Medical Humanities 2 Flashcards
A patient with advanced pancreatic cancer is discussing end of life care with his physician. He states that his major goal is not to die in pain or alone. He also states that recently the pain has gotten so bad that he sometimes wishes he was dead. Which of the following physician statements demonstrates empathy for the patient?
A) “We can up your dose of morphine so that you are in less pain.”
B) “What do you think is causing your pain?”
C) “Is there anything that relieves your pain?”
D) “I’m sorry to hear it and want to help in any way I can.”
E) “Fortunately, many of my patients get relief using guided imagery.”
Correct answer: D
Empathy is being able to imagine the emotional experience of the patient without experiencing the emotion directly. The physician’s expression of sorrow and offer of help demonstrate empathy for the patient and his situation. Answers A and E are problem solving and might come later when a treatment plan is being developed. B is eliciting the patient’s perspective which is important, but demonstrating empathy in the face of patient suffering takes priority here. C is important for the physician to know, but not before responding to the patient’s suffering with empathy.
A 24-year-old patient reports to her physician confidently that, after delivering 3 healthy children, she is ready for a tubal sterilization procedure. The physician schedules the procedure. Three weeks later, the day before the scheduled surgery, the patient returns, tearfully stating that she has to cancel the surgery and does not wish to reschedule it. Which of the following is the most appropriate response by the physician?
A) “I wish you would have told me sooner so that I could have scheduled another patient for that OR slot.”
B) “Your feelings about this have really changed; tell me what has happened since we last met.”
C) “Are you sure you don’t want to go through with this? Remember you have all the kids you want.”
D) “It’s just your nerves talking. Let’s get this done. I know you won’t regret it.”
E) “I’ve been promoting a 25% nonrefundable deposit for scheduled surgeries for this very reason.”
Correct answer: B
Choice B is the only statement here that elicits the patient’s perspective and reason for the change.
Choice A is completely doctor centered and does not express any concern for the patient’s perspective and reason for a change.
Choice C is condescending, and implies that the patient cannot know her own mind.
Choice D is also condescending with the same implications that the patient does not know herself. It reveals a lot about the doctor’s own assumptions about the reasons for the change but does nothing to help reveal the truth.
Choice E is a mean and manipulative statement, aimed at making the patient feel guilty or bad for having to cancel the surgery.
The Hidden Curriculum
Recognize Examples of Hidden Curriculum from vignettes.
The hidden curriculum chart
The Hidden Curriculum
“House of God”
“House of God” was a popular book written and published by Samuel Shem (pen name), a psychiatrist, in 1978. It is a satire, describing in a poignant and humorous way the clinical training of physicians at the time.
Most of the actors in this movie are considered comedians, based on their previous work. If you have a chance to view the entire film (available from multiple sources, including You Tube), note the juxtaposition of completely absurd scenes and dialogs with some of the most poignant themes in modern medicine. Also note the stereotypes of women and minority physicians.
How has clinical training changed (or not) since this book was written? Because you are still in the pre-clinical phase of your training, the answer to this may be “I don’t know” or your answer may change as your training progresses.
The Hidden Curriculum
“Scrubs”
Scrubs is a popular and more recent media depiction of clinical training presented through the narrative reflections of the character, J.D., a physician in his residency training.
J.D.’s reflections on his training, relationships with attending physicians, nurses, peers and patients provide insights on physician formation, despite a humorous bent.
The Hidden Curriculum
“House, MD”
Gregory House, MD, has a team of physicians in training, both residents and fellows, for whom he offers teaching and influence as they work with him to manage patients and solve difficult diagnostic problems.
You may be familiar with these quotes from the television series and we have seen them before in the Reflective Practice presentation earlier this semester. Here is another opportunity to reflect on these particular House aphorisms. What do you think about these, based on your own life (and medical) experiences?
Both television series and movies about physicians depict physician work, attitude and behaviors AND may both represent and influence evolving social norms and physician formation. How have your ideas about physician demeanor, lifestyle, communication, and even dress been influenced by media representations of physicians?
