Showing 31 - 40 of 906 annotations tagged with the keyword "Doctor-Patient Relationship"

Annotated by:
Miksanek, Tony

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

Pearl, a plastic surgeon and former CEO of a large medical group, writes powerfully and poignantly about the major role of physician culture - the customs and rituals, traits and beliefs of doctors. This culture is entrenched through years of medical training. He decides that physician culture "can be both a virtuous force and an equally destructive influence" (p70).

Some of that culture is readily on display: attire, tools of the trade, unique medical terminology, insensitive humor, frequent handwashing. Positive aspects of physician culture include self-confidence, integrity, compassion, and selflessness. Negative elements are ingrained to keep emotions and dread at bay: detachment, callousness, denial. This culture of medicine must navigate dual interests - healing (the mission of medicine) and profit (income, status, prestige).

Pearl suggests an evolutionary pathway for physician culture that he dubs "the five C's of Cultural Change" - confront, commit, connect, collaborate, contribute. He tackles issues of sexism, racism, and elitism in American healthcare. He explores the suffering of physicians and their need to seek forgiveness - often secretly and even in cases of perceived "failure" when everything possible was done correctly. His discussion is filled with agonizing, frustrating, and loving stories about patients, family members, and colleagues (including physician suicide).

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Global Healing

Thornber, Karen

Last Updated: Dec-14-2020
Annotated by:
Bruell , Lucy

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Karen Thornber is the Harry Tuchman Levin Professor in Literature and Professor of East Asian Languages and Civilizations at Harvard. In this expansive nearly 700 page book, she draws on work from global literature to explore the many ways societies view illness, stigma and healing.  She defines global literature as “narratives that grapple with challenges and crises that have global implications or counterparts globally, whether at present, in the past, or likely in the future” (p.10). 

The book is divided into three sections: Shattering Stigmas, in which she looks at Leprosy, AIDS, and Alzheimer’s disease; Humanizing Healthcare; and Prioritizing Partnerships.  Among the topics she addresses are patient-focused care as an imperative, the need to advance partnerships in caregiving, and support that extends beyond family and friends to the patient’s relationships with health professionals.  Healing, she notes, involves “changing the circumstances that exacerbate or even trigger a health condition, enabling the individual to obtain long-term wellbeing liberated from as much distress, if not disease, as possible.” (P331).

Thornber has selected literature that addresses the illness experience and the need to reduce suffering and promote healing, which she places within three interwoven  frameworks:  “Societies/communities, healthcare settings, and families/ friendships” (p.583).  She looks at both positive approaches to care as well as the negative impact of suffering, whether from stigma, inaccessibility to care, or dehumanized care. The book considers literary works from Africa, Asia, Europe, the Middle East, and Oceania, many that will be new to readers.  

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Together

Murthy, Vivek

Last Updated: Nov-09-2020
Annotated by:
Thomas, Shawn

Primary Category: Literature / Nonfiction

Genre: Longform journalism

Summary:

Since the first surgeon general was sworn into office in the 19th century, the Office of the Surgeon General has positioned itself as the leading voice on public health matters in the United States. In recent history, the office has had its highest profile campaigns rallying against issues such as tobacco use, obesity, and HIV/AIDS. Considering the combination of prevalence, morbidity, and mortality associated with these health issues, there is no doubt that any effort to stem the tide was a worthwhile endeavor.

When Dr. Vivek Murthy became the surgeon general in 2014, his office continued the historical campaigns against these health issues. At the same time, Dr. Murthy began investigating a looming epidemic within our borders: loneliness and social isolation.

It may be hard to convince the average person that loneliness is a problem of similar scale as tobacco use, obesity, or AIDS. There is no question that loneliness is unpleasant, even if it only lasts for a few moments. But the notion that one’s state of mind can predispose to disease or premature death somehow feels like a stretch. Addressing this skepticism, Dr. Murthy writes in his book about Dr. Julianne Holt-Lunstad, a psychologist at Brigham Young University who also faced a great deal of cynicism surrounding her research into the effect of social relationships on “everything from our behavior to our cellular function.” She had a breakthrough in 2010 when she published a massive study analyzing the health outcomes of over 300,000 participants, categorized by their degree of social connectedness. She found that social isolation was significantly linked to premature death, representing a risk nearly as serious as pack-per-day smoking, and more serious than obesity, alcohol use, and lack of exercise. Dr. Holt-Lunstad’s research spurred further studies which linked loneliness to heart disease, stroke, and depression, amongst other diseases.

