Ministry of Ethics.co.uk is a non-commercial student-run project aiming to bring learning about Medical Ethics and Law (MEL) into the Web 2.0 era. The website has revision notes, MCQs & EMQs, case videos and scenarios, and allows discussions with other students and professors or lecturers from across the UK and beyond. The website is the perfect revision resource for medical students, clinical students and juniors doctors to learn more about MEL. Doctors are so much more than walking books of facts; they are faced with ethically and legally challenging situations throughout their professional lives. Medical ethics education helps make students aware of the situations that they will face in the clinical setting and suggests appropriate ways of approaching them. In the long term, it aids the development of moral and ethical reasoning that will allow student doctors to understand other people's views, helping them to become more empathetic and caring clinicians. Since it's creation, our website has won a number of prizes including: - Winning Presentation at the 2011 Fifth Conference on Medical Ethics and Law - 2011 BMA Book Awards Highly Commended - 2011 BMJ onExamination Best National E-Learning Resource Prize We hope you enjoy looking at our site and in particular the case scenarios and interactive question bank.
over 8 years ago
In the initial interviews with patients who suffer psychotic symptoms, it might be striking that the usage of terminology of descriptive psychopathology lingers on an arbitration of knowledge of 'truth' by using terms like delusions or hallucinations with their definition as false beliefs or false perceptions (Casey & Kelly 2007). These terms can cause annihilation of value to patient's experience, which may pose an initial strain on the egalitarian patient-doctor relationship. In an era, where deference to experts is dead, it might be worthy on agreeing on the effect of these experiences prior to lablelling them. Delusions can not be objectively detected and described, because it evolves and exists within subjective and interpersonal dimensions. Severe psycopathological symptoms share the fact that they are statistically deviant, and thus can be labeled as 'unshared'. Symptoms may be perceived as 'distressing' and they might be 'disabling' to them. The outcome behaviour which may raise concern can be a 'dysfunctional' behaviour (Adams & Sutker 2004). Jaspers considered the lack of understandability of how the patient reached conclusion to be the defining factor of a delusional idea. The notion of defining 'delusion' as false belief was challenged by Jaspers. Sims gives the example of a man who believed his wife was unfaithful to him because the fifth lamp-post alone on the left was unlit. What makes it a delusion is the methodology not the conclusion which may be right (Sims 1991). Some delusions might be mundane in their content, others may not be falsifiable. Dereistic thinking is not based on logic but rather on feelings. It is possible to find ways to evade falsification; an ad hoc hypotheses may also be part of the presentation. Fish stated that delusional elaboration may follow delusion and/or hallucination which may have convergence with the concept of the ad hoc hypothesis. Absence of verification from the patient's side does not lead to deductive falsification (Casey & Kelly 2007). Otherwise, the doctor-patient relationship carry the risk to transform to detective-suspect relationship, where the latter may perceive the need to present evidence of innocence. Mental health professionals are usually encountered by people who suffer to various degrees or make others suffer, and not because of various degrees of conviction. The primary role of the therapist is to be defined as some one who tries to alleviate the sufferings of others rather than correcting their beliefs. Communicating with patients in terms of how functional is their belief rather than it's truth may prove to be more egalitarian and clinically tuned. This may provide some middle ground in communication, without having to put an effort on defining the differences between what is 'true' and what is 'real'. The criterion for demarcation between what is real and what is pathologic may be different in the patient-doctor relationship. The assertion on the clinician's part on the falsity of a belief or experience can have the risk of dogmatism. The statistical deviance of symptoms, their distressing nature, disabling consequences, the resultant dysfunctional behaviour and apparent leap from evidence to conclusion may be a more agreeable surrogate starting points. This might be more in line with essence of medicine or 'ars medicina' (art of healing). Concordance with patients on their suffering may serve as an egalitarian platform prior to naming the symptoms. The term delusion commonly identified as false fixed belief, when used by a psychiatrist, it does not address only a