REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
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Order vs Chaos in Medical Practice
As patients look at their experiences within the medical
system and profession, do you think they find a system that is well thought out
and is practiced in an orderly fashion to facilitate the basic premise of
medicine to care appropriately for those who are ill? On the other hand, there is always the
potential for chaotic disorder when dealing with uncertainties of disease and
humans on both sides of the medical relationship. Is there evidence of chaos
characterized by unsystematic medical practice which can lead to serious
medical errors, higher cost of medical care and inattention to humanistic aspects
of patient care? If patients find
significant chaos imbedded within the medical system, what might the patients' opinions
be regarding the cause of chaos and what might be the remedy to establish
order? Do you think that something is
missing in student medical education or the medical system itself to properly
deal with the aspects of diagnosis, treatment and general patient care which, if attended to might diminish the effects
of such lack of order?
On the other hand, does the medical system seem quite
properly functioning with signs of disorder either absent or properly managed
to the benefit of the patient? What is a
patient's view? ..Maurice.
Graphic: Order and Chaos painted by me 2916 with ArtRage
What Makes a "Good Doctor": Patients' Viewpoint
As I teach first and second year medical students. Is there one quality in the performance of being a physician that I should stress to the students is the most important in being a good doctor? I mean, one quality which sets the definition of a good doctor. In answering my question, I look to the perspective of the patient interacting with their physician and what the patient is really looking for to give the doctor the title "good".. However, which would also be most interesting would be to read opinions of those visitors to my blog who are or were patients themselves who have interacted with doctors as to what single quality they are looking for which makes that doctor "good" and should be part of the education of my medical students to attain. What should I teach them?
Physician's Political View: Does It Matter? It Might.
you suspect that your physician's political views may affect your doctor's
medical advice and attention to you as his or her patient? If you suspect that they do, this is
supported by a study published this year in the Proceedings of the National
Academy of Sciences of the U.S.A. by Eitan D. Hersh and Matthew N. Goldenberg
and summarized by this Abstract:
Physicians frequently interact with patients about
politically salient health issues, such as drug use, firearm safety, and sexual
behavior. We investigate whether physicians’ own political views affect their
treatment decisions on these issues. We linked the records of over 20,000
primary care physicians in 29 US states to a voter registration database,
obtaining the physicians’ political party affiliations. We then surveyed a
sample of Democratic and Republican primary care physicians. Respondents evaluated
nine patient vignettes, three of which addressed especially politicized health
issues (marijuana, abortion, and firearm storage). Physicians rated the
seriousness of the issue presented in each vignette and their likelihood of
engaging in specific management options. On the politicized health issues—and
only on such issues—Democratic and Republican physicians differed substantially
in their expressed concern and their recommended treatment plan. We control for
physician demographics (like age, gender, and religiosity), patient population,
and geography. Physician partisan bias can lead to unwarranted variation in
patient care. Awareness of how a physician’s political attitudes might affect
patient care is important to physicians and patients alike.
Read the article and return and express your opinions about
your experiences, if any, regarding the politicalization of how your doctor advises
or treats you. That's assuming that you
even asked your doctor or the doctor actually told you about his or her
political view. Did that ever happen?
All Pain: Treat It or Accept It?
The issue is whether it is ethical and spiritually worthy to treat all pain. Yes, some pain is a signal of illness which if the illness is properly diagnosed it can be cured and the pain is relived. But, there is pain which ends up without an illness to cure to relieve the pain. And now, the medical profession is faced with an epidemic of pain being treated with narcotics, narcotics leading to habituation fostered by physician prescriptions. And this epidemic is causing concern and challenges to physicians
but also should be a concern for the public, the pharmaceutical companies and the government.
Maybe, physicians and patients should look at some pain as an intrinsic and spiritual part of life and that, well, those experiencing pain should understand that and live with it. An example of this view was written by the Lebonese poet Khalil Gibran in a poem titled
Your pain is the breaking of
the shell that encloses
Even as the stone of the fruit must
break, that its
heart may stand in the sun, so
must you know pain.
