Medicine Going Research Articles

Where Has the Awe in Medicine Gone? Part II

This is the second part of a two-part article on the loss of awe in medicine. In the first article, I defined awe and discussed its benefits to healthcare providers. Today, we are experiencing unprecedented levels of burnout among healthcare providers, resulting in doctors leaving the practice of medicine in unprecedented numbers. Most physicians who are retiring don’t really want to quit. What we really want is to rekindle the meaning and joy that we once had. We really want to put the awe back into medicine. This second article discusses several approaches to replenishing the sense of awe in healthcare.

Where Has the Awe in Medicine Gone? Part I

Do you remember when you started medical school and received your first white coat? That symbol made us feel like real doctors, and all the energy and effort that was spent to reach that ceremony was worth it. How about the first time you were in the labor and delivery room and participated in the birth of a baby? Or how about the first time you conducted a history, performed a physical exam, wrote findings for the proctor, and functioned like a real doctor? Or how about when you were making rounds with the chief resident, and they told you where to put your stethoscope so you might hear the opening snap of mitral stenosis ... and you really did hear it? These were those special moments that made you feel exhilarated and provided you with a sense of awe. This article defines awe and its benefits to healthcare providers.

The Joy of Practicing Medicine

Medicine has traditionally been regarded as a profession which provides tremendous job satisfaction. Many doctors and even medical students are being increasingly dissatisfied with the practice of medicine. In the past, when doctors met, they used to talk about the interesting patients they helped to treat. These days they usually talk about financial stresses, job pressures, bureaucratic hassles and red tape. Doctors are increasingly toying with the idea of changing careers, while others are burning out in their mid-forties, where has the joy of practicing medicine gone?

Medicine Goes to the Opera: Vocal Health and Remedies for Professional Singers of the Belle Époque

In July 1892, Dr. Arthur Chervin (1850–1921), director of the Institut des bègues de Paris, was named physician of the Opéra, thus joining the group of health specialists tasked with the care of artists. A recognized specialist of vocal physiology and speech afflictions, Chervin was also the recent founder and editor of La Voix parlée et chantée, a periodical that straddled the worlds of medicine and lyrical performance. Vocal health and medicine, he and his community argued, were key to the execution of vocal prowess and the successful pursuit of lyrical ambitions for singers. This article explores the relationship of medicine and the burgeoning field of laryngology to the world of lyrical training and performance of the Belle Époque. In particular, we focus on the many roles played by laryngologists and physicians at the Opéra and the Conservatoire as well as in the pages of Chervin’s leading medical-musical journal. We argue that concerns driving the medical innovations of the increasingly sophisticated subfield of laryngology evolved in synergy with concerns about how to meet the demands of the changing world of the second half of nineteenth-century Parisian operatic performance. In so doing, we claim for medicine a key position in Paris’s vibrant world of lyrical performance during the Belle Époque.

Expecting the Unexpected: When Use of Complementary Alternative Medicine Goes Wrong

Expecting the Unexpected: When Use of Complementary Alternative Medicine Goes Wrong

Lancet Commission on the Value of Death

Without death every birth would be a tragedy. “We die so that others may live, we grow old so that others may be young”, writes the poet Kate Tempest. 1 Tempest K Let them eat chaos. Picador, London2016 Google Scholar Yet medicine continues to strive to keep patients with life-limiting illnesses alive, often beyond the point of benefit. Many people in high-income countries, and those in poorer countries who are able to access quality health care, have an uneasy relationship with death, unlike some traditional societies. 2 Kellehear A A social history of dying. Cambridge University Press, Cambridge2007 Crossref Scopus (286) Google Scholar Serious people hold out the prospect of immortality, 3 O'Connell M To be machine: adventures among cyborgs, utopians, hackers, and the futurists solving the modest problem of death. Granta Books, London2017 Google Scholar while dying baby boomers want as long a life as possible, symptom control, and a personalised death—a combination that may be unachievable. Yet many people around the world die without access to morphine or any care, illustrating the gross disparities that surround death. 4 Lancet Commission on Palliative Care and Pain Relief Study GroupAlleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet. 2017; 391: 1391-1454 PubMed Google Scholar Has medicine gone wrong in the way it deals with death? The Lancet Commission on the Value of Death will explore the relationship of medicine to death, consider failures in the relationship, and share ideas on how it might be improved.

