Academic journal article Journal of College Science Teaching

Let's Get Personal: Putting Personality into Your Cases

Academic journal article Journal of College Science Teaching

Let's Get Personal: Putting Personality into Your Cases

Article excerpt

Show me an actress who is not a personality and I will show you a woman who is not a star.

--Katherine Hepburn

You have a nice personality, but not for a human being.

--Henny Youngman

Personality trumps everything, say politicians. It is more important than policy, than demographics, than finances or amorous peccadillos. If folks relate to a politician on a personal level, you have a winner; everything else is theatrics. Writers say this too. Personality is essential. You must have characters that the reader cares about; otherwise, you are writing a novel that no one will ever read. Even if we don't like the protagonist very much, if she has charisma, we will watch her antics. How else can we explain the success of reality shows and the public's fascination with the exploits of celebrities? It is the interaction of people that capture our interest--much more than the titanic struggles of nations.

This brings me to the point: Why is it that so many medical case study writers fail in this regard? Instead, they write clinical puzzles for students and ask them to diagnose illnesses for phantoms. A typical case might read like Case 825 from the University of Pittsburgh's Department of Pathology (http://path.upmc. edu/cases/case825.html) and contributed by Daniel D. Rhoads, MD, and Octavia M. Peck Palmer, PhD.

Case 825: 66-year-old female with weakness

A 66-year-old female with metastatic colon cancer presents to the emergency department (ED) with the complaint of weakness, which was so bad that she had to be carried to the car before being driven to the ED. She underwent debulking surgery one month prior to presentation and has since followed up for problems including fecal impaction and diarrhea. She has poor oral intake and is losing weight. She reports compliance with her bowel regimen of docusate sodium, senna, polyethylene glycol, and milk of magnesia. Initial laboratory findings are listed in Table 1.

The ED evaluation concluded that the patient had an acute kidney injury that was likely due to volume depletion. Intravenous fluid resuscitation was commenced, and the patient was admitted. Which electrolyte abnormality may best help to explain the patient's weakness, and what predisposing factors put this patient at risk for the development of this abnormal finding?

Reflection

This may be a swell academic exercise; it was chosen as the case of the month for May 2014. But why should anyone really care about this patient who has no personality, no dog, no friends, no sister, no brother, no children, no spouse or lover, and most important of all, no name?

Does medicine merely consist of plumbing problems? Doesn't this play into the stereotype of the impersonal nature of the medical profession? Worse still, this type of case serves as a prototype for other health disciplines like nursing, physical therapy, pharmacology, and dentistry. Their cases are often mirror images of those in medicine. Perhaps we should be more forgiving. Medical personnel are relentlessly exposed to traumatic illness and devastating injuries; they are cautioned to set their emotions aside, otherwise they run the risk of jeopardizing the health of their patients and their own psychological well-being. This was nowhere better illustrated than in the MASH movie and television series where surgeons were regularly confronted with the horrendous casualties of the Korean War. The characters responded by continual jokes and hijinks to avoid the psychic devastation they faced daily.

Linda Young and Rodney Anderson of Ohio Northern University decided to find out if these cases can be improved (Young & Anderson, 2010). Teaching microbiology to nursing, pharmacy, and biology students, they chose to compare standard clinical cases with personalized cases that covered the same material. They wanted the case design that "was the most effective in promoting long-term retention of clinically significant microbiology concepts, developing patient empathy, improving comprehension of patient compliance problems, and facilitating student understanding of transcultural health care concerns. …

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