A SCHOLARLY BOOK REPOSITORY
Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself.
Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.
We all know the saying, “That which does not kill us makes us stronger,” but is that really true? After all, for some people, traumatic experiences ultimately lead to genuinely debilitating outcomes. For others, though, adversity does seem to lead to “post-traumatic growth,” where individuals move through suffering and find their lives changed in positive ways. Why does this growth happen for some people and not others? How exactly does it happen? Can the positive results be purposefully replicated?
At the edge of mortality there is a place where the seriously ill or dying wait—a place where they may often feel vulnerable or alone. For over forty years, bioethicist cum philosopher Richard Zaner has been at the side of many of those people offering his incalculable gift of listening, and helping to lighten their burdens—not only with his considerable skills, but with his humanity as well.
The narratives Richard Zaner shares in Conversations on the Edge are informed by his depth of knowledge in medicine and bioethics, but are never "clinical." A genuine and caring heart beats underneath his compassionate words. Zaner has written several books in which he tells poignant stories of patients and families he has encountered; there is no question that this is his finest.
In Conversations on the Edge, Zaner reveals an authentic empathy that never borders on the sentimental. Among others, he discusses Tom, a dialysis patient who finally reveals that his inability to work—encouraged by his overprotective mother—is the source of his hostility to treatment; Jim and Sue, young parents who must face the nightmare of letting go of their premature twins, one after the other; Mrs. Oland, whose family refuses to recognize her calm acceptance of her own death; and, in the final chapter, the author's mother, whose slow demise continues to haunt Zaner's professional and personal life.
These stories are filled with pain and joy, loneliness and hope. They are about life and death, about what happens in hospital rooms—and that place at the edge—when we confront mortality. It is the rarest of glimpses into the world of patients, their families, healers, and those who struggle, like Zaner, to understand.
Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.
Mizrahi observed and interviewed these physicians in six timeframes ending in 2016. Beginning with medical school in the mid-1970s, these physicians reveal the myriad fluctuations and uncertainties in their professional practice, working conditions, collegial relationships, and patient interactions. In their own words, they provide a “view from the front lines” both in academic and community settings. They disclose the satisfactions and strains in coping with macro policies enacted by government and insurance companies over their career trajectory.
They describe their residency in internal medicine in a large southern urban medical center as a “siege mentality” which lessened as they began their careers, in Getting Rid of Patients, the title of Mizrahi’s first book (1986). As these doctors moved on in their professional lives more of their experiences were discussed in terms of dissatisfaction with financial remuneration, emotional gratification, and intellectual fulfillment. Such moments of career frustration, however, were also interspersed with moments of satisfaction at different stages of their medical careers. Particularly revealing was whether they were optimistic about the future at each stage of their career and whether they would recommend a medical career to their children. Mizrahi's subjects also divulge their private feelings of disillusionment and fear of failure given the malpractice epidemic and lawsuits threatened or actually brought against so many doctors. Mizrahi’s work, covering almost fifty years, provides rarely viewed insights into the lives of physicians over a professional life span.
A masterpiece by one of the West’s best-loved authorsJust when Sacramento journalist Marty Martinez thinks his life can’t get any worse, it does. His beloved son has died of AIDS, his wife has divorced him and joined a cult, and his daughter blames him for the disintegration of their family. Then a chance medical examination reveals that he has prostate cancer. Marty faces his new role as a cancer patient with awkward grit and desperation. He is a sympathetic, utterly convincing character seeking faith in a Catholic Church as troubled as he is. He brings increased intensity to his career as he investigates a far-reaching political scandal, reunites his family in unexpected ways, and finds love with a fellow cancer patient. Grace Period is a profound and sometimes hilarious novel about living with serious illness. Marty copes with fear and the painful, sometimes embarrassing, treatment of his disease, but instead of winding down his life he finds fresh purpose and a joyful new love. Haslam brilliantly depicts the complexities of everyday life and the intricate, sometimes tortured bonds of family and friendship. In Grace Period, Haslam shows us that existence at the precarious edge of life offers not only pain and loss but hope, a chance at redemption, love, and even happiness. Grace Period is his masterwork.
The ancient Hippocratic oath that every doctor pledges upon graduation from medical school is a code based on genuine devotion to people and a desire to serve them. It is also a code in urgent need of updating to reflect the technological and moral changes of modern society and the complicated dilemmas facing every practicing physician.
