Medical Thinking Research Articles

The body in old age: Pernicious medical and materialist thinking

This article looks at the historical construction of knowledge about the elderly body from a medical perspective that is concerned with the materiality of the body and associated losses. It recalls, presents and analyses the paradigm of loss, decline and failure that dominates the way care is provided, and examines the issues associated with this domination. By presenting old age as a social construct produced by language and subject to values relating to a certain performance of the body, the author invites us to shift our perspective and take a finer, more complex and broader view of the body and the experience of being old.

Teaching abductive reasoning for use as a problem-solving tool in organic chemistry and beyond

The second-year undergraduate Organic Chemistry course sequence is often cited as one of the most, if not the most, challenging for students in the US. Thus, a persistent question remains: What is it about Organic Chemistry that makes the course so difficult for students? Herein, we put forward the hypothesis that a new mode of thinking and problem solving is expected of the students; these skills have not yet been developed in their prior scientific coursework and are often not deliberately taught in Organic Chemistry. This form of reasoning and problem solving, known as abductive reasoning, is highlighted for its connection to medical diagnosis and scientific thinking. We provide examples to showcase how instructors could explicitly foreground the reasoning process in their classroom. Ultimately, we argue that teaching how to reason using abduction may benefit students in both the short term (in the course) and the long term (in their careers as scientists and medical practitioners).

Out of Sight, Out of Mind: reflections from the Covid era on social knowledge and medical thinking in Adolf Lukas Vischer’s ‘barbed wire disease’

ABSTRACT This article explores the relationship between wartime captivity and the production of medical knowledge through the phenomenon of ‘barbed wire disease’. This was a term used by First World War POWs and internees themselves to describe symptoms of depression and related neurological disorders. The Swiss surgeon Adolf Lukas Vischer borrowed it for the title of a book he wrote in 1918 suggesting that the spatial and temporal peculiarities of camp life made prolonged captivity in such an environment inhumane and a threat to future societal stability. The article argues that Vischer’s findings should be seen through the lens of historical time. His observations led him to draw attention to the contemporaneous plight of previously highly mobile and self-reliant migrants across the world now living for an unknown duration within the confines of the barbed wire. Yet equally, the article makes the case for thinking in a transhistorical way about the (often under-appreciated) mutual inter-dependence of social knowledge and medical thinking, especially in times of large-scale displacement. The shadow of the past, it will be suggested, continues to shape approaches to the mental health problems faced by people living in atypical temporal and spatial settings today, including those experiencing the symptoms of Long Covid and those held in immigration detention.

Reproducing the normal and the pathological in personalized cancer medicine clinical trials

AbstractThe medical practice termed Personalized Medicine ideally uses all the patient’s possible characteristics in predicting disease predisposition and response to therapy, but primarily employs the individual’s unique molecular make-up in the tailoring of treatment. This change in medical practice also entails an epistemic shift towards ‘molecularization’: individuals and disease are now understood and governed through life’s basic building blocks. In this paper we argue that underlying personalized medicine is a continued understanding of the pathological state as a quantitative deviation from a normal state. In this we build on the critique of French philosopher Georges Canguilhem who positioned the quantitative interpretation of the pathological in nineteenth century medical thinking. Personalized cancer medicine takes each patient’s cancer as singular, implying that there is no ‘normal’ baseline for comparing individual pathology. We analyze cases of personalized cancer clinical trials from recent years to show that each displays a quantitative understanding of the pathological reminiscent of past thinking in two main modes: a molecularized interpretation of cancer pathology and a quantitative measuring of targeted therapy efficacy. We situate the analysis in broader discussions of historical medical shifts and in current studies of personalized medicine, to outline implications of this form of continuity.

