Preserving Patient Dignity (Formerly Patient Modesty) Volume 110

This graphic reminds us and summarizes all of the concerns repeatedly described with detail on this blog thread.  It comes from Google Images and I don't recall displaying it on a previous Volume of our topic.  I am sure there are additional "misbehaviors" and worse which you could add. ..Maurice.

Preserving Patient Dignity (Formerly Patient Modesty) Volume 109

JR wrote today in Volume 108 "Many man don't like how they are treated but don't know it should be done differently. Some are ashamed of what happened and thus remained silent."  and but this why "speaking up" both to the profession and to fellow patients is so important and has been stressed on this blog thread. Every patient, provided
valid information or witnessing improper professional behavior has every right to express a "No!". 



Graphic: From https://giphy.com/ via Google Images


AS OF MARCH 28 2020, NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME 109.  THE COMMENTS CAN CONTINUE ON VOLUME 110.

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 108

Continuing on with our current commentaries comparing physician vs 

veterinarians with regard to their relationship to the subjects (not objects)

of their attention,  I thought the above graphic tells us something for all

physicians to also consider: "the subject of your clinical attention may 

have an opinion about you or what you intend to perform which differs

from what you know or anticipate."  All physicians should not ignore

this possibility.

Graphic: From source noted below graphic through Google Images. AS OF FEBRUARY 11 2020, VOLUME 108 WILL BE CLOSED FOR COMMENTS. FURTHER COMMENTS CAN BE MADE OF VOLUME 109. 

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 107

And this is how it all started for many men who have come to write to this blog thread.  Do you think this would be the time for the youth to display  VIP characteristics, and say "NOT THIS WAY!"?

I would be interested to read if you were that youth in that situation what you would say and what would you do?  ..Maurice.

Graphic from Google Images

AS OF JANUARY 18 2020, COMMENTS TO THIS VOLUME WILL NOT BE PUBLISHED.
YOU MAY CONTINUE THE COMMENTARY ON  VOLUME 108..

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 106

The Graphic starting out Volume 106 came from a British doctor blogger blog titled "Dr. Grumble" presenting views of medical life within Great Britain in a series of posting topics with
reader responses from 2006 to 2015. Many issues discussed are what we have discussed and are discussing on my blog here.. but from a British experience. Go to the above link for a bit of insight into Dr. Grumble's grumbling but return and go ahead and "grumble" here.   p.s.- Doesn't the Graphic fit with our current discussion?  ..Maurice.




Maybe what is needed to improve the medical system as it interacts with patients is simple empathy.    Graphic: From Google Images.


AS OF DECEMBER 10 2019, THERE WILL BE NO FURTHER COMMENTS PUBLISHED
ON THIS VOLUME. COMMENTS CAN CONTINUE ON VOLUME 107

NO RESPONSE is NO "DISCUSSION"

What I have noticed as Moderator of this Bioethics Discussion Blog is that there is the fact that readers contribution of their own views have been markedly absent if the last visitor posting was years previously.  Yet,  I find with documented evidence, that there are currently repeated access to these "older" thread title subjects but nobody currently writes presumably because they might assume that the topic discussion is closed.  And yet, most of the topics, even if years have passed without comment by readers, are actually of current interest and are currently being referred to by Google and other resources and are actually being read. No reactive response means no discussion!

My request is for readers who access those "older" blog thread titles to realize that they are CURRENTLY being read by others, are of CURRENT INTEREST and should be written to, presenting your opinion, even if the last visitor comment posting was 5, 10 or more years ago. Your words and views will be read by myself but also by others.. so let's hear from you and your opinions.  Remember: NO RESPONSE IS NO DISCUSSION and this a Bioethics DISCUSSION Blog. ..Maurice.

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 105

There is no doubt that those writing to this blog thread are "Speaking Up" here but to attempt to meet the goal of the preservation of patient dignity within the medical system, it is necessary for your voices to be heard by your physician and office or clinic staff, your hospital, the boards of healthcare certification and the government.  And you need to gather others who have been, are or will be patients to join in the vocalization of the needed repair and improvement of the medical system.

