Showing 291 - 300 of 425 annotations tagged with the keyword "Professionalism"

Ionych

Chekhov, Anton

Last Updated: May-27-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

Dmitry Ionych Startsev is a physician in a provincial town. He is frequently entertained by the Turkins, the town's most cultivated residents. He falls in love with their daughter, Yekaterina, who teases the doctor by asking him to meet her in the cemetery at 11 PM and then not showing up. Finally, she rejects his suit coldly, saying that she must go to Moscow and study at the conservatory.

Four years later, Startsev has gotten corpulent, built a big practice, become affluent, and lost all interest in romance. Yekaterina returns and tries to rekindle their affair, but Startsev becomes irritated and says to himself, "What a jolly good thing I didn't marry her!" In the end, he just becomes fatter and more irritable, and he shouts at his patients.

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A Work of Art

Chekhov, Anton

Last Updated: May-27-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

In payment for the doctor's saving his life, a young man gives Dr. Koshelkov an antique bronze candelabra. The candelabra features "two female figures in the costume of Eve and in attitudes for the description of which I have neither the courage nor the fitting temperament." While the doctor finds the piece obscene, the young man chides him for not appreciating fine art. Finally, the doctor accepts the candelabra, but decides to give it to Uhov the lawyer, to whom he is indebted.

Uhov, in turn, judges the naked figures to be too raunchy: "I should be ashamed for my servants to see it." Yet, he is pressured to accept the gift. The same night he foists off the candelabra to Shashkin, the comic actor, who subsequently sells it. Two days later, the original young patient rushes into Dr. Koshelkov's office with the original candelabra, proclaiming that his mother had just discovered it in a shop. "Happily for you we have succeeded in picking up the pair to your candelabra!"

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Summary:

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.

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Servants of the Map

Barrett, Andrea

Last Updated: May-06-2003
Annotated by:
Clark, Stephanie Brown

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

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.

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Chocolates

Simpson, Louis

Last Updated: Mar-20-2003
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poem

Summary:

One day some people were visiting Chekhov and they wanted to talk about him, about his genius. The author was embarrassed. He asked them, "Do you like chocolates?" Although the visitors were reticent at first, Anton P. Chekhov encouraged them to speak. Soon everyone was talking about his or her preference in chocolates, relishing the fine points of "almonds and Brazil nuts" and "the flavor of shredded coconut." Later, in the coach on the way home, the people felt that their conversation with Chekhov was very successful. [30 lines]

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Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Collection (Essays)

Summary:

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.

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Annotated by:
Belling, Catherine

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Giovanni (Nanni Moretti) is a psychoanalyst. He has a beautiful wife, Paola (Laura Morante), and an adolescent son and daughter, Andrea and Irene. One Sunday morning, Giovanni gets a call from one of his patients, newly diagnosed with cancer and frantic. Instead of spending the day with his family, Giovanni attends to his patient. Andrea goes diving with friends, there is an accident, and he is killed.

The rest of the film examines the family’s bereavement. Giovanni finds his work increasingly difficult, and by the end of the film he has decided that he can no longer be a psychotherapist.

A love letter addressed to Andrea arrives from a girl called Arianna: it turns out Andrea had a secret girlfriend. Both parents become obsessed, in different ways, with contacting Arianna. Eventually she visits them, while hitchhiking with her new boyfriend, and the family drive all night along the Mediterranean coast, taking Arianna and the boy to France. Next morning, on the beach at Nice, in saying goodbye to Arianna, they seem to have made progress in continuing their life as a family without their lost son.

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Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

An anthology of poetry and prose by doctors, nurses, patients, and other authors, A Life in Medicine is divided into four sections: "Physicians Must Be Altruistic"; "Physicians Must Be Knowledgeable"; "Physicians Must Be Skillful"; and "Physicians Must Be Dutiful." Each section begins with the Association of American Medical Colleges' (AAMC) definition of the physician trait examined in that section, and short "explications" precede each individual poem and prose piece, linking them to the section's overall theme.

The anthology has a preface outlining the editors' goals and Robert Coles's introduction, "The Moral Education of Medical Students." These organizational touches make the anthology a classroom-ready text for medical students. The anthology's poems and prose--many of which are stunning--were taken from previously published works and exclude many well-known and often-used pieces. But those selections are readily available elsewhere, and the editors do readers a greater service by introducing many lesser-known, but equally important, poems and essays.

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Heart of the Land

Gray, Andrew

Last Updated: Jan-28-2003
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Short Story

Summary:

A lonely neurosurgical resident becomes involved with a comatose patient. Susan, a dying woman with an inoperable brain tumor, is the subject of a research study. Scientists are attempting to discern her thoughts with the aid of computers. The resident serendipitously stumbles onto a program that successfully translates the electrical activity of Susan's brain into speech. He labels the computer program a failure (but saves a copy for himself) so that others are unable to eavesdrop on her dreams.

He spends nights listening to her thoughts and soon begins communicating with Susan, sharing his own secrets with her. When the resident learns that the research project is about to be terminated, he decides that Susan is in desperate need of human contact. He kisses her and presumably has sexual intercourse with the comatose woman. The next morning he is found asleep beside her and is dismissed from the hospital.

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The Dead Alive and Busy

Shapiro, Alan

Last Updated: Jan-16-2003
Annotated by:
Bertman, Sandra

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

This collection of 36 poems, some of which have been published individually in various literary magazines, is primarily about dead--or nearly dead--family members: a brother and sister lost to cancer; the speaker's palsied, nearly blind father dying of Parkinson's disease; his mother's struggle with chronic arthritis and heart disease.

The collection is divided into three untitled sections. The first deals primarily with the aging and death of the speaker's parents; the second with a wider range of abandonment and death, lost loves, dreams, innocence; the third almost exclusively with his sister's six year struggle with breast cancer and dying.

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