Friday, July 28, 2006
Wednesday, July 26, 2006
I've just watched this unsettling documentary about the role and power of corporations. I was interested especially in the idea that the corporation is seen in the law as an individual, thus granting it the rights to buy and sell, for example.
The documentary held the idea of a corporation as an individual accountable for its actions, and in doing so diagnosed it with a personality disorder under the ICD 10 and DSM IV classifications, used by psychiatrists worldwide. By creating a list of personality features, the filmmakers dubbed the corporation individual a psychopath. Despite this being a legal term, it correlates most closely with what is identified under the ICD (International Disease Classification, as organised by the World Health Organisation) as an Anti-Social or Dissocial Personality Disorder. Features include a lack of empathy for others, a lack of accountability for one's own actions and manipulative strategies to further oneself.
The documentary used a number of medical, social and biological methods to investigate the corporate entity, which proved interesting and systematic.
Tuesday, July 25, 2006
We filled out feedback forms on our own performance, and those watching from a video link also graded us on various aspects of the consultations, as well as practical skills. We then gave our thoughts on the whole set-up and what we thought was good and could be improved in the future.
The system is a new approach implemented by Imperial College and called Integrated Procedural Performance Instrument (IPPI), whereby instead of performing a procedure on a dummy (and pretending it's a real patient) with an examiner present, the idea is a more natural approach, allowing more freedom and avoiding the contrived circumstances currently available for assessment. One can be graded by an examiner watching from another room, which aids the candidate's ease and flow.
Experiencing the trial first hand was interesting, not least as I had the chance to reflect on the way I deal with patients, as well as how I explain things to them. But it's also exciting to be involved in the evolution of medical assessment, and I commend the direction it is taking - currently we are assessed by Objective Structured Clinical Examinations (OSCEs), in which the time limits, lack of actors and patients to interact with and the presence of examiners makes the whole affair unrealistic and false. IPPI also encourages more personality than simply 'ticking all the boxes.'
Welcome to our garden. We’ve gathered together a multicoloured collection of species from all over the world. We’re interested here at Medical Humanities in artistic and literary metaphor which is why we’ve chosen gardening as our theme this week. So often matters medical are portrayed in the language of war: the fight against disease, the battle against cancer. These are the metaphors that have dominated medical discourse in the mainstream media. Yet, the military metaphor is not inevitable. Health-care professions tend their patients with the devotion and attention that gardeners lavish on their plants, hoping to keep them healthy. Medical Anthropologist Cecil Helman demonstrates in this narrative, ‘Possession’, the parallels between illness and a breakdown of order, as if in a garden overgrown with weeds. Our blogs, of course, are also little patches of territory, requiring cultivation and maintenance, and facilitating cross-fertilisation of ideas. We hope you enjoy a virtual tour through our 'Grand Grounds'.
The Knot Garden
Whether in Medieval, Renaissance or Contemporary times, the Knot Garden has always been characterised by intricate design detail. Like well-designed horticultral reports, the compartments of these gardens told their own stories through plant and pattern.
- Over at Breath Spa For Kids Shinga reports in song on the effects of pollution on children's lungs. A Buteyko Breathing practitioner and CapnoTrainer (biofeedback) trainer, Shinga raises awareness of the effects of pollution on our children. The statistics are frightening.
- The impact of the environment upon our health is taken indoors in Andrew Barna's report at Hospital Impact. Barna's survey of the 2006 Industrial Design Excellence Awards, gives particular mention to the Medical and Scientific Products category. The Insulet Omnipod Personal Diabetes Management System strikes me as a cross between a mobile phone and an IPOD. Products like these look familiar. Perhaps that sense of familiarity makes them easier to use.
- The precision of the Knot Garden must require a manual, or perhaps a good gardening program, to guide the gardener through the maze of planting, pruning and weeding. In a similar way, Grey's Anatomy (starring Ellen Pompeo and Sandra Oh) guides the medical student. Or does it? At My Life, My Pace, we get a student's take on 'school, lab and life' and find out house Grey's Anatomy misguides students about the training and lifestyles of surgeons.
- Sitting in a quiet corner of the Knot Garden we have time and space to contemplate and wonder. Rica Lode's poem at Genetics and Health concerns her frustration in trying to find pre-implantation diagnosis for neurofibromatosis 1 (NF1), from which her husband suffers.
- Talking RN presents us with some poignant thoughts on invasive brain fungal infection. They "sang ... in five-part harmony then they prayed". This is surely Talking RN's reflective side.
