Showing 341 - 350 of 425 annotations tagged with the keyword "Professionalism"
The author, a Canadian physician-historian-educator, blows the dust off the shelves of medical history with this fascinating text designed for medical students, educators, and those with an interest in history of medicine. Duffin begins this survey of the history of Western medicine with a glimpse at a pedagogical tool designed to spark the interest of even the most tunnel visioned medical students: a game of heroes and villains. In the game, students choose a figure from a cast of characters selected from a gallery of names in the history of medicine.
Using primary and secondary sources, the students decide whether the figures were villains or heroes. The winner of the game is the student who first recognizes that whether a person is a villain or hero depends on how you look at it. This philosophy imbues the entire book, as this treatise is not a tired litany of dates, names and discoveries, but rather a cultural history of the various times in which medical events occurred.
The book is organized by topics which roughly follow a medical school curriculum: anatomy, physiology, pathology, pharmacology, health care delivery systems, epidemiology, hematology, physical diagnosis and technology, surgery, obstetrics and gynecology, psychiatry, pediatrics, and family medicine. The last chapter, entitled "Sleuthing and Science: How to Research a Question in Medical History," gives guidance to formulating a research question and searching for source material. Fifty-five black and white illustrations are sprinkled throughout the book, as well as 16 tables.
Direct quotes from historical figures, such as Galen and Laennec, as well as excerpts from writings of eyewitnesses of events, anecdotes and suggestions for discussion, appear in boxes within the chapters. Many of the chapters contain discussion about the formation of professional societies. Each chapter ends with several pages of suggested readings and the third appendix delineates educational objectives for the book and individual chapters. The other two appendices list the recipients of the Nobel Prize in Physiology or Medicine, and tools for further study, including titles of library catalogues, and resources in print and on-line.
Although the book is a survey covering multiple eras and topics, each chapter contains choice tidbits of detail. For instance, the chapter on obstetrics and gynecology includes the story and photograph of Dr. James Miranda Barry, the mid-nineteenth century physician, surgeon and British military officer, who was discovered to be a woman at the time of her death. The impact of the stethoscope on the practice of medicine is explored in depth in the chapter, "Technology and Disease: The Stethoscope and Physical Diagnosis."
This posthumously published collection of essays by Dr. Klawans, an eminent neurologist and writer, explores the interactions between patient, family and neurologist and the implications of specific neurologic diseases. Klawans's special interest in neurology is movement disorders, such as Huntington's chorea and Parkinson's disease, but his outside interests range from evolutionary biology to classical music. His essays, therefore, focus on single patients or families, but the author weaves thoughts about his other interests into each "case."
The book is divided into two sections, "The Ascent of Cognitive Function" and "The Brain's Soft Spots: Programmed Cell Death, Prions, and Pain." In a brief preface, Klawans declares that this book is "more than just a set of clinical tales about interesting and at times downright peculiar patients" from his 35 years of practice, but rather it "humbly grapples with the 'whys' of our brain, not the 'hows.'" (pp. 9-10) In the preface, as well as in one essay, Klawans acknowledges the work and impact of fellow neurologist-writer Oliver Sacks ("Oliver is truly the father of us all." p 12).
The title essay concerns a six-year-old girl who was found, locked and completely speech-deprived, in a closet. Because she is still within the window of opportunity for language acquisition, "Lacey" quickly learns to speak, unlike Victor, the Wild Boy of Aveyron, whose story was immortalized in the François Truffaut film, L'enfant Sauvage. Klawans uses these stories as a launch pad to discuss the evolution of language, including a proposal that the cavewoman, not the man, was responsible for development of the human species as she taught her offspring language.
Other chapters focus on patients with epilepsy, Parkinson's disease, localized and hemispheric stroke, "painful-foot-and-toe syndrome, " and Creutzfeldt-Jakob disease. Two particularly memorable chapters concern Huntington's chorea and Refsum's disease. The chapter, "Anticipation," explores the profound ethical concerns of genetic testing for Huntington's chorea as applied to three generations of one particular family. In the chapter, "The Hermit of Thief River Falls," Klawans recollects his first year as a neurology resident, and his care of a reclusive patient with a rare eponymous illness, Refsum's disease--just in time for a visit by Refsum himself, a famous Norwegian neurologist.