symptom. It rather puts the interviewer in the position of an all knowing judge. After all, a service-user may argue that how come a doctor who never encountered or experienced any of the service-user's aspects of the problem as being persecuted at work and home, as plainly false. Then, does the psychiatrist know the truth. From a service-user point of view what he/she experience is real; which might not necessarily be true. The same applies for people who lead an average life, people who go to work bearing with them their superstitions, beliefs about ghosts, luck, horoscopes, zodiacs, or various revered beliefs. This term has the risk of creating a temporary crack in the mutual sense of equality between the therapist and the service-user. This may be due to the labelling of certain dysfunctional belief as unreal by one side. It has the potential for a subtle change in the relationship to the mental health professional placing himself/herself in the omniscient position and it contrasts with the essence of medical practice where practitioners assume the truth in what the patients say as in the rest of subjective symptoms as headache for example. The subsequent sequel of this is other labels such as 'bizarre delusions' or 'systematised delusions', further add to the deviation of the role of the professional therapist to an investigator in the domain of 'Truth' and architecture of 'Truth'. Furthermore, it might be strenuous to the relationship when the therapist - based on skeptic enquiry - starts explaining such symptoms. For example, if the service-user believes that Martians have abducted him, implanted a device in his brain and sent him/her back to earth, and the response communicated back is the 'delusional'. It could be argued by the service-user that the therapist who had not seen a Martian or a brain device before, labelled the whole story as 'delusion' in a rather perceived dismissive labelling with no intention to check on the existence of Martians or the device. In other words, the healer became the arbiter of truth, where both lack evidence for or against the whole thing; one member in the relationship stepped into power on basis of subjective view of plausibility or lack of thereof. In the case of hallucinations, the clinician labelling the patient's experience as hallucinations can be imposing fundamental dilemma for the patient. For example, if a patient hears a voice that says that everything is unreal apart from the voice, and the clinician says that the voice is the thing that is unreal. Both do not give evidence to their 'truth' apart from their statement. The clinician's existence to the patient's subjective reality is distorted by the multiple realities of the patient, and arguing on basis of mere existence that the 'voice' is the one that is 'false', does not give the patient a clue of the future methodology to discern from both, since percetption is deceived and/or distorted. In this case, another tool of the mind can be employed to address the patient. The same can be applied to a concept like 'over valued ideas', where the clinician decides that this particular idea is 'over valued', or that this 'idea' is 'over valued' in a pathological way. The value put on these ideas or not the patient values but the clinician's evaulation of 'value' and 'pathology'. The cut of point of 'value' and 'over value' seems to be subjective from the clinician's perspective. Also, 'derailment' pauses the notion of expecting a certain direction of talk. The concepts of 'grooming' and 'eye contact' implicitly entail the reference to a socio-cultural normative values. Thus, deviation from the normative value is reflected to the patient as pathology, which is an ambiguous definition, in comparison to the clarity of pathology. The usage of terms like 'dysfunctional unshared belief' or 'distressing auditory perception' or other related terms that address the secondary effect of a pathologic experience may be helpful to engage with the patient, and may be more logically plausible and philosophically coherent yet require empirical validation of beneficence. Taylor and Vaidya mention that it is often helpful to normalise, but this is not to minimise or be dismissive of patient's delusional beliefs.