The Flower Garden
- Ideas for Women considers the therapeutic value of art in coping with breast cancer. Blogger Trisha explores the idea that expressing emotion through visual art and music brings healing.
- At Unbounded Medicine Dr Jon Mikel Inarritu presents us with biomedical images. Looking at an image of human colon cancer cells, he remarkes, is beautiful and bad at one and the same time.
- The wonderful image of a rollercoaster, 'delivered' to us at Navelgazing Midwife, doesn't exactly hide something bad behind the beautiful. Rather, what we have is a strangely apt analogy for birth and parenthood in a photograph of a fun fare ride. How come? Well, sometimes you laugh, sometimes you cry and you have little choice but to go with the flow and enjoy the ride!
This is the place to relax and chat about interesting cases. We've assembled a group of bloggers here who, sundowners in hand, all have stories to tell about incidents this week that have meant something to them.
- Sometimes illness presents treasured opportunities, as Diabetes Mine found out when prompted by a question from her nine-year-old.
- Six Until Me relates an encounter with a diabetic child at a health fair which made a strong impression.
- When children turn into adolescents, doctors often find themselves having 'That Talk': the one about sex, drugs and alcohol. One such talk took place in The Examining Room of Dr. Charles, during which Dr Charles almost divulged a recipe for the greatest Sangria in the world, and his commentors seemed to get sidetracked into other prickly subjects!
- ChronicBabe has a round-up of tips from her readers on how to handle those irritating people that don't appreciate what living with a chronic condition is like.
- My Humble Opinion tells the story of a survivor of abuse illustrating how important an understanding of body language and non-verbal cues is to effective intervention.
- Dr Jest is off on holiday, but before he goes, he reflects on the difficulties of a holidaying doctor and asks for advice on appropriate behaviour when carrying out a breast examination in Dr Jest's Caseblog.
- Doctor Anonymous no doubt would also appreciate a holiday. He poses some tough questions after a long night of being on call. He also gets some answers to the question, 'Why?', from his readers.
The Physic Garden
Created in the pursuit of research of the properties, conservation and origins of plants, and to train apprentices in plant identification, the Physic Garden represents the technical side of our submissions.
- Cancer Commentary advises on earlier detection of lung cancer via a novel blood test.
- Role reversal in acute appendicitis: rather than look at the classic signs and symptoms, RDoctor Medical Portal gives us the patient experience.
- Read a personal account of 7 ways Yoga has helped the writer at RadicalHop.com.
- Medical judgement is a difficult call. Experience breeds authority, as demonstrated in this difficult case of possible ectopic pregnancy over at Storkdoc.
The Kitchen Garden
Growing your own fruit and veg can be both nutritious and fulfilling – here we take a look at the role of nutrition and medicine.
- Coffee is nectar to the hospital hive. Thankfully it's memory enhancing too, says straightfromthedoc.
- Sceptical of natural remedies? So is Hot Cup of Joe in this review of Kevin Trudeau’s ‘Natural Cures’.
- Obesity is bigger than ever. Is this thanks to the American diet?, asks diseaseproof.com.
- Unconventional approaches to treatment are all very well, but what about in the case of a child? Respectful Insolence fills us in. [Part 1] [Part 2]
The Potting Shed
The potting shed is the space where growth is acknowledged. Medical knowledge is accumulative, and often this involves adapting our ideas to accommodate new developments. It is like selecting an appropriate new pot for a growing seedling.
[Picture courtesy of http://news.bbc.co.uk/olmedia/1020000/images/_1023527_bill150.jpg]
The Herbaceous Border
- Emergiblog, blogging from her local Starbucks, explains why immediate bedding is a bad idea, whether one has the collywobbles or not.
- Being on the other side of the consultation has lead GruntDoc to evaluate his own bedside manner.
- While we're admiring the flowers here, it seems apt to mention Allergizer's link to information on the collection of vespids for their venom to be used in life-saving vaccines.
- Tundra Medicine Dreams provides an illuminating insight into the role of breastfeeding in Yupik Eskimo culture in Alaska.
- An evocative, illustrated travelogue from Borneo Breezes takes us to an innovative community training programme for medics in Malaysia.
- Warrior Mom travels to Paris every fortnight (okay, Paris, Texas), but it seems like another world when it comes to gynaecological healthcare for deprived communities.
