Self Reflection Exercises

First, please read the article “‘Every time it’s a battle’: In excruciating pain, sickle cell patients are shunted aside," by Sharon Begley, and reflect on how racial bias can affect patient care. Then, read the article “My medical school lesson was tinged with racism. Did that affect how I treated a sickle cell patient years later?” by Jennifer Adaeze Okwerekwu. Consider a time you personally cared for a patient with an acute pain crisis or acute chest syndrome; or if you haven’t treated anyone with sickle cell disease, perhaps a patient from any minority group. How might have personal biases led you to provide less (or more) aggressive medical care?

For many years, Ellen suffered unbearable pain while her doctors just recommended she lose weight. Here is her obituary.

Reflect on how our implicit biases and preconceived notions can cause harm to our patients. Read this article, "My sister’s cancer might have been diagnosed sooner — if doctors could have seen beyond her weight." How do other sorts of implicit biases affect our management of patients, from implicit racism to sexism to etc.? Read the articles, "BMI is Flawed, Especially for people of Color" and "What I Learned About Being a Fat Patient as a Fat Doctor," and consider how these biases can intersect.

First, read the article “The Death of Baby Doe,” by Jeff Lyon. Based on this historical viewpoint, reflect for a few minutes on how you think the treatment of “handicapped” babies and their families has evolved over the past 50 years. Then read the article “The Last Children of Down Syndrome,” by Sarah Zhang. Now try to imagine you are a parent of an 8-month-old child with trisomy 21. When you received the prenatal diagnosis, you strongly considered terminating the pregnancy, however you decided to have your baby, and fortunately he was born without any major malformations. Sadly, he has just been admitted to the PICU for the first time due to viral pneumonia (you always knew told his lungs can get very sick very fast). He just had to be intubated and placed on mechanical ventilation, and the doctors are telling you he has acute respiratory distress syndrome. Try to imagine everything you are feeling and thinking about during this critical time.

How does trauma affect a child's mind--and how can that mind recover? In the classic "The Boy Who Was Raised as a Dog," Dr. Bruce D. Perry, founder of Neurosequential Model of Therapeutics and Senior Fellow of The ChildTrauma Academy, explains what happens to the brains of children exposed to extreme stress and shares their lessons of courage, humanity, and hope. "Only when we understand the science of the mind and the power of love and nurturing, can we hope to heal the spirit of even the most wounded child." Read this excerpt  from his groundbreaking work.

First, read the article, “Indiana Teen with COVID Leaves Hospital After 6 Months, 160 Days on a Ventilator.” Imagine you are Wesley’s mother writing a Facebook post about her experience in the PICU. How do you think her and Wesley’s vaccination status affects the potential relationship with their care team? What do you think it feels like to be admitted to the hospital for the one thing everyone in the world is currently obsessed about, to be an adolescent at the center of public health crisis/national political conversation? Is it any different than being intubated for staph pneumonia? Then, read the articles, “Doctors treating unvaccinated Covid patients are succumbing to compassion fatigue,” and “Op-Ed: Anti-vaccine patients vent anger on healthcare workers like me. It takes a toll on care.” Now, imagine you are part of the PICU care team for Wesley, reflecting on your experiences while caring for Wesley. How do you think your own feelings may impact the way you treat Wesley and his family?

Recently at a national conference, there was a presentation on screening for Positive Childhood Experiences, in addition to Adverse Childhood Experiences. Touting additional benefits of their project, the pediatric resident physicians explained to the audience how such a screening program was very uplifting to their morale after dealing with a year of COVID, since it meant they didn't have to just focus on their patients' negative issues all the time. What do you think about that statement?

Participatory Action Research (PAR) is an approach to scientific inquiry which aims to shift the power dynamic from researcher to subjects being researched. Ever since the Tuskegee Study, academic bodies have realized the need for Institutional Review Boards and research oversight. Recently however, many have argued that these efforts aren't merely enough. Consider how researchers benefit from those they study, what sort of pitfalls arise when participants don't have a say in the direction of inquiry, and how scholarly projects can be made more equitable through PAR.