These findings are hard to ignore, especially in light of the ongoing opioid addiction crisis and rises in teenage depression and suicide, all of which have been linked to loneliness and social isolation. In Together, Dr. Murthy weaves together scientific research, personal anecdotes, and current events to create a manifesto for tackling the next great public health crisis.

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Summary:

This is a quick and personal history of the Longwood Symphony Orchestra (LSO), a group of Boston area musicians who, in their working lives, are medical personnel. The first of its kind, there are now several such orchestras across the US and scattered throughout the world, notably in Europe. Lisa Wong, a pediatrician and violinist, tells her own history of medicine and music, including her involvement with the Longwood Symphony Orchestra over some 28 years. Other stories of individual doctor/musicians are threaded throughout the book, giving us a personal look at their interdisciplinary enterprise. While their medical specialties, ages, and backgrounds vary widely, while playing in the orchestra and, various professional ranks aside, they accept the direction of the conductor. While Wong mentions antecedents of medicine and music in ancient times, she chooses Dr. Albert Schweitzer as a patron saint for the LSO.

For Wong and her fellow doctors, there are links between music and healing. Music helps keep doctors (and patients) healthy by calming the heartbeat, relaxing muscles, and lifting the mind (p. 86). Music therapy (the psychotherapeutic use of music) and music medicine (the more general uses of music, often in medical settings) can assist in patient care. For example, a dementia patient named Ruth reawakened upon hearing music. Some patients choose to listen to music in the final days of their lives (p. 184).      

For many doctors, music was an early pursuit. Neurological studies suggest that musical training helps develop “structural brain plasticity” that may show benefits in education and training. By contrast, however, sometimes musicians (doctors or not) develop overuse injuries and need specific physical therapy.           

Music has applications in mental health, hospitals in general, and community partners. The LSO has partnered with some 40 nonprofits in the Boston area. In one example, they helped grow the Asian bone marrow registry from 3,000 to 11,000 people (p. 225). An LSO concert raised $30,000 for the Mattapan Community Health Center in South Boston.  

Lisa Wong was president of the organization for 20 years. She writes, “Music goes a long way to heal entire communities. Social justice and social welfare are important determinants of health. Programs that look beyond the music are truly ‘Healing the Community through Music’” (p. 249). 

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The Beauty in Breaking

Harper, Michele

Last Updated: Sep-18-2020
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The Beauty in Breaking is the memoir of an African American physician who, in her own words, has “been broken many times” (p. xiii).  

Despite maintaining a veneer of affluence, the author, her mother and siblings live in constant fear of being battered by her father. Following one particularly vicious attack, she accompanies her injured brother to the local emergency room. That day she serendipitously discovers her calling: “As my brother and I left the ER, I marveled at the place, one of bright lights and dark hallways, a place so quiet and yet so throbbing with life. I marveled at how a little girl could be carried in cut and crying and then skip out laughing” (p. 18).  

Much later, the author (Michele Harper) undergoes a shattering breakup and divorce. She endures disappointments at work, some of which, regrettably, can only be explained by the color of her skin.    

As she picks herself up time and time again, Harper discovers her inner resilience: “The previously broken object is considered more beautiful for its imperfections” (p. xiii). She learns from the experience of her own suffering to develop compassion in her clinical work. The bulk of the Beauty in Breaking is devoted to case studies of the author’s clinical encounters with patients in the emergency room.

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Annotated by:
Kohn, Martin

Primary Category: Literature / Poetry

Genre: Collection (Poems)

Summary:

The Talking Cure is Jack Coulehan’s 11th book, seven of which, including this collection, are books of his poetry. This collection begins with selected works from his six previous books of poetry and continues with a selection of poems in the imagined voice of Chekhov. These sections are followed by previously uncollected poems, and the book ends with 25 new poems reflecting the title of this book--“The Talking Cure”. The poems represent multiple viewpoints—patients, caregivers, family members as they struggle to make sense of the vicissitudes—and unexpected joys—in life. The poems have appeared over the past four decades in medical journals (primarily Annals of Internal Medicine and Journal of the American Medical Association) and in many literary journals including Prairie Schooner and Negative Capability Press. 

