PurposeThe COVID-19 pandemic caused a massive healthcare crisis. To investigate what makes healthcare system resilient and physicians better at coping during a crisis situation, our study investigated the role risk exposure, such as working at COVID-19 entry points, sleep, and perceived work safety played in reducing negative psychological functioning at work, as well as their effects on adverse and potentially fatal incidences of compromised safety and medical errors.MethodsOur study included a representative sample of 1,189 physicians, from all 12 (...) Slovenian regions and all medical occupations, as registered by the Medical Chamber of Slovenia. For the purposes of this study, a Questionnaire of Sleep and Psychological Functioning at Work was developed in the form of an online retrospective self-report. Additionally, our study included items assessing physicians perceived work safety and frequency of negative outcomes during the first month of the Covid-19 epidemic.ResultsPhysicians working at COVID-19 entry points were more likely to experience night awakening, slept less than 5 h per night, experience nightmares, and had lower levels of psychological functioning in comparison to other physicians. Both hypothesized models showed adequate fit. A higher score on the sleep scale has been shown to predict lower levels of negative psychological functioning at work and, indirectly, reduced incidences of compromised safety and medical errors. Contrary to our expectations, no significant direct effect of sleep on compromised safety and medical errors was found. When perceived work safety was added into the model, the model showed improved fit, with perceived work safety predicting better sleep, less negative psychological functioning at work, and less compromised safety.ConclusionSleep and safety both play an important role in reducing negative psychological functioning at work and, by doing so, decreasing the negative and potentially fatal incidents during the pandemic, such as compromised safety and medical errors. Further, research is needed to see how medical guidelines can be updated to ensure physicians sleep and that their safety is protected. (shrink)

The medical profession is under a state of increasing scrutiny. Recent high profile scandals regarding substantial industry payments to physicians, surgeons, and medical researchers have raised serious concerns over conflicts of interest. Amidst this background, the public, physicians, and policymakers alike appear to make the same assumption regarding conflicts of interest; that doctors who succumb to influences from industry are making a deliberate choice of self-interest over professionalism and that these doctors are corrupt. In reality, a myriad of (...) evidence from social science indicates that influence from conflicts of interest often occurs on a subconscious and unintentional level. This poses an important issue, since such conflicts can steer wellintentioned physicians away from their primary professional goal to provide the best medical advice and treatment possible. (shrink)

It is easier to resist at the beginning than at the end.– Leonardo da VinciPhysicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their (...) marketing. To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice. (shrink)

In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the “slippery slope argument.” One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a “slippery slope” into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society’s values and moral perspective of a practice over an extended period of (...) time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that employing the psychological slippery slope argument against physician-assisted death is logically fallacious, this kind of slippery slope is unfounded in practice, and thus the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death. (shrink)

Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term ‘euthanasia’ has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided into three (...) groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term ‘euthanasia’. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City. (shrink)

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral (...) intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey. (shrink)

Some of the human relations of doctor and patient, by D.L. Edsall.--The care of patients. Its psychological aspects, by C.F. Martin.--The medical education of Jones, by Smith, by W.S. Thayer.--The significance of illness, by A.F. Riggs.--Some psychological observations by the surgeon, by F. G. Balch.--Human nature and its reaction to suffering, by L.K. Lunt.--The care of the aged, by A. Worcester.--The care of the dying, by A. Worcester.--Attention to personality in sex hygiene, by A. Worcester.

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal (...) code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (shrink)

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: The psychological toll on physicians: “I wonder if I'm broken”; the importance of and need for mass casualty shooting preparedness: “[We need to] recognize this as a public health concern and (...) train physicians to manage it”; massive media attention: “The media onslaught was unbelievable”; and commitment to advocacy for a public health approach to firearm violence: “I want to do whatever I can to prevent some of these terrible events.”. (shrink)

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The ideal physician is confident, empathic, forthright, respectful, and thorough. These ideals allow us to define broadly "the excellence" of being a physician. At the core of these ideals is the ability to be empathic. Empathy exhibits itself in attributes of an individual's moral character and also in actions that actualize and support (...) communal life. Empathy, however, can be diminished or even lost and must be nurtured on an ongoing basis. The development of ethical physicians is strongly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. Creating a clinical environment that is ethically nurturing and sustaining is an indispensable component of practicing medicine. (shrink)