Precision Medicine Goes Global: How to Get It Right? Four Ways to Mobilize Scientific Knowledge.

Globalization and knowledge mobilization (KM) are twin challenges impacting precision medicine currently. Previous KM models have been largely limited to an implementation framework whereby knowledge is imagined as a billiard ball to be simply rolled over from the laboratory to society and from developed to developing countries. This narrow and sanitized understanding of KM and science as being detached from social forces, human values, politics, and power inequities does not help to achieve robust and responsible emergence of precision medicine, not least because tailored medicines are not simple products ready to use off-the-shelf without customization in each country, local context and society. It is time to broaden the art and science of KM by rethinking knowledge as a dynamic co-product of both technology and social systems in which science is embedded. This article presents an analysis of the four possible approaches to KM available to the precision medicine community: (1) "knowledge implementation," (2) "research collaborator capacity building," (3) "collaborative entanglement" that removes the barriers between research and practice, and extends knowledge co-creation activities beyond scientists by inviting publics, patients, and clinicians as researchers, and (4) "knowledge ecosystem" approach that adopts systems thinking, addressing not only technology development but also the politics of innovation, whereby power differences in scientific practice are addressed, for example, to achieve gender parity and diversity in the scientific work force. Blending of laboratory science with KM theory and practice informs robust and responsible emergence of precision medicine innovations, and helps strike the right balance between promotion and regulation of emerging technologies.

\u201cFive hundred years of medicine gone to waste\u201d? Negotiating the implementation of an intercultural health policy in the Ecuadorian Andes

BackgroundIn Ecuador, indigenous women have poorer maternal health outcomes and access to maternity services. This is partly due to cultural barriers. A hospital in Ecuador implemented the Vertical Birth (VB) policy to address such inequities by adapting services to the local culture. This included conducting upright deliveries, introducing Traditional Birth Attendants (TBAs) and making physical adaptations to hospital facilities.MethodsUsing qualitative methods, we studied the VB policy implementation in an Ecuadorian hospital to analyse the factors that affect effective implementation of intercultural health policies at the local level. We collected data through observation, in-depth interviews, a focus group discussion, and documentation review. We conducted 46 interviews with healthcare workers, managers, TBAs, key informants and policy-makers involved in maternal health. Data analysis was guided by grounded theory and drew heavily on concepts of “street-level bureaucracy” to interpret policy implementation.ResultsThe VB policy was highly controversial; actors’ values (including concerns over patient safety) motivated their support or opposition to the Vertical Birth policy. For those who supported the policy, managers, policy-makers, indigenous actors and a minority of healthcare workers supported the policy, it was critical to address ethnic discrimination to improve indigenous women’s access to the health service. Most healthcare workers initially resisted the policy because they believed vertical births led to poorer clinical outcomes and because they resented working alongside TBAs. Healthcare workers developed coping strategies and effectively modified the policy. Managers accepted these as a compromise to enable implementation.ConclusionsAlthough contentious, intercultural health policies such as the VB policy have the potential to improve maternity services and access for indigenous women. Evidence-base medicine should be used as a lever to facilitate the dialogue between healthcare workers and TBAs and to promote best practice and patient safety. Actors’ values influenced policy implementation; policy implementation resulted from an ongoing negotiation between healthcare workers and managers.

Medicine Goes Female: Protocol for Improving Career Options of Females and Working Conditions for Researching Physicians in Clinical Medical Research by Organizational Transformation and Participatory Design.

