Showing 211 - 220 of 831 annotations tagged with the keyword "Doctor-Patient Relationship"

Summary:

This outstanding anthology of poems, stories, excerpts and essays by African-American writers is prefaced by a poem ("Aunt Sue’s Stories" by Langston Hughes), a foreword, two essays and an introduction. The book is then divided into three sections: Section I, Illness and Health-Seeking Behavior; Section II, Aging; and Section III, Loss and Grief.

Each section begins with an introduction which clarifies the choice of the section’s theme and briefly describes each piece. At the conclusion of each section is a list of ten to fifteen questions which "are intended for personal reflection and group discussion." Brief autobiographical information for each of the thirty-one authors is presented in Appendix 1.

As Secundy notes in the introduction, a divide exists between the health care worker and patient, which is particularly prominent when color and economic status are different between them. Secundy, as an educator in the medical humanities, selected pieces that reveal "the significance of color and social distinctions" when African-Americans face illness or enter the health care system.

The selections chronicle struggle and survival, illness and loss, humiliation and pride, triumph and sorrow. These pieces speak to all of us, as Edmund Pellegrino states in his essay, "Ethnicity and Healing": "[p]aradoxically, as we learn more about the uniqueness of African-American culture, we are drawn closer to the common humanity we share with the subjects of these stories and poems."

View full annotation

Summary:

Worlds Apart is a set of four documentary videos designed to stimulate thought and discussion about the effects of culture on communication and medical decision-making. Each video encapsulates the story of a real patient and his or her interactions with physicians and family.

The four videos are: (1) Kochi Story--an Afghan man, diagnosed with stomach cancer, decides about chemotherapy amidst miscommunication due to translation issues and religious convictions; (2) Chitsena Story--the mother of a four-year-old girl from Laos is caught between physicians who tell her that her daughter needs surgery to correct an atrial septal defect, and her mother who upholds the traditional Khmu beliefs that scars, including surgical scars, are injurious to a person in future lives; (3) Phillips Story--an African-American man on dialysis discusses the prejudices against black people in the health care system, particularly the decreased chances for receiving a renal transplant; (4) Mercado Story--a 60-year-old Puerto Rican woman who lives in Hell's Kitchen, New York City, explains the complex social situation which affects her ability to take care of her chronic health problems, such as diabetes and hypertension.

The films depict the patients and families in various settings--in doctors' offices, at other health care facilities, at home or work, during religious ceremonies. Phillips Story is different in that only the patient speaks during the film--in the other three stories we hear family members, translators, and physicians. The pitfalls of translation by a family member or friend are discussed, as well as the need for the physician to elicit information from patients about the social contexts that may affect their health and decisions.

For example, Mr. Kochi's religious beliefs contravene the use of continuous infusion chemotherapy, but not other regimens--this distinction is not elucidated for many months. Hence cultural competency in health care requires that the provider not assume reasons for patients' behaviors and decisions but rather emphasizes communication to understand the particulars of the situation.

View full annotation

Equal Partners

Heymann, Jody

Last Updated: Nov-22-2009
Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

A new graduate from medical school experiences her first seizure on the eve of beginning internship. Diagnostic workup reveals a mass in the wall of the third ventricle, which, at the time of surgery, is a vascular malformation. The narrative takes the reader through the four years of the author's struggle with her diagnosis, treatment and resultant disability, a seizure disorder.

Laced through the tale are patient vignettes, told from the vantage point of a newly sensitized doctor who is a long-term patient herself. Heymann is gently critical of many of the interactions she experienced with her physicians, attempting to chide her colleagues into being more sensitive to patient-centered concerns.

View full annotation

Summary:

In this study of a small group of children followed by an HIV clinic at an unidentified institution, the author describes in detail her experience with the children, their caregivers--sometimes biological family members, sometimes foster providers--and the medical staff responsible for the management of their viral infection. The writer, a humanities professor at a medical school, acknowledges the privilege she felt at having been in a position to develop a close personal contact over several years with the people about whom she writes.

The frame of the study is case-oriented. Each child is described and the medical and social histories of a total of nine are outlined and then fleshed out with personal interviews and home visits made by the writer. In addition to the histories, Hawkins includes a glossary of contemporary medical terms and common acronyms relevant to HIV, a bibliography, and a list of resources for those interested in looking further into this infection as it presents in children.

View full annotation

Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

This is the story of a child/young adult who had the misfortune of multiple health problems from the age of three until his death at 19. But even more than Jesse's story, this is the narrative of and by Jesse's father as he recalls the emotional rollercoaster accompanying the abbreviated span of his oldest son's life. The author kept detailed journals of his and his son's experiences with the health care professions, while also collecting the boy's artwork which appears to be Jesse's personal record of his own internal struggle.

