Physician Ought Research Articles

Targeted Therapies for Allergic Conjunctivitis

Allergic eye disease is extremely common as the eye is sensitive to irritants due to its constant exposure to the external environment. Approximately 40% of the general population is affected by ocular allergies. The majority of patients may also suffer with additional associated symptoms of allergic rhinitis, such as nasal congestion, sneeze, etc.; however, 6% may have isolated ocular symptoms. In addition, there are links between ocular allergies and other allergic conditions such as asthma, food allergy and atopic dermatitis. The challenge is that in addition to ocular symptoms, patients experience a substantial negative influence on their quality of life (QOL). The most common symptoms are watery and itchy eyes; redness; soreness; stinging; burning sensations; and swelling. Unfortunately, as these symptoms are quite common, most patients may choose to self-medicate and many cases are undiagnosed or underdiagnosed. As a result of this, patients may not utilize the correct management strategy; this can lead to a further propagation of symptoms and a greater reduction in patients’ QOL. Hence, it is crucial for patients to seek professional medical attention, while physicians must gather a comprehensive medical history and conduct relevant investigations. Additionally, the physician ought to propose the correct diagnosis and suitable treatment plan.

Patient-Physician Relationship: In Defence of W. D. Ross’s Prima Facie Duties

The patient-physician relationship is one of the most prevalent and topical issues in bioethics. Using various ethical theories and concepts, bioethicists and philosophers in general have offered similar and contrasting arguments on how a physician ought to treat and relate with his patient. The aim of this paper is to centre on William David Ross’s notion of “Prima Facie Duties” and its implications for human actions, especially, in the discourse on patient-physician relationship. This paper attempts to resolve the problem of the patient-physician relationship in relation to truth-telling in medical professions using Ross’s prima facie duties. Hence, this paper looks beyond the deficiencies of ideal utilitarianism and the stringency of Kant absolutism.

“I’m afraid I can’t let you do that, Doctor”: meaningful disagreements with AI in medical contexts

This paper explores the role and resolution of disagreements between physicians and their diagnostic AI-based decision support systems (DSS). With an ever-growing number of applications for these independently operating diagnostic tools, it becomes less and less clear what a physician ought to do in case their diagnosis is in faultless conflict with the results of the DSS. The consequences of such uncertainty can ultimately lead to effects detrimental to the intended purpose of such machines, e.g. by shifting the burden of proof towards a physician. Thus, we require normative clarity for integrating these machines without affecting established, trusted, and relied upon workflows. In reconstructing different causes of conflicts between physicians and their AI-based tools—inspired by the approach of “meaningful human control” over autonomous systems and the challenges to resolve them—we will delineate normative conditions for “meaningful disagreements”. These incorporate the potential of DSS to take on more tasks and outline how the moral responsibility of a physician can be preserved in an increasingly automated clinical work environment.

Johnny Tested Positive for COVID-19, What Is Next for the Team?

Johnny Tested Positive for COVID-19, What Is Next for the Team?

Evaluation of Subclinical Adrenal Insufficiency in Patients with Active Tuberculosis

The existence of subclinical adrenal insufficiency in active tuberculosis is a matter of debate and little is known in this regard. This analytical cross-sectional study is contemplated to find out the association between active tuberculosis and subclinical adrenocortical insufficiency. Where 77 active tubercular patients have been included consecutively in the study along with 30 age and sex matched healthy controls for comparison. Nearly two-thirds (64.9%) of the cases ware diagnosed as pulmonary tuberculosis and rest 35.1% as extra pulmonary tuberculosis. In pulmonary tuberculosis 68.8% had subclinical adrenal insufficiency but 31.2% in extra pulmonary tuberculosis. It shows that 62.3% of the cases had sub-clinical adrenocortical insufficiency as opposed to none in the control group (p < 0.001). Adrenal insufficiency appeared to be significantly associated with smear positivity, X-ray evidence of severe disease and multi-drug resistance. Therefore, physician ought to look for subclinical adrenal insufficiency among patients with active tuberculosis specially if they are sputum positive, X-ray evidence of severe disease and multidrug resistant TB. Faridpur Med. Coll. J. Jul 2019;14(2): 67-70

Michael Alberti and the Medical Therapy of the Internal Senses.

