Design Thinking in Action: Medical Students Weigh-In on the Mobile Health Clinic

From the December 23, 2022 issue of the Transformational Times

Perspective/Opinion 

Design Thinking in Action: Medical Students Weigh-In on the Mobile Health Clinic 

 

By Emmy Lambert, BS – Medical Student 

Patient-centered care calls for patient-centered spaces. Medical students were given the opportunity to dust off their creative brains and ponder the details, big and small, of an exciting new mobile clinic…  

Human-Centered Design. It’s all around us. Or at least, it should be… 

Simply put, human-centered design is a method of empathy-based problem-solving. Through a three-phase design process of inspiration, ideation, and implementation, human-centered design tailors products towards those involved in their use – so-called “stakeholders.” These stakeholders are consulted and considered in every step of the design process to ensure the output will meet their needs. Truly an ingenious approach, if you ask me.   

They’re building a WHAT? A mobile clinic! 

In an effort to address preventative health screening disparities in certain zip codes in Milwaukee, there is a joint venture between the Population Health Department and OB/GYN Clinic at Froedtert Hospital, the Kern Institute’s Human-Centered Design (HCD) Lab, and the UW-Milwaukee Lubar Entrepreneurship Center to design and implement a Women’s* Mobile Health Clinic. The working timeline aims to complete research by the end of the 2022 calendar year, build the clinic in late spring of 2023, and begin providing care next fall.   

As part of the ongoing research process, the HCD lab hosted a design workshop for second-year medical students in the Health Systems Management & Policy Pathway. As a student member of the HCD lab for nearly a year, I had the privilege of facilitating this session with Dr. Ilya Avdeev and Dr. Lana Minshew. As a team, we guided students through a series of activities to stimulate creativity and prime their listening skills before conducting design research for the clinic.   

We asked the HSMP students to brainstorm the needs of a women’s mobile health clinic, identify stakeholders, and generate solutions to a few stakeholder concerns. Students collaborated in teams, writing furiously on sticky notes, whiteboards, and scrap paper. The room was abuzz with solution-oriented energy. Their knowledge of health systems and roles as medical students added a unique perspective to the ongoing project. Some of Dr. Avdeev’s graduate-level engineering students attended the session as well, lending a different angle of design understanding to the process.    

The students said they loved it! 

The session was well received by the students. Clayton Vesperman, M2, commented, “I thought that the Mobile Clinic Design session was one of the most unique and engaging sessions I have had as part of the Health Systems Management and Policy pathway. The opportunity to collaborate with Engineering students who had a background that was outside of the medical field was a great opportunity to learn how other fields approach problems as well as the types of issues they prioritize. As medical students, we have abundant opportunities to learn from other health professions, but learning to work alongside entirely different fields can be very beneficial as they can play a large impact in the patient experience even without directly influencing the patients’ healthcare.”  

Victoria Le, an M2 also in the HSMP Pathway, commented, “I thought it was interesting to see the process of working through nitty-gritty details of making an idea come to life. I liked how thorough it was, including the way we tried to anticipate different issues that would be roadblocks to the mobile clinic. I also thought it was a good way to balance the creative process with a more rigorous evaluation of ideas.”  

My takeaway? 

I was so impressed with the creativity and collaboration demonstrated by my peers! Their willingness to engage across disciplines, work together to problem solve, and experience medicine from the patient perspective is promising for the future of medicine. A few of the ideas presented at this workshop have been considered for the ultimate implementation of the mobile health clinic, which is set to hit the streets in the fall of 2023.   

Design with us! 

The Human-Centered Design lab is currently collaborating with the Lubar Entrepreneurship Center at the University of Wisconsin – Milwaukee and Froedtert hospital on a community-centered design project focused on designing two mobile health clinics to serve the greater Milwaukee area. To create the most effective community-centered design as possible, we invite community members to join the design team by sharing your experience with mobile healthcare or offering your ideas using a full-scale clinic design model. The model is in the first-floor cafeteria lobby of the MCW – Medical Education Building and will be open to everyone through January 31, 2023.   

Note: 

*The term “women” encompasses those who identify as female, possess female reproductive anatomy, or face female-related health issues. 

Emmy Lambert is currently an M2 at MCW Milwaukee. She is a student member of the Human-Centered Design Lab pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. She passionately co-runs the MCW Chapter of Medical Students for Choice, manages operations of MCW DOSE, and teaches Hatha and yin yoga classes at Collective Flow MKE.  

