Bioethics Discussion Blog: December 2016

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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Monday, December 26, 2016

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

Tuesday, December 20, 2016

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?
..Maurice.. 

Tuesday, December 13, 2016

Physician's Political View: Does It Matter? It Might.



Did 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.

For those visitors here who have no access to the Proceedings, you can read the details of the findings in an  October 3 2016 Atlantic article.

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?  




Sunday, December 11, 2016

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


                                         "ON PAIN"

Your pain is the breaking of the shell that encloses
your understanding.
 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
pass over your fields.
 
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 physician within
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 tears.



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.

Saturday, December 10, 2016

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 a
class 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 to
their advantage at every turn
until a judge rules in class-action that males must be treated equally with females or BFOQ be
removed from law. If that were to happen, then all female patient modesty requests would also be
ignored 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 against
either sex in a straight forward
manner. To respond "you are 
not a woman" is all an American
Civil 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..
 ..Maurice.