What if you’re a doctor working with a 9-year-old girl who knows she is dying, but doesn’t know it’s from AIDS because her family wants to protect her from bias. Do you tell her?
You’re an emergency room doctor and a 17-year-old comes in coughing up blood. He’s near the end of his life and wants to spend what time he has left on a vacation with his girlfriend. Do you intubate him to keep him alive, as his mother orders, against his wishes?
These are the kinds of cases Wayne Waz ’84 works with as he teaches medical students at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. He spoke with students Oct. 13 in professor Stephen Hilgartner’s class on “Ethical Issues in Health and Medicine." The University Course receives support from the Writing in the Majors program.
Waz is director of pediatric medical student education and a clinical associate professor at Buffalo; medical director for Upstate New York Transplant Services; and chief of the Division of Nephrology, Pediatrics at the Women and Children’s Hospital of Buffalo.
As an undergrad, he played football for Cornell and majored in biology and society, a fairly new major at the time.
“Most students were attracted to the major because you got to read things like Darwin, which wasn’t just a science book. It changed everything,” Waz said. “You can’t not think about politics, policy and religion based on that type of scientific development that was happening. I really wanted to think about those things.”
Waz said the skills he learned in some of his liberal arts and social science classes serve him well in today’s medical environment, where patients are much more involved in their care than in previous generations.
“The old style of medicine was paternalistic, where the doctor was the healer and knew what was best for you,” he said. “But today, there’s more autonomy and shared responsibility between doctors and patients. We tell the patients: ‘You know what’s best for you.’”
The new dynamic creates challenges for today’s pediatric medical students, who need to balance the interests of many parties when they think about patient care – the patient, the parents and family, and doctors and nurses caring for the patient. Each one may have a different perception about what’s in the patient’s best interest. Waz said the question becomes, “who gets to decide?”
“Whenever you’re involved in ethical cases, you have to separate the two parts of yourself: your training and experience and your personal opinion,” he said.
A key skill is the ability to listen. When his students have downtime during their residencies, he encourages them to sit with families they’re caring for and get to know them.
Waz spends part of his time with patients (always with medical students in tow) and the rest of his time matching students with appropriate clinical settings and teaching.
Part of that teaching time is in a simulation center, where actors portray patients and family members and work through various situations doctors might encounter during a medical visit. In one scenario, child abuse is suspected.
“We talk about what your legal obligations are, but also how do you manage your own feelings in this situation, how do you keep working, how do you finish taking care of that kid and interviewing that parent and working through that,” he said.
Waz has been visiting Cornell to talk to the medical ethics class since the 1990s, Hilgartner said, and it’s a boon for his students.
“Wayne makes an important contribution to their education because the course focuses on theory, analysis and readings, and he comes in and talks about the very human dilemmas he encounters in his work with actual patients and families,” said Hilgartner, who teaches in the Department of Science and Technology Studies. “For many of our students who want to go to medical school, he’s what they want to become.”
Kathy Hovis is a writer for the College of Arts and Sciences.