Great Doctor Research Articles

Boundary Crossings in the History of Health Care

My assignment here is to map changes in of health as a field in last 30 years, setting stage, I think, for constitutive role nursing has played in this sea change. The Symposium organizers told me I had a fixed amount of time and my quick math tells me I can take up to 30 seconds per year. That might have been sufficient but I am also told we have to be provocative.So, I want to do three things. I first want to characterize that moment around 30 years ago: Where did our shared field stand around time when this Center was created? Then, I will lightly sketch kinds of change that have transformed field. And finally, just bullet point (no more) some of concerns about field we're facing.The phrase the of health care 30 years ago (in late 1970s and early 1980s) was highly polemical. It was a rallying cry for a way of thinking about and writing history, embroidered on banners waved at bar- ricades and inscribed in prefaces to books with titles like Medicine ivithout Doctors and Beyond 'the Great Doctors'.In that new social impulse, master narratives of an earlier medical were identified with exclusionary stories that privileged ortho- doxy, progress, and white male elites. In their stead, scholars who proselytized for history of health care began to produce a whole host of alter- native narratives that incorporated various institutions, practices, and voices. At stake were which historical questions about health and health were worth asking, who was best suited to come up with answers, and what work should do. It was a heady moment.And it did transform field. And let me just point to three of kinds of hard-won change we now tend to take for granted: attention to market- place, to patient agency, and to practice. Reflecting broader impulse to look beyond elites, historians of health turned their attention to variety of healers who coexisted (and often competed) in medical marketplace. They focused on healers other than regular physicians-practitioners who had been invisible or marginalized in an older canon, including midwives and other women healers but also anti-orthodox practitioners like homeopaths, botan- ies, and hydropaths, and a rich array of health reformers. This marketplace was a site of economic but also ideological competition (and, more subtly in later historical work, negotiation). These histories were also peopled with a differ- ent cast of characters-diverse in gender, race, ethnicity, class, and religion. It altered our baseline understanding of kinds of sources of health and advice people could turn to, in sickness and in health.At same time, there were calls to rewrite of health from patients perspective. It was not just a matter of shifting perspective, though, but also looking for agency of patients in shaping their own health culture and health system. Taking their cues partly from women's health move- ment, consumer movement, and rights movements, historians listened carefully for voices inflected by gender, race, region, and political ideologies. Just as histori- ans sought out other healers, they also worked to recover how individual, socially situated laypeople made choices, how they looked to and contested professional authority, and how they exercised agency as patients, clients, and consumers.Yet one final hallmark of that emerged in 1980s was a preoccupation with practice: practices of healing, of research (includ- ing research ethics), of policy making, of keeping people healthy-or cities healthy. We never set aside a of ideas or of innovation. But there was a valuation of everyday-how technologies were actually used on a workaday level, how institutions (from hospitals to home health services) actually operated, experience of life on wards (including not just exceptional but repetitive dailiness of working routines), what it meant to live inside an adolescent body or aging body, experience of giving birth or being ill, and practices of teaching and learning in laboratory or at bedside. …

A great department in a small town: 45th anniversary of the Nuclear Medicine Department, Helath Centre, Zajecar

The authors describe the formation and development of the Nuclear Medicine Department in the Health Centre Zaječar over the period of 45 years. At the begining of its work in September 1969, as a radioisotope laboratory within the Department of Internal Medicine of the Medical Centre in Zaječar, it became, by the end of the twentieth century, a prestigious Department of Nuclear Medicine, with several PhDs and specialists of different scientific disciplines, known across the world and in former Yugoslavia. It started at the time when little was known about nuclear medicine and when there were no such laboratories, except in major cities. It succseeded to arise interest among doctors of other medical branches in the area of the Timok Region on the use of radioisotope in diagnosis and therapy, thus contributing to the overall improvement of health care. It became very close with patients who were fond of doctors and the Department where special devices were used in diagnosing and treatment and with a high level of professionalism and ethics in relation to the population. Over several decades, the Department has produced several specialists, masters and doctors of medical sciences. The authors indicate that the activity, development and progress of a sector in medicine and elsewhere, in this case the Department of Nuclear Medicine of the Health Centre Zaječar, may arise and survive thanks to an individual. It was when imagination, intuition, dedication, love of medicine, persistance, entrepreneurship and creativity of an individual, such was the case with Dr. Nebojša Paunković, a great doctor in a small town, had a decisive importance for the development and improvement of the Department. He was the founder, animator and head of the expert team. Finally, the authors deal with the future of the Department for Nuclear Medicine, seeing its prosperity in further progress of the implementation of innovations in physics, chemistry, engineering, technology and computer science, as well as in the application of scientific advances in molecular biology and predictive medicine.

