Showing 101 - 110 of 244 annotations tagged with the keyword "Medical Advances"

How Doctors Think

Groopman, Jerome

Last Updated: Aug-06-2007
Annotated by:
Coulehan, Jack

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In How Doctors Think, Jerome Groopman explores clinical decision making with a particular emphasis on the poor communication skills and cognitive errors that often lead to misdiagnosis and inappropriate treatment. He uses a narrative approach, filling the book with compelling stories that illustrate the world of patient-physician interactions. Why did a second doctor quickly conclude that Blanche Begaye suffered from aspirin toxicity, while her first doctor mistakenly diagnosed viral pneumonia? Why did several physicians fail to diagnose Maxine Carlson's ectopic pregnancy until the day it ruptured? Groopman's storytelling skill permits him to convey complex concepts (e.g. availability bias, anchoring, and Ockham's razor) through conversation and narrative.

Three major themes run throughout the book, and each is presented with several variations. The first theme is that doctors who don't listen to their patients are likely to make serious mistakes in diagnosis and treatment. The second is that doctors frequently don't have the self-awareness to understand their own errors, especially those that involve dealing with ambiguity and understanding the importance of emotions. The final theme is that that patients ought to be active participants in their own care. This is not a new message, but Groopman frames it in a new way. Given the complexity of clinical decision making, and the many cognitive errors physicians may fall prey to, patients can improve their own care by helping their doctors minimize or avoid such errors. Among other things this means asking thought-provoking questions like "What else could it be?", "What is the worst thing it could be?," or "Is it possible I have more than one problem?"

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Word of the Cure

Glowney, John

Last Updated: Jul-13-2007
Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Poem

Summary:

The poet beautifully captures the connection between a successful neurosurgical operation that restores "the jitterbug of impulses" of the brain, with the neighbors' "word of the cure." He likens the neighbors' conversations to "the way, in Montana prairie country, / the first telephones let the local secrets / and sorrows pour through the survey-staked / barbed-wire fences now doubling / as makeshift transmission lines."

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.

The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).

In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.

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Summary:

Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.

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Summary:

This book, designed to accompany an exhibition "on the frequently Excessive & flamboyant Seller of Nostrums as shown in prints, posters, caricatures, books, pamphlets, advertisements & other Graphic arts over the last five centuries," displays and comments on 183 illustrations associated with the art of quackery. As the title suggests, Helfand surveys the graphic material of quackery of England, France, and America during the modern period, although most of the material dates from the eighteenth and nineteenth centuries. In his introduction, Helfand discusses the uncertain boundaries between "regular" (now termed allopathic) physicians and their "irregular" or "empiric" counterparts--quacks.

Through the mid-nineteenth century, many practitioners of both sorts relied on pharmaceutical agents like mercury, antimony, and opium; developed trade symbols and packaging; and flaunted the honorific "Dr." and their affiliation with science. Many patients visited both regulars and irregulars, who might consult with each other. Some physicians even prescribed quacks' proprietary preparations. Helfand also notes differences, such as irregulars' lack of medical training, exaggerated advertising, refusal to disclose the contents of their products, and use of entertainment and sometimes even religion in their "medicine shows."

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The Fundamental Pictures

Gilbert and George

Last Updated: May-18-2007
Annotated by:
Henderson, Schuyler

Primary Category: Visual Arts / Sculpture

Genre: Sculpture

Summary:

Gilbert and George's work over the past three decades has largely consisted of grid-like photomontages - note, they consider their work to be "sculpture". These often massive works are at once easily identifiable as part of Gilbert and George's oeuvre (in part because they often have Gilbert and George in them) and unflinchingly referential: to the manufactured sheen and unnaturally bright neons of Warhol, to the confrontational exposure of Mapplethorpe's photography, and, of course, to cathedral stained glass. They draw upon these same influences in their creative self-creation, their transgressive aesthetics, and their repetition and reworking of religious and secular motifs intertwined with abstractions. Gilbert and George are insistently doubles: original and derivative, repetitive and evolving, reactionary and visionary.