In the first half of the eighteenth century, the German physician Michael Alberti was responsible for hundreds of dissertations and other works in medicine. While the bulk of the production reflected the dominating medical topics of his time, he also developed an original focus on the internal senses and their effects on bodily health and disease. Depending on whether internal senses, such as imagination and memory, were cultivated in the right way or not, they could work as powerful remedies or as equally powerful triggers of disease and even death. This article explores this little known strand of early modern medicine in three steps. First, it shows that Alberti’s medicine took form in intimate connection to the Stahlian brand of Pietist medicine. As such, it further elaborated an existing strand of medicine that was intimately connected to German Pietism. Second, it analyses in some detail the role of the internal senses from a pathological and therapeutic perspective as well as examining what kind of persona the physician ought to embody. Lastly, it raises larger questions regarding how to understand this strand of early modern medicine. Rather than approaching it from the perspective of disciplinary history, the article seeks to reconstruct it as a part of what has sometimes been referred to as the early modern cultura animi tradition.

Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria.

Urinary incontinence is a source of health-related poor quality of life. It is, however, rarely disclosed, except when specifically enquired about by the healthcare provider. This study determined the prevalence of urinary incontinence and opportunistic screening for it in women attending a general outpatient clinic. A total of 1,250 consenting women attending a general outpatient clinic in Ile-Ife, a semi-urban town in Southwest Nigeria, were recruited into this cross-sectional study. Confidential post-consultation interviews were performed in each patient to determine whether they had been asked about urinary incontinence and whether they felt that they ought to have been asked. The Questionnaire for Urinary Incontinence Diagnosis (QUID) was administered to determine the prevalence and pattern of urinary incontinence. Results were expressed as proportions and compared using the Chi-squared test. The subjects' ages ranged from 20 to 100 years (mean = 46.8 ± 17.7 years). Sixty-five women had urinary incontinence (prevalence = 5.2 %). QUID classified 30 (2.4 %), 23 (1.8 %), and 12 (1.0 %) of them as having urge, stress, and mixed incontinence respectively. None of them self-reported incontinence to their physicians. Only 9 incontinent (13.8 %) and 44 continent women (3.7 %) had opportunistic screening (p < 0.001). Fifty of the incontinent women (76.9 %) felt that their physician ought to have asked them about it. Forty-eight of them (73.8 %) did not consider incontinence a sufficient reason for presentation in hospital, but the majority (90.7 %) desired treatment. Urinary incontinence was occasionally present, but usually undisclosed by women attending the general outpatient clinic, unless when specifically asked by their physicians. Opportunistic screening is therefore recommended in this setting.

Noncompliance: „Kontraindikation” für die Organtransplantation?

Noncompliant behaviour is often taken to constitute a "contraindication" to an otherwise necessary organ transplantation. At the face of it this appears reasonable, given that strict adherence to the regimen of immunosuppressive medication following the transplantation is a prerequisite of the therapy's success. Nonetheless, from an ethical point of view the classification as contraindication is questionable. Firstly, doing so may lead to lose sight of the manifold possibilities to change patient behaviour. Secondly, the classification wrongly suggests that the physician ought to relate to the patient as a neutral observer and judge rather than as a participative guide and assistant. Clinical practice as well as medical guidelines on organ transplantation ought to take account of this special status of the criterion of non-compliance.