Álvaro Pascual-Leone: a pioneer of non-invasive brain stimulation

Álvaro Pascual-Leone: a pioneer of non-invasive brain stimulation

I'm feeling lucky: the confessions of Google employee number 59

I'm feeling lucky: the confessions of Google employee number 59

What patients say about their doctors online: a qualitative content analysis.

Doctor rating websites are a burgeoning trend, yet little is known about their content. To explore the content of Internet reviews about primary care physicians. Qualitative content analysis of 712 online reviews from two rating websites. We purposively sampled reviews of 445 primary care doctors (internists and family practitioners) from four geographically dispersed U.S. urban locations. We report the major themes, and because this is a large sample, the frequencies of domains within our coding scheme. Most reviews (63%) were positive, recommending the physician. We found a major distinction between global reviews, "Dr. B is a great doctor." vs. specific descriptions which included interpersonal manner, "She always listens to what I have to say and answers all my questions."; technical competence "No matter who she has recommended re: MD specialists, this MD has done everything right."; and/or systems issues such as appointment and telephone access. Among specific reviews, interpersonal manner "Dr. A is so compassionate." and technical competence "He is knowledgeable, will research your case before giving you advice." comments tended to be more positive (69% and 80%, respectively), whereas systems-issues comments "Staff is so-so, less professional than should be…" were more mixed (60% positive, 40% negative). The majority of Internet reviews of primary care physicians are positive in nature. Our findings reaffirm that the care encounter extends beyond the patient-physician dyad; staff, access, and convenience all affect patient's reviews of physicians. In addition, negative interpersonal reviews underscore the importance of well-perceived bedside manner for a successful patient-physician interaction.

Microbes and a "Magic Box": Medicine and Disease in Early American Studies

Microbes and a "Magic Box":Medicine and Disease in Early American Studies Kelly Wisecup (bio) Domingos Álvares, African Healing, and the Intellectual History of the Atlantic World. James H. Sweet. Chapel Hill: University of North Carolina Press, 2011. 300 pp. Materials and Medicine: Trade, Conquest, and Therapeutics in the Eighteenth Century. Pratik Chakrabarti. Manchester: Manchester University Press, 2010. 259 pp. Miraculous Plagues: An Epidemiology of Early New England Narrative. Cristobal Silva. Oxford: Oxford University Press, 2011. 244 pp. In his Pulitzer Prize-winning study, Guns, Germs, and Steel: The Fates of Human Societies, Jared Diamond asks his readers to consider the transmission of European diseases to the Americas "from the microbes' point of view" (198). He imagines the various methods by which germs spread: they wait passively to be passed on by an unknowing host, they change their habits to accelerate their transmission, and they even induce people to transfer them with coughs or sneezes. As Diamond explains, what we consider "symptoms" represent for germs a brilliant strategy for survival (198). From the microbe's perspective, the epidemics that devastated Native American populations and consequently enabled Hernán Cortés's conquest of Tenochtitlan and English settlement at Plymouth were repercussions [End Page 199] of a biological fight for survival in which microbes found Native Americans to be ideal hosts. Diamond employs this approach to counter views that see Europeans' colonization of the Americas as a consequence of biological differences that endowed Europeans with superior bodies and civilizations. Instead, Diamond argues that Europeans developed immunities to diseases such as smallpox as a result of trans-European trade and contact with livestock, while Native Americans' isolation from such trading routes and the absence of domesticated animals left them susceptible to opportunistic microbes.1 In 1887, Ottawa Andrew J. Blackbird also represented the origins of a smallpox epidemic, but he told a different story of disease. Blackbird explained that the epidemic originated in the 1750s in Montreal, where the "small pox was sold to them shut up in a tin box," which was promised to contain something that would "do them great good" and which the Ottawas were not to open until they returned home (9). Upon unfastening the box, they found a series of smaller boxes, which they opened until, as Blackbird writes: they came to a very small box, which was not more than an inch long; and when they opened the last one they found nothing but mouldy particles in this last little box! They wondered very much what it was, and a great many closely inspected to try to find out what it meant. But alas, alas! pretty soon burst out a terrible sickness among them. The great Indian doctors themselves were taken sick and died. The tradition says it was indeed awful and terrible. Every one taken with it was sure to die. Lodge after lodge was totally vacated—nothing but the dead bodies lying here and there in their lodges—entire families being swept off with the ravages of this terrible disease. (9-10) Blackbird's narrative of the "magic box" (Jaskoski 143) containing "mouldy particles" provides an alternative to Diamond's account of microbes, hosts, and evolutionary processes (Blackbird 9). While Diamond focuses on exposure and immunity to European diseases to explain colonial epidemics, Blackbird emphasizes the curiosity, deception, and terror that characterized colonial exchanges of illness. Smallpox is one of the gifts of colonization in Blackbird's account, and he exposes the devastating value of this gift by representing the deaths even of the "great Indian doctors" and scenes of dead bodies (9). In Diamond's history, the culprits of colonial [End Page 200] epidemics are microbes that act with an evolutionary desire to reproduce and to survive. Conversely, Blackbird highlights the material contexts and human costs of colonial encounters, and he presents a direct connection between disease and encounters between European colonists and Native Americans. These two stories, one from a microbe's perspective and one from an Ottawa Indian's point of view, parallel two approaches to colonial epidemics characterizing early American literary and historical studies. In the first, which can be aligned with Diamond's focus on laws of evolution and...