This collection of essays by some of the wisest observers of modern medicine probes the various forces affecting health care today: the power of the new technology in diagnosing and treating illnesses, the growing appreciation of mind/body interactions, the emergence of corporate hospitals and health care centers, and, most importantly, the essence of physicianhood—what makes a doctor want to practice medicine.
In considering these issues, the essayists question whether the medical-industrial complex will destroy physicians as we know them, making doctors employees of large profit-making institutions and more responsible to their companies than to their patients. Will increasing versatility in technological medicine remove doctors even further from the patient's bedside, weakening the diminishing bond between patient and doctor? Are there points of contact between western "scientific" medicine and holistic practices? Is there a place in modern medicine for work therapy and the placebo effect?
Each of these issues prevalent in medicine today has, in its own particular way, an effect upon the core relationship between doctor and patient. In Search of the Modern Hippocrates is dedicated to the premise that current changes in medicine can produce an altered and strengthened medical profession resolved to preserve the inextricable link between commitment and care. Ending with the development of a modern oath of ethics, it provides an important guide to medicine in the complex world we now face.
Medicine and the Management of Living questions how it has been possible for the patient to change from a silenced specimen observed in the clinic to a person whose subjective experience of illness is important to medical practice and discourse. Arney and Bergen ask, What incited the demand that medicine take the whole person, including the patient's presentation of his or her illness, into consideration? And in whose terms are patients speaking about themselves? The authors argue that the inclusion of patients' experiences in medical discourse that has come about since the 1950s is not so much a result of a "patient rebellion" as an activity preciptated by the medical establishment itself. Drawing inspiration from the work of Michel Foucault, Arney and Bergen examine the structure of medical power, contending that new social technologies like support groups make the patient's subjectivity available for medical evaluation, judgment, and manipulation.
Throughout this sensitively written discussion, the authors vivify the issues they raise with excerpts from many sources—the writings of a poet dying of cancer, the comments of doctors pondering their own fatal illnesses, and excerpts from popular magazines, medical journals, and sociological studies. They examine the changing role of the medical profession through history, using a modern advertising image and woodcuts from Vesalius's Renaissance anatomy text to show the symbolic portrayal of health and medicine. Their wide-ranging concerns lead the reader through such topics as teenage pregnancy; the historical treatment of medical anomalies like hermaphrodites and the "elephant man" (John Merrick); and literary representations of illness in Sartre, Chekhov, and Brian Clark's recent Broadway drama, "Whose Life Is It Anyway?"
In a provocative yet thoughtful way, Medicine and the Management of Living points the way for a radical reassessment of medical power and the medical establishment.
In this expanded edition, an accomplished physician and teacher of medicine discusses the importance of being a caring doctor, especially now that the focus of medicine is increasingly on technological innovation and health care costs.
With wisdom and compassion, Dr. Jerome Lowenstein tells stories about relationships between medical students and their teachers, physicians and their patients. He reflects on what doctors learn from treating chronic illness; how they respond to patients' needs for reassurance; how they bear the burden of treating patients with life-threatening or degenerative disease; whether the distinction between traditional and "alternative" medical treatment is ultimately beneficial or destructive; and many other issues. Dr. Lowenstein's ruminations on humanistic approaches to learning and practicing medicine will be treasured by physicians, medical students, and patients alike.
In the nineteenth century, infants were commonly breast-fed; by the middle of the twentieth century, women typically bottle-fed their babies on the advice of their doctors. In this book, Rima D. Apple discloses and analyzes the complex interactions of science, medicine, economics, and culture that underlie this dramatic shift in infant-care practices and women’s lives.
As infant feeding became the keystone of the emerging specialty of pediatrics in the twentieth century, the manufacture of infant food became a lucrative industry. More and more mothers reported difficulty in nursing their babies. While physicians were establishing themselves and the scientific experts and the infant-food industry was hawking the scientific bases of their products, women embraced “scientific motherhood,” believing that science could shape child care practices. The commercialization and medicalization of infant care established an environment that made bottle feeding not only less feared by many mothers, but indeed “natural” and “necessary.” Focusing on the history of infant feeding, this book clarifies the major elements involved in the complex and sometimes contradictory interaction between women and the medical profession, revealing much about the changing roles of mothers and physicians in American society.