“Is There a Doctor Onboard?” Doctoring and Prayers at 35,000 Feet

From the December 16, 2022 Spiritually in Medicine issue of the Transformational Times

“Is There a Doctor Onboard?” Doctoring and Prayers at 35,000 Feet

By Adina Kalet, MD, MPH

Given the theme of Spirituality in Medicine in this week’s Transformational Times, Dr. Kalet shares the most recent of many experiences she has had answering the overhead call on airplanes. In this case, the faith traditions of both the doctor and of the patient led to series of surprises and unique styles of gratitude for caring and kindness expressed in prayer …

Given that I was listening to a movie through my headphones while my hands were busy knitting, the announcement just barely registered. We were three hours away from our destination, and a long, uncomfortable eight hours into our flight. After a few seconds delay, I untangled myself and headed toward the uniformed purser standing in the aisle. 

“I am a doctor. How can I help?” She looked me over and nodded discretely toward the young, pale, diaphoretic, and mildly distressed bearded man slumped in his seat. 

The flight attendant whispered, “He is asking for medication, but I can’t administer anything without a physicians order.” She gestured to her handheld device. “This is what we have available.” She looked back-and-forth from the man in the seat to me. “We are over land now, so if you decide…” Her voice trailed off, suggesting that, on my say-so, they were prepared to land the plane.

“Give me a minute to assess the situation,” I said. She offered to retrieve a blood pressure cuff and oxygen tank.  

My new patient’s religious garb, facial hair, and head covering told me that he was part of an Ultra-Orthodox Jewish family. I grabbed my sweater and covered my bare shoulders since, in his culture—one I know intimately—modesty is paramount. In his community’s view of the world, a secular appearing, barefooted and bareheaded woman might be dismissed or treated with suspicion. I assumed he would avoid eye contact and refuse to let me touch him. To be trusted enough to make an accurate medical assessment, I needed to minimize the barriers.  

Leaning over him, I introduced myself and asked him to tell me what was going on. I was happy to see that he was fully awake and alert, spoke fluent mildly-accented English, was willing to make eye contact, and seemed eager for my help. He described his weakness, dizziness, and nausea. After asking permission, I carefully and firmly ran my hand over the key locations (no belly, chest, or calf tenderness) landing on his wrist to feel for his radial pulse. I engaged him in conversation about his health and recent events as I monitored the cardiac rate and rhythm. He had been perfectly healthy  and described no ominous symptoms. 

The relatives surrounding him were eager to tell me that they had all spent the day before in a hospital emergency room with a beloved relative. As his uncle graphically described the details of how the old woman had fallen and had sustained a nasty, bloody gash, my patient became paler, his heart rate went up, and his pulse became “thready.” Before long, he was dry heaving into a plastic bag. Clearly, the stress of hearing the story again was taking a toll. I expressed my empathy for the upsetting situation to the group. My patient’s pulse slowed a bit. 

The flight attendant handed me the automatic blood pressure device. As I wrapped the cuff around his arm, I confirmed he had eaten little, had slept poorly, and had not had anything to drink during the flight because the options were not guaranteed to meet his religious requirements. The machine finished its reading and, although not dangerous, his blood pressure was quite low. 

We laid him as flat as the airplane seat would allow and elevated his legs. I assessed the width of the aisle just in case we needed to get him on his back. Happily, his blood pressure climbed a bit and his pulse headed toward normal. 

The flight attendant pointed out that we were seven miles above the Earth, and some supplemental oxygen might help. We put the mask on him and started the flow. He “pinked” up immediately, and his nausea resolved. Soon, he was able and eager to drink fluids. As time passed, his symptoms resolved, and he felt stronger. 

I spent a few minutes talking with his relatives, including the old woman with the fresh stitches and a bandage above her eye. I was able to fend off one of his aunts who offered several nonspecific pills she had in her carry-on bag. Everyone noticeably relaxed and soon I felt comfortable enough to return to my seat. 

The flight attendant stopped by, reporting that she had told the pilot we were not anticipating an emergency landing. She offered me a gift from the airline which I tried to refuse but, in the end, I accepted some extra miles for my frequent flyer account. 

After a while, the patient’s aunt came by, an emissary from the senior male members of the family. She thanked me profusely for my help, then said, “Your smile and gentleness are a blessing from G-d! You didn’t need to be kind, but you were.”  The family wanted to give me something in return for my kindness. 

“No!” I said. “That is very kind, but this is my work. There is no need for gifts.”

“Well, then,” she replied, “you will be in our daily prayers.” She nodded, thanked me again, and returned to her seat. I smiled, found my headphones, and went back to my knitting. 