BackgroundAll European countries need to increase the number of health professionals in the near future. Most efforts have not brought the expected results so far. The current notion is that this is mainly related to the fact that female physicians will clearly outnumber their male colleagues within a few years in nearly all European countries. Still, women are underrepresented in leadership and research positions throughout Europe.ObjectivesThe MedGoFem project addresses multiple perspectives with the participation of multiple stakeholders. The goal is to facilitate the implementation of Gender Equality Plans (GEP) in university hospitals; thereby, transforming the working conditions for women working as researchers and highly qualified physicians simultaneously. Our proposed innovation, a crosscutting topic in all research and clinical activities, must become an essential part of university hospital strategic concepts.MethodsWe capture the current status with gender-sensitive demographic data concerning medical staff and conduct Web-based surveys to identify cultural, country-specific, and interdisciplinary factors conducive to women’s academic success. Individual expectations of employees regarding job satisfaction and working conditions will be visualized based on “personal construct theory” through repertory grids. An expert board working out scenarios and a gender topic agenda will identify culture-, nation-, and discipline-specific aspects of gender equality. University hospitals in 7 countries will establish consensus groups, which work on related topics. Hospital management supports the consensus groups, valuates group results, and shares discussion results and suggested measures across groups. Central findings of the consensus groups will be prepared as exemplary case studies for academic teaching on research and work organization, leadership, and management.ResultsA discussion group on gender equality in academic medicine will be established on an internationally renowned open-research platform. Project results will be published in peer-reviewed journals with high-impact factors. In addition, workshops on gender dimension in research using the principles of Gendered Innovation will be held. Support and consulting services for hospitals will be introduced in order to develop a European consulting service.ConclusionsThe main impact of the project will be the implementation of innovative GEP tailored to the needs of university hospitals, which will lead to measurable institutional change in gender equality. This will impact the research at university hospitals in general, and will improve career prospects of female researchers in particular. Simultaneously, the gender dimension in medical research as an innovation factor and mandatory topic will be strengthened and integrated in each individual university hospital research activity. Research funding organizations can use the built knowledge to include mandatory topics for funding applications to enforce the use and implementation of GEP in university hospitals.

Five-hundred years of medicine gone to waste? Negotiating intercultural health policy in Ecuador

BackgroundIn Ecuador, access to maternity services remains signifi-cantly lower amongst indigenous women compared withnon-indigenous women partly due to cultural barriers [1].A hospital in Ecuador where the indigenous rights move-ment is particularly strong implemented the Vertical Birth(VB) policy to increase indigenous womens’ access tomaternity services by adapting services to the local culture.This included conducting upright deliveries, introducingTraditional Birth Attendants (TBAs) and making physicaladaptations to hospital facilities.Materials and methodsThis qualitative study explored the delivery of maternityservices for indigenous women in an Ecuadorian hospital.Data was collected through observation, in-depth inter-views, a focus group discussion, and documentationreview (e.g. hospital routine data). 40 interviews wereconducted with Health Workers (HWs), managers, andpolicy-makers involved in maternal health at the fieldhospital. Data analysis was guided by grounded theoryand drew heavily on concepts of“street-level bureau-cracy” to explore implementation.ResultsActors’ values motivated their support or opposition tothe VB policy and conflict ensued. Managers, policy-makers, indigenous actors and a minority of HWs sup-ported the VB policy. For this group, improving HWs’attitudes towards indigenous women, widely perceived asdiscriminatory, was key to promote equitable access toservices. Most HWs initially resisted the VB policybecause they were concerned about the clinical implica-tions they attributed to the VB policy (e.g. postpartumhaemorrhage and vaginal tears) and the tensions thatstem from working alongside TBAs (e.g. conflictingadvice given to patients). Nonetheless, TBAs played acrucial role in the VB implementation; they becamewomen’s advocates and helped improve HWs’ attitudestowards indigenous women. HWs effectively modifiedthe VB policy and developed coping strategies to dealwith their concerns. Managers accepted these as a com-promise to enable implementation. Implementation alsosucceeded because those supporting the VB policy weremore powerful and because HWs concerns over clinicalcomplications subsided.ConclusionsWhilst highly controversial, intercultural health policiessuch as the VB policy have the potential to improvematernity services for indigenous women.The VB implementation was heavily shaped by HWs’values and resulted from an ongoing negotiationbetween HWs and managers.

