Bioethics Discussion Blog: December 2012

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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Friday, December 21, 2012

Patient Modesty: Volume 52


And the discussion regarding the attention to patient physical modesty continues and seemingly still unresolved is the matter regarding the patient of which gender gets the best and wanted attention to their specific requests for their physical modesty... and which patient gender is usually ignored or unsatisfied in this matter. And what can be done about the suggested inequality? Continue onward..  ..Maurice.

Graphic: From Google Images and modified by me with Picasa3.


NOTICE: AS OF TODAY FEBRUARY 25 2013 "PATIENT MODESTY: VOLUME 52" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 53

Tuesday, December 11, 2012

Perspective in Medicine and Ethics

Perspective is how one looks at objects or concepts.

 In medicine, a physician's perspective of a cluster of symptoms or physical findings leading to a final diagnosis of an illness for treatment can vary by many factors, three of which might be the physician's specialty, physician's gender and physician's culture. Perspective can also be affected by the amount of information in terms of history or physical findings: inadequate information can limit the number of possible diagnoses, whereas excessive details, many of which turn out not to be related to the illness under consideration may actually divert attention from considering a more common and less complex disorder. The skill in medicine is for the physician to develop a way of broadening the making of a diagnosis by looking at the symptoms and findings from different viewpoints: that they represent all part of a single disease or that actually multiple diseases are present simultaneously. Even the symptoms presented by the patient must be individually considered as to what the patient is meaning or trying to express by naming that symptom. For example, "constipated" may be a symptom used by a patient but what the patient is trying to express may be different from patient to patient and may in reality, on further questioning, the patient's use of the word may not represent some abnormality in bowel function. For a physician to accept the patient's word "constipated", assuming the word represents the medical meaning without clarifying how the patient uses the word can lead the doctor's perspective of the illness off into the wrong direction.  The similar erroneous viewpoint may occur by the doctor rushing through a physical examination in a routine fashion without simultaneously trying to correlate each part of the examination with the suspected diagnoses and not repeating parts of the exam that appeared abnormal thus missing the chance to verify the abnormal finding.

In ethical analysis and decision-making, perspective can be very important since decisions can significantly affect one or many individuals. Again, the one making the decision, past experience, gender and culture or general moral beliefs or religion can play a role in how that person decides. What perspective to take on an ethical issue, when applied to a specific case or developing a generalized ethical view, should primarily be based on obtaining pertinent facts. What seems like a situation which calls for a specific response on fragmentary, incomplete information will often take on a whole new perspective as the facts become available.  Something which might be considered morally bad may become morally indeterminate or good when all the facts are considered.  For example, facts in recent years demonstrating increasing numbers of death row inmates who have been found innocent of their alleged crimes by DNA testing may change the view of some people who have been advocates of the death penalty.

There is nothing wrong in being able to actively attempt to look for a different view or perspective. Such an attempt may in fact promote and provide a more valid decision and conclusion.

To cover something I didn't detail above, I would like to read comments from my visitors regarding what they would consider examples of how the viewpoints and actions of physicians can be affected by their specialty, gender or culture and whether these perspectives need to or even can be, if necessary, changed in order to improve the diagnosis and care of patients.  Also, do you think that ethical decision making can be improved for all the stakeholders in a decision by attempting to override the effects of past experience, gender, culture and held moral or religious beliefs? ..Maurice.



GRAPHICS: Photographs taken by me December 2012 at Towsley Canyon, Santa Clarita, California.

Friday, December 07, 2012

Growing a Doctor: The Seed




If one has read the comments about doctors in my various blog threads regarding how doctors are seen in the eyes of their patients from wondrous, humane and curative to uncaring, selfish and even abusive, one wonders why the growth of a doctor through our medical schools and beyond lead to such a mixed final flower. Could it be that the seeds are different?  The selection of the seeds to be planted into the medical profession start with the admission process to medical schools.  Excellent grades given to the students in undergraduate education and passage of the medical admission exam questions provide medical school admission officers some understanding of the student's potential to learn facts in medical school but this information doesn't tell much about how the student will turn out as a doctor, beyond just the knowledge of the facts.  So how are the seeds separated into which will flower into that good doctor every patient desires?
For generations, student have appeared before one or two medical school faculty who talk and ask questions and listen to the responses to "screen" the student for acceptance or rejection. This classic method is helpful to screen but because of subjective variances in the faculty, some selections turn out to be problematic and it is suspected that some rejections may be inappropriate and a loss for the student and the medical school. A technique introduced by some medical schools in recent years involves screening by a multiple mini interviews (MMI) where the "interview" consists of the student entering and rotating multiple station rooms, perhaps 10 over an hour or so period, each monitored by a faculty member, and subjected to some brief challenging exercise from being asked to answer some thoughtful question to making an ethical decision or responding to an actor patient or writing a brief essay. It is felt that with a single faculty member evaluating a single challenge on all the students rotating through that station would yield a fairer evaluation predicting students with better medical education and behavior outcomes in later years. This has yet to be fully proven.

For this thread, I would like to challenge my visitors to become the faculty member in the classic method of screening where the student sits down in front of you and it is your duty to ask a series of questions and evaluate the student's answers  in terms of whether this student should be admitted to medical school because there is a good chance he or she will be a good student and there is a good chance that the student will become the good doctor that you and society are desiring. So what questions would you ask the student and what would you expect as an answer to find if this student seed might be the very seed to finally bloom to that flower we all want? ..Maurice.

Graphic: From Google Image which I modified using a cartoon doctor  from the website, "Small Steps for Big Change" and an article providing very helpful information for students who want to prepare for and get accepted to medical school.  My visitors here who are planning to go to medical school may find the article of value for them.