Showing 171 - 180 of 574 annotations tagged with the keyword "Physician Experience"

Summary:

Janis Caldwell, who practiced emergency medicine for five years before getting her Ph.D. in English, examines the philosophy and practice of nineteenth-century British literature and medicine in this book. In an erudite introduction, she explains what she means by the "double vision" of "Romantic materialism," "Romantic because [physicians and authors] were concerned with consciousness and self-expression, and materialist because they placed a particularly high value on what natural philosophy was telling them about the material world" (1). These writers' intellectual context, influenced by natural theology, was dualist, including both the Book of Scripture and the Book of Nature. Their methodology "tacked back and forth between physical evidence and inner, imaginative understanding" (1), giving rise to the two-part "history and physical exam" familiar to physicians today.

The book examines this dual hermeneutic in six influential sites over the course of the century. In Chapter Two, Caldwell reads early-nineteenth-century debates over vitalism in the context of Mary Shelley's Frankenstein, arguing against the materialist-spiritualist divide so often cited in that period. She also brings readings of the novel into line with contemporary theories of physiologic sympathy. Next, she turns to the enormously influential sage Thomas Carlyle, arguing that he broadens the body/soul model to include both natural and supernatural aspects of the world. Again rejecting the notion of a philosophical dualism that prohibits mixing differing approaches, she argues, both Carlyle and the anatomist Richard Owen enthusiastically endorse a more heterodox vision of the world, in which we learn from both natural and spiritual enquiry.

The fourth chapter reads Emily Brontë's Wuthering Heights in the context of contemporary popular treatises on children's health and child-rearing. Caldwell argues that Brontë's image of the Romantic child, as emblematized in Cathy and Heathcliff, and characterized as "a more social, empirical, physical, literal version of childhood," derives in part from the "domestic medical texts which function as a sort of secular scripture in the Brontë household" (74). She suggests that the dualist language of natural theology, which combined spiritual and natural interpretation, and which was well-known in the Bronte household, influenced Emily's mixture of religious and medical concepts in her portrait of Romantic childhood.

Chapter Five contrasts Emily Brontë's version of childhood to that of her sister, Charlotte Bronte, in Jane Eyre and Villette. Charlotte Brontë, argues Caldwell, inclines more to the professional version of medicine, less suspicious of physician authority and more likely to experiment (in her fiction) with alternative medical theories such as phrenology. In an extended discussion of theories of literalization and metaphor, using Ricoeur to argue that the literalization of a metaphor returns us to the fact but also reinvigorates the metaphor through its dissonance with the fact. Caldwell proposes that the supposed "coarseness" of Brontë's novels is linked to her use of literalization.

A chapter on Darwin posits that "Darwin's thought arises directly out of ... Romantic materialism" (117). Although by the end of his life Darwin had renounced literary reading, the "dialectic of Romantic materialism" (shaped by Romantic literature as well as science) appears in "Darwin's preferred scientific method," in his rhetoric, and in the narrative structure of his scientific autobiography (123-24).

Caldwell's final chapter provides a significant new reading of the genre of the medical case history, by studying George Eliot's Middlemarch in the light of the bipartite structure of "the patient's narrative and the physical exam" (143). Emphasizing the negotiations between doctors and patients in the mid-nineteenth century, and calling for similar negotiations today, Caldwell navigates the differing critical positions on George Eliot's novel, weighing whether the narrator "participates in the systematic, totalizing knowledge of the pathologist" or undercuts that knowledge (156). Caldwell concludes that the narrator of Middlemarch practices a "hermeneutic circling" that shuttles back and forth between incommensurate perspectives, part and whole, nature and spirit, seeking "a partial and provisional, rather than absolute or positive, knowledge" (160). The book ends with a call to return the term "clinical" to its full meaning, not just of detachment, but of engaged practice.

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Sicko

Moore, Michael

Last Updated: Jan-08-2008
Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The movie opens with a shot of a young man stitching up a laceration in his own knee. Another describes how he had to select which of two severed fingers would be re-attached because he could not afford both operations. They are among the millions of Americans without health insurance. But, the narrator says, the movie is not for them; rather it is for the majority of U.S. citizens who do have medical insurance and believe themselves protected.

