Showing 101 - 110 of 470 annotations tagged with the keyword "Medical Ethics"
This annotation is based upon the version presented at The Mint Theatre in New York City in 2010, translated and directed by Gus Kaikkonnen. It featured Thomas M. Hammond as Dr Knock and Patrick Husted as Dr Parpalaid, with Chris Mixon, Scott Barrow, and Patti Perkins in supporting roles.
A middle-aged but recently licensed physician, one Dr Knock, has arrived in rural France to take over a practice purchased from the genial old country doctor, Dr Paraplaid. Much to Dr Knock's surprise, he discovers that Dr Paraplaid has done very little over the past three decades, seeing only a few patients a week and enjoying much of the time playing pool, riding around in his jalopy, and admiring the countryside. Feeling slightly cheated, Dr Knock realizes that the practice he has purchased at some expense amounts to very little at all. He is, however, an ambitious man. He did not become a licensed physician in the eager flush of late adolescence but as a man of the world, or rather, a man of the entreprenurial modern world where opportunities are seized and technology is transformative.
Once Dr Paraplaid has gone, Dr Knock promptly sets about employing the town crier to advertise his practice so that the entire valley knows he is there. He meets up with the local school teacher and the pharmacist, enlisting them as allies. With everybody he encounters, he smilingly and then sharply insists that unlike Dr Paraplaid, he will not go by "Monsieur" but by "Doctor". And when he actually opens the office, he begins by offering free consultations. Of course, he always seems to find something wrong, elaborately explaining the aches, pains, and illnesses he discovers (or induces), but the free consultations, like free "samples" are designed to create grateful customers. Invariably, they learn that the cost of the treatment is commensurate with the exact maximum amount they could pay. And thus, Dr Knock takes a placid, lazy practice and builds up an expanding medical business.
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).
Summary:Some 40 years after a ceasefire that ended the Cylon wars, the 12 human colonies across the galaxy have been lulled into a state of calm complacence. This is abruptly interrupted by a Cylon attack that annihilates billions of humans, leaving only 50,000 survivors in a small fleet of ships, led by the one remaining ship from the Colonial Fleet, the Battlestar Galactica. Fleeing the Cylons, they set out to find the legendary 13th Colony: Earth.
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.
Summary:This is an anthology of 32 pieces, many directly relating to war and its aftermath, or, in general, kinds of violence humans inflict upon each other and the ensuing suffering: hence the title, "echoes of war." The pieces include short fiction, essay, a dozen poems, and a photo collection. Since none are lengthy, this is a good reader to supplement other longer texts or to serve as an anthology for a reading group. A short essay, "Suggested Longer Readers," mentions some three dozen pivotal topics, including "homecoming" and "sense of identity."
The speaker in this short poem is a physician whose father's "castrated body" is "crooked in prostatic pain." From the family home in Tennessee, the dying man's wife provides daily phone reports to the son about her husband's deteriorating condition. The speaker's mind swirls with conflicting feelings: he thinks about "Dr. Death," whose efforts he has just come to understand; he thinks about the suffering experienced by his father and his mother's "terminal voice"; and he considers "how many of those little pain killers it might take."
Similarly, recollection of the Hippocratic vows intrudes to counsel against the kind of assistance his filial nature wants to provide. The internal debate about choices directs readers back to the title's imperative, "let's talk about it," suggesting, I believe, the need for social and professional discourse about quality of life, futility, and physician-assisted-suicide.
The title refers to a Veteran’s Administration hospital regulation concerning the withholding of full medical benefits if an ailment is not specifically related to military service. In an oftentimes comic battle between the forces of good--physicians and vulnerable patients--and those of evil--the administrators and their minions--the story has currency and direct appeal to viewers.
The Darth-Vader-like administrators are self-serving, inhumane bureaucrats with emotions that run the gamut "from A to B" (Dorothy Parker). Physicians, especially the character played by Ray Liotta, but also his dedicated colleagues, are imaginative and non-rule abiding in their central concerns: the patients. They listen to stories and sympathize; in addition, they turf, lie, steal, and do whatever is necessary to protect, serve, and treat their patients. When the government denies a heart bypass, for example, the docs schedule prostate surgery for the official record and do, instead, the needed heart surgery.
At times, it’s as if the Marx Brothers or the Keystone Cops have donned white coats to sneak around the hospital with patient-centered antics. In the absurd bureaucracy, viewers, perforce, must cheer enthusiastically for the merry band of renegade docs.
The story is based on an actual 1950's trip by two university friends, Ernesto 'Che' Guevara (Gael Garcia Bernal) and Alberto Granado (Rodrigo De la Serna). Guevara is studying medicine, Granado biochemistry. They plan to travel from Buenos Aires across the Andes Mountains to Chile, Peru, and, then, to Venezuela. Before too many miles their derelict 1939 motorcycle fails, and the two young men continue by whatever means is available. The journey intent is one of adventure--drinking, meeting women, seeing the world.
