Author Archive

links to journals   Leave a comment

Here’s a list of links to rhet/comp and other types of journals put together by students at Bowling Green:

http://www.bgsu.edu/departments/english/rcweb/page87425.html

Advertisements

Posted November 22, 2010 by jblakescott in Uncategorized

Ideas for Tag Lines for Patient/Community Education Campaigns   4 comments

Feel free to add to these. Let’s discuss all of our ideas in class tomorrow:
Breaking Down Barriers (to health care)
Convenient Connectivity
Healthy Connections
Streamlining Your Health (with EHRs)
Modernize Your Health (with EHRs)
Boost Your Health (with EHRs)
Health Care Records Made Easy
Connect, Share, Empower

Posted November 8, 2010 by jblakescott in Uncategorized

Websites about the use of simulation in medical training   Leave a comment

I’m posting the links to some different types of sites, including journalistic, educational, research, and commercial:

Inside Higher Ed piece about new uses of simulation technology in medical training (mentions UCF)

Harvard-based Center for Medical Simulation (clinical training and research)

Immersion (commercial maker of medical simulation technology)

Laerdal Medical (maker of SimMan used at UCF Medical School)

Posted October 6, 2010 by jblakescott in Uncategorized

STORIES FROM THE ROAD: Electronic Health Records Improving Patient Care   2 comments

Here’s the link to the EHR success stories (from various perspectives–patients, caretakers, physicians) on the U.S. Dept of Health and Human Services website.

Posted September 22, 2010 by jblakescott in Uncategorized

From Mary (Lay) Schuster   Leave a comment

I didn’t say in the responses, but you can share with the students,

that in additional to the new book on Victim Advocacy in the Courtroom, I

have been working with a team of researchers on right-to-die

decision-making. The team includes (along with me) a health care lawyer who

heads the ethics committee at a large local medical center, a bioethicist

and nurse, and a family social science PhD student. Together we have

researched law cases post-Terri Schiavo, done a textual analysis of 129 DNR

requests for developmentally delayed state wards who are in the last stage

of life, and interviewed state and private guardians who make end-of-life

decisions for their clients or wards–all to discover what language and

principles are at work. Anyway, I found the students’ comments very

thoughtful and well-informed. Mary

Posted September 17, 2010 by jblakescott in Uncategorized

Elle’s Montgomery response   1 comment

Hi All:

In his book, _A Whole new mind: Why right-brainers will rule the future_, Daniel Pink shares two patient’s stories–they have similar beginnings but very different endings.

Patient 1: worked at the post office and left work feeling sick, lethargic, and achey; a post office nearby had received Anthrax in an envelope, so he went to the emergency room where a physician checked his symptoms against a check list for Anthrax poisoning. The patient did not have the required number of symptoms. He was sent home with the doctor’s assurance that he had not been exposed to Anthrax.

Patient 2: Like Patient 1, this man worked in the post office and felt sick while at work. He knew that a nearby post office had been attacked with Anthrax, so he went to the ER. The doctor used a check list to determine that the man had not been exposed to Anthrax, BUT she then said, “I can see from your body language that you are really scared, so I am going to run a test for Anthrax, and keep you here for observation.”

Patient one died later that evening of Anthrax poisoning. Patient two learned from the tests that he did have Anthrax poisoning. He was treated and lived.

Pink attributes the difference between the doctors to right brain versus left brain thinking.  Kathryn Montgomery addresses this in _How doctors think_  in her assertion that both “scientific knowledge and a collection of well practiced skills are essential” (2006, p. 33) to taking care of patients rather than simply working in a lab.

I am struck by the contradiction between what we expect of doctors and what is required of them to be the second kind of doctor. In order to save the Anthrax patient, the doctor had to ask the right questions of herself, but we expect doctors to have the answers. A doctor questioning his or her evaluation–an eval based on science–would not engender confidence. Yet, the example in Pink and the multiple examples in Goopman attest to the fact that doctors who question themselves, their biases, their prior knowledge, the patient’s own medical record are the doctors who save lives.

How can doctors be trained to have the confidence needed to practice medicine and be taught to rely on empathy and instinct? Can these dualities be taught or must one be a right brained person to possess this ability?