Through a series of riveting vignettes, for-profit health care is shown to tyrannize the well, ruin the ill, and destroy families. It also erodes the psychological and moral fiber of the people working in the industry. Excursions to England, Canada, France and Cuba are presented in a series of encounters with physicians and patients, none of whom believe that they would be better off in the United States. A French doctor opines that he earns an adequate salary for a good quality of life. Even those seated in a Canadian waiting room profess satisfaction with the care given and understanding about delays. When asked why anyone would accept to pay the expenses of others, an elderly golfer explains patiently that it is what we do for each other in a caring society. Ex-pat Americans gather at a bar to describe their positive experiences with foreign health and maternity care.

Interviews with emotionally distraught people who have worked in the insurance industry reveal the relentless pressure to deny coverage and its reward system that favors those who generate the biggest savings. Special attention is given to Dr. Linda Peeno who testified before Congress in 1996, confessing that she had harmed people for the economic benefit of the insurance industry.

Moore gathers up a group of people whose sorry dilemmas within the U.S. system have left them with serious health problems. He escorts them to Cuba where physicians and nurses are only too pleased to diagnose and treat their illnesses– for free. The movie ends with an exposé of the superior health care given prisoners at Guantanamo and Moore’s stunt at trying to bring the unhappy Americans there for treatment.

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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.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

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.

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Second Language

Wineberg, Ronna

Last Updated: Sep-25-2007
Annotated by:
Nixon, Lois LaCivita

Primary Category: Literature / Fiction

Genre: Collection (Short Stories)

Summary:

Summary: All thirteen short stories in this collection draw readers into the quietly compelling lives of disparate and very ordinary characters who function and suffer in unsettling ways. We are like them and not like them, but their circumstances, while sometimes disturbing, are familiar--and strangely magnetic. The opening lines of "The Lapse" illustrate this power of attraction:

I married Joanne during a lapse. A religious lapse. I don't display my beliefs like a gold medallion, though, as many whom I know do. I prefer to observe in private. After all, any intimate relationship belongs only to the entities or people involved. (p. 35)

Who can bypass an invitation to enter into announced intimacies, however private, that must be revealed in a matter of pages. What lapse and who is Joanne?!

"Bad News," centers around Sheila Powers, a psychologist, whose disruptive marital break-up is compounded by her mother's recent diagnosis of cancer and a subsequent flow of memories about her mother, her father, and herself. She is "between worlds...between life zones." (p. 113) Aspects of the future, at least her mother's, may be somewhat predictable, but the complex depths of the past mix with the present to generate sticky threads that belong to the story and to the readers as well who will recognize bits and pieces of their own family lives.

In a fourteen page story with a decidedly off-putting title, "The Encyclopedia," Wineberg zeroes in on Doris who, after a dissolved relationship, decides to sell the thirty volumes of the Encyclopedia Britannica-"the macro-edition, the micro-edition and the year books" purchased by the former couple. Not about remote bits of history or dinosaurs, we discover, but a story about separation, a series of lovers, benign conversation with a fellow worker who claims to be similarly tired of men, a possible buyer for the unwanted encyclopedia, a relationship with the married buyer, an end to the relationship, and a decision to keep the books after all. Her life, we might decide, is encyclopedic, a litany of minutiae that does, indeed, provide information about conditions of existence.

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Annotated by:
Duffin, Jacalyn

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The exquisite young artist, Angélique (Tautou) sends a rose to her lover, the cardiologist Loic Le Garrec (Le Bihan). She is planning a future with him; the only problem is that he is married. But he has promised to leave his wife. Angélique is little troubled that the couple are expecting a baby and when the pregnancy is lost following an accident, she believes the day will be soon.

Her medical student friend, David, worries that she is being used and is appalled by the accumulation of disappointments and slights that Angélique must endure. She falls apart, neglects herself and the home and exotic plants that she has been watching for friends, but when she hears that Loic has been accused of assault by a female patient, she is utterly disbelieving. The patient is found dead and the doctor falls under suspicion.

Rapid rewind, and the movie begins again with the rose, and by repeating a handful of earlier scenes, retells the same events from the perspective of the doctor. He has no idea who is the sender of the rose, and as the flowers, notes, and gifts accumulate he grows more distracted, even angry, and his wife is suspicious.

It emerges that Angélique and Loic have barely ever spoken to each other and that she actually volunteered for house-sitting next door, in order to be close to him. The accident that caused the miscarriage was Angélique’s attempt to kill his wife by running her down with a motor scooter. The patient who charged the doctor with assault was wrongly mistaken by him for the secret admirer; he struck her out of anger and fear. She presses charges against him and pursues him through the courts until she is murdered by Angélique.