The Walled Garden
There are many taboos in medicine akin to walled areas to which access is restricted. One of the consequences of the rise of blogging is that previously unspoken of areas have been opened up to debate. Bloggers break down walls and provide alternative voices to those in the mainstream media.
- A major issue this week has been the arrest of health professionals for alleged euthanasia in the wake of Hurricane Katrina. Kevin, M.D. is providing rolling coverage of reactions to the arrests.
- Nurse Dan explains why he finds aspects of the story so disturbing.
- Euthanasia raises issues about what constitutes 'do no harm'. So does the involvement of health professionals in capital punishment. Should they assist in executions? Digital Doorway has strong views on the matter in this thought-provoking discussion.
- Ruminating Dude comes to the conclusion that it has been a bad week for the medical profession. Medication errors, conflicts of interest, and off-label prescribing have led him to conclude: 'Some doctors think they're just plain special.'
- Speaking of prescribing, InsureBlog has serious qualms about drug advertisements aimed at patients.
- Hospital Impact is dubious about the growth of retail clinics. There's a lively debate going on about their merits and drawbacks.
The Tool Shed
- Fixin’ Healthcare suggests a less technical approach to medicine.
- Depending on technology makes Nurse Dan uneasy…
- In her new blog Alone, 18-year-old Jessica describes how she hopes blogging will help her cope with her depression.
- Happystance presents a thoughtful discussion on what constitutes unhappiness vs depression, and how governments can intervene to facilitate happiness and resilience.
- Anxiety, Addiction and Depression Treatments highlights a study that shows how sad-mood stimuli can trigger relapse in depression.
The Garden Path
- Dr Deborah Serani gives advice on what to do if you are the victim of a stalker.
- Should you be unlucky enough to be in a collision with a moose, Inside Surgery has some tips on how to survive.
- If you happen to be cycling along the garden path, Flea will want to be assured that you have no previous injuries. He thinks Floyd Landis, winner of the Tour de France and soon to be receipient of a prosthetic hip, is setting a bad example to sports-mad kids and their parents.
- Do you feel you're being led up the garden path by well-intentioned but anxiety-inducing gatekeepers? Rita at MSSP Nexus Blog has a public service announcement on being persistent when scheduling an appointment.
[Picture courtesy of http://www.andreyyanev.com/Oil%20on%20canvas/A%20path-50x40.jpg]
This blogging bouquet was brought to you by cross-continental collaboration between Giskin, AJ and Beth. Thank you to all the contributors and to Nick who makes the Grand Rounds grand. Next week's Rounds will be hosted by Inside Surgery.
Sunday, July 23, 2006
Friday, July 21, 2006
A lot has happened since I last wrote an entry as the flippantly-entitled “regular Colonist”. For a start, I have not been a regular, rather an ex- or suspended-from-active-service Colonist. A lot has happened in the world, too.
In fact, it has been over a year.
In this year I have been once again an active medical relative, or medi-relly. This merged seamlessly with becoming a medical patient (there is probably a term for this so rude it cannot be printed or even thought) as my hips fell apart. Well, my pelvic girdle did less girdling and more grinding of its component parts against each other under crazed hormonal instructions.
Next, it was a mini education that every surgeon should undertake: being operated on. My, doesn’t it hurt? Amazing, it is, that one could have made so many easy slits with scalpel in skin that immediately parts and then the blood comes in little points you swab before getting down to the job. And never once known how much that little or long wound would hurt as the ensuing hours un-numb it and the days and nights slowly pass before you can hope for anything other than severe pain. And how unsympathetic doctors of all shades are, whatever they say.
Then, fairly instantaneously, I became a mother again. (Give me endorphins every time – cannot remember the pain of natural childbirth at all. In retrospect it gains a halo of ennobling effort. Especially in contrast with a caesarean section.)
A long while after, we took all of us to the States for half a year.
And now I am back, walking without crutches and taking up colonoscopy again as if it all had never happened at all.
Yet the NHS has changed. Where before we were a happy-go-lucky department, admittedly the least busy of any I’d ever seen – now I walk in and the tension is crackling on all sides. I am immediately appraised of this redundancy here, cuts there, job threats and, disconnected as I am, floaty still on my little cloud of happy baby-gazing, I am dragged into the argument first one side then the other. I reel home shocked less at my predictable failure in confidence and technique that allows me to get stuck at the hepatic flexure on 3 cases than on the steamy atmosphere of accusation and overt rowing. This is what causes me to back off and hand over the colonoscopies to the boss - I am trying hard not to get any flak directed at me. Dodging the cross-fire is enough to deal with. I don’t want the grievous sin of holding up the list as well.