Clinical observation using virtual reality for dental education on surgical tooth extraction: A comparative study

BackgroundClinical observation conducted during the 3rd and 4th years of dental school is an important part of dental students’ clinical education. However, conventional clinical observation is associated with several problems, including the lack of opportunity for all students to assist during surgery. Virtual reality (VR) technologies and devices can be used to demonstrate clinical processes that dental students need to learn through clinical observation. This study aimed to evaluate the effectiveness of teaching dental students the surgical tooth extraction procedure through clinical observation using VR.MethodsWe recruited third- and fourth-year dental students and divided them into a VR clinical observation group (VR group) and a conventional clinical observation group (control group). The control group visited an outpatient clinic and observed an oral and maxillofacial specialist perform surgical tooth extraction, whereas the VR group watched a 360° video of surgical tooth extraction using a head-mounted display. After observation, both groups were surveyed regarding their satisfaction with the clinical observation and their understanding of the procedure.ResultsUnderstanding of the procedure and satisfaction with the observation were significantly higher in the VR group than in the control group (p = 0.001 and p = 0.047, respectively). Compared with conventional clinical observation, VR clinical observation improved learning motivation and medical thinking and judgment skills; however, interaction between professors and students was lacking.ConclusionsVR clinical observation using 360° videos might be an effective teaching method for students. However, to allow interaction between professors and students during clinical observations, using it along with conventional clinical observation is necessary.

The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors.

Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.

Fertility preservation before cancer treatment: the dilemma of saying 'no' as the price of glory.

A great deal of work has been carried out by professionals in reproductive medicine in order to raise awareness about fertility preservation (FP) techniques, particularly for women, and to ensure that FP is included in the care of young adults treated for cancer or a pathology requiring gonadotoxic treatment. If the importance of the development of our discipline is obvious, our militancy in favour of FP and our emotional projections must not make us forget that medical thinking must be carried out not only on a case-by-case basis, weighing up the benefit-risk balance, but also without losing sight that conceiving a child with one's own gametes is not a vital issue. The cultural importance given to the genetic link with offspring may bias patients' and physicians' decisions, while other ways of achieving parenthood exist, and are often more effective. Systematic information should be provided on the existence of FP techniques, but this should not lead to their systematic implementation, nor should it obscure that early information will also allow patients to begin projecting themselves in alternative options to become parents.

The temporality of economic decisions applied to clinical reasoning

INTRODUCTION: Medical thinking lacks economic thinking although temporality plays a crucial role in shared clinical decision-making. Present benefits, such as symptom relief, at times, should not be underestimated in the economic evaluation of medical interventions; and immediate effects in present benefit scenarios allow for valuable feedback, aiding in the assessment of the appropriateness of the chosen intervention. Ultimately, we underscore the need for a nuanced understanding of the interplay between time, costs, and benefits in clinical decision-making.

How do medical schools influence their students' career choices? A realist evaluation.

The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking. We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made. A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school. Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits ('easing in') but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.

"A Person Like Me": Systemic Lupus Erythematosus, Gender, and Racial Immunity in the Twentieth-Century United States.

Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects mostly women and disproportionately Black women. Until the 1940s, SLE was rarely diagnosed in Black Americans, reflecting racist medical beliefs about Black immunity. In the 1940s and 1950s, SLE and its treatment were part of a patriarchal narrative of American industrialization. By the 1960s, newer diagnostic techniques increased recognition of SLE, especially among Black women; medical thinking about SLE shifted from external causes like infection or allergy to autoimmunity, which emphasized biological, genetically determined racial difference. In the 1970s and 1980s, an advocacy structure crystalized around memoirs by women with SLE, which emphasized the experiences of able-bodied, economically privileged white women, while Black feminist health discourse and SLE narratives by Black authors grappled with SLE's more complicated intersections. Throughout the twentieth century, SLE embodied immunity as a gendered, racialized, and culturally invested process.

