Showing 111 - 120 of 263 annotations tagged with the keyword "Medical Education"
Summary:Two hospice nurses describe their work with dying patients, especially with the special forms of communication typical of dying patients. The authors define "Nearing Death Awareness" as patients' knowledge and expression about their own dying. What doctors and family members may assume is the patient "losing it" or "hallucinating" actually is often a kind of symbolic communication dying patients typically use, either to describe their dying experiences or to request something they need for a peaceful death (such as seeing a loved one). By dismissing the patient as "confused," caregivers miss the opportunity to help the patient and may also alienate and frustrate both patient and family. By being aware of what is going on, caregivers can be more responsive and comforting to the patient and the family.
Summary:Part of a series, "Letters to a Young . . . [fill in the career]," this collection of essays by pediatrician-author Perri Klass is addressed to her son Orlando during the recent period when he was applying to medical school. The essays follow a chronological sequence, beginning with the decision to apply to medical school, the first two years of medical school, learning how to examine and talk to patients, residency training, physicians as patients, making mistakes, grappling with the most fundamental human issues in medicine, and the mingling of professional work and life.
Summary:Author Diedrich investigates ("treats") mid-late 20th century memoirs about illness (illness narratives) from an interdisciplinary perspective drawing on the disciplines of literature, social sciences, and philosophy. Her analysis uses the theoretical frameworks of poststructuralism, phenomenology, and psychoanalysis to consider "what sort of subject is formed in the practice of writing . . . illness narratives," the kind of knowledges articulated by such writing, whether and how such writing can transform "expert medical knowledges," how language operates in these memoirs, and "what sort of ethics emerges out of such scenes of loss and the attempts to capture them in writing" (viii).
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?"
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.
In this collection, twenty-two medical students and young physicians across the United States eloquently recount the process of medical education for those who do not believe they fit standard measures of student demographics. The editors, Takakuwa, an emergency medicine resident physician; Rubashkin, a medical student; and Herzig, who holds a doctorate in health psychology, group the essays into three sections: Life and Family Histories, Shifting Identities, and Confronted.
Each section is prefaced by an essay explicating the essay selection process, the history of medical school admissions policies and requirements, the basic progression of medical education and the reasons for this collection, such as "putting a human face" (p. xx) on the changing characteristics of admitted medical students: "With their diversity and through their self-reflections, we hope that these students will bring new gifts and insights to the practice of medicine and that they might one day play an important role in transforming American medical education into a fairer and more responsive system." (p. 141)
Additionally, a foreword by former Surgeon General Joycelyn Elders outlines her experience as a black woman entering medical school in 1956, including eating in the segregated cafeteria. The book concludes with recommendations for further reading and improvements to the medical education process as well as with brief biographies of the contributors and editors.
The range of essays is impressive: diversity itself is given a new meaning by the variety of narrative voices in this volume. Contributors include people from impoverished backgrounds, both immigrant (Vietnamese, Mexican) and not. One student, marginalized by his academic difficulties, began a homeless existence during his first clinical year. Others were made to feel different because of being African or Native American.
In two essays, mothers defy labels placed on them (pregnant black teen; lesbian) and describe the trials and triumphs of their situations. Students write of being subjected to ridicule, ignorance and prejudice due to their gender, interest in complementary medicine, political and advocacy views, or religious beliefs. Due to pressures to conform, even students from what might be considered more mainstream in American culture (e.g., growing up in a small town, or being Christian) can experience the effects of being "different" when in medical school.
A number of essays communicate the difficulties of illness, disability and bodily differences. Issues include recovered alcoholism (rather tellingly, this is the only essay that is anonymous), obsessive compulsive disorder, sickle cell anemia, Tourette Disorder, attention deficit hyperactivity disorder, chronic pain, and obesity. The authors balance their narratives of hardship with insights into how their struggles improve their opportunities for empathy, perspective and fulfillment as physicians.
In this poem, a young male patient receives stitches in an emergency room for a face wound from an alleyway knife fight. It seems the violence involved drugs, as a "broken syringe" is involved in the fight. However, more telling is the label that the ER doctor uses to describe the patient. The narrator of the poem, apparently an exhausted physician-in-training, is told by the ER doctor to quickly "Stitch up the faggot in bed 6."
The narrator meticulously sews his patient's wound, empathizing completely with him: "Each suture thrown reminded me I would never be safe / in that town." He too, could be ripped open "to see the dirty faggot inside." Furthermore, he ruminates that when the perpetrators of such violence themselves become victims, he would also stitch their wounds--silently, carefully, passively, "like an old woman."
The subtitle to this collection of insightful and compassionate essays by gastroenterologist David Watts is: "One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer." Watts provides 48 narratives, most of which concern his patients and are written in the first person. In the preface Watts states "The stories in this book are true" (xv), that he has received permission from his patients, and that he has "disguise[d]" his patients to respect their right to privacy.
The stories cover a range of settings, from Watts's home and locations in the San Francisco Bay area, to the clinic and hospital. They also cover a range of his experience from medical school ("Sylvester" and "Love is Just a Four-letter Word") to his current position as a practitioner and an attending physician at a teaching hospital.
Stories in which Watts clearly situates himself with the patient and details the encounter are most compelling. For example, in the opening essay, "White Rabbits" and later, in "Flu Shot," Watts allows the reader to discover that patience and listening are required to in order for the patient to expose why he or she is truly there. In that space, Watts becomes present for his patient, and one learns that what may initially appear tangential is central to the patient's concern.
Watts writes of some very difficult patients and families, such as a woman who stalks him ("The Stalker's Bridegroom"), a woman who obsesses over caring for her elderly mother ("Home Remedy"), and a woman who demands narcotics ("The Third Satisfaction"). In one of the longer pieces, "Codger," Watts describes an irascible, elderly Jewish patient who skewers just about anyone with his critiques, including Watts's young son, and yet who later exposes his vulnerability by unfolding the tale of his World War II service and discovery of a Nazi death camp. It is because Watts spends time with the Codger and recognizes that the doctor-patient relationship is above all a human relationship that the doctor receives the gift of the story: this terrible experience which informed the rest of the Codger's life.
A few of the vignettes explore the therapeutic potential of poetry. For instance, in "Annie's Antidote" a piano teacher, fearful of endoscopy, asks Watts to recite one of his poems. The poem concerns the tender relationship between Watts and his son and is a metaphor for Watts's patient encounters as well: "for this is one of those moments / that turns suddenly towards you, opening / as it turns, as if we paused / on the edge of a heartbeat. . . " The poem works, the moment opens, and the woman has her endoscopy.
Summary:A group of eight women gather for a joint consultation with Dr. Kailey Madrona who is a devotée and colleague of the research endocrinologist, Dr. Jerilynn Prior, a professor at University of British Columbia in Vancouver. Madrona explains that she has arranged for the unorthodox group encounter because she will be leaving practice to pursue graduate studies in medical history.
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.