The Fundamental Pictures consists of a series of some 39 scultptures, most involving juxtapositions of bodily execretia - sputum, tears, urine, semen, feces - in monumental close-up; the tears, urine and semen are captured through a microscope, dessicated and crystalized. The sensational titles of the individual works, such as 'Piss Faith' and 'Spit on Shit', are fairly accurate in describing the central themes of each work. In some of the montages, Gilbert and George appear, pink and naked, against a kaleidoscopic backdrop of bright, magnified bodily fluids; in others, they are dressed in their familiar suits. They were exhibited at the Lehmann Maupin Gallery, New York, in 1997.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In this account of early practitioners and advocates of 'inoculation,' or the use of tiny amounts of smallpox contagion to induce a mild case of smallpox and immunity, author Carrell weaves prodigious historical research with fictionalized dialogue to create a tale of two prominent figures: Lady Mary Wortley Montagu of London and Dr. Zabdiel Boylston of Boston. Both Lady Mary and Boylston suffered scarring from smallpox, and, by living in the early 18th century, both witnessed the devastation of epidemics in terms of public health and private loss.

Both were also aware of the use of inoculation to prevent severe disease in Turkey (Lady Mary visited with her ambassador husband) and in Africa (on the advice of Cotton Mather, Boylston interviewed Africans, slave and freemen, living in Boston). Both faced formidable challenges and risked personal security to promote the use of this technique. Both proved their belief in the technique by the inoculation of their own children. And both, perhaps, met. At the behest of the Royal Society, Boylston traveled to London, witnessed numerous inoculations, and presented his Boston experience to the Society.

The book also chronicles the natural course of the disease, its various symptoms, forms and popular treatments, and the political impact of smallpox on the royal families of Europe and business interests in Boston. The medical research of various doctors is detailed. In particular, selected Newgate prisoners were offered pardon in return for participation in an experiment conducted by Mr. Maitland, who also inoculated Lady Mary's children. These experiments were used to test the safety and efficacy of inoculation prior to royal inoculation.

Ultimately, detractors of inoculation ceased their vitriolic attacks, as the risks of inoculation were proven to be far lower than exposure without such protection. The success of inoculation paved the way for Edward Jenner, often called 'the father of immunology,' to successfully use cowpox to induce smallpox immunity later in the 18th century.

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The Agnew Clinic

Eakins, Thomas

Last Updated: May-15-2007
Annotated by:
Mathiasen, Helle

Primary Category: Visual Arts / Painting/Drawing

Genre: Oil on canvas

Summary:

The Agnew Clinic by Eakins was commissioned by Dr. D. Hayes Agnew's students at the University of Pennsylvania to celebrate the seventy-year-old physician's retirement as Professor of Surgery in 1889. It was unveiled at commencement 1 May 1889. The size of the painting, the largest Eakins ever created, is 84 3/8 x 118 1/8 inches. The artist painted the work in ninety days and received a fee of $750. Its frame carries this inscription in Latin: The most experienced surgeon, the clearest writer and teacher, the most venerated and beloved man.

Dr. Agnew (1818-1892), a Pennsylvania native, was a well-respected surgeon and educator who had served in two army hospitals during the Civil War. He was best known for his competence in removing bullets, but Eakins has chosen to show him performing a lumpectomy or partial mastectomy.

The surgeon is shown standing in an enclosure, having stepped back from the operation. He is lecturing to students, faculty, and spectators seated in the operating theatre. Dr. Agnew holds a scalpel in his left hand. He is wearing a white surgical gown.

Eakins has placed the operating table with the female patient in front of Dr. Agnew. Her hair and face are visible, the ether cone just above her chin. Her right breast and arm are shown; the left breast is being operated on. A sheet covers her lower body. The sheet beneath the patient carries the inscription: University of Pennsylvania. Between Dr. Agnew and the bed we see a closed case holding the sterilized instruments. The anesthesiologist and the surgeons all wear white. Dr. Agnew's nurse, Mary Clymer, stands by the patient's waist. She is dressed in a high white cap, white apron and black dress.

Eakins illuminates Dr. Agnew, the patient and her doctors, and the nurse. The spectators sit in semi-darkness, but they are individualized by face and posture. The painting contains about thirty small portraits of doctors. Most of the doctors and spectators have been identified by name (see site at University of Pennsylvania: http://www.archives.upenn.edu/histy/features/1800s/1889med/agnewclinic.html). Eakins is standing to the extreme right, listening to a doctor who whispers to him. Because of time constraints, Eakins's mini portrait was painted by his wife, the artist Susan Macdowell Eakins.

