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I hate this touchey feely crap that they added just to waste our time. I'd rather be doing pretty much anything other than this crap.
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Like changing your tampon? Jesus Christ, enjoy the brief mental vacation.
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I, for one, prefer my mental vacations to be free of the incessant background babbling of pseudo-intellectual masturbation.
The words "I agree wholeheartedly" would be the biggest understatement I have ever made. 👍
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I like the part of my "soft skills" program that deals with ethics and issues - even if I don't agree with some of what they say, at least it's interesting to see how they present it.
It's the "communication/observation skills" part that I find tedious. You'd think the faculty imagines that all the med students are severely autistic or something: "this is what a human emotion looks like; this is what a scrunched-up face could mean; oh, and when you listen to patients speak, you will be able to hear words, and the words will form an idea, and that idea will be coming from the patient!"
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My favorite quote from our Doctoring class, during a lecture on talking to children: (Showing pictures of children on a PP slide): "And this is an example of a child." Nope, no follow up to that. Just an example of a child.
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Exactly. I swear they designed this stuff just to annoy us by taking as much time stating the obvious as possible.
I know the feeling. We had a lecture this morning. I only went knowing that I could surf the web and play cards. To my dismay, something was wrong with my wireless. I had nothing to do that entire time but stare at the wall and try to block out the incessant rambling.
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It could be worse. I remember when I was doing it there were a couple of classmates that wouldn't SHUT THE HELL UP! Every piece of crap the lecturer threw out they had to comment on it and of course Ms. Touchy-Feely just loved to get feedback. I could have stabbed somebody. Why can't they just sit back, stare at the wall and quietly restrain the urge to shove a pencil through their eardrums like everybody else!!
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Yuck! We've got a group of clappers in our class who think it is important to frequently clap for whoever is talking. It annoys the hell out of me and just encourages whoever is rambling to keep rambling.
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My favorite quote from our Doctoring class, during a lecture on talking to children: (Showing pictures of children on a PP slide): "And this is an example of a child." Nope, no follow up to that. Just an example of a child.
👍
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A question for my fellow ethics lovers: yesterday I had to give a presentation to my ethics small group. I blacked out for awhile there, but I'm pretty sure I admitted to the class that even after finishing only a year of school I already feel little empathy for those who smoke, drink, or eat their way to disease. Do you think this will lead to a lousy evaluation?
You know, not that I care. It was worth the look on my classmates' faces.
You know, not that I care. It was worth the look on my classmates' faces.
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Hell, I'm only an RT and I've already lost most emotions- other than the occasional urge to lobotomize myself with a spoon to make it all go away- towards people who have done something to put themselves in their predicament (>98% of our patients).
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We had Tuesdays and Thursdays blocked off for the 'useless' classes and I would so skip it if it wasn't for the fact that we're in small group and absence would look bad and earn me a Fail. I don't mind some of the stuff they have us do but I feel it's not making good use of our time. Most of the useful stuff could be taught in a weekly one hour course (which shouldn't have mandatory attendence). Instead, I am forced to give up a good 10 hours per week (including outside of class work) on these stupid classes. This makes me mad because the science courseload hasn't decreased in med school but they now add on more 'soft skill' courses making it harder for some of us who really NEED that extra time to study in order to pass our courses. Just think what I could do with an extra 10 hours per week....sleep, study, watch a movie?!
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I agree. I liked medical ethics at my school, but maybe thats because the class was a minimal time commitment as well. We only met 3 times in the 10 week trimester, and most of our grade stemmed from online discussions with our group members. We had to make a minimum number of posts for each week. Our final was either a 5 page paper on some ethical topic, or a discussion (either individual or group) with the course director). I went with the discussion. The class was pass/fail too, making things easier.
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I feel like singing "Kumbayah" or "I'd Like to Teach the World to Sing" when some of this feel-good, get in touch with your ethical inner child crap is presented. Of course some of the cannabis sotted philosphy PhD's that are class facilitators would probably not recognize sarcasm and start singing along.🙄
This is what happens when lawyers and hippies get together to teach a class. . .medical ethics.