On improvement of legal regulation of personnel training in the sphere of state forensic medical activity

Legislation and industry-specific regulatory documents of Russia, some historical aspects and current problems of staffing in forensic medical organizations were analyzed to improve legal and regulatory framework for skilled personnel training in the sphere of forensic medical examination. Changes in the qualification requirements to medical and pharmaceutical workers with higher education in specialty are proposed, namely to remove restrictions on the possibility of postgraduate training in forensic medical examination specialty for those who have received higher medical education (specialist's degree program) in «medical and preventative care» specialty, considering the interdisciplinary relationship between forensic medical activity and preventive medicine, common approaches to the specialist's degree programs formation and general medical thinking development in students. This will help to achieve the target of the President and the Government of the Russian Federation on provision of health care with qualified personnel and increase of staffing of specialists in forensic medical organizations.

The History of Orthopedics in the Long Term: From General Medicine to Medical Specialties.

A thorough literature search was done in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of medicine and orthopedics. The philosophical ideas that emerged in ancient Greece served as a foundation for the development of medicine. In the 5th century BC, the schools of Knidos and Kos emerged as influential centers for the development of medical thinking. The field of orthopedics can be traced back to early human civilizations. Ancient Egyptians perpetuated the tradition of employing splinting techniques. Hippocrates provided insights for the diagnosis, correction and treatment of many musculoskeletal entities. The field of medicine experienced a period of limited advancement during the Middle Ages. The Renaissance provided for the foundation of modern orthopedics and important contributions to the understanding and implementation of antisepsis. The discovery of x-ray and advancements in infection control and anesthesia have shown substantial progress in the domain of orthopedics and have contributed to the development of orthopedic subspecialization. Orthopedic surgery holds a historical lineage deeply entrenched in ancient practices and early human civilizations. Physicians specializing in orthopedics should be aware of the historical origins of their discipline and continue to evolve through further subspecialization and enhanced research.

Social Media and Social Ills: Overcoming the Challenges in the Contemporary Era

Social media has become an integral part of modern society, offering unprecedented opportunities for communication, education, entertainment, and activism. However, social media also poses significant challenges and risks for individuals and communities, such as cyber bullying, misinformation, privacy predation, mental depression, social isolation, and addiction. Especially, this paper reviews the situations of the positive and negative effects of social media on various aspects of human well-being for the children and teens age group, such as physical and mental health, social capital, personal privacy, civic engagement, and democratic participation. It also discusses the potential strategies and interventions to overcome the challenges and enhance the benefits of social media in the contemporary era. To overcome these challenges, the article proposes solutions such as enhancing content moderation procedures, promoting digital and medical literacy and critical thinking among users, implementing transparent and accountable procedures, and fostering collaboration between platforms, policymakers, and civil society organizations. These include promoting digital literacy, fostering online civility, regulating harmful content, supporting vulnerable users, and encouraging positive online behaviors. The paper concludes by highlighting the need for more interdisciplinary and collaborative research on the complex and dynamic relationship between social media and social ills.

Neuroscience in pictures:1. History of psychiatric neuroscience

Our understanding of the brain basis of mental illness has evolved over three and half millennia. Early insights into the role of the brain in relation to the mind faded during the middle ages as mental illness became the province of religion, spirituality, and philosophy. Psychiatry became a medical discipline again as medical and scientific thinking evolved during the 17th century. However, progress in neuroscience and astute clinical observations were punctuated by setbacks due to lingering dualism, reductionistic thinking, and dogma. Accelerating neuroscience discoveries and methodological innovations are beginning to bring neuroscience and psychiatry closer than ever as we begin the 21st century, This pictorial article seeks to briefly highlight this journey for an early trainee in psychiatry and related professions in mind.

