Time and Personhood across Early and Late-Stage Dementia

How do time and personhood become related when dementia sets in? This article brings together ethnographies from a memory clinic and a dementia nursing home in Copenhagen, Denmark, pursuing how personhood and time become intertwined across early and late-stage dementia. In the memory clinic, the dementia diagnosis is enacted and experienced simultaneously as an indispensable prophecy of discontinuity of personhood and life for the patients, and as a prognosis that renders the future indeterminate and open to intervention. In the nursing home, institutionalized care marks the fulfillment of the prophecy of decline, yet nursing home staff insist on practicing prognoses for the residents. Across our empirical sites, we enquire what the tension between prophecy and prognosis mean for personhood and the possibilities of the present, arguing that people with dementia are made and unmade through different understandings and enactments of future-oriented temporalities.     

On regularity and regulation, health claims and hype

There is “a broad trend in the food industry—using nutrition‐related claims to market products when the scientific substantiation that consumers will actually benefit is weak or non‐existent. … Going after them one‐by‐one with the legal and resource constraints [that the Food and Drug Administration] work[s] under is a little like playing Whac‐a‐Mole, with one hand tied behind your back.”     

Europe and the United States: contrast and convergence

Though the health care systems of the United States and the European countries are very different, they are being buffeted by similar problems: rising health care costs caused by aging populations, technology, and rising public demand and expectations. The primary difference is that the US system is heavily privatized, whereas the European systems are heavily government run or operated. But the latter systems are increasingly open to market ideas and practices while the US is steadily being pushed toward a stronger government role. This article offers some speculation about their gradual convergence in the years ahead.     

Social media and professional identity: Pitfalls and potential

Introduction: Social media developments have completely changed how information is accessed and communicated. While great potential exists with these platforms, recent reports of online unprofessional behavior by doctors has threatened the medical professional identity; a matter of critical importance for clinicians and medical educators. This paper outlines a role for social media in facilitating support for clinicians and medical teachers; it will raise awareness of pitfalls and explain ethical and legal guidelines.

Methods: An analysis of inappropriate behaviors and conflicting attitudes regarding what is acceptable in online posts, including the inter-generational contrast in online presence and perceptions of where the boundaries lie.

Results and discussion: Guidance documents are analyzed and potentially confusing and conflicting statements are identified and clarified. The authors believe that clinicians and medical students must follow ethical imperatives in both personal and professional spheres.

Conclusions: It is essential that medical educational and professional bodies encourage clinicians to support one another and share information online while providing clear legal and ethical advice on maintaining standards and avoiding common pitfalls. Education on the responsible use of social media and associated risk awareness should be a priority for medical school curricula.     

Medicine and Public Health,Ethics and Human Rights

There is more to modern health than new scientific discoveries, the development of new technologies, or emerging or re-emerging diseases. World events and experiences, such as the AIDS epidemic and the humanitarian emergencies in Bosnia and Rwanda, have made this evident by creating new relationships among medicine, public health, ethics, and human rights. Each domain has seeped into the other, making allies of public health and human rights, pressing the need for an ethics of public health, and revealing the rights-related responsibilities of physicians and other health care workers.     

Development and validation of a new measure of student attitudes and knowledge of international health and medicine

There is increasing awareness of the importance of international health and medicine (IHM) but there is a paucity of data regarding medical students' attitudes towards and knowledge of the subject. To the best of our knowledge there is currently no validated measure to assess this. The aim of the present study was to develop a validated measure of medical students' attitudes and knowledge of IHM and examine its correlates. A panel experienced in IHM formulated attitude and general knowledge items and clinical cases based on personal experience, literature review and texts. The survey was piloted and then administered to 82 students of the Ben Gurion University-Columbia University MD program in IHM, and 59 students from programs without specific IHM focus. Cronbach's a was 0.87. Test-retest reliability of attitudes was r=0.87. Correlation of openness to experience with attitudes was r=0.376, showing construct validity. Third-year IHM students scored higher than incoming students on IHM knowledge and clinical cases, demonstrating sensitivity. General IHM knowledge was positively correlated to clinical IHM knowledge r=0.36, but not attitude or openness to experience. Those with previous IHM work experience showed greater openness and positive attitude. Women showed more positive attitudes towards IHM than men. Attitude was negatively correlated with number of languages spoken r=-0.198. The survey may be a reliable and valid tool to assess and compare medical students' knowledge and attitude toward international health. This survey can be used to evaluate curricular innovations in the field.     

Moral damage to health care professionals and trainees: legalism and other consequences for patients and colleagues

Health care professionals' and trainees' conceptions of their responsibilities to patients can change over time for a number of reasons: evolving career goals, desires to serve different patient populations, and changing family obligations, for example. Some changes in conceptions of responsibility are healthy, but others express moral damage. Clinicians' changes in their conceptions of what they are responsible for express moral damage when their responses to others express a meager, rather than robust, sense of what they owe others. At least two important expressions of moral damage in the context of health care are these: callousness and divestiture. Callousness describes the poor condition of a clinician's capacity for moral perception; when her capacity to accurately appreciate features of moral relevance that configure others' needs, vulnerabilities, and desert of care diminishes, such that she fails to respond with care to those for whom she has duties to care, she is callous. Callousness has been explored in detail elsewhere,1 and so the focus of this paper is divestiture. A clinician divests when the value of responding with care to others becomes less centrally and importantly constitutive of his personal and professional identity. Divestiture has important consequences for patients and health professions education, which I will explore here.