend enough, or any, time at this stage. This involves the planning and practicing of the new behavior. It involves identifying potential obstacles that you may encounter and planning for how you will overcome them. If you want to exercise more, do you have the right equipment? Do you have gym shoes, a gym membership, or routine for working out on your own? If you want to cut back on smoking or drinking, have you thought about what behavior will replace it? This may involve rearranging the environment you live in, removing triggers of a negative behavior and putting in things to remind you of your new positive behavior. Throw away old alcohol bottles, lighters, and junk food. Put your running shoes in a place that you will be sure to see them, leave motivational sticky notes around your house, keep healthy snacks in your car. Tell people about your resolution and find people that support you. Anticipate slips in your journey, but don’t let them become falls. Even with preparation and motivation, you may still resort back to old behaviors from time to time, but persevere! Behavior change takes time and the occasional detour is okay, just try not to stray too far off course.

During my public health education, we would talk a lot about how objectives to any program should be SMART. The same applies for your resolutions. Any resolution should be:

S: specific

M: measurable, meaningful, motivational

A: attainable, achievable

R: realistic, relevant, results-oriented

T: time bound

So time to take my own advice. What is my New Year’s resolution? I want to lower my A1c. Well that’s pretty abstract. I want to lower it by 0.5 in the next 6 months. Okay, that’s better, but how exactly will I do that? I suppose there are lots of things I could try, but based on my past behaviors there are 2 main areas that I want to improve on:

• The first is that I want to be better at bolusing right after I finish eating, instead of occasionally having 15-300 minutes pass before I remember. How can I be better at remembering? Perhaps I can set reminders on my phone or move my missed bolus reminder closer to when I typically eat my meals.
• The second behavior is that I want to be better about sending in my glucose numbers to my endocrinologist when I notice that my numbers may need adjusting. For me this means finally putting the CGM software on a computer so that I can download all the data and then email it to my doctor. It also means remembering to do this every few weeks. Perhaps I can also set a reminder on my phone every 2-3 weeks to email my doctor my glucose numbers.

Hopefully by accomplishing the above 2 behaviors, it will help to bring my blood sugars under tighter control which will ultimately lower my A1c. By coming up with concrete steps that I can do to accomplish this goal, I feel more confident that this year’s New Year’s resolution will not go unfulfilled. 

What about you? Have you thought about what your resolution is going to be? Whatever it is, just remember to be SMART.

Good luck and Happy New Year!

 You can read more of Reva’s posts at www.typeonederful.com

Ann Arbor’s Midnight Madness

Danielle

I’ve taken part in Ann Arbor’s Midnight Madness festivities for the past two years.  When I went to the University of Michigan as an undergraduate, I was either unaware of the event or I chose not to attend. During undergrad I tended to stick to undergraduate-friendly State Street or South U.  But there is truly something special about being a grad student and spending time on Ann Arbor’s dynamic Main Street, which caters to a more mature crowd.

On the last weekend in November, local shops in Kerrytown Market and on and around Main Street stay open from 6 until midnight and feature special late-night sales.  There are also street performances that include University of Michigan dance and a cappella singing groups.

Midnight Madness 2012 was this past Friday night. The streets and stores were absolutely flooded with eager students and Ann Arborites! But it wasn’t crowded enough to drive my friends and me away.  The stores we visited were each unique and it was even fun to just window-shop and listen to the carolers huddled around the storefronts.

If you’ve been too busy working or studying to take a walk down Main Street this season, you should take a moment to experience it—the hundreds of twinkling holiday lights and unique storefront displays are almost magical and they are also a much-needed reminder that winter break is just around the corner.

http://www.annarbor.com/entertainment/get-into-the-holiday-spirit-this-weekend-at-festivals-parades-and-shopping-sprees/

“Life Is For Living”

Danielle

“Life is for living, it’s not just for surviving. It’s how we deal with things that either makes us better or bitter. And I refuse to be bitter.” –Joy Kistnasamy

This semester at the University of Michigan School of Public Health, we are lucky enough to have 18 visiting scholars with us from Africa.  The scholars are all either senior scientists or PhD students and they hail from Mozambique, South Africa, Tanzania, Zambia and Zimbabwe. As grad students we—and I include myself in that we—are so focused on our studies and research positions and commitments and life that we often don’t take the time to interact with the amazing people who walk the halls at U-M SPH.  Without a doubt, the students here engage with one another and the faculty, and I so appreciate the commitment the faculty has to getting to know each student who wants to get to know them. But I for one almost missed the exciting opportunity to engage with someone different this semester, someone who will not be here next semester, someone who has an entirely different perspective and comes from a wholly different background from my own. Luckily, several weeks ago I had the privilege of meeting one of the scholars.  Even in the short time we interacted, I had a renewed sense of the importance of staying positive, not taking things—including my education—for granted, and having pride in my country and in what it stands for.