This is what happens when lawyers and hippies get together to teach a class. . .medical ethics.
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Those of you saying "quit whining" just don't understand where i am coming from. For me, the only thing that makes medschool tolerable is that I can see most of it as useful (that and I dont have to attend class). Medical ethics is open ended nonsense (and I have a degree in philosophy so I know a thing or two about nonsense). They could also boil whatever they are saying into a quick read and not require me to write some stupid report about the importance of maintaining patient autonomy.
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Sounds like we go to the sames school, with the patient autonomy report and all.
One bright note. . .I had a bit of insomnia a few weeks ago, and all I had to do to cure myself was read a chapter in my Bernard Loh medical ethics text. I was asleep before the end of the third page.😉
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How do you know? I graduated from medical school in 2005, and I assure you that I spent more than enough time listening to idiots drone on about nothing. You have the pain threshold of a 6 year old girl. Grow a pair.
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Feelings are good, mmkaay?? You need to express your feelings... because they're good. Empathy is good, mmkayy?
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If growing a pair means i'll find this ******ed nonsense taught by some douchie reject with a molester's mustache tolerable, than keep calling me Nancy.
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I hear what NonTradMed is saying about the opportunity cost of sitting through ethics when people should be able to budget their own time. But, I disagree that all the other stuff during the preclinical years is relevant and ethics isn't. I think the time devoted to understanding when a patient is autonomous or capable of providing consent is more important than learning specific details about the rate-limiting step in the urea cycle.
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Well I don't think it is all useful but i am able to decieve myself into believing it is. I can't do that with ethics.
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Have you considered that ethical problems do actually occur in the practice of medicine, Nancy?
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Well, sure, if one didn't already know it's important to have the patient provide informed consent. 99% of the stuff my profs go over in classes like this is either common sense or stuff one can and will pick up on the wards anyway, just like any number of other other soft skills. Can't say the same for the urea cycle. Their only redeeming quality seems to be as a grade-padder. We'll have exam questions like,
"Which of the following is the BEST way to tell a patient they've contracted chlamydia?
A) tell everyone you know about it.
B) yell at the patient to quit slutting around.
C) cut off the patient's genitalia
D) inform the patient straightforwardly and non-judgementally, and present treatment options.
Hmmm.
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sure they do and I dont think these ethics courses will do jack**** to change that.
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So, out of less than idle curiousity, do they talk to you guys about things like "ethics consults" and "ethics committees" and the situations in which patient autonomy is challengable? Do they discuss how different cultures make decisions, so it's not always a cut and dried case? Do they discuss case precedents like Buck v. Bell, Griswald v. Connecticut, In re: Quinlan, Cruzan, and the effect they have had on public policy (and recent cases like Schiavo)?
I ask because it sounds like you're getting a superficial treatment of a nuanced field, and that's a shame, because you're going to be woefully underprepared once you start working with patients. I gave my medical ethics lecture tonight as part of Philosophy 101, and gave them a case consult I was on as part of clinical rounds for my graduate program, and to a team they came up with "solutions" that would have destroyed families, opened them up to legal liability, and demonstrated a profound inability to recognize that some of the most challenging issues faced by clinicians have nothing to do with metabolic pathways, diagnosis, or medical management.
I ask because it sounds like you're getting a superficial treatment of a nuanced field, and that's a shame, because you're going to be woefully underprepared once you start working with patients. I gave my medical ethics lecture tonight as part of Philosophy 101, and gave them a case consult I was on as part of clinical rounds for my graduate program, and to a team they came up with "solutions" that would have destroyed families, opened them up to legal liability, and demonstrated a profound inability to recognize that some of the most challenging issues faced by clinicians have nothing to do with metabolic pathways, diagnosis, or medical management.
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I doubt an ethics class is intended to change the landscape. It should serve to expose you to the salient concepts that frequently arise in ethical dilemmas (beneficence, autonomy, etc.), review how the law in you state applies, and give you case studies. My ethics class wasn't exactly the highlight of my day, but in retrospect I'm glad I saw some of it.
