Anne Armstrong-Coben '85: Pediatrician Emphasizes Medicine’s Human Side
Issue   |   Fri, 10/20/2017 - 02:06
Photo courtesy of Anne Armstrong-Coben ’85
Anne Armstrong-Coben’s career has taken her through the subfields of narrative medicine, pediatrics, legislative work and service.

Empathy for others and a resolve to affect positive change define Anne Armstrong-Coben’s multifaceted career as a pediatrician. A political science major while at Amherst, Armstrong-Coben brought skills and traits that she picked up in her undergraduate career into medical school and beyond.

She has taught medical students and residents at Columbia University in New York City, and she also opened and ran a medical practice for children in foster care for several years, hoping to address their unique and pressing medical needs. Her heart for her patients has led her to emphasize the importance of narrative medicine in her teaching, and she now oversees service learning for the medical school, raising up new classes of physicians with hands-on experience in providing care to those who need it most.

A Political Science Past
Armstrong-Coben grew up in a big family, the second of seven children. “I always knew I wanted to be a doctor since I was three years old,” she told me. “I wanted to be a pediatrician.”

She took the first step toward realizing this goal when she decided to come to Amherst College, which was the perfect fit for her — one of Amherst’s key advantages was that she could play Division III women’s basketball while being on the pre-medical track and getting to know her professors on a close, personal level.

Similarly, Armstrong-Coben was a perfect fit for Amherst. Even though she came from a high school where “there wasn’t a lot of emphasis on reflection and thinking,” she quickly adapted to the college’s thoughtful academic atmosphere.

Her sights were still set on medicine, but she also declared political science as her major. Armstrong-Coben felt drawn to the professors in the department and the way political scientists thought about various issues.

“You learn how to think,” Armstrong-Coben said of her Amherst education. “I learned how to write, and I learned how to listen.” When people ask why she chose to receive a liberal arts education, she asnwers that those skills have helped her “be humanistic in practice,” which she considers important for any physician.

Professor of Political Science Austin Sarat, who was an important professor to Armstrong-Coben, recalled that she was an engaged and curious student.

“She was, in addition, a wonderful person whose human concerns seemed to drive her studies,” he said.

The Importance of Narrative Medicine
After graduating in 1985, Armstrong-Coben moved to New York City to attend medical school at Columbia, where she enjoyed the new educational and urban environments.

“There was just something about [Columbia] and … the patient population that I found very, very exciting,” she said.

Armstrong-Coben did not leave Columbia after obtaining her MD; she completed her pediatric residency there and stayed on later as faculty, first working primarily with residents, and then with medical students.

She and other faculty members have been involved with integrating the ideas of the field of narrative medicine into the medical students’ curriculum.

“[I’m] very fortunate the person who invented narrative medicine, or created it as a field, is actually at Columbia,” Armstrong-Coben said.

Narrative medicine is a substantial part of Columbia’s medical curriculum, and she said it improves physicians’ practice by helping them become “better listeners and observers; when you’re with your patients in one-on-one encounters, you become much more present for them and you can hear their stories and witness their experiences better.”

From her experiences as a physician and teacher of future physicians, Armstrong-Coben has recognized a need for what she calls “humanism in medicine.” Several factors contribute to a widening gap between physicians and patients, including the increasing presence of computers for record-keeping and a productivity needs. However, to her, the patient-physician relationship is the most important aspect of being a doctor.

Narrative medicine, then, “keeps the humanism in the patient-doctor relationship really forefront in the education,” she said. She hopes that the skills students learn through narrative medicine will become an integral part of their identity as physicians.

Armstrong-Coben credits her time at Amherst as helping to foster her interest in narrative medicine, since it shaped the way she thought about patients and approached her interactions with them. Even though narrative medicine did not yet exist when Armstrong-Coben was starting her career, her interests and her way of thinking aligned very closely with what narrative medicine teaches, inspiring her to become more interested in the field when it finally emerged.

“My education at Amherst — it did teach me to think more, and be more attentive with things, and curious,” Armstrong-Coben said.

“I loved not just the patient in my exam room — I loved knowing about their lives outside of there and all the impact that everything else has had on them,” she added.

