Medicine (MED)

Lecturer: Julian E. Asher

Julian E Asher graduated magna cum laude from Harvard University and attended medical school in the United States. He is now in the second year of a PhD in neurogenetics as part of a joint MD-PhD programme with the Departments of Psychiatry and Experimental Psychology at the University of Cambridge. His research focuses on a neurological condition known as synaesthesia, in which patients perceive a sensation in one sense when another sense is stimulated – for instance, hearing sounds can evoke colours, or tasting food can evoke tactile sensation. This condition affects approximately 0.05% of the population, and may occur either sporadically or in families. Julian’s research concentrates on the latter type, with the goal of finding a gene or genes linked to this condition. Previous research experience includes the genetics of absolute (perfect) musical pitch and issues faced by marginalised and underserved patients. He teaches neurobiology for the Cambridge Medicine Course at Trinity Hall.

Syllabus

Medicine is a subject of immense scope, and this course will of necessity only scrape the surface of a discipline of almost infinite variety. Rather than attempt to cram the science of medicine into the short time we have, we will focus on the essence of medicine, where science meets art to become something more than the sum of its parts.

The readings have been chosen for their intelligibility to the non-medic, and will hopefully be as interesting as they are informative. You will be expected to have done the required reading prior to each seminar. All of the readings should be readily available; in the cases where only a very small portion of a book is used (designated by *), copies will be distributed to you in a course packet on arrival.

You may wish to purchase a small medical dictionary, such as the Oxford Concise Medical Dictionary (Oxford University Press, 2003), to assist with some of the technical terms, though this is by no means necessary.

SEMINAR 1: THE DOCTOR-PATIENT RELATIONSHIP

The unique relationship between patient and physician lies at the core of the practice of medicine, and will form the core of this course as well. We will begin with an examination of the doctor-patient relationship from both theoretical and first-hand perspectives, incorporating viewpoints from philosophers as well as physicians. How do doctors relate to patients? How should doctors relate to patients?

READINGS

- Medical Ethics, Chapters 1, 2, and 4
- Bedside Stories, 'Medical House Officer' and 'Casualty'

SEMINAR 2: THE DOUBLE-EDGED HELIX - MEDICAL GENETICS

The completion of the Human Genome Project heralds a new era, in which genetics will play an ever-larger role in the practice of medicine. Bespoke drugs, designer babies, and pre-diagnosis at birth of diseases that may affect a person in old age - all this and more hovers on the horizon. What will this new information mean for the practice of medicine?

READINGS

- Medical Genetics, Chapters 1-5, 11-14
- Medical Ethics, Chapter 5

SEMINAR 3: THROUGH A GLASS DARKLY - PSYCHIATRY

Despite the great advances that have taken place in neuroscience, the brain remains the final medical frontier. It is in psychiatry that the art of medicine truly comes to the fore, where the doctor-patient relationship becomes not only the core of the clinical encounter but the main diagnostic tool as well. In the absence of laboratory tests, the clinical interview offers the sole window into the patient's mind and thus into his or her illness. How can (and how should) a doctor treat a patient who does not realise that he or she is sick - and may not wish to be 'cured'? Where does one draw the line between eccentricity and madness?

READINGS

- Psychiatry, Chapters 1, 2, 8
- Bedside Stories, 'Psychiatry'
- An Unquiet Mind, All; focus on 'Flights of the Mind'
- Touched with Fire, Chapters 1-3, 5
- Medical Ethics, Chapter 10

SEMINAR 4: A CHANCE TO CUT IS A CHANCE TO CURE - SURGERY

For centuries, doctors were forbidden to perform surgery, as it violated the primary Hippocratic injunction: 'First, do no harm.' Even now, doctors divide themselves into 'those who practice internal medicine' and 'surgeons' - those who don't cut and those who do. The surgeon's perspective is fundamentally different from that of the non-surgeon, for crossing that forbidden line and taking up the scalpel redefines the relationship between doctor and patient. We will explore the surgical perspective and the accompanying set of unqiue dilemmas in this seminar.

READINGS

- Mortal Lessons, 'The Exact Location of the Soul,' 'The Surgeon as Priest,'
- 'Lessons from the Art,' 'Bone,' 'Liver, 'Stone', and 'The Knife'
- * Confessions of a Knife, 'Sarcophagus;'
- Bedside Stories, 'Surgical House Officer'
- * Raising the Dead, Chapters 1 and 5
- Medical Ethics, Chapter 8

SEMINAR 5: CARE BEYOND CURE - HIV MEDICINE

For all that medical science has accomplished, there remain all too many problems we cannot solve. What is the doctor's role when there is no cure? What can medicine offer those whose bodies cannot be healed? In this seminar we will examine the doctor's role in the treatment of chronically ill patients and patients at the end of life.

READINGS

- * Medical Microbiology and Immunology, Chapters 57-59, 61
- Medical Ethics, Chapters 4, 9, 11-12
- Mortal Lessons, 'The Corpse'
- AIDS Doctors, Chapters 2 and 4
- * Dreamsnake, Chapter 1

SEMINAR 6: SPEAKING IN TONGUES - CROSS-CULTURAL MEDICINE

Healing traditions and beliefs vary widely across cultures, and the increasing ethnic and cultural diversity of 21st century society will make cultural competence as important as medical competence for physicians. Even 'mainstream' patients are increasingly supplementing their medical care with 'alternative' therapies, such as herbs, aromatherapy, and acupuncture. How will the increasing use of other healing methods affect the practice of medicine?

READINGS

- Medical Ethics, Chapters 3 and 14
- Mortal Lessons, 'The Twelve Spheres'
- The Spirit Catches You and You Fall Down, All

Reading List

* Texts marked with an asterisk will be supplied in a course packet on arrival.

- Bayer, Ronald; Oppenheimer, Gerald. AIDS Doctors: Voices from the epidemic. Oxford University Press (2000)
- Campbell, Alastair; Gillett, Grant; Jones, Gareth. Medical Ethics (third edition). Oxford University Press (2001)
- Fadiman, Anne. The Spirit Catches You and You Fall Down. Farrer Straus and Giroux (1998)
- Foxton, Michael. Bedside Stories: Confessions of a junior doctor. Guardian Books, London (2003)
- Gelder, Michael; Mayou, Richard; Geddes, John. Psychiatry (second edition). Oxford University Press (2001)
- Jamison, Kay Redfield. An Unquiet Mind. Picador (1997)
- Jamison, Kay Redfield. Touched with Fire: Manic-depressive illness and the artistic temperament. Simon and Schuster (1996)
- Jorde, Lynn; Carey, John; Bamshad, Michael; White, Raymond. Medical Genetics (second edition). Mosby (1998)
- * Levinson, Warren; Jawetz, Ernest. Medical Microbiology and Immunology (seventh edition). Lange Medical Book (McGraw-Hill) (2002)
- * McIntyre, Vonda. Dreamsnake. Bantam (1994)
- * Munson, Ronald. Raising the Dead: Organ transplants, ethics, and society. Oxford University Press (2002)
- Selzer, Richard. Mortal Lessons: Notes on the art of surgery. Thomson Learning (1996)
- * Selzer, Richard. Confessions of a Knife. Michigan State University Press (2001)