Empirical surveys about medical futility are scarce relative to its theoretical assumptions. We aimed to evaluate the difference of attitudes between laypeople and physicians towards the issue. A questionnaire survey was designed. Japanese laypeople (via Internet) and physicians with various specialties (via paper-and-pencil questionnaire) were asked about whether they would provide potentially futile treatments for end-of-life patients in vignettes, important factors for judging a certain treatment futile, and threshold of quantitative futility which reflects the numerical probability that an (...) act will produce the desired physiological effect. Also, the physicians were asked about their practical frequency and important reasons for futile treatments. 1134 laypeople and 401 (80%) physicians responded. In all vignettes, the laypeople were more affirmative in providing treatments in question significantly. As the factors for judging futility, medical information and quality of life (QOL) of the patient were rather stressed by the physicians. Treatment wish of the family of the patient and psychological impact on patient side due to the treatment were rather stressed by laypeople. There were wide variations in the threshold of judging quantitative futility in both groups. 88.3% of the physicians had practical experience of providing futile treatment. Important reasons for it were communication problem with patient side and lack of systems regarding futility or foregoing such treatment. Laypeople are more supportive of providing potentially futile treatments than physicians. The difference is explained by the importance of medical information, the patient family’s influence to decision-making and QOL of the patient. The threshold of qualitative futility is suggested to be arbitrary. (shrink)

On 11 March 2011, Japan experienced a major disaster brought about by a 9.0-magnitude earthquake and a massive tsunami that followed. This disaster caused extensive damage to the Fukushima Daiichi nuclear power plant with the release of a large amount of radiation, leading to a crisis level 7 on the International Atomic Energy Agency scale. In this report, we discuss the obligations of physicians to provide care during the initial weeks after the disaster. We appeal to the obligation of (...) general beneficence and argue that physicians should go to disaster zones only if there is no significant risk, cost or burden associated with doing so. We conclude that physicians were not obligated to go to Fukushima given the high risk of radiation exposure and physical and psychological harm. However, we must acknowledge that there were serious epistemic difficulties in accurately assessing the risks or benefits of travelling to Fukushima at the time. The discussion that follows is highly pertinent to all countries that rely on nuclear energy. (shrink)

This essay highlights an argument for the moral impermissibility of physician-assisted death based on the prohibition of killing innocents that unfolds in four phases. First, I identify the operative moral principle and then develop a moral argument based upon it. Second, I raise challenges to such an argument designed to mitigate the force of the conclusion. Third, I sketch out a potential defense of the argument in light of these counter-responses for those who want to maintain moral opposition to physician-assisted (...) death based upon the prohibition of killing innocents. Finally, I conclude with a brief postscript that highlights the limits of the philosophical approach taken in this essay in conversation with the role of moral psychology in moral judgment. (shrink)

OBJECTIVES: To compare the perceptions of physician executives and clinicians regarding ethical issues in Saudi Arabian hospitals and the attributes that might lead to the existence of these ethical issues. DESIGN: Self-completion questionnaire administered from February to July 1997. SETTING: Different health regions in the Kingdom of Saudi Arabia. PARTICIPANTS: Random sample of 457 physicians (317 clinicians and 140 physician executives) from several hospitals in various regions across the kingdom. RESULTS: There were statistically significant differences in the perceptions of (...) physician executives and clinicians regarding the existence of various ethical issues in their hospitals. The vast majority of physician executives did not perceive that seven of the eight issues addressed by the study were ethical concerns in their hospitals. However, the majority of the clinicians perceived that six of the same eight issues were ethical considerations in their hospitals. Statistically significant differences in the perceptions of physician executives and clinicians were observed in only three out of eight attributes that might possibly lead to the existence of ethical issues. The most significant attribute that was perceived to result in ethical issues was that of hospitals having a multinational staff. CONCLUSION: The study calls for the formulation of a code of ethics that will address specifically the physicians who work in the kingdom of Saudi Arabia. As a more immediate initiative, it is recommended that seminars and workshops be conducted to provide physicians with an opportunity to discuss the ethical dilemmas they face in their medical practice. (shrink)

Some authors argue that the ethics of medical care and the ethics of research differ, and that it is a mistake to conflate the two. They propose “that medical research and medical treatment are two distinct forms of activities, governed by different ethical principles.” This raises the question of whether physicians who are also clinical investigators may separate their role as physician from that of researcher when they are involved in clinical trials, thereby avoiding the obligations required in the (...) physician-patient relationship. Miller and Brody suggest that medical training is to blame for what they believe is the physicians’ tendency to confound the obligations of research and practice. “Physician-investigators, after all, went to medical school” they explain. They believe that considering research with patients outside the ethical framework of the physician-patient relationship may be “difficult and threatening” to physicians who have “psychological needs” to consider the ethical obligations flowing from their relationship with their patients. (shrink)

BackgroundMedical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care.DiscussionThe Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, (...) Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses.SummaryPracticing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia (...) or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

