Good Physician Research Articles

Palliative Care: Staying Alive As Long As We Live

Palliative Care: Staying Alive As Long As We Live

Anesthesiologist's Lament

After a day of keeping up the shtick ,As a colleague calls it, all the backslappingAnd one-liners that put the staff at ease,Dodging comebacks of passing gas and napping,The old clichés of caring for the sickWhile saving lives and stamping out disease,I settle in for an all-night case on callAnd let myself consider the surreal:Some sorry bastard known as Stat Unknown Who passed out, I am told, behind the wheelAnd managed to steer straight into a wallOf the courthouse, no less, has now been flownHere to purgatory, his positionSuspended somewhere between life and death.That colleague told me once a good physician Is sometimes right, sometimes wrong, never in doubt .Sobered with that thought, I draw a breath,Hold it for a moment, let it out,And bow my head to pray with all my might,One sinner for the next, that I am right.

Una internista en el Museo Nacional del Prado. La facies en la pintura: ¿espejo del alma?

Painting and medicine include the humans. They describe, investigate, diagnose and magnify them, with the idea of being able to offer them a cure. The aim of this paper is to describe the disease through the eyes of the painting. To do so, we have selected the pictures exhibited in the Prado Museum and have described the diseases that they express and that may attract the attention of a good physician. All of this has then been contrasted with the opinion of experts in medicine and painting.

Una internista en el museo del Prado. El reto del diagnóstico “de visu”

Painting and medicine include the humans. They describe, investigate, diagnose and magnify them, with idea of being able to offer them a cure. The aim of this paper is to describe the disease through the eyes of the painting. To do so, we have selected the pictures exhibited in the Prado Museum and have described the diseases that they express and that may attract the attention of a good physician. All of this has then been contrasted with the opinion of experts in medicine and painting.

The Ethics of the Muslim Physician and the Legacy of Muhammad (pbuh)

DOI: http://dx.doi.org/10.5915/43-1-7124 Contemporary physicians have become entrepreneurs, and the patient is often seen as a client and medicine a commodity. As such, many patients as well as members of the healthcare team feel that medicine is not living up to its own standards. It is the contention of the author that the Muslim physician, guided by the two primary sources of Islamic Law, the Qur’an and the Sunna , will possess the necessary character traits of a good physician. In this article I argue that the Muslim physician who abides by the Sunna will develop the character traits that will help him/her develop the virtues necessary for making a good physician that will do the right thing even when no one is looking.

Committee Opinion No. 480: Empathy in Women's Health Care

Empathy is the process through which one attempts to project oneself into another's life and imagine a situation from his or her point of view. Most individuals do have an innate capacity to show empathy toward others. Empathy is as important to being a good physician as technical competence. However, at times the health care environment and educational process overly emphasize technological competence, curing disease rather than healing the patient, or the economic aspects of medicine. This may interfere with an empathic approach in the clinical setting. In this Committee Opinion, the Committee on Ethics of the American College of Obstetricians and Gynecologists defines empathy and related terms, describes the role of empathy in medicine, outlines objections and barriers to incorporating empathy into clinical care, reviews research on measuring empathy, discusses the inclusion of empathy in medical education, and makes recommendations about empathic care for health care providers and the health care system.

Letter to the Editor

To the Editor; Thank you Dr Haslam, I really mean it: THANK YOU! I have worked as a community paediatrician for 25 years and have taught family practice residents for almost as long. I cannot agree more with Dr Haslam. I was recently called to see a young nine-year-old girl who had come to our emergency room with abdominal pain. She was thought, by the emergency room doctor, to have “? Appendicitis” and the surgeon was consulted. By the time I was called to see her, she had spent approximately 8 h in the emergency room, and had gone through no less than one ultrasound of the abdomen and two (yes TWO) computed tomography scans of the pelvis. The diagnosis of benign acute gastroenteritis had not yet been made. No one had taken the time to examine her yet, no one had even put a hand on her abdomen to find out whether there was guarding of any sort, and no one had taken the time to ask about the four-year-old brother who had an episode of vomiting, diarrhea, dehydration and fever one week earlier. If someone had performed these basic steps, the diagnosis of rotavirus gastroenteritis would have been made very much earlier. The environment of overwork, the constant medical legal ‘Damocles sword’ coupled with the exponential multiplication of guidelines, clinical pathways and protocols have created an atmosphere of ‘dys-ownership’ of the patient. Consequently, extenuated physicians are, at times, more concerned about following the ever-changing most recent protocol so as not to be harassed by administrative measures, than they are about the actual well-being of the patient. I should add that the physicians involved in that case are my friends, and I know they are good physicians. The solution to this issue is to have less administration, less protocols, more legal ‘protection’ (which does not mean that one should not be penalized for negligence, but this is another topic) and a return of the ‘moral’ ownership of the patient to the caregivers. We must insist on teaching residents these extremely important basic steps in medicine: take a history and perform a good physical examination. Dr Frank Ford was right; it is still true today and will be true tomorrow: laboratory tests and x-rays are here to confirm the clinical impression – if they don’t, they are wrong. If we do not have a clinical diagnosis before we order them, we won’t have one after. Once again, thank you Dr Haslam.

