Perspectives in biology and medicine
-
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.
-
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.
-
Perspect. Biol. Med. · Jan 2005
From autonomy to accountability: the role of clinical practice guidelines in professional power.
Evidence-based medicine (EBM) aims to address the persistent problem of clinical practice variation with the help of various tools, including standardized practice guidelines. Based on a systematic evaluation of the available scientific evidence, these guidelines offer recommendations for clinicians about details of patient care and clinical decision making. Because clinical practice guidelines specify how health care should be performed, they could be considered a threat to clinical and professional autonomy. ⋯ Professional organizations develop clinical practice guidelines as a service to their members but do not require strict adherence to the guidelines. Indeed, implementation studies show at best a modest change in clinical behavior. Such non-adherence might render a profession vulnerable, however, when third parties seize upon guidelines and offer financial incentives to keep clinicians accountable for delivering optimal patient care.
-
Straw men play a major role in the debate over racial disparity in American medicine. Most have been deployed by the disparities-denying right, but progressives intent on "outing" racism have sent forth their share. This essay flushes out the straw men while attempting to understand the competing moral premises that drive the politics of health care disparity. ⋯ Further research into the factors that correlate with racial differences in health care can shed light on the circumstances that bring about these differences. Whether these circumstances, once understood, should be deemed acceptable is a moral and political matter, and sharp differences over the scope of personal and public responsibility for these circumstances are inevitable. Such disagreements, however, distract us from efforts to reach common ground solutions to agreed-upon inequities in health care.