In the article “Scientists Gain Insight Into How COVID Harms the Heart” by U.S. News and World Report, Cara Murez describes recent findings on how COVID-19 affects the coronary arteries of older individuals who were infected by the original virus strains. The article opens by making a general statement that new research has found that the virus can increase the risk of heart disease and stroke. The author goes on to explain how the virus infects macrophages and could lead to the build-up of plaque, suggesting that there could be further studies based on this premise and that this study could be generalized to larger populations – that is, anyone who gets the virus. The study is suggested to be a good source of information to predict future research on the effects of acute and long-term COVID-19 and is said to demonstrate a better understanding of the virus.

To understand how this article may impact a patient’s engagement with medical information, one should first isolate the true information reported in the study from how it may be presented at face value. Upon opening the article, readers are introduced to what they expect to be the summary of the study’s implications, which conveys to the readers that research has shown that COVID-19 can lead to heart disease and stroke in patients. This incredibly general statement has no specifications or true information about the nature of the study, which can be misleading for casual readers. Further in the article however, readers are finally introduced to information regarding the nature of the study and learn that the research was focused on older people with plaque in their arteries who died from COVID-19. However, in the same sentence, the author goes on to state that these findings, which are relatively narrow in the breadth of cases they cover, could implicate anybody who is infected with the coronavirus. This singular statement would lead patients to assume that this study applies to absolutely everyone, and therefore themselves if they have been or will be infected with the virus, even though the article itself contradicts this statement. At the very end of the article, there is a note from the researchers that states that the study only included a small group of older individuals infected with the original virus strains and that it cannot be generalized to other strains or other populations. This statement directly refutes the previous claim about the research’s generalization by Murez, and it provides further specification that the results are not even relevant to the strain of virus that is circulating today. After dissecting the conflicting statements made throughout the article, it seems as if the author is portraying the findings to apply to the readers’ everyday lives when it should instead be a report of the true, conditional conclusions the study has the authority to yield.

This misleading portrayal of scientific research can deeply affect patient’s opinions and beliefs about COVID and therefore could impact their medical decisions. One discussion in our IDMD 101 class that I believe applies heavily to this scenario is our analysis of how the media reports on studies and how that can turn into harmful, lasting beliefs, exemplified by the MSG hoax reviewed in the This American Life podcast. Because the New England Journal of Medicine published a letter to the editor, which was not backed by any scientific research, without making it clear to the readers that it was just an opinion piece, decades were spent with patients having medical misconceptions and false beliefs that MSG was harmful to the body. Similarly, articles being published today, such as the one in this discussion, can cause patients to falsely believe that a correlation found in one study is always applicable to their own health and medical decisions. This specific article may lead to patients believing that they will have a higher risk of heart disease or stroke solely because they have caught the virus due to its initial lack of specification of who and what strain the study pertains to. The misleading aspects of this article misinform the public, which affects patients’ medical decisions. Doctors are then tasked with reassuring patients of untrue beliefs, which can prove to be a hurdle that can get in the way of the true treatment a patient might need. Suppose the patient truly trusts this article because it seems to cite straightforward evidence. In that case, this might harm the doctor-patient relationship when the doctor clarifies the true meaning of such research. Instead of being able to treat the patient as needed, the physician must combat the spread of misinformation and put their relationship with the patient on the line. These situations may be avoided if articles are upfront and clear about the research they report instead of trying to make untrue generalizations to get more attention from readers. 

Furthermore, an article that does not clearly portray the findings of a research study could affect the concept of informed consent and medical decision-making. Through the readings “The Concept of Informed Consent” by Faden and Beauchamp and “Informed Consent: What Must be Disclosed and What Must be Understood” by Millum and Bromwich, we learned the importance of ensuring that patients are as well-informed as possible when making decisions about their health so that they may accurately exercise autonomy and be able to give or refuse authority to their doctors in performing procedures. There is an argument to be had for the idea that media portrayals of medical concepts, as seen in “Scientists Gain Insight Into How COVID Harms the Heart,” actively interfere with the concept of informed consent. To expound on this idea, let us consider the fact that informed consent relies on the patient’s understanding of the information they are presented with. If a patient receives information from a piece of media that is not clear on how such information may affect them, then he or she does not fully understand the data presented, and such patients may base future medical decisions on their innate understanding of how COVID may affect them, whether that be by avoiding treatment out of fear or seeking out unnecessary interventions to protect them from the heart disease that this article implies is imminent. While the beliefs patients elicit from these articles do influence their understanding of future medical decisions, doctors are not privy to understanding these beliefs unless the patient comes forth with them, which creates a circle similar to the “extrapolator’s circle” that Stegenga discusses in Chapter 7 of Care and Cure. If a patient misinterprets the data of a study because of an article’s presentation of such data, then they are unable to seek a doctor’s clarification due to the fact that they do not understand that they are misinterpreting the evidence in the first place. This predicament fundamentally undermines the concept of informed consent because patients do not have a complete understanding of their medical situation, and it is detrimental to the doctor-patient relationship because a foundation of truth and understanding has been tainted by the media’s presentation of medical issues for public consumption. 

This article very effectively demonstrates the misunderstandings and the strain on doctor-patient relationships that come from the mass consumption of articles that report on medicine. Without articles properly conveying the evidence and conclusions from a study, patients may assume fragmented beliefs about illnesses and are unable to clarify this misunderstanding because the articles are not clear in the first place. When these articles inevitably influence patients’ personal medical decisions, it becomes a strain on the doctor to convey the truth to patients and uphold their relationships. This dilemma could be avoided simply by recognizing that such misunderstandings take place and taking an active role in producing clear articles that the average patient can thoroughly understand. 

 

Works Cited

Faden, Ruth R., and Tom L. Beauchamp. “Decision-Making and Informed Consent: A Study of the Impact of Disclosed Information.” Social Indicators Research, vol. 7, no. 1–4, Jan. 1980, pp. 313–36, doi:10.1007/bf00305604.

HealthDay. “Scientists Gain Insight into How COVID Harms the Heart.” U.S. News & World Report, 2 Oct. 2023, https://www.usnews.com/news/health-news/articles/2023-10-02/ scientists-gain-insight-into-how-covid-harms-the-heart.

Millum, Joseph, and Danielle Bromwich. “Informed Consent: What Must Be Disclosed and What Must Be Understood?” The American Journal of Bioethics, vol. 21, no. 5, Jan. 2021, pp. 46–58, doi:10.1080/15265161.2020.1863511.

Stegenga, Jacob. Care & Cure: An Introduction to Philosophy of Medicine. University of Chicago Press, 2018.

“The Long Fuse.” This American Life, 8 Feb. 2019, https://www.thisamericanlife.org/668/the- long-fuse.

Emma Brecht

Emerson

IDMD 101

10 October 2023

Patient Care: A Whole Story Picture

“Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever had” (Margaret Mead). All change in the world has been spurred by the actions of a few people who began on a small scale. When it comes to the volunteers of a program called My Life, My Story, this quote will soon ring truer than ever. Because of their out-of-the-box ways of thinking and active initiative, I believe that their ideas will soon revolutionize the way a disease is evaluated and treated. 