And could you keep your heart
in wonder at the
daily miracles of your life,
your pain would not seem
less wondrous than your joy;
And you would accept the
seasons of your heart,
even as you have always
accepted the seasons that
And you would watch with
serenity through the
winters of your grief.
Much of your pain is self-chosen.
It is the bitter potion by which the
you heals your sick self.
Therefore trust the physician,
and drink his remedy
in silence and tranquillity:
For his hand, though heavy and
hard, is guided by
the tender hand of the Unseen,
And the cup he brings, though
it burn your lips, has
been fashioned of the clay
which the Potter has
moistened with His own sacred
Do my visitors look upon pain or their own pains in the same way as Gibran. And if accepted as simply part of life, much pain can be accepted without involving the narcotic prescription written by that licenced physician "outside" of you? ..Maurice.
Patient Modesty: Volume 78
HERE WE ARE AGAIN! This graphic was published in Patient Modesty, Volume 4, June 26, 2008. And the following is from Avram on that date:
MER is absolutely correct. As I've been posting here for over a year, nothing is going to change until the issue of a double-standard in modesty considerations for males ends up in court as aclass action test of DISCRIMINATION Law-- unequal treatment by gender. We have had BFOQ provisions in law which manditate that health insitutions use them to protect the patient modesty(read privacy) of ALL patients, regardless of gender.The right to privacy and modesty were linked in BFOQ legislation to include what would be viewed as intimate pelvic care. Everything that is currently status quo is outside the law and it will change if it is challenged because it can not be upheld within the existing law. Female nurses, male doctors, HMOs all have a vested interest in maintain high levels of female staff. They will stonewall totheir advantage at every turnuntil a judge rules in class-action that males must be treated equally with females or BFOQ beremoved from law. If that were to happen, then all female patient modesty requests would also beignored and male staff could rushed into OB/GYN and L&D, etc. What's good for the goose is good for the gander.I'm not a lawyer but I know you can not discriminate againsteither sex in a straight forwardmanner. To respond "you are not a woman" is all an AmericanCivil Liberties attorney would need to make something out of this. Have any of those posting here, who are being denied equal rights to medical privacy/modesty, attempted to do this? MER, have you sent highlights of your extensive and well organized research to any legal body for an evaluation?
So my question is: ARE WE ANY FURTHER ALONG IN THE DISCUSSION AND SOLUTION??
Hate to be pessimistic..
Patient Modesty: Volume 77
Interestingly, the conversation is back to this blog thread #24 begun September 2009. and here is the link to zoom back in time and visitors to compare. I do think that this direct communication with the medical provider is the best way for the individual patient to make his or her standards known. It may be that there is no way to change the medical profession through political or legislative action. Isn't that what the consensus of my visitors are here? ..Maurice.
AS OF DECEMBER 10, 2016 THIS THREAD WILL BE CLOSED FOR ALL COMMENTS. DO NOT ATTEMPT TO WRITE ANY FURTHER COMMENTS HERE. PLEASE GO TO "PATIENT MODESTY: VOLUME 78" TO CONTINUE COMMENTS
Patient Modesty: Volume 76
The narrative currently going on in the previous Volume 75 reminded me of what was being discussed back in November 2011 in Volume 45. For my newer visitors, you might be interested to go back to that Volume or the ones previously to see that this issue of medical staff intentionally violating patient modesty was and still has been a "thorn" or more in the list of complaints about medical practice. ..Maurice.
Graphic: From Google Images
NOTICE: THIS "PATIENT MODESTY: VOLUME 76 IS NOW CLOSED FOR FURTHER
COMMENTS. GO TO "PATIENT MODESTY: VOLUME 77" FOR FURTHER COMMENTS
Patient Modesty: Volume 75
HOW ABOUT PATIENTS SETTING A LIMIT? Analogous to this posted sign by merchants, it is interesting to read (Volume 74) discussion about possible, potential patient reactions or responses to the behavior of the medical system itself with regard to issues of patient dignity and modesty.
