Showing 101 - 110 of 558 annotations tagged with the keyword "Physician Experience"

Summary:

This guide identifies short film clips designed to support “Cinemeducation,” word and method both coined by the editor Matthew Alexander. The editorial team consists of three family therapists--two psychologists and a social worker—with input from 26 other psychologists, behavioral scientists, and family physicians—all American, with the exception of one Brazilian. Most contributors train residents in family medicine. Both more and less than a scholarly treatise, this book is predominantly an annotated index.

Thirty short chapters are devoted to various subject themes: chronic illness, sexual behavior, aging, substance abuse, research, and medical error. In a paragraph or two, the clinical problem is outlined, then subheadings introduce specific, related keywords exemplified by the scenes selected. The plot and main actors of every film are summarized briefly at its first mention; a single movie can be cited in several different chapters. Each clip is similarly described and located precisely within the film (minutes and seconds).

In this manner, 125 films are parsed for 400 scenes, ranging in length from 1 to 6 minutes.  Most are Hollywood films, released since 1980. Questions for discussion accompany each film clip. The consistency and concise descriptions are admirable, but, sadly, the year of release is not supplied. 

A few chapters break from this format. One discusses aspects of technology. Another attempts evaluation of this teaching method through a ten-year retrospective survey of physicians who had been exposed to films in residency. The response rate was 60% but a fifth were rejected because the respondents could not recall the use of films. The remaining 48% who could remember the use of film clips found the method memorable, fun, and effective; however, they thought it would benefit from more context and amplification.

Appendices point to similar resources and more films under other keywords without details. This database is cited by URL without any description.

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The Anatomy of Deception

Goldstone, Lawrence

Last Updated: Jul-09-2010
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1889, young doctor Ephraim Carroll is in Philadelphia working with the team of the famous physician and pathologist, William Osler. In their zeal to learn more, they conduct careful autopsies, but the body of a young woman upsets Osler and teammate Dr. George Turk, and they defer the examination. Baffled when her body vanishes, Carroll becomes preoccupied with identifying the woman and the cause of her death.

A darling of Philadelphia society, Osler arranges for Carroll to attend a dinner where Carroll meets and falls head over heels in love with the unconventional Abigail Benedict. Abigail is a painter and free thinker, friendly with the great artist Thomas Eakins. Both are worried about their missing friend, Rebecca Lachtmann, and they engage Carroll to help find her. Through a series of adventures he is able to locate and identify the missing corpse as hers. He discovers the cause of death by exhuming the body.

In the meantime, Turk is found dead of what appears to be cholera; however, Carroll’s suspicions lead him to conclude that the young doctor was murdered by a dose of arsenic cleverly calculated to mimic symptoms of the infection. Drug addiction and an abortion ring lie at the heart of this crime.

Osler is being courted for a position at the new Johns Hopkins Medical School and he invites Carroll to consider joining him there.  But Carroll decides not to go to Baltimore.

To write more would give too much away. The surprise ending implicates famous doctors for unethical behavior, if not murder.

 

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The Betrayal

Dunmore, Helen

Last Updated: Jun-11-2010
Annotated by:
Mathiasen, Helle

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In this novel medicine and  politics interface, with disastrous results. The time is the early 1950s, the place Leningrad, and the Soviet leader is Josef Stalin. Andrei Mikhailovich Alekseyev is a  conscientious young pediatrician in a city hospital.  Though Andrei has been warned to be careful, he chooses to take on Gorya, a patient with osteosarcoma, the only child of Volkov, an official high in the Ministry for State Security. Dr. Brodskaya, a Jewish woman surgeon, performs a biopsy and recommends amputation above the knee. Andrei recommends that she perform the surgery. But Gorya develops lung cancer. Brodskaya applies for a transfer to Yerevan, well aware that Volkov will take revenge if the boy doesn't improve, but Andrei decides to stay in Leningrad.