The second list, second week – it is the same. No one is even pretending to ask about the baby now. I’d had a preview trip with baby in tow before starting, but had not really got a handle on the situation, not met the key players before she was awake and needing feeding and, worse, wanting to crawl. Not in an endoscopy unit, I don’t think so dear.
But I was worse this time – couldn’t even get a venflon in to one poor guy with veins like ropes. I know how much that hurts, too, now. Can’t look him in the eye. Call the boss over after 3 failures. There is nothing odd about his motorway-veins. The kind you give to beginner medical students before sending the cocky ones to stick the lady on Warfarin. (My own mother now the Lady on Warfarin. It was me who was sent, not cocky just practical joker of a houseman, to take my first blood ever from a lady on warfarin. I am sorry, Lady, wherever you are. I wish I’d told you you were my first. You had a right to refuse.) The boss’s venflon slides in and rocks around inside. Has to be taped down to stop the whole tiny thing being swallowed up by the great vein it is a tap into, like a mosquito. The boss does not deign to be triumphant – it is only a venflon. First day back. Still, I expect to be watched a little more carefully now. I talk to the guy, tell him everything to expect before giving me first his signature and then his colon to inspect – fully acquainting him with the expected side effects of sedation and the risks of the procedure. My two bosses differ slightly in how rigorous they expect this chat to be.
Any how, there he is undergoing the first part of it – up to the splenic flexure, which we do routinely with no sedation as a limited procedure. But in this guy, we have to get all the way round. He jumps. I apologise, and as I do, I suddenly realise that I never gave him the sedation. I resist the temptation to tell him. My boss could give it but misinterprets my pained looks as merely my being stuck in the colon and offers advice. As the patient is fully awake, I can’t communicate as clearly as I want to shout argh help I've forgotten something! As I try to assess how serious this mistake is and how best to get out of it, my realisation I am going to have to fess up leads me to flush to the roots of my hair. I turn to the boss – “haven’t.. sedation” I stutter then just grab the waiting drugs (one hand on the ‘scope) and give him it via the disputed venflon muttering honestly (yet it is not quite the whole truth), “I’m just going to give you a bit more painkiller”. Alice’s offended answer to the March Hare’s offer of more tea comes into my head: “I’ve had nothing yet..so I can’t take more”"You mean you can't take less" says the Mad Hatter. "It is very easy to take more than nothing".
I am suddenly glad that after a year off, I am not back doing a list of anterior resections and trauma surgery. It is like riding a bike, the physical cerebellar-controlled actions of the skill you have learnt by practising. It really does come back. But other components to doing the job are not so easily recalled. Perhaps I should have warned him that I’d been away for a year. Would you want to be the first patient of such an operator?
Afterwards they laugh at me. You’ve been away from the NHS for too long, they say. You are being too nice to the patients. No time for that! That’s not what we do...
And it is true.
Wednesday, July 19, 2006
You see, I've got a wisdom tooth poking out in the wrong direction. The tooth is heading towards an operation. Since people rarely have just the one impacted tooth, further procedures may well be required. This means more X-rays and considerable delay to the tongue-web piercing I've been meaning to get for a while.
It's interesting to note the conflicts between the medics and the modifiers, especially when considering both are here to increase the happiness and function of their clients bodies. We can also revert back to the first principles from the WHO definition of health. If beautifying your body in a safe & consensual way is compatible with the definition given, exactly how do ill-educated professionals have a right to make unnecessary comments and decisions such as this and this? What's more galling is that the GMC outlines that first duty of a doctor is to treat, not to judge!
The increasing popularity of body modification, both on the intense and superficial spectra has resulted in doctors needing to gain a more comprehensive understanding of the issues involved. Many of the heavier modifications are comparable with cosmetic surgery, such as tongue splitting and transdermal implants.
I have touched upon the physical & legal aspects of the industry here. More pressing progress needs to be made on the psychological front as 'eurgh' and paternalistic behaviour are not acceptable exceptions from empathetically-aware professionals.
Current UK regulations for anatomical and physiological training are lacking beyond the hygiene aspect; certification in these in addition to professional policing should serve to make something so popular more pleasurable for all.
Monday, July 17, 2006
There are three ways to submit:
(1) E-mail me the link to your post with a brief summary of what it's about.
(2) Submit your link via the carnival blog submission form.
