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The nature of suffering and the goals of medicine
This is a revised and expanded edition of a classic in palliative medicine, originally published in 1991, with three added chapters and a new preface summarizing our progress in the area of pain management. The obligation of physicians to relieve human suffering stretches back into antiquity. But what exactly, is suffering? One patient with cancer of the stomach, from which he knew he would shortly die, said he was not suffering. Another, someone who had been operated on for a minor problem—in little pain and not seemingly distressed—said that even coming into the hospital had been a source of pain and suffering. With such varied responses to the problem of suffering, inevitable questions arise. Is it the doctor's responsibility to treat the disease or the patient? And what is the relationship between suffering and the goals of medicine? According to the author of this book, these are crucial questions, but ones that have unfortunately remained
only queries void of adequate solutions. It is time for the sick person, the author believes, to be not merely an important concern for physicians but the central focus of medicine. With this in mind, he argues for an understanding of what changes should be made in order to successfully treat the sick while alleviating suffering, and how to actually go about making these changes with the methods and training techniques firmly rooted in the doctor's relationship with the patient.
eBook
Technology and the doctor-patient relationship
\"Medicine is an ancient profession that advances as each generation of practitioners passes it down to the next. It remains a distinguished, flawed and rewarding vocation-but it may be coming to an end as we know it. Computer algorithms promise patients better access, safer therapies and more predictable outcomes. Technology reduces costs, designs more effective and personalized treatments and diminishes fraud and waste. Balanced against these miraculous developments is the risk that medical professionals will forget their primary responsibility is to their patients, not to a template of care. Written for anyone who has considered a career in health care-and for any patient who has had an office visit where a provider spent more time doing data-entry than examining them-this book weighs the benefits of emerging technologies against the limitations of traditional systems to envision a future where both doctors and patients are better-informed consumers of health care tools\"-- Provided by publisher.
Book
Biological, clinical, and ethical advances of placebo effects
For many years, placebos have been defined by their inert content and their use as controls in clinical trials and treatments in clinical practice. Recent research shows that placebo effects are genuine psychobiological events attributable to the overall therapeutic context, and that these effects can be robust in both laboratory and clinical settings. There is also evidence that placebo effects can exist in clinical practice, even if no placebo is given. Further promotion and integration of laboratory and clinical research will allow advances in the ethical use of placebo mechanisms that are inherent in routine clinical care, and encourage the use of treatments that stimulate placebo effects.
Journal Article
From detached concern to empathy : humanizing medical practice
Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. The book argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy. How can doctors use empathy in diagnosing and treating patients without jeopardizing objectivity or projecting their values onto patients? The book develops an account of emotional reasoning as the core of clinical empathy. It argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet it argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?
eBook
Attending : medicine, mindfulness, and humanity
\"As a third-year Harvard Medical student doing a clinical rotation in surgery, Ronald Epstein watched an experienced surgeon fail to notice his patient's kidney turning an ominous shade of blue. In that same rotation, Epstein was awestruck by another surgeon's ability to slow down and shift between autopilot and intentionality. The difference between these two doctors left a lasting impression on Epstein and set the stage for his life's work--to identify the qualities and habits that distinguish masterful doctors from those who are merely competent. The secret, he learned, was mindfulness\"--Amazon.com.
Book
The Patient–Doctor Relationship and Online Social Networks: Results of a National Survey
ABSTRACT
BACKGROUND
The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient–doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described.
OBJECTIVE
To quantify the use of OSNs, patient interactions within OSNs, and attitudes toward OSNs among medical students (MS), resident physicians (RP), and practicing physicians (PP) in the United States.
DESIGN/SETTING
A random, stratified mail survey was sent to 1004 MS, 1004 RP, and 1004 PP between February and May 2010.
MEASUREMENTS
Percentage of respondents reporting OSN use, the nature and frequency of use; percentage of respondents reporting friend requests by patients or patients’ family members, frequency of these requests, and whether or not they were accepted; attitudes toward physician use of OSNs and online patient interactions.
RESULTS
The overall response rate was 16.0% (19.8% MS, 14.3% RP, 14.1% PP). 93.5% of MS, 79.4% of RP, and 41.6% of PP reported usage of OSNs. PP were more likely to report having visited the profile of a patient or patient’s family member (MS 2.3%, RP 3.9%, PP 15.5%), and were more likely to have received friend requests from patients or their family members (MS 1.2%, RP 7.8%, PP 34.5%). A majority did not think it ethically acceptable to interact with patients within OSNs for either social (68.3%) or patient-care (68.0%) reasons. Almost half of respondents (48.7%) were pessimistic about the potential for OSNs to improve patient–doctor communication, and a majority (79%) expressed concerns about maintaining patient confidentiality.
CONCLUSION
Personal OSN use among physicians and physicians-in-training mirrors that of the general population. Patient–doctor interactions take place within OSNs, and are more typically initiated by patients than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic.
Journal Article
Narcissism and Its Discontents
The definition of narcissism can be a moving target. Is it an excess of self-love? Profound insecurity? Low self-esteem? Too much self-esteem? Because of the multifaceted nature of narcissistic personality disorder (NPD), treating this disorder presents clinicians with a range of wholly unique challenges.
Narcissism and Its Discontents recognizes the variable nature of NPD and provides a template for adjusting treatment to the patient rather than shoehorning the patient into a manualized treatment that may prove to be less effectual.
This guide offers clinicians strategies, including transference and countertransference, to deal with the complex situations that often arise when treating narcissistic patients, among them, patient entitlement, disengagement, and envy. The authors provide a skillful integration of research and psychoanalytic theory while also addressing psychotherapeutic strategies that are less intensive but also useful -- being cognizant of the fact that a majority of patients do not have access to psychoanalysis proper.
A chapter on the cultural aspects of narcissism addresses the recent societal fascination with NPD in the discourse on politics and celebrity, particularly in the age of social media. Regardless of the treatment setting -- psychoanalysis, psychotherapy, pharmacotherapy, partial hospital, or inpatient -- clinicians will find a wealth of approaches to treating a diverse and challenging patient population in Narcissism and Its Discontents.
eBook