Although not chronologically linear, the narrative allows the reader into the soul of the parents' agony, from the time of Jesse's initial diagnosis of hydrocephalus, through management of inflammatory bowel disease, and into the final chronicle of unsuccessful liver transplantations.

View full annotation

Annotated by:
Willms, Janice

Primary Category: Literature / Nonfiction

Genre: History

Summary:

This is the wrenching history of the development, evolution, and eventual obsolescence of the leper colony established in 1866 on the isolated and only sometimes accessible peninsula on the Hawaiian island of Molokai--and the lives of the people who were exiled there to die over a period of more than 100 years. The tale opens with the declaration by the Board of Health that all persons proven (or strongly suggested) to be afflicted with leprosy be exiled immediately to the site on Molokai.

The author dramatically describes the selection and separation of the exiles from their families and the tortuous and sometimes deadly sea voyage to their primitive new homeland. Mixed with the public policy and the individuals who made and implemented it, are the descriptions of the hospital in Honolulu where diagnoses and dispositions were rendered, as well as the poignant personal stories of the "detainees." The reader follows the colony from the arrival of its first 13 patients in 1866, through its peak population of 1,144, to its residual 28 in 2003.

View full annotation

Summary:

One day in the 1920’s, a newspaper reporter walked into the laboratory of Russian psychologist A. R. Luria and asked him to test his memory, which he recently had been told was unusual. It was not unusual. It was uniquely and astoundingly retentive. Luria gave him very long strings of numbers, words, nonsense syllables and could not detect any limit to his ability to recall them, generally without mistake, even years later. (Luria studied S., as he identifies him, for thirty years.)

Luria discovers that the man had some interesting characteristics to his memory. He experienced synesthesia, i.e., the blending of sensations: a voice was a "crumbly, yellow voice." (p.24) S.’s memory was highly eidetic, i.e., visual, a characteristic not unique to him but which he used as a technique to memorize lists and details. (He had become a performing mnemonist.) It was also auditory. He had trouble remembering a word if its sound did not fit its meaning. The remainder of the section on his memory involves fascinating aspects of his having to learn how to forget and his methods of problem solving.

The remainder of the book is equally interesting since it relates the epiphenomena of S.’s prodigious memory: how he mentally saw everything in his past memory; how he was virtually paralyzed when it came to understanding poetry since metaphorical thinking was almost impossible for him, a mnemonist who lived in a world of unique particulars! As Luria wrote, "S. found that when he tried to read poetry the obstacles to his understanding were overwhelming: each expression gave rise to an image; this, in turn, would conflict with another image that had been evoked." (p. 120)

S. could control his vital signs by his memory and, last but not least, this human experiment of nature had such a vivid imagination that, probably more than the most creative of us, he engaged in "magical thinking": "To me there’s no great difference between the things I imagine and what exists in reality. Often, if I imagine something is going to happen, it does. Take the time I began arguing with a friend that the cashier in the store was sure to give me too much change. I imagined it to myself in detail, and she actually did give me too much--change of 20 rubles instead of 10. Of course I realize it’s just chance, coincidence, but deep down I also think it’s because I saw it that way." (p. 146)

View full annotation

The Ninth Life of Louis Drax

Jensen, Liz

Last Updated: Nov-19-2009
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Louis Drax is a nine-year-old boy living in France with his stay at home mother and Air France pilot father. Such an apparently normal family description is the merest tissue of appearances. The father is probably an alcoholic and unfaithful; the son is "accident-prone" (a nearly fatal episode of SIDS at two weeks of age, a near fatal electrocution at age 6 after falling on the tracks of the métro in Lyon; salmonella, tetanus, botulism, meningitis, etc. [or, as Louis is fond of saying, "blah, blah, blah."]) and the mother has issues that only emerge as one becomes more deeply involved in what is a mystery story.

Like Gabriel Garcia Marquez’s A Chronicle of a Death Foretold, or Janet Lewis’s superb The Trial of Søren Qvist, one knows the ending early on (page 16 in Louis Drax), but not the details. The why and the how are the stuff of the novelist’s art in all three books.

With premonition of more danger, Louis goes on a family picnic (see below for the author’s biographical basis for this tale) and winds up at the bottom of a ravine, dead. Drowned and dead. A few hours later, in the morgue, he is found to be alive. Comatose and in a persistent vegetative state but alive. He is therefore transferred to the care of a neurologist specializing in comatose patients at the Clinique de l’Horizon (formerly l’Hôpital des Incurables).

It is here that the mystery unfolds. The questions are: How did Louis end up at the bottom of the ravine? Did his father, now missing, push him as his distraught mother alleges? What role does the clearly neurotic mother play in this tragedy? And who exactly is Louis Drax? Lastly, how do the mysterious letters allegedly from him, written while still in a coma, come to be?