(Taylor & Vaidya 2009). The concept can be extended to cover other terms such as 'autistic thinking, 'apathy', 'blunting of affect', 'poor grooming', 'over-valued ideas', other terms can be applied to communicate these terms with service-users with minimal deviation from the therapeutic relationship. The limitation of these terms in communication of psychopathology are special circumstances as folie a deux, where a dysfunctional belief seems to be shared with others Also, symptoms such as Charles-Bonnet syndrome; usually does not have negative consequences. The proposed terms are not intended for use as a replacement to well carved descriptive psychopathological terms. Terms like 'delusion' or 'hallucination' are of value in teaching psychopathology. However in practice, meaningful egalitarian communication may require some skill in selecting suitable terms that is more than simplifying jargon. They also may carry the burden of having to add to the psychiatric terminology with subsequent effort in learning them. They can also be viewed as 'euphemism' or 'tautology'. However, this has been the case from 'hysteria' to 'medically unexplained symptoms' which seems to match with the zeitgeist of an era where 'Evidence Based Medicine' is its mantra; regardless advances in treatment. Accuracy of terminology might be necessary to match with essence of scientific enquiry; systematic observation and accurate taxonomy. The author does not expect that such proposal would be an easy answer to difficulties in communication during practice. This article may open a discussion on the most effective and appropriate terms that can be used while communicating with patients. Also, it might be more in-line with an egalitarian approach to seek to the opinion of service-users and professional bodies that represent the opinions of service-users. Empirical validation and subjection of the concept to testing is necessary. Patient's care should not be based on logic alone but rather on evidence. Despite the limitations of such proposal with regards to completeness, it's hoped that the introduction of any term may help to add to the main purpose of any classification or labelling that is accurate egalitarian communication. DISCLAIMER This blog is adapted from BMJ doc2doc clinical blogs Philosophical Streamlining of Psychopathology and its Clinical Implications http://doc2doc.bmj.com/blogs/clinicalblog/_philosophical-streamlining-of-psychopathology-its-clinical-implications The blog is based on an article named 'Towards a More Egalitarian Approach to Communicating Psychopathology' which is published in the Journal of Ethics in Mental Health, 2013 http://www.jemh.ca/issues/v8/documents/JEMHVol8Insight_TowardsaMoreEgalitarianApproachtoCommunicatingPsychopathology.pdf Bibliography Adams, H. E., Sutker P.B. (2004). Comprehensive Handbook of Psychopathology. New York: Springer Science Casey, P., Kelly B., (2007). Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry, Glasgow: Bell & Bain Limited Kingdon and Turkington (2002), The case study guide to congitive behavior therapy for psychosis, Wiley Kiran C. and Chaudhury S. (2009). Understanding delusion, Indian Journal of Psychiatry Maddux and Winstead (2005). Psychopathology foundations for a contemporary understanding, Lawrence Erlbaum Associates Inc. Popper (2005) The logic of scientific discovery, Routledge, United Kingdom Sidhom, E. (2013) Towards a More Egalitarian Approach to Communicating Psychopathology, JEMH · 2013· 8 | 1 © 2013 Journal of Ethics in Mental Health (ISSN: 1916-2405) Sims A., Symptoms in the mind, (1991) an introduction to psychopathology, Baillere Tindall Taylor and Vaidya (2009), Descriptive psychopathology, the signs and symptoms of behavioral disorders, Cambridge university press
Dr Emad Sidhom
about 7 years ago
An essay I wrote for my course, with which I received an Honours grade (75%). I have an interest in Medical Ethics, and this essay discusses the possible physiology and ethics surrounding the controversial topic. **Introduction** (taken from the essay): My topic is designer babies. A designer baby is defined by the Oxford Dictionary of English as, “a baby whose genetic make-up has been selected in order to eradicate a particular defect, or to ensure that a particular gene is present” (1). In this essay, I shall be exploring the arguments and ideas surrounding the selection of a baby’s genes, which in modern times has become a highly controversial subject. This essay will start by describing the methods by which designer babies may be produced, namely pre-implantation genetic diagnosis (PGD) and pro-nuclear transfer, also coined the ‘three-parent baby’ by some (2). Once these procedures have been presented, ethical considerations forming both sides of the debate will be discussed. Whilst the typical argument used is ‘autonomy vs. playing god’, other ideas include whether such procedures will have a drastic effect on the future, and change the world as we know it, as suggested in the science-fiction film Gattaca (3). The ‘nature vs. nurture’ debate is also described: whether we are defined by our genes as shown in Gattaca, or if the environmental influence we are subjected to can cause our genotype to be negligible, i.e. our genes have no impact on our traits; personality, looks etc. The expectations placed upon our offspring; the definition of disease and disability; the fear of the rate of medical development – will all be discussed in this essay. The conclusion will summarise the arguments of both sides, and will attempt to answer the following question: should we be allowed to design our babies?