Yes, feel free to "Speak Up" here but this blog thread is only the beginning, a place to ventilate, discuss and plan but it is necessary to send your words, suggestions and demands OUT to where pressure is applied and there are those who hear you and attention and changes can occur.  ..Maurice.

Graphic: From https://gifer.com/en/HYXa via Google Images


AS OF OCTOBER 29 2019, NO FURTHER COMMENTS WILL BE POSTED HERE. GO TO
VOLUME 106 TO CONTINUE POSTING.

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 104

What emotional reaction to the behavior of the medical profession in the examination and treatment of male patients is the basis for what is being discussed here?  Is it fear? Is it not fear itself of exposure but the discrimination when considering the behavior of the profession to female patients.
Have we detailed here the opinion of the psychodynamics of what is really going on in the mind of the male patients who are attempting to survive their illness but also survive the alleged emotional mistreatment by the medical profession on male patients?  Is the real upset, evidence of gender inequality in medical care with regard to bodily privacy?  Let's get down to the "nitty gritty" if it hasn't been clearly defined in all the Volumes up to this new Volume 104.  ..Maurice.


Image: From British Museum via Google Images. For details of the image this classic image drawing read the information at https://www.britishmuseum.org/research/collection_online/collection_object_details.aspx?assetId=192152001&objectId=711876&partId=1

BEGINNING SEPTEMBER 14 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON VOLUME 104.  YOU CAN SUBMIT YOUR COMMENTS NOW
TO VOLUME 105.

Preserving Patient Dignity (Formerly: Patient Modesty):Volume 103

There is no doubt that, in these modern times of medical system-patient interaction where we have taken away autonomy from the medical system and delivered it to the patient while scrubbing off the eons-long paternalism, a previous hallmark behavior of the physician and the medical system, we face clinical interactions, reported many such clinical interactions and behaviors, that tend to diminish this decision for this switch of "who is the decider". Some of this unethical "switchover" is based on medical professional "monetary greed"  and some nationally publicized or otherwise patient-experienced based on sexual or other self-interest "greed" or just plain ignorance of ethical professional behavior. So, currently, here in America and perhaps to various extents in other countries, those of us, active or potentially future patients who believe in ethical medical professional behavior should see these professional misbehaviors or "worse'' and  should require action started now to contribute to make changes in the medical system to prevent destruction of the inherent dignity properties of all patients.  The methodology to promote and make these changes should continue to be the goal for discussion here.  Yes, "ventilation" of one's past noxious experiences may be personally therapeutic from an emotional point of view but unless the discussion includes approaches to  prevent these traumas from recurring (GETTING RID OF THE BAD APPLES AND BAD APPLE BEHAVIOR) should be the goal of this blog thread.  ..Maurice.

Graphic: From Google Images


NOTICE: NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME BUT CAN BE CONTINUED ON VOLUME 104.

Patient Dignity (Formerly:Patient Modesty):Volume 102

The last Volume of this thread stressed the patient carries with him or her the ethical power of autonomy, self -final decision-making. And I have a concern that a number of patients don't display that power in decision-making because they are not familiar with issues related to their suspected condition or disease in terms of medical principles, diagnosis or treatment and often the healthcare provider may make assumptions overestimating their patient's medical knowledge or just be too busy to teach. Yet without that knowledge, the power of autonomy cannot be fully expressed in the best interest of the holder of that power.  The solution may be self-education in medical matters before the need to express the patient's ethical power.

 We call for patients to feel free to "speak up" to their attending medical professionals regarding matters that concern them. But understanding general medical principles beforehand which may apply to the patient's symptoms or diagnosis or treatment is worthy and may be obtained from books and now the more easily obtainable  reliable medical internet resources.  Sometimes even talking over the fence with a next door neighbor might be of help in the patient's education but be cautious since their experiences and views and philosophy  may be different from what you need for your own decisions.

In conclusion, pre-educate yourself  in general medical principles for the time you wield the power to express to your healthcare providers your power of autonomy. ..Maurice.

Graphic: From Google Images

NOTICE: AS OF TODAY JULY 29, NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS BLOG VOLUME. COMMENTS CAN NOW BE WRITTEN TO VOLUME 103.

