Talk:Medicine/Archive 2

Extensive edits
Erich and I have made a large number of copyedits to this article, which is finally starting to look like a normal encyclopedia article. I've removed phage therapy. It belongs under infectious disease, not here. Otherwise, I have finally tidied up the "unsorted links". JFW | T@lk  10:38, 12 May 2004 (UTC)

nature of alt med link
I have no objection to linking to alternative medicine, which points the reader who wants it in the direction of the alt med series, but the cam tag suggesting that this article in some way was part of an alt med "project" is misleading; there is nothing non-standard or "alt" about this article and I would prefer we not make the reader wonder where the nonsense is. Mr MNH, please discuss this with us before replacing the tag. Alteripse 21:15, 5 Jun 2004 (UTC)


 * As you, may or may not know, the medicine article has been historially laced to all sorts of links to alternative medicine. I see no reason to change now.  Also, if it is not appropriate to have our link here than why in the world is category:alternative medicine a sub-category of category:medicine? You are not being consistent!!!  As long as category:alternative medicine is a sub-category of category:medicine this link is staying in medicine. -- John Gohde 21:25, 5 Jun 2004 (UTC)


 * I don't follow your reasoning. There is nothing wrong with directing the reader to your wonderful series of alt med articles. I think alternative medicine is a better link because it doesn't imply this medicine article is about alternative medicine. I wish to avoid uncertainty and ambiguity for the reader. Regardless of your intentions for the label, I, the other medical editors, and most readers, will think that your label means the content is sympathetic to or written from an alt med perspective.
 * Mr. Gohde, may I also suggest most strongly that you stop and think here. You have gotten a clear message from the authors working on the clinical medicine project that we would prefer to maintain a distinction between medicine articles and alt med articles. When you made it EMPHATICALLY clear that our perspectives were unwelcome in the alt med articles, we refrained from engaging in edit wars in the articles you seemed to be "claiming." The physicians on this project have been busily making new medical articles and leaving the alt med articles alone. Therefore,


 * as a matter of keeping a useful distinction for the readers,
 * as a matter of courtesy to those of us who are asking you politely to refrain,
 * as a matter of furthering the purposes of the wikipedia (so we are all writing articles and not engaging in edit wars),
 * as a matter of your keeping unchallenged control over your vision for the alt med series,
 * pause and think hard before turning this article and the disease article into a battleground over alt med labels. Think about the likely outcomes: (1) you get banned from editing here; (2) you manage to provoke a widespread edit war that gets everybody arguing and reverting instead of writing articles; (3) you "win" from persistence or cussedness and drive the physicians away from wikipedia; would you be willing to admit in public that you want any of these outcomes?.
 * I don't know how we can make this any clearer, Mr. Gohde, but this is where you get to declare publicly whether your primary purpose at Wikipedia is as an editor or a troll: do you want to write articles or provoke new edit wars? Alteripse 22:19, 5 Jun 2004 (UTC)


 * MNH's public declaration appears to be in the edit summary to this edit: "I will continue this edit war in medicine on the next day, the day after, the week after, the month after and the year after." - David Gerard 13:26, 6 Jun 2004 (UTC)

The link Alternative Medicine is more consistent with the section that it is in. (Looks like others share this opinion as well.) I don't know who the you is in "You are not being consistent"  The history of the links with the braces like CamTiny and others have been in a great deal of flux, speaking of consistency. The link could be changed all over wikipedia just by editing CamTiny. CamTiny at this point points to Alternative Medicine. If this keeps being a point of contention the Alt Med links can just be left out. Kd4ttc 22:24, 5 Jun 2004 (UTC)


 * To be fair, we have to agree that Alternative Medicine deserves a link by the virtue of its disambiguation from "Medicine" in the normative sense. It seems is too elaborate for this article. Someone who reads this will not really be looking directly for "Terms and concepts in alternative medicine". I propose that the link remains, and the box disappears. I have made the appropriate edit and await a response. All concerned, please be reminded that reverting 3x is a bannable offense. JFW |  T@lk  22:41, 5 Jun 2004 (UTC)


