Celestine Warren, a second-year medical student at Dartmouth’s Geisel School of Medicine, is fascinated by the subtle disruptions that can occur when doctors and patients communicate. Warren thinks that patients likely get sidetracked—sometimes by the fear that a word like “cancer” evokes or when thinking through a difficult concept—while the doctor, pressed for time, forges ahead.
How can a doctor know what the patient has understood and what needs elaboration or repetition?
For Warren, this is an ethical question because physicians and patients can only make good decisions together if they understand each other. Now, Warren and Geisel classmate Lauren Kascak are exploring such questions through a medical ethics student fellowship program, which is supported by the generosity of a couple who passed away in 1997. Warren is testing ideas for filling gaps in doctor-patient communication, and Kascak is exploring whether photographic portraits of people receiving palliative care will generate conversations that inform care decisions.
The Olive M. & Joseph F. Swigart Fund for Practical Education in Medical Ethics, which is providing stipends for the students, was established through a bequest from Olive “Polly” Swigart, a teacher, and Joseph Swigart, who worked in finance. The fund reflects their shared concern for the ethical practice of medicine and their belief that training in ethics should be integral to medical education. Twenty years later, their fund has doubled in size, and, more importantly, continues to support ethics education—a powerful example of the enduring impact of endowments.
Partnering with each student fellow is a faculty member: Warren is working with Glyn Elwyn, MD, PhD, a professor and senior scientist at The Dartmouth Institute for Health Policy and Clinical Practice, who is internationally known for his work on shared decision-making; Kascak has partnered with Kathryn Kirkland, MD, section chief of Palliative Medicine at Dartmouth-Hitchcock and the Dorothy and John J. Byrne, Jr., Distinguished Chair in Palliative Medicine.
“The physician-partner also gains from this experience,” says William Nelson, PhD, MDiv, who is the fellowship co-director and head of Geisel’s Health and Values program. “So we see this partly as professional development for faculty too.”
Warren says she appreciates formal training in ethics, because even in routine care, physicians must keep in mind both their obligations to their patients and what’s best for society at large.
“Ethics is what drew me to medicine,” she adds. “In people’s time of need, there’s such a potential for the right or wrong action to make all the difference.”