醫療行善: 中國醫學道德傳統的詮釋

LANGUAGE NOTE | Document text in Chinese; abstract also in English.中國古代醫學道德具有悠久的傳統。中國醫學史上“醫乃仁術”的命題，充分體現了中國醫學傳統十分重現醫療實踐的倫理價值。該文基於中國傳統文化的背景從四個方面討論了醫療行善的思想基礎和實踐意義。首先，文章追溯了中國古代儒、道、佛思想對醫療行善觀念的重要影響，指出中國傳統醫學的醫療行善觀念是以儒家仁愛思想為核心，融合了道家和佛家的仁慈、慈悲觀念而形成的一種多元價值取向的框架體系。其次，該文闡述了中國傳統醫學非常重視醫療實踐的道德價值，其中主要包括強調醫療活動以病人而不是疾病為中心；將病人視為一個整體的人而不是損傷的機器；主張關懷病人、尊重病人；重視醫患之間的合作關係；重義輕利、捨利取義的理想人格成為醫生的追求目標；反對義醫射利。再次，文章評述了在以儒家文化背景下醫療行善的社會道德價值，表現在：知識分子因各種原因不能治國安邦時，將行醫治病作為實現個人價值的重要途徑；將行醫治病作為增進家族或家庭和睦的有效手段；將行醫治病作為傳播宗教思想的重要途徑；將行醫治病作為政府舒緩民怨的良方。最後，該文簡要地比較了中西方醫療實踐中醫療行善觀念的異同，指出醫療行善作為醫療實踐的一項最基本原則在中西方得到普遍的認同，但是，在具體的實踐過程中，中西方對於醫療行善的理解和解釋依然存在着一定的差異。西方醫學倫理學認為醫療行善應服從於尊重病人自主權，醫療行為的善體現在以病人利益為目的，而中國醫學倫理學則是強調醫生救死扶傷的義務，主張醫療行為在注重病人利益的同時也應兼顧家庭的利益。China has a long standing of a dominant medical ethical tradition. This tradition can be characterized a medial beneficence. The physician, within this tradition, is morally required to pursue the best interest of the patient rather than the best interest of himself. The practice of this tradition is characteristic of the Chinese culture of family determination on medical issues and is also closely related to the basic virtues approved in the Chinese community.This tradition is rooted in three primary Chinese religions. First, Confucianism sets the basis of Chinese medical beneficence. Confucianism emphasizes humanity (ren) as the fundamental principle of human life. Humanity represents a specific human heart-mind that has been invested to every human by Heaven, the ultimate reality. The human heart-mind includes the potential of loving, respecting others, and distinguishing right and wrong. Accordingly, humanity, in its very basic sense, requires loving humans. Medicine provides a good means in practicing humanity. Thus in Chinese culture medicine is termed "the art of humanity." In addition, the Confucian virtue of filial piety has often been the impetus to push the Chinese physician to study and practice medicine effectively.Daoism cherishes human life and seeks to gain longevity in terms of Daoist techniques, such as doing physical exercise and making chemical drugs. It includes a strong idea of retribution. Heaven, earth, and man co-exist in a vast field of qi (flowing energy), where qi of each part influences others through the influence of the qi field. Good moral behavior, according to Daoism, becomes a necessary condition for one to be able to gain longevity or even immortality. Thus, Daoism joins Confucianism in stressing that the physician ought to do his best to help the patient improve health, both bodily and mentally.Chinese Buddhism is similar in this regard. A crucial idea involved here is the Buddhist concept of karma. Karma is literally "action," "doing," or "deed." It says that one reaps what one sowed. Until one is entirely enlightened, everyone goes through an infinite process of rebirth and the result of one's rebirth depend s upon one's accumulated karma. Hence one must do as much good as possible in order to obtain a better next life. Practicing medicine is an effective tool to achieve this goal. Besides, the Buddhist precepts such as "no killing" also plays an important role in Chinese medical practice.In short, Confucian, Daoist, and Buddhist teachings have shaped the Chinese tradition of medical beneficence. This tradition requires the physician to place the patient's benefit first and the physician's interest second. For Confucianism, this is the requirement of human appropriate ness, fairness, or justice. This tradition also shows a closely-knit team work between the physician and the family to seek the best interest for the patient. The consideration of truth- telling to the patient and the patient's right to medical decision has never been emphasized.DOWNLOAD HISTORY | This article has been downloaded 32 times in Digital Commons before migrating into this platform.

The Christian Physician in the Non-Christian Institution: Objections of Conscience and Physician Value Neutrality

Christian physicians are in danger of losing the right of conscientious objection in situations they deem immoral. The erosion of this right is bolstered by the doctrine of "physician value neutrality" (PVN) which may be an impetus for the push to require physicians to refer for procedures they find immoral. It is only a small step from referral to compelling performance of these same procedures. If no one particular value is more morally correct than any other (a foundational PVN premise) and a physician ought to be value neutral, than conscientious objection to morally objectionable actions becomes a thing of the past. However, the argument for PVN fails. Therefore, Christian physicians should state their values openly, which would allow patients the ability to choose like-minded physicians. Some possible responses to this erosion of conscientious objection include, disengagement from non-Christian institutions, the formation of distinctly Christian medical institutions and political action. However, for the Christian the initial focus should be on a life of holiness which requires each of us to avoid evil.

Euthanasia, the terminal patient, and the physician's role.

