Bioethics Discussion Blog: "See one, Do one, Teach one"

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

FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD

Saturday, December 14, 2013

"See one, Do one, Teach one"









 You must read the satire on the "Glorious Tradition" of the description of medical education as "See one, Do one, Teach one" in the October 1 2012 issueof  the "Daily MedicalExaminer" where a doctor K.R. Thuxston. III, MD writes an essay about the topic, presumably "tongue in cheek" but then who knows.   This concept of a medical student or intern learning a procedure  but in reality actually learning it upon a patient and often the patient unaware of the learning going on was a practice considered acceptable back in the old days of medical professional paternalism.  Ah! But then came the last generation of medical practice and education with an ethical switch from medical professional paternalism to patient autonomy.  "See one and Do one" has become a "no-no" ..well, at least not on a living patient or at least not to "do one" with minimal, if any, supervision unless it is only drawing blood from a vein.  Simulators are all the rage now in medical education.  Simulators characterized by "standardized patient" (actors playing patients)  are used for honing up on interview techniques and general physical examination techniques but particularly female breast and genital exam of both genders.  For surgical practice, the simulators can be divided into organic, a very old technique in education in which animals and fresh human cadavers are utilized and inorganic, the current and future educational tools which comprise  virtual reality simulators and synthetic bench models and who knows what other "gadgets" in the future.  These tools bearing major medical educational investment are said to be of significant educational value but there are still studies going on regarding the validity of that conclusion.   For example even the use of standardized patients to instill the skill for students to later convey satisfactory "end-of-life" communication to real patients is still under investigation (JAMA. 2013;310(21):2257-2258}.

On the other hand, what is wrong with "See one, Do one..."?  Shouldn't patients take an altruistic view of donating their living body to medical education?  And as Dr. Thuxston concluded " Post-op, patients should look down at the ragged, poorly sutured scar on their abdomen and forget about the fact that they can’t wear a swimsuit at the beach anymore.  Instead, they should beam with pride, because the misshapen scar will remind them that their body was once used to teach a budding doctor how to operate."  And you, how about you? A bit of altruism? ..Maurice.

Graphic: Ancient Greek Medicine. Wikipedia via Google Images

4 Comments:

At Saturday, December 14, 2013 11:26:00 PM, Blogger Maurice Bernstein, M.D. said...

For more on the same topic, on a thread I wrote in 2007, go to "'See One, Do One, Teach One' A Medical Education Mantra and Issues of Patient Safety in Teaching Hospitals" ..Maurice.

 
At Tuesday, December 17, 2013 3:07:00 PM, Anonymous Anonymous said...

You are correct, the commentary on "the glorious tradition" was definitely tongue-in-cheek... And alas, there is no real Dr. Thuxston, only a cowardly practitioner hiding behind a pseudonym. I enjoyed reading your article and looking around your blog. Pleased that my satire provided further fuel for discussion. Thanks for linking and for reading!
-daily medical examiner

 
At Thursday, December 19, 2013 12:35:00 PM, Anonymous Anonymous said...

Back in 1981, I sawed off a finger. I was talking to a friend while starting up a saw and while I thought I was "clear," my right fifth finger was in the blade when I started the saw. It literally wrenched and tore the finger off through the knuckle.

My wife found the finger, the ambulance took me to the hospital, and glory-be, I was the first patient in the brand new Long Beach Memorial Microsurgical Lab.

I no longer had a knuckle and my finger was pinned on in a straight position with a slight curve towards the fourth finger, the surgeon reasoning that it wouldn't get caught on things as much as being perfectly straight.

It served me well, I could still type, but I lost a lot of grip strength in my hand.

I became a nurse. Doing Home Health at the time, I helped deliver one of my patients to a local Emergency Room when he started going downhill. I shook hands with the ER physician when I said goodbye...he was a body builder and he subconciously squeezed my hand pretty hard.

I drove away with the finger in pain. About an hour later it was turning blue.

I was readmitted to Long Beach Memorial with another MD/hand surgeon as consult.

He picked up my hand, looked at the way the finger was attached and said, suspiciously, "Who did this to you?"

I called him out on that statement and told him that I was damned lucky to have what I have, in my opinion, as it's viability was always in question for at least a week after the reattachment.

It's interesting that when the finger shut down ten years after the fact, microsurgery had advanced so much that my emergency reanastomosis was now a "hatchet job" and considered archaic.

He told me that I could now have a knuckle and have some of my hand restored to it's previous function.

I'm too old to care now.

JM in Las Vegas.

 
At Thursday, December 19, 2013 1:40:00 PM, Blogger Maurice Bernstein, M.D. said...

JM, excellent example of how even medical institutions mature in their skills with time just as the beginning surgical residents. ..Maurice.

 

Post a Comment

<< Home