Saturday, July 21, 2012

Is Current "Teaching" Medical Students Really "Preaching" to Medical Students?

You know, I was thinking, medical school is all about preaching to the students their Commandments toward their future practice of the profession of medicine.  We are saying to them:
1. "Here are Your Tools for practice We have Chosen to be Given to You, Here is Your Medical Education We have Devised, Here are Your Standards of Practice
2.Here are Your Codes of Ethical Practice
3.You will be Monitored by Us to Graduation and by Others beyond for adherence to Continuing your Medical Education 
4. Your Adherence to Standards of Practice and Codes of Ethics
5.You may Select a Specialty of your Choosing and Comfort but Monitoring for Your Adherence will Continue." 

And if that isn't Preaching the gospel of Medicine, I don't know what Is? 

Should we, in medical school education, really be teaching students only about the options available for taking a history, for performing a physical exam, for making a diagnosis, for providing treatment and for the overall practice of medicine including the pros and cons of various behaviors within the responsibilities of a medical doctor rather than be setting a series of medical rules which have been carried down from one medical generation to another without empiric, statistical documentation of the value or harm of each dictum?

What do you think?  ..Maurice.

Graphic: Preaching from Fellowship Room via Google Images.


Friday, July 13, 2012

"The Truth, Whole Truth and Nothing But.." Followed by Words of Comfort

Now here is an Essay from the Hastings Center Report July-August 2012 issue which you can read free and in full by clicking on this LINK which I think brings out a modern and perhaps a common behavior by physicians which clearly is of ethical importance and should be considered by all patients.. The Essay, titled "Comfort Care as Denial of Personhood" by William J. Peace starts with the following abstract.  

Comfort care is an ethical good for the patient but should not be used to meet the needs or frustrations of the healthcare providers. Read the Abstract below but then go to the Essay LINK and read the entire Essay. Then return here and present your comments. Do you think that a physician's suggestion for "comfort care" could be premature and actually be an ethical wrong for the patient? ..Maurice.

It is 2 a.m. I am very sick. I am not sure how long I have been hospitalized. The last two or three days have been a blur, a parade of procedures and people. I had a bloody debridement for a severe, large, and grossly infected stage four wound-the first wound I have had since I was paralyzed in 1978. I know the next six months or longer are going to be exceedingly difficult. I will be bedbound for months, dependent upon others for the first time in my adult life. As these thoughts are coursing through my mind, a physician I have never met and the registered nurse on duty appear at my door. As they put on their gowns I am weary but hopeful. Surely there is something that can be done to stop the vomiting. The physician examines me with the nurse's help. Like many other hospitalists that have examined me, he is coldly efficient. At some point, he asks the nurse to get a new medication.
What transpired after the nurse exited the room has haunted me. Paralyzed me with fear. The hospitalist asked me if I understood the gravity of my condition. He grimly told me I would be bedbound for at least six months and most likely a year or more. That there was a good chance the wound would never heal. If this happened, I would never sit in my wheelchair. I would never be able to work again. Not close to done, he told me I was looking at a life of complete and utter dependence. He went on to tell me I was on powerful antibiotics that could cause significant organ damage. He informed me I had the right to forego any medication, including the lifesaving antibiotics. If I chose not to continue with the current therapy, I could be made very comfortable. I would feel no pain or discomfort at all. Although not explicitly stated, the message was loud and clear. I can help you die peacefully.

Saturday, July 7, 2012

Which Direction is Ethical? Should We Simply "Count the Cars"?

My question for this thread is who should set ethics? Who should establish "what is ethical and what is not"? Should it always be society as a whole to establish which direction is the right ethical direction with the decision based on observation of which direction the majority of society is moving?  Or is "what is ethical and what is not" really not a matter of statistics but should be decided upon independent criteria and beyond simply observing the direction set by the general public?

If so then should the decision  be based on what philosophers or other "thinkers" have set in the past and then carried on to the present and the future? In other words do ethical actions and behavior really change over the years? Or if they can and do change should what is ethical be based on how current philosophers look at current issues? What should be the role of religions to establish what is moral and what isn't? Are the religions and their members really the ones to define what is or is not ethical? Finally, should we disregard society, philosophers and religions and say that what is "good" and what is "bad" be defined only by those who are directly involved as actors or recipients in any activity or behavior?  Should it be only the participants who set the ethical standards. 

Who do you want to tell you what is ethical and what isn't? ..Maurice.

Graphic: Photograph taken by me today of the 405 Freeway in Southern California