He lives a spartan existence with his wife, Anna, and Anna's younger brother, 16. They bicycle out to their country dacha to fish and  harvest fruits and vegetables. Suddenly, a phone call to his home tells Andrei he is suspended from his medical practice. The police arrest Brodskaya. Shortly thereafter, in the night, Andrei hears police  boots on the stairs. The officers raid Andrei's and Anna's home, breaking furniture, emptying pickle jars into the sink, and confiscating their English dictionary. They send Andrei to Lubyanka prison in Moscow, where he is tortured to get him to sign a confession. Andrei reflects on his situation: "If he dies here, he'll die alone. The last faces he will see will be the guards' faces. Outside, he would never have believed that three initials scratched into a piece of soap [from the shared lavatory] could be so precious. In here, to know that another prisoner has taken the risk of trying to communicate brings a kind of hope"(262). He forces himself not to think about his pregnant wife, instead naming the muscles of the hand, or bone after bone of the human skeleton.

Finally, he is confronted with Volkov who tells Andrei Comrade Stalin has begun a purge of doctors because doctors have been killing communist leaders: "We are uncovering an international conspiracy of Zionists working as tools of the Americans, who directed these criminal murderers and saboteurs" (277). Volkov tells Andrei the Jewish Dr. Brodskaya has ‘suffered a heart attack', that is, she has been executed. Volkov accuses Andrei of betraying his trust by amputating his boy's leg, an operation that did no good, as the boy is now dying of cancer. Volkov dismisses Andrei and goes to visit his son who is comatose. Then he shoots himself in a dark Moscow street. Andrei is sent to the Gulag for ten years.

Anna has moved to safety at their dacha with her brother, Kolya. There she gives birth to her daughter and names her Nadezhda. In March 1953, Stalin's death is announced. Beria, head of the NKVD, announces an amnesty of Gulag prisoners serving shorter sentences. Beria sets up an investigation into the Doctors' Plot and exonerates those doctors. In the following years, thousands of prisoners make their way back to the Soviet Union - one of them is Andrei.

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Amazing Change

Carroll, Robert

Last Updated: Jun-04-2010
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

In his preface to Amazing Change, Robert Carroll speaks directly about the power of poetry to heal. At a time of great personal loss, he says, "I began writing as a way of dealing with the inchoate, yet overwhelming, feelings I was experiencing... hopefully, to facilitate a healing process for myself." The poems collected in Amazing Change, which bears the subtitle "Poetry of Healing and Transformation: The Wisdom That Illness, Death and Dying Provide," reveal the depth and power of that healing process. They show the reader that poetic healing not only engages a person in self-discovery, but also in sharing that discovery with others. Wholeness is a community project.

While Amazing Change deals with serious subjects, many of the poems approach the subjects with humor and a light touch of irony. This is particularly true in "Dr. Bob's Psychomedical Poetics--Infomercial 1" (pp. 78-80) and "Dr. Bob's Psychomedical Poetics--Infomercial 2" (pp. 109-111). "Spiritual Soup" (p. 93) is another example of the value of humor in the good life, along with other core ingredients like marriage, prayer, hospitality, blues, hope, and pot luck.

Among the finest poems in this collection is "Kaddesh for My Father" (pp. 47-53). Written in filial homage to the poet's father, in artistic homage to Allen Ginsberg, and in spiritual homage to the Judaic tradition, "Kaddesh for My Father" seamlessly integrates personal detail and anecdote about his father with ritualized expressions of prayer and emotion.  In this and many other poems, Carroll employs poetic form and/or historical exemplars to enhance the meaning of his work, but never allows them to constrain or dilute his personal vision.

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Dying for Beginners

Clary, Patrick

Last Updated: Jun-04-2010
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

Patrick Clary's Dying for Beginners is a collection of vibrant poems about living (as well as dying); about family, friends, music, loss, war and love. The book's title is evocative of the countercultural insight that dying is an essential part of living.  We only become fully human by coming to grips with our own mortality.  This engagement with mortality emerges from love and humor, as well as from suffering and loss.  Clary's poems speak to what he has discovered about himself, as a beginner to his fellow beginners.