about 8 years ago
Medical blogging is blogging in the field of medicine. It is a relatively recent addition to the medical field. While its closest predecessor medical journalism; is about 300 years old, medical blogging is currently about a decade old. This blogpost aims at exploring the field of medical blogging and comparing it to related disciplines when relevant. It examines some opinions of bloggers, and reviews some medical blogs aiming to infer reasons for blogging, derive technique or outline of blog and hopefully arriving at a conclusion to the future prospects of medical blogging. Medicine is the practice of the art and science of healing 'ars medicina'. It is a branch of applied science, which started probably in the pre-historic era. The practice continued to flourish, specialise, sub-specialise and sub-sub-specialise. The word blog is most probably derived from the contraction of the words 'web log' which is a form of website that is more interactive, allowing comments, tagging,and is displayed in counter-chronological order from the most recent at the top of the page. The term 'blog' is currently used as a noun as well as a verb. The aggregation of blogs is named 'blogosphere', and the blog writer is named 'blogger'. There are single author blogs and multi-author blogs, they are as diverse in there content as the diversity of the bloggers, with regards to form they can be written text, images, videos, sounds or combination of more than one medium. The term 'blogroll' is referred to blogs followed by a person. Blogging is just more than a decade old now. However, the number of blogs have been increasing exponentially at times. The concept of blogging is considered as one of the components of the concept of web 2.0. Medical blogs refer to blogs that are primarily concerned with medical/health subjects. The name 'medical blog' is derived from content based taxonomic classification. Medical blogs can be classified by author, there are blogs by physicians, nurses, patients, medical institutions, medical journals, and anonymous blogs. They can be classified by target audience as either to other doctors, patients and carers, general public or a combination of more than one target. There are also medical blogs by patients or patient blogs that expresses their viewpoints. A study examined medical student blogs and concluded that they might be beneficial for students to reflect on their experience (Pinilla et al, 2013). The Nephrology Dialysis and Transplantation (NDT) made it own blog (El Nahas, 2012). The American Journal of Kidney Disorder (AJKD) made its own official blog (Desai et al, 2013). During the same year, the American Heart Association and American Stroke Association launched their official blog (Sanossian & Merino, 2013). Pereira discussed the blogs by neurosurgeons (Pereira et al, 2012). In the BMJ doc2doc blogs, they do not have to meet certain number of word count but will have to be reviewed prior to publication. KevinMD requires blog posts to be of maximum five hundred words, Medical-Reference require a minimum of one thousand words. Meducation requires a blog post to vary between 1500-3000 word. Independent blogs may show more variation in the number of words per blog post. Some blogs are predominantly in text format, other may combine multimedia or get linked to other medical blogs. The BMJ doc2doc tentatively recommends blog posting to be in the frequency of one to two blogs/month. Chrislyn Pepper, a medical blog writer, (2013) states that medical blogging can aim to be 'three blogs of 300+ words each week and three to four short blogs of less than a hundred words five days per week.' Medical bloggers seem to have various reasons to blog, some communicate clinical data to fellow doctors, in this case some blogs seem to resemble research or review articles in content and language which can contain medical jargon. There are diagnosis blogs that were studied by Miller and Pole (2010). The comparison between the electronic predecessors of blogging including Electronic Bulletin Board, USENET, and emailing in addition to the why of blogging in general has been discussed by Mongkolwat (Mongkolwat et al, 2005). Some put their hypotheses forward, others share clinical experience or discuss a clinical matter. Some bloggers direct their attention to the general public providing information about medical topics. Some discuss issues which can be difficult to be put in research topics. Dr Rob discussed that importance of medical blogging as an equivalent to the concept of democracy in an online world. Doctor Blogger website offers 10 reasons for medical blogging including public education, correction of misconceptions and establishing a name. For the medical blogger's direct benefit Medical Rant blog offers an overview of personal benefits from medical blogging including stimulation of thought and stimulation of academic writing. Dr Wible seems to use her medical blog to promote a standard of care that seems to be a mix between the medical model and the befriending model of care. Another study examined the young adults blogging and concluded that powerlessness, loneliness, alienation, and lack of connection with others, where the primary outcomes of young adults as a result of mental health concerns (Eysenbach et al, 2012). Wolinsky (2011) enquires whether scientists should stick to popularizing science or more. Medical blogs are essentially online activity which renders them immediately accessible to any area with internet connection, they are paperless by definition which makes them more environment friendly. The medical blogs are open access by default which adds to the accessibility, and they are decentralised which decreases control over the control and seems to accentuate diversity. As compared