In the article Storytelling Helps Hospital Staff Discover the Person Within the Patient, written by Bram Sable-Smith, the efforts and successes of My Life, My Story are told through the experiences of a man named Bob Hall. Bob Hall is a US veteran who had been in and out of the hospital for quite a long time. While recovering from his recent surgery, a volunteer entered his room to talk. The volunteer asked for his story, and Bob was happy to comply. As he spoke, the volunteer wrote his story down on a file. When she was finished, she allowed Bob to read over the story and make any changes to parts that were inaccurate or that he didn’t like. The story was then placed in his permanent medical record for the VA hospitals. The program was originally created for residents and med students to quickly learn a lot about the patient in a short period of time, helping to build their connection with the patient. Some physicians do not know the right questions to ask, and for this reason, a professional writer was hired to tell the patient’s story. Over time, these filed stories improved patient care and expanded patient outreach.

This article reinforces one of the main ideas of our class discussions: the biopsychosocial model. We have found ourselves asking questions such as “How do the doctors convince patients to tell them their entire story,” “How do doctors bridge the patient, physician trust gap,” and “How do doctors know what questions to ask and what information is relevant?” The initiative made by My Life, My Story answers these questions. The initiative suggests that a part-time or full-time employee at hospitals is hired to document the stories of patients. It would be a small cost with a large outcome. If physicians have access to the stories of their patients, then they will be able to better understand the patient; if physicians are able to better understand the patient, then they will know where a patient is coming from and how to approach the appointment, which will improve the overall patient care experience. 

The biopsychosocial model views medicine from the perspective of the whole life of the patient. It declares that biology, psychology, and social well-being are all intrinsically connected when it comes to the patient’s state of health. Bio affects the psycho, psycho affects the social, social affects the bio, and vice versa. Some aspects are within the physician’s control, some aspects are not, while others lie in a gray space. In most cases, biological aspects are within the control of the physician, social well-being aspects are out of their control, and psychological aspects can be both within and outside of the physician’s control. There are many debates regarding how much control a physician can have over the psychological factors of a patient, and how much information should be taken into account when it comes to assigning a diagnosis and treatment plan. 

The initiative set by My Life, My Space expands the responsibility doctors have in regard to considering psychological factors. The stories being attained and written will help the physician get a fuller picture of the patient’s world and life experiences, which will lead to a more thorough diagnosis and treatment plan. When doctors are able to better understand their patients, they attain a higher capacity of respect for the patient. When a doctor cares for their patient and is able to show their care in a way the patient can see, the patient will trust the doctor more. It will make healthcare visits run smoother and will strengthen the bonds between a patient and their physician. 

Another aspect of the volunteer organization that I find interesting is that it not only strengthened the physician’s care but also drew in people from outside of the patient’s typical care unit. An employee at the hospital stayed after her shift one night to talk to Bob because she had read his story in a file and it sparked an interest. Because of this, Bob and the employee had a lovely conversation, and both parties walked away from it with an improved mental state. The program ran mostly in VA hospitals, whose patients are older and do not have very many family members and friends visiting them in the majority of cases. Humans were built for socialization, and when stuck in a hospital room alone all day, patients are missing these crucial interactions. To have their physicians and others who care for them taking the time to reach out means a lot to the veterans. It makes them feel less alone and desolate, which has been shown and proven to improve the overall state of health in these patients. 

Alongside the veterans hospitals, the program has begun to expand to some smaller hospitals. I think that as this program and its ideas continue to grow, it will expand to healthcare practices all over the country. It will become the normal and expected standard of care, and will permanently improve the healthcare industry. So much change is coming, and it was all sparked by one person.

What started out as something small eventually grew and took on a whole new meaning. Dr. Elliot Lee set out to help medical residents more quickly connect with patients who would not have the time to form a meaningful connection, and ended up improving the medicine for all physicians. No doctor is perfect, and no patient is perfect, therefore there will always be a gap between patients and physicians. Regardless, the simple addition of a story in a medical file can lessen this gap and improve healthcare all around the world. 

 

Works Cited

Sable-Smith, Bram. “Storytelling Helps Hospital Staff Discover The Person Within The Patient.” NPR, 8 June 2019, Accessed 10 October 2023. Medical Storytelling at the VA Bridges Gap Between Patients And Caregivers : Shots – Health News : NPR

Engel, George. “The Biopsychosocial Model and the Education of Health Professionals.” University of Rochester Departments of Psychiatry and Medicine, pg 169-181, Accessed 10 October 2023.

Alejandro Gonzalez
Dr. Emerson
IDMD-101-004
10/10/23

Physicians Being Paid to Prescribe

The article I chose was from CNN Health about physicians being paid by pharmaceutical
companies and how it affected how often they prescribed that drug. The article talks specifically
about opioids and how an overprescription of them could lead to an addiction to the drug which negatively affects the patients well being. They analyzed databases with the information of doctors being paid by companies and compared it to how often they prescribed the drug, in
which they found a positive correlation. A counterpoint was brought up about the doctors truly
believing the benefits of the drug and that the research only proves correlation and not
necessarily causation. Still, there was a large concern about conflicts of interest for the doctor,
and the financial incentive outweighing the best interest of the patient. There are many ethical
questions raised about this scheme, but the two I want to focus on are brought up in Stegenga’s
Care and Cure are medical paternalism and the patient and physician relationship.

Firstly, medical paternalism, which is defined by the NIH as “The physician makes
decisions based on what he or she discerns to be in the patient’s best interests, even for those
patients who could make the decisions for themselves.” This would come into question when the physician prescribing medication was paid a large sum of money by a pharmaceutical company and is now more often prescribing that drug to more patients. It could be inferred that since they are getting kickbacks from those companies, it provides more incentives for the physician to prescribe that medication, to then receive more money. According to the article, pharmaceuticals pay physicians to do research and also for promotional work, they later go on to claim that the largest amount is paid for the latter. The article also goes into detail about a couple of patient cases where the physician prescribed opioids and the effects they had on the patient. Specifically in the case of Angela Cantone, who was prescribed “an opioid called Subsys for abdominal pain from Crohn’s disease”. The drug Subsys was cited as being “50 to 100 times more potent than morphine”, and it caused her to frequently pass out and caused her great discomfort, and whenever she was off the drug it caused “uncontrollable diarrhea and vomiting.” With these terrible symptoms, she consulted the physician who prescribed her the drug in the first place, and he stated that it couldn’t be Subsys causing it. What she responds with is what I want to focus on, which is the fact that she trusted him, “I trusted my doctor as you trust the police officer that’s directing traffic when the light is out.” This is essential to the root problem of paternalism, which is the fact that patients believe they don’t have autonomy when it comes to their health, and in a hospital setting some patients believe that the physician’s word is law. So, when a physician prescribes them medicine, they believe it is in their best interest and that the physician knows best. In even worse cases, like Cantone, when they ask to be switched to a different medication, they simply refuse. There could be a case where the doctor isn’t affected financially, though for this physician it’s pretty clear why, but even then it is a gross offense to the autonomy of the patient, where they can decide for themselves.

