Showing 41 - 50 of 108 annotations tagged with the keyword "Physical Examination"
Summary:The famed surgeon Douglas Stone flaunts his notorious affair with Lady Sannox, although his professional reputation begins to suffer. One night a mysterious Turk asks him to attend his wife, who has cut her lip on a poisoned dagger. The Turk insists that amputation offers the only hope of recovery. Anxious to pocket the proffered gold, and impatient to get to his mistress, Stone dismisses his professional misgivings. He excises the lower lip of the veiled, drugged woman--only to find that he was tricked into disfiguring Lady Sannox herself. Lord Sannox (disguised as the "Turk") thus gains his revenge, with his wife morally chastised (and forever after in seclusion), and Stone’s "great brain [thenceforth] about as valuable as a cap full of porridge."
This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.
The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).
In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.
The subtitle to this collection of insightful and compassionate essays by gastroenterologist David Watts is: "One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer." Watts provides 48 narratives, most of which concern his patients and are written in the first person. In the preface Watts states "The stories in this book are true" (xv), that he has received permission from his patients, and that he has "disguise[d]" his patients to respect their right to privacy.
The stories cover a range of settings, from Watts's home and locations in the San Francisco Bay area, to the clinic and hospital. They also cover a range of his experience from medical school ("Sylvester" and "Love is Just a Four-letter Word") to his current position as a practitioner and an attending physician at a teaching hospital.
Stories in which Watts clearly situates himself with the patient and details the encounter are most compelling. For example, in the opening essay, "White Rabbits" and later, in "Flu Shot," Watts allows the reader to discover that patience and listening are required to in order for the patient to expose why he or she is truly there. In that space, Watts becomes present for his patient, and one learns that what may initially appear tangential is central to the patient's concern.
Watts writes of some very difficult patients and families, such as a woman who stalks him ("The Stalker's Bridegroom"), a woman who obsesses over caring for her elderly mother ("Home Remedy"), and a woman who demands narcotics ("The Third Satisfaction"). In one of the longer pieces, "Codger," Watts describes an irascible, elderly Jewish patient who skewers just about anyone with his critiques, including Watts's young son, and yet who later exposes his vulnerability by unfolding the tale of his World War II service and discovery of a Nazi death camp. It is because Watts spends time with the Codger and recognizes that the doctor-patient relationship is above all a human relationship that the doctor receives the gift of the story: this terrible experience which informed the rest of the Codger's life.
A few of the vignettes explore the therapeutic potential of poetry. For instance, in "Annie's Antidote" a piano teacher, fearful of endoscopy, asks Watts to recite one of his poems. The poem concerns the tender relationship between Watts and his son and is a metaphor for Watts's patient encounters as well: "for this is one of those moments / that turns suddenly towards you, opening / as it turns, as if we paused / on the edge of a heartbeat. . . " The poem works, the moment opens, and the woman has her endoscopy.
Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.
In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.
The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.
The authors analyze developments in the scientific article in Europe from the seventeenth century to the present. They devote a chapter to "style and presentation" in each century, and a separate chapter to "argument" more specifically in each century, in French, German, and English examples. They find a remarkable similarity of style already evident in seventeenth-century examples, demonstrating that scientific authors were already addressing an international audience. Seventeenth-century articles show an "impression of objectivity" and "a movement toward a more impersonal style" (47), although the English examples were somewhat more personal, less quantitative, and less interested in explanation than were the French examples, and the prose overall is hardly what we would currently expect from a scientific article.
Although the eighteenth-century examples should, perhaps, be considered part of a larger period that included the seventeenth century, Gross et al do track a movement from impersonal to personal style, nominal to verbal style, and minimal presentation to more elaborate presentation during this period. Also, the French examples continue to approximate more closely to twentieth-century norms of scientific style, reflecting their more professionalized community. Overall, the authors characterize much of the eighteenth century as a period of "consolidation and altered emphasis," with "relative stability" of style (116), although the last quarter of the eighteenth century showed a sharp rise in standardization and standards for accuracy and precision.
Gross et al note that nineteenth-century prose still addresses amateurs as well as professionals, and they comment on its persistent difference from "the highly compressed, neutral, monotonal prose" of late-twentieth-century science(137). However, the English and German examples do become more professional in their use of impersonal style, and examples demonstrate a consolidation toward a more "homogeneous communicative style" (138). They also note that the nineteenth century exhibits a "master presentation system approaching maturity," with "title and author credits, headings, equations segregated from text, visuals provided with legends, and citations standardized as to format and position," as well as standardized introductions and conclusions (138).
They find that the combination of an increasing "passion for factual precision" and systematization produces more careful theorizing generally in science during this period, even as individual sciences specialize and diverge (158). Increased attention is given to the process by which facts are linked to theory, and to the role of evidence, governed by an "overriding need for explicitness" (160).
