Cell 2 Soul: The Humane Health Care Blog

Atul Gawande's Reith Lectures

The Reith Lectures were inaugurated in 1948 by the BBC. Bertram Russell gave the first talk.

In  2014, there were four Reith orations by Atul Gawande on The Future of Medicine.  They were presented in Boston, London, Edinburgh, and New Delhi.  All can be listened to or read.  In addition they can be downloaded for free to iTunes and transferred to an iPod for easy listening.  O! Brave New World!

You can gain access to Gawande’s four lectures at the BBC site.  They are:

Why Do Doctors Fail?
1/4 Surgeon and writer Dr Atul Gawande explores the nature of fallibility in medicine.

The Century of the System
2/4 Atul Gawande calls for a radical rethink of medical systems to transform healthcare.

The Problem of Hubris
3/4 Atul Gawande calls for a new approach to the 'great unfixables' - ageing and death.

The Idea of Wellbeing
4/4 Atul Gawande calls for a new focus on systems to ensure doctors work more effectively.

Even if you have read “Being Mortal” you will enjoy these presentations.

 

 

 

 

 

Overdiagnosis and Overtreatment: A Modern Epidemic

Role of Fear in Overdiagnosis and Overtreatment: an essay by Iona Heath

The title says it all regarding this extraordinary essay in the October 24, 2014 British Medical Journal. Here are a few quotations from the article. If you would like a copy of the entire paper, let me know (email DJE )and I will send it to you. I cannot post it online because of copyright issues.

In recent decades, health has become a commodity like any other. The exploitation of sickness, and fears of sickness, for the pursuit of profit has increased recently, underpinned by the rapid commercialization of healthcare.

Montaigne wrote: if you don't know how to die, don't worry: nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don't bother your head about it.

Every healthcare professional is now required to consider an ever greater array of potential risks to the patient's health, however well patients might be feeling. And every responsible and rational citizen is expected to actively seek out and eliminate all possible risks to their future health and to consume medical technologies in order to achieve this aim.

A great comfort is the unpredictability of the future. No one knows exactly what will happen tomorrow. We know a lot about probability, but probability is a long way from certainty. People do not always get the result predicted by their lifestyle. Not everyone who smokes will die prematurely. Conversely, a good diet and regular exercise do not provide complete protection from random disaster.

Plato's Doctors

In Laws, Plato wrote that there are two classes of patients, slaves and freemen. And, similarly two kinds of doctors:  slave doctors and freemen doctors. Slave doctors run about and cure the slaves, or wait for them in the dispensaries; while free doctors attend and practice upon freemen. They carry enquiries far back, and go into the nature of the disorder. They enter into discourse with their patients, instructing them as far as they are able.  For the full quote go to: Download Plato Physician  .

      

So, what has changed since Plato made this observation?

The Care of the Patient by F.W. Peabody

Francis Weld Peabody’s The Care of the Patient is the most cited article in the medical literature.  This is even more impressive when one considers that it deals exclusively with the humane aspects of medicine and not science.   All care providers, patients and patient's family members  would benefit from reading and rereading it every few years.  It is especially important for medical students and trainees.  The Care of the Patient used to be on the web - but not any longer.  We had a student type it out a few years back and you can find it: Download The_care_of_the_patient 1

The Healer's Role

Neuroscientist, John Skoyles, wrote a fine essay on the role of the healer (physician, doctor, shaman, all others).  This is an important piece that explains the origin's of the care giver's function in human societies.  It is well worth reading, for as we embrace the technical and procedural model, we can lose sight of the responsibility we have to always  provide comfort.  The adage:  "To cure sometimes, to relieve often, to comfort always" holds true in all we do.

To read John Skoyles' piece see the PDF Download Skoyles.pdf

Schweitzer on Service

Almost 20 years ago, Dr. Art Brownstein passed this inspiring Schweitzer quote along to me.  I transcribed it and printed it out.  It sits on a window sill above my office desk.  Every few days, a patient reads it and remarks how much it means to them.  I wish I remembered to read it every day, since it heps one to be a better and more caring physician.

Diving-Bell and the Butterfly

The Diving-Bell and the Butterfly

David Warriner, FY1 general surgery, York
[email protected]

Translated from the French, The Diving-Bell and the Butterfly is a beautiful and poignant account of a 45 year old father of two falling victim to a catastrophic stroke. The resulting "locked-in syndrome" means he is unable to speak or move—his only means of interaction is through blinking his left eye.

This fine review appeared in the June 30, 2007 BMJ.  Download divingbell_butterfly.pdf

Osler Quotes

Over a decade ago, a friend gave me a copy of Harvey Cushing's The  Life of Sir William Osler.  He knew I admired Osler but  had read little of his work.  Somewhat  reluctantly, because of its forbidding length, I  waded into the volume and was swept away by the elegance of both  Cushing and Osler's writings.  You may be interested in perusing some of the selections which I highlighted.

Here is a .pdf which you can examine at your leisure.  Download life_of_osler.pdf  (The page numbers refer to the Oxford University Press one volume edition of 1940.)

Arrowsmith

Arrowsmith has a claim to be the greatest ever novel about medical research.
To read the review in the BMJ:
Download arrowsmith_bud_334_7592__539_bmj.pdf