Patient Dignity (Formerly:Patient Modesty):Volume 101

Is the image above, the way patients, especially male patients, as extensively discussed here, are expected to look at and accept nurses and their behavior? Or should we disregard the published
exceptions and  look at a nurse this way:

It is the nurse who manages the day to day and hour to hour care of patients after being diagnosed and treated by physicians.  The discussions concluding Volume 100 of this thread specifically deal with nursing behavior which enter into the sexual misbehavior or worse realm.  Should this smear on the nursing profession be considered as characteristic of the profession, perhaps more apparent in our current era  and more active means be carried out to rid the profession of those who continue "sexual misbehavior or worse"?  ..Maurice.

Graphic: From Google Images.


NOTICE: NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME.
FURTHER COMMENTS CAN BE WRITTEN TO VOLUME 102.

Patient Dignity (Formerly:Patient Modesty):Volume 100

Should we all look at this blog thread as an elevator where a small group of patients or potential patients are gathered together, floor by floor, to talk about the issues that disturb us within the current medical system? As we stop at a floor, others may look in and even join us in conversation to move along to another floor.  But, beyond our conversations, the only way to make change is to step out of this elevator and walk into the governmental, legal and medical business world and carry out the declarations and approaches which has been repeatedly discussed during the elevator ride.
How is that for an analogy to Patient Dignity (Formerly Patient Modesty) as we have moved up to the 100th floor in our little elevator?  ..Maurice.

                                                                                                      Graphic: From Google Images.
AS OF JUNE 23 2019 THERE WILL BE NO FURTHER COMMENTS POSTED ON THIS VOLUME. COMMENTS CAN NOW CONTINUE ON VOLUME 101.

Patient Dignity (Formerly:Patient Modesty):Volume 99

Does  the above animation tell us anything about the
patient-doctor relationships which has been amply described
and detailed on this blog thread?  Could any of the patient
reactions to the actions of the physician or the medical system
simply be a natural reflex to some actions by the profession which
were not intended to be traumatic? Could some actions of the
professionals be well intended (in this example to test for neurologic
reflex impairment) and  yet turn out to appear that it was not fully
 considered?

In this analogy, by working together, could the patient have reminded
the physician, based on the patient's previous experience that the doctor
may be sitting too close for the test?  Usually, patients know more about
themselves and their reactions (both emotional and physical) and the
physician deserves to be informed in advance. So..the message again
to the patient: "Speak up".
 ..Maurice.


Graphic: From https://gifimage.net/interrogatorio-medico-gif-3/
via Google Images


NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 99.
NEW COMMENTS CAN NOW BE WRITTEN TO VOLUME 100.

Patient Dignity (Formerly:Patient Modesty):Volume 98

So the "Rules of the Road" is a worthy presentation to each patient who comes to the physician for help but what is often missing is that the doctor needs to understand the "Rules of the Road" as taught by each patient.  As you walk into the doctor's office you get a Welcome document from the doctor. What is missing often is the doctor doesn't get a "Its about me" instruction paper from the patient to educate the doctor regarding his or her rules as they both go down the same road with upcoming Stop signs, turnoffs and speed limits.  One major issue within  such a driving analogy is WHO FOLLOWS WHO? (physician paternalism vs patient autonomy).   Can any of my visitors add to this road analogy? ..Maurice

Graphic: From ZNX Health via Google Images and modified by me.

AS OF MAY 13 2019, THERE WILL BE NO FURTHER COMMENTS POSTED ON THIS
VOLUME 98. YOU CAN CONTINUE POSTING ON VOLUME 99.

Patient Dignity (Formerly:Patient Modesty): Volume 97

"Not OK" and who decides it's "OK" or "not OK" in a medical professional-patient relationship? Should the final decision be made by the patient (autonomy) or by the medical professional (paternalism).  My view and practice as a physician is that patient informed but autonomous decisions (or informed decisions made by the patient's surrogate, if necessary) should be the determinant state in all patient-medical profession relationships from onset to final actions.  So this view applies to clinical interaction in all stages of medical practice.  In non-clinical relationships (as briefly discussed in Volume 96) the final decisions are more complicated if a clinical relationship had previously been present.

