It was not just the blood and guts that enthralled me. It was the idea that a mere person would have the confidence to wield the scalpel in the first place .
There is a saying about surgeons, meant as a reroof :" Sometimes wrong, never in doubt". But this seemed to me their strength. (查看原文)
As patients, we want both expertise and progress. What nobody wants to face is that these are contradictory desires. In the words of one British public report, “There should be no learning curve as far as patient safety is concerned.” But that is entirely wishful thinking. (查看原文)
The explanation of pain that has dominated much of medical history originated with Rene Descartes, more than three centuries ago. Descartes proposed that pain is a purely physical phenomenon - that tissue injury stimulates specific nerves that transmit an impulse to the brain, causing the mind to perceive pain. The phenomenon, is like pulling on a rope to ring a bell in the brain. It is hard to overstate how ingrained this account has become. Twentieth-century research on pain has been devoted largely to the search for and discovery of pain-specific nerve fibers and pathways. In everyday medicine, doctors see pain in Cartesian terms - as a physical process, a sign of tissue injury. We look for a ruptured disk, a fracture, an infection, or a tumor, and we try to fix what's wrong.
The degre... (查看原文)
Now, kindness will often involve respecting patients' autonomy, assuring that they have control over vital decisions. But it may also mean taking on burdensome decisions when patients don't want to make them, or guiding patients in the right direction when they do. Even when patients do want to make their own decisons, there are times when the compassionate thing to do is to press hard: to steer them to accept an operation or treatment that they fear, or forgo one that they'd pinned their hopes on. Many ethicists find this line of reasoning disturbing, and medicine will continue to struggle with how patients and doctors ought to make decisions. But, as the field grows ever more complex and technological, the real task isn't to banish paternalism; the real task is to preserve kindness. (查看原文)