Sexology, sexual development, and hormone treatments in Southern Europe and Latin America, c.1920–40

Displacing the physiological model that had held sway in 19th-century medical thinking, early 20th-century medical scientists working on hormones promoted a new understanding of the body, psychological reactions, and the sexual instinct, arguing that each were fundamentally malleable. Hormones came to be understood as the chemical messengers that regulated an individual's growth and sexual development, and sexologists interested in this area focused primarily on children and adolescents. Hormone research also promoted a view of the body in which ‘hermaphroditism’, homosexuality, and ‘sexual perversions’ such as masochism and sadism were attributed to anomalies in the internal secretions produced by the testes or the ovaries. This article focuses on Spanish, Italian, Argentinian, and Brazilian sexology shaped by endocrinological research in the interwar period. First, it shows the key role hormone treatments played in the historical development of sexology in Southern Europe and Latin America. Second, it looks at how sexologists employed hormone research to study human sexual development in the early stages of life, and how they set about ‘correcting’ what they viewed as ‘sexual anomalies’.

Mothers’ Milk and Mothers’ Time: Childcare Advice and the Conceptualization of Demand Feeding in Post-1945 Britain and Italy

AbstractThis article draws on childcare advice to investigate the shift from breastfeeding by the clock to feeding on demand in twentieth-century Britain and Italy, to demonstrate that it was not just mothers’ bodies, nor what they fed their children, but their time that was subject to political, medical, and cultural attention. The comparative approach highlights the convergences and divergences in breastfeeding advice, illuminating the interactions with political and intellectual currents, as much as social and economic patterns. ‘Scientific motherhood’ and the promotion of feeding by the clock dominated in Britain and Italy at the beginning of the century, and persisted under fascist initiatives to regulate breastfeeding. Some existing differences, however, contained the seeds of greater divergence after 1945 in the two countries. Shaped by differing intersections of medical, psychoanalytic, and feminist thinking, the uneven shift to the concept of demand feeding slowly took root in Britain in the post-war period, but in Italy only in the context of 1968 counter-cultural ideas. The 1970s brought the conversation back to a point of convergence between Britain and Italy in the feminist recognition of the complexities of balancing the ‘rights and duties’ of mothers and children when it came to feeding babies.

Online education isn’t the best choice: evidence-based medical education in the post-epidemic era—a cross-sectional study

BackgroundThe COVID-19 pandemic led many educational institutions to shift to online courses, making blended education a significant trend in teaching. We examined the effectiveness of blended learning in an evidence-based medicine course.MethodsWe compared the examination scores of a blended learning group, an online only group, and a traditional offline group and conducted a questionnaire survey on students’ preferences for different learning modes and the reasons for their preferences. A total of 2100 undergraduate students in clinical medicine were included in this cross-sectional study. Examination results were collected, and questionnaires were administered to the study participants. We compared the mean scores and exam pass rates of the three teaching groups using ANOVA and c2test for multiple comparisons.ResultsThe blended group’s exam scores and pass rate were significantly higher than those of the offline and online groups. Furthermore, 71.6% preferred the blended teaching mode. In the survey on " learning effectiveness”, the majority of the students believed that blended education could better enhance the initiative of learning, the interest of the course, the pertinence of the learning content, the comprehension of evidence-based medical thinking, and the basic skills of evidence-based practice. Subsequently, in a questionnaire administered to a blended group of students, their foremost reason for liking online instruction was ‘flexible in time and space’ (99%), followed by ‘can be viewed repeatedly, facilitating a better understanding of knowledge points’ (98%). Their foremost reason for liking offline teaching was ‘helps to create a good learning atmosphere’ (97%), followed by ‘teachers can control students’ learning status in real time’ (89%).ConclusionsThis study explored the effectiveness of learning in evidence-based medicine courses by comparing the learning outcomes and personal perceptions of three different teaching modes. This is the first cross-sectional study in which three different teaching models are compared and discussed in an evidence-based medicine course. We also elaborate on the specific instructional protocols for each model. This study shows that using a blended education approach in evidence-based medicine courses can improve students’ learning motivation, autonomy, and satisfaction. It also enhances instructional efficiency, thereby improving students’ understanding of the course content.