“The strength of Apple’s book is her ability to indicate how the mutual interests of mothers, doctors, and manufacturers led to the transformation of infant feeding. . . . Historians of science will be impressed with the way she probes the connections between the medical profession and the manufacturers and with her ability to demonstrate how medical theories were translated into medical practice.”—Janet Golden, Isis
The rise of the nurse practitioner as a new kind of health care professional has blurred the traditional distinction between physicians and nurses. Nurse practitioners argue that they combine both the traditionally male health care delivery of the M.D. and the traditionally female caring attention of the R.N. In her previous work Sue Fisher has analyzed the difficulties that women patients have in getting doctors to listen to their medical concerns. Now she asks whether women fare any better with nurse practitioners.
Nursing Wounds takes us into the examining rooms of nurse practitioners and doctors to listen to how health care professionals and women patients communicate. The nurse practitioners, unlike the doctors, go beyond the medical problem to ask about the social context of the patients' lives. In these exchanges the doctors insist on reinforcing both their professional status and dominant cultural assumptions about women. While the nurse practitioners sometimes do this, they also distance themselves from their professional identities, respond to their patients woman to woman, and undermine traditional understandings about gender arrangements.These differences have important consequences for the delivery of health care.
This compelling and complex analysis employs a range of theoretical perspectives–-from sociolinguistic to postmodern and materialist. Fisher concludes by urging a health care policy that capitalizes on the special strengths of nurse practitioners as providers of primary care who pay real attention to what their patients are saying and who support an alternative, even oppositional, understanding of women's lives.
With disarming candor and the audacity to admit that practicing medicine can be a crazy thing, Watts fills each page with riveting details, moving accounts, or belly-laughs. As the stories in this work unfold, we are witness to the moral dilemmas and personal rewards of ministering to the sick. Whether the subject is the potential benefits of therapeutic deception or telling a child about death, Watts’s ear for the right word, the right tone, and the right detail never fails him.
From The Orange Wire Problem and Other Tales from the Doctor’s Office:
We were lingering in the outer office. He mentioned again, no biopsy. I knew that. And I knew there would be no chemotherapy.
Maybe it's like that Orange Wire Problem, I said.
Yes exactly, he said, and four years from now when we're all sitting around the campfire we'll remember the Orange Wire Problem. . .
And I thought to myself, my brother did that. Spoke of the time ahead as he was dying of lung cancer. Six months from now he had said, we'll be glad we did all those drug therapies—as if to speak of the future laid claim to the future.
While Osler’s talks were frequently published during his lifetime and they have been published individually and in different compilations since his death, none contain the over 1500 annotations that appear here, notes that serve to explain the many philosophical, biblical, historical, and literary allusions contained in Osler’s writings.
This thoroughly explicated selection of Sir William Osler’s writings will be cherished by physicians, medical students, nurses, philosophers, theologians, and ethicists in this—and future—generations.
Parenting today is virtually synonymous with worry. We want to ensure that our children are healthy, that they get a good education, and that they grow up to be able to cope with the challenges of modern life. In our anxiety, we are keenly aware of our inability to know what is best for our children. When should we toilet train? What is the best way to encourage a fussy child to eat? How should we protect our children from disease and injury?
Before the nineteenth century, maternal instinct—a mother’s “natural know-how”—was considered the only tool necessary for effective childrearing. Over the past two hundred years, however, science has entered the realm of motherhood in increasingly significant ways. In Perfect Motherhood, Rima D. Apple shows how the growing belief that mothers need to be savvy about the latest scientific directives has shifted the role of expert away from the mother and toward the professional establishment. Apple, however, argues that most women today are finding ways to negotiate among the abundance of scientific recommendations, their own knowledge, and the reality of their daily lives.
We all have a good idea of how we want things to go when we visit a physician. We expect to be able to explain why we are there, and we hope the physician will listen and possibly ask questions that help us clarify our thoughts. Most of us hope that the physician will provide some expression of empathy, offer a clear, nontechnical assessment of our problem, and describe "next steps" in a way that is easy to understand. Ideally, we would like to be asked about our ability to follow treatment recommendations. Some experts say that these expectations are not only reasonable but even necessary if patients are to get the care they need. Yet there is a growing body of research that suggests the reality of physician communication with patients often falls short of this ideal in many respects.