This invaluable resource presents a state-of-the-art account of the psychology of pain from leading researchers. It features contributions from clinical, social, and biopsychological perspectives, the latest theories of pain, as well as basic processes and applied issues. The book opens with an introduction to the history of pain theory and the epidemiology of pain. It then explores theoretical work, including the gate control theory/neuromatrix model, as well as biopsychosocial, cognitive/behavioral, and psychodynamic perspectives. Issues, such as the link between psychophysiological processes (...) and consciousness and the communication of pain are examined. Pain over the life span, ethno-cultural, and individual differences are the focus of the next three chapters. Pain: Psychological Perspectives addresses current clinical issues: * pain assessment and acute and chronic pain interventions; * the unavailability of psychological interventions for chronic pain in a number of settings, the use of self-report, and issues related to the implementation of certain biomedical interventions; and * the latest ethical standards and the theories. Intended for practitioners, researchers, and students involved with the study of pain in fields such as clinical and health psychology, this book will also appeal to physicians, nurses, and physiotherapists. Pain is ideal for advanced courses on the psychology of pain, pain management, and related courses that address this topic. (shrink)

_Despite advances in standard of living of the population, the condition of widows and divorced women remains deplorable in society. The situation is worse in developing nations with their unique social, cultural and economic milieu, which at times ignores the basic human rights of this vulnerable section of society. A gap exists in life expectancies of men and women in both developing and developed nations. This, coupled with greater remarriage rates in men, ensures that the number of widows continues to (...) exceed that of widowers. Moreover, with women becoming more educated, economically independent and aware of their rights, divorce rates are increasing along with associated psychological ramifications. The fact that widowed/divorced women suffer from varying psychological stressors is often ignored. It has been concluded in various studies that such stressors could be harbingers of psychiatric illnesses (e.g., depression, anxiety, substance dependence), and hence should be taken into account by treating physicians, social workers and others who come to the aid of such women. A change in mindset of the society is required before these women get their rightful place, for which a strong will is needed in the minds of the people, and in law-governing bodies._. (shrink)

This book describes the psychological ideas current in medieval Europe. It aims partly to correct misperceptions about the nature of psychology in the Middle Ages; an important theme is the surprising unity and coherence of medieval psychology. Kemp outlines two major influences on medieval psychology: Christian beliefs and the views of classical philosophers and physicians. He outlines medieval views on the nature of the soul and spirit, deals with medieval theories of perception, covers cognition and memory, and considers and (...) evaluates Thomas Aquinas' account of emotion and will. (shrink)

Physicians often appear more troubled by moral dilemmas than would seem justified given the present social and professional consensus on many of the questions involved. Their discomfort arises not only at ethical, technical, and behavioral levels (the most commonly identified sources of difficulty), but also at an existential level, that is, as the manifestation of conflicts rooted in the processes and conditions of our coming-to-be as persons. Analysis of this level of physicians' moral difficulties requires renewed attention to (...) the physician as a person, and suggests new perspectives on the interpersonal environment of medical practice. Keywords: medical ethics, existential themes, religion and psychology, physician as person CiteULike Connotea Del.icio.us What's this? (shrink)

This review examines issues relating to biomedical ethics and literature in the African drama The President’s Physician by Emmanuel Babatunde Omobowale. The play investigates the psychological dilemma of Doctor Bituki Warunga, a personal physician to General Kalunga Ntibantunganyah who brutally and inhumanely rules Wavaria, a fictional African country. The doctor is faced with deciding to uphold the ethics of his profession versus terminating the tyrant’s life to set the nation free. The play aims to help budding medical doctors rightly inculcate (...) the principles of medical ethics—autonomy, beneficence, competence, and power—by providing a fictional platform to investigate difficult issues that can arise in clinical practice. The play highlights Warunga’s complex dilemma as he struggles to uphold the Hippocratic Oath and at the same time satisfy his conscience towards his contribution to his country’s freedom. This review explores the difficulties in decision-making when professional duties not only clash with personal preferences but also with the well-being of an entire nation. This discussion is done alongside the ethical concept of utilitarianism and also highlights significant literary concepts such as satire, symbolism, intertextuality, utopian aesthetics, and authorial vision as conveyed in the text. (shrink)

How physicians can get better ratings and more page views in online healthcare communities is an important issue. Based on 38,457 physicians' profiles from a popular online healthcare community in China, we used Latent Dirichlet Allocation model, which is a common topic model, to analyze the non-English text to obtain more doctor's latent characteristics. We found five of the most frequently mentioned topics. In addition to the first topic, “research ability,” “foreign experience,” “committee position,” and “clinical experience” were (...) included as unstructured descriptions in the doctor's profile. Inferences about physician ratings and page views could be improved if these themes were set as characteristics of physicians. Specifically, in our findings, Physicians' mentions of their “research ability” and “foreign experience” had a significant positive impact on physician ratings. Surprisingly, physicians mentioning more “clinical experience” had a significant negative impact on physician ratings. Moreover, while descriptions about “foreign experience” and “committee position” had a significant positive impact on page views, physician mentions of “research ability” had a significant negative impact on page views. These results provide new insights into the ways in which online healthcare community managers or physicians create their personal online profiles. (shrink)

