宗教心理—鬼神心理疾病——濒死体验的诊断与预后

濒死体验是科学现象而不是灵学现象,有初步问卷和最终量表可供筛查和诊断;是心理疾病而不是精神病.美国精神病学学会《精神疾病诊断与统计手册》标定为"宗教-鬼神问题".除非获得适当的心理治疗与社会心理康复,患者预后不良.     

铲除医学领域的伪科学

简要回顾几年来关于医学庸俗化的学术讨论明确提出应从本质上对前科学、科学、伪科学和反科学这四个相关概念加以区分。医学庸俗化现象事实上包括伪科学和反科学两种既相联系、相区别的社会现象。指出“法轮功”是反科学而不是伪科学。医学中伪科学包括在基础医学１临床医学、临床药物不,乃至卫生管理领域弄虚作假,欺世盗名,违背科学,图财害命的百法行径。医学中的反科学则包括邪教活动、巫医神汉、预卜吉凶等迷信破坏活动。     

论希波克拉底的医学哲学思想

被尊称为"西方医学之父"的希波克拉底同时也是当之无愧的"医学哲学之父".希波克拉底的医学哲学思想具有源于而不囿于自然哲学的特征;希波克拉底为医学哲学铸造了基本的理论范式:他对医学哲学的研究对象、研究方法、临床认识主体的人文品格等诸多问题有着原创性的论述,他对医学实践中的普遍问题的研究如医学性质、早期诊断、预后分析、病人个体差异、遗传现象、生理与心理的关系、误诊误治等,为医学哲学理论框架的形成奠定了坚实的基础.     

现代医学存在自身缺陷的依据、原因、现象及其后果

目的 探讨现代医学理论体系存在的自身缺陷、根本原因和现象以及由此而产生的后果。方法 明确指出现代医学的理论主体就是实验医学,指出现代医学理论体系所存在的自身缺陷是由于过于依赖实验医学的研究方法而造成的,通过对世界医学发展史上医学与哲学之间关系上的变化进行深入分析,全面阐述了现代医学在对人体研究上的片面性和不完整性,指出现代医学理论之所以存在自身缺陷的根本原因就是没有科学地认识实验医学和经验医学各自的优点并加以合理地利用,列举了现代医学理论存在自身缺陷在基础与临床方面的具体现象及其后果。结论 现代医学理论体系存在着难以自我完善的自身缺陷,并使其发展举步维艰。     

由网络成瘾列为精神疾病反思医学化倾向

由于精神疾病的诊断特点,精神科中的医学化现象尤为突出.但精神科的这种现象会产生不当的行为控制、个体与社会的隔阂等弊端.一些网络成瘾的矫治措施限制或剥夺被矫治青少年的人身自由,有的已经带有对精神病性障碍患者进行强制性医疗的色彩.网络成瘾目前归为精神疾病的科学依据不足、容易引起误解和误导,是医学化在精神科中的又一表现.     

一个临床医生所遭遇的尴尬

学习自然辩证法的好处之一,就是使得一个多年从事临床医疗实践的医生获得了一个宝贵的机会,可以静下心来从理性和哲学的高度来思考问题,而不是整日沉溺于病人、手术之类的繁琐事物中。然而,通过对医患关系的本质的思考,以及对医学临床当中一些现象的分析,比如,医生和病人对截肢术的不同想法,并上升到哲学高度对医学范式进行了讨论,竟引发出令人困惑的哲学尴尬。最终感到,“以人为本”的思想才是解决困惑的利器。     

不能自制和考虑 ——亚里士多德通往明智之路

不能自制作为一种典型的"知而不行"现象是道德心理学研究的一个热点问题。按照亚里士多德的行动理论,考试或推理的作用是把实践三段论中的两个要素关联起来。明智是好的考虑,而不能自制则不是好的考虑。通过对两种不能自制的诊断,亚里士多德提供了一条追寻德性之路。     

论医学哲学是什么和不是什么

弄清医学哲学是什么和不是什么,是医学哲学学科建设的基本问题。医学哲学理论构架的逻辑起点是生命健康,基本结构是医学哲学的本体论、认识论、方法论、价值论和发展观以及一系列医学范畴。“哲学理论 医学实例”不是医学哲学。医学哲学具备超验的思维方式、反思的学术精神、创新的学术风格、开放的学术视野,而临床经验总结、紧跟时局的宣传、时髦热闹的效果,从者众多的场面不是医学哲学。     

一个临床医生所遭遇的尴尬

学习自然辩证法的好处之一,就是使得一个多年从事临床医疗实践的医生获得了一个宝贵的机会,可以静下心来从理性和哲学的高度来思考问题,而不是整日沉溺于病人、手术之类的繁琐事物中.然而,通过对医患关系的本质的思考,以及对医学临床当中一些现象的分析,比如,医生和病人对截肢术的不同想法,并上升到哲学高度对医学范式进行了讨论,竟引发出令人困惑的哲学尴尬.最终感到,"以人为本"的思想才是解决困惑的利器.     

在科学与伦理之间——人胚胎干细胞研究向何处去

人胚胎干细胞的研究使我们不得不在科学与道德之间作选择。治疗性克隆是如帕金森氏病、糖尿病等许多疾病的最有潜力的治疗方法。体细胞核转移是治疗性克隆关键步骤,因此治疗性克隆与克隆人只有一步之遥。科学史证明,科学的进步给人类带来了许多福利而不是灾难。我们不能低估人类理性的力量。     

医学影像诊断工作中的哲学思维与人文思考

医学影像诊断不单纯是技术工作,也涉及到社会人文因素,尤其需要正确的诊断思维.进一步阐述了如下问题:(1)人本精神;(2)因人、因病制宜;(3)影像诊断的多因素性;(4)模式化和高效化;(5)动态论;(6)比较与综合;(7)实事求是与模糊思维;(8)极致性及其矛盾面;(9)影像医生的中位身份.     

