Showing 11 - 20 of 820 annotations tagged with the keyword "Doctor-Patient Relationship"
Summary:Extremis, a Netflix documentary directed by Dan Krauss, follows Dr. Jessica Zitter a palliative care ICU physician at Highland Hospital in Oakland, California. The documentary begins with an exasperated Dr. Zitter trying to communicate with a patient on a ventilator: “Is this about the breathing tube? You want it out?” she asks. When the patient nods in affirmation, Dr. Zitter replies, “What if you die if I take it out?” The questions confronting the physicians, patients and their loved ones get no easier over the course of the film. The documentary is propelled by a dramatic tension between its protagonists: on one side Dr. Zitter, who is compassionate but dogmatically pragmatic, on the other side the family members of patients who are driven above all by hope and faith. This tension manifests itself in palpable ways. In one particularly powerful scene, a patient’s daughter says to Dr. Zitter: “it would feel like murder to pull that life support. That’s what it would feel like to me…I feel like maybe as a doctor, you know, being as smart, and being as knowledgeable, and being inside medical journals, it can dwindle your optimism a little bit.” Dr. Zitter replies simply, “I’m just trying to help you make a decision that’s right for your Mom.” Of course, for Dr. Zitter there does appear to be a categorically appropriate decision in all of these cases. In most of her conversations, she is transparently trying to get family members to see that there is no realistic chance of meaningful recovery for their loved ones. That is not to say that she is insensitive to the family’s wishes or the complex bioethical conundrums which arise around her. In fact, her bravery and deftness in broaching these serious and difficult topics is on full display throughout the film.
Summary:It is a strange and cruel world that Amelia finds herself in. The 17-year-old woman from Mexico who speaks very little English travels to Oakland, California to marry her boyfriend Manolo. Soon after, he is sentenced to 8 years in prison. Amelia is already pregnant. She and her newborn son, Jesus Romero, move in with Manolo's aunt and uncle. Amelia refers to the baby as "mijito" (an affectionate Spanish term for "little son"). He cries constantly and has a hernia that requires repair. But the teenage mother is overwhelmed and frightened. She receives little support.
Summary:The collection is prefaced and named for a poem by Walt Whitman, The Wound Dresser, annotated in this database by Jack Coulehan. In “On Reading Walt Whitman’s ‘The Wound Dresser’” Coulehan sees Whitman as a nurse tending the Civil War wounded, and, while using some of the words and language of Whitman’s poem, imagines himself moving forward in that created space of caring for patients: “You remain / tinkering at your soldier’s side, as I step / to the next cot and the cot after that.” (p. ix) The poem introduces us to all the ‘cots’ of the book – where we step from patient to patient, through history and geography, and through the journey of medical training. The book is comprised of 4 sections without overt explanation, although there are 4 pages of Notes at the end of the book with information about select individual poems. In general, the themes of the sections can be described as: 1.) clinical care of individual patients and medical training; 2.) reflections on historical medical cases, reported anecdotes or past literary references; 3.) meditations on geographically distinct episodes – either places of travel or news items; and 4.) family memoir, personal history and the passage of time. Many of the poems have been previously published and a few are revised from an earlier chapbook. Notable among the latter is “McGonigle’s Foot” (pp 42-3) from section 2, wherein an event in Philadelphia, 1862 – well after the successful public demonstration of anesthesia was reported and the practice widely disseminated, a drunk Irishman was deemed unworthy of receiving an anesthetic. Although it is easy to look back and critique past prejudices, Coulehan’s poem teaches us to examine current prejudices, bias and discrimination in the provision of healthcare choices, pain relief and access to care. There are many gems in these 72 poems. Coulehan has an acute sensibility about the variety of human conditions he has the privilege to encounter in medical training and clinical practice. However, one of the standouts for me was “Cesium 137” based on a news report of children finding an abandoned radiotherapy source (cesium) in Goiania Brazil, playing with the glowing find and suffering acute radiation poisoning. He writes: “the cairn of their small lives / burst open…their bodies vacillate and weaken / hour by hour, consumed by innocence / and radiant desire.” (p. 68). Following another poem inspired by Whitman, Coulehan concludes the collection with a sonnet “Retrospective.” He chronicles a 40-year career along with physical aging, memories of medical training “etched in myelin,” and the search for connection across that span of career including, “those he hurt, the woman / he killed with morphine, more than a few he saved.” Ultimately, he relies on hope with fitting understatement: “His ally, hope, will have to do.” (p. 97)
Summary:Talking with Doctors, a memoir by David Newman, follows the author’s dizzying journey to find a physician and treatment plan after being diagnosed with a rare malignant tumor perched dangerously near his brain stem. Despite the author’s education, money, connections and geographic privilege (Mr. Newman is a New Yorker surrounded by “the best” hospitals and the “the best” doctors), he finds himself struggling to make any sense of the conflicting medical advice he receives. The vertigo induced by the deluge of advice he gathers in his countless trips to multiple medical centers, is only exacerbated by the egotism and childishness of some of the doctors he sees. The indecencies range from the routine—waiting hours for doctors that are running behind schedule—to the utterly bizarre—a doctor returning Mr. Newman’s $10 copay as a gesture of good will after explaining that his tumor was inoperable and would likely be fatal. Mr. Newman’s career as a psychotherapist is intimately interwoven into the fabric of the memoir. His analytical eye strongly informs his search for a physician whom he can trust. Moreover, knitted into the narrative is Mr. Newman’s experience with his own patients whom he is forced to refer to other therapists while he is receiving treatment. Coloring the tone of the entire memoir is the fact that Mr. Newman has survived the tumor around which the memoir is framed. Nonetheless, Talking with Doctors is a harrowing and suspenseful read.
