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.

   

"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.








 ABSTRACT

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.

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

Failure to Use the Anatomic Names for Female Genitals: Ethical Illegitimacy?

I was a bit surprised and perplexed when I found and read an Essay in the current May-June 2012 issue of the Hastings Center Report, one of the major ethics journals.  Sarah Rodriguez and Toby Schonfeld wrote the Essay titled "The Organ That Must-Not-Be-Named: Female Genitals and Generalized References". It is all about the observation that in various public presentations, the vagina is referred to as "it"  or  "the v" or the female genitalia, presumably the vagina, as "down there" and failure to specifically name the vulva,clitoris, mons or the vagina itself.

My concern with the Essay is whether this is really a vital ethical issue and whether TV's hiding the anatomic names from their advertisements of women's products is worth an ethical dialogue as hoped for by the authors in their final paragraph excerpted here: "Our purpose is to encourage not a monologue about the vagina, but rather a dialogue. Part of this discourse involves recognition on the part of women, men, their doctors, and advertising companies that female genitalia, like male genitalia, are multiply constituted, diverse, and, of necessity, named. We must start using words like vagina in order for the words to become normalized and for the speakers of the words to be empowered and respected—something Betty Ford did for “breast” in the 1970s."


I think there are so many more significant ethical issues around us in this world and the way humans are treated that printed space and reading time should be better applied to them. Go to the link above and read the free full Essay and then return and share your opinion regarding my concern.  Oops! Well, I guess we will have started the authors' dialogue.  ..Maurice.


Graphic: Image from Wikipedia modified with Picasa 3.

Doctor Spying on a Patient's Blog

How would you feel, as a patient, if without your knowledge, your doctor found your blog and was monitoring it for additional information about you?  If you would be upset about that, why? If the doctor told you in advance that he or she was going to look but asked your permission, how would you respond? Do you think that your doctor has every right to look at your open blog as any other visitor? Do you think that your privacy is being intruded upon by the doctor looking at or following your postings on your blog? Would it make any difference if you had a mental illness and your doctor was your psychiatrist? 

In the June 2012 issue of the American Medical Association's Virtual Mentor, the topic of psychiatrists monitoring their patients' blogs is brought up with a scenario and followed by a commentary by psychiatrist David H. Brendel, MD, PhD under the title "Monitoring Blogs: A New Dilemma for Psychiatrists". The first paragraph of the commentary follows.  Go to the link above and read the entire article and then return and answer my questions. Your responses will be worth while to this topic since Dr. Brendel can only express his concerns speaking as a psychiatrist but you can provide feedback to us from any patient's point of view. ..Maurice.

Internet technologies in the twenty-first century have provided countless opportunities and potential pitfalls for professional practice in areas as diverse as medicine, law, politics, business, and academia. These technologies have especially serious implications for psychiatry, where emotional complexities, boundary issues, and privacy concerns are of particular concern in the relationship between clinician and patient. In the course of routine clinical practice, psychiatrists nowadays must grapple with questions about whether to exchange e-mails with patients, to participate in social networking sites such as Facebook, and to perform Internet searches in order to learn information about patients. Each of these uses of Internet technologies in psychiatry has received growing attention in the professional literature [1-3]. The case scenario raises the question of whether clinical psychiatrists ought to read and monitor the websites or blogs of some of their patients.

Graphic: From Colocation America. com via Google Images.

Bad Smell vs Good Smell: Can the Smell of a Decision Determine Its Ethics

 

In life, most of us can smell and make some
interpretation of the source and significance
of the smell. The odor may often be the 
first sign of something bad such as an un-
expected fire or something good such as 
a favorite pie baking in the oven.


Can we carry the analogy of smell to the interpretation of our initial casual observations or by hearing the explanations by others for the basis of their decisions or actions and then go on to develop a firm conclusion as to whether what was decided or what was done was ethical? Can one "smell" the good and the bad of a decision? And with that smell can we accept that smell as a basis for a conclusion?  Can we accept the smell as the basis for whether or not to further investigate the decisions or actions? A "bad smell" requires a thorough investigation of the facts, whereas a "good smell" is evidence enough of a "good". I would argue that it takes more than the presenting odor to establish any final conclusion. Whether a smell is good or bad, I think is in the nose and mind of the beholder and it takes an analysis of as much of the facts as available to reach a reasonable conclusion about the ethics. I bring this topic up because I think it is very easy and I think it often occurs that we "rush to judgment" about someone's behavior or someones decisions or actions.  Criticism or ethical conclusions without all the facts is unwarranted.  Or, perhaps..our lives are too busy with not enough time or interst to develop the facts and it is just easier to go by our noses. What do you think? ..Maurice.