Some critiques of cybermedicine claim that it is problematic because it fails to create physician–patient relationships. But, electronically mediated encounters do create such relationships. The issue is the nature and quality of those relationships and whether they are conducive to good patient care and meet the ethical ideals and standards of medicine. In this paper, I argue that effective communication and compassion are, in most cases, necessary for the establishment of trusting and morally appropriate physician–patient relationships. The creation of these (...) relationships requires patients and physicians to take psychological and emotional risks and to make commitments to each other. The problem is that by altering the form and content of verbal and non-verbal behaviors and by limiting the kinds of interactions that can take place, cybermedicine makes risk-free interactions easier and more commonplace and retards the development of physician compassion and patient trust. In doing so, cybermedicine encourages morally inappropriate physician–patient relationships. I argue that Merleau-Ponty''s notion of embodiment and Kierkegaard''s criticisms of disinterested reflection help us to understand how cybermedicine can undermine patient health and well being and why it should be seen as a possible threat to the moral integrity of physician–patient relationships. (shrink)

During the COVID-19 pandemic, online health platforms and physicians’ online knowledge sharing played an important role in public health crisis management and disease prevention. What influences physicians’ online knowledge sharing? From the psychological perspective of stimulus–response, this study aims to explore how patients’ visit and patients’ consultation influence physicians’ online knowledge sharing considering the contingent roles of physicians’ online expertise and online knowledge sharing experience. Based on 6-month panel data of 45,449 physician–month observations from an online (...) health platform in China, the results indicate that both patients’ visit and patients’ consultation are positive related to physicians’ online knowledge sharing. Online expertise weakens the positive effect of patients’ consultation on physicians’ online knowledge sharing. Online knowledge sharing experience weakens the positive relationship between visit of patient and physicians’ online knowledge sharing, and enhances the positive relationship between patients’ consultation and physicians’ online knowledge sharing. This study contributes to the literatures about stimulus–response in psychology and knowledge sharing, and provides implications for practice. (shrink)

From a psychological standpoint, communicating a severe diagnosis entails more than just naming a disease, it is a complex process with a number of stages: finding out what the patient already knows about the illness (some of which might be wrong, and thus psychologically detrimental), informing the patient while answering any questions (about the illness itself, the treatment, prognosis, recovery period, etc.) and last but not least, providing a minimum of psychological support depending on the patient’s reaction. Romanian law regarding (...) doctor-patient relationship and communication is modeled on the Anglo-Saxon model centered on patient autonomy and direct communication with the latter if the patient desires to know the truth about his condition. If this is not the case, the patient can name a proxy for doctor-patient communication. There are three legal documents that clarify these aspects: Law of Patient Rights, Medical Association’s Ethics Code and the Health Reform Law. The first two are conflicting on several aspects that we will discuss in this paper. The few studies on doctor-patient communication published in Romania reveal that there is no unitary methodology in this field. The doctors attest that often times the patient’s family, when faced with severe illness turn to the traditional model of communication, i.e. they desire to know the severe diagnosis first and pressure the physician to hide the truth form the patient, contrary to the letter of the law. The aim of this paper is to discuss the issue of communicating severe diagnosis in nowadays Romania in a very complex context: 1. The model of doctor-patient relationship and communication has changed after communist era (from paternalistic to partenerial); 2. Conflicting and missing issues in laws; 3. Laws based on patient’s autonomy principle in a traditional society based on another model of taking care (the patient is part of a family nucleus and the family wants to interfere into the medical communication process). Communication has only recently entered the curriculum of some medical schools in Romania. The doctors questioned as part of a study reveal that they‘ve learned to communicate a severe diagnosis by trial and error. This being said we recommend the inception of practical doctor-patient communication courses that could lead to improving doctor-patient relationships, communication of the diagnosis being their foundations. (shrink)