Perhaps, either through regulatory agencies or simply by individual patient actions, the patients' requests will be met. If you were designing a simple sign to be displayed by every patient to "set the limits", how would you design the text or graphics? ..Maurice.
Graphic: From Google Images.
NOTICE: AS OF TODAY MAY 29, 2016 "PATIENT MODESTY: VOLUME 75" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 76
"Pimping": Not About Sex-- About Medical Education"
This cartoon below is certainly a good example of "pimping" which has been for years, really generations a technique of medical education. I recently wrote the following to a professional medical educator's listserv:
The December 8 2015 issue of JAMA (Volume 314 No. 22) presents a Viewpoint article which I believe challenges us medical school teachers to find evidence of educational value in a practice carried out by medical school teachers and attendings which is apparently not rarely applied to their students. The practice is "pimping" and is defined in the article by referring to an 1989 JAMA article by Brancati: "a series of difficult and often intentionally unanswerable questions posed to a medical student or house staff in quick succession. The objective of pimping is to teach, motivate, and involve the learner in clinical rounds while maintaining a dominant hierarchy and cultivating humility by ridding the learner of egotism."
So what we must decide is whether this "pimping" is an effective and benign form of Socratic teaching or in most cases really a form of medical student "mistreatment"
To learn more about "pimping" in medical education, read this outline of the practice in eTalk.
The cartoon also brings up another issue as to whether "pimping" medical students, interns and medical residents not only may intimidate and emotionally "harm" them but could this behavior eventually harm the patient. A second year medical student writing in the Pulse website describes not only her own "pimping" but also witnessing her teacher "pimping" a clinic patient.
However, a surgical resident who read the Pulse story wrote me the following:
I may be in the minority when I say, I'm "pro"-pimping/Socratic method. I didn't think it was a fair analogy for the student to compare herself to the patient--the patient is not a medical professional. Making decisions with incomplete information is part of all of our jobs. I say this from the perspective of someone that still has to take written and oral boards as part of my board certification process. Practicing for oral boards is serial escalation of difficult questions.
Pimping exposes the things that "I don't know that I don't know". It is normal to feel defensive when you don't know the answer to a question and pimping teaches you to repress the "fight or flight" response, to acknowledge gaps in understanding, to maintain humility and to remain poised in the face of uncertainty. I consider pimping the surgical love language. How else does the attending quickly assess where deficiencies lie? How do you otherwise also motivate the student that gets great scores on standardized exams to keep studying? You don't take the time to pimp people when you're not invested in their education.You just ignore them.
My favorite attendings can always find me in a crowd of residents and call me out--it's how I know they still care.
So, what do you think about this form of "pimping"? Have you experienced such questioning as part of your own occupation or experience? If you are or were a medical educator would you use this technique to educate your students or could this really be only a form of self-interest on the part of the physician educator and intimidation of the student of any sort should not be part of the education process. Let's hear from you on this behavior. ..Maurice.
Graphic: From Google Images. Referred source: https://euuuh.com/
Patient Modesty: Volume 74
Throughout the entire discussion about the issue of patient modesty there is one issue that still hasn't been resolved. That issue is: within the "doctor-patient relationship" is there really any balance existing or required between the "needs" of the patient and the "needs" of the physician? Yes, there is imbalance in favor of the physician with regard to medical education and medical/surgical skills and the need to apply this knowledge and skills effectively for the patient. However, since it is the patient who has the illness and who is about to be diagnosed and treated should the balance with regard to "needs" be loaded on the patient's side because it is the patient who is ill and because the patient should have the primary interest and concern which then includes all matters of modesty? The physician's "needs", such as facilitation of time spent with the patient, assistance by others (which might include gender other than that of the patient) during interaction with the patient or other physician professional but self-interest demands, should bear far less weight on balance than the patient's modesty needs. On the other hand, shouldn't the goal be an attempt to balance the "needs" to provide a safe and effective outcome of any doctor-patient relationship? And, yes, in that balance some matters of patient modesty might be affected. I speak as the blog moderator and not as a physician as I present this issue of balance for discussion. ..Maurice.