A careful analysis of the findings of this research can provide guidance to physician educators, health care administrators, and health policy makers interested in understanding the role that improved physician communication can play in improving quality of care and patient outcomes. Physician Communication with Patients summarizes findings from the academic literature pertaining to various aspects of this question, discussing those findings in the context of current pressures for change in the organization and delivery of medical services.
The first scholarly exploration of the forums, practice, and economics of functional medicine.
Physicians of the Future interrogates the hidden logics of inclusion and exclusion in functional medicine (FM), a holistic form of personalized medicine that targets chronic disease. Rosalynn Vega uncovers how, as “wounded healers,” some FM practitioners who are former chronic disease sufferers turn their illness narratives into a form of social capital, leveraging social media to relate to patients and build practices as “doctor-influencers.” Arguing that power and authority operate distinctly in FM when compared to conventional medicine, largely because FM services are paid for out of pocket by socioeconomically privileged “clients,” Vega studies how FM practitioners engage in entrepreneurship of their own while critiquing the profit motives of the existing healthcare system, pharmaceutical industry, and insurance industry. Using data culled from online support groups, conferences, docuseries, blogs, podcasts, YouTube, and TED Talks, as well as her own battles with chronic illness, Vega argues that FM practices prioritize the individual while inadvertently reinscribing inequities based on race and class. Ultimately, she opens avenues of possibility for FM interlocutors wrestling with their responsibility for making functional medicine accessible to all.
With over forty years of experience as a sought after diagnostician, Dr. Stuart Mushlin has cracked his share of medical mysteries, ones in which there are bigger gambles than playing the ponies at the track. Some of his patients show up with puzzling symptoms, calling for savvy medical detective work. Others seem to present cut-and-dry cases, but they turn out to be suffering from rare or serious conditions.
In Playing the Ponies and Other Medical Mysteries Solved, Dr. Mushlin shares some of the most intriguing cases he has encountered, revealing the twists and turns of each patient’s diagnosis and treatment process. Along the way, he imparts the secrets to his success as a medical detective—not specialized high-tech equipment, but time-honored techniques like closely observing, touching, and listening to patients. He also candidly describes cases where he got things wrong, providing readers with honest insights into both the joys and dilemmas of his job.
Dr. Mushlin does not just treat diseases; he treats people. And this is not just a book about the ailments he diagnosed; it is also about the scared, uncertain, ailing individuals he helped in the process. Filled with real-life medical stories you’ll have to read to believe, Playing the Ponies is both a suspenseful page-turner and a heartfelt reflection on a life spent caring for patients.
The Renewal of Generosity evokes medicine as the face-to-face encounter that comes before and after diagnostics, pharmaceuticals, and surgeries. Frank calls upon the Roman emperor Marcus Aurelius, philosopher Emmanuel Levinas, and literary critic Mikhail Bakhtin to reflect on stories of ill people, doctors, and nurses who transform demoralized medicine into caring relationships. He presents their stories as a source of consolation for both ill and professional alike and as an impetus to changing medical systems. Frank shows how generosity is being renewed through dialogue that is more than the exchange of information. Dialogue is an ethic and an ideal for people on both sides of the medical encounter who want to offer more to those they meet and who want their own lives enriched in the process.
The Renewal of Generosity views illness and medical work with grace and compassion, making an invaluable contribution to expanding our vision of suffering and healing.
Drawn from two decades of their experience with transcultural mediation, Spirits in the Consulting Room tells the stories of eight patients—mainly migrants—and their families. Each chapter focuses on a different patient, and Christelle, Djibril, Moncef, Alhassane, Jacinthe, Amy, Cyril, Alice, and Pierre leap off the page as distinct people with unique situations. Together, these chapters reveal how patients’ comprehension of their symptoms is shaped by their cultural background, while recounting the challenges of translating that into terms the doctors can grasp.
The book shows how trained transcultural mediators can help to redress the power imbalance between doctors and the migrants they treat, providing patients with advocates who respect the authority of their background and experiences and don’t just take the side of the medical professionals. The groundbreaking insights modeled in this book can be applied to any medical situation where doctors and patients find themselves speaking different languages.
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