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I believe that we have learned some valuable information, but the touchy-feely kumbayah role-playing skits are too much. It is a waste of time to use that methodology in an already packed schedule. Perhaps our small group can all sit around the table and hold hands, swaying to the tunes of Peter, Paul, and Mary!😎
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For me, anyway, the problem with medical ethics at my school isn't that it's taught, but that it's not taught very well. My dad sits on the bioethics committee at a county hospital, and the cases that he gives advise on are fascinating and are much more real-world than "You need informed consent," or "You shouldn't divulge what a patient told you." I think that by making medical ethics more clinically oriented and more sophisticated, the class could easily become both more useful and more fun--hence, less of a waste of time.
Ethics Committie - yes. We had to each pretend to be a different member of the ethics committie. They even had little stickers we had to put on to identify who was the doctor and who was the social worker and who was the priest and so on and so forth. Then we had to discuss a pretend case that was pretty cut and dry.
Cut and dry is actually something that is pretty rare. We do all sorts of ethical scenerios we have to go through or are forced to take a side of and argue about, but they are rarely realistic and never end with "the answer". We pretty much break them down on a white board into what comes under each of these 4 ethical principals that they gave us (without evidence or explaination) first year. That is, they intentionally ignore all of the factors that would affect the outcome. The main factor that is ignored is the law and the legal system. We can talk about it until were blue in the face but if there is an answer in the law or a question that only a court can determine it would be infinately more usefully to know how to approach getting that answer or complying with the law. The choose to ignore any outside factors to make us try and argue about the cases. Everything is totally academic.
situations in which patient autonomy is challengable - no, because that would involve the legal system. But they might give a case and arbitrarily split us up into two groups who have to argue that a patient is autonomous or not.
Do they discuss case precedents like Buck v. Bell, Griswald v. Connecticut, In re: Quinlan, Cruzan, and the effect they have had on public policy (and recent cases like Schiavo)?
Wha? Um no. That involves the legal system which would stifle our free thinking ethics debating ability. You can learn that "information" later, anybody can do that, afterall it is common sense. We're learning how to feel. 🙄
Ours is not all medical ethics either, weve done sessions in the same class on other stuff. We did alternative medicine earlier this year. Now we are doing a session (=lecture + small group) about "meaning in medicine". Sadly, i've been to the lecuture, had to listen to it for lack of wireless internet, yet I still have no clue what the lecturer was trying to say.
And all this comes from a school that constantly brags about having the best program of this type in the nation.
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I just retired from a major teaching hospital in a major city, where I was heavily involved in our ethics committee, PGY 1 orientation, hospital administration and risk management. I PROMISE you the following 3 examples happened exactly as I report them here:
1. MD walks into a hospital room, walks to patient bedside where there are several visitors, and tells patient in front of them that a complication was related to his HIV + status
2.MD examines African woman who has been beaten up in unknown circumstances, declines to wait for official interpreter, and insists on using the woman's husband as interpreter
3.MD walks into SICU waiting room and announces to 18 yr old patient's mother without any preface that he heard she wanted everything done for him, but she should come "see his brain leaking out onto the bed" and sign a DNR
We are a major academic center where, presumably, my colleagues have been well educated. I cannot agree more with Quix; maybe the quality of your ethics classes is poor, but don't think for a moment that you don't need them, no matter HOW SMART you think you are...the academically smarter staff often were the worst offenders.
1. MD walks into a hospital room, walks to patient bedside where there are several visitors, and tells patient in front of them that a complication was related to his HIV + status
2.MD examines African woman who has been beaten up in unknown circumstances, declines to wait for official interpreter, and insists on using the woman's husband as interpreter
3.MD walks into SICU waiting room and announces to 18 yr old patient's mother without any preface that he heard she wanted everything done for him, but she should come "see his brain leaking out onto the bed" and sign a DNR
We are a major academic center where, presumably, my colleagues have been well educated. I cannot agree more with Quix; maybe the quality of your ethics classes is poor, but don't think for a moment that you don't need them, no matter HOW SMART you think you are...the academically smarter staff often were the worst offenders.
