Bioethics Discussion Blog: January 2010

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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Wednesday, January 27, 2010

The American vs Haitian Homeless: Irony and Injustice?

To start, I want to be clear that I am not against the United States government's humanitarian aid to Haiti and the people of Haiti either now or in the future including reconstruction. However, I am struck by the irony in political behavior where there seems no political will in America to feed, house, educate, get jobs and provide adequate medical care for the millions of homeless, unbefriended and hungry Americans here at home. Yes, there is political concern for support to the "middle class" and Wall street but where is any politician coming out and saying "I intend to allow my government to spend all the money necessary to support the homeless in the United States"? Those on our American streets without home or food are just as helpless and needing of governmental assistance and help as those as those currently living on the streets now in Haiti. If this is political blindness toward one group but not to another, it seems to me that this represents a humanitarian injustice beyond being simply ironic. What do you think? ..Maurice.

Tuesday, January 26, 2010

Patient Modesty: Volume 31



Patient modesty may cause concern from something as simple as the above graphic or it may be associated with behaviors of medical staff while examining or doing procedures which raise questions regarding unprofessional behavior. We continue here on Volume 31 with followup from the previous volumes regarding approaches to respond to these concerns. ..Maurice.

NOTICE: AS OF TODAY FEBRUARY 19, 2010 "PATIENT MODESTY: VOLUME 31 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 32.

Monday, January 18, 2010

"Why is my doctor giving me thyroid medication for thyroid nodules?": Who Should Answer?

May I introduce my visitors to Medpedia, a great resource site for medical information and discussion for medical professionals, patients and organizations? There is a section on Questions, the answers provided by professionals. As an example and to start a new topic on my blog, here is the question asked by a visitor to Medpedia and my answer. The question “Why is my doctor giving me thyroid medication for thyroid nodules?” interested me in wondering whether the patient first asked the question to her own physician and if not, why not. Or if she did, was she satisfied with the response or simply wanted to check up on the doctor’s response? Read my response and write here what your own experience has been about being able to ask questions and get understandable answers from your physicians. No names please. ..Maurice.

"Why is my doctor giving me thyroid medication for thyroid nodules?" That is an important question but one that shouldn't and really can't be fully answered on Medpedia. Physician education of the patient with regard to the nature and treatment of their disorder is as important in the practice of medicine as making the diagnosis and beginning treatment. Therefore, the question should really have been asked to and answered by the patient's own physician. The patient's understanding about their disease and their treatment is one major important factor to assure patient ongoing cooperation and compliance. There is no substitute. If the doctor can't explain, as a patient I would be concerned. Paternalism ("I know what is best for you so just do as I say") is no longer the mantra of modern physicians.

Sunday, January 10, 2010

Intuition and the Practice of Medicine

"The most decisive actions of our life... are most often unconsidered actions." ~André Gide, The Counterfeiters, 1926


But is what Gide writes intuition? If “unconsidered actions” is really the consequences of intuition, is that what physicians use in making diagnoses and establishing treatment? A dictionary definition of intuition would be the act or faculty of knowing or sensing without the use of rational processes; immediate cognition. Knowledge gained by the use of this faculty; a perceptive insight or a sense of something not evident or deducible; an impression. Other words can also express intuition such as feeling, hunch, idea, impression or suspicion. But, do you think that these words describe what goes on in the mind of a physician when attending to a patient? My answer would be “well..yes, well..no”. First, there is debate as to how to define the word intuition when it is applied to the medical profession. Does it represent a “made-up” theory or assumption without any connection to previously established facts? Or is it a professional way to look at and interpret any facts that are available? Obviously, I can’t tell you what is going throughout the mind of any doctor except myself. To me, however, I find that I use intuition as a method in which I can personally make sense of the facts, both historical including my experience and contemporary. In medicine, simply laying out and evaluating the facts developed in taking a history, performing a physical examination and performing tests or procedures may be clearly insufficient toward coming to a conclusion. The diagnosis or the decision regarding further workup or treatment may still be ambiguous. It takes something more to feel confident to initiate action. That something more, I think, is intuition.


Intuition in medicine has nothing to do with ignoring or setting aside all the facts and proceeding de novo with some innate unexplained but significant mental mechanism which is “all knowing” or spiritual which has powers beyond any rational understanding of mental or physical mechanisms. I do think that intuition is related to the physician’s personal and professional experiences and recollection of the outcomes of those experiences. This recollection is then applied perhaps rightly or wrongly to the contemporary facts and an attempt is made to mold these facts with intuition into a conclusion for action.


Often, physicians must make critical decisions in short time spans during which time other needs for other decisions are appearing. There may not be enough time and the facts may be inadequate to come to a decision based on these facts. Particularly, in such a situation, doctors turn to intuition. This means that the doctor doesn’t simply look at A and B and C and automatically finds a direction toward action D because of established standards of professional practice or because A, B and C have been recognized and D has been rigorously tested in a controlled scientific study and found to be an appropriate action. This is where intuition plays a role. I say to myself "Will what I have learned in the past about this disease or symptom complex, will what I know about the patient, will what has been the standards of practice regarding this condition, and what has been tested and proven valid by scientific studies really apply to this patient and this patient’s condition?" I think it is intuition that then plays a role in getting a decision defined. It may become, as an answer to these questions, “yes, yes, yes, yes” or “yes, yes, yes,yes… but…” and it is the “but” which represents the physician’s use of intuition. My conclusion is that Gides “unconsidered actions” would not represent intuition particularly the way I have used intuition and the way I suspect other doctors have used it in medicine.


As a patient, how to you feel about the physician’s use of intuition, as you define it, and whether you think it is something that doctors should use? Do you have any examples of how your doctor’s intuition played a role in your illness? ..Maurice.

Saturday, January 09, 2010

Patient Modesty: Volume 30



The discussion of patient physical modesty concerns continues, particularly related to the genital areas, and its relationship to medical examination and procedures performed or observed by individual healthcare providers of the opposite gender. In Volume 29, an attempt was made to introduce the issue of whether some significant behaviors of mothers toward their sons might contribute to the cross gender modesty concerns raised by male visitors here. Whether or not that possible relationship is continued to be discussed here, the need is to continue to comment about and work out approaches to mitigate the concerns but to the patient's benefit. One of the approaches is to "spread the 'word' (concerns)" directly to the medical system. In this regard, I want to remind my visitors of what I wrote on Volume 29:

CONTRIBUTORS TO THESE PATIENT MODESTY THREADS HAVE AN OPPORTUNITY TO EXPRESS THEIR MODESTY CONCERNS TO A BROADER AND MORE SIGNIFICANT AUDIENCE THAN SIMPLY AND ONLY WRITING COMMENTS HERE. THE ONLINE PUBLICATION HOSPITAL.COM HAS OFFERED TO CONTINUE THIS DISCUSSION ON THEIR PUBLICATION. WITH A GREATER AND MULTI-DISCIPLINE MEDICAL SYSTEM AUDIENCE THEIR PARTICIPATION WILL BE A VALUABLE CONTRIBUTION TO THE BROADCASTING OF THE CONCERNS BEING EXPRESSED HERE.

I have not received word that anyone here has taken advantage of this offer by hospital.com. I strongly suggest that my visitors do participate.
..Maurice.

Graphic: Photograph of painting by Albert Edelfelt, 1877 Ateneum Art Museum, Helsinki Finland and published on Wikipedia in the public domain.
Queen Blanche of Norway and Sweden with Prince (later King) Hacon, a fantasy painting.

NOTICE: AS OF TODAY JANUARY 26, 2010 "PATIENT MODESTY: VOLUME 30 WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 31