to peer reviewed journals, medical blogs seem to be less referenced, are hardly ever taken as academic writing, the process of peer reviewed medical blogs is minimal if any, and they do not get reflected on resume or be considered as publication, though the term 'blogfolio' started to become a watch word. It seems hard to base clinical decisions on medical blogs. However, medical blogs can offer more diversity into research and non-research medical topics. They are published online with no delay or review time, they can comment on the most recent advances in the medical field or most contemporary issues instantaneously. Very recently, citing blogs seems to become a bit accepted. BMJ Journals have their dedicated blogs Some online resources give a comprehensive outline on blogging in general and medical blogging in particular including video interview with a medical blogger Michelle Guilemard in her blog makes a valid point of how medical blogging can enhance career. Medical Squid also highlighted medical blogging as a career Kovic et al (2008) conducted a research on the medical blogosphere an concluded that 'Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers'. Miller & Pole (2010) concluded that 'Blogs are an integral part of this next stage in the development '. Stanwell-Smith (2013) discussed the aspect as an important tool to communicate with patients. The blur between academia and blogging was discussed in research blogs. (Sheema et al, 2012). During the same another study discussed the impact of blogging on research (Fausto et al, 2012). While Baerlocher & Detsky (2008) warn in an article against the hazards of medical blogging due to potential breach of confidentiality. After an exhaustive study of the content of weblog written by health professional, Lagu reached the concern of breaching of confidentiality (Lagu et al, 2007). Rebecca Golden (2007) cites the perils of medical blogging she concludes her article saying 'Science has a peer-review process for a reason'. Brendan Koerner (2007) in wired magazines posted an article about the problems of giving medical advice via blogging. Dr Val Jones makes a point by concluding that social media provide the 'allure of influence'. Thomas Robey (2008) offers arguments for and against medical blogging, including confidentiality, and ruining personal reputation on the negative side, while enhancing democratization of conversation and having a creative outlet on the positive side. Brendel offers an intriguing discussion to whether it would be ethical or not to monitor patients' blog to determine their health status. (Brendel, 2012). O'Reilly voiced in 2007 the need for blogging code of conduct. The GMC published guidance on the use of social media by doctors and it included blogging as a form of social media. The Royal College of General Practitioners also published the social media high way code to offer guidance on social media including medical blogging. There is also the medblog oath online. Flaherty (2013) argues that blogging is under attack by micro-blogging, and that it is in its deathbed. Mike Myatt in his article Is Blogging Dead, discusses various views about blogging in an era of micro-blogging The Royal College of Psychiatrists recently introduced a number of blogs including the president's blog, overseas blogs and other blogs. The medical blogging seems to occupy a middle space between the quick micro-blogging and the thoughtful research article. Its diversity and freedom are its strongest tools and can have the potential to be its worst enemies. One wonders whether the emergence of guidelines for medical blogging – given the seriousness of the content – would save medical blogging and elevate it to the next level or change the essence of it. After all, the question is how much the medical field which is a top-down hierarchy accept grass-root movement. Freedom of expression is probably at the heart of blogging. It would be logistically impossible to impose rules on it. However, guidelines and code of honour may help delineating the quality of medical blogs from each other. This post is previously posted on doc2doc blogs. Bibliography & Blogiography Brendel, D. Monitoring Blogs: A New Dilemma for Psychiatrists Journal of Ethics, American Medical Association, 2012, Vol. 14(6), pp. 441-444 Desai, T., S.M.A.N.V.S.K.T.J.K.C.K.B.E.J.K.D. The State of the Blog: The First Year of eAJKD Am J Kidney Dis., 2013, Vol. 61(1), pp. 1-2 El Nahas, M. An NDT blog Nephrol Dial Transplant (2012) 27: 3377–3378, 2012, Vol. 27, pp. 3377-3378 Eysenbach, G., B.K.M.M. What Are Young Adults Saying About Mental Health? An Analysis of Internet Blogs Journal of Medical Internet Research, 2012, Vol. 14(1) Fausto, S. Machado, F.B.L.I.A.N.T.M.D. Research Blogging: Indexing and Registering the Change in Science 2.0 PLoS one, 2012, Vol. 7(12), pp. 1-10 Lagu, T, K.E.J.D.A.A.A.K. Content of Weblogs Written by Health Professionals J Gen Intern Med, 2008, Vol. 23(10), pp. 1642–6 Miller, EA., P.A. Diagnosis Blog: Checking Up on Health Blogs in the Blogosphere American Journal of Public Health, 2010, Vol. 8, pp. 1514-1518 Mongkolwat, P. Kogan, A.K.J.C.D. Blogging Your PACS Journal of Digital Imaging, 2005, Vol. 18(4), pp. 326-332 Pereira, JLB., K.P. d.A.L. d.C.G. d.S.A. Blogs for neurosurgeons Surgical Neurology International, 2012, Vol. 3:62 Pinilla, S. Weckbach, L.A.S.B.H.N.D.S.K.T.S. Blogging Medical Students: A Qualitative Analysis
Dr Emad Sidhom
almost 7 years ago
This video consists of two short films, addressing 1) the ethics of screening programes, and 2) the moral and legal issues associated with treating asylum seekers in the NHS. Alex Presland & Aliya Bryce
almost 10 years ago
Shrink Rap: Does Watch-Your-Words Political Correctness in Universities Contribute to Mental Illness?
Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen. All patient vignettes are confabulated; the psychiatrists, however, are mostly real. --Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)
over 5 years ago
BMA - GMC Unable to Act Over Revalidation Conflict of Interest Claim - 2013 - August | British Medical Association
GMC says accreditation scheme is a 'matter for the faculty' of occupational medicine
over 5 years ago
An account of the talks given on 24th March 2011, by Professors Joe Collier and John Wyatt , during "Ethical Perspective on Dying": an event organised collaboratively by the Ethics Society and the Christian Union, St. George's, University of London.
almost 10 years ago
These slides are from a talk I was invited to give at the Teacher Scientist Network (www.tsn.org.uk) Master Class on Reproductive Technologies. This turns out…
over 5 years ago
As a physician who regularly discusses health news online and in the media, I find myself in a very fortunate position — I am able to quickly reach vast numbers of people and provide them with credible (and hopefully impactful) information on health and wellness. Because of this, just as in clinical interactions, I know I must put patients first, choosing my words carefully so that I can provide people with facts they need to better understand their disease state and treatment options. I also know that I must be aware of the fact that as opposed to clinical encounters, there is no opportunity for patient interaction. What I say must be geared toward stimulating further conversation between members of my audience and their own private physicians. Statements must be clear and evidence-based, and stories must be reported without bias.
over 5 years ago
"Ethical Issues in Pediatric Surgery" Eric Grossman, MD Lurie Children's Hospital of Chicago 25th Anniversary MacLean Conference on Clinical Medical Ethics P...
over 5 years ago
www.Ministryofethics.co.uk is a student-led, non-profit, free-to-use website aimed at addressing the current resource gap for Medical Ethics and Law learning in the UK. Using the Consensus Statement developed by the Institute of Medical Ethics, we cover MEL topics through a variety of innovative mediums, including videos of clinical scenarios, case notes, self-assessment MCQ tests and uploaded shared resources.
almost 10 years ago
Ministry of Ethics.co.uk is a non-commercial student-run project aiming to bring learning about Medical Ethics and Law (MEL) into the Web 2.0 era. The website has revision notes, MCQs & EMQs, case videos and scenarios, and allows discussions with other students and professors or lecturers from across the UK and beyond. The website is the perfect revision resource for medical students, clinical students and juniors doctors to learn more about MEL. Doctors are so much more than walking books of facts; they are faced with ethically and legally challenging situations throughout their professional lives. Medical ethics education helps make students aware of the situations that they will face in the clinical setting and suggests appropriate ways of approaching them. In the long term, it aids the development of moral and ethical reasoning that will allow student doctors to understand other people's views, helping them to become more empathetic and caring clinicians. Since it's creation, our website has won a number of prizes including: - Winning Presentation at the 2011 Fifth Conference on Medical Ethics and Law, 2011 BMA Book Awards Highly Commended, 2011 BMJ onExamination Best National E-Learning Resource Prize. We hope you enjoy looking at our site and in particular the case scenarios and interactive question bank.