 * I agree entirely with Dr Wolff's proposal. Thank you. Alteripse 13:26, 6 Jun 2004 (UTC)


 * Agree. Keep link to alt med as a simple link. I am concerned that edits to CamTiny in the future would recreate the problems noted above.  By keeping a simple link such an effect would be prevented. Steve, Kd4ttc 14:56, 6 Jun 2004 (UTC)

Person Category?
What's with giving medicine the category of person? Medicine fits in categories of Science, Biology, Maybe engineering, but Person? Kd4ttc 15:02, 6 Jun 2004 (UTC)

You may read, what about Category:person is. Kenny 16:04, 2004 Jun 6 (UTC)

Yeah, I read that originally. Person seems a miscategorization for Medicine. Kd4ttc 03:21, 8 Jun 2004 (UTC)

well medical doctor is really in the category person. medicine is a profession. eg a painter is a person, painting is an activity.... Erich 04:40, 8 Jun 2004 (UTC)

Agree completely --BozMo|talk 12:57, 8 Jun 2004 (UTC)

Person catagorization removed. Kd4ttc 14:30, 8 Jun 2004 (UTC)

Criticism of
"As medicine became increasingly effective through the course of the twentieth century, doctors focussed more on the science – often at the expense of the tradition of care. This resulted in criticism for the loss of compassion and mechanistic, detached treatment. This issue started to reach collective professional consciousness in the 1970s and the profession had begun to respond by the 1980 and 1990s."

Excellent! *pint* to Erich Gasboy! - David Gerard 22:35, 9 Jun 2004 (UTC)


 * wotz a pint? is that a pint of beer? well as long as it's lager... any way now for a brain dump of themes to explore:
 * modern medicine in fiendishly expensive and spends enormous effort treating preventable diseases when its too late.
 * it is also elitist, by the nature of the difficulty getting into med school. elitism can lead to arrogance and the instrument throwing surgeon has not yet died...
 * oh and we make lots of mistakes which kill lots of people (apparently)


 * other than that of course we're all great and faultless ;-) Erich 23:16, 9 Jun 2004 (UTC)


 * It's a pint of real ale. But good real ale. The above look good for the section too - David Gerard 23:33, 9 Jun 2004 (UTC)

I cut that paragraph:
 * Gee, sounds profound. But is there evidence that the tradition of care has suffered? That is a pretty heavy handed criticism.  I have not seem such behavior in my colleagues.  What evidence is there for this conclusion?  Folks have complained about docs for years, as the article says.  I would think there could at least be some editorials one could quote to on this. Kd4ttc 23:52, 9 Jun 2004 (UTC)

To expand on that: An exercise worth doing is reading the introduction to Clinical Medicine in each edition of Harrison's textbook of medicine. The introduction is a classic of humanistic care. The current version was written by a committee, and is not inspiring, but the earlier editions were classic. The interesting thing to find by the exercise is the concern the authors had over the dehumanizing effect of technology on medicine, and the amusing thing is that where in one version the advent of the Air Contrast Barium enema is pointed to, a later version decried the dehumanizing effect of the CT. I think the concerns of technology dehumanizing medicine are a timeless concern, probably starting with trephination in prehistoric times to MRCP nowadays. We come across editorials from time to time reminding us of the mistake of substituting technology for clinical judgement. Technology may serve more to distance the physician from the patient than it distances the patient from the physician. In the mean time I find nothing more satisfying than the challenge of dealing with saints, sinners, sholars, and rogues. Kd4ttc 01:56, 10 Jun 2004 (UTC)


