7.How Medicine Constructs its Objects

Please address the following prompts, which refer to Chapter 3 in Byron Good’s book Medicine, Rationality, and Experience:

1. What are the key shifts that take place in the mind of medical students as they learn to become “doctors”? 

2. What are the key practices that facilitate this transformation? How is it accomplished? 

3. Why does Good argue that the core practices of medicine describes are “cultural” rather than reflective of objective biological reality?

8.Disclosure of Cancer Diagnosis

– If one of your older family members (parent or grandparent) were seeking care for a deadly condition such as cancer, would you want their doctor to be completely frank and open with them at each stage of the treatment process — and directly give them a diagnosis of cancer if that’s what the test indicate?

– Under what conditions might you not want the diagnosis to be fully disclosed?

-What role do you think statistics might play in your desire to know?

– What difference do you think “knowing” might make for the ultimate outcome of treatment?

Peers:

Zhiying Zhou1:53pmAug 18 at 1:53pmManage Discussion EntryI want their doctor to be completely frank and open with them at each stage of the treatment process. As a whole, I want the doctor-patient relationship to be good and mutually trusting. I think the doctor’s honesty plays a big role in the patient’s treatment process. Communication about health issues can be complex. As a case progresses, physicians must often deal with conflicting and confusing information. I think there are several reasons why doctors choose not to tell the truth to their patients. First, the doctor may have made a diagnostic error and is afraid of being sued by the patient. Second, if a symptom has no effect on the patient’s health. The doctor believes there is no need to exaggerate the medical results. Third, the doctor wants the patient to be hopeful about his or her health condition. I think it needs to be analyzed on a case-by-case basis to see if the diagnosis is fully disclosed.  Most of the time, telling the truth means delivering bad news, such as confirmation of serious cancer or a recurrence of a disease for which treatment is not effective. Patient autonomy is important in this case. Suppose the patient is in a situation where he or she is informed that he or she has a condition that will lead to an increase in the cost of his or her treatment. In this case, the patient may choose not to disclose the diagnosis. On the other hand, relatives usually tend not to speak the truth about the patient because the family wants the patient to be hopeful about his or her future life.I think statistics can be thought of not only as just a few numbers but also as survival probabilities, depending on the mindset of the patient. And I don’t think every patient believes in statistics. People are subjective and personal about their physical condition. For example, a very high recovery rate does not mean hope for the patient. Overall, if the statistics are positive, then it is possible that there is a glimmer of hope for the patient. If the statistics are negative, it is possible that they may lead to the disappearance of hope for the patient, but they do not mean absolute abandonment of treatment.I think knowing the outcome will have either a positive or negative result on the treatment process. In a positive way, patients can seek more authoritative treatment in the early stages of disease diagnosis. This can prevent the condition from worsening or chronic inflammation. In addition, assuming that the doctor speaks kindly “lies” to the patient, it will instead motivate the patient to take better care of himself. Mitigating the blow of bad news can help the patient feel hopeful about his or her potential recovery. On the negative side, if the patient does not have health insurance, this will lead to higher treatment costs. Faced with the burden of money, patients may choose to forgo treatment. Another scenario is when a doctor tells a patient the truth, for example, that very low post-operative recovery rates and recovery outcomes can lead to patients either choosing to enjoy the time they have left in life or facing life with frustration.Hiela Manely4:08pmAug 18 at 4:08pmManage Discussion EntryThe key shift that takes place in the mind of medical students as they learn to become doctors is the ability to look at the world in a different way. As stated in class 4 part 1 lecture, the medical students are taught all the technical expertise that is required for a doctor to know but, the way they interact with that information is different. You are not simply trying to absorb the information but, instead a new way of thinking is required where your brain is able to interact within this specialized realm of medicine. As stated in Chapter 3 of Byron Good’s book, medical students have learned to become a “doctor” by using the pathway approach. This approach causes some key shifts allowing medical students to reorientate themselves and become re-socialized. Thus allowing medical students to embody a new set of practices and recognize/learn a new way to embody this world of medicine as described in Good’s book.The key practices that facilitate this transformation is through formative practice. This approach of formative practice allows medical doctors to understand and actively engage with the world using a medical lens. Furthermore this medical lens allows medical students to become specialized in the proper way of “seeing, writing, and speaking” that is required of a doctor (Good 71).  This specialized way of seeing allows medical doctors to see the human “body” as a “medical body”. Seeing a “body” as a “medical body” allows medical students to recognize this object as a groundwork of new knowledge that requires an observation in great detail. The key practice of sight is accomplished in the anatomy lab. In the anatomy lab students are not simply taking the body apart but are disassembling it, a way that seems unnatural to an outsider who is not in the medical realm. The construction of the medical gaze can be switched on and off however, when it is on, students must see the body anatomically. Writing and speaking in a specialized way requires presenting the information logically and also with clarity. Good describes medical writing as “multifaceted” (77). This multifaceted approach is accomplished through a write-up that ensures all facts are clearly stated. Each category in the write up must be filled and ensure that all areas were clearly discussed. The writing allows medical students to document their authority and illustrate their understanding of the patient’s needs. Furthermore, specialized speaking is accomplished through a medical interview that is structured based off of the medical write up. The write up as described in Good’s book is a formative practice that reflects all areas of the individual  and used as a reflective approach when speaking to the patient. Good argues that the core practices of medicine are described as cultural rather than reflective of objective biological reality because of the way that medical students must view the world. They must look at everything through a hierarchical perspective where things are built upon each other. Medicine involves looking at all aspects that go beyond the social and divine level. In addition, medicine requires a physician to look at the human body in a culturally distinctive viewpoint that invokes a symbolic objective.  Discussion Question: How do the medical students decipher between the important stuff and why is this important for becoming a physician? pls reply both, thx

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