From the onset of this thread topic,  the views presented have clearly held, with examples of patient hurtful contrary professional behavior, that it is the patient who should "be in charge".   What is my opinion is that simply mumbling and grumbling  on this blog thread as to what is "not OK", I fully agree with the attempts by some of our visitors to "move on" to publicize their view for a need for a changes within the medical system to attend to the needs of patients to maintain their dignity beyond maintaining their health and that there are many examples of professional behaviors which are simply "not OK"with them.  ..Maurice.

GRAPHIC: Created by me utilizing the Microsoft Paint Program

NOTICE: BEGINNING APRIL 29 2019 NO FURTHER COMMENTS WILL BE PUBLISHED ON  THIS VOLUME. COMMENTS CAN BE WRITTEN TO VOLUME 98.

Patient Dignity (Formerly:Patient Modesty): Volume 96

Isn't this is what is facing patients who want to express their "concerns, desires and wants" and is amply exemplified by the
Comments already and to be written to this blog thread topic?
..Maurice.
Graphic:  From FamMedVitalSigns.com and excellent article on our subject by Kyle Bradford Jones.



BEGINNING APRIL 10 2019, NO FURTHER COMMENTS WILL BE PUBLISHED IN THIS VOLUME 96.  COMMENTS CAN CONTINUE IN VOLUME 97

Patient Dignity (Formerly: Patient Modesty): Volume 95

Ray B. said in Volume 94:

If you believe Steven Miles, M.D. (“Oath Betrayed: Torture, Medical Complicity and the War of Terror”) the answer is, “All of them.” That’s hardly evidence of outliers. At the same time, however, there is reason to believe, from Milgram’s study, that the people who commit evil acts may, in fact, be outliers – it depends on the situation. 

And so where are we, as patients and our dignity, within the medical system? ..Maurice.

Graphic: From Google Images and modified by me with Art Rage.
As of March 21 2019, no further Comments will be published on
this Volume. Comments will continue on Volume 96.

Patient Dignity (Formerly: Patient Modesty): Volume 94

Entering the "dirty pond" or "down the drain", these expressions along with accompanying graphics are amongst a host of verbal expressions with their visual analogies which I have used over many Volumes to describe the status of the medical system as brought out in the views presented by the contributors to this blog thread over the years. And now with Volume 94 comes another: the medical system utilizing the conveyor belt image within the process of diagnosis and treating of its patients.  This analogy is spelled out in a "Perspective" description of a clinical event in the January 3, 2019 issue of the New England Journal of Medicine with the title of "Walking Away from Conveyor Belt Medicine".

The story begins and the conveyor belt first starts moving when a community hospital notifies a major medical-surgical hospital that it found in a 70 year old demented patient who spends  his life simply "walking" that his previously surgically stabilized aortic aneurism is enlarging compared to his previous checkup and he was felt to be in need of immediate surgical repair to prevent rupture.  He was on his way by ambulance "and the conveyor belt started moving" in the major hospital to carry out all the preparations involved in what was to happen on the patient's arrival. On arrival "the conveyor belt is speeding up".  Then the "belt was moving fast" as all the many components which were needed to prepare and carry out this risky surgery were proceeding and being accomplished.  And, if continued to the anticipated end-point, the patient, elderly and demented would be dropped off onto the operating room table for the start of this  surgery and..and.. but, fortunately the conveyor belt stopped running when time was taken for communication between surgeons and the family who arrived and that communication changed everything and it was decided that the risks of surgery was too great for this particular patient.  So the patient was sent home with a pair of slippers for his walking and was alive 6 months later and carrying out his life as before his immediate life was governed by that medical system "conveyor belt".

What impressed me about this article is  a suggestion, which some may consider, that the medical system may have a tendency to be employing a "conveyor belt" mentality in its approach toward virtually all patients.  And this uniformity of belief and action may be contributing to a loss of dignity to each individual patient involved in the system.  "It's always done in this way and so that is how we will do it."  That is, hopefully, until the patient or family intervenes  and "speaks up".  What do you think about this analogy?  Do you see that you have been sitting on that fast moving "conveyor belt" within the medical system as a patient?  ..Maurice.

GRAPHIC: From Google Images and modified by me with ArtRage Studio Pro

AS OF FEBRUARY 14, 2019 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON THIS VOLUME. CONTINUE COMMENTARY ON 
VOLUME 95.