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Blue Ticket

Mackintosh, Sophie

Last Updated: Sep-07-2020
Annotated by:
Martel, Rachel

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In Blue Ticket, Sophie Mackintosh constructs a dystopian vision of modern life for women. Ambiguously set in space and time (given the technology presented we know it takes place around the present day, and not much else), Mackintosh’s universe is one in which a girl’s destiny is set at the time of her first period, when she receives either a white ticket or a blue ticket from the government. These designations are supposedly based on intense scrutiny from the State, and they determine the path each woman will lead. White ticket women, as they’re called, are destined for motherhood, having been deemed worthy of childrearing. Blue ticket women, implanted with a permanent intrauterine device and forbidden from getting pregnant, are bound for the working world, bound for a "free" life that "could change at any time." Each girl must leave her family to start a new life after her ticket is drawn, and the white tickets and blue tickets immediately diverge. The white ticket girls are ferried safely to their destination cities, while the blue ticket girls must brave the open road on foot and alone, fighting for survival and the privilege of an adult life.            

We meet Calla, the narrator, as she teeters on the brink of menarche. One by one her female classmates have disappeared from around her, and she is one of only three girls left in school when her period finally arrives. She draws a blue ticket, and embarks on a new life as a chemist, initially living the free and unencumbered life that blue ticket women are supposed to lead. Yet desire for a child smolders inside her, a “dark” feeling that crawls under her skin until it is impossible to ignore. Desperate, Calla removes her IUD and finds a man, known only as R, to unwittingly father her child. When R learns what she has done he turns his back on her, disgusted by her aberrant behavior.            

Calla’s illicit pregnancy is communicated to the government by her doctor, known as Doctor A. In this world, citizens are required to meet with their doctor regularly, and the doctors, who act as a hybrid between therapist and primary care provider, report their patients’ thoughts and behaviors to the government. Doctor A offers to terminate the pregnancy with no consequences, but Calla refuses, a decision from which there is no coming back. Calla is provided with a backpack of basic survival tools and a map, and told that she must be prepared to flee to the border at any moment—the government will give her a head start to reward her years of loyal service, but even so, they’re sure to find her before she can cross.                  

The question of what will happen if she is caught haunts Calla as her pregnancy progresses and she awaits the signal to flee. When it finally arrives, in the form of government emissaries on her doorstep, Calla’s final view of her old life as she speeds away is of her neighbors destroying her home. On the road, Calla is once again alone and vulnerable. Strangers, eager to take advantage of a lone woman, pose a more immediate threat than the government. Yet Calla’s outlook takes a turn for the better when she meets Marisol, a self-assured blue ticket woman who is also pregnant and headed for the border. The two protect each other, and as time goes on they are joined by other blue ticket women on the run, and one white ticket woman, who fears returning to her husband after an illegal abortion. Determined to escape the lives chosen for them, their freedom rests not only on their individual tenacity, but also on their ability to help each other. Yet the question of who to trust looms large, and casts a shadow as they flee towards a new life.

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Annotated by:
DiLeonardo, Olivia

Primary Category: Literature / Nonfiction — Secondary Category: Literature /

Genre: Graphic Memoir

Summary:

Dr. Weaver-Hightower wrote, illustrated, and published this powerful graphic work in the Journal of Medical Humanities.  The comic itself is presented in a traditional paneled format, with a few exceptions, and rendered in a moody ink wash in black, white, and various shades of darker and lighter greys. The story is told in the authentic, sometimes faltering voice, of the father of Thomas and Ella, a pair of twin infants who died at 22 and 24 weeks into pregnancy. Beginning with their harrowing trip to the hospital, the comic describes the father and mother’s loss of Ella, shortly after she was born prematurely; their subsequent wait for Thomas to reach the “viable” age of 24 weeks; his stillbirth; and the couple’s sudden discharge from the hospital, going home with “empty arms”.  The story then transitions into “The Long After”, including the funeral and the phases of the parents’ grieving process.  The father describes his grief, frustrations, the couple’s differing ways of coping, and his ambivalence and anger toward religion as a source of comfort or deeper understanding.  On the last page, he recounts their hopes and fears as they enter into their second pregnancy, concluding with panels of the father wrestling with how to understand and process this loss.  The final panel is an image of the father in profile, expressionless, saying nothing, a fitting conclusion to a story for which words seem to fail. 