The Muslim physician and the ethics of medicine

Virtuous physicians seem to have become a rarity in modern day medical practice. Many patients and physicians feel that the profession of medicine is not living up to its own standards and expectations. It is the contention of the author that the Muslim physician, guided by the two primary sources of Islamic Law, the Qur’an and the Sunna, will possess the necessary character traits of a good physician. In this article I argue that the Muslim physician who abides by the Qur’an will live a contented life, will be trusted by his/her patients and community, and will be in line with the recently enacted Western principles of medical ethics.

“When patients and families feel abandoned”

Patients with serious illness derive a sense of security by forming strong, healing relationships with their providers. These bonds are particularly strong in life-threatening illnesses, such as cancer, which carry the stigma of death and suffering. These strong relationships create expectations in patients that are not necessarily shared by their clinicians. Providers often focus on treating disease and emphasize technically excellent, "evidence-based" practice while failing to fully appreciate the power of the patient-provider relationship. In contrast, vulnerable patients expect much more than technical competence, including open and clear communication, security, continuity, and access. Patients are often left feeling abandoned when their providers do not meet their expectations, even when their care is technically sound. In this paper, we describe scenarios that can lead to feelings of abandonment and discuss strategies to avoid and respond to them. These strategies can help us maintain healing relationships with our patients by maintaining their trust, confidence, and satisfaction. Cultivating relational aspects of medical practice requires an interchange and takes time. Experienced doctors know this and continue to do so because being present and staying with the patient during difficult times is a pillar of moral and ethical training and a fundamental attribute of a good physician.

Re: Future of Board Certification in a New Era of Public Accountability

(currently $1,570). 2 Ironically, those who created this policy do not have to recertify, unless required to do so by their employers. Given the costs associated with recertification (recertification fee plus time lost from work or vacation to take the examination), this amounts to a regressive tax, since it falls more heavily on younger physicians who have spent fewer years in practice and may have lower incomes and higher educational debts. In addition to being fair, requiring recertification for all practicing physicians may improve quality of care. One study found some evidence that physicians who had graduated from medical school more than 20 years ago were more likely to score in the lowest quartile on the Maintenance of Certification examination for internal medicine and do worse on some performance measures for Medicare patients. 3 In a systematic review of data relating experience and age to physician performance, 70% of studies demonstrated a negative association between length of time in practice and several measures of good physician performance. 4 It would be interesting to know how many academic medical centers require their more senior faculty to maintain board certification, given that these institutions function as leaders in education and policy. Furthermore, consideration should be given to creating a national medical license. Having obtained a number of state licenses over the years myself (consequent to brief locum tenens stints between residency and fellowship), the process of licensing by state boards places a financial burden on physicians (separate fees for each state) and creates a large administrative burden. Having separate state licensing boards may not efficiently root out bad physicians who leave one state under a cloud of suspicion only to have their trails of malfeasance rooted out later because state reports regarding physicians who have been disciplined for unethical and/or illegal activity are not always readily available to other states or to the general public, 5 even since the estab

An early 18th-century proposal for improving medicine by tabulating and analysing practice

An early 18th-century proposal for improving medicine by tabulating and analysing practice

The Art of the Knee Examination: Where Has It Gone?

