Showing 421 - 430 of 479 annotations tagged with the keyword "Art of Medicine"
A woman medical student finds herself in a hierarchical dilemma while rotating through her internal medicine clerkship. She is helping to take care of a middle-aged man who has been hospitalized for a diagnostic work-up. As a consequence of invasive procedures ordered by his physicians to determine the cause of his symptoms, the patient has suffered serious complications and is moribund. The doctors are evasive with the patient and his family, who beseech the medical student for an explanation. Even though she has been instructed by the physicians to refer all issues back to them, she follows her own convictions and tells the truth: "Your father is dying."
As a result of this "insubordination," she is called in to see the head of the department, a man of "legendary diagnostic skill" with a long tenure at the hospital. He says that he will have her dismissed, and launches into a long diatribe, making the case for a paternalistic medicine in which the patient needs to believe that the physician is omniscient and possesses quasi-magical healing powers. "Miracle, mystery, and authority," he says, are at the heart of what physicians can do for their patients and to undermine these is to do harm to the vast majority of the sick. Having made his point, he terminates the interview but reinstates the student, who, it is suggested, is so grateful (for his advice or for not being dismissed?) that she kisses him.
This is a collection of stories and sketches by a practicing neurologist. Most of the material is clinical and autobiographical. In "Mrs. Bachman" a new patient enters the doctor's office, carrying a thick stack of medical records. It all started in 1946 and no doctor has ever found the explanation of her condition. Meanwhile, the doctor is wearing contact lenses for the first time. His eyes begin to tear. Mrs. Bachman thinks that he is crying over her misfortune. She consoles him, "I want you to know that you are the kindest, most sympathetic man I have ever met."
In "Intensive Care" an elderly woman is agitated after a seizure. The staff try unsuccessfully to calm her. Finally, her husband approaches and kisses her. She settles peacefully and they hold hands.
The doctor in "Continuing Medical Education" finally discovers metastatic breast cancer as the cause of a psychotherapist's neck pain, long after he and other physicians had told her again and again that the "driving mechanism" of her chronic pain was "unresolved anger and frustration." In a longer essay, "The Narrow Bridge," the author reflects on the meaning of healing, "Healing helps us find a place in this world for ourselves and for each other."
William Morton first introduced ether anesthesia in 1846. This was followed shortly by nitrous oxide and chloroform. Within a few years, surgical anesthesia was being used throughout the United States. However, widespread acceptance did not mean universal usage. Physicians and surgeons debated the risks and benefits of anesthesia. Anesthesia was thought to be dangerous. Some argued that pain was a necessary part of life, that it made people stronger, and/or that it was a punishment from God. Others argued that anesthesia constituted an abuse of medical power.
Surgeons took care to select appropriate patients for anesthesia, while performing surgery without anesthetics on others. Women, people of higher social and economic classes, and people of the white race were thought to be more sensitive to pain than men, the poor, and Negroes and American Indians. Likewise, the young experienced pain more than the elderly. Certain procedures (e.g. major limb amputations and prolonged tissue dissection) were also thought to require more anesthetic than others (e.g. natural childbirth or ENT surgery). These beliefs carried over into practice, as evidenced by records from the Massachusetts General Hospital and other hospitals in the mid-19th century.
This study explores the history of physician-patient relationships, especially as it relates to the ascendancy of science in medicine. The book begins by describing traditional physician-patient relationships in the 18th century. The focus, however, is on the "modern" doctor (beginning in the 1880's) and the "postmodern" doctor (beginning in the 1950's).
The author describes the transition from modern to postmodern doctor and a corresponding transition from modern to postmodern patient. A "sympathetic alliance" between physician and patient was essentially a development of the modern period (1880's - 1950's).
Dr. Hertzler leads the reader, topically and generally chronologically, through the nature of the practice of medicine in rural America from the 1880's through the 1930's. His early narratives are those of a child observing the ravages of epidemic diseases in the face of medical futility.
The remainder of the work, divided into subject headings, is devoted to anecdotes and observations on such things as horse and buggy home visits, kitchen surgery, the proprietary hospital and physician education. Having served not only as a rural practitioner, but as a professor of pathology at academic centers and a consulting surgeon, Hertzler draws on a wide experience over a period of time known for rapid advances in basic biological science which would, near the end of the narrator's life, open the way for technological medicine as we know it today.
This collection of vignettes follows the growth and development of one internist as he reflects on some of the critical experiences that shaped him as physician. The common thread of the work is the celebration of the relationship that can, and perhaps should, be built between the physician and his or her patient in the course of caring: this relationship is the sacred space of the title.
The author accomplishes his self-imposed task of describing this space by presenting situations in his practice life that illustrate the concept. The chronological structure of the collection enables the reader to study the maturation of the author as a self-reflective practitioner over the many decades of his professional life. Many of the stories are very funny; others are wrenching; all are gently told.
The narrator recalls a boyhood encounter with Rab, a majestic dog. Rab causes the lad to make friends with his master, James Noble, a simple horse-cart driver. Six years later, James brings his beautiful old wife, Ailie, to the hospital where the narrator is now a medical student. She has breast cancer and the surgeon tells her that it must be operated the following day. James and the dog are allowed to remain nearby.
Ailie endures the operation in brave silence, commanding silent respect from a lively group of students. James nurses her tenderly, but she develops a fever and dies a few days later. Shortly after her burial, he too falls ill and dies. Rab refuses to eat, becomes hostile, and is killed by the new driver.
Summary:Canadian artist, Robert Pope (d.1992), devoted the last years of his short life to documenting his decade-long experience as a patient with Hodgkin's Disease. Shortly after his diagnosis he was influenced by the 1945 autobiographical novel of Elizabeth Smart, By Grand Central Station I Sat Down and Wept. Pope's early work explored the interconnectedness and pain of individuals bound by an imperfect love, in Smart's case for a married man. After his disease went into remission, he began to paint the patient's perspective on illness, hospitals, visitors, family, and health-care providers in a series of images that suggest the lighting of de la Tour, the photographic immediacy of Doisneau, and the menacing surrealism of de Chirico. His book, Illness and Healing: Images of Cancer (1991), became a bestseller.
An intern in internal medicine is frustrated by his weekly clinics; he seems unable to understand why most of his patients come to see him, why they seem happy when they leave, and wonders when he is going to have the chance to do "real" medicine, such as ordering tests and making sophisticated diagnoses. One day, he sees an elderly woman who had been worked up over the years for "heart pain" without finding a diagnosis. In the past she had seen other residents for no discernible reasons.
At this visit, the author recognizes that she seems upset, encourages her to talk, realizes that she reminds him of his grandmother. The woman reluctantly admits she has fallen in love with a younger man. The resident is respectful towards her, and recognizes the beautiful woman she had once been. He begins to realize that she has experienced much that he hasn't, and that she has much to teach him about life and about being human.
The writer, a comparative literature professor, elected to spend one full semester as an up-close observer in a medical school anatomy lab during the student dissection experience. He approached the experiment with the clearly articulated intention of writing about the lab, the instructors, the students, and their subjects. The book takes the reader dissection by dissection through the socialization process, as well as the technical content, of the class--from the first cut to the final memorial services for the cadavers at the closure of the term.