Patient Dignity (Formerly: Patient Modesty): Volume 93

This graphic is my repeat presentation to this thread.  It first appeared here 5 years ago as the graphic on Volume 56 of "Patient Modesty". (Photograph  from U.C.L.A. library website  obtained through Google Images.  )

Now that we are focusing on patient dignity, it would be of interest to compare dignity vs modesty as applied to a patient fully asleep under anesthesia within the operating room.  

Might I suggest that modesty is no longer a matter of ethical concern when the patients body is uncovered but the issue becomes the preservation of dignity. Modesty requires awareness .  Anyone want to discuss this conclusion related to the unconscious but exposed patient? ..Maurice.

AS OF JANUARY 6 2019 VOLUME 93 WILL BE CLOSE FOR FURTHER COMMENTS.  GO TO https://bioethicsdiscussion.blogspot.com/2019/01/patient-dignity-formerly-patient.html FOR MAKING COMMENTS.

Patient Dignity (Formerly: Patient Modesty): Volume 92

"Modesty is Not About Hiding Your Body. It's About Revealing Your Dignity"

What I wrote in Volume 91 detailing  this expression:

In other words "hiding your body" is a component of "dignity", a concept that is worthy of reminding those in the medical profession who simply consider physical modesty as a matter of personal "shame" for which the goal of correct diagnosis and treatment should trump. How's that??  


And now..let the discussion continue with the goal of how we all, patients as well as members of the medical profession (who one day will be patients) rehabilitate and change the medical system to be the supporters of patient dignity in all of its various contents and expressions.    ..Maurice.


Graphic: From Google Images and Pinterest.com https://www.pinterest.com/

BEGINNING NOVEMBER 22 2018 NO FURTHER COMMENTS WILL BE PUBLISHED ON VOLUME 92. COMMENTS CAN CONTINUE ON VOLUME 93.

Patient Modesty: Volume 91

There currently is discussion as to exactly or inexactly what is the topic of this thread which has been published Volume after Volume for 13 years.  And whether there is a need to make the title of this thread more appropriate to the content that actually has been already published here. As Moderator, I agree that the discussions and documentations here are far more broad in terms of the patient-medical system relationship than the simple "Patient Modesty" title represents.  The problem is deciding how to express the title of content most appropriately, particularly for the new visitors to this bioethics thread.

I think it is of value to reproduce here the view of a faithful contributor to the blog and this thread whose identification is "Banterings" and my response as presented at the end of Volume 90.  I think it is then important to continue the discussion of the meaning of this thread and the consensus of the contents and ethics meaning of the many posting contributions over the years here.  Banterings last posting follows after my published suggestion for a title.

---------

How about:
"Patient Modesty, Dignity and Expected Respect by Medicine:Volume 91"

???

Isn't this precisely what is the theme presented over and over here?  
..Maurice.
===================================================================

Maurice,

Again you are making it look like the patient is (now) asking for 2 things they are not entitled to. Not only are they too modest, now they are "expecting respect."

...how dare you expect to be treated with respect? If you come to a teaching hospital, it is understood that you will be treated like a warm cadaver. Students will line up to practice their "probing" skills on you...

This is "victim blaming," plain and simple. In this era of the #MeToo movement, the last thing that one would want to do is victim blaming.

If we want to be brutally honest, then title the thread exactly what it is: 


Medicine's Lack of Respect for Human Dignity and Patient Modesty



-- Banterings

===============================================================================================

And now the discussion of a new title continues followed hopefully by further dissection of the status of medical care behavior towards their patients.  ..Maurice.

Graphic: Google Images.


AS OF OCTOBER 11 2018, NO FURTHER COMMENTS  WILL BE ACCEPTED ON THIS VOLUME.  YOU MAY CONTINUE THE DISCUSSION ON THE BLOG THREAD NOW
TITLED: "PATIENT DIGNITY (FORMERLY "PATIENT MODESTY") VOLUME 92"

Patient Modesty: Volume 90

The animated GIF picture for Volume 90 (thanks to matthen.com via Google images) is my graphic

impression of what has been one of the primary concerns of patients writing here: unwanted, unnecessary or even non-permitted  bodily visual inspection during medical or surgical procedures.  Of course, other unprofessional acts by the "professionals" have also been described but unnecessary and patient unwanted inspection, looking or "peeking" is a common behavior presented. 

