Voices from the Front Lines: An Analysis of Physicians’ Reflective Narratives about Flaws with the ‘System’

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n?=?282). By consensus, we identified those that addressed system flaws (n?=?87). Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.

     

Varsity medical ethics debate 2018: constant health monitoring - the advance of technology into healthcare

The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate.     

Simple Co‐Occurrence Statistics Reproducibly Predict Association Ratings

What determines human ratings of association? We planned this paper as a test for association strength (AS) that is derived from the log likelihood that two words co‐occur significantly more often together in sentences than is expected from their single word frequencies. We also investigated the moderately correlated interactions of word frequency, emotional valence, arousal, and imageability of both words (r's ≤ .3). In three studies, linear mixed effects models revealed that AS and valence reproducibly account for variance in the human ratings. To understand further correlated predictors, we conducted a hierarchical cluster analysis and examined the predictors of four clusters in competitive analyses: Only AS and word2vec skip‐gram cosine distances reproducibly accounted for variance in all three studies. The other predictors of the first cluster (number of common associates, (positive) point‐wise mutual information, and word2vec CBOW cosine) did not reproducibly explain further variance. The same was true for the second cluster (word frequency and arousal); the third cluster (emotional valence and imageability); and the fourth cluster (consisting of joint frequency only). Finally, we discuss emotional valence as an important dimension of semantic space. Our results suggest that a simple definition of syntagmatic word contiguity (AS) and a paradigmatic measure of semantic similarity (skip‐gram cosine) provide the most general performance‐independent explanation of association ratings.     

The boundaries between attachment and personality: Localized versus generalized effects in daily social interaction

A diary study examined the effects of romantic attachment (avoidance, anxiety) and autonomous and sociotropic personality on levels of sociability within social interactions across relational contexts (N = 89 undergraduates). As expected, the effects of domain-specific romantic attachment avoidance and anxiety on sociability were localized to social interactions with romantic partners, whereas the effects of autonomy and sociotropy were generalized across relational contexts (i.e., across social interactions with romantic partners, family members, friends, and acquaintances/others). Furthermore, the effects of both autonomy and sociotropy on sociability were partially mediated by domain-specific attachment in domain-congruent (romantic) but not domain-incongruent (non-romantic) relational contexts: romantic avoidance partially mediated the effects of autonomy on sociability toward romantic partners, whereas romantic anxiety partially mediated the effects of sociotropy. These results suggest that autonomy and sociotropy summarize global regularities in relational responding that correspond to those described by attachment avoidance and anxiety—although (unlike attachment) they do so across relational contexts. Domain-specific attachment representations, in contrast, govern responding within context-congruent domains and act as a mechanism through which personality guides social interaction within these domains.     

The Big Five personality traits and perceptions of touch to intimate and nonintimate body regions

This investigation tested whether (1) the Big Five personality traits contribute to favorable perceptions of touch from a relational partner, (2) participants’ sex or personality better predicted positive perceptions of touch, and (3) perceptions of touch vary as a function of relationship satisfaction. A total of 305 participants aged 18–69 years completed self-report measures of reactions to touch, personality, and relationship satisfaction. Results showed that agreeableness was a significant predictor of positive perceptions of touch to both intimate and nonintimate body regions. Openness to experience was also a significant predictor in positive perceptions of touch to nonintimate body regions. Overall, personality was a stronger predictor of positive perceptions of touch than either biological sex or relationship satisfaction with the toucher.     

Prime-trial processing demands and their impact on distractor processing in a spatial negative priming task

A spatial negative priming (NP) paradigm was used where trials were presented in pairs, first the 'prime' and then the 'probe', and where participants responded manually to a target's location. In Experiment 1, three prime-trial types were used: distractor-plus-target, predictable distractor-only, and unpredictable distractor-only, with prime-probe trial onset delays of 2, 5 or 10 s (NP longevity). In Experiment 2, the latter two prime-trials were employed with onset delays of 75 and 750 ms (distractor response activation-inhibition sequence). With the exception of the 10 s onset delay, the spatial NP effect data (NP size, longevity, distractor response activation-inhibition sequence) was the same for all three prime-trial types. Thus, the varying processing demands associated with each of the prime-trial types (e.g., selection, intervening response) did not alter prime distractor processing so that they differentially contributed to the spatial NP process. The three prime-trial types can be used interchangeably, within limits, to study the NP process.     

The impossibility of incommensurable values

Many recent attacks on consequentialism and several defenses of pluralism have relied on arguments for the incommensurability of value. Such arguments have, generally, turned on empirical appeals to aspects of our everyday experience of value conflict. My intention, largely, is to bypass these arguments and turn instead to a discussion of the conceptual apparatus needed to make the claim that values are incommensurable. After delineating what it would mean for values to be incommensurable, I give an a priori argument that such is impossible. It is widely accepted that value is conceptually tied to desire. I argue that, more specifically, it is proportional to merited desire strength. This connection gives one a metric of all value if there is any such thing. This metric entails that value is a complete ordering over all states of affairs, or, in other words, that value is commensurable.     

Fictionalism and the attitudes

This paper distinguishes revolutionary fictionalism from other forms of fictionalism and also from other philosophical views. The paper takes fictionalism about mathematical objects and fictionalism about scientific unobservables as illustrations. The paper evaluates arguments that purport to show that this form of fictionalism is incoherent on the grounds that there is no tenable distinction between believing a sentence and taking the fictionalist's distinctive attitude to that sentence. The argument that fictionalism about mathematics is ‘comically immodest’ is also evaluated. In place of those arguments, an argument against fictionalism about abstract objects of any kind is presented in the last section. This argument takes the form of a trilemma against the fictionalist.

A critique and comparison of two scales from fifteen years of studying compulsive buying

Compulsive buying is an important construct in marketing that has far-reaching personal and social implications. The profile of the adult compulsive buyer in the literature is based largely on the 1992 Faber and O'Guinn Compulsive Buying Scale. A second compulsive buying scale by Edwards has also been used but sparingly. Empirical research conducted over that past 15 years with these two scales shows that, although both scales were designed to measure compulsive buying, the two appear to be different operationalizations of the construct. The present review raises several psychometric issues about both scales. Their robustness is crucial to a clear understanding of the antecedents and consequences of compulsive buying. Directions for research are added.