Graphic: Balance--from Google Images
NOTICE: As of March 14 2016, Volume 74 is now CLOSED to further Comments. Go to "Patient Modesty: Volume 75" to continue posting.
Right Way and Wrong Way: Making an Immediate Ethical/Legal Medical Decision
This thread is about what is the ethical and legal
"right way" and what is
the "wrong way" for doctors and nurses in an emergency room to
respond when they are in the act of attempting to save a patient's life and
then after resuscitation, started earlier by the paramedics, and was in
progress was told by the patient's surrogate to stop at once and let the
patient die, not allowing the opportunity to taper off the resuscitation and
observe possible recovery. Here is the
scenario as written as the Case Study in the September-October 2015 issue ofthe "Hastings Center Report" for which I have received permission to
Robert F. is an eighty-five-year-old who
suffered a heart attack at home in a rural location some thirty minutes from
any major hospital. By the time the paramedics arrived, he was unconscious and
nonresponsive. After spontaneous return of circulation, they began their
standard procedure of therapeutic hypothermia. Robert's core temperature was
lowered using ice packs, and cold intravenous fluids were initiated. Soon
afterward, Robert started to shiver when his body temperature reached 35.6°
Celsius. He was then given a bolus of vecuronium as a neuromuscular blockade,
sedated, and intubated. He was also given a low-dose vasopressin for
blood-pressure control. Shortly after Robert arrived in the emergency room, his
daughter, his medical decision-maker, produced an advance directive documenting
that her father has a do-not-resuscitate (DNR) order, and she demanded that the
breathing tube and any other life-sustaining treatments be withdrawn
The medical staff is very reluctant to comply
with this demand for immediate action. Until the neuromuscular blockade wears
off, removing the ventilator will prevent Robert from breathing. Furthermore,
it may take some time to reverse the therapeutic hypothermia procedure to the
point that the patient is at normal temperature. In addition, therapeutic
hypothermia itself often causes arrest, so the patient may need to be
Should the staff wait until the patient is
warm or honor the decision of his daughter, who holds his medical power of
stop all resuscitation at once will cause the patient to die while being
professionally treated and the patient's status for surviving without injury
would remain unestablished. This obviously was a moral "no no" by the
doctors and nurses since this act at this time might represent to them as
unprofessional "killing" of the patient. On the
other hand, to not follow the request of the patient through an advance
directive for medical care and the demand of the surrogate daughter, would mean
that the doctors and nurses were ignoring the legal and ethical autonomy of the patient.
tell me, which is the "right way" and which is the "wrong
way" for those medical professionals to act. ...Maurice.
Graphic: From Google Images
The "Dark Side" of Medical Education?
It is rare that a medical journal would publish an essay by a physician anonymously which describes the "dark side of medicine" and perhaps including the "dark side" of medical education. The article is in the August 18 2015 issue of the Annals of Internal Medicine
and in an editorial in the same issue, the following:
We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dark side of the profession, we emphasize to physicians young and old that this behavior is unacceptable—we should not only refrain from personally acting in such a manner but also call out our colleagues who do. We all need the strength to act like the anesthesiologist in this story and call our colleagues “assholes” when that label is appropriate. We owe it to ourselves, to our profession, and especially to our patients.
So this "dark side" can be said to also involves those of us in involved medical education such as myself.. Perhaps medical educators are inadequately inspecting and controlling the content of the "hidden curriculum" being presented to medical students and not facilitating advice and support for those students and doctors who witness "dark behavior" to "speak up" to the perpetrators but also to superiors in administration.
an immediate response to the Annals essay. ..Maurice.