Context and the inverse base rate effect

Recent categorization research set in abstract medical diagnosis contexts has demonstrated an ‘inverse base rate effect’, whereby subjects make diagnoses which are consistent with base rates when presented with some sets of symptoms, but inconsistent with base rates when presented with other sets of symptoms. This paper reports three experiments which demonstrate that whether or not the inverse base rate effect is observed depends on the context in which categorization takes place. Inverse base rate effects are replicated in the abstract medical diagnosis context used in prior research, but not in a relatively realistic financial auditing setting, a less realistic financial auditing setting, or a very abstract generic setting. These results indicate that the inverse base rate effect may not generalize to applied settings, suggesting that interventions designed to mitigate the inverse base rate effect should not be instituted without first determining the existence of the effect in the particular setting in question.     

浅谈现代医学模式在影像诊断实践中的应用

医学模式由传统的生物型向生物心理社会医学模式转变需要全社会共同努力,影像诊断虽然＂见病不见病人＂,但通过影像诊断报告同样会向患者传递出对他们健康、疾病诊疗的指导和人文关怀,并能在化解医疗纠纷改善医患关系方面起到关键作用.因此影像诊断同样需要现代医学模式的指导,达到这一目标的必要途径,就要树立＂以人为中心＂的医学理念,把病人作为一个统一整体来考虑疾病的诊断,同时影像与临床资料相联系;加强影像报告的书写,描述既要客观,又要有目的性,结论尽量明晰,措词准确,通过字里行间的表达增加医患之间的信任.     

诊断中的异化与异化的诊断——1例误诊病例的反思

随着诊断技术的日新月异,极大地拓展了临床医师对疾病的认识,但同时也限制了医师的临床思维,形成诊断过程中的"异化"现象。本文以1例患者的误诊过程为例,说明诊断中的异化现象及其对诊断的影响。为减少误诊,医师必须回到"人"的位置,避免成为医疗技术的"奴隶"。     

The significance of prognosis for a theory of medical practice

A typical problem of modern medicine results from the gap between scientific knowledge and its application in individual cases. Whereas scientific knowledge is generalized and impersonal information, medical practice takes place under conditions which are singular, individual and irreversible. The paper examines whether prognosis is able to bridge this gap or hiatus theoreticus. It is shown that diagnosis of a single case always relies on prognostic considerations. The individual prognosis (as distinguished from the nosologic prognosis of a certain disease) enables doctors to apply scientific knowledge and practice according to the actual situation, the history and personal preferences of the patient. Prognosis – not diagnosis – therefore legitimizes medical interference. A methodology of individual prognosis as the basis for a theory of practice is discussed.     

新医学模式在慢性前列腺炎临床中的应用

现代医学对慢性前列腺炎的认识已经经历了近200年,其发病机制、诊断和治疗等多方面存在很多疑惑和争议。慢性前列腺炎不能单纯视为躯体性疾病,其发生、发展和转归与精神心理和社会因素密切相关。新医学模式(生物-心理-社会医学模式)发展和医疗实践有机结合,将促进泌尿外科医师和患者对慢性前列腺炎疾病更深刻认识,这不仅为提高慢性前列腺炎诊断提供了新的视角、指标和工具,也为有效治疗提供了新的思路、技术和方法,为全面提高患者的生活质量提供了可能。     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

Surgical patents and patients — The ethical dilemmas

It is obvious that every inventor should be rewarded for the intellectual effort, and at the same time be encouraged to successively improve his or her discovery and to work on subsequent innovations. Patents also ensure that patent owners are officially protected against intellectual piracy, but protection of intellectual property may be difficult to accomplish. Nevertheless, it all comes down to this basic question: Does a contradiction exist between medical ethics and the “Medical and Surgical Procedure Patents” system? It may well turn out that medical-procedure patents can have a negative influence on the standard of medical care. Medical-method patents may also interfere with the physician-patient relationship. At present, physicians do not question the usefulness of patent protection for medicines, biotechnology, equipment and devices, but they strongly oppose it for surgical procedures.     

Medical Students' Views on the White Coat: A South African Perspective on Ethical Issues

There is a debate regarding the use of the white coat, a traditional symbol of the medical profession, by students. In a study evaluating final-year South African medical students' perceptions, the white coat was associated with traditional symbolic values (e.g., trust) and had practical uses (e.g., identification). The coat was generally perceived to evoke positive emotions in patients, but some recognized that it may cause anxiety or mistrust. Donning a white coat generally implied a responsibility to the profession. For a few, without the coat, patients would not cooperate, resulting in some perceiving no need to be distinguished from qualified practitioners. There was thus some evidence of entitled (vs. earned) respect. In the light of the underresourced health care setting in which these students learn clinical medicine, we recommend that students be able to recognize the potential for unprofessional or unethical behavior. Students should also be able to identify role models.     

Borderline personality: traits and disorder

Although the 5-factor model (FFM) has been advocated as an alternative to representing the construct of borderline personality, some argue that this diagnosis carries essential information that is not well captured by the FFM. The present study examined antecedent, concurrent, and predictive markers of construct validity in a sample of 362 patients with personality disorders. The results indicated that neuroticism best distinguished borderline and nonborderline patients, whereas the FFM as a whole captured a sizable proportion of the variance in the borderline diagnosis. However, the residual of the borderline diagnosis that was not explained by the FFM was found to be significantly related to childhood abuse history, family history of mood and substance use disorders, concurrent symptoms, and 2-year and 4-year outcomes. Thus, some elements of the borderline diagnosis may not be fully captured in a 5-factor representation.