Journal Article Living Worth: Value and Values in Global Pharmaceutical Markets. Stefan Ecks Get access Living Worth: Value and Values in Global Pharmaceutical Markets Stefan EcksDurham: Duke University Press, 2022. 288 pp. Steven Server Steven Server University of Chicago, IL, USA sserver@uchicago.edu https://orcid.org/0000-0003-2944-7810 Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of the History of Medicine and Allied Sciences, jrad051, https://doi.org/10.1093/jhmas/jrad051 Published: 10 August 2023

During the early months of the COVID-19 pandemic, when health systems were overwhelmed with surging hospitalizations and a novel virus, many ambulatory patients diagnosed with COVID-19 lacked guidance and support as they convalesced at home. This case report offers insight into the implementation of a telehealth service utilizing third- and fourth-year medical students to provide follow-up to ambulatory patients diagnosed with COVID-19. The service was evaluated using medical student surveys and retrospective chart review to assess the clinical and social needs of patients during the spring of 2020. Students assessed symptoms for 416 patients with COVID-19 from April 8 to May 20 and provided clinical information and resources. Eighteen percent of these patients sought higher levels of medical care, in part from student referrals. Three key implementation lessons from this experience that may be relevant for others include: 1) Vulnerable patient populations face unique stressors exacerbated by the pandemic and may benefit from intensive follow-up after COVID-19 diagnosis to address both medical and social needs; 2) Medical students can play value-added roles in providing patient education to prevent the spread of COVID-19, assisting patients with escalating care or resource connection, and providing emotional support to those who have lost loved ones; 3) Continuous re-assessment of the intervention was important to address evolving patient needs during the COVID-19 outbreak. Future work should focus on identifying high-risk patient populations and tailoring follow-up interventions to meet the unique needs of these patient populations.

This article was migrated. The article was marked as recommended. COVID-19 has disrupted traditional forms of clinical practice in both inpatient and outpatient settings. This novel, potentially-fatal infection proliferated to such a degree that many patients with mild disease had to engage in self-care at home. This disruption to clinical services has also upended in-person clerkship education across the country, leading to sustained periods of student furloughing. We developed a telehealth service-learning opportunity for COVID-19 patients who were advised to self-care in their homes. The service was staffed by medical students in their clinical training years, providing triage advice to patients, their families, and co-habitants until their symptoms improved. Callers set patient education around red flag symptoms as their first priority, but also offered counsel on home infection control and self-isolation strategies, composed work letters, offered resources regarding home management issues such as food and sanitation, and attended to the mental health needs of the patients and their families. An attending was on-call daily to assist and educate students about issues relating to clinical decision-making and the social determinants of health. A survey assessed medical students' opinions on the service. Student respondents found the service valuable, with 100% agreeing or strongly agreeing that the service was worth their time and important. Respondents reported learning important telehealth skills such as triage and patient education. Overwhelmingly, students found emotional connections with patients to be the most meaningful aspects of the service. Our telehealth service allowed students to learn from patients in a longitudinal manner, while remaining safely away from clinical settings. This service may prove a useful model for others in the case of another outbreak, particularly when medical students are furloughed. We hope to develop more clinical experiences in telehealth for medical students moving forward.

‘Niche’, from the Middle French term nicher, ‘to nest’, is defined by the Oxford English Dictionary as ‘The actual or potential position of an organism within a particular ecosystem, as determined by its biological role together with the set of environmental conditions under which it lives’, so Carving a Niche is aptly named. Hernández Sáenz offers a detailed analysis of medicine’s fight for centralisation, legal and regulatory monopoly and social prestige. Her argument is richly researched, filled with sources as diverse as pieces of legislation, applications for licensure, professional censuses, licensing exams and medical school curricula. These show the juridical, bureaucratic and legislative mechanisms by which Medicine guarded its nest in turbulent times. Unlike studies of professionalisation set in a stable, industrialised context, Hernández Sáenz dives deeply into the ‘chaotic’, ‘fluid’ world that Mexican medicine navigated in the nineteenth century (p.268). Indeed, for Hernández Saenz, it was precisely the upheavals of early independence that catalysed the coalescence of a modern professional ‘Medicine’ in Mexico. The collapse of colonial structures after the Napoleonic occupation of Spain touched all sectors of colonial society, including medicine. For doctors who had enjoyed the privileges offered them by the Protomedicato, the board which had ‘ensured the racial purity and social standing of the medical elite’ (p.64), the erasure of traditional colonial privilege posed an existential threat. Physicians engaged in a fierce battle of survival of the fittest. In 1831, physicians and surgeons, who had historically been viewed more as craftsmen, joined in a ‘marriage of convenience’ (p.71). This alliance ‘enabled physicians and well-educated surgeons to strengthen their position at the apex of the medical hierarchy and guaranteed them control over the minor branches of the profession’ (p.112). If the Protomedicato was now unable to protect racial and gender privilege, the profession was now able to oblige. By controlling the licensure of midwives—most often women without much formal education—Medicine subordinated midwives to obstetricians—most often highly educated men. The story was similar for phlebotomists, who in the colonial period had enjoyed status as ‘an integral part of therapy’ (p.83). In the 1830s and 1840s, the clinical independence of phlebotomy was removed, subordinating practitioners frequently of mixed-race background to the oversight of mostly creole physician-surgeons. By expanding its role in public health, doctors (in the form of representative organisations such as the Consejo Superior de Salubridad and Facultad Médica) finally recaptured ‘their authority over all health-matters’ by mid-century (p.113).