A New Model for Ethical Practice

You know how physicians take notes on their laptops while they talk to you? How would you feel if a physician waited and opened the lid just a little bit later?

Choices like that – micro-ethical choices, they’re called – and larger ethical topics have been on Lillian Hetson’s mind lately. Writing her master’s thesis at Northeast Ohio Medical University, Hetson learned that people make choices in interpersonal interactions all the time – and these choices affect how a physician and patient perceive each other.

“It could be language choice, eye contact, choosing to sit down. It could be to open your computer a little bit later. All of these choices can make a patient be heard and understood better. Just considering those micro-ethical choices within the patient interaction can really help, and we should want to do that because we want to take care of people,” Hetson says.

When she graduates from the College of Medicine with an M.D. this May, she’ll also be one of NEOMED’s first students to have earned an M.A. in Medical Ethics and Humanities, through a program recently launched within the University’s College of Graduate Studies. Two other College of Medicine students (Alisha Alabre and Emanuela Peshel), along with Emily Mattern, a University of Akron student who also previously earned a Master of Public Health from NEOMED, will also earn these dual degrees.

Hetson’s thesis topic? She’s creating a new ethical model of patient care – one that focuses on holistic views of health and micro-ethical choices in patient interaction. The biopsychosocial model that is still widely taught to medicine students was first published in the late ‘70s and needs to be updated, says Hetson. Her intended audience is the family medicine physician – which she plans to be.

Loving people’s stories

Completing the medical ethics and humanities degree alongside an M.D. has helped Hetson balance her interests.

“Medical school is a very science-heavy environment and I’ve always loved reading and hearing people’s stories. That’s a lot of the reason why I went into family medicine: because I get to follow a patient’s story for a long time. I think if you know people’s stories you can help them a lot. It makes the care more tailored to them, and honestly, just having that interaction is great!”

The Hubbard, Ohio (near Youngstown) native started taking the College of Graduate Studies classes during her second year in the College of Medicine. Spreading them out, with a couple of classes each semester, worked best for her, though scheduling is up to the individual.

For Hetson, weekend classes with professors including Julie Aultman, Ph.D., a professor of family and community medicine who directs the Medical Ethics and Humanities program, was a welcome reminder that people are more than their diseases. It was also nice to get away from memorizing the Krebs cycle or all of the diseases associated with the GI system, Hetson says with a grin.

The need to listen

One class that Hetson calls “fantastic” was Invalid Women: Narratives of Women’s Illness, about how the narratives of women are often portrayed in literature and basic science research. It’s taught by Rachel Bracken, Ph.D., assistant professor of family and community medicine, who joined the Human Values in Medicine faculty this year.

“There are so many times when a women’s pain isn’t fully understood or she’s brushed off as crazy, and all of her aches and pains are dismissed as psychosomatic. This class is about seeing how women are portrayed through history and literature,” explains Hetson.

And Dr. Bracken relates the literature to today’s news.

“Actually, right now, the FDA is looking at breast implants because they cause sickness, but people have been complaining about it since, like, the late ‘90s or early 2000s, and physicians have said that they’re crazy; it isn’t real. But there are changes in the blood tests and very obvious symptoms that resolve when the breast implants are removed.

“There are a lot of Swiss cheese holes, a lot of things that went wrong in the research and no one checked up on it,” says Hetson. “That’s one way we as a medical society kind of failed these women.”

The solution

The answer to being a better physician?

“I think it just goes back to listening. I’m not sure if it’s by asking great question or by just listening to the answers,” says Hetson: “What’s important is to be present in the interaction.”

Inducted into the Gold Humanism Honor Society in 2018, Hetson won the Department of Family and Community Medicine Ethics and Humanities Award and also named as one of two Outstanding Students in Geriatrics Award recipients this year. After graduating in May, she will begin a residency in family medicine at The Ohio State University.