 * Steve, I don't doubt the saints of our profession have always remained intimately involved in the feelings of their patients. Perhaps Drs Iselbacher, Braunwald, Longo and their team are saints. But there have been too many sinners who referred to appendicitis patients by "The Appendix over There", and ignored pleas to properly address the patient's longstanding worry over that very unmalignant mole.
 * Wouldn't we all love to see list of saints, sinners, scholars and rogues by Stephen Holland, MD???? JFW | T@lk  10:45, 10 Jun 2004 (UTC)
 * I think the section to write is on the tension that exists between technology and humanism. The resort to technology when a good history and physical fails us sometimes leads to amazing discoveries but other times incidental findings calling for workups that then get out of hand.  Every neurologist I know has had his share of cases where the lesion was NOT where the exam pointed, and every physician has dealt with hepatic and renal cysts found on CT.  With all that, the fun of figuring out the patients problems with an H&P is still rewarding, and there still is no machine that easily breaks the news of a metastatic ca to a patient.  So yes, we can talk about the technology of medicine, but there is more to it than technology is advancing and docs haven't figured that out. Docs have always been aware of the march of technology and have carefully embraced the prickly matter.  (If you want my list of Saints and sinners you'll have to see my patient list, but then there are HIPAA issues related to that ;-) ) Kd4ttc 20:53, 10 Jun 2004 (UTC)


 * The paragraph on the technology of medicine displacing humanism has no references. I don't know of any reference that suggests that the 50s to 70s was any worse than any other time in that regard, or that the 80s-90s were any  more enlightened in that regard than any other time.  What evidence is there that there was detachment developing over that time? Kd4ttc 01:26, 11 Jun 2004 (UTC)   BTW, Erich: deleteing is one method of editing.


 * The section is on criticisms. If it's a common criticism (and it is), then it should be listed - whether or not it's a justified criticism. - David Gerard 07:47, 11 Jun 2004 (UTC)

Dr Holland,

oh and sarcasm is a form of wit.

I'm not going to die about the timing. Maybe we should just say that doctors have always had a perceived problem with communction???

a ten minute medline scan found these abstracts: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7804476&itool=iconabstr Arch Fam Med. 1994 Nov;3(11):948-53.]
 * Hospitals. 1979 Nov 16;53(22):76-9.
 * "Data also show the quality of caring to be lagging the quality of cure" Mark Health Serv. 1997 Winter;17(4):28-35.
 * In the areas of communication ... public needs are not always being met.
 * 
 * 
 * recognition of problem and response Am J Emerg Med. 1993 Sep;11(5):556-9.
 * "I will look at the challenges that confront us today with the intrusion of high technology and the market economy into the practice of our profession. I will show how this has fundamentally altered the way we practise medicine and surgery and the delivery of health care."
 * nurses of course wouldn't even question me ;-)

best wishes ;-) Erich 02:20, 11 Jun 2004 (UTC)

Oh, God. We're starting to sound like MrNH!

Well, good references. Actually I tried a Google search to try to get a handle on the issue posited by the paragraph in the article, which was that humanism was being lost in the 60's and 70's, only to be making a comeback in the 80's and 90's. To that issue these articles address current times. The articles here mix quality and communicaitons and humanism, which are different, albeit related subjects. I'll pull the articles (which will take a while) and see if there are references in them to "the old days". As to the general comment, do we need references? Yes. If you have a colleague who has a contrary opinion going to the literature is always useful, and mitigates the opinion wars that can otherwise erupt. What were the search criteria you used for the medline search. I'd like to do the search decade by decade (presuming the MESH headings are stable!) Stephen Holland, M.D. Kd4ttc 04:12, 11 Jun 2004 (UTC)

well if we cant fight amoungst ourselves, who can we fight with ;-)

I didn't set out to write a critique decade by decade. my intention was to merely state that the potent technology acted as a distractor from the patient and that after a while the profession awoke to this and responded. I started my seach using 'compassion and technology' and drifted into 'caring and technology' but drifted a bit using the 'related articles' link&hellip; a wouldn't call it a systematic review ;-)

I'm not sure if humanism is really the issue - I thought that was a surrogate religion. I think 'care' and 'compassion' 'communication' 'empathy' 'warmth' are better descriptors of what our science distracts us from (I criticise myself here as much as anybody else).

