Showing 561 - 570 of 863 annotations tagged with the keyword "Patient Experience"

Annotated by:
Shafer, Audrey

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.

The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)

The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).

Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.

Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.

Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)

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The Imaginary Invalid

Molière

Last Updated: Oct-21-2003
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Plays

Genre: Play

Summary:

Argan, a fearful but miserly hypochondriac, divides his time between summoning the doctor to care for his ills and trying not to settle the resultant bills. He resolves to marry his daughter, Angélique, to a medical student, hoping to acquire unlimited access to gratis consultation. The chosen fiancé is an unattractive dolt, who would never interest Angélique, even if she were not already in love with clever, handsome Cléante, who poses as her music instructor.

Argan's wife, however, plans to send Angélique to a convent, removing her from the line inheritance. At the urging of the sensible servant Toinette, he feigns death to test his wife's affection only to discover her contempt. Again with the help of Toinette, the young lovers convince Argan to liberate himself from the twin tyrannies of his ailing body and his grasping physicians by becoming his own doctor. The play closes with the physicians' lively examination of Argan and his entry into the profession, full of musical pomp and pidgin Latin.

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Summary:

The sculptor Ken Harrison (Richard Dreyfuss) is badly injured in a car accident and finds himself in the middle of life permanently paralyzed below the neck and dependent on others for his care and survival. Ken is a strong-minded, passionate man totally dedicated to his art, and he decides he does not want to go on with the compromised, highly dependent life that his doctors, his girlfriend Pat (Janet Eilber), and others urge on him. He breaks up with Pat and fights to be released from the hospital, to gain control of his life in order to stop the care that keeps him alive and unhappy.

His antagonist is the hospital's medical director Dr. Emerson (John Cassavetes), who believes in preserving life no matter what, and so tries to get Ken committed as clinically depressed. Ken's attending physician, Dr. Scott (Christine Lahti), begins with the establishment but gradually moves toward Ken's position.

The film ends with the judge at a legal hearing deciding that Ken is not clinically depressed and that he thus has the right to refuse treatment and be discharged. In the last scene, Ken lies in a hospital bed framed by his own sculptural realization of the forearm and hand of God from Michelangelo's Creation of Man.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

This medical thriller begins with two crazed naked men escaping from an unmarked urban institutional building. One of them winds up in the Gramercy Hospital (NYC) Emergency Room under the care of the young Dr. Guy Luthan (Hugh Grant). The patient dies while exhibiting baffling symptoms and under suspicious circumstances. Dr. Luthan decides to investigate, against the advice of his boss, but with the assistance of ER nurse Jodie Trammel (Sarah Jessica Parker). Suddenly, police are breaking into his apartment and finding (obviously planted) cocaine. Luthan is fired by the hospital, his promising career apparently ruined by a faceless criminal conspiracy.

Still intrigued by the mystery patient, Luthan follows some street leads that take him to the Inferno-like caverns underneath Grand Central Station and the homeless people who live there. He is pursued by armed agents, is wounded, and wakes up in a hospital bed paralyzed from the neck down. Enter the prize-laden Dr. Lawrence Myrick (Gene Hackman), who explains to Luthan that he is trying to develop a medical procedure that will regenerate human nerve tissue and has been secretly using the homeless as guinea pigs. He rationalizes this practice on the basis of its huge potential benefits and tries to enlist Luthan on his side, explaining that his paralysis is temporary (but under Myrick's control) and in part an attempt to stir up Luthan's empathy for the patients who could be helped by Myrick's procedure if it is developed.

Of course, Luthan escapes from the bed. On the way out he encounters Myrick and his armed agents in the lobby, where there is one last round in the ethical debate before Myrick is accidentally killed by one of his henchman. Luthan's career is reconstituted, he is awarded a fellowship, and the film ends with Myrick's widow standing at the gate of the NYU School of Medicine giving Myrick's data to Luthan, saying that her husband was trying to do good but in the wrong way. She hopes that Luthan will use the data in the right way. Luthan smilingly enters a stone building with "Neurology" carved in the lintel.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Following the death of an aphasic hermit woman in the woods of North Carolina, it is discovered that she is survived by a daughter (Jodie Foster), a young woman who lives by herself as a kind of wild child, speaking a private language, and intensely fearful of human contact. The authorities decide that she must be normalized for her own good, but Dr. Jerry Lovell (Liam Neeson) disagrees, arguing that, although different, she is fine and has not asked for help. He insists on getting her informed consent before treatment. A judge agrees to give Lovell three months to observe the woman, whose name turns out to be Nell, and find evidence that she should not be treated against her will.