I was relieved that things turned out so well; they don’t always. This was not my first rodeo. I have had  a few opportunities to answer “the call” on airplanes, at the theater, and on the sidewalk.  Given the settings, the medical intervention and decision-making options are severely limited. Had the situation worsened, and I had needed extra hands to help start an IV or do chest compressions, I suspect other healthcare workers might have appeared, or the trained crew members would have been there to assist. Depending on the acuity of the crisis, I might have recommended to the pilot that she land the plane.

But, on this day, that was not what was needed. In the end, what was most needed and appreciated was kindness. This experience, as well as medical student Sarah Root, in her essay in this issue of the Transformational Times, reminds me once again, through the the words of Sarah’s physician grandfather, “that medicine is not just a practice, but a privilege.”

We reached our destination and headed our separate ways. I am humbled to know that there is a family, not so very different from my own, that is prayerfully grateful for our moments together at 35,000 feet. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

The Kern Institute Announces Publication of the Second Collection of Transformational Times Essays

 Book Presale - Character and Caring: Medical Education Emerges From the Pandemic

The Kern Institute Announces Publication of the Second Collection of Transformational Times Essays

Medical students, residents, physicians, and caregivers have struggled during the pandemic. The times in which we live will transform medicine. These essays, drawn from the Kern Institute’s Transformational Times newsletter, offer glimpses into what we have experienced and what might yet come. 
Each essay reveals remarkable insights and reflects the interplay of the world we inhabit with the present and future of medicine and healthcare.

"Incredibly timely."
—Carol Bradford, MD FACS
“[This book] provides an unparalleled opportunity to bring one’s best self to the bedside and looks for the unexpected opportunities to impact the world.”
—Jesse Ehrenfeld, MD, MPH
“...a ready-made syllabus to embrace social, psychological, spiritual, and humanistic dimensions of medical education.”
—Louis N. Pangaro, MD, MACP
“...the art, as well as the science, of medicine are eloquently delivered, provoking the reader to reflect and see the world from new perspectives.”
—J. Larry Jameson, MD, PhD

In these pages, readers engage with unsettling realities unmasked by COVID-19, including workplace biases, inattention to wellness, residency-related stress, the loneliness of military responsibility, the inequity of the world around us, reproductive healthcare uncertainty, new educational realities, and the imperative for flourishing and practical wisdom in physicians.

To purchase a copy of Character and Caring: Medical Education Emerges From the Pandemic, click here. 

To purchase a copy of our our first book, Character and Caring: A Pandemic Year in Medical Education, click here.

Focus on Genetics: Lessons from Uncle Dave

 From the December 9, 2022 Genetic Counseling Issue of the Transformational Times  

Focus on Genetics:  Lessons from Uncle Dave

By Wendy Peltier, MD

Dr. Peltier shares the candid story of how her uncle brought early inspiration to pursue a career in Medicine, and also opened her eyes to the personal challenges and opportunities of genetic testing as he faced a rare, progressive lung disease …

 

My uncle, Dr. David Pogue, worked as a cardiologist for twenty-nine years in the small community of Wichita Falls, Texas.  He inspired me very early on, to pursue a career in Medicine.  As “Yankees” from Illinois, my family lived far away from Texas, and holiday time together with the Pogue clan was truly a gift. I have wonderful memories of my brother and I connecting with our three cousins, all of similar age, and giggling together around the big table at family meals as our parents had spirited discussions.  At one of these memorable visits, my uncle took me on hospital rounds, where I observed his kindness and generosity with his patients and staff.  There were no Hospitalist services in those days, so “checking in” on his patients was common practice, even on a holiday weekend.  I can bring in my mind’s eye his long white coat, gentle smile, and patience as he carefully listed to heart sounds and reviewed care plans with his patients.  

He answered all my questions, sparked my interest in science, and empowered me that being a doctor was not just far away dream, but in reach if I was willing to put in the hard work.

Fast forward a decade or so, when I was in medical school, we got the news that he was ill.  After exhaustive testing for shortness of breath with exercise, he was found to have a rare form of emphysema, alpha-1 antitrypsin deficiency, a progressive and incurable genetic disorder.  This condition, which is expressed most severely in patients carrying two recessive alleles, causes a spectrum of lung disease that can manifest as progressive emphysema, chronic bronchitis or asthma, and can also affect the liver, pancreas and gallbladder.  Carriers of this gene can pass on risk to their children.  What a bitter irony that Uncle Dave would have emphysema after spending so much of his time trying to convince others to stop smoking!  I had just started learning about genetics and DNA in school, our bodies’ “phone book.”  I was particularly fascinated by how science allowed us to track these missing “addresses” that tied so eloquently to understanding of a disease process.  Genetic discoveries were just starting to have clinical impact, and the thought of gene therapy still a far away dream. 