It is well known that the belief that music is inherent in the beating of the pulse was widely held throughout the Middle Ages. Numerous brief but explicit statements of this belief, and of the associated ideas that music is present in other bodily rhythms and or in the virtues and humors can be culled from the writings on music of music theorists and encyclopedists. For such writers, the idea of the musicality of pulse was, of course, one specific expression (...) of the more general notion that musical harmonies inhere in the body and soul of man. The supposed links between music and human physiology and psychology were, however, not only of interest to writers on music: as might be expected, physicians too concerned themselves with the subject. Moreover, certain medical writers who flourished in the north Italian studia during the fourteenth and fifteenth centuries seem to have been much readier than either musical theorists or natural philosophers to provide their readers with detailed discussion of the nature of the music of pulse. The works of these physicians span nearly two hundred years of the teaching of the Italian schools and represent a fairly continuous tradition. Their views not only throw light on the concept of pulse music itself, and hence on one aspect of late medieval handling of the ancient theme of the harmonies of the universe; they also illustrate, in one small area, something of the nature of the actual application in medical training of the venerable tradition linking medicine with the liberal arts and with philosophy, a tradition institutionalized in the very existence of the faculties “of arts and medicine” of the Italian universities. For academic writers on medicine, indeed, the value of a knowledge of music for the understanding of pulse became one of a set of axiomatic illustrations of the importance of an education in liberal arts for physicians. To what extent this particular prescription was seriously intended or taken the following discussion of the opinions and sources of some of the academic medical writers on the music of pulse may help to show. jQuery.click { event.preventDefault(); }). (shrink)

IntroductionFrontline healthcare workers have faced significant plight during the ongoing Coronavirus disease 2019 pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous (...) population of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences. (shrink)

ObjectiveInvestigating the mental health status of Chinese resident physicians during the 2019 new coronavirus outbreak.MethodsA cluster sampling method was adopted to collect all China-wide resident physicians during the epidemic period as the research subjects. The Symptom Checklist-90 self-rating scale was used to assess mental health using WeChat electronic questionnaires.ResultsIn total, 511 electronic questionnaires were recovered, all of which were valid. The negative psychological detection rate was 93.9%. Among the symptoms on the self-rating scale, more than half of the (...) Chinese resident physicians had mild to moderate symptoms of mental unhealthiness, and a few had asymptomatic or severe unhealthy mental states. In particular, the detection rate of abnormality was 88.3%, obsessive-compulsive symptoms was 90.4%, the sensitive interpersonal relationship was 90.6%, depression abnormality was 90.8% /511), anxiety abnormality was 88.3%, hostility abnormality was 85.3%, terror abnormality was 84.9%, paranoia abnormality was 86.9%, psychotic abnormalities was 89.0%, and abnormal sleeping and eating status was 90.8%. The scores of various psychological symptoms of pediatric resident physicians were significantly lower than those of non-pediatrics.ConclusionThe new coronavirus epidemic has a greater impact on the mental health of Chinese resident physicians. (shrink)

Background According to some medical ethicists and professional guidelines, there is no ethical difference between withholding and withdrawing life-sustaining treatment. However, medical professionals do not always agree with this notion. Patients and their families may also not regard these decisions as equivalent. Perspectives on life-sustaining treatment potentially differ between cultures and countries. This study compares Japanese physicians’ and citizens’ attitudes toward hypothetical cases of withholding and withdrawing life-sustaining treatment.Methods Ten vignette cases were developed. A web-based questionnaire was administered to (...) 457 citizens and 284 physicians to determine whether they supported withholding or withdrawing treatment.Results In a case where a patient had an advance directive refusing ventilation, 77% of the physicians and 68% of the citizens chose to withhold treatment. In a case where there was an advance directive but the patient’s family requested treatment, 55% of the physicians and 45% of the citizens chose to withhold the ventilator. When a family requested withdrawal of the ventilator but patient wishes were unknown, 19% of the physicians and 48% of the citizens chose to withdraw the ventilator. However, when the patient had also indicated their wishes in writing, 49% of the physicians and 66% of the citizens chose to withdraw treatment. More physicians were prepared to withdraw dialysis (84%) and artificial nutrition (81%) at a patient’s request than mechanical ventilation (49%).Conclusions A significant proportion of Japanese physicians and citizens were reluctant to withhold or withdraw life-sustaining treatment, even in cases where the patient had indicated their wishes in writing. They were more likely to withhold than withdraw treatment, and more likely to withdraw artificial nutrition than mechanical ventilation. Japanese physicians gave significant weight to family views about treatment but were less likely to agree to withdraw treatment than citizens, indicating a potential source of conflict in clinical settings. (shrink)