She has the same outlook in her interactions with students. At Columbia, she is an advisory dean to over 100 medical students. This position is exciting to her because she can see her students through formative years in terms of career and personal life, and her students’ perspectives remind her of her own reasons for going into medicine.

As with her patients, Armstrong-Coben values one-on-one interactions with her students and learning more about them during what she called “a neat time in people’s lives.”

Improving Outcomes for Children in Foster Care
While Armstrong-Coben has contributed to medical education at Columbia, she also dedicated her time to serving a traditionally underserved community with unique health needs: children in foster care.

Armstrong-Coben identified the strong and unmet health need among these children when she opened a practice for homeless adolescents. She realized a trend among her patients — most of them had been in foster care until they turned 18, at which point they were turned out with no place to call home and nowhere to go. The health care they received while in foster care, she said, was “horrendous.” Some of them also landed in foster care because they suffered abuse and neglect.

“My dream was to open a practice for children in foster care, and so that’s what I ended up doing,” she said. “It’s a population that I love and feel passionate about.”

As of this past year, Armstrong-Coben is no longer running the Newark, N.J. foster care practice that she opened up seven years ago. However, her passion for working with underserved populations in New York City remains.

She has also engaged in legislative work for New Jersey’s child advocate’s office on the issue of homeless adolescents and children in foster care. This is, as she put it, one of her various careers within a career. She has relayed her experiences and stories — as well as the knowledge she gained from her political science major — in order to influence policies on child welfare in her state.

Her decision to become involved with legislative advocacy, she said, was inspired by a realization that “you have patients who keep walking through the door with similar problems, and you realize that addressing certain things at an individual level isn’t going to be the most effective way to do it.”

The positive side of legislative work, for Armstrong-Coben, is the potential impact when an entire patient population can improve their health and health care access. The downside? “It moves really slow,” she said with a laugh.

Bringing Service to the Clinic and Classroom
Armstrong-Coben did not limit her passion for working with the populations most in need of quality health care to her own practice. Where Columbia is in New York City, medical students and residents are surrounded by people who need better care, many of whom live in poverty. She has identified and now brings attention to factors affecting patient outcomes so that her students can be more effective in tailoring their approach to patients, accounting for differences in class and socioeconomic status.

In her experience, many disparities in medical outcomes are related to families’ different resources. For example, she said, a child living in a family unable to consistently pay their electric bill would be at higher risk of being hospitalized. All patients could see and hear the same things in an exam room, but their different environments or resources can lead to differences in outcomes.

“Access to resources, what you end up seeing, has so much more of an impact on health than actually a lot of the direct health care that we’re doing,” Armstrong-Coben said.
Recently, Armstrong-Coben said, she was named the director of the Office of Service Learning for the medical school at Columbia, which indicated to her a growing interest in hands-on experiential learning and serving. Community service is growing increasingly important in medicine, which she largely credits to incoming medical students who often choose to work with nonprofit and community organizations and public or global health.

“I think many from my generation — and also generations after me — felt like so much of education is just very selfish,” Armstrong-Coben said. “It’s sitting in a library with a book and studying.” With this practical, service-oriented approach to learning, she said, “You can go out into communities and learn that way.”

Life Outside Medicine
Beyond her work in the clinic and the classroom, Armstrong-Coben also values her time with her family. She has four young children, and they are a priority to her. Although balancing work and personal life comes with its own challenges, she said her husband Harlan Coben ’84, whom she met during her time at Amherst, has been “instrumental in me being able to do what I did” — to continue advancing in her career while remaining a dedicated parent.

“As a physician, Anne has always tried to help the underserved and been their champion,” Harlan, a bestselling author, said. “People sense her goodness right away. I am ridiculously proud of her.”

Armstrong-Coben reminisced that she and Harlan Coben had started dating in college and — with a laugh — that she had started taking political science classes because he was a political science major.

Overall, she considers herself fortunate for having her many opportunities.

“I’ve just been given a lot of opportunities to do some really cool stuff that I hope has had a lot of impact,” she said, driving home once more the longtime passion that she has had for changing the world around her for the better.