When I arranged to meet with Joy Kistnasamy, a senior scientist from South Africa, she agreed and offered me coffee and cake, even though I had invited her. I immediately told her that while that was so sweet, I couldn’t accept. But then I had to remember that Joy is from a different country with a different culture and customs than my own. It was really lovely to see her generosity and bigheartedness before even meeting her.

When I met with Joy, I wanted to learn about the reasons she chose to be part of the program and what she has gotten out of it so far.  For those of you who don’t know, all of the African Scholars’ work is focused on chronic noncommunicable lung diseases associated with environmental and occupational exposures. Joy explained that there were many different factories in her area in South Africa and she wanted to personally look at the social determinants of asthma and how the factories lead to manifestations of asthma. She said one of the most meaningful aspects of being at SPH has been the mentorship program and the relationship she has been able to form with her own mentor. She said that even though the mentors have such busy lives themselves, they make time to go through their proposals, to give expert opinions, and to ask them about any challenges they’re having.  Indeed, Joy says that she really views mentoring as being “not all about your degrees, but at the end of the day how you can help [students] see where they will be in a few years even if they can’t see it in themselves”.  She hopes that her work with faculty at U-M SPH extends to collaborative work.

Finally, Joy said that sometimes she says “yes” too often and that one of the things she has learned from this whole experience is that “yes you can care, but sometimes you should care enough to close your door.”  From talking to people at SPH, she really learned the true meaning of prioritizing.  They explained how important “me time” really is and that if you can take the time to prioritize and refocus your energies, it makes you really strong.  I think Joy was talking more here about working with students and needing to know when it’s necessary to close her door from time to time.  But when I think about the message of this statement, it really relates to us as students as well.  I agree that sometimes I want to do everything and say yes to everyone.  It’s not a bad thing to want to be very involved and connected.  But sometimes it is so important to reconnect with yourself and to recognize when you have overcommitted yourself.

Joy told me: “I love learning; I love listening to people” and that “you have to have yourself open to learning.”  I have to say that I’m so glad I was open to learning from Joy, because I really learned so much. I encourage you to take some time and introduce yourself to one or all of the African scholars before they leave at the end of the semester in December.

Lloyd Hall Scholars Program 50th Anniversary Reading

Danielle

As an undergrad at the University of Michigan I was part of the Lloyd Hall Scholars Program (LHSP), which is housed in the Alice Lloyd dormitory (right across the street from the School of Public Health building).  I was part of LHSP from 2007-2008, which makes me feel so old!  LHSP is one of a number of living-learning communities available to students.  The idea behind the living-learning community model is that students not only work collaboratively with their peers in the program, but they live with them, study with them, and learn from them on a daily (and nightly) basis.  LHSP is specifically for students passionate about writing and the arts and the program offers several undergraduate-level courses for its students. I loved the classes I chose because they were creative and challenging and different from any English class I had ever taken.

http://www.lsa.umich.edu/lhsp

I typically like writing non-fiction pieces or in-depth critiques of other people’s writing.  But as a hobby, I have always loved writing poems.  As a freshman in the program, I entered several poems into a poetry contest and to my surprise, one of my poems won. I had never before entered a poetry contest. I most often write poems for fun or to de-stress after a particularly stressful moment; I like to think of my own poetry writing as a very intimate experience rather than something to publicize.  But still, when my poem was included in the annual LHSP literary and arts journal I thought it was very cool.  

This year, LHSP is celebrating its fiftieth anniversary.  I received an email several weeks ago asking me to attend the launch of the “Fiftieth Anniversary” Arts and Literary Journal.  I am happy to know that the program is so connected with its past students.  At the event, I read a poem called “El Horno”, which I wrote about my Alternative Spring Break trip to Nicaragua from my freshman year of college.  The event itself was quite short, with only about ten participants, but each piece was so powerful and emotional that I appreciated the brevity of the occasion.  It was amazing to hear the other students’ wonderful pieces of writing and musical compositions.  I felt truly honored and humbled to be reading among such talented artists.

LHSP Arts and Literary Journal 2012-2013-50th Anniversary Edition

Attending the launch sent me back to my days of being in the middle of the magical, complex, and remarkable literary world.  I am comforted to know that the literary part of me has never left.  It is just a bit deeper inside of me now.  And the public health part of me has emerged.  I know even more now that I can use my creativity and love of words to guide my career path within public health.  That’s the beauty of this dynamic field.

Prospective Students Day for HBHE

Danielle

Last Saturday I participated on a panel of students for Prospective Students Day.  We were four students from HBHE, asked to speak in front of a group of about 70 students. Each of these students was coming to see if the HBHE program at the University of Michigan School of Public Health is a proper fit for them.  When I walked into the building I suddenly felt very old.  I would finally be on the other side of things; I was finally not the one applying.  I did not need to frantically write down every last word about how to perfect my application and look in awe at the students who were already halfway through their master’s degree.  Instead, I was one of those students.   Instead, I would be the one answering questions, ready to bring forth my greatest wisdom.  The students would—in theory—be hanging onto my colleagues’ and my every word.  So, the pressure was on.  I wanted to represent the school well and help the prospective students get a better idea of whether public health, Health Behavior and Health Education, and a public health degree at the University of Michigan would be a good choice.