 It seemed quite unbelievable that a genetic disorder could be in my family.  Could I be a carrier? Would I want to know? Would it impact major decisions in my life?

As was his brave and humble nature, my uncle learned everything he could about his condition, what to expect, and opportunities to contribute to research.  Pre-symptomatic genetic testing was not readily available at the time, but he sought resources for anonymous testing for his siblings.  I keenly remember what it was like to wait for my Mom’s results.  My uncle deeply believed in science and the power of research.  He knew that having this type of information could mean receiving early preventative treatments, once they were developed.  He also actively sought information about his prognosis, so he could make plans for his family to be supported, and to make his own careful decisions about future therapies with a lung transplant or other interventions.  He became very involved in the Alpha-1 Foundation.

As his disease slowly progressed, he made the necessary changes to his medical practice and sought continued opportunities to serve.  Using his background in cardiac rehab, he took a very diligent approach to his own health and was able to far outlive his prognosis, despite declining a lung transplant.  During this time, I was starting my career as a neuromuscular neurologist (despite his multiple attempts to convince me that Cardiology was a superior discipline!) and found myself often in the position of counseling families about genetic testing for muscular dystrophies and other progressive neurologic conditions. 

It was my good fortune to do this shoulder-to-shoulder with exceptionally talented genetic counselors.  Their knowledge, wisdom, and kindness in approach to all our patients and families, regardless of their health literacy, was a true inspiration.  

I knew, first-hand, how challenging decisions about testing could be, and the emotional impact to affected individuals in navigating this, sometimes with complex family relationships.  I did my best to provide balanced options, educate about the cautions of asymptomatic testing, and link families to important resources through the Muscular Dystrophy Association (MDA).  Incredible scientific progress was being made at this time in understanding the molecular biology and genetics of muscular dystrophies, previously named by the famous neurologists who described the syndromes (Becker’s, Duchenne’s, Emery-Dreifuss, etc.) now re-labeled by the specific type of gene defect or “address.”  Genetic testing became more available and allowed diagnostic accuracy without necessarily having patients go through painful muscle biopsies.  Gene therapy seemed closer in reach.

I will never forget attending my Uncle Dave’s funeral.  All of his family members had been carefully prepared for the event.  His favorite band, The Mad Medics, were playing Dixieland music as folks entered the church.  As my Uncle Don stood to give his eulogy he remarked, “I was given very strict instructions as to how this event will be, short and happy.”  And it was. So many people from the community attended to pay respects.  My aunt had a video camera in the church library, where attendees could sit and share a story in remembrance of the beloved Dr. Pogue.  One of my favorites was from one of his former nurses, who was a smoker.  She and her colleagues would occasionally sneak down to the smoking room during breaks.  She recalls seeing little paper airplanes floating down through the ceiling vent, and retrieving them only to see anonymous, hand-written random facts, about the health risks of tobacco use.  There was no electronic record back then, so of course she recognized his handwriting!  She described this as a true act of caring, without being judgmental.

He was remembered by his community and colleagues for his tireless service, a mission trip to Africa with the Peace Corps, starting the first cardiac rehab unit at the Clinics of North Texas, a Distinguished Service Award from the Wichita County Medical Society, and for being a proud charter member of the Wichita Runner’s Club. 

My Uncle Dave remains a steady presence and source of inspiration to me at challenging times, despite the many years that have passed since his death.  

For me, it’s not as much the professional accolades, as the memory of his kind, humble, and funny spirit, and ability to make “good trouble” in his work as a physician.  As a patient, he was always looking for opportunities to help others despite his own personal challenges. 

I recently connected with my aunt Georgia about these memories.  She was touched by this tribute and shared that one of the things she most admired about Dave as a doctor was how deeply he cared for his patients as people and recognized the importance of giving time to them during visits, something that she sees as a rarity now in medial encounters.  

There has been miraculous progress in science since my days in medical school to make gene therapy a reality.  Uncle Dave would be proud.

Wendy Peltier, MD, is a Professor of Medicine in the Division of Geriatric and Palliative Medicine at MCW.  She serves on the Faculty Pillar for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and on the editorial board of the Kern Transformational Times.