In the past ten years, I have become increasingly concerned as to where the practice of orthopaedics is headed. While at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 2009, I had a long discussion with several of my peers from around the country about many of the problems we, as orthopaedic surgeons, are facing. The discussion included our thoughts regarding the use of technology in our profession. Although we all agreed that technology has benefited us in some ways, we also agreed that it has not necessarily made us better physicians. One of my peers stated, “I think I am a worse doctor now than I was twenty years ago.” Increasing dependence on technology, although attractive, might be making us lose our ability to reason and, hence, be good physicians. In my orthopaedic practice, I specialize in the treatment of knee injuries and I see many patients who are seeking a second opinion. In recent years, some of the trends I have observed regarding how other physicians arrive at a diagnosis have been alarming to me. I have seen some patients who had undergone a magnetic resonance imaging scan before they were seen for an initial evaluation. Some patients were told they needed a total knee arthroplasty, on the basis of radiographic findings, but they had never had their knees examined physically. Other patients were told that they needed an articular cartilage repair procedure after their physician had evaluated their radiographs and magnetic resonance imaging scan but had not examined the knee or had a conversation about pain and symptoms. I have observed that some patients are surprised when they are asked to wear shorts so I can see their legs for the physical examination. Patients have been even more surprised when their knees were touched …

Guarding the guardians: Bioethics curricula for psychiatrists-in-training in developing countries

A good physician must be both clinically and ethically competent. High ethical standards are especially important in psychiatry in which several unique challenges present due to a vulnerable patient population, intimate physician–patient relationships, diagnoses made on signs and symptoms rather than irrefutable laboratory investigations, and therapeutic options directed at altering thinking and behaviour. It is critical that psychiatric training equip practitioners with the ability to identify ethical dilemmas in clinical practice and research and respond appropriately. Despite a call to action and the development of guidelines for ethical practice by several regulatory bodies, formal ethics teaching in psychiatry training programmes is still in embryonic stages in the developed world and virtually non-existent in the developing world. Here we highlight the current status of bioethics teaching in psychiatry residency programmes in Pakistan, an example of a developing country where such training is vital, as unethical practices abound in resource-poor settings where clinical and research practices are non-transparent and there are no effective regulatory, legal and accountability bodies. It is critical and urgent that needs-responsive bioethics curricula are developed, institutionalized and implemented in medical schools and post-graduate training programs across the developing world.“Take-home” points• Bioethics teaching should be a key, assessed component of all psychiatric training programmes• Bioethics curricula should be culturally contextual, responsive to stakeholder needs and geared towards preparing psychiatrists for ethical clinical practice and research, bioethics teaching and institutional leadershipFuture directions• Comprehensive needs assessment studies should be conducted to document current bioethics-related knowledge and attitudes in psychiatry training programmes in developing countries• Development, institutionalization and dissemination of needs-responsive bioethics curricula for psychiatry programmes in developing countries

Required vs. Elective Research and In-Depth Scholarship Programs in the Medical Student Curriculum

The ability to understand and integrate new knowledge into clinical practice is a necessary quality of good physicians. Student participation in in-depth scholarship could enhance this skill in physicians while also creating a larger cadre of physician-scientists prepared to advance the field of medicine. However, because no definitive data exist demonstrating that in-depth scholarship in medical school leads to improved patient care or to productive academic careers, whether such scholarship should be required as part of the medical school curriculum is unclear. In this article, the authors present both sides of this debate. Theoretical benefits to students of a required scholarly program include closer mentorship by individual faculty, enhanced capabilities in critical interpretation of research findings, and increased confidence to investigate conundrums encountered in clinical care. Society may also benefit by having physicians available to create and apply new knowledge related to biomedicine. These theoretical benefits must be balanced, however, by pragmatic considerations of required scholarly projects including their impact on medical school applications, their effect on the medical curriculum, their costs, the availability of mentors, and their effects on the school's educational culture.

Attributes of a good physician: what are the opinions of first-year medical students?

BackgroundUndergraduate medical education is beginning to concern itself with educating students about professional attributes as well as about clinical knowledge and skills. Defining these characteristics, and in particular seeking the...

