Perspectives in biology and medicine
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Perspect. Biol. Med. · Jan 2006
Historical ArticleDietary treatment of diabetes mellitus in the pre-insulin era (1914-1922).
Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.
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Perspect. Biol. Med. · Jan 2006
Historical ArticleBeyond the physician charter: reflections on medical professionalism.
The numerous challenges now facing the profession of medicine have led to an intense focus on professionalism by individual physicians and by their professional and academic organizations. In 2002, a distinguished group of leaders in internal medicine created the Physician Charter, which calls on physicians to reaffirm medical professionalism through commitment to three principles and 10 responsibilities. ⋯ The authors argue that medical professionalism should reflect the values of a virtue-based ethic that stresses compassion and beneficence, rather than the values of a duty-based ethic. The challenges that now confront the practice of medicine can be addressed successfully only to the extent that physicians promote virtue-ethics, act collectively in the public interest, and render service that clearly transcends their own self-interests.
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Iraqi detainees subjected to torture and mistreatment at Abu Ghraib prison may continue to suffer from significant physical and psychological consequences of their abuse. This article reports two cases of Iraqi individuals allegedly tortured at Abu Ghraib. ⋯ Furthermore, these cases support assertions that abuse of prisoners was not limited to being perpetrated by guards, but also occurred systematically in the context of interrogations. These cases also raise concerns about inadequate medical care for Iraqi detainees.
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Physician power has been attacked, and tabooed, in legitimate efforts to strengthen patients' rights. Yet the structural and symbolic power wielded by doctors is what makes good and right healing actions possible. Avoiding the power issue contributes to a confusing state, where patient trust is faltering and physicians are uncertain about how to fulfill the doctor's role with the intellectual tools of mere science and technology. ⋯ The article proposes clinical leadership as a concept offering practical and ethical direction to clinicians, education, research, and health policy. Leadership presupposes reflective awareness of physicians' structural and symbolic power, and is displayed as discerning, empowering improvisations in critical situations, based on empathy and willingness to learn from patients. The notion of clinical leadership highlights patient vulnerability, medicine's ethical core, and the importance of character development in medical education.
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This essay explores the various places inhabited by doctors and patients, in order to lead doctors to a more complex understanding of their patients' experiences of illness. Using Adam Haslett's "The Good Doctor" (2002), we examine what happens when doctors enter the worlds of their patients, both the literal landscapes of their patients' homes and the hidden landscapes of their minds. We illustrate the impact place has on doctors' understanding of their patients and on the patients' attitudes toward their illness. In addition, we examine how place informs readers' perceptions of both the coherence and the divide between the worlds of doctor and patient.