But the doctor knows none of that. When Angélique attempts suicide with gas, he saves her life and she is all the more smitten. Gradually the doctor realizes her real identity and the police link her to the murder. She is sent to a psychiatric hospital.

Years pass. Loic and his wife have two beautiful children. Angélique is finally discharged with reassurance that she will be well as long as she takes her medicine. In the final scene, the caretaker moves a large cupboard to find all the pills that she had been prescribed over four years pasted to the wall in a larger-than-life portrait of Loic.

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The Enemy

Campo, Rafael

Last Updated: Aug-26-2007
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

The poems in physician Rafael Campo's latest collection examine familiar themes: lost homelands, the agonies of patients and providers, local and global abuses, love and betrayal, of both the heart and the body.  In this book, Campo expands these themes, writing of child abuse, war, and the certainties and uncertainties of maturing love.  As in his earlier collections, Campo investigates these themes in poems that are expertly crafted and often in form, as if form might contain this poet's empathic and deeply felt connection to the world.  While Campo has always been a reliable witness, especially to the world of healthcare, in this volume his vision becomes even more incantatory, paradoxical and mature.  The narrator's personal losses and responsibilities expand into the universal, into a world that cries out to us to care, to act, to heal, to notice, to tell, to "realize the human" (92).

Divided into four sections, the first section begins with a poem, "Dialogue with Sun and Poet," dedicated to June Jordan, a deceased activist and poet whose poems once made Campo uncomfortable but now mobilize him to "arise."  Following poems tell of local abuses--an abused woman ("Addressed to Her"), the displacement of memory ("Elsa, Varadero, 1934" and "Night Has Fallen"), the crushing of the spirit ("Personal Mythology") and the reality of evil, evil that calls poets to "refuse nostalgia's reassurance that the way was clear" ("Brief Treatise on the New Millennial Poetics").  This section ends with a translation from Neruda's "Book of Questions," a poem that asks if we are in control and if we are indeed capable of change (22).

In the second section, Campo takes us, in sonnets, through "Eighteen Days in France," another country and yet one in which he is still haunted by melancholy, by both sadness and joy--when one sees clearly one cannot leave behind suffering or the potential for suffering.  These sonnets speak of loss, fear, doubt and death grounded in moments of pure happiness.  

The book's third section, "Toward a Theory of Memory," opens with another masterful Neruda translation, one that speaks of love's convolutions, "just as life is of two minds" (47).  Following are exceptionally beautiful poems that speak of the misuse of love and power ("Granymede, to Zeus") and of the deep joy and deep complications of long-married love (see especially "The Story of Us").

Section Four, "Dawn, New Age," is a collection of laments for human selfishness, for war, for the inevitable passage of time, for the emotional depressions we might lose ourselves in, for the patients we cannot cure.  In "Tuesday Morning," the poet says, "No poet cares / for such deceptions anymore, and words / don't cure" (93).  Perhaps words alone cannot cure, but these poems, intelligent and very often incredibly beautiful, can sustain us and remind us that only human connection, human love might help us survive.

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Brute

Selzer, Richard

Last Updated: Aug-15-2007
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

In the Emergency Room at 2 AM, a doctor tries to suture a laceration on the forehead of "a huge black man," brought in by the police. The man groans and strains; he won't hold still. Finally, the doctor becomes so angry that he sutures the patient's earlobes to the mattress. Not only that, he leans over the man's face and grins: "It is the cruelest grin of my life." Then he sutures the man's wound.

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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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Annotated by:
Kennedy, Meegan

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

The famed surgeon Douglas Stone flaunts his notorious affair with Lady Sannox, although his professional reputation begins to suffer. One night a mysterious Turk asks him to attend his wife, who has cut her lip on a poisoned dagger. The Turk insists that amputation offers the only hope of recovery. Anxious to pocket the proffered gold, and impatient to get to his mistress, Stone dismisses his professional misgivings. He excises the lower lip of the veiled, drugged woman--only to find that he was tricked into disfiguring Lady Sannox herself. Lord Sannox (disguised as the "Turk") thus gains his revenge, with his wife morally chastised (and forever after in seclusion), and Stone’s "great brain [thenceforth] about as valuable as a cap full of porridge."

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