Twentieth-century examples include shorter sentences with more information packed into each by way of "complex noun phrases with multiple modifications in the subject position, noun strings, abbreviations, mathematical expressions, and citations" (186). The scientific article is now generally marked by high incidence of passive voice and low incidence of personal reference, along with a "master finding system" made up of "headings, graphic legends, numbered citations, numbered equations, and so on" (186). They argue that the current state of the scientific article reflects an evolutionary process whereby "current practices are a consequence of the selective survival of practices that were, persistently, better adapted to the changing environments of the various scientific disciplines over time" (212).
In the year 2000, Nafas (Niloufar Pazira) a 29-year old Afghan-born Canadian journalist travels back to her homeland in search of her sister. The sister was maimed by the long war, and her life under oppressive Taliban rule is no longer worth living; she has resolved to commit suicide on the last solar eclipse of the century.
Dependent for her travels on the uncertain help of men, Nafas encounters many other charismatic women hiding under the seclusion of the burqas. The inquiries she makes to find her sister raise the veil just enough to reveal the torment of Afghan women, deprived of rights, education, and basic health care. A doctor must question his women patients, who are hidden from him by a canvas wall, through a child intermediary; he does not touch them. The ending is inconclusive.
Winter surveys the rise and fall of mesmerism in Victorian Britain, from animal magnetism to hypnotism, including electrobiology (a form of group hysteria), table-turning, and other fads. The book offers rich detail about the different stages of the use of mesmerism in medicine: its initial appearance in staged experiments; its uncertain status and the struggle to locate the boundary demarcating alternative medicines; its performance by professional medical men as well as travelers and quacks; its importance in the development of anesthesia; and its role in prompting skeptical scientists to consider the possibility of mental reflexes as one way to explain away mesmeric phenomena.
Winter argues that mesmerism was not "illegitimate" so much as it brought "legitimacy" itself - of medical authority, of evidence, of knowledge -- into question. Thus, she argues, mesmerism crucially inspired many of the considerable changes in nineteenth-century medicine as well as the reorganization of science and the educational reforms of the later nineteenth century. The book also discusses mesmerism as a form of religion, as a conduit for spiritualism and communication with the dead, as a catalyst in orchestral conducting, and as a model for liberal political consensus.
This collection by a physician-poet covers a wide spectrum in topic and tone. The poems in the first of the four sections speak in voices of those waiting surgical outcomes, those whose loved ones are about to undergo invasive and dangerous procedures, those who are coming to terms (partly clinical terms) with death. The poems in the second section focus more explicitly on Jewish experience, and on experiences of suffering that take place in the wider context of biblical tradition and recent history.
The third section features lighter-hearted poems, many rhymed, that make playful reference to moments in domestic life and relationship which, while not free of suffering and anxiety, are also the stuff of laughter. The fourth focuses on love--erotic, romantic, familial--and death, which includes the ordinary losses that living through time entails. Elegiac, wistful, musing, and poignant, they end the collection in a complex, sustained key that holds an elegant tension between sorrow and hope.
The text explores the experiences of a nurse practitioner in an inner city OB-GYN (Obstetrics & Gynecology) clinic and four of her women patients, from a fifteen-year-old homeless pregnant child to a mature woman struggling with cancer. Another of her patients is pregnant and drug addicted; a fourth suffers from pains that come from buried memories of sexual abuse. The stories of all four patients weave in and out of the narrator's own stories about herself, her own health and illness experiences, her own respectful appreciation of the female body.
Ian Stevenson, a psychiatrist at the University of Virginia, has devoted his career to the study of cases suggestive of reincarnation. The cases consist of narratives of young children who claim to remember past lives. The cases occur primarily in India, Sri Lanka, South Asia, West Africa, Lebanon, and among Northwestern Native Americans, in cultures and religions in which reincarnation is accepted. Stevenson and his colleagues have collected over 2000 such narratives, but only a much smaller number provide what he considers "strong" evidence.
In the latter cases, Stevenson has performed detailed, nearly contemporaneous investigations that appear to rule-out communication of any kind between the child's family and the relatives of the recently deceased person the child claims to be. In addition, many of the "strong" cases have birth defects or birthmarks at the exact sites of traumatic injuries in the deceased person's life.
This book is a shortened and popularized version of a scientific monograph entitled Reincarnation and Biology: A Contribution to the Etiology of Birthmarks and Birth Defects (also published by Praeger Press in 1997). Stevenson categorizes his cases by strength of evidence for a precisely located traumatic injury in the deceased person (i.e. simply remembered by the family, identified in medical records, or verified at autopsy). He also categorizes cases by the size and nature of the child's defect or birthmark.
In each chapter he presents a series of short narratives summarizing cases in a particular category, and comments on the weight and possible interpretations of the evidence. In Chapter 26 Stevenson analyzes a variety of explanations (including normal and paranormal possibilities), and concludes that the strongest of his cases are best explained by accepting the hypothesis of reincarnation (i.e. the discarnate personality of a recently dead person influencing the personality of a newborn child).