Graphics:  I photographed the images of the artwork of Francis Xaver Messerschmitt found in the 2009 Auction Catalog of Koller Auktionen, Zurich Switzerland.

Telling Bad News: Should the Doctor "Say It Flat Out"?

In my previous blog threads, the issue of a physician telling the patient "bad news" has been rather fully discussed (see links below to those threads).  It always was and always will be a challenge for any physician to communicate this diagnosis since  often the doctor doesn't know how much and how quickly the patient can understand and accept the information.  It also means that the doctor has to find the right words to be informative, supportive and yet empathetic to what the patient may be about to experience.  In the attached video clip from the John Wayne movie "The Shootist", the doctor played by James Stewart finds this challenge as he must tell the "bad news" word to John Wayne who comes for a consultation.  The confrontation of the news by both parties is beautifully played out in this segment of this movie, which, by the way, has been an educational worthy segment for medical students to review. It shows how the patient helped the doctor with the doctor's first challenge with  the words "say it flat out". What the doctor should say after the diagnosis is revealed is the second challenge in doctor-patient communication. If you were the patient, would you be a John Wayne and have your doctor "say it flat out"?  ..Maurice.

Previous "Telling Bad News" blog thread links:

http://bioethicsdiscussion.blogspot.com/2004/07/telling-bad-news.html

http://bioethicsdiscussion.blogspot.com/2005/08/telling-patients-they-are-terminal.html

http://bioethicsdiscussion.blogspot.com/2005/09/doctors-telling-bad-news-but-there-is.html

http://bioethicsdiscussion.blogspot.com/2005/09/how-to-tell-bad-news-telling-it-first.html

http://bioethicsdiscussion.blogspot.com/2006/08/not-telling-bad-news-ethical-dilemma.html

http://bioethicsdiscussion.blogspot.com/2007/03/telling-bad-news-and-not-walking-walk.html

http://bioethicsdiscussion.blogspot.com/2011/08/how-would-you-like-to-be-told-that-you.html

Video Clip: Downloaded from Turner Classic Movies website.

(A Truism)"If You Can't Leave Your Mark, Give Up": Is Procreation That Mark?

I came upon that classic truism "If you can't leave your mark, give up" and then I wondered about procreation as a way to follow the truism. Is there a human necessity for us to find ways to bring a child into the world in order to leave our mark in the world for the future? Of course, for those who can "automatically" procreate, this may not always be the basis for the creation of an offspring.  But for those who can't have children for one medical or biologic reason or another is this need to leave a mark so pervasive as to encourage the single or couple to attempt procreation through one method or another with the help of fertility clinics and the current science of creating an embryo along with implantation and delivery rather than adopting a child? Is instilling our genes into the genetic pools of the future essential to ensure that our life has left that mark? Is this the basic motivation of those who enter a fertility clinic for help? I would like to read the answers from all my visitors with regard to these questions but particularly from those who have utilized fertility clinics .  ..Maurice.

Graphic: Photograph I took of a wooden bench at Yosemite Falls, Yosemite National Park, CA, June 2012.

Coerced Medical Care: Is That Ethical?

Coerced medical care means that the patient will or is having or has received medical care not by their own autonomous decision but because the legal system has decided, after consultation with the patient's doctors that such care must occur.  Dr. Julie Cantor discusses the matter in a New England Journal of Medicine free full text article in the June14 2012  issue.

The first paragraph sets an example:

Samantha Burton was 25 weeks pregnant when her membranes ruptured. Burton's obstetrician admitted her to Tallahassee Memorial Hospital (TMH) and prescribed continuous inpatient bed rest. But with two young children and a job to consider, Burton found the prospect of a 3-month hospital stay overwhelming. She decided to go home. When she tried to leave, authorities barred her exit.

Go and read the Journal article and then return with you own views regarding such legislative, medical or legal actions taken upon patients.

Under what circumstance do you find that a law or court decision should override any voluntary medical decision by the patient? Is it ethical to deny a competent patient's informed and autonomous decision?  Is there a difference if the issue is regarding a communicable disease versus a pregnancy? ..Maurice.