Graphic: From Google Images and modified by me with ArtRage and Picasa3.
Patent Modesty: Volume 72: NOTICE
"PATIENT MODESTY VOLUME 72" HAS BEEN CLOSED TO NEW COMMENTS SINCE AUGUST 5 2015 AND IS NO LONGER ACCEPTING COMMENTS.
YOUR COMMENTS ARE STILL WELCOME. PLEASE GO TO "PATIENT MODESTY: VOLUME 73"
Patient Modesty: Volume 73
So the issue now with regard to patient modesty and patient dignity issues in the care of patients is whether there is "broken" trust in the doctor-patient relationship, particularly with regard to the patient not trusting their physician or nurses. Or, one might argue, was there any trust from the very beginning of the relationship? If so, was the absence of trust because the physician or nurse did not offer evidence which would support trust by the patient or that patients enter or put into the relationship with the mindset that "all professionals in medicine are considered untrustworthy"?
Whatever the origin, it is clear from the comments on the previous Volumes that trust is a missing element in medical care and is clearly a part of any discussion of patient modesty or dignity. ..Maurice.
Graphic: From Google Images.
AS OF DECEMBER 8 2015, NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 73 BUT COMMENTS WILL CONTINUE ON VOLUME 74.
"Commercial Surrogacy": Women'$ Bodie$ as Container$
The title of this blog thread " 'Commercial Surrogacy': Women's Bodies as Containers" with the plural expressed with dollar signs may be a bit over descriptive but yet it emphasizes a commerce present today which is utilizing local women or bringing foreigners into the United States and elsewhere to directly participate in the pregnancy and delivery another family's genetic child. The question is whether this is a fair utilization and commercialization of a woman and her body and whether, after delivery and she is no longer a container for the pregnancy, she should be allowed to maintain some relationship to the child and the child's family.
This topic is, I think, very nicely described, in a paper by a PhD student Hannah Giunta on the Michigan State University Bioethics website. The ethical and humanistic point which is stressed by Ms Giunta is "Commercial surrogacy arrangements where prospective parents possibly supply the raw ingredients, sign a contract, and return for pick-up with the intention never to see the surrogate again require women to do fundamentally relational work without relational support or respect. Effectively, couples are saying,'You’re good enough to carry our child but not welcome as part of our family.' It’s this attitude that is unacceptable."
What I would like to see discussed here on this blog thread is both the ethical good or bad of this form of commerce but also Ms Giunta's concern that if such use of women and their bodies is socially and legally acceptable whether something more should be offered to these women: acceptance into the newly born child's family as a family member. ..Maurice.
Graphic: From Google Images modified with ArtRage and Picasa3..
Patient Modesty: Volume 72
What has been written throughout all these now 72 Volumes of Patient Modesty has been descriptions after descriptions of the "bad", thoughtless behavior of the medical system with regard to the dignity of the patients under the system's care. I have repeatedly voiced on this thread the need for my visitors now, beyond simply writing here about the problem, to make an effort to change the way the medical system "thinks" and "works".
I have found today evidence that the system is looking for ways to make changes in teaching, practice and behavior. The Association of American Medical Colleges (AAMC) has now publicized its attempt to make such changes. It is guided by a statement by the AAMC Board of Directors who in 2014"affirmed the value of fostering a positive learning environment with a formal statement that reads in part: 'We believe that the learning environment
for medical education shapes the patient care
environment. The highest quality of safe and
effective care for patients and the highest
quality of effective and appropriate education
are rooted in human dignity.'"
So, to my visitor, there you are: this major medical system organization involved in medical school education and the teaching of medical practice to the residents and fellows in this profession is looking for change. It is now your opportunity to write to the AAMC and express your concerns of the current system and your advice for the future. This will be your opportunity to "plant a good" which has a chance to flower. ..Maurice.
Graphic: From Google Images and modified by me with Picasa3.