The young men do discover South America's impressive natural beauty but more strikingly, their eyes and sensibilities are directed to abject poverty and shocking injustices. These blatant inequities, as well as an extended period of time in a leper colony, contribute to the reframing of their original happy-go-lucky adventure and explain, in part, the impulses that eventually would shape Guevara's role in the Cuban Revolution.
Oscar, the narrator of this fresh fictional gem, is ten years old. Because his form of leukemia has not responded to treatment, he has been living in a French hospital for a very long time. His parents, who bring him gifts and surely love him, are uncomfortable during their infrequent visits. Dr. Dusseldorf and the nurses are kind, but indirect and distant in their communications with him. Because no one talks to him about his illness or what is likely to happen, he feels isolated, alone, and miserable.
When Mamie-Rose, a very elderly hospital "pink lady" (hospital volunteer) with an exotic past, enters Oscar's life, she brings honesty, warmth, and comfort to the lost child known as Bald Egg. Guided by this incredible person--a blunt-spoken, irreverent woman who touches him, kisses him, and tells him wondrous stories of her wrestling feats--the boy grows stronger. Who wouldn't under the influence of the Strangler of Languedoc?
Of course Oscar is going to die. In addition to her generous companionship and her introductions of him to other children in the hospital, Mamie-Rose suggests letters to God as a way of feeling less lonely. "So God, on the occasion of this first letter I've shown you a little of what my life in the hospital is like here, where they now see me as an obstacle to medicine, and I'd like to ask you for clarification on one point: Am I going to get better? Just answer yes or no. It's not very complicated. Yes or no. All you have to do is cross out the wrong answer. More tomorrow, kisses. P.S. I don't have your address: what do I do" (65).
With Mamie-Rose treating him like a real kid, "move your but . . . we're not ambling along like snails" and Oscar scripting very candid letters to God, the first-person story about loneliness, love, and compassion is presented with spirited imagination. Oscar's story is quite extraordinary--and unforgettable.
Because this lucid, rich, and incisive book has not, as yet, been published in the United States, it has not acquired the readership it deserves. For those teaching Medical Humanities or those interested in broader or more global stories and perspectives about physician training, practice, and experiences, Helman’s most recent publication should be considered.
Part One (“Setting Out”) begins in South Africa where Helman’s family, comprised of a dozen doctors, has lived for generations and where his own medical studies occurred. As a child, he accompanied his father on rounds while other children spent holidays at the beach. Before long he discovered how hospitals, during the madness of Apartheid, were to “some extent a distorted mirror-image of the world outside” (3). Appalled by the differences in care and treatment, the keenly aware young man kept notes. His vivid observations of the harsh context of social injustices provide an unequivocal, eloquent, and disturbing critique of medicine then and there. His acute observations of physician behaviors and indigent populations in the city and in the bush contribute, as readers discover in later chapters, to the author’s expanded and compelling interests in cultural anthropology.
Part Two (“The Family Doctor”) leads to London. “After all the heat and light and space of Africa, London—with its low leaden sky and constant drizzle—was like living inside a Tupperware box, one stored deep inside a refrigerator” (47). In the 60s Helman’s migration required an adjustment to a world of technology and order, where as a family practitioner, he had become, in fact, a suburban shaman. In any society, patients wanted “relief from discomfort, relief from anxiety, a relationship of compassion and care, some explanation of what has gone wrong, and why, and a sense of order or meaning imposed on the apparent chaos of their personal suffering to help them make sense of it and to cope with it” (xvi).
Gradually Helman saw connections between the role of family physician and traditional healer: both involved an understanding of “not only a body’s internal equilibrium but also the equilibrium of the patient’s relationships with the world he or she lives in and how treatment should aim not only to treat the diseased organ but also to restore the patient’s life that equilibrium of relationships” (xvii). His encounters with patients and the stories they reveal suggest how important these often overlooked connections are and why they ought to be included in medical training and practice.
By the time readers reach Part Three ("States of the Art”), the author has moved into broader realms of thinking, in which medicine and illnesses are examined anthropologically. After 27 years of clinical practice Helman’s white coat and stethoscope are placed on a hook. Now, as a credentialed anthropologist at University College London, his larger lens allows for sustained scrutiny of the complexities, ambiguities, and nuances in such chapters as “Grand Rounds,” “Hospitals,” “Placebos,” “Third Worlds.” Helman’s range of experiences, multi-disciplinary training, intellectual conclusions, and abundant common sense argues for techno-doctors to learn from holistic practitioners. Whether devastating or humorous, the critiques reflect not just care provision but shared human capacities: the insights are thoughtful and fresh and very worthwhile.