In recent times, due to the expansion of media and access to medical information, I believe patients are becoming more autonomous medically speaking, but I also believe that it has
affected the patient and physician relationship. Also called the doctor-patient relationship, it can be defined as, “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.” This involves trust between parties and there is a relationship built, which allows for cooperation and vulnerability. Articles such as this one allow patients to be aware of their voices, but it can also harm the trust of physicians. It is true that the doctors and companies discussed in this article probably had financial gains as a priority over the health of the patient, for which they were sued and investigated. This is to say that not all physicians are like this, the majority will be on the patient’s side and will look out for their best interest. The article stated that “ In 2015, 48% of physicians received some pharmaceutical payment.”, even for those who were, a portion of them were the ones overprescribing medication, though the severity increased as the number of prescriptions increased. So while these cases are immoral, in most cases it won’t end up this way for patients. Though, after people read this article, and others like it, it creates a negative stereotype for physicians, which are greedy people who are self-centered and only care about their gain. This puts a dent in the patient and physician relationship, where the patient has a pre-established notion that the physician is untrustworthy. This is an unrealistic expectation for patients to have against all physicians and can cause a lack of cooperation and trust that leads to other problems, such as misdiagnosing due to their being lack of information divulged.

Overall, I believe that articles being published like this one are helpful to people, it allows them to be aware of problems in the medical field that they might not have known or considered. Always having access to more information is a good thing, it allows people to make decisions for themselves and be more autonomous, which combats medical paternalism. What I have apprehension about is the over-sensationalized of problems presented by the media. While this article I believe showed both sides and provided studies and information to support their claims, not every publication would go through this length. Articles that sensationalize problems and have hyperbolic headlines are often clicked on and sold. This can create a false perspective for people that has a negative effect on the trust between patients and physicians.

Works Cited
Chipidza, Fallon E, et al. “Impact of the Doctor-Patient Relationship.” The Primary
CareKessler, Aaron, et al. “CNN Exclusive: The More Opioids Doctors Prescribe,
the More Money They Make.” CNN, Cable News Network, 12 Mar. 2018,
www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html.
Kilbride, Madison K, and Steven Joffe. “The New Age of Patient Autonomy: Implications
for the Patient-Physician Relationship.” JAMA, U.S. National Library of Medicine,
20 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6988779/.
Murgic, Lucija, et al. “Paternalism and Autonomy: Views of Patients and Providers in a
Transitional (Post-Communist) Country.” BMC Medical Ethics, U.S. National
Library of Medicine, 29 Sept. 2015,
www.ncbi.nlm.nih.gov/pmc/articles/PMC4589086/.
Stegenga, Jacob. Care and Cure an Introduction to Philosophy of Medicine. The University
of Chicago Press, 2018.

Medical Developments and Disagreements

After Roe v. Wade was overturned in 2022, many states have decided to either restrict or completely ban abortion. This has caused several issues within the medical world, specifically with the training of OB/GYNs. Many medical schools have done away with their abortion training, leaving students underqualified and limited in their future opportunities. Texas, Missouri, and Idaho have been especially open about their refusal to even teach abortion skills or allow a resident to receive an abortion even if in another state, in Missouri’s case. This leaves future physicians confused and worried, possibly throwing a wrench in their “methodically plotted career paths” (Varney). Students attending institutions that do not provide abortion training will have to seek it in another state or learn it through another program, after already spending the time and money on medical school. Those that do not learn this treatment will be “less skilled” at performing “lifesaving procedures” that are needed due to the likelihood of maternal death (Varney). In connection with the concepts in Care & Cure by Jacob Stegenga this development goes against the well-being of patients and decreases physicians’ abilities to properly care for their patients.

In chapter one of Stegenga’s Care & Cure, the definition of health is debated. According to the World Health Organization, “to be healthy involves more than merely being free of diseases” (Stegenga 11). This is what is known as positive health which deems a person as healthy if they are able to “flourish in various respects” (Stegenga 7). This theory of health is more consistent with the idea that well-being plays a big part in whether someone is truly healthy or not. The well-being of the pregnant patient and all those involved in the pregnancy can be extremely degraded if they have no choice other than to raise the baby to full term. Imagine there is a sixteen-year-old girl who uses contraceptives such as birth control and still ends up pregnant. She would likely be labeled as unhealthy by standards of the positive health theory because of all the stress and turmoil in her life. Social, mental, and physical effects of the pregnancy could negatively impact her such as having to drop out of school or facing backlash from her family and peers. Although she does not have a disease in the sense of a biological misfunction, she does have internal and external factors that are inhibiting her from flourishing.

In addition, not all abortions are performed because the person pregnant simply does not want the baby. Sometimes a pregnancy is terminated because the developing baby has a serious condition or because the pregnancy is putting the mother’s or child’s life at risk. Although most states still allow the termination of a pregnancy for medical emergencies, many physicians and patients have become scared to perform these procedures due to the possible repercussions. According to Missouri laws, anyone who performs an abortion can be charged with a class B felony, “as well as subject to suspension or revocation of his or her professional license” unless it is in a case of medical emergency (Revisor of Missouri). Dr. Eve Espey, a professor at the University of New Mexico in Albuquerque, says that more Texas residents have been coming to New Mexico to terminate their pregnancies, some even with “serious pregnancy complications” (Varney). Both the providers and patients in Texas (and Missouri) are afraid to deal with abortion situations due to the fear of prosecution since the term “medical emergency” has a lot of legal ambiguity. If a pregnant person is having to board a plane or drive hours for a procedure when their health is in serious danger, then that is putting the person’s life at risk as well. The well-being of this patient is drastically decreased because not only is there added stress, but it is costing even more money and having to put themselves in an uncomfortable situation in order to get the care they desire. Therefore, their overall health is negatively affected by what some argue is supposed to be a beneficial development.

Now let’s look at this development from more of a physician’s point of view. In chapter ten of Stegenga’s Care & Cure he discusses the effectiveness of certain medical treatments, but what about the effectiveness of the physician? If the positive view of health is taken into account, then a medical treatment is effective if it “contributes to a person’s state of complete physical, mental and social well-being” (Stegenga 160). Certainly, the skills needed to terminate a pregnancy can contribute to a person’s well-being, especially if it is a situation where the pregnant person’s life is at risk. Thus, by taking away the skills to potentially perform life-saving treatment or procedures, the physician is also rendered virtually ineffective. What happens if an OB/GYN’s patient comes in with a blood clot due to elevated hormones and stress on the heart? In this case, it is either perform the abortion or it is very likely that the patient will die. If a physician has no training in these skills, they will not be able to effectively treat and save their patient.

From the perspective of students striving to become OB/GYNs, being perceived as less than due to a lack of opportunity to gain this knowledge is terrifying. The decrease in medical schools teaching these skills has limited prospective medical students in their options as to which school they can even apply to. For example, once the abortion ban took place and many schools stopped offering the training, some schools that do offer the training, like the University of Washington in Seattle, “decided to admit only residents committed to providing abortion care” in response to schools in states such as Texas and Missouri. Consequently, students looking to be OB/GYNs are given less opportunity to get into medical schools based on whether that school offers the training. After finding out about this development from articles such as Vanger’s, some medical students have been swayed to switch specialties because they do not want to have to seek out more training on top of their eight years of schooling. This is troubling for both the health field and the general population due to the fact that there is already a doctor shortage, with the number OB/GYNs declining recently.