View full annotation

The Echo Maker

Powers, Richard

Last Updated: Nov-19-2009
Annotated by:
Ratzan, Richard M.

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Mark Schluter, a 27 year old beef-processing plant worker, becomes involved in a car crash outside Kearney, Nebraska, the locus of this novel. The car crash---on February 2, 2002, a date that the author wishes to impress the reader as one that seems too numerically mystical (02/02/02) to be co-incidental--clearly has mysterious elements about it since it occurred far outside town on desolate flat country roads and amidst the tire tracks of another car. Too, just after Mark is hospitalized, there appears an undecipherable note of anonymous provenance:

I am No One
but Tonight on North Line Road
GOD led me to you
so You could Live
and bring back someone else.

Mark has an initially troublesome route to recovery, including a temporary ventriculostomy to relieve the pressure in his head. Meanwhile his only sibling, Karin, 31, rushes to his side from Sioux City, a move that becomes permanent and costs her her job. Mark eventually awakens but with an unusual mis-identification syndrome, called the Capgras syndrome (more commonly encountered in patients with psychiatric condition), in which the patient fails to recognize those closest to him as such. For a Capgras patient, there is a disconnect between the visual ability to recognize their faces and emotional response to them as close relatives or friends. He recognizes the visual similarity but considers the significant other an impostor.

This rupture in the usual see-sister's-face-acknowledge-as-sister apparently occurs, in the Capgras syndrome, in connections between one's "primitive" or "reptilian" brain, including the amygdala, and the cortex. Much is made of this failure of neuronal circuits to connect, and reminds one of the parable in His Brother's Keeper (see database) about the Chinese Emperor and the failure of the transmission of a message to explain the pathophysiology of amyotrophic lateral sclerosis. As Karin remembers the neurologic explanation, " 'His amygdala, she remembered. His amygdala can't talk with his cortex" [original italics] (80). This amygdala-cortex dichotomy becomes, in behavioral terms, feeling versus reason. As discussed by the two neurologists involved in Mark's case, "But no emotional ratification. Getting all the associations for a face without that gut feeling of familiarity. Pushed to a choice, cortex has to defer to amygdala"; "So it's not what you think you feel that wins out, it's what you feel you think" (131).

Out of desperation, Karin emails a request to Gerald Weber, a famous cognitive neurologist-author modeled primarily after Oliver Sacks but with a little A. R. Luria, whose "To find the soul it is necessary to lose it" is the epigraph of the novel. From the time Weber meets Mark and Karin, the book becomes an intricately entangled design of various metaphysical threads all of which, directly or indirectly, revolve around Mark's syndrome and identity--in fact the identity of all the characters. Karin becomes involved-- re-involved-- with two men from her earlier days in Kearney, Robert Karsh, a developer, and Daniel Riegel, a conservationist. Later the two men become ideologically more opposed than ever when Karsh tries to develop the annual nesting grounds of the cranes, Grus canadensis, who return to Kearney, thousands of them, every February. Barbara Gillespie, a guardian angel to Mark at the extended care rehab center, and Gerald Weber, until then a man happily married to a prototypically liberal intellectual woman, Sylvie Bolan, become romantically drawn to each other. Weber's own doubts about his work and his public image after unprecedentedly critical reviews of his latest book torment him and lead to concerns about his own identity as a physician who may be using, rather than trying to understand, his patients.

View full annotation

Annotated by:
Mathiasen, Helle

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

Subitled, Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, this monograph features 27 contributing researchers. Published by the RAND Corporation, it is funded by a grant from the Iraq Afghanistan Deployment Impact Fund. The study was conducted under the joint auspices of the Center for Military Health Policy Research, a RAND Health Center, and the Forces and Resources Policy Center of the National Security Research Division of the RAND Corporation.
 
The work deserves our full attention as it delineates and explains the economic, human, medical, political, public health, and social consequences of injuries suffered by returning veterans of US involvement in 8 years of continuous conflict in Afghanistan and Iraq. The introduction defines the three kinds of invisible wounds affecting thousands of the 1.64 million American troops deployed in Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) since 2001. These combat related injuries are post traumatic stress disorder (PTSD), major depression, and traumatic brain injury (TBI). Upwards of 26% of returning troops may have mental health concerns, including drug and alcohol dependency, homelessness, and suicide.

The monograph analyses numerous studies of these issues, both governmental and non-governmental, and RAND has conducted its own study. The data collection is recent: from April 2007 to January 2008. RAND estimates that approximately 300.000 persons currently suffer from PTSD or major depression; in addition, 320,000 veterans may have experienced TBI during deployment.

The recommendations include evidence based care at the VA level, the state and community level, and on site in Afghanistan and Iraq. Adequate care would pay for itself and save money in the long run by improving productivity and reducing medical and mortality costs for members of the US armed forces.

View full annotation