The crisis of medicine: philosophy and the social construction of medicine

During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and health care.     

Motor learning during social interaction: the role of social interdependence

Motor learning has mostly been studied in laboratory settings where participants execute the task alone, unlike in real life, where people perform activities together with others. Recent discovery of mirror neuron system (MNS)—linking perception of others' actions and execution of our own—makes the scarcity of studies on social aspects of motor learning even more peculiar. Here, we investigated motor learning during interaction with a partner. Participants engaged in 2 consecutive sessions executing the task alone or in pairs. We found that social interaction improved motor performance only when participants had prior individual experience with the task. This effect was amplified if subjects could first observe their partners' actions, suggesting that it may be mediated by prior MNS configuration.     

Social skills and the stress-protective role of social support

Cross-sectional analyses of data collected from a large sample of incoming college freshmen were used to determine whether the perceived availability of social support protects persons from stress-induced depressive affect; whether social competence, social anxiety, and self-disclosure are responsible for the stress-protective effect of perceived social support; and whether these social skill measures discriminate among persons for whom support will help, hinder, or be ineffective in the face of stress. Prospective analyses based on the original testing (beginning of school year) and 11- and 22-week follow-ups of a randomly selected subsample were used to determine how the same social skill factors influence the development and maintenance of support perceptions and of friendships. Evidence is provided for a stress-buffering role of the perceived availability of social support. The stress-buffering effect is unaffected by controls for the possible stress-protective influences of social anxiety, social competence, and self-disclosure. Although these social skill factors do not discriminate among persons for whom support will help, hinder, or be ineffective, they are prospectively predictive of the development of both social support and friendship formation. These prospective relations between social skills and the development of perceived availability of social support are only partly mediated by number of friends.     

Reconsidering the role of language in medicine

Background

Despite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine.

Methods

In this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be applied to communication in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization.

Results

The authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information.

Conclusion

Ultimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients.

     

Marijuana-related problems and social anxiety: the role of marijuana behaviors in social situations

Individuals with elevated social anxiety appear particularly vulnerable to marijuana-related problems. In fact, individuals with social anxiety may be more likely to experience marijuana-related impairment than individuals with other types of anxiety. It is therefore important to determine whether constructs particularly relevant to socially anxious individuals play a role in the expression of marijuana-related problems in this vulnerable population. Given that both social avoidance and using marijuana to cope with negative affect broadly have been found to play a role in marijuana-related problems, the current study utilized a new measure designed to simultaneously assess social avoidance and using marijuana to cope in situations previously identified as anxiety-provoking among those with elevated social anxiety. The Marijuana Use to Cope with Social Anxiety Scale (MCSAS) assessed behaviors regarding 24 social situations: marijuana use to cope in social situations (MCSAS-Cope) and avoidance of social situations if marijuana was unavailable. In Study 1, we found preliminary support for the convergent and discriminant validity and internal consistency of the MCSAS scales. In Study 2, we examined if MCSAS scores were related to marijuana problems among those with (n = 44) and without (n = 44) clinically elevated social anxiety. Individuals with clinically meaningful social anxiety were more likely to use marijuana to cope in social situations and to avoid social situations if marijuana was unavailable. Of importance, MCSAS-Cope uniquely mediated the relationship between social anxiety group status and marijuana-related problems. Results highlight the importance of contextual factors in assessing marijuana-related behaviors among high-risk populations.     

Development of social role understanding

The concepts of social roles and role intersections have been used to explain adults' social competence. However, children's social competence in terms of developing role concepts has not been systematically delineated. After a brief review of the few developmental studies that have been performed in this area, a systematic developmental sequence of role understanding in children from 1 to 13 years of age is discussed and a method for assessing such sequences is described. The sequence, which was based on K. W. Fischer's (1980, Psychological Review, 87, 477–531) construction-inclusion model of conceptual skill development, was tested in several studies using two sets of social roles and tasks and was found to be highly scalable and age related. The significance of role concept development is also discussed as it relates to the development of social competence in other domains.     