Decision making is the physician's major activity. Every day, in doctors' offices throughout the world, patients describe their symptoms and com plaints while doctors perform examinations, order tests, and, on the basis of these data, decide what is wrong and what should be done. Although the process may appear routine-even to the physicians in volved-each step in the sequence requires skilled clinical judgment. Physicians must decide: which symptoms are important, whether any laboratory tests should be done, how the (...) various items of clinical data should be combined, and, finally, which of several treatments (including doing nothing) is indicated. Although much of the information used in clinical decision making is objective, the physician's values (a belief that pain relief is more important than potential addiction to pain-killing drugs, for example) and subjectivity are as much a part of the clinical process as the objective findings of laboratory tests. In recent years, both physicians and psychologists have come to realize that patient management decisions are not only subjective but also prob abilistic (although this is not always acknowledged overtly). When doc tors argue that an operation is fairly safe because it has a mortality rate of only 1 %, they are at least implicitly admitting that the outcome of their decision is based on probability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 29, Number 1, April 2003, pp. 125-141 Dr. George Cheyne, Chevalier Ramsay, and Hume's Letter to a Physician JOHN P. WRIGHT The publication of a new intellectual biography of George Cheyne1 provides a "propitious" occasion for "a thoroughly skeptical review"2 of the question which has long exercised Hume scholars, whether Cheyne was the intended recipient of David Hume's fascinating pie-Treatise Letter to a Physician,3 the letter (...) which describes his own hypochondriacal physical and mental symptoms and gives an account of his early philosophical development.4 Hume's nineteenth-century biographer, John Hill Burton, argued that Hume was probably writing to Cheyne,5 while Ernest Mossner claimed to definitively refute that hypothesis in an article entitled "Hume's Epistle to Dr. Arbuthnot," published in 1944.6 Anita Guerrini's intellectual biography does not discuss Cheyne as a possible recipient of Hume's letter, but she does present a well-rounded picture of this interesting eighteenth-century physician from which we can judge his appropriateness as its addressee. In the following discussion I will make use of the biographical material found in this new biography of Cheyne, as well as other sources, to show that Mossner's arguments are less than definitive, and that it would be wrong to dismiss the possibility that the letter was sent to George Cheyne.7 This is a possibility that, for reasons that I will make clear, makes good biographical and philosophical sense. At the same time, it is important to keep a proper suspense of judgment as Burton did, for the evidence that the letter was either intended for or actually sent to Cheyne is not definitive. John P. Wright is Professor of Philosophy, Central Michigan University, Mt. Pleasant, MI 48859, USA. e-mail: [email protected] 126 John P. Wright Burton, who first published the autobiographical letter of the 22-yearold Hume in 1846, narrowed down the possible addressees of Hume's letter to either Cheyne or John Arbuthnot. He also pointed out that it is possible that the letter was never sent, and that the ten and a half page manuscript is only a neatly written draft, rather than a fair copy of an actual letter. Nevertheless, Burton thought he could identify the unnamed addressee on the basis of the internal evidence of the manuscript and the records of Scottish physicians practicing in England at the time. In the letter, Hume refers to the intended recipient as his "Countryman, a Scotchman [,]... a skilful Physician, a man of Letters, of Wit, of Good Sense, & of great Humanity."8 Further he writes that he is consulting him because he is a person "of great Learning beyond [his]... own Profession" who is acquainted with the "Motions of the Mind" he has described in his letter, and that "Fame pointed [him]... out as the properest person to resolve my Doubts..." about the cure of his disorder.9 Burton tells us that "the first name that suggested itself... was Arbuthnot, whose fine genius was just then flickering in the socket."10 (John Arbuthnot had been ill for some time, and died a year later.) But he then added that "a more full consideration showed to my satisfaction that it must have been destined for Dr. George Cheyne." His main reason for settling on Cheyne was that Cheyne's immensely popular The English Malady (1733) had recently been published, and that "there is a certain unison of tone between Hume's letter and this book." Burton quotes a portion of Cheyne's own long autobiographical account of his own disease in The English Malady. Cheyne's autobiography begins with the claim that "I passed my Youth in close study, and almost constant Application to the abstracted Sciences, (wherein my chief pleasure consisted) and consequently in great Temperance and a Sedentary Life"; it is followed by the reflection that any overindulgence in food or drink led to physical and psychological problems.11 He goes on to describe these in great detail for 39 pages, along with a history of his life. Burton also quotes a section of the book in which Cheyne describes how a studious and sedentary life causes the symptoms... (shrink)

Randomization is the “gold standard” design for clinical research trials and is accepted as the best way to reduce bias. Although some controversy remains over this matter, we believe equipoise is the fundamental ethical requirement for conducting a randomized clinical trial. Despite much attention to the ethics of randomization, the moral psychology of this study design has not been explored. This article analyzes the ethical tensions that arise from conducting these studies and examines the moral psychology of this design from (...) the perspectives of physician-investigators and patient-subjects. We conclude with a discussion of the practical implications of this analysis. (shrink)

