Showing 181 - 190 of 258 annotations tagged with the keyword "Medical Education"
Note: I try not to reveal too much here. Nevertheless, I urge you to read the book first. I would not want the magic of reading this book to be diminished by too much foreknowledge--no matter when the book is initially opened.
Harry Potter and the Order of the Phoenix is the fifth book in a planned series of seven (see Harry Potter and the Sorcerer's Stone for an introductory summary). Harry is now fifteen years old. The opening chapter, "Dudley Demented," features a return of the Dementors (see Harry Potter and the Prisoner of Azkaban), who had been sent to Harry's neighborhood in Little Whinging to deliver their soul-sucking kiss. In order to repel the Dementors and save himself and his bullying cousin Dudley Dursley from the kiss's death-in-life, Harry uses magic. This transgression from rules on underage wizardry leads to Harry's near expulsion from his school, Hogwarts, and a trial by the full court, the Wizengamot, led by Cornelius Fudge, in the Department of Mysteries of the Ministry of Magic.
Headmaster Albus Dumbledore, concerned with Harry's safety as well as with leading the resistance efforts (The Order of the Phoenix) against the resurgent evil Lord Voldemort, not only prevents Harry's expulsion, but also organizes the guard for Harry's transfer from the Dursley home to the ancient house of Harry's godfather, the wonderfully moody and complex Sirius Black. Sirius, like Harry's parents, would risk anything for his godson, but the relationship is charged by Sirius' goading of Harry to be more cavalier like James Potter--Harry's father and Sirius' best friend--and by Sirius' antipathy towards being imprisoned in his ancestral home, filled with reminders of his pureblood wizard family.
These include a portrait of his raging, hate-filled, deceased mother and a malevolent house elf, Kreacher. Communication between Harry and Sirius is a key theme in the book, as Harry looks to Sirius for guidance on the tribulations of adolescence and to satiate Harry's continued craving for information about his father. Harry's emotional tether is short in this novel, and runs the gamut from frustration and envy that his two best friends, Ron and Hermione, were made prefects of Gryffindor House, to despising two teachers (potions teacher Snape, of course, and the new venomous, officious Defense of the Dark Arts teacher, Dolores Umbridge) and finally to absolute fear and hatred of Voldemort, his mortal, yet intimate, enemy.
Harry's scar pains him almost continuously now that Voldemort has returned in the flesh, and also now that Harry has dreams and visions of Voldemort's actions. With this ability, Harry envisions himself as a snake and witnesses the wounding of Ron's father, Arthur Weasley. This episode leads to two visits to the wizard hospital: St. Mungo's Hospital for Magical Maladies and Injuries. The reader is deliciously informed that the personnel in green robes are not doctors ("those Muggle nutters that cut people up" p. 484), but rather Healers: wizards and witches who passed a large battery of tests in a range of subjects to qualify for such training.
The hospital is a mix of the mundane (the irritable receptionist) and the arcane (patients suffering from bizarre spell damage). Mr. Weasley's recovery from the nearly lethal snake bite suffers a minor setback when Trainee Healer Pye (not the Healer-in-Charge, Hippocrates Smethwyck) tries some "complementary medicine . . .
[an] old Muggle remed[y] . . .
called stitches . . . " (pp. 306-7). The loving Mrs. Weasley, whose temper is notorious and hence humorous, shouts at her husband that even he "wouldn't be that stupid" as to allow his skin to be sewn together. (p. 307)
While in the hospital, Harry and his friends encounter schoolmate Neville Longbottom visiting his parents, who suffer dementia caused by dark magic performed by one of Voldemort's Death Eater followers. Mental illnesses prove far more difficult to remedy than bodily injuries and maladies. Indeed, late in the book, Madam Pomfrey, the Healer at Hogwarts, wisely advises that "thoughts could leave deeper scarring than almost anything else." (p. 847) As Dumbledore, the embodiment of sagacity, states, memories of old hurts, slights and abuses, make "some wounds run too deep for . . .
healing." (p. 833)
Other medically related items include the Skivving Snackboxes--an assortment of magical treats and their antidotes concocted to fake various illnesses in order to skip classes, and Umbridge's detention punishment which results in the painful etching of the required written phrases on the back of the hand of the miscreant student.
Professor Snape is charged with teaching Harry the subtleties of mind-reading (Legilimency) and its prevention (Occlumency), in an effort to prevent Voldemort's use of Harry's mind. "The mind is a complex and many-layered thing," says Snape, and hence the mind cannot be read like a book. (p. 530) Harry's failure at these lessons leads to the denouement of the book and ultimately to the loss of someone very dear to him. After the inevitable confrontation between Voldemort and Harry, Dumbledore gently coaches Harry through his guilt and anger to teach him about destiny, love and death.
This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.
The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)
The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).
Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.
Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.
Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)
Argan, a fearful but miserly hypochondriac, divides his time between summoning the doctor to care for his ills and trying not to settle the resultant bills. He resolves to marry his daughter, Angélique, to a medical student, hoping to acquire unlimited access to gratis consultation. The chosen fiancé is an unattractive dolt, who would never interest Angélique, even if she were not already in love with clever, handsome Cléante, who poses as her music instructor.
Argan's wife, however, plans to send Angélique to a convent, removing her from the line inheritance. At the urging of the sensible servant Toinette, he feigns death to test his wife's affection only to discover her contempt. Again with the help of Toinette, the young lovers convince Argan to liberate himself from the twin tyrannies of his ailing body and his grasping physicians by becoming his own doctor. The play closes with the physicians' lively examination of Argan and his entry into the profession, full of musical pomp and pidgin Latin.
A year in the life of a group of interns in a big city hospital guided by the wise internist (Buddy Ebsen) and the irascible, woman-hating surgeon (Telly Savalas). Contortionist posturing designed to lead to desired residencies is the major theme. The only female intern, and the most brilliant of the lot, wants to be a surgeon, but she is repeatedly belittled by the surgical chief until he realizes--not that she is good--but that she is the sole support of a daughter.
Another intern falls in love with a young Asian patient and at her death resolves to work in her country. A crisis emerges around the overdose of a suicidal patient with syringomyelia; all the interns are held responsible until they rather brutally force a confession from the man's wife. Friends throughout medical school, Lou Worship (James MacArthur) and Sean Otis (Cliff Robertson) plan to become surgeons and open a clinic for the poor. Otis falls for a glamorous model, while Worship is smitten with obstetrics and a student nurse (Stephanie Powers).
Forsaking the original plan, Worship applies to obstetrics, pressures his fiancee to sacrifice her dream of an international career, and tells on Otis when he discovers that he is helping his girlfriend abort her unwanted child. His career ruined, Otis marries the irretrievably pregnant woman and expresses his admiration to Worship for doing the right thing.
In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.
Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.
Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?
Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).
In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.
Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.
He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.
Nikolai Stepanovich, a famous professor of medicine, narrates his own story. An elderly man, he believes he will die in a few months, although he refuses to consult a doctor about his illness. He knows his wife to be a fat, old busybody, but he remembers her as a young beauty. His daughter Lisa is engaged to Gnekker, an ugly young man who seems to have neither talent nor employment. The professor's only enjoyment is to spend hours talking with Katya, his young ward, who once ran off to join the theater in Moscow, but later returned to become an indolent do-nothing.
Although he is not cynical, Nikolai Stepanovich decries the poverty of medical education and he seriously questions the ability of graduating physicians to care for their patients. He finds himself beset by negative thoughts: "Feelings I never felt before have built a nest in my heart. I hate, I despise, I am filled with indignation."
He encourages Katya to go back to Moscow and become an actress, but she admits that she has no talent. After much urging by his wife, Stepanovich agrees to go to Kharkov to investigate Gnekker's background. When he gets there, however, he receives a message that Lisa and Gnekker were secretly married on the day before.
This thorough and fascinating treatment of the politics of anatomy studies in 19th-century America provides a variety of perspectives on the vexed question of how appropriately to study human anatomy while also maintaining respect for the human body and honoring the various, deeply held community beliefs, and attitudes toward treatment of the dead. Sappol seeks, as he puts it, to "complicate the cultural history of medicine in late-eighteenth- and nineteenth-century America. . . by telling it from an anatomical perspective."
That statement of his objectives hardly suggests the startling range of approaches to the topic he takes in the book's nine chapters. These cover such issues as the legacies of belief about the "personhood" of the dead human body; the status of anatomy as both a legitimate and valuable study and also as an "icon of science"; the relationship of dissection and anatomy study to medical status and professionalization; the political tensions engendered by the "traffic in dead bodies" that most often expropriated corpses from marginalized communities; and the relationship of anatomy studies to sexual commerce and sensationalist fiction.
Max Vigne, the most junior member of a survey group mapping the Himalayas in the 1860s, writes letters to his young wife Clara in England. She has prepared in advance of his journey a series of postdated letters which he keeps in his trunk. When these have been read, Clara sends numbered letter packets which arrive sporadically, out of sequence, if at all, over the months of the expedition. Max struggles to describe and to edit his daily experiences on the mountains which are extraordinary, often terrifying, and disorienting for him.
Separated by time, distance, and experiences, they are slowly and irrevocably estranged. Max discovers that his real scientific passion is alpine botany, and he must decide how to tell Clara that he will not be returning to England after the Survey ends. The exchange of letters ingeniously maps out the complexities between Max's love for his wife and his passion for scientific knowledge, and the wide expanse between them.
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)