Online professionalism: social media, social contracts, trust, and medicine

The AMA Council on Ethical and Judicial Affairs (CEJA) has initiated an important discussion on medical professionalism and the use of social media by issuing thoughtful and practical guidance for physicians and medical students. The implications of online activities for trust in the profession, as well as for trust between patient and doctor, however, will need further exploration as digital life expands and evolves.     

Psychotherapy,complementary and alternative medicine and social dysfunction

This article investigates a bio-psycho-social approach to psychotherapy which works, where possible, with interdisciplinary complementary and alternative medicine teams. The model, called anthroposophic psychotherapy, sees body, soul and spirit as interconnected and the study discusses the bio-psycho-social aspects of the model by linking cardiovascular disease, psychological stress, asocial behaviour and social dysfunction utilizing single case study methodology. The limitations of this method are acknowledged and discussed, but it is also argued that the study has a valuable part to play in a research programme which may also later include efficacy and effectiveness research. The methodology incorporates the principle of data synthesis, as well as data analysis, in accordance with the holistic nature of the clinical model, since it takes the view that all of the elements in the research field are connected. The anxieties presented by the client were linked to arteriosclerotic symptoms and social problems. All of these elements had their roots in childhood and needed to be treated with a number of interventions, including anthroposophic psychotherapy and medicine, which incorporates the homeopathic principle of ‘like cures like’.     

Attitudes to women in society: the role of social dominance orientation and social values

his research assessed the extent to which attitudes to women in society are predicted by the personality trait social dominance orientation (SDO) as well as the values international harmony and equality (INT) and national strength and order (NAT). Respondents were a community sample of adult non‐students (N = 158). Sex differences were observed on INT and attitudes to women. Multiple regression analyses showed sex differences in the extent to which SDO predicts attitudes to women, while no support was found for the view that social attitudes are underpinned by both security and harmony values. The results are discussed with reference to social dominance theory and the nature of the security value domain. Copyright © 2001 John Wiley & Sons, Ltd.     

Culture and social comparison seeking: the role of self-motives

Three studies examined the relation between cultural background and social comparison seeking. Compared to European Canadians, Asian Canadians sought more social comparisons, particularly those that were upward (Study 1), more social comparisons after failure (Study 2), and more social comparisons after failure when the opportunity for self-improvement was made salient (Study 3). Taken together, these data spotlight Asian Canadians' interest in social comparisons that allow for self-improvement.     

职业精神与弱势病人

医学职业研究所对美国医生的现实行为的调查说明:医生们是相信且赞同职业精神在对待弱势病人方面的关键信条的;增强美国医生的职业精神的努力,也应该包括努力转变医生照顾弱势病人的行为方面。但是,增强职业精神的努力不仅要通过书本上的或理论上的教育,也应该包括致力于制定使医生更容易履行这些义务的实践政策,提供体制上的支持可使医生更容易做他们已经知道其应该做的行为。     

职业精神与弱势病人

医学职业研究所对美国医生的现实行为的调查说明:医生们是相信且赞同职业精神在对待弱势病人方面的关键信条的;增强美国医生的职业精神的努力,也应该包括努力转变医生照顾弱势病人的行为方面。但是,增强职业精神的努力不仅要通过书本上的或理论上的教育,也应该包括致力于制定使医生更容易履行这些义务的实践政策,提供体制上的支持可使医生更容易做他们已经知道其应该做的行为。     

职业精神和医患关系

通过调查发现,外科医生在提供做决策的信息的问题上执行得较好;有些医生无论错误多么严重也不会把医疗错误披露出来;但是能够公开医生的经济奖励,这样医生的信任不但没有被损害,相反医生和医生团体的信任和忠诚却增强了。从知情决策、医疗错误的披露和利益冲突三个方面展示职业精神对医患关系产生的影响,并为职业精神的发展提供了新视角。     

关于医学专业精神的几个问题

职业与专业有所不同。医学专业精神基于医学专业的特点而产生,起着维护医学专业的社会责任和规范医疗行为的作用。医学专业的核心理念是病人健康利益高于一切,且具有历史的继承性与时代性的特点。医疗自治权的获得是医学专业形成和医学专业精神从自发走向自觉的标志。医学专业精神首先依赖医生的自律,但同时也需要来自外界的社会调控。