When the common public reads this article, one of the main takeaways is that future OB/GYNs may not be totally qualified or knowledgeable in their specialty. This notion could cause a very skeptical environment between the patient and physician because the patient might doubt the physician’s capabilities. A huge part of healthcare is the relationship between physician and patient which needs a lot of trust in order for the best outcomes. OB/GYNs require some of the most trust since there is a lot of invasions of privacy along with literally helping people bring life into this world. Most will choose to go to a doctor that has the skills to save the patient’s life if a medical emergency were to occur. Thus, those that do not have the training seem less appealing to the public and it may be harder for them to get a job or patients.

Not only does the decrease in abortion training affect physician capabilities, but it limits patient autonomy and safety. When the public consumes this information, they could fall under the notion that many OB/GYNs will be less qualified, a notion that happens to be true if they lack the abortion training. This could create an untrustworthy environment, especially if the patient is not confident their physician has the skills to save their life in case of an emergency. Furthermore, much like the patients that are forced to seek medical treatment in another state, future physicians that are not offered the training at their medical school but wish to have it will have to seek out another program. This article not only highlights the possible inefficiency of future OB/GYNs, but it also shows the public how their well-being could be affected by medical schools taking abortion training out of their curriculum. Although it is important to share this information, the way the article presents the information may strike fear into both students and patients, rightfully so.

 

Work Cited

“Right to Life of the Unborn Child Act.” Revisor.mo.gov, 24 June 2022, revisor.mo.gov/main/OneSection.aspx?section=188.017#:~:text=Any%20person%20who%20knowingly%20performs. Accessed 11 Oct. 2023.

Stegenga, Jacob. Care and Cure. University of Chicago Press, 13 Nov. 2018.

Varney, Sarah. “Fewer Medical Students Trained for Abortion Procedures.” NBC News, 22 Mar. 2022, www.nbcnews.com/health/womens-health/fewer-medical-students-trained-abortion-procedures-rcna21003.

 

 

 

Nicolas Hewitt

Emerson

IDMD 101

4 September 2023

The Less Fun Medical Green

          In order to combat diseases such as diabetes, obesity and hypertension, a study has given

produce vouchers to around four thousand people who struggle to afford healthy foods. The

study tracked the participant’s weight, blood pressure, and blood sugar to see if there were any

noticeable improvements in the conditions of the participants. Those with uncontrolled

diabetes were found to have a significant reduction in average blood sugar, around half as

effective as typically prescribed medications. The vast majority, around 94%, of participants

reported improvement in their heath due to taking part in the program. Produce prescriptions

are only providing assistance in the short term, but advocacy groups like the Milken Institute as

well as the Biden administration are pushing to have them as well as other nutrition based

health programs implemented more permanently.

         When considering the role of physicians in treating disease and improving health, a

standard assumption would consist of prescribing drugs that target the specific cause of the

disease and to a lesser extent mitigate unpleasant symptoms. In the biomedical model, the goal

of medicine stops with treating the disease with empirically tested drugs or therapy. Beyond

that, medicine has little it should achieve. The biopsychosocial model would extrapolate that

goal to include considerations of the patient’s personal and social condition, but whether that

should extend into treatment outside traditional understanding of what is medicine depends

on one’s philosophy regarding health. The positivist perspective, in which health goes beyond

the mereabsence of disease, is where I argue the medical issue of prescription fruits and

vegetables originates. When you view the goal of medicine as maximizing the well being of the

patient, prescription produce and other treatments that provide general health benefits

(although prescription medicine does provide some specific medical treatment as supported by

the study in the article) are as important as treatments that reduce the detriments of specific

illness, such as antibiotics. The potential benefits of providing incentives to purchase more

produce are strong, as they help solve root dietary issues that cause many diseases. Produce

ought to be considered medical in the sense that although they are not an active drug that

targets a condition, it still is used by the physician to improve patient condition. Other

treatments, such as probiotics, are also general in their use and their benefits. Additionally, the

nature of medicine as largely provided by insurance lends itself to treatments that reduce the

overall health risks of the patient, as insurance companies are encouraged to support actions

that reduce risk of paying for additional care down the line.

          The implementation of prescription produce raises the debate of whether or not medicine

ought to consider inequalities in wellbeing as something to be treated by medicine, as well as

what constitutes medical inequalities. In a broader social context, inequalities of wellbeing, such

as housing or food insecurity are considered, with relatively less controversy, to be the

responsibility of the state and society as a whole. The idea of food stamps and other

government benefits are accepted as things the state can do, even if they are not considered by

all to be something the state should do. Medicine’s role in reducing inequality is met with more

resistance, perhaps because of the wish to keep medical institutions apolitical and focused on

purely scientific perspectives. Since medicine does not exist in a perfect vacuum, inequalities

will affect well being even if medical institutions try to remain as unbiased as possible. To treat

systemic issues of food inequality, especially in quality, medicine needs to be cooperatively

involved with other institutions such as the state in order to reduce the effect of socioeconomic

inequality on the health of underprivileged patients. Prescription produce blends the medical

knowledge of diet with the societal goal of improved general wellbeing, and supports the idea

that medicine should not only consider the entirety of what affects a patient’s life, but should

also not limit itself to what it can treat.

          The average reader will likely view this topic more through the broader lens of

socioeconomics rather than the question of medicine’s role of even providing such a

prescription. A reader, regardless of their opinions on the subject, would focus on the relation

of food based prescriptions to government benefits and medical insurance. Patients would

likely be enthusiastic to the idea of prescription produce as a more holistic treatment, and their

enthusiasm would only increase the effectiveness of the treatment due to their perception.

Getting produce prescriptions from their physician would also cause patients to be more

conscious of their diet overall, improving the relationship between psychological and biological

health. One concern about prescription produce would be poor reception from patients to a

physician suggesting changes to their diet. Some patients might be sensitive to the idea of a

patronizing doctor forcing patients to eat their vegetables as if he was their parent. This patient

concern touches on a fear of paternalism by physicians, and can be remedied by ensuring the

patient retains their autonomy to choose this treatment and does not feel pressured to change

their diet because of a physician’s personal belief of what is best for the patient. Instead it

should be made clear that the patient is deciding what dietary decisions that they should be

making.

          Prescription produce lends itself well to patient autonomy because it greatly increases the

patient’s agency to choose healthier food options, both in quantity and variety. With most

treatments, such as choosing what blood pressure medication they will take, the patient is

heavily dependent on the physician to inform them on the potential benefits and risks of

different medications. Often the physician has biases about what medication would be best and

may guide a patient to choose a medication that, if they were fully and impartially informed of,

they would not choose over another. With produce prescriptions much more of the decision

making is in the hands of the patient, both in the sense that the patient gets to choose what

produce to buy and is more familiar with what kinds of produce works best for them. Physicians

would likely still give advice about what produce to eat for the patient’s specific condition, but

the risk of that preventing patient autonomy is reduced. Unlike most medications, the relevant

facts about produce, such as nutritional values and bodily reactions to certain types of fruits

and vegetables, are as readily available to the patient, if not more, as they are to the physician.