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Just for kicks, here is the case I presented to my class; this case is factual (it was one of the cases I had to deal with clinically while doing rotations), but identifying information has been changed.
I'm curious to see how people respond to it:
"Ms. A. is an 84 year-old African American woman. She is currently in the ICU and is non-responsive. She has a past medical history significant for multiple cerebral vascular accidents (strokes) resulting in hemiparalysis (an inability to move her left side). She has diabetes mellitus, peripheral vascular disease (very poor circulation), congestive heart failure, severe sepsis (blood poisoning), and her right leg has been amputated below the knee (secondary to a gangrenous wound several years ago). She has been minimally responsive to treatment.
You have been called on an ethics consult because her family and the treatment staff are divided on whether to pursue aggressive care. The treatment staff isnt convinced that further aggressive care is warranted and while beneficial, would not return her to the life she lived before. Her family is divided and adamant in their beliefs. One daughter (Anne) was the primary caretaker for her mother for ten years. She states that she feels her mother would want to continue living, and bases this on an accident twenty years ago in which another daughter had a stroke and required ventilation. Despite a poor neurological prognosis, her mother told her dont you turn off that machine. Ms. A.s other daughter (Bethany) argues that her mother wouldnt want all these machines she states that when she visits her mother, she gets the feeling that her mother wants all this to be over. Bethany is a registered nurse, and was the one responsible for her mothers amputation (Bethany spotted the gangrenous wound and recognized it for what it was). Anne and Bethany disagreed vehemently about whether the amputation should occur, and after the decision was made, did not speak to each other for three years. Ms. As son Michael is also present, but is visibly intoxicated and smells of alcohol. He states that he wouldnt want anything done, but thats just his opinion about him, not about his mother. He states that he will go along with what they decide to do.
How do you proceed? What do you recommend?"
I'm curious to see how people respond to it:
"Ms. A. is an 84 year-old African American woman. She is currently in the ICU and is non-responsive. She has a past medical history significant for multiple cerebral vascular accidents (strokes) resulting in hemiparalysis (an inability to move her left side). She has diabetes mellitus, peripheral vascular disease (very poor circulation), congestive heart failure, severe sepsis (blood poisoning), and her right leg has been amputated below the knee (secondary to a gangrenous wound several years ago). She has been minimally responsive to treatment.
You have been called on an ethics consult because her family and the treatment staff are divided on whether to pursue aggressive care. The treatment staff isnt convinced that further aggressive care is warranted and while beneficial, would not return her to the life she lived before. Her family is divided and adamant in their beliefs. One daughter (Anne) was the primary caretaker for her mother for ten years. She states that she feels her mother would want to continue living, and bases this on an accident twenty years ago in which another daughter had a stroke and required ventilation. Despite a poor neurological prognosis, her mother told her dont you turn off that machine. Ms. A.s other daughter (Bethany) argues that her mother wouldnt want all these machines she states that when she visits her mother, she gets the feeling that her mother wants all this to be over. Bethany is a registered nurse, and was the one responsible for her mothers amputation (Bethany spotted the gangrenous wound and recognized it for what it was). Anne and Bethany disagreed vehemently about whether the amputation should occur, and after the decision was made, did not speak to each other for three years. Ms. As son Michael is also present, but is visibly intoxicated and smells of alcohol. He states that he wouldnt want anything done, but thats just his opinion about him, not about his mother. He states that he will go along with what they decide to do.
How do you proceed? What do you recommend?"
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Well if we got stuff like this the classes wouldn't be a waste of time. Is this all the info you're given, no AD or durable PoA?
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An ethics class isn't going to make someone more compassionate or even much better at hiding what a jackass they are.
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Exactly, do they think we are idiots?
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See, that's what makes the scenario so bogus. Read the first paragraph again. We would never tell the family of a patient in that situation that any treatment was going to be beneficial. Just not a word we'll use if we think the patient needs to be transferred to celestial care.
And that alcohol twist is also incredibly bogus. Jeez. The situation is not as difficult as you think. You just get the family together, tell them what you think, politely tell them to come to grips with reality, and then do what the legal gaurdians decide. If they can't decide then you continue on doing what you're doing. If you feel strongly about it, and you won't usually, you can get a court order to withhold futile care.