Lovell recruits a partner, psychologist Paula Olsen (Natasha Richardson), and together they set up an observation base on a houseboat with a view of Nell's cabin. From there Lovell makes a series of attempts to win Nell's confidence and understand her language. (Olsen for much of the film mainly represents a set of professional values more conservative that Lovell's unconventional therapeutic moves--which, for example, make her suspect that he is sexually attracted to Nell. Her own sexual presence, while downplayed, serves to defuse this potential.)

Lovell wins Nell's confidence (she calls him her "guardian angel") and the secrets of her speech and wounded psyche (a twin sister died young, and Nell has apparently at least witnessed sexual abuse). Following a court hearing in which Nell speaks in her own defense, the world gets word of her case and journalists descend on her remote cabin on foot and by helicopter.

Fearing that civilization will destroy Nell, Lovell arranges to have her hospitalized as the least available evil. However, when he finds her drugged, he sees that hospitalization is no solution, and he carries Nell out of the hospital and back to her cabin. He tries to make her understand that he is not her guardian angel.

The film switches to a warmly-lit lakeside scene five years later, when all problems seem to have been solved. Lovell and Olsen, who are married with a little girl, and several other sympathetic characters are picnicking with Nell near her cabin, and Nell is shown entranced and somehow emotionally fulfilled in being with the child, who is the age at which her twin sister died.

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Death on Request

Nederhorst, Maarten

Last Updated: Oct-21-2003
Annotated by:
Shafer, Audrey

Primary Category: Performing Arts / Film, TV, Video

Genre: Video

Summary:

In this documentary film about euthanasia in the Netherlands, a man--Kees van Wendel de Joode--with amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) requests death in his home, to be performed by his doctor, Wilfred Sidney van Oijen. The film mostly consists of what appear to be unscripted discussions between Kees, his wife Antoinette, and the doctor; however, there are also interviews with the doctor and views of the doctor seeing other patients. The film shows the doctor performing euthanasia: we watch him inject a barbiturate and then a muscle relaxant and we see him supporting Antoinette during the bedside deathwatch.

Kees has had a rapid deterioration of his ability to function: he is unable to move his legs and right arm, he can no longer speak coherently, and he is having difficulty swallowing. His wife cares for him in their Amsterdam apartment. The film documents the legal requirements for euthanasia in the Netherlands: Kees's repeated requests for euthanasia, confirmation that he has an incurable disease, the second opinion doctor's visit, and reporting the death to the municipal coroner and public prosecutor.

The film's strength lies in the sensitive treatment of the impact of this request on the patient, his wife, and especially on his doctor. Dr. van Oijen is an introspective man who cares for his patients--he makes house calls, explains medical terms to his patients, touches his patients, and asks what they are concerned about. He allows his patients (Antoinette is, in many ways, his patient too) to weep and be emotional.

The religious and moral dimensions of euthanasia are explored mostly with the doctor, who does not view himself as a wanton killer, but rather a doctor whose duty includes the alleviation of suffering. The film concludes with a voice-over stating the doctor will not sleep this night, but still has a clinic full of patients awaiting him in the morning.

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Annotated by:
Martinez, Richard

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

In Rethinking Life and Death: The Collapse of Our Traditional Values, Peter Singer argues that "the traditional western ethic has collapsed" as we enter "a period of transition in our attitude to the sanctity of life" (pp. 1). The book begins with the tale of Trisha Marshall, a twenty-eight year old woman, who in 1993 was seventeen weeks pregnant when a gunshot to her head left her in an intensive care unit, her body warm, her heart beating, a respirator supporting her breathing. However, she was brain dead.

Her boyfriend and her parents wanted the hospital to do everything possible so that the baby would be born. The ethics committee of the hospital supported the decision. For the next 100 days, Trisha Marshall continued to be supported in the ICU until her baby was delivered by cesarean birth. After a blood test showed that the boyfriend was not the father, and after three weeks in the intensive care unit, the baby went to live with Marshall's parents.

Singer uses this introduction to pose the many ethical questions that are raised because of medicine's ability to keep a "brain dead" body warm for an extended period of time. "How should we treat someone whose brain is dead, but whose body is still warm and breathing? Is a fetus the kind of being whose life we should make great efforts to preserve? If so, should these efforts be made irrespective of their cost? Shall we just ignore the other lives that might be saved with the medical resources required?

Should efforts to preserve the fetus be made only when it is clear that the mother would have wanted this? Or when the (presumed?) father or other close relatives ask for the fetus to be saved? Or do we make these efforts because the fetus has a right to life which could only be overridden by the right of the pregnant woman to control her own body--and in this case there is no living pregnant woman whose rights override those of the fetus?" (pp. 17-18).