          As medicine expands and challenges the great illnesses of our day, including cancer,

autoimmune diseases, and dementia, it is beneficial to also focus on the simpler, but equally

important issues that need to be treated. Prescription produce is by no means as glamorous as

revolutionary cancer treatments or advanced biomedical technology, yet it connects to

overlooked aspects of medicine: patient agency and access to care, as well as generalized

beneficial treatments. Prescription produce indicates medicine’s growing orientation to the

needs of patients beyond the biological.

 

Reference Article

Aubrey, Allison. “Prescriptions for fresh fruits and vegetables help boost heart health.” NPR,

9 Sep. 2023, 

https://www.npr.org/sections/health-shots/2023/09/04/1197266058/prescriptions-for-fresh

-fruits-and-vegetables-help-boost-heart-health.

Philip Brutkiewicz

Dr. Emerson 

IDMD 101 

10 October 2023 

Short Paper

Written by Harriet Pilpel, The Right of Abortion advocates for the ability to get an abortion in the United States. The article first explores the issue of population control. The U.S. is experiencing overpopulation, and while few argue for compulsory sterilization to combat this, little is done to make birth control easily available for those who want it. This is particularly a problem for the poor and underprivileged, such as racial minorities. Part of this is due to strict anti-abortion laws in many states. These laws limit healthy abortions in these areas to those who can afford an out of hospital abortion, which are usually middle and upper class white women. Society should see that in order to slow population growth rate without compulsion, abortion must be made easily and legally available. 

This article connects to the issues regarding death in Care and Cure by Jacob Stegenga. In Chapter 3, the death of an organism is contrasted with the death of a person. While most define death as the permanent end of biological functioning in an organism, many believe biological functioning alone does not make us alive. While to be an organism one only needs a heartbeat, to be a person one must have consciousness and a soul. This question of what makes us dead has in turn asked us to question what makes us alive. In the context of abortion, a young unborn fetus is organismically alive. This is the view which many lawmakers in our country have taken, such as the Supreme Court when overturning Roe v. Wade and removing the constitutional right to abortion (“Roe v. Wade”). On the other hand, the unborn child has not yet achieved consciousness, thereby not a “person” in the model that the book presents. This issue is significant as depending on which criteria decision-makers in our country take, access to healthy abortions can either be easily available or scarce like in many states today. Lawmakers, such as the Supreme Court, are ignorant of the fact that abortions, like it or not, are going to happen. This is seen in a quote from the article, saying, “Abortion is still the most widespread…method of fertility control in the modern world.” If abortions are vitally important to reduce unwanted births and are going to happen regardless, we should legalize them and promote healthy abortions in hospitals. Lawmakers should be more worried about a person’s livelihood and those already born than the lives of the unborn. 

This piece on the right to abortion also highlights the issue presented in Care and Cure of physician-assisted death. The Hippocratic Oath states that physicians must cause no harm and only give beneficial treatments, but if the child is not wanted and cannot be taken care of, is harm truly being inflicted or really just avoided? Physicians should answer to the mother’s decision, as the parent can decide for themself if the procedure will benefit them more than harm in an abortion. As seen in Care and Cure, patient autonomy has been an ideal of American law since the 1950s. Physicians must seek their patients’ consent, and there is no greater scenario to abide by this rule than in the decision to receive an abortion. By physicians assisting in abortions, it not only gives a higher rate of success and safety, but also mental comfort to mothers who can trust a physician more than someone unqualified. According to the Atlantic, there are 8000-1000 abortions in hospitals compared to 1 million outside hospitals annually. We need to support physician-assisted abortions in hospitals so that less people are attempting home abortions that are much more dangerous for the child and the mother. As the article states, we must not compel the “unwilling to bear the unwanted”. 

Not only does our nation have a problem with general access to abortions, but there are major inequalities in abortion access based on race, color, and socioeconomic status. This is in large part due to the fact that white women tend to be able to better afford out of hospital abortion care, whether it be in their area or traveling to a different state. As Pilpel reveals in her article, “women whose deaths were associated with abortion in New York City in a typical year were 56 percent black, 23 percent Puerto Rican, and 21 percent white”. This sort of statistic is the focus of Hausman’s article What’s Wrong with Health Inequalities?. The article evaluates whether health inequalities involve injustice and compares these inequalities to the standards of the World Health Organization. The World Health Organization, or WHO, generally defines an injustice as a lack of the ability “to be given an opportunity to have equal health status insofar as possible”. In the statistic of New York City abortion deaths, this is a clear injustice as black women and women of color in the city are at a much higher risk of dying than white women. City officials and hospitals must focus on offering easier access to abortions in areas where these women are statistically underserved, such as predominantly black or Puerto Rican neighborhoods. These officials and hospitals can do this by building more hospitals in these areas, setting up clinics, and building trust between the physician and patient. If the patient does not trust the physician, as seen in Care and Cure, the patient is much less likely to tell a physician the entire story or even see the physician again. Take the example of Anne Dodge, a patient who had to go to many different primary care doctors as no doctor truly listened to her situation. Eventually Dodge received a proper diagnosis after going to a doctor that gave her a proper evaluation (Introduction-How Doctors Think). Just as with Dodge, physicians should listen to the mother’s demands when performing an abortion to prevent physical and mental trauma. The end of a possible life is sure to give these women feelings of regret and depression, and physicians must coordinate check-ups after the procedure to ensure well-being. This is why it is important in the fight against abortion injustice to not just have clinics in these areas, but to also have qualified physicians to serve these women. 

Abortion access is a right that all women should have, regardless of where they live. Though some argue for the organismic model of living, an unborn fetus should not be considered living as it has not yet attained consciousness. Lawmakers should use this model to guide their decisions and make abortions easier to obtain. Physicians should be the guiding hand in these abortions, not only performing them but also guiding the mother mentally. We must also try to eliminate injustice in inequalities the best way possible through a reallocation of resources. Abortions have been happening since the advent of humanity. They always will, so we should make them as safe and available as possible.

 

Works Cited

Hausman, Daniel  M. “What’s Wrong with Health Inequalities .” Journal of Political Philosophy: Volume 15, Number 1, University of Wisconsin-Madison , 2007. 

Introduction- How Doctors Think , 10 Oct. 2023. 

Pilpel, Harriet. “The Right of Abortion.” The Atlantic, Atlantic Media Company, 16 Aug. 2018, www.theatlantic.com/magazine/archive/1969/06/the-right-of-abortion/303366/. 

“Roe v. Wade.” Oyez.Org , www.oyez.org/cases/1971/70-18. Accessed 8 Oct. 2023. 

Stegenga, Jacob. Care and Cure an Introduction to Philosophy of Medicine. The University of Chicago Press, 2018. 