I’m Sorry and an Unexpected Response

I’m Sorry and an Unexpected Response

Access to Care: Too Much or Not Enough?

Access to Care: Too Much or Not Enough?

Christoph Gradmann, Laboratory Disease: Robert Koch’s Medical Bacteriology, Elborg Forster (trans.), (Baltimore: Johns Hopkins University Press, 2009), pp. viii + 318, £18.00/$35.00, hardback, ISBN: 978-0-8018-9313-1.

Most noteworthy biographical revisionism these days tends to remove the fig leaves of former hero worship from what Sigerist called the Great Doctors to reveal men and women as much of their times as anyone else. Yet I am hard put to think of any current work that strips any of these earlier superstars so naked that not an atom remains of genius, technical inventivity, moral leadership or whatever quality was deemed by their contemporaries to mark their greatness. So it is with Christoph Gradmann’s Robert Koch. In this excellent study, we see much more of the petty bourgeois, much more of the laboratory worker who arrived at and tested a ‘germ theory’, much more of the world out of which that theory came and into which it dissolved so as to make its truth obvious, yet in the end we are still left with that unique, enigmatic kernel, that composite of intellectual originality, practical creativity and amazing patience that made Koch an extraordinary medical innovator. Gradmann’s study is divided into four parts. The first on ‘Lower Fungi and Diseases; Infectious Diseases between Botany and Pathological Anatomy, 1840–1878’ is one of the best introductions I know of to that world of disease aetiology that looks so hideously complicated in the light of modern germ theory. This section, besides synthesising the secondary literature, endorses Koch’s own claim that he was doing something new. He turned away from pathology—pyaemia, septicaemia, etc.—as the object of study and investigated the symptoms of infectious disease in experimental animals and the specific micro-organism that supposedly caused them. Gradmann convincingly claims that Koch’s insistence on a constant one-to-one relation between bacterial species and symptoms was original—‘the classification of disease, correlated with the classification of bacteria’ (p. 58). Quite where Koch got this from is not revealed. We await Andrew Mendelsohn’s study of Koch for more on this. The second part of the book deals with ‘Tuberculosis and Tuberculin: History of a Research Program’ and part three, ‘Of Men and mice: Medical Bacteriology and Experimental Therapy, 1890–1908’ explores the relations between the germ theory as a laboratory science and clinical medicine. But since the focus of this latter part is mainly the clinical testing of tuberculin it continues the story begun in part two. That tuberculin, Koch’s cure for tuberculosis, was a failure and brought him some disgrace is well known. What Gradmann provides in these two sections is a better contextual understanding of this episode in terms of Koch’s character and the contemporary comprehension of and enthusiasm for germ theory. Most striking is that the very qualities that enabled Koch to provide substantial evidence for his germ theory abandoned him in his search for a TB therapy. He seems to have been impatient and hasty in his endorsement of data. Gradmann also deals here with the development of an experimental therapy for sleeping sickness and once again a similar tale of rushed conclusions emerges. The bigger picture here seems to be that if, at this time, in the world of diagnosis it was difficult to move the laboratory into the clinic in the universe of therapeutics it was almost impossible. The final section ‘Traveling: Robert Koch’s Research Expeditions as Private and Scientific Undertakings’ is both revealing as case study of the exportation of the medical laboratory as a colonising instrument and more so as an instance of the allure of Africa at this time and, personally, Koch’s love of hunting. Science in his later career seems rather like an excuse for bagging ‘everything that moved, from hippopotamuses to crocodiles, from herons to eagles’. Koch’s delight at having shot ‘a beautiful blue heron’ reminds us the past was a foreign country not very long ago (p. 223).