Medical Thinking in the Light of Classical, Non-Classical and Post-Non-Classical Rationality

In the modern theory and practice of medical sciences, one can observe the proximity of various types of rationality, which determine both the direction and quality of thinking. This is due both to the heterogeneity of the development of various areas of medical culture and clinical thinking. This determines the relevance and expediency of the study, associated with the need to distinguish between the prevailing methods of rationality of medical thinking; to determine its direction and, accordingly, the effectiveness in the activities of medical workers. The definition of the limitations inherent in a particular type of scientific rationality in relation to medical thinking. This approach makes it possible to overcome the limitations associated with foundations of thinking in one form or another of scientific rationality, thereby expanding the heuristic possibilities of medical thinking itself as such. To achieve the goal of the study, methodological practices of philosophical reflection and analysis of thought processes are used. Classical rationality is characterized by a mechanistic approach to a person; non-classical rationality is characterized by the penetration of researchers into the microcosm and a corresponding expansion of ideas about reality; post-nonclassical rationality is characterized by a search for integrity and interactions, as well as human-dimensional research practices. The main conclusion arising from the study was the statement that medical thinking is characterized by the use of various types of rationality, which determines both the deontological approach to the patient, based on appropriate medical anthropology, and the choice of strategies and methods of treatment.

L’Assommoir and Zola’s Nuanced Vision of Nineteenth-Century Alcoholism

This article examines depictions of problem drinking in Emile Zola’s 1877 L’Assommoir, situating the novel within contemporaneous writings about alcoholism. While criticism has long found in Zola’s novel the ruinous effects of hereditary degeneration, I propose that L’Assommoir also illuminates the flaws in nineteenth-century French medical thinking about alcoholism. One curious point about L’Assommoir is that this most famous work of French literature to deal with alcoholic drinking never uses the word alcoholism or alcoholic. Underneath that very elision, though, is a surprising amount of clarity and modern nuance about the realities of the disease. In the context of a contemporaneous French medical discourse that argued for the feasibility of moderation in drinking, that overwhelmingly counted wine as part of the solution, and that underscored the damning role of heredity, this novel is clear about the variance among constitutions, even among people in the same demographic and with similar family histories. It indicates that individual compulsion, not solely choice, and not solely heredity, drives the problem drinker. It also indicates that an alcoholic compulsion can be nourished through wine. In this manner, Zola was more aligned with the modern disease model of alcoholism than the prevailing French wisdom of his time.

Reflections on the Implications of the Developments in ChatGPT for Changes in Medical Education Models

Ever since its official launch, Chat Generative Pre-Trained Transformer, or ChatGPT, a natural language processing tool driven by artificial intelligence (AI) technology, has attracted much attention from the education community. ChatGPT can play an important role in the field of medical education, with its potential applications ranging from assisting teachers in designing individualized teaching scenarios to enhancing students' practical ability for solving clinical problems and improving teaching and research efficiency. With the developments in technology, it is inevitable that ChatGPT, or other generative AI models, will be thoroughly integrated in more and more medical contexts, which will further enhance the efficiency and quality of medical services and allow doctors to spend more time interacting with patients and implement personalized health management. Herein, we suggested that proactive reflections be made to figure out the best way to cultivate health professional in the context of New Medical Education, to help more medical professionals enhance their understanding of developments in artificial intelligence, and to make preparations for the challenges that will emerge in the new round of technological revolution. Medical educators should focus on guiding students to make proper use of AI tools in the appropriate context, thereby prevening abuse or overreliance caused by a lack of discrimating ability. Teachers should focus on helping medical students make improvements in clinical reasoning skills, self-directed learning, and clinical practical skills. Teachers should stress the importance for medical students to understand the philosophical implications of the mind-body unity concept, holistic medical thinking, and systematic medical thinking. It is important to enhance medical students' humanistic qualities, cultivate their empathy and communication skills, and continually enhance their ability to meet the requirements of individualized precision diagnosis and treatment so that they will better adapt to the future developments in medicine.