Patient Modesty: Volume 71
I would like to start out this Volume 71 with a basic question to help define what is understood as physical modesty and how it applies to this issue as experienced by patients within the medical system. Is modesty of an individual only related to how the individual feels about their own personal exposure to others or does it also includes how the individual reacts to the exposure or "immodesty" of others? For example, is a patient expressing modesty when they see and react to a woman breast feeding her baby in public? or finding someone on the beach with a "bikini"? Does every patient who finds challenges to their modesty within their experience with doctors and nurses also are emotionally upset upon viewing, experiencing what is felt to be immodest behavior by others? In other words, does patient physical modesty concerns actually involve an individual's general philosophy regarding attention to modesty of self but, in addition, also of others? This distinction, I think, is important. ..Maurice.
Graphic: "Bathing Suits" from Google Images
NOTICE: AS OF TODAY FEBRUARY 25, 2015 "PATIENT
MODESTY: VOLUME 71 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE
POSTING COMMENTS ON VOLUME 72.
WOMAN'S BREAST MILK: SHOULD IT BE UP FOR SALE?
In case you didn't know, a woman's breast milk is a
commercially but also a nutritionally valuable commodity at least as an example
supported by Medolac Labs and Mother's Milk Cooperative. This milk is said to be needed by hospitalized
pre-term infants whose mothers are not yet lactating. I read about it in an article in the Michigan State University Bioethics website on lactation and the laws and actions which have been taken
including commodification of the woman's milk.
A scholarly article on the subject of the sale of mother's
milk was written in the Winter 2009 issue of the Nevada Law Journal
The sale of organs for transplant is not approved in the
United States, only donation. The
question arises as to whether it is ethical to have lactating women provide
their breast milk for sale. Is breast milk analogous to a solid organ?
How about comparing
selling the mother's milk to the legal commodification of eggs and sperm or
A physician ethicist
has reassured me on this topic:
There are American markets for buying and selling human
body parts, including blood, plasma, platelets, breast milk, hair, sperm, and
unfertilized eggs. The National Organ Transplant Act bans compensation for
organs, including livers, kidneys, and bone marrow. Flynn v. Holder adds the acquisition of hematopoietic
stem cells from circulating blood to the list of acceptable activities.
An ethical analysis suggests that the key characteristics
of these acceptable market-based donations of human body products are:
– The donated stuff can with time be regenerated.
– The injury to the donor is minimal and commensurate
with the sale price.
– The risks to the donor of more serious morbidity and
mortality are minimal."
And then, of course, there is the long history of
"wet nursing" when other women took on the task of nursing a child if
the mother was unable to do so.
To my visitors: Do you find any arguments against the
selling of the milk obtained from a
lactating mother and, if you do, what are they? ..Maurice.
Graphic: Migrant Mother, Dorothea Lange, Library of
Congress / Public Domain / Wikimedia Commons
Patient Modesty: Volume 70
The consensus of what is written here about the medical system's behavior toward attention to patient modesty including the ability of patients to select the gender of those who attend to patients is that IT IS TIME TO CHANGE and respond to their serious concerns. Changing a system requires education of the system regarding the need. This education can occur at the level of the single provider who is attending to the patient and may lead to specific changes for that patient but it is doubtful if such limited education unless done by millions of patients will make any significant community, state or national changes within the medical system. What is necessary is the formation of an advocacy group to educate and apply pressure on institutions, medical boards and governmental agencies to make effective and positive changes and meet the concerns of patients about their physical modesty and to prevent unintentional or intentional abuse by members of the medical profession and their institutions. ,..Maurice.
Graphic: From Google Images and modified by me with Picasa 3.
NOTICE: AS OF TODAY JANUARY 23, 2015 "PATIENT MODESTY: VOLUME 70 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 71.
Is Pregnancy a Disease?
a topic hot off the September-October 2014 Hastings Center Report, a bioethics journal, that should raise
a few eyebrows of agreement or rebuttal.