 

The Listening Problem 

Noah Taeckens 

IDMD 101 Short Paper 

10/10/23 

“Why Doctors Don’t Listen to Patients” is a short article written by Qing Yang, a doctor who graduated from Yale’s School of Medicine, and Kevin Parker, a public policy administrator, as part of a local newspaper outlet in Springfield, Illinois called “Special To The State Journal-Register.” The article discusses the importance of listening when practicing medicine and why that skill has fallen out of favor with physicians in recent years. Yang and Parker start off by stating that in the modern age of medicine and technology, listening has taken a back seat due to time constraints. The authors claim that an average primary care physician sees about 20-30 patients a day for usually only 15-30 minutes with little time in between visits to return calls, chart information, and write prescriptions. As a result, physicians are overwhelmed and constantly running behind schedule. In order to make up time, physicians in all disciplines including specialties, become overly reliant on the decision-tree model to ask rapid-fire questions and generate a quick diagnosis. This is problematic because it makes the patient feel as if their thoughts are not valued and could cause the physician to ignore issues within the biopsychosocial model, such as the effects of grief. The article ends with Yang emphasizing the need for physicians to actively work to clear the listening hurdle and resist the urge to forgo real and meaningful face-to-face interactions. While failure to listen may seem trivial, Yang and Parker shed light on why that is not true. Patients are more than their disease, and thus failure to treat them as complete human beings, with emotions ranging beyond their chief complaint, results in worse outcomes. As the Hippocratic Oath states, “There is an art to medicine as well as a science.” 

 

The “art” of medicine is perhaps best expressed by the biopsychosocial model. George Engel first suggested the concept in a lengthy paper in 1977 and since then its ideas have permeated the worlds of medical literature and philosophy, including as a focal point in Jacob Stegenga’s “Care and Cure.” The biopsychosocial model states that a person’s biological, psychological, and sociological health are all distinct, yet interconnected, meaning that they can affect one another. Based on that idea of interconnectivity, the model calls for physicians to examine their patients in a more holistic manner. Instead of purely examining biological issues, physicians need to ask open-ended questions and obtain qualitative information to gauge how their patient is doing psychologically and socially. This is necessary because a patient’s psychological and sociological health can have a strong impact on their biological health and vice versa. In essence, the biopsychosocial model implores physicians to examine the whole person behind the patient. In order to successfully examine the whole person, a physician must listen to that individual. This is where conflict arises, and it’s not necessarily all the physician’s fault. As Yang and Parker point out, the medical training system is deeply flawed: “medical training still emphasizes asking questions more than listening for answers. Even the asking has shifted to diagnostic tests and the search for “data,” rather than direct conversations with patients.” While we have been blessed to live in a golden age of medical testing where almost any condition can be discovered based on lab results, data only tells the biological side of the story. Data can tell a physician that a patient’s calorie intake is too low. However, data cannot tell that the low-calorie intake is a result of heartbreaking grief that a patient is shouldering by hyper-controlling the one thing in their life they can still control: food. In this situation, overreliance on data and the biological model may lead the physician to simply tell their patient to eat more, missing the evidence of the beginning of an eating disorder that requires therapy. 

 

An extension of this overreliance on the biological model that poses new roadblocks to listening is the decision tree; a decision-making flowchart used by physicians to quickly come up with a logical diagnosis. While the tree sounds good in theory, it often causes physicians to miss the rarer cases, or situations that don’t fit cleanly into a box. This happens for two main reasons: the desire for efficiency and stereotypes. Yang and Parker touch on efficiency by stating, that physicians often do not evaluate their patients on a biopsychosocial level because they are too busy getting through “guidelines, algorithms, and checklists” and thus there is “little room for open discussion.” Additionally, the authors claim that stereotypes and biases are unfortunately, and often accidentally, used by some physicians in the “helpful skill of pattern recognition” which can increase the “risk of drawing conclusions too early” based on preconceived notions. When one combines the effects of stereotyping with the push for an efficient decision tree model, the effect on patients is devastating. Instead of walking into an environment centered around the patient, patients are walking into an environment centered around time, all the while providers scrutinize them based on their appearance and their race among other things. When the patient finally gets to the exam room, the provider may already have a diagnosis cemented, before the patient has even had a chance to speak. Not only is this offensive and hostile to the patient, but more importantly, it is the wrong approach, even from a purely scientific perspective. While rushing and stereotyping may work for the regular fall flu case, it will potentially cause the provider to miss the lurking meningitis case, a mistake that could have fatal consequences. 

 

The lack of physician listening is a problem that is only getting worse because of the extensive use of technology and online health visits replacing in-person sit-downs. Technology, while helpful, has exacerbated the problems posed by the overreliance on the biological model and the decision tree model. However, the patient-physician relationship and listening itself are not doomed. In understanding why the biological model is flawed and how physicians need to go beyond using a decision tree, we can avoid the pitfalls of these issues. In other terms, awareness is the solution, and not just for the doctor. Patients have agency and can take charge of their own care. If patients are made aware of the dangers of failure on the physician’s behalf to listen, and refusal to evaluate based on the biopsychosocial model, then they will feel more empowered to speak up when necessary. It is through communication and development of the patient-physician relationship that the medical world will learn to listen again and in doing so will better itself to the benefit of the patients. 

 

Sources: 

Miles, Steven H. The Hippocratic Oath and the Ethics of Medicine. Oxford ; New York :Oxford University Press, 2004. 

Stegenga, Jacob. Care and Cure: An Introduction to Philosophy of Medicine. University of Chicago Press, 2018. 

Yang, Qing, and Kevin Parker. “Why doctors don’t listen to patients.” The State Journal-Register, 22 November 2022, https://www.sj-r.com/story/lifestyle/health-fitness/2022/11/21/why-doctors-dont-listen-to-patients/69658485007/. Accessed 10 October 2023. 

Pharris Livingston

Physician Assisted Death

Physician assisted death is the practice of a physician giving a terminally ill patient the means to end his or her life. Physician assisted death has been a controversial medical topic for many years. The opposing sides of the debate are a fantastic representation of the long standing medical dilemma of balancing patient autonomy with a physician’s paternalism and traditional role as a healer. An article by Charlotte Huff discusses the history of this debate and outlines each side of the argument. Huff begins her article by describing some statistics originating from the state of Washington, who had just legalized physician assisted death just over a year before the article was published. She explains that this makes Washington the 2nd U.S. state to legalize physician assisted death as Oregon legalized it as early as 1994. Huff transitions this description of what was the current political state of physician assisted death to the more general aspects of the moral dilemma. She explains how the physicians opposed to physician assisted death generally hold the view that it violates the physician’s core responsibility to heal and comfort. On the other hand, supporters argue that patients have a right to decide how they will die, especially considering that these patients are already terminally ill.

The statistics that Huff includes from Washington were that, in total, 63 people requested and obtained the lethal medication. Of these 63, 47 died, but only 36 did so as a result of taking the medication. Huff explains that “in expressing their end-of-life concerns, all reported fearing loss of autonomy. Other common concerns were loss of dignity, reported by 82%, and loss of the ability to participate in enjoyable activities, reported by 91%” (Huff). Similarly, of the 460 people who underwent physician assisted death in Oregon from 1998 to 2009, 91% stated that “loss of autonomy was the leading concern” (Huff). Inadequate pain control and financial implications of treatment were also points of inquiry, but, when compared to loss of autonomy, they were significantly less prevalent. The main takeaway from this data is that autonomy is of utmost importance to patients when considering physician assisted death.