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

Dr. Pauline Chen is a transplant surgeon and hence highly trained in the surgical care of desperately ill patients. She found, however, that although she had intensive and first rate training, time and again the message she received from her mentors and peers encouraged a distance from frank discussions about dying with patients who were clearly dying. Dr. Chen successfully suppressed her urges to reflect on the meaning of illness and death. Years into her training, she finally witnessed an attending surgeon stay with a patient and the patient's wife until the patient passed away. The widow sent a thank you note to Dr. Chen for allowing a "dignified and peaceful death." (p. 101) Chen notes that observing her attending stand with the patient during death changed her profoundly: "...from that moment on, I would believe that I could do something more than cure. This narrative, then, is my acknowledgment to him." (p. 101)

Final Exam chronicles Chen's journey from medical student to attending surgeon and examines her experiences with death and serious illness - of patients, family members, friends. The memoir contains three parts: Principles, Practice, and Reappraisal - each with three chapters. The book is chronologically arranged, beginning with anatomy dissection at the start of medical school and ending with Chen as an attending arranging for hospice, thus honoring a patient's desire to die at home rather than in hospital. Chen skillfully weaves her stories around commentary on the social, cultural and philosophical issues surrounding death and the medical response to death. An introduction and epilogue bookend the text and 46 pages of extensive notes and bibliography complete the book.

Although Chen claims to have slowly and painfully awakened to the fact that patient needs extend well beyond good technical care, in fact one sees Chen emerge as a caring physician even from her initial patient contacts in medical school. Chen speaks more to her role as an Asian-American than to being a woman in a male-dominated field, but she clearly has what it takes to succeed in this extremely competitive field, including a good dose of compulsiveness and an incredible work ethic.

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Annotated by:
Mathiasen, Helle

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

This 2002 DVD, copyrighted by WHYY in Philadelphia and narrated by Blythe Danner, consists of a one-hour documentary about Philadelphia-born painter, photographer, and sculptor Thomas Eakins (1844-1916) and eight short films about different facets of his life and work. Photographs by and of Eakins, his paintings, letters, and sketches are interspersed with commentary by his biographer Elizabeth Johns, and by art historians and historians. The DVD describes Eakins’s training, art production, and aspects of his personal life.

Eakins was already an excellent draftsman, trained at Central High School in Philadelphia, but he first learned to paint during the three-plus years he spent in Paris at École des Beaux Arts. The practice there was to paint from live, nude models instead of from plaster casts, as was customary in Philadelphia. After Paris, he traveled to Spain where he visited Madrid and Seville. He developed great admiration for Goya, Ribera, and Velazquez. His letters home indicate how much he missed his family, yet also how seriously he worked on his art.

Returning to Philadelphia, Eakins set up his studio in his family's home on Mt. Vernon Street. He spent most of the rest of his life in his childhood home. Eakins painted portraits of athletes, for example, rowers and boxers. He chose sitters skilled in the arts, in medicine, business and industry, and painted family members. He always portrayed people and scenery he knew well, and athletes skilled in sports he himself loved. An excellent draftsman and highly trained painter, Eakins became a popular instructor at the Pennsylvania Academy of Fine Arts.

Pennsylvania Academy of Fine Arts had an institute policy that prohibited the use of live, nude models, especially in mixed classes, but Eakins rebelled against these rules by asking his students to model nude in the classroom and outside. Eakins also modeled in the nude himself. He photographed and painted his students in the nude. He believed that artists must study human anatomy through anatomy lectures, dissection, and observation of the body in motion. He assigned such tasks to his American students. Because of his rebellion against Academy rules, he was forced to resign.

Eakins finished his most ambitious painting, The Gross Clinic (annotated in this database) when he was 31 years old. The work, now recognized as an American masterpiece, was poorly received by his contemporaries. Much of his later production was portraits of people he asked to sit for him, including Walt Whitman. He painted a number of cowboy pictures during his stay at a North Dakota ranch where he was recuperating from depression. He also painted twenty-five portraits of Philadelphia physicians.

The last photo of Eakins in his studio, featured in the documentary, shows him seated with his back to the viewer and surrounded by the many pictures he had been unable to sell or which were rejected by his sitters. Eakins is now recognized as a major American artist, particularly in portraiture.

 

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