The book concludes with a speculative "afterthought" about genetics, evolution, and the importance of extended "juvenilization" --the protracted post-natal development of Homo sapiens. This essay intertwines some of the threads regarding speech development and evolutionary biology, particularly brain development, that were introduced earlier in the text.
The author of this memoir is a poet and writer who developed systemic lupus erythematosis (SLE) during her first year at the University of Pennsylvania. Initially, her condition was difficult to diagnose, which led to her first negative encounters with physicians and the health care system. Later, Ms. Goldstein developed unusual neurological manifestations of SLE. Once again, she had trouble convincing her doctors that her symptoms were not only real, but also disabling. She was fortunate enough to come across a few good physicians who respected her as a person and earned her trust.
Despite her chronic illness, Ms. Goldstein thrived throughout college and graduate school. She approached each new challenge with such a positive attitude that some of her doctors considered her emotionally unstable. (I guess they thought it would be more "normal" for her to lose hope and turn herself into an invalid.) Her graduate work in literature focused on the new field of literature and medicine.
Millie is a "baby nurse," hired as a domestic helper and live-in night nurse who cares for other women's infants up to the age of two years. She is "condemned by life to love many babies and lose them all" (1). Millie is described as old, but we are not told how old, or of what else her life has consisted; probably little, since she appears to have cared for one child after another, and has no home apart from where she is employed.
The story begins as she starts a new job, caring for Mrs. Jones's baby daughter. She adores the baby, but is tense and possessive, strongly dislikes the Jones's noisy six-year-old boy, and complains to Mrs. Jones about the other servants. Reluctant to let the baby grow up, she does not encourage her development, and she is overly defensive and protective of the child.
As the baby gets older, Millie becomes more and more anxious until, after a fight with one of the other servants, Mrs. Jones fires her. The story ends where it began, in the waiting room of the employment agency as Millie seeks a new position, a new baby to love and lose.
Corky Nixon is a patient in a ward of amputees in a military hospital for casualties of the Korean War. He has lost both legs. The head nurse on the ward has been given the nickname "Old Ironpuss" because she is so fierce and strict and unattractive, showing, as Corky says, "no warmth, no sympathy, no concern" (131). By implication, she is unfeminine. All the patients fear and hate her.
On Christmas Eve, a severely injured patient, Hancock, is brought in. He is conscious but catatonic. Corky is outraged that "Old Ironpuss" should be taking care of Hancock (he says that so sick a patient should get "the best damn-looking nurse in Christendom"!). Corky tries to get Hancock to talk, but is interrupted when the nurse comes in and berates Hancock for being such a difficult patient. Corky is outraged and complains to the colonel, who then points out that Hancock, reacting to the nurse's diatribe, has roused himself, talked back, and begun to recover.
He tells Corky that in cases like this, kindness and sympathy don't work and that the best treatment is the provocation of anger. Corky accepts this, and decides to collaborate with the nurse by having all the men in the ward stage the loud singing of Christmas carols with bawdy new lyrics, ostensibly to irritate her. In the midst of this chaotic display of good spirits, we see "Old Ironpuss" listening to their spirited defiance, and then turn away, alone, weeping.
Fred McCann is an energetic man in his thirties, something of a playboy, when the Second World War breaks out. He becomes a soldier, and in an Italian village one day he goes to a pump for a drink of water. The pump is booby-trapped and explodes. He is blinded and loses all four limbs. The story traces the development of a relationship between Fred and Alice, his nurse in the military hospital.
As he learns to submit to being entirely helpless, reliant on Alice for all his needs, he gradually begins to adapt to his new condition. Then Alice changes everything by having sex with him. At first their new and obsessive relationship makes him happy, restoring some of his old sense of himself as a man. When Alice is moved to another duty and replaced by a sadistic male nurse, Fred is so devastated and makes such a scene that he gets Alice back.