Confined Ontic Open Systems

Confined Ontic Open Systems is a new ecodynamic model based on Prigogine's thermodynamics, Ulanowicz's ontic openness and Coherence Domains with defined boundaries and constraints. The model has a wide range of applications, including ecosystems (e.g. invasive species, the lagoon of Venice), ecological economics, urban organization, the supra-molecular structure of water and global biosphere's models. The model is explained in terms of evolutionary thermodynamics and Jorgensen's ecosystems theory, namely out of chaos and eco-exergy. Particular attention is devoted to the emergence of novelties and to the role of water. COOS is an acronym for Confined Ontic Open Systems from the name of the Greek island (Kos, Coo or Coos) where the science of medicine originated at the time of Hippocrates. In Greek mythol- ogy, Asclepius, the first great doctor, ascended Mount Olympus as a god and was the first to love water. The primordial element water was considered essential in traditional Asclepiadean therapy, where the ritual of bathing was a form of purification before offering gifts to the great god of health. Hippocrates of Coos separated medicine from religion, magic and philosophy and used it in various fields. He was the first to describe the properties of water as one of the four elements (fire, earth and air) of human nature on which perfection (health, well-being) depends. Health was impaired if one or more of these elements were out of balance. Hippocrates had the merit of describing the power of water and of identifying the origin and characteristics that contribute to knowledge of diseases aris- ing from the environment, as distinct from those of human origin. He not only trusted the religion of the gods, but tried to coexist with it, teaching his students that Nature has its own life, which is not always tied to the supernatural and magic. The major problem of his studies was therefore to give medicine a theoretical instrument of effective explanation and a method of assessment that justified and upgraded the link between theory and experience. The development of the theory was seen as a new approach to medicine that was the forerunner of greater knowledge and the exchange of ideas with doctors operating outside COOS. Hippocrates therefore improved fundamental knowledge that was based on the tradition of religion, magic and observation of natural phenomena (1). The acronym COOS was coined to describe thermodynamic systems open to interactions with the outside, but that also maintain their own historical identity (ontic), because they are bound to the mem- ory of their origins. The primary aim of this paper is to present COOS as a new thermodynamic model for understanding evolutionary dynamics that create new structures and enable complexity to emerge, increasing the information in a great variety of systems, more commonly known as living systems capable of self-organization. In order to achieve this, living systems need to be protected (confined). RESULTS AND DISCUSSION 2 In order to introduce this new thermodynamic model, it is necessary to distinguish between isolated, closed and open systems. Isolated systems do not exchange energy or matter with their surround- ings. Closed systems exchange energy but not matter with the outside. Open systems exchange both energy and matter with their environment.

