Nuancing the Healer's art — The epistemology of patient competence

The programmatic thrust of Thomasma and Pellegrino [5] is clarified and underscored and is interpreted as an attempt to introduce a fixed point into the ethical dimension of medicine by specifying some regulative principles for the medical profession. Two important features of this type of enterprise are noted: on the one hand, it may lead the profession to distinguish between technically identical actions on the basis of the normative principles it produces, thus excluding some morally permissible actions as duties constitutive of the art. It is argued that the formulation of the grounds for this ethic given by Thomasma and Pellegrino is insufficient. In order to speak to the clinical situation, medical ethics must not be based on merely the ‘living human body’ alone, but on the patientqua person.     

Exploring how the psychiatrist experiences the patient during the diagnostic evaluation: the Assessment of Clinician’s Subjective Experience (ACSE)

Phenomenology and the Cognitive Sciences -     

Carson Strong's “positive killing and the irreversibly unconscious patient”: A commentary

There is general agreement that death of the entire brain results in death of the person, and that such a condition can exist in a body which is still technically “alive.”1,2 Dr. Strong additionally contends that in cases of irreversible coma, since cognitive abilities characteristic of the person are no longer manifest and cannot be expected to reappear, such an individual no longer has the “right to life” and somatic death can be initiated by “positive killing.” This, the author claims, can be considered a logical and morally acceptable extension of the conceptual framework now in force for dealing with cases of isolated brain death.     

The healing relationship: Edmund Pellegrino’s philosophy of the physician–patient encounter

Theoretical Medicine and Bioethics - In this paper I briefly summarize Pellegrino’s phenomenological analysis of the ethics of the physician–patient relationship. In delineating the...     

A review of patient outcomes in pharmacological studies from the psychiatric literature, 1966–1993

A literature search was conducted on studies of new drugs used with patients with schizophrenia reported by U.S. and non-U.S. researchers from 1966–1993, yielding 41 U.S., and a total of 24 other non-U.S. studies, among them 11 British studies. Results of the U.S. and non-U.S. studies were pooled separately and compared. Among several comparable conditions discussed, the lack of any data on suicides in the U.S. studies was observed. For a second statistical analysis of suicide rates ‘person-years’ were calculated to adjust for differing washout durations. The results obtained include findings that the percentage of patients relapsing in U.S. studies was slightly lower (37.9%) than in non-U.S. studies (46%); the percentage of patients dropping out in U.S. studies (10.5%) was higher than in non-U.S. studies (7.6%); known location of dropout patients in U.S. studies was 1.7%, compared to 2.6% in non-U.S. studies. The most interesting finding was that no suicides were reported in U.S. studies, compared to 0.6% of patients reported in British studies. Some U.S. studies used ‘challenge doses’, such as amphetamines or L-dopa; no non-U.S. studies reported their use. Compared to U.S. studies, those by non-U.S., and particularly British, researchers appeared to report adverse events in their studies. ‘Challenge’ drugs were not used; suicides were reported. It is estimated that the probability that no patients suicided who participated in the U.S. is small—one in 500.     

‘You have to treat the person,not the mouth only’: UK dentists’ perceptions of communication in patient consultations

Effective communication between patients and health professionals is a key component of patient-centred care. Although there is a large body of literature focusing on doctor-patient communication, there has been limited research related to dentist-patient communication, especially presented from the dentists’ perspective. The aim of our study was to explore UK dentists’ perceptions of communication in their consultations, and the factors they perceive may influence this. We conducted semi-structured interviews with eight dentists in UK dental NHS practices. Thematic analysis revealed three themes (‘Treating the whole person’, ‘Barriers to patient-centred communication’ and ‘Mutuality of communication’), which reflected the dentists’ perceptions of their own communication during consultations, the patients’ interaction skills, attitudes (and characteristics that may affect them), and external factors, such as time constraints, that can influence dentist-patients’ encounters. These in-depth accounts are valuable, in that we see what dentists perceive is important, obstructive and facilitative. They report using a patient-centred approach in their everyday dental practice; however this is often difficult due to factors such as time constraints. Although they emphasized that the patient has an active role to play in the communication process, it may be the case that they also need to play their part in facilitating this.     

Using continuous heart rate monitoring to investigate anxiety and its communication with the dentist–patient interaction

Abstract

The importance of communication within the dentist–patient relationship has long been recognised with regard to patient satisfaction and anxiety. However there has been little research into the anxiety experienced by both patient and dentist during the administration of dental treatment nor how such affects are perceived and communicated within the dentist–patient interaction.

The study reported here, examined affective communication between dental students (n=16) and their patients (n=64) by using continuous and simultaneous cardiovascular monitoring during an entire dental treatment session. The data was analysed using stepwise regression analysis together with the development of a measure of emotionality in order to understand the communication of anxiety during dental treatment procedures. The results suggested that anxiety was communicated between dental operator and patient but was dependent on the degree of clinical experience of the operator.     

How a therapist survives the suicide of a patient—with a special focus on patients with psychosis

The article draws from a personal clinical experience of two suicides, not far removed from each other in time. The first patient was a 33-year-old intellectual suffering from depression with narcissistic traits but no psychotic elements, while the second patient was a 21-year-old student with a manifest psychotic episode behind him and with characteristics of post-psychotic depression at the time of suicide. The two suicides had very different impacts on the therapist: the first left open some “space” for reflection, communication, and working-through, while the second closed such a “space,” leaving only a tiny door to the existential roots of human beings and suffering. The therapist was able to find some “shelter” by talking to supervisors, colleagues, and friends in the first case; in the second, the only possible “shelter” was glimpsed in the philosophy of groundlessness (Ungrund) of the Russian existentialist Nicolai Berdyaev. The personal experiences of the therapist, along with some theoretical interpretations of the after-effects of both suicides, are presented using a psychodynamic and existential–phenomenological understanding of the therapeutic relationship with a psychotic and a non-psychotic patient. The main dilemmas exposed by a patient’s suicide, especially if the patient suffers from psychosis, are difficult to deal with in the usual clinical settings and call for resources beyond it. The authors propose that these can be found in philosophical and theological insights.