The Stanford Encyclopedia of Philosophy defines paternalism as “the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm” (Dworkin). Paternalism is relevant to physician assisted suicide because withholding the option of physician assisted death from patients is a paternalistic act that does not respect patient autonomy, so the question as to the justification of this paternalistic act is what the debate on physician assisted death largely hinges on. The articles “Medical Paternalism – Part 1” and “Medical Paternalism – Part 2” by Daniel Groll discuss the moral validity of medical paternalism. Groll finds that two accounts of paternalism hold the most moral weight: the authority account and the beneficence account. Groll explains that the authority account is when “a clinician acts paternalistically when, for her patient’s good, she usurps his decision-making authority,” and the beneficence account is when “a clinician acts paternalistically when, for her patient’s good, she acts only or overridingly out of concern for his good” (Groll 1). The main difference between these accounts is that the beneficence account characterizes a physician’s act as paternalistic because the choice to disregard a patient’s autonomy is based on the physician’s belief that the act is for the patient’s own good. This is different from the authority account because the authority account does not take the physician’s motivation to act for the patient’s own good into account. Groll argues “for a conception of paternalism according to which a person acts paternalistically to the extent that she acts in a way that is only or overridingly motivated by concern for another person’s good. In the context of medicine, this is often appropriate since for many patients – i.e. those that are not competent to make their own decisions – the only (or at least primary) consideration that is relevant for the surrogate decision maker is the patient’s good” (Groll 8). With this definition of paternalism established, Groll recognizes that the well-being of the patient is not the only factor that must be taken into account as the patient’s right to dictate his or her own treatment is also important. The conflict arises when what the physician views as preferable for the patient’s health contradicts what the patient desires (Groll 8). Groll concludes that because the authority account trumps the beneficence account, “acting paternalistically (at least when it comes to competent patients) is presumptively impermissible” (Groll 1). 

When placing the issue of physician assisted death in the context of this conclusion, it appears that restricting patient access to physician assisted death is not justifiable as it is a paternalistic action that does not allocate patient’s with the freedom to choose if they want physician assistance in their death. One counterclaim that could be made against this conclusion is the idea that patient’s who are not mentally fit to make decisions about their treatment could request physician assisted death. In this scenario, Groll explains that it is morally permissible to make decisions for a patient that is unfit to make his or her own decisions: a belief that is well established across medicine (Groll 8).

When reading the article by Huff regarding the history and ongoing debate of physician assisted death, I believe that the side of the argument that a reader would take would be largely based on the reader’s own perceived preferences for his or her own death and the likelihood that he or she would be open to utilizing physician assisted death if the possibility presented itself. I would assume that the readers that fear a loss of autonomy, being a burden, or suffering greatly in their final moments are generally more likely to support the legalization of physician assisted death because they would actually consider using it. Conversely, readers that would not consider physician assisted death are more likely to support the restriction of it. Another factor that would likely affect how readers perceive the issue would be how strictly they believe doctors must abide by their traditional role as a healer. Readers who believe that doctors must stay extremely loyal to their obligation to heal patients are more likely to be against physician assisted death while readers who do not feel that this traditional role is binding or should have any tangible authority over real world issues are more likely to support physician assisted death.

 

Works Cited

Dworkin, Gerald. “Paternalism (Stanford Encyclopedia of Philosophy).” Stanford.edu, 2020, plato.stanford.edu/entries/paternalism/.

Groll, Daniel. “Medical Paternalism – Part 1.” Philpapers.org, 2014, philpapers.org/rec/GROMPP. Accessed 10 Oct. 2023.

Groll, Daniel. “Medical Paternalism – Part 2.” Philpapers.org, 2014, philpapers.org/rec/GROMPP. Accessed 10 Oct. 2023.

Huff, Charlotte. “Doctors Debate the Ethics of Assisted Suicide.” ACP Internist, 1 July 2010, acpinternist.org/archives/2010/07/suicide.htm.

Noah Taeckens- Empathy Exams Presentation Paper 

9/28/2023 

This week we only had one reading, Empathy Exams, by Leslie Jamison. Jamison discusses the importance of empathy in the medical world, and what can happen when there is a lack of it. She compares her personal experiences to those that her fictional but very realistic character, Stephanie Phillips has as part of Jamison’s work as a patient actor. The narrative starts off with an explanation of Stephanie’s ailment, which is her unexplained seizures. Stephanie’s convulsions are actually caused by the impact of the loss of her brother; however, Jamison has been told not to reveal this to the medical students evaluating her. The medical students who get closer to the root cause of the seizures are the ones who display more empathy and as Jamison explains this means going beyond saying “that must be hard for you” and emotionally connecting with the patient. Jamison then switches gears and begins to tell her own story about how she struggled with the complexity of her emotions when dealing with a pregnancy, subsequent abortion, and heart surgery all within a couple of months of each other. Jamison felt guilt for having the abortion, fear of not understanding its effects on her upcoming ablation, and constant worry that she was either not having enough emotions or having too much. This level of emotional weight made it hard for Jamison to communicate with her doctors about her needs both as a patient and as a human. Jamison related this to Stephanie’s experience as both of them had a difficult time identifying what was the root cause of their emotional distress. The one-time Jamison tried to express herself, she was shut down by Dr. M, who was too busy trying to check off boxes to notice how worried and stressed Jamison really was. This further reinforced the harmful idea that Jamison was making a big deal out of nothing. Despite the difficulties, Jamison got the abortion and after a couple of physician miscues, was able to have successful heart surgery. As the piece comes to a close, Jamison makes a critical point that empathy is not as simple as projecting someone’s situation onto yourself as she had done with her brother who has Bell’s Palsy. What empathy is exactly is left up to interpretation. The narrative ends with passionate paragraphs that emphasize the constant questioning, lack of control, and pure exhaustion that many patients face in today’s medical system without the help of empathy. 

 

Discussion Questions: 

• What is your definition of empathy in regard to medicine? Could this definition change depending on the patient? 
• To what extent is the patient responsible for expressing their internal thoughts and emotions to the physician? 
• Were Dr. M’s actions harmful enough to constitute medical negligence or medical malpractice? 
• Which structure of empathy is most important: sensitivity, nonconformity, even temperedness, or social self-confidence? 
• Can we expect physicians to have empathy for patients that they do not like? 
• How can we emphasize the importance of empathy to already-practicing physicians? 