A random sample of Cleveland clergy was asked to assess 1) the terminal patient's views on death, 2) the desires of some terminally ill patients to find an easy and dignified death, and 3) the role the physician ought to play in treating terminal patients. Protestant clergy more than their Catholic counterparts are substantially in favor of 1) disclosure of terminal illness, 2) allowing an easy death for the terminal patient at his request, and 3) facilitating the role of the physicians in cases of terminal illness. Fundamentalist Protestants are less approving than liberal Protestants. Clerics who saw their role extend beyond man's spiritual need approve of the physician's disclosure of terminal illness and his cooperation with patients who request with holding or terminating medical treatment. The Uterature abounds with reports of the role conflict medical professionals are increasingly experiencing in treating terminal patients. Technological advance, material costs, the moral and reUgious feelings of the patient, family pressure, and fear of legal risks aU create severe conflict for physicians.1 The two central functions of the medical profession are the struggle against death and disease and the aUeviation of pain and suffering.2 Medical education, with its lack of preparation for caring for the dying patient and its firm dedication to the Hippocratic Oath, interpreted as the saving of Ufe at any cost, is a major source of role conflict.3 The physician is in a quandary because he is expected both to ease suffering and to save Ufe.4 Currently, it appears that the medical imperative of sustaining aU Uves, regardless of costs, may be the more encompassing force acting on the physician.5 In fact, it seems as though death offends the medical profession.6 Unfortunately medical education does not provide adequate training to deal with various complicated problems connected with death. Physician surveys reveal that few doctors beUeve that their approach to the patient with terminal disease owes anything to medical training. Furthermore, doctors disagree markedly concerning what such patients should be told.7

A Moral Theory of Informed Consent

M o st medical codes of ethics, and most physicians, agree that the physician ought to obtain the free and informed of his subject or patient before attempting any serious medical procedure, experimental or therapeutic in nature. They agree, moreover, that a proxy consent ought to be obtained on behalf of the incompetent subject. And informed consent is seen as not merely a legal requirement, and not merely a formality: it is a substantial requirement of morality. Acceptance of this doctrine, however, requires the solution of a number of problems. How much information need be imparted? At what age is a person mature enough to consent on his own behalf? Can prisoners give a free and informed to be experimented upon? Lurking behind these and similar questions there are more fundamental difficulties. What are the functions of consent for the competent and the incompetent? What is the sense in which the patient/subject must be free, informed, and competent? It is by way of an approach to these latter questions that I shall attempt to respond to the more specific questions.'

THE COUNTRY DOCTOR.

A country doctor ought to know what any trained physician ought to know. In order to make a success of his profession he must have a most thorough preliminary education, must avail himself of the advantages of his medical course to the utmost and be determined to improve himself at every opportunity. His training when he enters on his life's work has simply laid open to his vision a glimpse of its possibilities. His future depends largely on his capacity for work. His savings for years must be reinvested in office equipment. He must embrace the opportunities freely given by the masters of the profession at their clinics to see their work and to learn to a certainty that their success has been by intense application for years along definite lines. Specialism is only a division of labor as practiced by all people as they have advanced through the various

THE EXTENSION CORSET AND ITS INDICATIONS.

Lewis A. Sayre revolutionized the treatment of tubercular processes of the spinal column by the propaganada of absolute immobilization and freedom from pressure of the diseased portion. That the results obtained by his method were unprecedented is amply evidenced by the fact that his principles have made a triumphal tour around the civilized world and that the use of the plaster of paris corset has come to be considered indispensable in the treatment of Pott's disease. The symptoms of tubercular infection of the spinal column, first described by Perceval Pott in 1783, have been dilated upon by Sayre in so clear and scholarly a manner that every physician ought to memorize his words, so as to always have them at command; for how many beginners in practice fail to diagnose properly the early stages of Pott's disease and owing to their lack of skill expose themselves to the serious charge

CURABILITY OF CONSUMPTION.

About 200 years ago (in 1672), Sir Thomas Browne, the author of that famous book, the<i>Religio Medici</i>—which every physician ought to read—wrote his almost equally famous "Letter to a Friend upon Occasion of the Death of his Intimate Friend." In this letter there is much curious and interesting writing in regard to consumption, to which disease the subject of it fell a victim. Of him Sir Thomas Browne says that he is "by this time no Puny among the mighty Nations of the Dead; for tho he left this World not very many days past, yet every hour, you know, largely addeth unto that dark Society; and considering the incessant Mortality of Mankind, you cannot conceive there dieth in the whole Earth so few as a thousand an hour." He describes, in like quaint terms, the symptoms of consumption and the signs of approaching death, and reflects the common

CARBONATE OF TITANIUM.

Read before the Detroit Academy of Medicine, November 18, 1884. Gentlemen of the Academy: The use of a class of remedies whose composition is either wholly the secret of the manufacturer, or else is deliberately misrepresented in the statements purporting to give an account of their composition, seems to be gaining ground among reputable physicians. I cannot but regard this as a misfortune to the profession. A few years ago there were few educated physicians who would attempt to defend the use of nostrums and secret remedies. Now I meet often with men who hold a high position in the medical profession who openly maintain that the physician ought not to be restricted in any way in the choice of his remedies. They take apparently high philanthropic ground, and say that we have no right to deprive our patients of the benefit they might obtain from the use of a