Doing better at doing good

Documenting Medicine to make deeper connections

September 4, 2011 

Pregnant with her first child and serving as chief resident in the child and adolescent psychiatry department at Duke University Medical Center, Jennifer Segura already had her hands full.

Then she heard about a plan to equip young physicians with documentary skills.

Despite her jammed schedule, Segura, who treats adolescents struggling with substance abuse, saw an opportunity she couldn't resist - the chance to put a human face on a significant societal problem and, at the same time, educate the public about treatment options.

A year later, Segura has completed the pilot run of the Documenting Medicine project, a groundbreaking marriage between Duke's medical center and its renowned Center for Documentary Studies.

Begun last year with a three-year grant from a fund at the medical center, the program is unique in North Carolina and nationally. Already, universities from around the country are exploring how to replicate this pioneering effort to address a growing communication gap between physicians and their patients.

For her project, Segura created a website that tells the stories of the doctors, counselors, parents and patients involved with Duke's adolescent intensive outpatient program for substance abuse. Segura produced all of the photographs, audio and narrative, and she built the site at .

"It has made me a much more sensitive physician and a better listener - and that helps create much more individualized care for my patients," Segura says.

That is exactly what John Moses had in mind when he teamed with Liisa Ogburn at the Center for Documentary Studies to start the program. Moses, a pediatrician at Duke Medical Center and a longtime photographer, has documented gun violence, teen pregnancy and other challenges.

He wants more medical residents "to incorporate a documentary approach to their learning that will hopefully make them better clinicians."

Moses and Ogburn directed five medical residents through the program this past academic year. This year, on a budget of $50,000, they hope to attract 15.

As the medical industry expands, contact between doctors and patients continues to shrink. House calls ended a long time ago, and group practices can have a corporate feel. Patients are more likely to be assigned to whichever doctor is available on a given day, making it harder to develop the relationships that can improve care.

Drilling deeper

Meanwhile, the complexities of revenue and insurance reimbursements compel many practices to shuttle patients in and out of exam rooms in a hurry, leaving precious little time for doctors to treat the symptoms, much less the underlying causes, of illnesses.

They might, for example, prescribe medications for a diabetic patient but have no time to even learn about more systemic issues - such as the patient's family preparing meals that exacerbate the condition. In the end, doctors are rushed, patients do not receive optimal care and costs skyrocket.

Moses thinks documentary practices can help improve the situation. They give doctors insights into the home and societal context that informs the health and treatment of their patients - and that knowledge can potentially improve treatment strategies and reduce costs.

Because Documenting Medicine is so new, it is just beginning to track data about its effect.

Moses has seen the effect in his own career. After graduating from Duke in 1978, he spent a year photographing the conditions of migrant workers in the Southeast before going to medical school.

Trained in adolescent pediatrics, Moses still found himself uncomfortable around teens even after finishing his residency.

His documentary skills came to the rescue. Back in North Carolina, he split time between practicing medicine and photographing teen parents in their communities. It was an exercise that took Moses way out of his comfort zone - hospitals - and allowed him to see patients in a place where they were more comfortable - their own homes. He grew far more familiar with the factors that lead to teen pregnancy and much more at ease with his patients.

More recently, he has photographed victims of gun violence, including a 9-year-old boy with a head wound from a drive-by shooting. As a result, Moses is interested now not only in treating the damage caused by guns but also in advocating for policies and resources that will help prevent shootings in the first place.

For Moses and Segura, empathy is no longer a luxury in treating patients. It's a fundamental starting point.

Christopher Gergen is the founding executive director of Bull City Forward in Durham, a member of the faculty of the Hart Leadership Program at Duke University, and co-author of Life Entrepreneurs. Stephen Martin, a former business and education journalist, is a speechwriter at the nonprofit Center for Creative Leadership in Greensboro.

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