Medical prognosis — Some fundamentals

Background: The concept of prognosis as a prediction concerning the probable outcome of an attack of disease shows some severe contextual drawbacks in the everyday clinical sense. It is often used to describe possible outcomes of the disease in general, or the progression of a disease course, not the expected course in a particular case. Goal: To render more discriminating uses of the term prognosis, in order to provide the prognosticating physician with a valid tool, comparable to the theoretical basis of diagnostic and therapeutic actions. Procedures: Analysis and discussion of etymology, definition and practical usage. Conclusion: Prognosis is not to be considered soothsaying, but forecasting on qualified grounds. Prognostic statements are announcements containing prognostic information. Prognostic factors are pieces of information associated with a specific outcome of disease, which can be utilized in the formulation of the prognosis. Prognostic estimates involve subjective probability and can be formulated by using frequencies along with (clinical) experience. A prognosis is a prediction of a particular future stage of disease, considering a single case — the prognosis is neither part of the patient, nor part of the disease.     

Medical Students’ Gender Awareness

Gender awareness in medicine consists of two attitudinal components: gender sensitivity and gender-role ideology. In this article, the development of a scale to measure these attitudes in Dutch medical students is described. After a pilot study and a feasibility study, 393 medical students in The Netherlands responded to a preliminary instrument consisting of 82 items (response rate 61.3%). Reliability and validity were established. A gender awareness scale containing a gender sensitivity subscale (14 items), and gender stereotypes towards patients (11 items) as well as towards doctors (7 items) was developed. The instrument may be used for research purposes to evaluate gender awareness raising courses.     

Medical technology: A pandora's box?

This paper examines the development of medical technology in terms of Max Weber's theory of rationalization. It argues that medical technology is a part of the general process of social, political and economic changes in modern Western societies. Medical technology today keeps many people alive who, in the past, would have died from their illness. In recent years, burgeoning technological achievements in medicine have been regarded as a threat to the individual's freedom to die. Many people believe that the prolongation of life only adds to the suffering of the patient and to the emotional distress of the family. They argue that a quiet death is preferable to the indignities inflicted by mechanical life support. This paper addresses these issues in light of Weber's theoretical arguments.     

The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.     

Psychology’s Adaptation to Academic Medical Settings

This introduction provides an overview of the papers that follow. Each paper contributes to the central theme of the issue, psychologists’ adaptation to the realities of academic medical settings. The specific approach of each paper to the shared theme of “adaptation” is described in some detail so the busy reader can go directly to the papers of greatest interest.     

A Student’s Perspective on Medical Ethics Education

Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.     

Medical Thrillers: Doctored Fiction for Future Doctors?

Medical thrillers have been a mainstay of popular fiction since the late 1970s and still attract a wide readership today. This article examines this specialized genre and its core conventions within the context of professionally-based fiction, i.e. the class of thrillers written by professionals or former professionals. The author maps this largely unchartered territory and analyzes the fictional representations of doctors and medicine provided in such novels. He argues that medical thrillers, which are not originally aimed at specialized readers and sometimes project a flawed image of medicine, may be used as a pedagogical tool with non-native learners of medical English.     

Investigating Iranian Medical Students’ Second Language Reading Motivation

Concentrating on second language reading motivation as an important construct with different constituents, this study sought to investigate the factors that majorly motivated medical students to read in English, and to find the orientation of the students in terms of intrinsic and extrinsic motivation. The data were collected from a sample of 131 students in Fasa University of Medical Sciences, Iran, using questionnaires and semi-structured interviews. On the basis of the data collected, the researchers found that among the eight constructs of L2 reading motivation proposed by Komiyama, the lowest mean value was found in the construct “social sharing”, whereas the highest mean value was found in the construct “grades”. Moreover, it was observed that the medical students were both extrinsically and intrinsically motivated.     

Psychology’s Adaptation to Medical Schools,Teaching Hospitals,and Academic Medical Centers: The Role of Academic Medicine Organizations

Psychologists in medical schools, teaching hospitals, and academic medical centers are comparatively small in number, and are often undervalued and denied full practice privileges. As a profession, psychologists must therefore adapt to the realities of a physician-driven, physician-controlled environment. Psychologists’ adaptation to academic medical settings has been considered from several vantage points. An overlooked aspect of adaptation is psychologists’ knowledge of and participation in academic medicine organizations that regulate medical education and specialization. These organizations significantly influence teaching hospital and medical school environments and the psychologists and academic physicians who work in those environments. This paper focuses primarily on three academic medicine organizations, the Liaison Committee on Medical Education (LCME), the Accreditation Council for Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS), which together shape and regulate medical education across all levels and specialties. Knowledge of the evolution and workings of these organizations is useful information for psychologists, but beyond that, such information is a framework that provides benchmarks for understanding psychology’s evolving system of education and specialization.     

The Association of American Medical Colleges and the Association of Medical School Psychologists: Finding Psychology’s Place in Academic Medicine

This paper highlights the role of the Association of Medical School Psychologists (AMSP) as a bridge between academic medicine and psychology. AMSP’s affiliation with Division 12 of the American Psychological Association is discussed, but the primary focus is AMSP’s affiliation with the Association of American Medical Colleges (AAMC) and the AAMC’s Council of Academic Societies (CAS). The history, structure, activities, and goals of AAMC and CAS are examined. AMSP’s affiliation with AAMC is important for psychologists in medical schools and academic medical centers, and for psychology in general, because AAMC is the major voice of academic medicine in the US. AAMC activities affect medical education at all levels, as well as research and health services at academic medical centers, and health care policy at the national level. AMSP’s dual affiliation with AAMC’s CAS and APA’s Society of Clinical Psychology will increase psychology’s visibility and influence in academic medical centers and enhance the two-way flow of ideas and information between academic medicine and psychology.     

The Doubling Undone? Double Effect in Recent Medical Ethics

Abstract

This article treats recent bioethical discussions of double effect reasoning (DER), offering a summary account of DER and construing it as rooted in a sensible view of what is central to someone's identity as a moral agent. It then treats objections raised in recent years by Judith Thomson, Alison McIntyre, and Frances Kamm against familiar ways of applying DER to certain controversies within medical ethics, especially, that over physician-assisted suicide. After detailing, interpreting, and attempting to rebut the challenges from these philosophers, who are especially interesting because their criticisms of DER come from allies in DER's struggle against consequentialist reasoning, the essay engages DER's contribution to a recent dispute over treatment of patients in what is called ‘persistent vegetative state.’ Near its end, the paper sketches several possible points of entry to DER and sources of justification for it. The essay concludes by indicating a connection between these paths and its opening idea of moral identity.     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

Parent–Child Roles in Decision Making About Medical Research

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4–15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The audiotaped interviews were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent–child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making.