With this piece, the author introduces us to the genre of the “research comic”. The comic is followed by a methodological appendix, which explains the author’s process for choosing, capturing, and relating this history in words and illustrations, as well as his rationale for selecting a comic or graphic memoir format for the piece.  The author also elaborates upon the concept of the comic as a form of “rigorous, informative research” (226).  The appendix is very interesting and will satisfy the curiosity of readers asking the questions, “How did he do this?”, or “Why is this story a comic?”, but the piece stands on its own without the appendix, as well.  

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The Winter Soldier

Mason, Daniel

Last Updated: Jun-20-2020
Annotated by:
Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When The Winter Soldier opens, Lucius Kszelewski, youngest son of a patrician Polish family living in Vienna, is on a train bound in the dead of winter for a field hospital in the Carpathian Mountains.  It is 1915, and Austria-Hungary is at war with Russia.  Lucius, a medical student, has completed only six semesters of medical school, but World War I has intervened, and due to a shortage of physicians in the army the government has decreed that students may graduate early, become doctors, and immediately be commissioned.   Lucius has done so and is on his way to Lemnowice, a Galician village, where he believes he will work with other physicians and finally learn to be “a real doctor.” 

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician.  The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma.  The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and  surreptitiously guides him through rounds, surgeries, and battlefield medicine.  Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.    

The transforming event is the arrival of the winter soldier, Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds.  Lucius is fascinated by diseases of the brain and mind, and this patient presents a tremendous challenge.  Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him.  Lucius and Margarete make slow progress with their patient, but his attempts to care for Horvath have unintended effects, and Lucius must then deal with the consequences of his actions.  

The war, and the hospital routine, go on.  One day, while Lucius and Margarete are relaxing in the woods, Lucius asks her to marry him.  Margarete runs off, and Lucius returns to the village, but Margarete is not there.  While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry.  He escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians.  The hospital has been evacuated—and Margarete has disappeared.   Lucius’ search for her will take him across the war-torn remnant of the Empire.

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The Eye in the Door

Barker, Pat

Last Updated: Jun-08-2020
Annotated by:
Field, Steven

Primary Category: Literature / Fiction

Genre: Novel

Summary:

The Eye in the Door is the second volume in Pat Barker’s Regeneration trilogy (the first and third volumes, Regeneration and The Ghost Road are also annotated in this database).  It continues the story of Dr. William Rivers and the soldiers he treats for shell shock, what we today would call Post-Traumatic Stress Disorder, in World War I era Britain.  The action has now shifted from Craiglockhart War Hospital, near Edinburgh, to London; and while Rivers remains a primary character, seeing patients now at a London clinic, this volume focuses on Rivers’ relationship with Billy Prior, an officer who was treated at Craiglockhart after a service-related nervous breakdown. 

Billy Prior, released from service on the Front and now serving on “home duty,” is working in the Intelligence Unit of the Ministry of Munitions, a domestic information-gathering and surveillance unit.  England, on wartime footing, is rife with paranoia and conspiracy theories, and the primary objects of state surveillance are two groups of people felt to be disloyal or untrustworthy:  conscientious objectors, or “conchies,” and homosexuals, who are seen as both abnormal and subversive.  The state is unremitting in its hounding and pursuit of these two groups, and is in fact “the eye in the door,” always watching and ready to pounce. 

Although Billy is an officer and has a position in the surveillance apparatus, he is living a double life, and is doubly at risk in this environment.  He is bisexual; the book opens with him failing to complete the seduction of a young woman and promptly thereupon having a liaison with a fellow officer whose wife and children are out of town.  This officer, who also works in the Ministry, has been vaguely threatened about his association with the presumed network of homosexual subversives.   In addition, while Billy is not a pacifist, he has friends from his childhood in working-class northern England who are conscientious objectors.  These friends may or may not have participated in terrorist activities, are either currently in jail or wanted by the police, and are no surer than Billy is as to exactly whose side he is on.  

Prior plays a dangerous double game, attempting to use his position in the government to help his old friends, and continuing treatment with Dr. Rivers, as his past psychological traumas continue to intrude upon, and complicate, his personal and professional lives, building to a powerful conclusion.

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