I think the criticism relates equally to the potent science as it does to technology. Taking a history and doing a physical examination can be just as (or even more) dehumanising if done by a grumpy doc more focussed on the 'signs' and 'symptoms' rather than communicating in a compassionate way with the patient.

btw I'm not averse to a good bit of evidence, but requests out of the blue for can be perceived as a form of passive aggression. It can be too easy to say 'what evidence do you have for that?' Erich 05:13, 11 Jun 2004 (UTC)


 * Sorry if the request came off that way. My perception out here in the midwest US in a private practice setting just doesn't connect with the perception the cricism has.  What's interesting is that I recall that as a student and resident I had more or less the same sense that medicine was at risk of not having sufficient compassion.  Some years ago I went through and read the introductions to medicine in Harrision's to guage the sense of the times.  I haven't yet read through the articles.  Thanks for posting the search strategy.  It is so nice that Wikipedia is WWW accessible for leaving notes and discussion.  The comments above are interesting.  Kd4ttc 23:52, 11 Jun 2004 (UTC)


 * yes different perspectives on what realy are different systems. Interestingly the hospital labor floor i'm typing this note from is public at one end (my end as a lowly registrar) and private at the other end. (literally one corridor with different ends) I'm pleased to say that both ends give an excellent service... but... you are much less likely to have a vaginal delivery up the other end! Steve, maybe you could write about 'overservicing' and 'defensive medicine' ;-) (don't feel obliged) he he Erich 00:38, 12 Jun 2004 (UTC)


 * The quality of care issue is probably an article in itself. The big problem that any UK resident will tell you is not the effects of technology on care, but the effects of bureaucracy on care. The NHS is horribly top-heavy with management and red tape regulations on the frontline staff. This is actually a worse problem than low funding. The doctors and nurses and so on want to leave medicine because of the bureaucracy. Dunno if that's addressable - David Gerard 00:02, 12 Jun 2004 (UTC)


 * Hi David, well the NHS... sigh... what can you say... it is very cheap! anyway I think it is useful to clearly distinguish between criticism or doctors/medicine and criticism of the health care system. You may (as well as helping this page of course) want to enter the fray at Publicly funded medicine ;-) we may all need go have a look at Iatrogenesis as I can't find a page on quality or medical error Erich 00:38, 12 Jun 2004 (UTC)


 * see medical error with pre-emptive evidence ;-) Erich 02:46, 12 Jun 2004 (UTC)
 * Heck, you only need preemptive evidence when you know you will challenge MY invariably correct opinion. :-) Kd4ttc 02:52, 12 Jun 2004 (UTC)
 * now who's starting to do mnh impersonations ;-) Erich


 * Lots of neat ideas here. The c-secton rates at either end of the corridor is a tremendous opportunity for a controlled trial.  Sure, selection bias is there, but would one really expect the spacing between the sciatic notches to differ between the groups? ;-).   I wonder if one can really distinguish between the physicians and the system.  Then there is the socialization process in medicine.  In my class ('82) I think we went in pretty idealistic, yet at the end of residency there was a vogue of cynicism.  Them off to fellowship for many of us.  One thing that was special about Northwestern University where I went to medical school was that the attendings back then were independent private practitioners.  How they did research and maintained a private practice is in retrospect pretty amazing.  On each service there were the private attendings that directed each case communicating with the R2 or R3 who headed the service, with R1s and M4's and M3's in tow.  Each service also had a teaching attending who would see us three times a week and have cases presented.  At the end of each rotation there was the attending dinner.  This was always a treat.  And in retrospect was an opportunity to join the attending and residents as colleagues.  There may be traditions in the US system and British system that seem minor that have significant impacts.  But then there are differences in approaches in different schools in the US.  My residency program and fellowship had no such traditions and the feel of the programs was different.  Steve Kd4ttc 02:52, 12 Jun 2004 (UTC)