Before the prospective students piled into the auditorium in the School of Public Health building, Dr. Marc Zimmerman, Dr. Woody Neighbors, the other student panelists and I casually chatted and joked around, mentally preparing ourselves for approaching the morning session.  Finally the students came in.  I was amazed to see the large number of people—mostly girls—who were in attendance.  I realized then that I really am concerned with who will carry the school into the future and how well the students of the future will maintain the reputation of the program.

Marc Zimmerman made a speech about HBHE and the program, which included an analogy between the Karate Kid’s lessons from Mr. Miyage and underlying lessons learned throughout the MPH degree program.  It was an entertaining moment, but also very true.  As students we often do not realize how much we’re learning on a day-to-day basis until we go out into the field and apply the skills we’ve developed and the knowledge we have absorbed in the classroom.

Next Woody Neighbors spoke about the things he, as the head of HBHE admissions, and the admissions committee look for in student applications.  Overall, he said that there is not one factor or item in the application that the admissions committee pays most attention to or that carries the most weight.  The committee really looks for a candidate that is strong overall.  This means the devilish GRE that you didn’t do as well on as you’d hoped doesn’t have to be the end of a future career in public health.  So, all of the prospective students out there can hopefully now breathe a bit more easily.

Then it was our turn.  Marc Zimmerman and Woody Neighbors left the room to give us a comfortable space to speak openly about our experiences and allow the students to ask the “big” and “burning” questions.  I was amazed at the interesting and thought-provoking questions the prospective students, who were mostly undergraduates from the University of Michigan, posed.  How does the workload compare to your workload during undergrad? How do you maintain relationships during the program? Can you do international internships? What has your favorite course been so far?

Following the panel session, we went to have lunch with the students.  One eager student approached me and asked if I had one moment in which I knew I wanted to be in the field of public health.  I told her it was really a compilation of experiences that led me to pursue this degree. I sat with her at lunch so she could continue to pick my brain.  She seemed unsure about what field was the right one for her, but I could tell she was on her way to figuring it out.

Detroit is where it’s at

The University of Michigan’s School of Public Health program is unique in that Ann Arbor is in such close proximity to the City of Detroit.  Many of the projects that our professors run, whether they involve research or programming, are set in Detroit and tailored to the needs of the local population.  It’s great to not only be able to develop projects for a specific nearby city, but to also then be able to visit and work there.  I have now had three classes that involved working on projects in Detroit.  Each of these courses has a different goal in mind when sending its students there.  For Needs Assessment I ran a focus group surrounding food choices with Hispanic young adults.  For Program Planning I helped create a youth program to beautify their neighborhood.  And now in Community Organizing I am helping to recruit youth advocates for policy change in their schools.  They have all involved youth, but with a different purpose and through different methods.

I’ve lived in Michigan my entire life, but I have seldom gone to Detroit and had never before interacted with the people who call it home.  Even though it’s a challenge to drive out there when we have so much going on on campus and are so busy during the week, it’s really rewarding once I’m there and I always remind myself of that.  There’s a city that’s so close to us that can use our help.   I want to contribute by working directly with the city’s residents and aiding them in creating change.

Today’s young people are highly invested in addressing the needs of the city, getting involved, and transforming Detroit.  I only hope individuals’ interests in supporting initiatives in the city lead to a healthier and safer community.

When I Grow Up

Danielle

It seems to be that as degree-seeking students, the first question we get from people is “What do you want to do with it?” It certainly sounds simple. It’s something even 5-year-olds in kindergarten have mastered: “When I grow up, I want to be a doctor! I want to be a teacher! I want to be an astronaut!” But what happens when we find ourselves grown up and actually making these grown-up decisions? To me, and I suspect to many of you, grappling with this relatively simple question can feel quite daunting. We have already accomplished a lot by enrolling at the School of Public Health and deciding that we want to be future public health professionals.  But once we have the degree and are done with school, it is necessary to have some idea of what we want to do and what we hope to accomplish in our career.

For me, the best way of getting closer and closer to “what I want to do with it” is taking classes that are interesting to me, speaking with people who share my interests to see what path they took, and taking a step back to see what I love doing. I have found myself gravitating toward health communication courses, so I have tried to create my own area of specialization by taking classes with that theme.   But sometimes this process may involve doing something you don’t like to realize what it is that you love.  And so bad experiences are not necessarily negative ones.  

There are some students who know exactly what they want to do and where they want to work.   But it’s okay to figure it out as you go and to discover where it takes you.  I constantly think about what I want to do once I’m done with school, but I also try to focus on getting the breadth of knowledge that a public health degree offers and soaking in the experience of being a student.