To celebrate her return, Alice sneaks some whiskey into his room and they get drunk. She then says something that appalls him: she calls him her "thing" and confides that she has always hated men, who look at her and touch her and have power. Fred is nauseated, seeing himself reduced to nothing more than a "a phallus on its small pedestal of flesh." He realizes now that he is no longer a man, and later that night he manages to drag himself out into the garden, where there is a small pool in which he drowns himself.
In this extensive review of her experiences in public health and rural and urban medicine, Eva Salber, MD, explores the commonalities and the differences in medical practice among three environments: pre-World War II South Africa, urban America, and the hills of North Carolina. Trained in South Africa, where she and her husband practiced for many years, Salber came to the US during a very difficult political period for whites in Cape Town.
In Boston, she pursued her passion for the plight of the poor and their health issues by studying further public health and running a ghetto clinic. Later, as a member of the Duke University faculty, she established rural health clinics in North Carolina. She describes, in this memoir, the contrasts among the cultures as well as her own difficulty in obtaining the funding and support she needed to carry out her work in each setting.
Alice Goodwin is the wife of Howard, a midwestern dairy farmer, the mother of two daughters aged five and three, and the nurse at a local elementary school. She and her friend, Theresa Collins, a family therapist who lives in the nearby suburbs, take turns watching each other's children. One morning, while Alice is momentarily distracted, Theresa's two-year-old daughter, Lizzy, falls into the pond on the Goodwin farm. Despite Alice's attempts to resuscitate her, she dies after three days in the hospital.
Not long after, while she is severely depressed, Alice is arrested on (false) charges of sexually abusing some of the schoolchildren in her care. Confused, and thinking only of Lizzy's drowning, Alice says to the police, "I hurt everybody." They take this to be a confession.
She spends three months in prison awaiting trial, until Howard sells the farm to pay her bond. The novel gives us both Alice's experiences in prison--in a world she had hardly imagined--and Howard's struggle to take care of their children. Theresa, who seems never to have blamed Alice for her child's death, helps him and they develop a powerful bond. The novel ends with the trial, in which Alice is exonerated, and their family's tentative beginning of a new, urban life.
This is a collection of medically related stories and poetry, most of which were previously published in medical journals like JAMA (Journal of the American Medical Association), Annals of Internal Medicine, and the American Journal of Medicine. "Country Doctors of Humble Pie," "Boss Cow," and "Discipline" are humorous tales about small town medical practice. "Second Opinions," "Net Worth," and "Making Friends" are stories of patients and their idiosyncrasies.
"Hafiz Ali Goes Home" concerns a dying man who wishes to return to his home village to die, rather than dying in the sterile confines of the hospital. The story details the misadventures of Hafiz Ali's two sons as they attempt to carry out his last request.
Many of the poems deal with clinical diagnoses ("Zoster" and "Lupus Erythematosis") or the history of medicine ("Towne of Guy's" and "The Turning"). "Doing Post-Mortems" is a thoughtful poem about the war (or relationship?) between the sexes in medicine.
Jacob Hansen is sheriff, undertaker, and pastor in the little Wisconsin town of friendship. A Civil War veteran like many of the men in his town, he has seen many faces of death and knows how to balance compassion, prayer, and practicality in the presence of grief. When he recognizes a diphtheria epidemic as one after another the people of Friendship fall ill and die, he has to shoulder responsibility for protecting public health.
This means imposing and enforcing quarantine, extending even to the encampment of religious revivalists at the edge of town who mostly keep their distance and their own ways. Jacob's equanimity falters when his wife and baby daughter succumb; he keeps them alive in his mind and unburied for days, unable to acknowledge his own loss, though he helps others through theirs.
Finally he forces a passing railroad engineer to transport the survivors across the quarantine border into a neighboring town for safety, but the train is sabotaged, wrecked, and the fugitives killed. Jacob survives almost alone to return to what is now a ghost town and cope with the grim fate of survival.