The point of the article
is if pregnancy is NOT a disease then healthcare providers who refuse to
perform abortions need not claim "conscience" as the basis for their
refusal but claim that pregnancy and abortion are not part of what medicine has
always been defined. The premise: "the scope of the very concept of
medicine and disease circumscribes the scope of proper medical practice. Procedures and activities that fall outside the scope of
medicine and disease are not properly within the brief of healthcare
and other healthcare providers can refuse to provide abortions if it is against
their religious or moral views. However,
it also a social understanding that every employee 's responsibility toward his
or her occupation in terms including of "taking on a job" depends
specifically on the what society expects from those trained for that work. You don't expect a plumber to perform an
appendectomy or a physician to design or construct a highrise building as part
of the criteria of the profession of medicine. So the argument could be that the duty to
perform the work of healthcare is set by the standards set by the work itself
and to refuse an activity which has not been formally set is acceptable. Pregnancy
itself is not a abnormal condition or disorder of a healthy life and therefore
a disease and for a healthcare provider whose professional responsibility is to
attend to the issues of disease or the prevention of disease, to be compelled
to terminate a normal life function without a disease basis could be considered
professionally unacceptable. What do you think? What view do you hold?
Graphic: Pregnancy. From
Patients Killing Doctors
A discussion starting on a
bioethics listserv to which I subscribe. The opening of the thread and followed
by 2 responses. Would you want and are you in favor for your physician to have a gun available in his or her office accessible for self-protection? ..Maurice.
The current issue of the New Yorker (Aug.
25, 2014) has a man-bites-dog story "Under the Knife" (pp. 30-35)
about an epidemic of doctor-killings by Chinese patients Physicians, of course,
have been (mostly inadvertently) killing patients throughout the history of
medicine. With a few notable exceptions ( e.g., Gabrielle Zerbi 1455-1505/9 who
was killed by the sons of one in retaliation for the death of one his patients
a Turkish Pasha), patients have seldom retaliated in kind.
This happens in the United States as well.
There seem to be three major categories
The "political murder" of doctors who perform
The murder of psychiatrists.
The murder of doctors because of the patient's believe that the doctor caused a
Then I suppose one must also include what Grace Paley called "the little
disturbances of man" where patients kill doctors over broken hearts. e.g.
Dr. Herman Tarnower,
And maybe another category, related to chronic care of end-stage organ failure.
Nephrologist in MA shot over dialysis scheduling issue. Left paraplegic
Transplant surgeon in FL shot by patient.
Does anyone believe this will not be seen increasingly with "open carry"
laws, and people bringing semi-automatic weapons on errands?
Graphic: From Google Images
Patient Modesty: Volume 69
As we continue on communicating about all the issues of
patient modesty, I find that I may have been suggesting a wrong approach for my
visitors to help resolve these issues: "speaking up" to physicians and the medical system.
"Up" suggests that the patient is somehow less significant and is
inferior in the patient-doctor/medical system relationship. And I don't believe this is true. Even though the
patient may be the one who is ill, to meet the medical system's professional responsibilities,
the system cannot act alone and must give equal attention to the patient as to
their own personal and operational interests.
So, as we move forward on this blog thread, working out ways
to communicate the needs of those who write here, let's change the suggestion
to "speak to..." as part of a more level "speaking field"
rather than the wrong view of "speaking up".
But as we begin Volume 69, let's remember that we have had 9
years and 68 volumes to "moan and groan" about the painful issues
that are seen but now is the time to change the discourse to one of presenting
a positive approach to attaining the needed relief by showing how the
participants here plan and have already started to change the system to meet
Graphic: From Google Images and modified by me with ArtRage.
NOTICE: AS OF TODAY NOVEMBER 14, 2014
"PATIENT MODESTY: VOLUME 69 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN
CONTINUE POSTING COMMENTS ON VOLUME 70.