A Call for Management and Economic Training in Medical Education

To the Editor: Practicing medicine in the current environment is more demanding than ever. In addition to providing high-quality clinical care, physicians must adopt electronic medical records, navigate health care reform, and maintain their practices under the constant threat of reimbursement cuts. Are “the golden days” of medicine gone? We think the answer is “No.” But to overcome these challenges, we must train a new breed of physicians. What new skills will these doctors need? We propose three categories: population medicine proficiency, organizational expertise, and business competence. Regarding the first category, the traditional dogma of focusing on the individual patient is necessary but no longer sufficient. Today’s physicians are expected to provide appropriate clinical care to each patient while also being good stewards of public resources. To do so, they must understand the findings of clinical effectiveness research and be exposed to all health care stakeholders (e.g., pharmaceutical companies, insurers). Such preparation will help them effectively navigate the health care system to provide cost-effective, high-quality care for their patients. Second, physicians must have organizational expertise. They need opportunities to refine “soft” skills like managing, public speaking, and negotiating. These competencies can enable them to be effective players in the nation’s discourse on health care. Changes in each physician’s practice environment are inevitable, and they must be equipped with the tools to take an active role in navigating these changes. Finally, doctors would benefit from training in business fundamentals. A basic understanding of finance, accounting, marketing, and strategy is required in order to develop a nuanced view of health care reform and to execute effective strategies for operating hospitals and clinics in an ever-changing environment. Mastery of these areas will ensure that research is properly financed, that clinical leaders are effectively rewarded, and that the necessary resources are available to safeguard the social mission and autonomy of medical professionals. For too long, physicians have allowed professional managers and government regulators to control care delivery. But this does not have to be the case. Physicians are highly intelligent and hardworking. But to succeed in medicine today, they need more. Armed with the skills described above, this new breed of doctors will be a powerful force—ensuring that health care remains accessible to patients and friendly toward physicians for generations to come. Chia Wu MD/MBA candidate, Perelman School of Medicine and Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; [email protected] Peter Derman, MD, MBA Orthopaedic surgery resident, Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York.

Nobel Prize in Medicine Goes to Two Physician Scientists With Close Ties to ASH

Nobel Prize in Medicine Goes to Two Physician Scientists With Close Ties to ASH

Educating Patients as Medicine Goes Green

When a patient challenges the use of a reusable, stainless steel speculum rather than a plastic, throw-away one, the physician should educate her on the safety and environmental benefits of reusable medical devices.

The Nobel Prize in Medicine Goes to Fighters of Global Epidemics

The Nobel Prize in Medicine Goes to Fighters of Global Epidemics

Hospice and Palliative Medicine Goes Mainstream

Journal of Palliative MedicineVol. 9, No. 6 News from the AAHPMHospice and Palliative Medicine Goes MainstreamRonald SchonwetterRonald SchonwetterSearch for more papers by this authorPublished Online:22 Dec 2006https://doi.org/10.1089/jpm.2006.9.1240AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySpirituality and end-of-life care in disadvantaged men dying of prostate cancer19 December 2010 | World Journal of Urology, Vol. 29, No. 1Changes in the Quantity and Level of Evidence of Palliative and Hospice Care Literature: The Last CenturyJournal of Clinical Oncology, Vol. 26, No. 35 Volume 9Issue 6Dec 2006 InformationCopyright 2006, Mary Ann Liebert, Inc.To cite this article:Ronald Schonwetter.Hospice and Palliative Medicine Goes Mainstream.Journal of Palliative Medicine.Dec 2006.1240-1242.http://doi.org/10.1089/jpm.2006.9.1240Published in Volume: 9 Issue 6: December 22, 2006PDF download

Medicine Goes to School: Teachers as Sickness Brokers for ADHD

Christine Phillips explores the roles of teachers as brokers for ADHD and its treatment, and the strategies used by the pharmaceutical industry to frame educators' responses to ADHD.

Medicine Goes to the Mall: Enhancement Technologies and Quality of Life

The proliferation of enhancement technologies and pharmacological agents has perpetuated the view of American doctors and patients of medical care as a market commodity driven by what consumers want and are willing to pay for. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply.

Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional support and fluid replacement. The decision-making process should be based on a knowledge of the risks and benefits of giving or withholding treatments. There is no clear evidence that increased nutritional support or fluid therapy alters comfort, mental status or survival of patients who are dying. Rarely, subcutaneous fluid administration in the dying patient may be justified if the family remain distressed despite due consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from reversible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid replacement therapy should be given along with the specific treatments for the condition.

