Showing 181 - 190 of 250 annotations tagged with the keyword "Medical Education"
This masterful collection of essays was written by Gawande while he was a general surgery resident. The book consists of fourteen essays divided into three sections: Fallibility, Mystery, and Uncertainty. Although some of the essays fall clearly within the boundaries of the section title (such as "When Doctors Make Mistakes" and "When Good Doctors Go Bad" in the Fallibility section), others cross boundaries or don’t fall as squarely in these general themes ("Nine Thousand Surgeons," an anthropological essay on the cult and culture of a major surgical convention, is also located in the Fallibility section). Nevertheless, the many pleasures of the individual essays, the range of topics explored in depth, and the accuracy of the medicine portrayed are the true strengths of this work.
The book begins Dragnet-style with an Author’s Note: "The stories here are true." (p. 1) And it is this attention to fidelity that makes the essays so compelling. Because even when the truths are hard--the terrible acknowledgment by the medical neophyte about lack of skill and knowledge, the mistakes in judgment at all levels of doctoring, the nature of power relations and their effects on medical pedagogy and on the doctor-patient relationship, the gnawing uncertainties about so many medical decisions--the author confronts the issues head on with refreshing rigor, grace and honesty.
Many of the essays reference scientific and medical research (historical and current) as part of the exploration of the topic. This information is imbedded within the essay, hence avoiding a dry recitation of statistical evidence. Typically, the reader’s interest in an essay is immediately piqued by a story about a particular patient. For example, the story of an airway emergency in a trauma patient, her oxygen saturation decreasing by the second as Gawande and the emergency room attending struggle to secure an airway, surgical or otherwise, sets the scene for "When Doctors Make Mistakes."
This leads to a meditation on not only the culture of the Morbidity and Mortality Conference, with its strange mix of third-person case narrative and personal acceptance of responsibility by the attending physician (see Bosk, Charles, Forgive and Remember: Managing Medical Failure, U. Chicago Press, 1981 for an in depth analysis of this culture), but also a positive examination of the leadership role that anesthesiologists have played in improving patient safety via research, simulator training and systems improvement.
Gawande’s journalistic verve takes him beyond the confines of his own hospital and training to interview patients and physicians on topics as diverse as incapacitating blushing ("Crimson Tide"), chronic pain ("The Pain Perplex"), malpractice and incompetence ("When Good Doctors Go Bad") and herniorraphy ("The Computer and the Hernia Factory"). In addition, he visits his own post-operative patients at home ("The Man Who Couldn’t Stop Eating" and "The Case of the Red Leg") which gives a longer view of postoperative recovery and a broader exposure to patients’ perspectives.
Some of the most telling moments come with the introduction of his children’s medical problems into the text. These range from the relatively straightforward (a broken arm, but a chance to comment on detection of child abuse in the emergency room) to the downright parental nightmare scary (severe congenital cardiac defect in their oldest child and a life-threatening respiratory infection in their prematurely born youngest).
These last two experiences are introduced to provide an angle on issues of choice. Choice of a fully trained, attending physician rather than a fellow to provide follow-up cardiac care for their oldest, and the choice to opt out of the decision-making process for whether to intubate the trachea of the youngest and hence leave the medical decisions up to the care team.
This book's title is from a Goethe poem, "The Holy Longing," translated from German in its entirety by Robert Bly: "And so long as you haven't experienced / this: to die and so to grow, / you are only a troubled guest / on the dark earth." Ten intensely personal essays tell of the suffering and everyday presence of pain of a severely disabled writer who has advancing multiple sclerosis, and of how, "in a very real sense, and entirely without design, death has become [her] life's work." (p. 13)
Beginning with her father's sudden death when she was a child, the essays describe her aging mother's expected death and the family's decision to take her off life support; her caretaker husband's diagnosis of metastatic cancer with uncertain prognosis; her own attempted suicide; death of friends, pets, including her beloved dog; and a young pen-pal executed on death row. If that weren't enough, a coda, her foster son's murder and again the decision to remove life-support, provides "[t]he end. For now." (p. 191)
Tim Metcalfe is an Australian general practitioner who gave up medical practice to become a full-time poet and writer. A statement on the back cover summarizes the process in relation to this collection of 38 poems: " ’Cut to the Word’ is a moving account of one man’s transition from doctor to poet." He begins with the customary initiation: "We were introduced, respectfully, / to the volunteer dead . . . " (p. 13) He discovers the limitations and uncertainties of his new profession: "In tense moments / I wish my stethoscope / was all they want it to be." (p. 18) And the omnivorous demands of medicine: "I come home from work / and there it is: the family / the oldest crying / at the youngest crying / at her mother’s anger / at her crying . . . " (p. 21)
Metcalfe carries the reader through a series of short, incisive poems describing the doctor’s day-to-day work ("Morning Session, " pp. 47-50), as well as through a number of disturbing poems about the world of mental illness, but the book’s climax--so to speak--arrives with "The Doctor’s Complaint, " in which the physician heals herself "by laying down her stethoscope / and walking right out / of that in-patient clinic." At the end the poet writes, "Like a patient I have learned silence . . . Fine steel scissors in hand, / I cut to the word." (p. 63)
Written by a medical historian who is also a physician, The Breast Cancer Wars narrates how breast cancer diagnostic methods and treatments have developed from the early twentieth century. More significantly, the book describes the debates and controversies that permeated this evolution and the ways in which not only clinicians and researchers, but, increasingly, women patients/activists shaped how we view, diagnose, and treat breast cancer today.
Individual chapters explore the influential (and ultimately contested) radical mastectomy procedure of William Halsted, the development of the "war" against breast cancer as a full-blown campaign developed and conducted within the public media and consciousness of the United States as well as within medical practice and research, the intertwined development of feminism and breast cancer activism, the "fall" of the radical mastectomy, and the continuing controversies surrounding mammography and genetic testing as modes of early detection and risk assessment. Lerner draws on a range of primary sources including texts from the archives of the American Cancer Society, the papers of doctors and patients, and advertisements from popular and professional magazines throughout the century.
This is an excellent review of the authors' choices of the ten greatest medical discoveries. They arrived at the ten selected after narrowing five thousand or more possibilities down to one hundred and then finally down to ten based on these three components in the field of medicine: 1) structure and function of the human body, 2) diagnosis of medical conditions and 3) treatment of such maladies. Finally the ten selected were approved by four avid and informed physician collectors of rare and important medical publications.
Chronologically, the anatomical observations of Vesalius come first with his publication of the Fabrica in 1543. Harvey's discovery of the circulation of the blood is considered the single most important discovery. Leeuwenhoek gets credit as the founder of bacteriology, but Koch and Pasteur are included in a discussion of this discovery. Jenner gets his just recognition for introducing vaccination and Roentgen for discovering the X-ray beam.
Crawford Long is recognized for the initial use of surgical anesthesia and Fleming for the discovery of penicillin. More unlikely choices are Ross Harrison for tissue culture, Anichkov for the relation of cholesterol to atherosclerosis and Wilkins, rather than Watson and Crick, for the DNA story.
Each chapter describes not only the discovery but also tells the life stories of the chosen "discoverers" and others who contributed to extension and usefulness of the discoveries. The authors conclude that it is not genius so much as curiosity and the ability to conduct methodological investigations that distinguish these men.
Summary:A physician recounts an experience he had assisting an American plastic surgeon as he performed charity surgery in Honduras. One young woman, Imelda, dies of malignant hyperthermia prior to surgical repair of her cleft lip. After her death, the surgeon returns to the patient to finish the surgery. The narrator tries to imagine the surgeon's motivation for this act, as well as the family's reaction to it.
Summary:A third year medical student rotates through a gynecology clinic at the university. The attending Dr. Snarr, is supposed to treat his patients' chronic pelvic pain, but only seems to inflict pain himself. The student/narrator wants to comfort the patients, but lacks the knowledge, skills, and authority. The student also feels uncomfortable with issues of sexuality and intimacy with these female patients.
Philip Carey, the central character of this early 20th century Bildungsroman, is both an orphan and afflicted with a club foot. He is sent at age nine, after the death of his mother, to live with a childless uncle--a deeply religious Vicar--and his submissive aunt. They have no idea how to be parents, so send Philip away to a boys' boarding school where the child begins to learn what it means to be less than physically "perfect." The remainder of Philip's development is cast in this light.
He roams about looking for himself and his place--to Germany to learn languages, to London to learn a trade, to Paris to study art, and finally, as a last resort, a default decision to follow in the steps of his father the physician. A major part of Philip's maturation is based in making decisions about women and about sensual love. The most painful portions of his story are those that evolve around his stumbling and frequently failed attempts to find security in his personal relationships.
The Physician in Literature is an anthology edited and introduced by Norman Cousins that aims to illustrate the multiple ways in which doctors are portrayed in world literature. Literary selections are organized into 12 categories including Research and Serendipity, The Role of the Physician, Gods and Demons, Quacks and Clowns, Clinical Descriptions in Literature, Doctors and Students, The Practice, Women and Healing, Madness, Dying, The Patient, and An Enduring Tradition.
Some of the notable authors represented in this collection include Leo Tolstoy, Herman Melville, Albert Camus, William Shakespeare, Charles Dickens, George Bernard Shaw, Anton P. Chekhov, Orwell, Fyodor Mikhailovich Dostoevski, Ernest Hemingway, Thomas Mann, Gustave Flaubert, and Sir Arthur Conan Doyle. A healthy dose of William Carlos Williams makes for some of the most enjoyable reading ("The Use of Force" and excerpts from his Autobiography).
Dr. Sacks was growing up in London during World War II and had a very traumatic experience when he was sent away from his home for protection from the bombing. He and his brother were sent to a boarding school, where they were beaten and underfed. Sack's home had been filled with a wonderful extended family of physicists, mathematicians, teachers, and chemists, in addition to his parents who were both practicing physicians. Being unusually bright and talented, Sacks responded to a wide variety of stimuli when he returned to this environment.
He became fascinated with the chemistry of metals and with the periodic table of elements. An uncle, for whom the book is named, was a manufacturer of light bulbs with tungsten filaments and encouraged him in setting up his own chemistry laboratory in the family laundry room, to do experiments. The family allowed him a great deal of freedom, which encouraged his creativity.
In writing about these experiences Sacks includes the history of the development of chemistry concepts that fascinated him. It was only much later that his interests moved on to the natural sciences and medicine. He says that his parents had been tolerant and even pleased with his early interests in chemistry but by the time he was fourteen they felt that the time for play was over. He kept a journal from the age of fourteen and took advantage of every opportunity to read broadly and experience nature, music and art.
In retrospect, however, Sacks felt that life was shallower after he left behind his passion for chemistry. He says that he dreams of chemistry at night. This description of such intense interest in the world around him and the people he read about or knew explains a great deal about his great success as a neurologist and as a remarkable story teller.