In the chapters that follow, Singer argues that whether western society will acknowledge it or not, we have, in our actions and decisions, moved to an ethic where "quality of life" distinctions trump "sanctity of life" positions. Yet, many continue to raise the "sanctity of life" position when it is clear that our legal and ethical positions in western society have embraced the "quality of life" stance. For Singer, this paradox results in an incoherent and illogical approach to the ethical challenges presented by modern medicine.

Throughout his book, Singer presents evidence for his argument through ethical and historical analysis of brain death, abortion, physician assisted suicide and euthanasia, organ donation, and the nature of persons. For those uncomfortable with Singer's position on "infanticide," this book allows one to follow Singer's argument and his recommendations in the last chapter for a coherent approach to these "quality of life" decisions.

He closes his book with the recommendation that a new ethic should embrace five new commandments to replace the old "sanctity of life" commandments. His commandments are: 1) Recognize that the worth of human life varies; 2) Take responsibility for the consequences of our decisions (in end of life care); 3) Respect a person's desire to live or die; 4) Bring children into the world only if they are wanted; and 5) Do not discriminate on the basis of species.

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Summary:

The film opens with a bird's-eye sweep over the frieze of a post-engagement battlefield--mud, strewn with bodies and shards of machinery, all iron grey and relieved only by rare patches of crimson blood. Psychiatrist William Rivers (Jonathan Pryce) treats shell-shocked soldiers in the converted Craiglockhart Manor. He is obliged to admit the poet and decorated war hero, Siegfried Sassoon (James Wilby), because his military superiors prefer to label the much-loved Sassoon's public criticism of the war as insanity rather than treason. Rivers is supposed to "cure" the very sane poet of his anti-war sentiments.

At the hospital, Sassoon meets another poet, Wilfred Owen (Stuart Bunce), equally horrified by the war although he, like Sassoon, believes himself not to be a pacifist. A secondary plot is devoted to the mute officer Billy Pryor (Jonny Lee Miller) who recovers his speech, his memories, and a small portion of his self-respect through the patience of his doctor and his lover, Sarah (Tanya Allen). Vignettes of other personal horrors and the brutal psychological wounds they have caused are presented with riveting flashbacks to the ugly trenches. Sassoon, Owen, and Pryor return to active service. The film closes with a dismal scene of Owen's dead body lying in a trench.

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Annotated by:
Woodcock, John

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

This is the true story of Christy Brown (Daniel Day-Lewis), who was born with cerebral palsy (CP) into a poor Irish family in 1932 and overcame severe physical disability to become a famous artist and writer. In his early years Christy is severely disabled and disfigured--spastic, unable to speak, and close to quadriplegic, able to control only his left foot. His father (Ray McAnally) initially regards him as both retarded and sinful, but his mother (Brenda Fricker) faithfully and heroically cares for him.

Gradually, as he begins to speak, Christy's intelligence becomes apparent, his father accepts him into the family, and he trains himself to paint with his left foot. In his Dublin neighborhood, Christy is widely accepted, playing football goalie (by lying across the goal) and being made King of the Bonfire on All Hallows Eve, and he at least passively participates in an adolescent game of spin-the-bottle.

CP specialist Dr. Eileen Cole (Fiona Shaw) recognizes Christy's artistic talent and offers to train him. She brings him Shakespeare's "To be or not to be" soliloquy, gives him training in speech and movement control, and arranges for a one-man show of his artistic work. Christy falls in love with Dr. Cole and is crushed when she reveals that she is already engaged, and he tries unsuccessfully to slit his wrists.

Recovering emotionally from that disappointment, Christy in the years that follow sees more success as an artist and writes the autobiography on which this film is based--and, we are told in a closing title, he marries his nurse when he is about 40. (Christy Brown died in 1981 in his late forties.)

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Dehiscence

Haddad, Amy Marie

Last Updated: Jun-02-2003
Annotated by:
Davis, Cortney

Primary Category: Literature / Poetry

Genre: Poem

Summary:

In her poem, "Dehiscence," Amy Haddad speaks in the voice of a nurse tending a suffering patient. The patient has "come unstitched," and, seen through the nurse's eyes, the patient's wounds are devastating: fistulas "connect bowel, liver, pancreas"; the "stench is overwhelming," telling everyone, caregiver and patient alike, that medical science has failed, that no more can be done.

Moved by her patient's suffering and her own inability to help, the nurse does what she can. She washes the patient, changes the soiled sheets, removes the dirty dressings and replaces them with clean gauze and tape. "Done," she says. Stepping back, looking from a distance, she can no longer see the patient's wounds. She "is caught," as all caregivers have been at one time or another, in "the illusion" of the patient's "wholeness."

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