Death, Dying and Bereavement

Introduction to Second Edition - Jeanne Katz PART ONE: LIFE AND DEATH Introduction - Jeanne Katz Death in Staithes - David Clark Death Denied - Philippe Ari[ac]es Death in the News - Tony Walter, Jane Littlewood and Michael Pickering The Public Invigilation of Private Emotion Approaches to Death in Hindu and Sikh Communities in Britain - Shirley Firth Demographic Change and the Experience of Dying - Clive Seale Health Policy and Services for Dying People and Their Careers - Christina R Victor Sudden Death from Suicide - Stella Ridley The Dream - T R S The Good Death? - Mary Bradbury Little Henry or, God Will Take Care of Me - H M Benson Death Be Not Proud - John Donne Aubade - Philip Larkin Do Not Go Gentle into That Good Night - Dylan Thomas The Prophet - Kahil Gibran Doctor's Mask on Pain - Jane Martin Spiritual Care of Dying People - Alyson Peberdy Death and the Meaning of Life - Leo Tolstoy PART TWO: CARING FOR DYING PEOPLE Introduction - Jeanne Katz Extending Specialist Palliative Care to All? - David Field and Julia Addington-Hall The Case for Palliative Care in Residential and Nursing Homes - Moyral Sidell, Jeanne Katz and Carol Komaromy Complementary Medicine - Patrick C Pietroni Its Place in the Care of Dying People Speaking Out - Sarah Palmer Caring for Mother - Susan Leifer Plus Postscript Living with MS - Richard Were Saturday Times Column 3.10.98 - John Diamond The Alphabet - Jean-Dominique Bauby Communication in Palliative Care - Robert Buckman A Practical Guide Saturday Times Column 23.1.99 - John Diamond Communicating with Dying Children - Dorothy Judd Jewish Perspectives on Death, Dying and Bereavement - Jeanne Samson Katz The Syllabus - Mitch Albom Dying Trajectories, the Organization of Work and Expectations of Dying - Anselm Strauss Sitting It Out - Elizabeth Dean A Very Easy Death - Simone de Beauvoir Teach Me to Hear Mermaids Singing - Clare Vaughan PART THREE: DILEMMAS AND DECISIONS AT THE END OF LIFE Introduction - Jeanne Katz Learning the Hard Way - Clare Williams Somebody Loves Me - Anthony Masters The Death of Ivan Ilyich - Leo Tolstoy Intimacy and Terminal Care - Judy Gilley The Use of Deception in Nursing - Kevin Teasdale and Gerry Kent Do-Not-Resusciate Decisions - Johannes J M van Delden The 'Blue-Spotted' Patient - Basiro Davey Do-not-resuscitate decisions in the acute surgical wards of a district general hospital. The Main Tradition - Fiona Randall and R S Downie Right to Die or Duty to Live? - William Grey The Problem of Euthanasia Euthanasia and Assisted Suicide - Luke Gormally Seven Reasons Why They Should Not be Legalized A Student's Story - Anonymous Betting Your Life - Christopher James Ryan An Argument against Certain Advance Directives Palliative Care and the Doctrine of Double Effect - Stephen Wilkinson Palliative Care and the Ethics of Resource Allocation - Eve Gerrard On Withholding Nutrition and Hydration in the Terminally Ill - Gillian M Craig Has Palliative Care Medicine Gone Too Far? On Withholding Nutrition and Hydration in the Terminally Ill - R J Dunlop, J E Ellershaw, M J Baines, N Sykes and C M Saunders Has Palliative Medicine Gone Too Far? A Reply PART FOUR: BEREAVEMENT: PRIVATE GRIEF, COLLECTIVE RESPONSIBILITY Introduction - Jeanne Katz Bereavement as a Psychosocial Transition - Colin Murray Parkes Processes of Adaptation to Change The Social Distribution of Sentiments - Lindsay Prior Cross-Cultural Perspectives on Bereavement - Shirley Firth I Desperately Needed to See My Son - Sheila Awooner-Renner A Single Parent Confronting the Loss of an Only Child - Evelyn Gillis Epitaph of Libby Dickenson, 1798-1818 - Anonymous Care of the Suddenly Bereaved - D W Yates, G Ellison and S McGuiness Pregnancy Loss and the Death of a Baby - Nancy Kohner Parents' Choices When a Baby Dies - Gavin Fairbairn A Father's View Gay and Lesbian Bereavement - Dudley Cave The Grief That Does Not Speak - Maureen Oswin Personal and Medical Memories from Hillsborough - Tom Heller Ruth - Lesley Moreland Death by Murder Essays upon Epitaphs - William Wordsworth December - Douglas Dunn

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?

This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession.