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.
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Patient Modesty: Volume 33
Here we go into Volume 33. From what is being written it seems that though the women have much greater access to the healthcare providers of the gender they desire than the men, there are still are many upsetting modesty issues that the women face. So, despite this inequality, both genders have unresolved patient modesty issues. There is the suggestion that the lives in the medical environment of both genders could be improved by both genders working on the problems..together! Perhaps we can read here more about this and how this joint advocacy can best be carried out. ..Maurice.
GRAPHIC: "Walking Together" from webshots.com
and modified by me with Picasa3.
NOTICE: AS OF TODAY MAY 11, 2010 "PATIENT MODESTY: VOLUME 33" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 34.
Which is Best for the Patient?: A Patient Patient vs An Impatient Patient
If the title of this thread started with "Which is best for the Doctor", my general opinion would be easily answered with "a patient with patience." Doctors know that diagnoses are not made easily and treatments do not always give instantaneous cures. So patient patience is the most comfortable patient behavior looked for by the doctor. However, answering the question from the viewpoint of what is best for the patient, the one who is ill and symptomatic, ah! there probably are different responses. And it is from that viewpoint that I would like my visitors to respond. First, though, let's look at a list of what writers and philosophers had to say about patience and impatience and which I culled from the Thinkexist.com
"All human wisdom is summed up in two words - wait and hope” ...Alexandre Dumas Père (French Writer, one of the most prolific and most popular authors of the 19th century, 1802-1870)
“Patience is the companion of wisdom.”...Saint Augustine (Ancient Roman Christian Theologian and Bishop of Hippo from 396 to 430. One of the Latin Fathers of the Church.354-430)
“The two most powerful warriors are patience and time.”...Leo Nikolaevich Tolstoy (Russian moral Thinker, Novelist and Philosopher, notable for his influence on Russian literature and politics.1828-1910)
“Patience and fortitude conquer all things”...Ralph Waldo Emerson (American Poet, Lecturer and Essayist, 1803-1882)
And now, impatience:
“In all evils which admit a remedy, impatience should be avoided, because it wastes that time and attention in complaints which, if properly applied, might remove the cause”...Samuel Johnson (English Poet, Critic and Writer. 1709-1784)
“Perhaps there is only one cardinal sin: impatience. Because of impatience we were driven out of Paradise, because of impatiencewe cannot return.”...(English born American Poet, Dramatist and Editor who achieved early fame in the 1930s as a hero of the left during the Great Depression. 1907-1973)
“Patience is the support of weakness; impatience the ruin of strength”...Charles Caleb Colton (English sportsman and writer, 1780-1832)
“All human errors are impatience, a premature breaking off of methodical procedure, an apparent fencing-in of what is apparently at issue.”...Franz Kafka (German Writer of visionary fiction, 1883-1924)
“Experience has taught me this, that we undo ourselves by impatience. Misfortunes have their life and their limits, their sickness and their health.”...Michel de Montaigne (French Philosopher and Writer. 1533-1592)
“Impatience is the mark of independence, not of bondage”...Marianne Moore (American Poet, 1887-1972)
So now considering the uncertainties and burdens of a patient who is ill and in this age of patient autonomy where the patient has become more responsible for their own decisions and treatment, which behavior, patience or impatience, would be the most productive for a better outcome? Which behavior would you classify yourself as demonstrating? ..Maurice.
Physician's Mantra?: "If You Can't Cure It, Your Job is Over"
The issue is simple: Should the doctor's job in interacting with a patient be to make a diagnosis, establish treatment and then cure the patient? Do all patients come to their physicians with the view that it is the doctor's duty to continue all medical management to a cure and if that is not at all times the physician's goal then their preoccupation with the patient's illness is over? This view seems consistent with what is happening in practice. When an illness appears terminal, there often seems to be a conflict between the physician's prognosis and advice that further treatment or procedures will be futile and to institute simply comfort care vs the patient or family's demands for continuing a program directed at attaining a cure or if not in their mind statistically possible at least go for a "miracle cure". Does the physician's duty toward the patient then stop if he or she cannot expect or provide a cure? Of course, I think not. But is that really what most patients and families expect of a physician? I must say, however, that when cure is not possible there may be a tendency by some physicians to forget that their professional and humanistic duty is to actively participate in a palliative role toward the patient. Their excuse to themselves might be "if you can't cure it, your job is over." ..Maurice.
Uncertainty in the Diagnosis: How Do You Want That Told to You?
The patient comes to me
Sick with symptoms and uncertainty
Is it bad; is it fatal, can I be cured?
She sits in front of me with that look
That look asks me to tell her the answers
“Sure” I think to myself
No uncertainty on my part to myself
And I guess no uncertainty is on my face
I say to her “Tell me how you feel”
Then comes the stream of symptoms and complaints
I try to keep the stream from flooding my understanding
In my mind the diagnoses start their own stream
It could be this, it could be that, but it couldn’t be the other
Or could it?
I reassure myself. The physical exam will sort it all out
But does it? I thought it would but it doesn’t
Maybe this or that seems now unlikely but yet on the other hand…
The history and physical is over and the patient sits in front of me
She awaits my diagnosis
But, in fact, I, myself await the diagnosis
Is uncertainty now seen on my face?
I have no decision since, in fact, I am undecided.
How do I respond to her and her look for me to tell her the answers? I would like your help. Should the words “I don’t know yet” come from my mouth? Will that be therapeutic for her symptoms and her concerns? Should I say “Well, it could be this, it could be that, it could be…It could be”?
Should I say “I know it could be this, I know it could be that, I know it could be… it could be”? Should I just say “I am just uncertain as to what is wrong with you so let’s wait until the tests are back”? What is wrong for the doctor telling the patient “I just don’t know at present”? Or is it wrong for the doctor to be expressing uncertainty to a patient who has symptoms and herself uncertainty? Help me understand how you would expect the doctor to express the doctor’s uncertainty about your symptoms and concerns. ..Maurice.
Hospital Romances: What to Do About Them?
The ethical and professional goal in a doctor-patient relationship is directed toward attaining the benefit for the patient. The goal of a hospital attending to the care of patients should be the same. There are many factors that can interfere with meeting that goal. One interesting issue is one related to the interaction between two professionals who work in the hospital but who develop a romantic relationship with each other. If you watch the TV dramas about hospital life, it seems that such romantic relationships appear frequently and almost as frequently as those dramatic critical medical emergencies.
But as with other employment environments, such relationships between two individuals who are working together particularly under stressful conditions is not unpredictable. The question is whether a hospital should tolerate the development of such relationships which may lead to progression along with distractions to patient care or if the relationship ends with one of the parties hurting, similar distraction might be expected. In addition issues of sexual abuse can occur along with discrimination in the workplace, particularly if one of the couples is an administrative or professional superior to the other or to other professionals in the hospital.
How should hospitals ethically and legally handle the issue of romance, particularly between professionals within the hospital workplace? Is it practical and realistic for a hospital administration set a zero-tolerance policy to such romantic relationships? What should be the hospital’s response to such relationships?
This subject is discussed in an interesting clinical cases discussion in the January 2010 issue of the American Medical Association’s Virtual Mentor titled “Zero Tolerance for Hospital Romance”
. Go to the link, read the discussion and return here with your view of a fair and realistic response for a hospital to make. ..Maurice.