A more realistic scenario is what to do if your attending wants to do unnecessary tests and studies on a terminal patient because he can charge, say, 900 bucks for a bronchoscopy.
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Panda Bear-
I'm sorry to tell you that this is a legit case; there is nothing bogus about it. This was one of the first cases I was involved in in clinical consultation. The patient was real, the family was real, and the conflict was real. If you think the solution is straight-forward, you really are unprepared for clinical ethics.
Tic- No she didn't have an AD or PoA. That was part of the reason why the consult was called.
I'm sorry to tell you that this is a legit case; there is nothing bogus about it. This was one of the first cases I was involved in in clinical consultation. The patient was real, the family was real, and the conflict was real. If you think the solution is straight-forward, you really are unprepared for clinical ethics.
Tic- No she didn't have an AD or PoA. That was part of the reason why the consult was called.
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Panda Bear is a resident
A resident unprepared for complex ethics work. Mea culpa - I meant to write clinical ethics.
EDIT:
A bit of a retraction, PB, since I've been thinking about how I don't really know you and was basing the above on a handful of statements made; I still disagree with your analysis of the situation, however. I don't know if you genuinely feel the case is cut and dried, or if there were other factors at play in writing your response. The case under consideration stymied clinicians with decades of work and a lot of experience dealing with families who were conflicted about how to proceed, which is why the case consult was called. The case did involve nuance and some non-traditional thinking, so it wasn't a simple one by any stretch. So while I will retract the comment about being unprepared for complex ethics work, the consult team still disagreed with the resolution you propose.
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Hey, Quix.
I'm sorry to tell you that you are a ****ing d-bag. Please don't try to talk down to PBear, just don't try you'll just make an ass of yourself in the process and look utterly ridiculous. So please,
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I honestly hope this isn't the approach you take towards your patients. The fact of the matter is that PB is attempting to simply dismiss a relevant case, and in the process demonstrated unfamiliarity with very important principles of medical ethics. Sorry if you disagree, but them's the facts.
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Sorry, I am gonna have to side with the resident physician over some douchebag premed who thinks he knows jack **** about medicine because he studied medical ethics (btw, I have a degree in philo and you guys are the excrement of the philosophical field - if you couldn't actually understand any real philosophy you go into some form of professional ethics and pat yourself on the back for being so smart as to pose open ended questions and then come up with arbitrary decisions based on what is the ethic du jour).
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^^Lamest and most overplayed statement that can be written on SDN. 👎 Yes, what someone writes on an anonymous internet message board is definitely the best predictor of beside manner in medical student.
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I just wish that Des Cartes jackhole would've just taken his block of wax and gone home. 😴
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MA degree in philosophy, Ph.D. in Ethics, but I doubt that will matter much to you. The two years of clinical rotations and daily rounds in internal medicine and the ICU won't matter much either, I suspect. Nor the Grand Rounds presentations and clinical consultations, nor being faculty and the ethicist-in-residence. Nor that I am writing a textbook on areas of critical care with my research group (and not the "touchy-feely" parts of medicine reviled in this thread, but gene polymorphisms and how they affect care and the disease process, acid-base disorders, prevention of renal failure, and other clinical issues). But again, feel free to categorize me all you want as a know-nothing pre-med.
Again, whether or not you agree with me is really moot; what I find interesting is the vitriol with which you address people with whom you disagree. You are free to side with whomever you choose, but by all means, if you are calling BS on what I am saying, back it up. Tell me the case precedent(s), tell me the philosophical grounding, tell me *why* you think you're justified in venting your spleen. I don't know you or the poster in question from a hole in the ground, but the statements being made are very questionable ethically, and it concerns me.
Yes, what someone writes on an anonymous internet message board is definitely the best predictor of beside manner in medical student.
I agree, I generalized too much with that statement, considering I don't know the person in question; the only information I have is the analysis offered in this thread, which made some fundamental mistakes, and the reaction of those who chose to offer insults and crass characterizations as a response.
