Bioethics Discussion Blog: January 2014

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com

IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice

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Monday, January 13, 2014

Shadowing a Doctor: A Benefit or Harm?






Entering a physician's office for a visit and examination may allow you to be a participant in a medical exercise called "pre-medical shadowing".  This means that, hopefully with your full informed consent,  a college student called a "pre-med student" who has been studying courses to apply to medical school, will be present to learn what the practice of medicine is all about as seen within the office of a doctor in practice. Some medical educators believe that if  these college students "shadow"(watch)  professional physicians at work they will get some insight into the profession before applying to medical school and their education in this regard may be of some value. 

Though, as a medical educator and physician myself, I find some value in this "shadowing" I do have some concerns and I expressed my opinion to a medical education website as follows:

Does anyone think that "clinical shadowing" by pre-med students will, whatever the benefits from the experience, also instill elements of the "hidden curriculum" taught to 3rd and 4th year students and beyond   even before experiencing the more "humanistic" learning provided 1st and 2nd year students? Or am I becoming overly concerned?

The "hidden curriculum" is defined as being the education of these students and residents by experience mature superiors who promote their own view of medical practice in a way different and perhaps more organizational and bureaucratic but perhaps less humanistic from what their subjects learned in the earlier years of medical school.

A medical educator responded to the website with the following comment:

Maurice's question is a good one, and one on which my colleagues and I have been reflecting.  We have seen evidence of the interference of the shadow in the ways M1 and M2 students make patient notes, using abbreviations that are no longer acceptable or are short-hand used by physicians who learned the longer versions first.  We have also seen evidence in the ways in which students talk about patients: non-compliant; drug seekers; physician-centered, disease-first speak rather than patient-centered, people-first speak.  

The phenomenon seems to be a bit akin to rituals of tribal acceptance.  Medical students are in school to become part of a given subculture, the tribe of medicine.  They may have different reasons for doing so, but the end point is the same: join a culture with its own language, behaviors, norms, and so on.  If they shadow members of this culture, tribal elders who were trained to behave in certain ways, then go to an educational institution that attempts to tell them to behave otherwise, it would seem rational for them to comply with the institution externally but with the tribal elder internally.  The elder is practicing in the field and therefore seems to have more social capital than institutional pre-clinical educators.  

This is a particularly interesting phenomenon given that medical schools are working on creating future leaders for a medical culture that is itself in the midst of an intense transformation.  The tension between tribal tradition and transformational innovation is palpable, manifesting in a variety of ways including the necessary use of practicing elders as faculty and mentors for said future leaders.   

Shadowing may help pre-matriculants to get a better grasp on the daily routines of the profession, but it may also be contributing to a prior knowledge base that hinders development of the medical culture. 

What I find of importance in this response is regarding the possible effect of this "shadowing" on inhibiting  the medical profession to advance medical practice from "old tribal tradition" to new ways, in new times, to improve the patient's value from the doctor-patient  relationship.  

There is much more to consider regarding this issue of  "shadowing" by some undergraduate college student including issues of patient privacy with regard to both sensitive history taking, physical examination and the physician's discussion of emotionally sensitive conclusions with the patient with a student in attendance.

I would be most interested to read what my visitors here think about "shadowing" by pre-medical college students.   ..Maurice.

Graphic: From Google Images.

Friday, January 03, 2014

Patient Modesty: Volume 62










The argument of what all healthcare providers are thinking in terms of sexuality, sexual feelings and sexual intent when they are attending to patients of either gender is truly an empty argument since we will never know.  And as Don (writing in Volume 61) pointed out, the providers will be damned by patients both if they admit their thoughts or refused to admit.  So, instead, let's all gather around the tables for discussion of what is most important: how to get the medical system understand that there is to some patients considerable more to patient modesty concerns than what is taught to the doctors and nurses and techs in school.  That is now what this thread is all about.  ..Maurice.

NOTICE: AS OF TODAY FEBRUARY 9 2014  "PATIENT MODESTY: VOLUME 62" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 63.


Graphic: "Empty Tables" A photograph taken by me of an eating area at the Getty Museum, Los Angeles 1-2-2014