Have changes in the context of doctors' work altered the concept of the professional in medicine?

There is clearly current interest in the subject of doctors as professionals. Many other bodies look towards medicine for a definition of a professional. The term 'professional' is not easy to define but appears to include the concepts of a body of specialized knowledge and skill, autonomy, trust, responsibility and integrity, serving society, direct interaction with clients, duty to speak with authority and a licence to practise. This paper reflects on the changes in doctors' work, looking for any alteration in the concept of a professional. There have been significant recent changes in the context of medical work; medicine has suffered much bad publicity. In addition there have been major changes to the regulatory council and there have also been fundamental registration changes, including the revalidation of registration. The government has made substantial changes involving performance targets and management. In addition, patient power has been enhanced. This paper contends that there has been little change in the professional role of medical practitioners; this lack of change assists with defining the whole concept of a professional. The professional role appears to include elements of specialized knowledge, a service ethic and critical evaluation, but there are traits of personality within the concept. The paper concludes with the realization that a definition of a professional is both difficult and continually changing. There are important implications from this paper for other groups that seek to be professionals. Certainly, any such group needs to convince others that this title should indeed be used.     

Human embryos in the original position?

Two different discussions in John Rawls' A Theory of Justice lead naturally to a rather conservative position on the moral status of the human embryo. When discussing paternalism, he claims that the parties in the original position would seek to protect themselves in case they end up as incapacitated or undeveloped human beings when the veil of ignorance is lifted. Since human embryos are examples of such beings, the parties in the original position would seek to protect themselves from their embryonic stages onward. When discussing the basis of equality, Rawls claims that the parties in the original position would guarantee basic rights for all those with the capacity to take part in this original position. To guarantee the basic rights of infants and young children, he goes on to interpret this capacity as a "potentiality that is ordinarily realized in due course." Since human embryos have this potentiality, they too should have basic rights.     

Who's in the business of saving lives?

There are individuals, including children, dying needlessly in poverty-stricken third world countries. Many of these deaths could be prevented if pharmaceutical companies provided the drugs needed to save their lives. Some believe that because pharmaceutical companies have the power to save lives, and because they can do so with little effort, they have a special obligation. I argue that there is no distinction, with respect to obligations and responsibilities, between pharmaceutical companies and other types of companies. As a result, to hold pharmaceutical companies especially responsible for saving lives in third world countries is unjustified.     

Blood and expertise: the trials of the female medical expert in the ancien-régime courtroom

This article explores the obstacles faced by the female medical expert in the early modern courtroom through a close reading of three case studies: Marie Garnier, expert midwife tried for false testimony in 1665, and Angélique Perrotin and Barbe-Fran?oise D'Igard, accused of false accusation of rape and infant substitution, respectively, in the 1730s. The difficulties of determining the veracity of the corporeal signs of a crime were particularly acute with regard to the reproductive female body, which was perceived to be less reliable than its male counterpart. The ability of the female medical expert to accurately and truthfully interpret such signs was also questionable, and at times she seems to have been as much "on trial" as the bodies of those she examined.     

Was the black death in India and China?

Firsthand accounts of the Black Death in Europe and the Middle East and many subsequent historians have assumed that the pandemic originated in Asia and ravaged China and India before reaching the West. One reason for this conviction among modern historians is that the plague in the nineteenth century originated and did its worst damage in these countries. But a close examination of the sources on the Delhi Sultanate and the Yuan Dynasty provides no evidence of any serious epidemic in fourteenth-century India and no specific evidence of plague among the many troubles that afflicted fourteenth-century China.     

Can Autonomy and Equity Coexist in the ICU?

Cohen reviews two collections of essays on ethical issues in critical care medicine: Ethics and Critical Care Medicine, edited by John C. Moskop and Loretta Kopelman (D. Reidel; 1985), and "Ethical Moments in Critical Care Medicine," a symposium issue of Critical Care Clinics, edited by James P. Orlowski and George A. Kanoti (1986 Jan; 2(7): 189 p.). Some of the topics discussed by the contributors include physician beneficence vs. patient autonomy in critical care decision making; the pressures created by the "rescue ethos" of the critical care setting; the selection of patients for admission to intensive care; the equitable distribution of critical care resources; and the increasing need to factor costs into treatment decisions. E. Cassell, E.D. Pellegrino, J. Katz, D. Walton and N. Donen, J. Moskop, J. Perrin, H.T. Engelhardt, R. Veatch, J. Paris and F. Reardon, S. Youngner, and S. Imbus and B. Zawacki are among the essayists.     

Doctor in the house: the medical student as academic,attendant and apprentice?

It is contended that change in the health services should be accompanied by a re-examination of medical education. Changes in professional roles and practices, specialist training and the location of patient care should be more central to informing change in undergraduate medical education. Although innovation in undergraduate curricula is taking place, much of this is in relation to improvement in educational methods. We would argue that these initiatives need to be more firmly linked to the realities of delivering healthcare today.     

Mediation in the Medical Field: Is Neutral Intervention Possible?

Neutrality is held to be the touchstone of good mediation. True neutrality is elusive, however, and probably not even desirable, at least when applied to patient-provider disputes over medical care. In this context, mediators should not posture as "neutrals"; they should strive instead to protect their clients' autonomy.     

What makes a good children’s doctor? Exploring the child perspective in the OSCE setting

Background: Patient feedback is increasingly important in clinical practice, and this should include children’s views. 28 children aged 8–10 years participating in a large-scale OSCE underwent cranial nerve examination by student candidates. They scored each out of 10 for the question: ‘If you had to see a doctor again, how happy would you be to see this one?’ An age-adapted qualitative focus group methodology was used to explore why they scored some students more highly than others.

Results: Children’s scores for the 256 medical students ranged from 2 to 10 (median 9; mean 8.46). 76% of scores were above 8. ‘Good' doctor attributes included: ‘friendly’, ‘funny’, ‘knowledgeable’, ‘confident’; ‘bad’ doctor attributes were: ‘making mistakes’, ‘not paying attention’, ‘forgot everything’, ‘serious’. Children’s reasons for specific scores are further explored.

Discussion and conclusion: Scores were positively skewed, in line with most patient/simulated patient feedback, and children discriminated between candidates. It should not be assumed that clinician examiners can accurately represent the views of child patients who may value different qualities in doctors. Children participating in our study had clear views of what they want from a doctor: a consultative approach with clear and kind explanation of the process of examination.     

Exceptional Suffering? Enumeration and Vernacular Accounting in the HIV-Positive Experience

Drawing on 17 months of ethnographic fieldwork in Freetown, Sierra Leone, I highlight the recursive relationship between Sierra Leone as an exemplary setting and HIV as an exceptional disease. Through this relationship, I examine how HIV-positive individuals rely on both enumerative knowledge (seroprevalence rates) and vernacular accounting (NGO narratives of vulnerability) to communicate the uniqueness of their experience as HIV sufferers and to demarcate the boundaries of their status. Various observers' enumerative and vernacular accounts of Sierra Leone's decade-long civil conflict, coupled with global health accounts of HIV as exceptional, reveal the calculus of power through which global health projects operate. The contradictions between the exemplary and the exceptional-and the accompanying tension between quantitative and qualitative facts-are mutually constituted in performances and claims made by HIV-positive individuals themselves.     

Health hazards in hospitals: who's caring for the workers?

The issue of responsibility for protecting hospital workers from hazardous materials is discussed. The Occupational Safety and Health Administration is reported to be moving very slowly to tighten its regulatory standards for hospitals.