Steve, sorry mate but you may have unleased a sleeping monster ;-) Here's another section for the criticism of medicine on this page:
 * "In the absence of mechanisms for healing, physicians find dysfunctional ways to protect themselves. They often respond to their own mistakes with anger and projection of blame, and may act defensively or callously and blame or scold the patient or other members of the healthcare team. " Albert W Wu, associate professor, Johns Hopkins University, Baltimore, MD 21205, USA. BMJ 2000;320:726-727

The thing I really love about the above ref is its an American prof writing in the BMJ. perfect for a global encyclopaedia! (yes I have been a stirrer for as long as I can remember).

So are we happy if I summarise that as:
 * 'Doctors have been criticised for having a dysfunctional response to error.' ?

Erich 05:08, 12 Jun 2004 (UTC)

Medical error
Erich started a nice job on the article, and I managed to end up in a simultaneous edit and messed up some refs. Ooops! This could be a VERY nice article. It needs a link out of the Medicine article. Kd4ttc 03:26, 12 Jun 2004 (UTC)

aw shucks... :-) Erich 04:32, 12 Jun 2004 (UTC)

saying something nice for a change
now personally, i think what follows is verging on poetic. It comes verbatum of the GMC website and I think should be quoted verbatum on physician or medicine. I think it would be to obscure on the medical ethics and is more a 'code of conduct'. what do others think?Erich 02:32, 16 Jun 2004 (UTC)

The duties of a doctor registered with the General Medical Council


 * "Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life. In particular as a doctor you must:


 * make the care of your patient your first concern;
 * treat every patient politely and considerately;
 * respect patients' dignity and privacy;
 * listen to patients and respect their views;
 * give patients information in a way they can understand;
 * respect the rights of patients to be fully involved in decisions about their care;
 * keep your professional knowledge and skills up to date;
 * recognise the limits of your professional competence;
 * be honest and trustworthy;
 * respect and protect confidential information;
 * make sure that your personal beliefs do not prejudice your patients' care;
 * act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practise;
 * avoid abusing your position as a doctor; and
 * work with colleagues in the ways that best serve patients' interests.


 * In all these matters you must never discriminate unfairly against your patients or colleagues. And you must always be prepared to justify your actions to them."

The practice of medicine section
Just added a draft version. Goal is to explain what doctors do and why or how they do it (the other sections covered the who, when, where). Plan to add subsection about patients and/or more about patient-doctor relationships, informed consent, compliance, ethics, patient rights, DNR, etc. [The_practice_of_medicine] Petersam 22:16, 19 Aug 2004 (UTC)

Add section on film, TV, literature with medicine themes?
Need feedback on including this section. Goals would be to show the practice of medicine (The Doctor, Marcus Welby and other TV shows?), criticism of the medical system (The Hospital) with alternatives (Patch Adams?), Possible film candidates:

The Doctor (1991) http://imdb.com/title/tt0101746/ Plot Summary: Jack McKee is a doctor diagnosed with throat cancer. Now that he has seen medicine, hospitals, and doctors from a patient's perspective, he realises that there is more to being a doctor than surgery and prescriptions. This movie is based on the real life story of Edward Rosenbaum, MD, who wrote an autobiography of his experience entitled "A Taste of My Own Medicine: When the Doctor Becomes the Patient". This book/movie is used in some medical school curriculums to sensitize medical students to being patients.

Patch Adams (1998) http://imdb.com/title/tt0101746/

The Hospital (1971) http://imdb.com/title/tt0067217/

Marcus Welby, M.D. [TV 1969-1976] http://imdb.com/title/tt0063927/ read user comments 15 October 2002

St. Elsewhere (TV 1982-88) http://imdb.com/title/tt0083483/

ER (TV 1994-date)  http://imdb.com/title/tt0295222/ and http://imdb.com/title/tt0108757/

Any others? Comments? Petersam 07:57, 21 Aug 2004 (UTC)