Burnout is a well-documented entity in Care Workers population, affecting up to 50% of physicians, just as it is equally well established that managing an infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, increases Post-Traumatic Stress Disorder and the psychological burden. Mental health support, in the form of formal or remote sessions, has been shown to be helpful to health care staff, despite the organizational difficulties in an emergency. During the first emergence of COVID-19 in Italy, the (...) Scientific Institute for Research, Hospitalization and Health Care Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, the Italian hospital that treated “patient 1,” has activated an agreement with the Soleterre Foundation, an international Non-Governmental Organization that manages health emergency projects, to provide psychological support. A task force of psychologists was created with the aim of designing and administering a Therapeutic Mental Health Assessment for COVID-19 Care Workers to evaluate and support health care workers’ mental health. The assessment battery was developed to evaluate symptoms and behaviors associated with trauma and the corresponding maladaptive behaviors. Once the TMHA COVID-19 CWs had been developed, the team of psychologists regularly visited healthcare staff in the ward to administer it. One hundred seven care workers across Intensive Care Units, the emergency room and medical ward were administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as severe for 14%. Severe psychotic symptoms were experienced by 2% and severe suicidal thoughts by 1% of the population. The possibility of acting upon the results of the TMHA COVID-19 CWs allowed an early intervention through individual session beyond the cut-off level for PTSD in NSESSS. In fact, 280 individual support sessions were offered. Therefore, we considered our project a protective and support factor for healthcare workers’ mental well-being and we recommend implementing a mental health screening program in ward involved in COVID-19 patients’ care. (shrink)

Christians have an obligation to attend to the voices of persons who are crying out that their dignity and very lives are in jeopardy when physician-assisted suicide becomes legalized. The following essay begins with an account of the concept of “disability moral psychology,” which elucidates the unique ways persons with disabilities perceive the world, based on their phenomenological experience. The author then explores the disability critique of PAS and the shared social conditions of persons who are chronically disabled and terminally (...) ill. Finally, the author positions the disability critique within Christian moral deliberations on PAS to unearth its significance for Christian ethics. To bear witness to a compassionate God, theological and ethical judgments concerning PAS must seek perspectives from persons who claim that their dignity and even their lives are in jeopardy by the practice. (shrink)

IntroductionThe 2019–2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.Materials and MethodsThis study uses a mixed-method cross-sectional design, including a (...) quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants’ socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi’s phenomenological method.ResultsThe results reveal that 25.7% of patients reported higher level of psychological distress. After controlling the sociodemographic variables, only severity of COVID-19 and uncertainty in illness shown significant effect on psychological distress in the regression model. The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.ConclusionThe 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies. (shrink)

The deeply entrenched, sometimes heated conflict between the disability movement and the profession of bioethics is well known and well documented. Critiques of prenatal diagnosis and selective abortion are probably the most salient and most sophisticated of disability studies scholars’ engagements with bioethics, but there are many other topics over which disability activists and scholars have encountered the field of bioethics in an adversarial way, including health care rationing, growth-attenuation interventions, assisted reproduction technology, and physician-assisted suicide. The tension between the (...) analyses of the disabilities studies scholars and mainstream bioethics is not merely a conflict between two insular political groups, however; it is, rather, also an encounter between those who have experienced disability and those who have not. This paper explores that idea. I maintain that it is a mistake to think of this conflict as arising just from a difference in ideology or political commitments because it represents a much deeper difference—one rooted in variations in how human beings perceive and reason about moral problems. These are what I will refer to as variations of moral psychology. The lived experiences of disability produce variations in moral psychology that are at the heart of the moral conflict between the disability movement and mainstream bioethics. I will illustrate this point by exploring how the disability movement and mainstream bioethics come into conflict when perceiving and analyzing the moral problem of physician-assisted suicide via the lens of the principle of respect for autonomy. To reconcile its contemporary and historical conflict with the disability movement, the field of bioethics must engage with and fully consider the two groups’ differences in moral perception and reasoning, not just the explicit moral and political arguments of the disability movement. (shrink)

The longstanding view of doctors as scientists has been an emphasis in the MCAT and medical school training. However, the AAMC recommended recognizing the importance of social and behavioral science for medicine. There is also a growing realization that being a smart problem solver and the physician as scientist model emphasizes a cold cognitive problem-solving paradigm that overlooks other human capacities that may be critical to medical reasoning and decision-making. Considering a smart physician versus a wise physician, intelligence and problem-solving (...) are important, but a wise physician can use other important capacities beyond intelligence and rationality. This could benefit patients by introducing patient and family perspective taking, as well as compassion in doctor-patient interaction. By reconceptualizing professions from the perspective of practical wisdom, this may increase resilience to problems such as burnout. I outline some psychological capacities viewed as important in wise reasoning that are not about traditional views of intelligence. I argue that wise reasoning is not a native talent but a skill that can be developed. I argue that different kinds of experiences can increase aspects of empathy, epistemic humility, perspective taking, and wise reasoning and I examine evidence that wise reasoning may increase resilience. (shrink)

Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization – or cynicism – and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as “pathology of care relationship”. That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between (...) the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care. (shrink)

Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm (...) patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles. (shrink)

The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the (...) commitment to toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated. (shrink)

Mind and environment evolve in tandem—almost a platitude. Much of judgment and decision making research, however, has compared cognition to standard statistical models, rather than to how well it is adapted to its environment. The author argues two points. First, cognitive algorithms are tuned to certain information formats, most likely to those that humans have encountered during their evolutionary history. In par ticular, Bayesian computations are simpler when the information is in a frequency format than when it is in a (...) probability format. The author investigates whether fre quency formats can make physicians reason more often the Bayesian way. Second, cognitive algorithms need to operate under constraints of limited time, knowledge, and computational power, and they need to exploit the structures of their environments. The author describes a fast and frugal algorithm, Take The Best, that violates standard principles of rational inference but can be as accurate as sophisticated "optimal" mod els for diagnostic inference. Key words: Bayes' theorem; bounded rationality; infor mation format; probabilistic reasoning; satisficing; training; medical education. (shrink)

Decision making is a crucial element in the field of medicine. The physician has to determine what is wrong with the patient and recommend treatment, while the patient has to decide whether or not to seek medical care, and go along with the treatment recommended by the physician. Health policy makers and health insurers have to decide what to promote, what to discourage, and what to pay for. Together, these decisions determine the quality of health care that is provided. Decision (...) Making in Health Care is an up-to-date, comprehensive overview of the field of medical decision making. It includes quantitative theoretical tools for modeling decisions, psychological research on how decisions are actually made, and applied research on how physician and patient decision making can be improved. (shrink)

BackgroundPhysician burnout is a growing phenomenon in current health systems worldwide. With the emergence of COVID-19, burnout in healthcare is progressively becoming a serious concern. Increasing emotional exhaustion, depersonalization, and reduced personal accomplishment threaten the effective delivery of healthcare. Compassion fatigue and moral injury are a considerable risk to the doctor-patient relationship. These issues can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in physicians.MethodologyA scoping review was (...) conducted to investigate the effects of mindfulness practice on physician burnout. High-ranking journals were targeted to analyze high-quality studies and synthesize common themes in the literature. Studies conducted on current practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Gray literature and studies conducted only on allied health personnel were excluded from this review.Results31 studies were included in this scoping review. Mindfulness practice decreased emotional exhaustion and depersonalization while improving mood, responses to stress, and vigor. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to physician mindfulness practice.ConclusionMindfulness was widely reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate physician leader will play a crucial role in addressing current practice gaps, prioritizing staff mental health, and providing a supportive platform for innovation. (shrink)

Although previous studies have recognized the important role of patients' trust in promoting their intention to use health information technologies, most of those studies were under the “risk-benefit” theoretical framework. To deepen the understanding of patients' online consultation decisions, this paper develops a dual-path model investigating how patients develop trust beliefs toward online physicians from the perspective of communication. Drawing on media naturalness theory, we propose that HIT media naturalness will improve patients' perception of communication effort from online (...) class='Hi'>physicians and decrease communication ambiguity between patients and online physicians. This improved communication will further strengthen patients' trust in online physicians and promote their intention to use HIT. Based on a two-wave time-lagged survey from 361 participants, the empirical results demonstrated that the relationship between HIT media naturalness and patients' intention to use HIT is individually and serially mediated by two chains, including perceived communication effort and patients' trust and perceived communication ambiguity and patients' trust. We thus contribute to the related literature and provide practical implications. (shrink)

Elective abortion has become an issue of ethical and political debate in many countries including Mexico. As gynecologists are directly involved in the practice of abortion, it is important to know the psychological meaning that the term ‘elective abortion’ has for them. This study explores the psychological meaning and attitudes toward elective abortion of one hundred and twenty-three Mexican gynecologists. We used the semantic networks technique, which analyzed the words the participants associated with the term ‘elective abortion’. The defining words (...) most frequently used by participants implied a negative sanction. There were important differences by gender and religiosity: male gynecologists, as well as those with strong religious beliefs (mainly Catholics), revealed a more negative psychological meaning and more negative attitudes than females or physicians with weak religious beliefs. A contribution of the present study is that it highlights the importance of psychology to enhancing understanding of the issue of elective abortion. (shrink)