However, the graphic should also represent the eye movements and "attention" by patient's themselves, looking out, keeping their eyes open to professional misbehavior coming from any direction.

I think this graphic should emphasize the need for such attention and if unwanted "gazing" other "unprofessional" behavior is found, patients should feel free to "speak up" and contribute to making the medical profession truly "professional" toward a goal directed solely to  patient beneficence and not some other goal set solely for "the system person" or the system itself.  Is there anything further to add describing any relationship of this graphic to the issues brought up in these 90 Volumes?  ..Maurice.

AS OF SEPTEMBER 8 2018, NO FURTHER COMMENTS WILL BE PUBLISHED ON
VOLUME 90. THE DISCUSSION WILL BE CONTINUED ON VOLUME 91

Pharmacist:: Just Filling Prescriptions or Should They Also Diagnose?

      There may be some confusion about the full role of the professional pharmacist in medical care. The patient, with

prescription from a physician in hand may consider the 

diagnostic phase completed and comes to the pharmacist for

the prescribed medication to take for their physician identified

illness.  On the other hand, pharmacists after their studies and

licensing may feel that they represent another link in the role of illness  diagnosis. But, are they? Some feel that they do and "Although debate about pharmacists’ diagnostic role has existed for some time both within the pharmacy profession and between professions (mainly medicine and pharmacy), there is considerable evidence, especially from community practice, that pharmacists commonly engage in diagnosis."

But, "Changes to modernize traditional medical education and care delivery are, in fact, currently being introduced, with interdisciplinary health professional teams emerging as a core element of new models. Before graduates of different health programs are assigned practice responsibilities, however, many questions still need to be answered: What are the core functions and responsibilities of practitioners in each profession? What is the minimum education and training needed for someone to attain the core competencies required to perform these functions well and safely? Where do the different professions intersect and where could the public benefit from services offered by more than one provider? How can interprofessional learning and practice environments foster and support collaboration? How can we prevent turf battles and encourage true collaborative, patient-centred, complementary care?"

So, the question to my blog readers is whether, as a patient, you would think that pharmacists should taught further to play the bigger role as diagnostician beyond screening and packing medication already prescribed by the examining physician? Are you satisfied with the relationship you have with your licensed pharmacist? Would you want your pharmacist to learn and carry out more clinical responsibility?  Physicians in the past and occasionally now have dispensed medication to their office patients after making a diagnosis. Should pharmacists take on a bit of the responsibility of making a diagnosis based on their more limited pharmacy school and hospital internship experiences? How do you want your pharmacist to be interacting with you as a patient? ..Maurice. 

 Graphic: From Google Images and NIDDK Image Library.

Patient Modesty: Volume 89

I took the above photograph of a "dirty" pond this morning (Descanso Gardens, Southern California) because it struck me as analogous with what is currently being written on this thread about the medical system which we are all experiencing.  Each fragment of  "dirt" was actually part of adjacent beautiful and organized plantings but each fragment going their own way ended up in this pond no one would want to enter..  Is this analogy consistent with the current medical care system? Worthy parts from the past and elsewhere but now just a "dirty pond" ..Maurice.

AS OF AUGUST 4 2018, NO FURTHER COMMENTS TO THIS VOLUME WILL BE ACCEPTED.  COMMENTS CAN CONTINUE ON :"PATIENT MODESTY: VOLUME 90".

Patient Modesty: Volume 88

So.. based on what has been written in all the previous Volumes of this thread, it appears that a consensus is that the medical system just going "down the drain".  And if so..whose fault? Who should we blame?  And if this analogy is realistic, what is the solution since seems obvious that we (all of us) need trained humans to diagnose and treat us for many of  our illnesses?  Should we have folks not trained in medicine or business to actually run the medical system? Should they be "voted into office" and that by public vote
decisions in medical-surgical practice be made? What is your opinion? Got one? If so, then Comment.  ..Maurice.

As of July 1 2018, Volume 88 will be closed for further Comments.
However, Comments can continue on Volume 89.

Graphic: From Google Images and modified by me with ArtRage 3.