Towards a realistic approach to medical biography

It is notable that the history of medicine was first taught through biographies, and mainly through hagiographical texts of ‘great doctors’ – often called the Oslerian approach. Charles Coulston Gillispie saw the history of ideas ‘as centred on “individual great men”, the thought of a few brilliant lights who bravely probe at the “edge of objectivity” in a quest to advance the collective scientific understanding of humanity’. 1 Medical biography praises the inspirational work of these great doctors and medical men, exemplars in their fields. The social history of medicine attempted to demonize the old-school biographically-centred approach in the history of medicine, executing quite a hit on this mentality. Nevertheless, recent texts have proposed reconsidering the significance of medical biography by medical historians since biographies are, after all, another form of microhistory, versions of which currently fill the pages of medical history journals. Biography is suggested to have significance for the history of medicine but how is it possible to give reliable descriptions of facts, a necessary facet of history, if we tend to sanitize every action of the subject? A realistic approach depicts the subject in a more human dimension, under personal or social constraints and boundaries. Before we re-accept the role of medical biography in the history of medicine, we should reflect on the definition of biography and the purpose it serves. Nye 2 explains that it maintains a great public appeal and offers historians of science an opportunity to reach a

Oxygen.

Brooklyn, New York. david.eisenach@mail.mcgill.caOxygen. By Carol Cassella, M.D., New York, Simon & Schuster, 2008. Pages: 288. Price: $15.00.The great doctor and the great writer are equally defined by the same faculty: the sympathetic imagination. Without this, the doctor cannot inspire the confidence of the patient, so essential to a successful diagnosis and treatment. Similarly, the unsympathetic author will never succeed in creating well-rounded and believable characters, or forging the necessary connection with her readers. It is this imagination that creates and saves the lives that we cherish the most. Fortunately for us, Carol Cassella’s sympathetic imagination shines through her writing, and its product is her immensely successful first novel: Oxygen .This book brings readers into the world of Dr. Marie Heaton, who, like the author in real life, is an anesthesiologist. Her routine is launched into chaos after a young girl dies on her operating table from unknown complications. From this moment on, the narrative follows the arc of a Kafkaesque nightmare as one horrific and unresolvable event propels another. On top of her personal turmoil, Dr. Heaton is soon faced with a malpractice suit that becomes more and more serious as the facts of the case begin to reveal themselves. Yet there is more: a vein of intimate troubles runs through the novel as she must deal with an estranged and aging father, an old love returned, the feeling of anonymity engendered by her profession, and the debilitating loss of confidence that follows the death of a child at her hands.The course of events in Oxygen is certainly not unheard of in the medical world; many physicians can attest to the shock and personal struggle of malpractice suits from personal experiences. Doctors are often vilified in the mass media—and, therefore, in the public consciousness—as cash-hungry businessmen whose greed leads to disastrous neglect. Oxygen , however, paints a very different portrait of the accused: a confused and guilt-ridden individual who is, above all, a human being—and a highly moral one at that. Yet Cassella’s book is far from a self-congratulatory glorification of the medical profession. Instead, she takes aim at the bureaucracy of the healthcare and malpractice systems, both of which attempt to remove the humanity from dire situations that are all too human.Yet Oxygen is not only directed at those who harbor hesitations toward the medical community. Perhaps the best possible reader of this novel would in fact be a fellow anesthesiologist. There is great humor in Cassella’s characterization of various doctors, each of whom conform to knowable “types” (the smugly self-assured surgeon, the thrill seeker, the naively overconfident resident) without settling into clichés. But much more important is the sense of community engendered by this novel. At the core of the work is the search for redemption: how, or even if, the self can again be secured after the terrible accidents that invariably occur in the medical world. As Oxygen attests, a malpractice suit is an alienating thing, for one must fear not only the loss of faith in oneself, but also the loss of faith of one’s colleagues, friends, and family. While neither unrealistically optimistic nor sadistically dark, Cassella’s brilliant novel provides a voice of comfort for those who have been or will be involved in a malpractice suit at some point in their lives. Oxygen may not have all the answers, but it does let us know that, despite all appearances, we are not alone.Brooklyn, New York. david.eisenach@mail.mcgill.ca

Pride and prejudice

Pride and prejudice

Medical professionalism development of oliver R. Avison.