Intérêt des revues de mortalité et de morbidité pour la formation des médecins et l’amélioration de la qualité et de la sécurité des soins : revue de la littérature

In France, national incentives promote the development of morbidity and mortality conferences (M&MC) in hospitals. A systematic literature review was performed to investigate the effectiveness of M&MC as well as how they were conducted and how participants experienced them. The review was carried out by searching the MEDLINE and PASCAL databases and included articles in English and French. The following keywords were used: mortality, morbidity, conference, rounds, review, meetings, committee. Two independent reviewers selected all original studies describing or evaluating M&MC and published from 1st January 2002 through 31st December 2008. We analyzed 17 articles, of which 11 reported structured interviews, 3 analyzed M&MC minutes, 2 monitored indicators, and 1 described observations of M&MC. They showed good physician participation and a wide variety of types of meeting organization. Attendance by paramedical staff, the number of cases covered per meeting, and case selection criteria affected their content. Studies of the efficacy of M&MC were rare and concerned specific topics (digestive endoscopy and childbirth). Both the methods and the objectives of studies analyzing M&MC are heterogeneous. The published studies viewed M&MC as a valuable tool for physician education and quality assurance, but the factors associated with their effectiveness require further study.

Googling Ourselves — What Physicians Can Learn from Online Rating Sites

After reading physician-rating sites, Dr. Shaili Jain is reassured that what patients want from their physicians is not all that different from what good physicians want to offer their patients.

Expanding Our Horizons

1. Lawrence F. Nazarian, MD, Editor-in-Chief As I interview candidates for admission to medical school, I marvel at the experiences they have had compared with my generation. International travel, volunteer experiences of kaleidoscopic diversity, exposure to research from the bench to the clinic, excursions into disciplines far removed from medicine—these young people roam far beyond the traditional track that I and most of my classmates followed. Similarly, the perspectives of medicine and of pediatrics have broadened constantly. Although good physicians always have realized that any aspect of the human condition is relevant to the patient's welfare, we now formally study areas that were not part of the curriculum decades ago. One example is cultural effectiveness, which has had more than one name but in essence connotes sensitivity to and knowledge of the elements of …

Better Physician Writing and Speaking Skills

This 118-page paperback carries a title that is extremely relevant to today's undergraduate and postgraduate medical trainees. We live in an era when aspiring doctors and postgraduate trainees must concentrate on sciences from an early stage of their education. As a consequence, skills in the use of both written and spoken language are less well developed and the result is that the communication skills of doctors have become an issue for both patients and the profession. The book therefore carries an expectation that it will provide much-needed instruction in the art of good communication. It is clearly written for an American market and there is occasional use of words that would be unfamiliar, though understandable, to a UK audience. It has chapters covering writing and speaking skills, communication skills, technical writing, writing for publication, conference presentation, grant applications and interpersonal skills. There is no doubt that each area is one in which young trainees often need guidance in the early stages of their careers. The chapter content is occasionally confused, such that under the chapter headed ‘Good Physician Writing is a Communication Skill’ the author wanders into a discussion of verbal communication and body language. The author also advocates the avoidance of technical jargon but actually uses jargon that will lead to confusion among those unfamiliar with the finer points of English grammar. The chapters on preparing to write, writing for publication and grant writing contain useful advice but, overall, the book fails to live up to the promise suggested by the title. There is repetition that gives the impression that the book is a collection of published papers thrown together, rather than a carefully edited combination of previous articles. Sadly, because of the verbose and repetitive nature of the text, the book is unlikely to hold the reader's attention long enough to convey the important messages contained within.

Saints and Ophthalmology: A Pattern for Emulation, A Model of Healing, and Physicians in Action

From the earliest times, medical practitioners have sought divine help and support to aid them as they go about their busy rounds. In Christian Europe of the High Middle Ages, saints played a central role in the everyday life of the ailing. Alongside healing attempts which involved magic, folk or scientifically-based medicine, the invocation of specific patron saints for the curing of ailments was a widespread practice. The miracles of vision performed by saints over the past two millennia are listed and interpreted by various reviewers along faith healing, spontaneous recovery, or physicians acting as saints. The individuals honored as patron saints of medicine were practicing physicians who served their patients and their communities well. It is their role as saints to represent the spiritual element in the healing process as well as personifying the charitable idealism of the good physician, and therefore are models for humanitarian physicians, with the ultimate model of healing being Jesus Christ.