Summary:This monograph is an important contribution—along with the Health Humanities Reader (2014)—to the burgeoning field of health humanities, a new academic field and the presumed replacement for (and expansion of) medical humanities. While the medical humanities included philosophy, literature, religion, and history, health humanities includes many more disciplines, and the creative arts.
Summary:In 1780, Thomas Silkstone, a young American surgeon and anatomist, is invited by Lydia to establish the cause of death of her brother, Lord Crick, a dissolute who held the Oxfordshire estate that she will inherit. Her goal is to absolve her husband of the suspicion of murder; however, as the investigation proceeds, it increasingly seems that her husband is guilty after all.
Summary:The speaker of this dramatic monologue in prose is an archangel. He attempts to tell his listeners—mortals, presumably—of the beauty to be treasured in the extraordinary ordinary of the everyday world. The Archangel speaks in nothing less than glorious diction, baroque syntax, and enchanting rhythm: he labors, rhetorically, to communicate in a language congruent with the complex, extravagant beauty of the world he describes. He pleads with his audience to listen to him and share in the profound aesthetic experience so readily available—but he pleads to no avail: his audience will not listen. In response to his audience's attempted departure, the Archangel implores, “Wait. Listen. I will begin again.”
Summary:The narrator of this story is a lifeguard who contemplates his identity and life-roles as he lounges in his lifeguard chair, elevated above the crowd of beachgoers. In the winter months, he is a student of divinity; in the summer months, he ascends the throne marked with a red cross in the hopes of guarding the lives of those at play before him. While he remains vigilant for calls of help, those calls never come, and the lifeguard confronts the troubling insight of the limited contributions he’s devoting his life to make.
Summary:“Tithonus” is a dramatic monologue that imagines the once handsome, magnificent Trojan prince to be well-advanced in an unfortunate state brought about by negligent gods and his own lack of foresight. Exultant over the blessings of his youth, he’d asked Aurora, goddess of the dawn, for eternal life, and she had obtained Zeus’s permission to grant the request. But Tithonus had failed to ask for eternal youth with his immortality—and neither Aurora nor Zeus had managed to recognize that this feature of the request might be important—so that Tithonus spends eternity growing increasingly decrepit. In Tennyson’s poem, Tithonus addresses Aurora, hoping he might persuade her to reassign him his mortal status and allow him to die.
Summary:The aim of these reflections on uncertainty in medicine is not to discredit evidence-based medicine or to incite suspicion of the careful and caring processes by which most clinicians arrive at the advice they give. Rather it is to change conversations among practitioners and between them and their patients in such a way as to raise everyone’s tolerance for the inevitable ambiguities and uncertainties we live with. If the public were more aware of the basic rules of mathematical probabilities, how statisticians understand the term “significance,” and of how much changes when one new variable is taken into account—when a new medication with multiple possible side-effects is added to the mix, for instance—they might, Hatch argues, be less inclined to insist on specific predictions. He goes on to suggest that there is something to be gained from the challenge of living without the solid ground of assurances. When we recognize the need to make decisions with incomplete information (a condition that seems, after all, to be our common lot) we may refocus on the moment we’re in and see its peculiar possibilities. Changing the conversation requires a critical look at medical education which, Hatch observes, “measures a certain type of knowledge essential to medical practice, but it consequently engenders a conception of medicine best described as overly certain . . . .”