How does professionalism develop while becoming a great doctor? This study based on the life of Avison, a great doctor, aims to identify the developmental features of an excellence and professionally ethical doctor. We chose Oliver R. Avison, who founded the first modern hospital and medical school in Korea, now known as Severance Hospital and Yonsei University College of Medicine. Sixteen pivotal events in Avison's life were extracted, based on 2 standards: self-memory and strong feeling. Further we analyzed Avison' life using a professional development analysis model. Oliver Avison's medical professionalism development was divided into 4 periods: 'Motivating in Medicine period', 'Medical Training period', 'Medical Doctor period', and 'Medical Educating period'. A hallmark of Oliver Avison's medical professionalism development was the growth of motivation and social responsibility, medical knowledge, medical creativity, intra-personal intelligence, and relationship forming abilities. To excel in medicine, a medical student should be encouraged to understand his unique intellectual potentials and interest as a medical worker, and try to understand problems in the established domain and field of medicine, to develop new medical symbol systems, and climates.

Building a team of champion chiropractors

Building a team of champion chiropractors

Andrés Blei in memoriam

The Team of Liver Transplantation joins our colleagues and scientific organizations in honoring and mourning the loss of Andrés (Andy) Blei, MD, a distinguished hepatologist and clinical researcher in liver diseases. In spite of his heavy work load and chronic illness, he was a great supporter of Liver Transplantation. Andy was an active member on the Editorial Board of Liver Transplantation; he submitted and published many important papers in this journal and also participated in the peer-review process of manuscripts. The current Editorial Team overlapped with Andy in his role as Editor of Hepatology for two years. Andy truly believed that the complement of the respective sister journals, Hepatology and Liver Transplantation, was in the best interest of the growing community of liver disease specialists. Andy was always thoughtful, collegial and generous in his personal and professional interactions. Shortly before his death, he reflected on his role as Editor, in a letter he sent to the current Editors of Liver Transplantation: “Once your editorship is over, you will be able to reflect on a rich period of professional activity. And you will feel good about it.” At the 2008 Annual meeting of the AASLD, the liver community recognized his contributions by way of the acknowledgements that AASLD afforded in his memory, as well as the many expressions of sorrow and loss amongst his colleagues and friends. Andy will always remain among us; we are reminded of him when we come across his many contributions in the study of liver diseases; we are reminded of him when we pick up Hepatology and Liver Transplantation and realize his impact on the publication process; and we are reminded of him when we recall his wonderful smile and laugh. Thank you Andy, you were a great friend, colleague and doctor.

The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis

This article discusses the history surrounding the debate on the etiopathology of endometriosis, specifically deep infiltrating endometriosis, and traces the controversies in its management that are as pertinent today as they were when the disease was first described in the late 19th and early 20th centuries.

Newsmakers: Senator Tim Johnson

Newsmakers: Senator Tim Johnson

Progress in the history of Alzheimer's disease: The importance of context

The history of Alzheimer's disease (AD) is typically formulated as the history of great doctors and scientists in the past making great discoveries that are in turn taken up by great doctors and scientists in the present--all sharing the aim of unraveling the mysteries of disease and discovering how it can be prevented or cured. While it can certainly be edifying to study the "great men" and how their contributions laid the foundation for current work, there are problems with this approach to history. First, it oversimplifies the actual historical development of science. Second, using history to legitimate the present can keep us from asking critical questions about the aims and limits of contemporary research. This chapter urges a broader view of the history of AD, one that recognizes that context is as important as the great doctors to the historical development of the concept of AD. Thought of this way, I argue that it is useful to divide of the history of AD into three periods. First there was the period in which Alzheimer and Kraepelin laid the clinical and pathological foundations of the disease concept. Then there is our own period, which began in the late 1970s and has emphasized the biological mechanisms of dementia. In between, there is the period - almost completely ignored in most histories of AD--that conceptualized dementia in psychodynamic terms. It is true that the psychodynamic model of dementia did not directly contribute to the concepts and theories that dominate AD research today. But it did change the context of aging and dementia in important ways, without which AD could not have emerged as a major disease worthy of a massive, publicly supported research initiative.

The Story of the Johns Hopkins. Four Great Doctors and the Medical School They Created. By Bertram M. Bernheim, M.D. 47/8 × 71/4 in. Pp. 274 + xiv. Illustrated. 1949. Kingswood, Surrey : The World's Work (1913) Ltd. 12s. 6d

The Story of the Johns Hopkins. Four Great Doctors and the Medical School They Created. By Bertram M. Bernheim, M.D. 47/8 × 71/4 in. Pp. 274 + xiv. Illustrated. 1949. Kingswood, Surrey : The World's Work (1913) Ltd. 12s. 6d