Elle

Posted August 30, 2010 by jblakescott in Uncategorized

Seeing is Believing, How Much Will You Believe If You’re Not Looking Thoroughly?   1 comment

I felt like _How Doctors Think_ by Kathryn Montgomery was strongly influenced by her daughter’s early detected breast cancer. 

     On page 84, chapter six, Montgomery states, “At 28, [my daughter] was…far too young, an unlikely patient who might have eluded the attention of anyone reasoning ‘scientifically’ from general principles to her improbable case.  Luckily, medicine is a practice that ignores the requirements of science in favor of patient care.”

     I disagree.  I don’t think her daughter is in the “norm,” but rather lucky to have a doctor who further investigated without delay.  Hypothetically speaking, let’s say her daughter is the “norm” for today’s medical practice.  I think it’s relevant to point out not only was the cancerous breast lump not a transient symptom, but it was something tangible that the physician could physically detect for him/herself, even prior to mammogram.  I feel this is an important aspect of getting a physician to take a symptom seriously enough for further testing.  Seeing is believing, or in this case, feeling is believing.

     In chapter six, page 92, Montgomery asserts, “Physicians have no interest in the individual details or sequences that are not established markers of disease.”  Later on she states, “Once the clinically relevant details of the case fall into a diagnostic category with no leftovers that demand explanation, there is no further need for investigation.”

     This type of thinking can be potentially dangerous for two reasons.  First, how can a symptom detail ever become an established marker of a disease if time and time again physicians everywhere fail to document a detail based on whether it has already been established as a marker of the disease?  Secondly, even Groopman’s_How Doctors Think_ outlines the problems associated with “search satisfaction” that can potentially limit a physician’s ability to make a thorough diagnosis, which can be detrimental to the patient. 

     On pgs 118 – 119, Montgomery recounts a story of a 40 year old man who fit the family history and symptomology of a stroke diagnosis, but thankfully due to a medical student’s attention to detail, the diagnosis of endocarditis was made.  How long after the fever started would the correct diagnosis been made if the doctor had not deemed the potential heart murmur “clinically relevant”?

     Also, I would assert that all details are “clinically relevant” until the patient is sufficiently treated and becoming healthy again.  The diagnosis may be inaccurate or perhaps there is indeed a comorbid diagnosis yet to be made [as in the case of Anne Dodge].  Furthermore, just because a diagnosis is following the “established markers of disease,” should that be used as an excuse to cease investigation into causes and/ or new or supplementary treatments?  Shouldn’t the ultimate goal be a healthy patient regardless of pattern of disease? 

     In the case of a diagnosis that has no known definitive cause yet (such as in the case of Chronic Fatigue Syndrome/ ‘CFS’ or Fibromyalgia/ ‘FM’ or Postural Orthostaic Tachycardia Syndrome/ ‘POTS’) and thus the diagnosis is essentially a ‘diagnosis of symptoms’; why isn’t it standard practice to seek out the cause of each patient’s CFS/FM/POTS instead of stating that what the patient is feeling is just part of the package of their diagnosis dilemma?  If the patient is openly willing to further investigate, why would a physician rather wait for some other clinician or researcher to put out a paper detailing a new-found cause and/ or treatment for the disease, rather than ordering some more non-invasive tests to investigate potential new leads? Is this a result of “decision tree” learned medicine limitations? [see Groopman, pg 5, intro] 

     For that matter, if a situation presents itself in which not only a cause cannot be found but also a diagnosis is eluding, what prompts a doctor to halt investigation and conclude a diagnosis of psychosomatic illness instead of finding a potential “zebra” diagnosis? [Montgomery, pgs 122-125] And when is it the appropriate time to let medical technologies rule out physical illness even when the patient is feeling quite ill; when the illness seems all but invisible to everyone but the patient?

     On the site www.stopthethyroidmadness.com patients detail going for months and even several years being told that their test results revealed they are “fine.”  It used to be, when a patient had symptoms of hypothyroidism they were simply given a trial dose of thyroid hormone replacement to see if that corrected the symptoms.  Nowadays, hypothyroidism is solely determined on test results, for which there are several that can be ordered.  However, most doctors only utilize a couple of those tests which often miss proper diagnosis.  What makes a doctor stop at just a selective set of tests instead of further investigating in the midst of a patient’s complaints and ailments?  Even when further testing is non-invasive?

–Genevieve

Posted August 30, 2010 by jblakescott in Uncategorized