Our in-class discussion began with deep insights into the meaning of empathy and the responsibilities physicians have when attempting to display empathy. Throughout this part of the discussion, several students emphasized the necessary use of non-verbal communication when displaying empathy. Skills such as listening, and proper body language were highlighted as key elements of successful non-verbal empathy. Additionally, students mentioned that empathy will look different for every person and that authenticity is critical because patients can tell when a physician is disingenuous. Next, the discussion centered around physician responsibility. Overall, the group agreed that a calm demeanor and composure are essential for all physicians to maintain when dealing with patients, as patients can often feel very nervous since they may not fully understand what is going wrong. It is the doctor’s responsibility to help the patient feel comfortable and taken care of. One student brought up how Dr. G was able to read Ms. Jamison and knew that she needed to hear a straightforward explanation delivered in a calm tone. The student then made a great point stating that a critical piece of physician responsibility is the ability to make an inference on how a patient wants information delivered and how their preferences may change depending on the circumstances. In this case, Dr. G was correct to assume Ms. Jamison wanted a relatively emotion-free explanation, but in other cases, she may have wanted someone to feel emotion with her and it’s the physician’s responsibility to gauge that. The group then discussed possible solutions to the lack of empathy in the medical world. Popular ideas that came up included training sessions for older physicians to get them to embrace the biopsychosocial model instead of just the biological model, as well as the need to teach physicians how to decompress and self-reflect. Those last two solutions I thought were particularly interesting because self-care is not emphasized enough for physicians, and the idea that we could help the patients by putting the doctors in a better mental state is something I hadn’t heard or thought of before. Our discussion concluded with a back-and-forth debate about patient responsibility in regard to empathy. The group settled on the idea that while the patient is not responsible for providing any information, they are responsible for recognizing that the doctor can only help them based on the information they choose to disclose. 

 

Our discussion yielded critical insights into how we could potentially solve the deficiency of empathy in the medical world. Perhaps none of the insights were more powerful than reinforcing the importance of the biopsychosocial model. While the biopsychosocial model was not explicitly brought up often, its fingerprints are found all over our talking points. In particular, it was the group’s approach to physician and patient responsibility that involved the model. The idea of including practices such as self-reflection and decompression for physicians to help them maintain their own mental health, and setting their mental state as something that they have a responsibility to take care of completely embraces the biopsychosocial model. According to the biopsychosocial model, all of the biological, psychological, and sociological factors, both internally and externally, play a role in the patient’s experience. We often just consider the internal factors, however obviously the mental state or even mood of the physician plays a big role in the patient care experience as an external sociological factor and thus is something that falls under the biopsychosocial model. As the group mentioned, the physician’s responsibility to take care of their mental state is a somewhat novel idea but is critical in terms of patient care. Lastly, informing patients about their responsibility to help the doctor by disclosing the information they feel comfortable with is another aspect of the biopsychosocial model because it emphasizes the need for a strong, trusting physician-patient relationship that goes beyond sharing just biological information. It is by examining medicine through the lens of the biopsychosocial model, recognizing the interconnectedness of mental and physical health, and understanding the responsibilities of both the physician and the patient that we can begin to incorporate empathy as a routine part of the patient experience. 

 

Work Cited 

Jamison, Leslie. Empathy Exams. Minneapolis, Graywolf Press, 2014. 

In September, the Australian Parliament initiated an inquiry into Obstetricians and Gynecologists (Obgyns) amid allegations of “obstetric violence” (Social Media Birth Plans). This term describes instances where pregnant individuals feel violated during the birthing process due to gaps between their expectations and care provided. The Australian Medical Association (AMA) argues that social media has significantly contributed to skewed perceptions of childbirth, giving parents unrealistic ideals of a flawless birthing experience. This, in turn, has created a considerable gap between the patient’s birth plan and the reality that healthcare professionals sometimes face. Balancing the safety of both the birthing parent and the unborn child is the physician’s goal. In order to do so, doctors may occasionally need to disregard the detailed birthing plans crafted by expectant parents. The AMA emphasizes that part of the problem is the lack of proper education provided to the parents, leaving them with the feeling that their autonomy has been intentionally disregarded.  The tension between paternalism and patient autonomy, aggravated by concerns around informed consent, lies at the heart of this issue.

Doctors face a dilemma between doing what they believe is best for the patient and adhering to the patient’s wishes when childbirth doesn’t go as planned. Daniel Groll argues that competent patients have the right to make informed decisions about their care. However, the complexity arises when a patient’s choices impact both themselves and their unborn child. It begs the question of whether a birth-giver’s personal preferences should take precedence over the well-being of another human, the preborn child. This creates a conflict between personal autonomy and the interests of others, a complex dilemma.

The complexity extends further when considering the experiences of nurses and midwives who feel stifled in advocating for their patients. While life-threatening situations require immediate action, sometimes, the deviation from a birth plan is more convenient for the doctor than medically necessary for the parent. Issues like unnecessary induction and other non-essential procedures can arise, raising questions about whether doctors are prioritizing patient welfare or their own ease. 

This issue is even more concerning when considering the expertise of experienced nurses and midwives who often understand what is medically necessary, highlighting instances where doctors are acting inappropriately rather than paternalistically. Furthermore, procedures such as vaginal checks may not always be medically necessary. One nurse explained she had to physically restrain a physician from conducting a cervical check without consent (Social Media and Birth Plans). This incident, coupled with the sentiment shared by eighty percent of members of the Nurse and Midwife Association who feel unable to effectively advocate for their patients, indicates that doctors are not merely acting paternalistically but rather selfishly (Social Media and Birth Plans).

Another significant concern is informed consent, particularly the information aspect. Informed consent becomes impossible when patients lack a realistic understanding of what’s occurring. It’s not only about signing a form; it’s about having a genuine grasp of the situation. It’s counterproductive to commit to something without a genuine comprehension of the situation. This is where social media plays a substantial role. When individuals rely on influencers or celebrities as their primary sources of medical information, genuine understanding becomes hard to get. Consequently, patients struggle to comprehend why certain measures are taken, leaving them feeling violated (Social Media and Birth Plans). In such situations, doctors face a critical decision between adhering to a patient’s possibly shortsighted preferences and providing proper care.

This indicates the vital importance of building a doctor-patient relationship and educating patients before childbirth. It’s far more effective for a doctor to dispel misconceptions when a mother is not in a high-pressure situation rather than attempting to have that conversation while she is undergoing the stress of medical procedures. As emphasized by Millum and Bromwich, patients are more likely to make decisions that align with their values when they have access to adequate information.

It’s important to note that the power dynamics between patients and doctors can sometimes lead to patients merely submitting to authority rather than making autonomous decisions. This is exacerbated when doctors provide a one-sided perspective, undermining the patient’s ability to consent with a full understanding of the situation.

An expectant parent reading an article about the disregard for birth plans has valid reasons to feel apprehensive. The foundation of the doctor-patient relationship relies on trust, and instances of not respecting birth plans erode the trust that doctors have worked to establish over generations. Considering the heightened protectiveness many parents feel toward their newborn babies, it’s entirely reasonable to expect a lack of trust in their doctors. Furthermore, this situation creates an opportunity for the “crunchy community” to step in and spread potentially misleading information about the birthing process, perpetuating a cycle of mistrust.

A physician must approach this topic with care and sensitivity. While having an honest and open conversation about the realities of childbirth and the potential limitations of a birthing plan can be crucial for a positive birthing experience, a doctor must also be cautious not to inadvertently frighten the parent or make them feel isolated. It’s essential to strike a balance that informs the patient while ensuring they still feel empowered to have a voice in the delivery room.

The very fact that this conversation is taking place offers hope for the future of medicine. As society continues to hold individuals and institutions accountable for their actions in a public forum, there’s the potential for a restoration of trust in the doctor-patient relationship. Doctors will need to prioritize patient education from the beginning, not just during delivery. This approach can foster stronger interpersonal connections between doctors and patients, with the potential to be truly transformative.