over 8 years ago
"One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong" Sir William Osler Well, it's almost Christmas. I know it's Christmas because the animal skeleton situated in the reception of my University's Anatomy School has finally been re-united with his (or her?) Christmas hat, has baubles for eyes and tinsel on its ribcage. This doesn't help with my trying to identify it (oh the irony if it is indeed a reindeer). This term has probably been one of the toughest academic terms I've had, but then when you intercalate that is sort of what you choose to let yourself in for. I used to think that regular readings were a chore in the pre-clinical years. I had ample amounts of ethics, sociology and epidemiology readings to do but this is nothing compared to the world of scientific papers. The first paper I had to read this term related to Glycosaminoglycan (GAG) integrity in articular cartilage and its possible role in the pathogenesis of Osteoarthritis. Well, I know that now. When I first started reading it felt very much like a game of boggle and highly reminiscent of high school spanish lessons where I just sat and nodded my head. This wasn't the end. Every seminar has come with its own prescribed reading list. The typical dose is around 4-5 papers. This got me thinking. We don't really spend all that much time understanding how to read scientific papers nor do we really explore our roles as 'scientists' as well as future clinicians. Training programmes inevitably seem to create false divides between the 'clinicans' and the 'academics' and sometimes this has negative consequences - one simply criticises the other: Doctors don't know enough about science, academics are out of touch with the real world etc... Doctors as scientists... The origins of medicine itself lie with some of the greatest scientists of all time - Herophilus, Galen, Da Vinci, William Harvey (the list is endless). As well as being physicians, all of these people were also respected scientists who regularly made contributions to our understanding of the body's mechanics. Albeit, the concept of ethics was somewhat thrown to the wind (Herophilus, though dead for thousands of years, is regularly accused of performing vivisections on prisoners in his discovery of the duodenum). Original sketches by William Harvey which proved a continuous circuit of blood being supplied and leaving the upper limb. He used his observations to explain the circulatory system as we know it today What was unique about these people? The ability to challenge what they saw. They made observations, tested them against their own knowledge and asked more questions - they wanted to know more. As well as being doctors, we have the unique opportunity to make observations and question what we see. What's causing x to turn into y? What trends do we see in patients presenting with x? The most simple question can lead to the biggest shift in understanding. It only took Semmelweiss to ask why women were dying in a maternity ward to give rise to our concept of modern infection control. Bad Science... Anyone who has read the ranting tweets, ranting books and ranting YouTube TED videos of academic/GP Ben Goldacre will be familiar with this somewhat over used term. Pseudoscience (coined by the late great Karl Popper) is a much more sensible and meaningful term. Science is about gathering evidence which supports your hypothesis. Pseudoscience is a field which makes claims that cannot be tested by a study. In truth, there's lots and lots of relatively useless information in print. It's fine knowing about biomarker/receptor/cytokine/antibody/gene/transcription factor (insert meaningless acronym here) but how is it relevant and how does it fit into the bigger picture? Science has become reductionist. We're at the gene level and new reducing levels of study (pharmacogenetics) break this down even further and sometimes, this is at an expense of providing anything useful to your clinicial toolbox. Increasing job competition and post-graduate 'scoring' systems has also meant there's lots of rushed research in order to get publications and citations. This runs the danger of further undermining the doctors role as a true contributor to science. Most of it is wrong... I read an article recently that told me at least 50% of what I learn in medical school will be proven wrong in my lifetime. That might seem disheartening since I may have pointlessly consumed ample coffee to revise erroneous material. However, it's also exciting. What if you prove it wrong? What if you contributed to changing our understanding? As a doctor, there's no reason why you can't. If we're going to practice evidence-based medicine then we need to understand that evidence and doing this requires us to wear our scientist hat. It would be nice to see a whole generation of doctors not just willing to accept our understanding but to challenge that which is tentative. That's what science is all about. Here's hoping you don't find any meta-analyses in your stockings. Merry Christmas.
about 7 years ago
Speaker: Anne Tamar-Mattis An estimated 1 in 2,000 babies is born with a Difference of Sex Development (DSD or intersex condition). Currently, there is much controversy regarding the best course of treatment for those children with DSD born with atypical genitals. However, little attention has gone to the process of decision-making, or to other important questions such as sterilization of children with DSD or protecting privacy rights. This workshop begins with an overview of the biology of DSD and the basic legal and ethical principles of surrogate consent in pediatric cases. We will then discuss some key legal and ethical questions. Participants will become familiar with key legal and ethical issues in the treatment of children with DSDs, with special attention to unsettled questions of law and uncertain medical outcomes. Participants will deepen their understanding of the ethics and law of surrogate decision-making for children. Participants will be able to identify potential situations in the treatment of children with DSDs where additional legal or ethical consultation may be indicated.
about 7 years ago
Here's the information students need to know about how drugs work and how they can affect athletic performance. Through "real life" scenarios, students gain insights into the application of pharmacology in their clinical practice—from assisting an athlete who is taking a new medication to recognizing drug-related side effects when a negative reaction is occurring to handling instances of drug abuse. Beginning with an overview of pharmacokinetics and pharmacodynamics, the text presents prescription and over-the-counter medications in relation to the injuries or health conditions athletic trainers commonly encounter. Frequently abused substances such as amphetamines, herbals, and anabolic steroids are also addressed. Legal and ethical issues of drug use are presented, such as HIPAA–mandated privacy issues, drug testing, and which drugs are deemed as acceptable or banned according to NCAA and US Olympic standard.
almost 6 years ago