The poet's route to discovery traverses Death Valley, where, during a spiritual retreat and vision quest, he has this epiphany: "Suddenly, I find all my wounds are turning into blessings" (p. 1). This inversion of categories is not an exotic, one-off event, but becomes a new way of looking at the world, a perspective in which life events, carefully observed and described, blossom with deeper meanings that can only be expressed by metaphor or paradox. For example, in "Days I Don't Remember," Clary reflects, "And all my roads are turning into rivers" (p. 27). Or, in "Meditation on the Pays d'Oc," he observes, "Instead of dying, I cough up a butterfly, watch it / dry its wings in the sun..." (p. 74). Or the essential quietism of "That silence moving through our lives was me" (p. 33).

The poet had his first lessons in dying when he worked as a medic during the Vietnam War, In "Orientation at Bien Hoa," he discovers, "Yes, gentlemen / This little war here / Exists only / For one reason: / To give you all the pleasure / You can handle" (p. 10).  He also learns how easy it is to kill with an M 16 rifle, which can "Put eighteen holes in / Whatever you point it at / Inside of two seconds" (p. 11). Meanwhile, the human tragedy of Vietnam takes place all around him.  

Clary reflects on the limits of his calling in "Three Variations", where he observes his own hands, "professionally / Tender on demand, but still uneasy / At your easy tenderness" (p. 35). The words "professionally tender on demand" evoke his work in palliative medicine, although the same words could-and should-apply to medical practice in general.  But Clary recognizes that the human capacity for compassion is not inexhaustible. There will always be a tension between the work that needs to be done ("another pair of hands in the emergency room," p. 63) and our limited reserves of kindness and empathy.

The book ends with a humorous and moving short prose narrative ("Origins of the Earwax Patrol," pp. 83-86) about caring for terminally ill patients.

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Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

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Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The author, a young physician, guides the reader in temporal sequence through her years as a medical student, medical resident at several levels, and into the final days of her formal training. The format of the work is anecdotal, that is, a series of memorable patient encounters that seem to shape the writer's developing attitude toward her chosen profession. The precise time frame of the experiences is not clear, but this is an acknowledged story of growing into the practice of medicine as a trainee at Bellevue Hospital.

In describing her interactions with her patients, Dr. Ofri reveals her own doubts about her ability to accomplish some of the things expected of her as "healer." As she grows more confident with experience, she begins to challenge some of the rituals in which medical education seems mired. Each of the chapters is a self-contained story focused on a particular patient, some of which have been published previously as free standing essays. The composite is the physician-writer's personal narrative of her own growth and change.

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Summary:

This book is exactly what it claims to be in the title. Dr. Ofri gives us fifteen clinical tales, each of which describes a lesson she has learned from a patient or from her own experience as a patient. It is an extension of her first book, Singular Intimacies: On Becoming a Doctor at Bellevue (see this database) and relates to her experiences after she completes residency training at Bellevue Hospital in New York City, to which she eventually returns as a staff physician. Three of the stories are examples of how a physician experiences the patient role, including one in which she relates an early personal experience to that of a patient she cares for ("Common Ground").

Since Ofri served as several locum-tenens, some of the stories take her to rural communities and small towns but most concern experiences with patients at Bellevue in clinics or in the hospital. She also discusses the challenges and limitations of teaching the next generation of doctors at Bellevue ("Terminal Thoughts").

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Love in the Ruins

Percy, Walker

Last Updated: Mar-22-2010
Annotated by:
Wear, Delese

Primary Category: Literature / Fiction

Genre: Novel

Summary:

First published in 1971 and subtitled, The Adventures of a Bad Catholic at a Time Near the End of the World, the novel is a satire of the limits of technology, the medicalization of the human spirit, and the trivializing tendencies of 20th century medical science. Dr. Tom More is an "impaired" psychiatrist: an alcoholic, a womanizer, and a half-hearted clinician. He develops the lapsometer, a kind of stethoscope of the human spirit with which he plans to cure humankind’s spiritual illnesses. Living daily with the contempt of his colleagues, he tries to prove himself and runs into all kinds of mischief, allowing the author to spoof the ills of medicine as it is practiced today.

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