(3) If your blog is registered with The Medical Blog Network, you can submit via this form.
Because we work to British Summer Time, please would you submit your posts by 1 pm EST on Monday (that's 6 pm BST and 5 pm GMT).
Thursday, July 13, 2006
Recent coverage has provoked an understandable backlash and the fat-acceptance campaign in the US is bigger than ever. Concentrating on the positive aspects of being comfortable with one's body, these organisations campaign to end the open-marginalisation of overweight and obese individuals in society.
As doctors, we are indeed guilty of institutionalised fattism. Countless studies have proved that obesity is indeed linked to a higher incidence of ischaemic heart disease, diabetes, hypertension & many other physical/psychological consequences. We try our hardest to keep our patients healthy, in deference to the Body Mass Index charts.
Health is defined in WHO's Constitution as a 'state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'. If somebody is happy in their overweight body, then who are we to judge them as unhealthy & paternalistically instruct them to lose weight regardless of whether they want to or not? Many lead stimulating and productive lives, as shown in this most-entertaining reply to Rachael Cooke's almost-offensive piece in last week's Observer.
Read Cooke's semi-classist take on life in a fatsuit here.
Monday, July 10, 2006
Coma has an enduring appeal in cultural representations of matters medical. An individual poised precariously between life and death is imbued with dramatic potential, but it is the psychic aspects of coma which is liberating for novelists, dramatists and screenwriters. To enter the head of the comatose is to experience a heady cocktail of memory, fantasy and hallucination: the subconscious can be well and truly mined with no obligation to consistency or a stable reality. Anything can happen. This is brilliantly exploited in the TV series 'Life on Mars'. The title warns of its improbability. DCI Sam Tyler is put into a coma by a car accident and finds himself living a parallel life in the 1970s. It's a daft concept, but it works as a vehicle for juxtaposing 1970s with 21st-century policing -- without resorting to a tardis. And who could forget the series finale of House in which coma-induced hallucination had us all going for half the episode. 'It was all a dream' is usually a heckuva cop-out in event-driven drama, but if cleverly done, it enriches characterisation. We learnt a lot about House's motivations and alter-ego by getting inside his head.
Sam's and House's prognoses for returning to 'reality' is rather good. A study published in the BMJ last year found that your chances of recovering from coma on TV is much higher than in real life. In their study of American TV soaps, of 64 people suffering comas, only 6% died: the actual death rate is 67%. Only 7% of coma victims return to full function, but on TV a whopping 89% suffer no ill effects from trauma-induced coma. The authors conclude that soap operas generate unrealistic perceptions of favourable outcomes from coma in the viewing public. Another study published in the journal Neurology criticised feature films for a lack of realism. In 30 films featuring coma since 1970, 60% of patients had sudden, unproblematic awakenings, and the authors criticised the 'sleeping beauty' appearance of coma victims in film (beautific, peaceful sleep with eyes closed). Only two films were singled out for 'accuracy': 'Reversal of Fortune' and 'The Dreamlife of Angels'.
Coma is well covered in literature. One of the most recent offerings is 'The Coma' by bestselling author of 'The Beach', Alex Garland. I remain unconvinced of the merits of the story, but the book is worth buying for the stunning woodcuts by Garland's father which punctuate the text. Then there is the weird 'Girlfriend in a Coma' by Douglas Copeland in which a 17-year-old spends two decades oblivious to a changing world. Recently published and garnering excellent reviews on Amazon, is 'Notes from a Coma' by Irish novelist Mike McCormac. In this story, induced coma is explored as an option for the EU penal system -- but it turns reality show when the project is televised.
One of my favourite ever films is 'Talk To Her' by acclaimed Spanish director Pedro Almodovar. Here, we follow the fates of men devoted to two women in comas. An ethical dilemma is brilliantly set up as part of the plot, but the whole movie is a masterpiece of cinematography, fine acting and an excellent script.
My personal roundup of coma-inspired literature and drama would not be complete without a mention of Robin Cook's thriller 'Coma'. I read it in my teens and it was a nailbiting awakening to the dark side of medicine.
Anyone else have suggests for the coma genre?
Thursday, July 06, 2006
The Death of Mr Lazarescu is on at the ICA from 14th-30th July. The ailing Mr Lazarescu is transported from hospital to hospital by medic and driver team. As the ICA write-up suggests it is a journey with an inevitable destination. Directed by Cristi Puiu, this Romanian film promises to be something special. You can find more details here.