The Good Doctor - Ca...
Since the 1970s patients' groups, and women's health groups in particular, have drawn attention to the deficiencies of the traditional medical model and its tendency to demean and disempower patients.3 The reaction of the early antipaternalists was to emphasise self education and self help as a way of redressing the power imbalance between doctors and patients and avoiding dependence on orthodox medicine. It is often forgotten that most healthcare is self care,4 but too often the manner of healthcare delivery serves to increase dependency and undermine coping skills. Nevertheless, despite the feminist critique, the practitioners of orthodox medicine remain as firmly on their pedestals as ever.
The Good Doctor - Ca...
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Patients' ratings of doctors' interpersonal skills are strongly related to trust. Most patients want to be able to trust the health professionals they consult, but this does not mean they want to be deceived about the nature of their illness or the risks and potential harms of medical intervention. Mechanic and Meyer asked American patients about what trust meant to them.11 Themes that were most commonly mentioned included honesty, openness, responsiveness, having one's best interests at heart, and willingness to be vulnerable without fear of being harmed. Trust is very important, but it does not equate to blind faith. Sick people need empathy, support, and reassurance, all essential features of a therapeutic relationship, but they also need honest information about their condition, options for treatment, and clinicians who listen to their concerns and preferences.
If doctors find it difficult to listen to patients, understand their preferences, and involve them in decisions about their care, they may need training in the competencies for shared decision making. A recent systematic review found 17 trials of training interventions designed to promote a more patient centred approach in clinical consultations.12 Most of these led to notable improvements in consultation processes and patient satisfaction. Those responsible for medical education would do well to take note.
Salen thinks Walt should be treated like a consulting physician. Shaun chases after her and says Walt is not a doctor. Salen doesn't care. She doesn't see why they should treat Walt like a family member and not a doctor.
Park and Morgan argue over technique. Park thinks Morgan has been emotional and unfair this whole case. Morgan tells him to shut up. She says she has been injecting herself with hormones to freeze her eggs. Park says why didn't she tell him? Because they just got together, that's why (typical Morgan). Shockingly, she admits she's not the most unselfish person and doesn't know if she'd be a good mom. No one would defend her if she made bad choices. She leaves before Park can respond.
Shaun comes to see Lea. He says he was wrong about the billboard. Lea says that's good, right? Shaun says he thought it was dumb but it turns out that his ASD inspired Holly. And he wasn't fair to Walt the whole time. He yelled at him. Maybe Walt's idea did work. Shaun does his visualization thing and runs to the OR. He says use a feeding tube as a pressure valve and that Walt was right. Walt agrees to this plan and to Shaun assisting.
The show follows a young surgeon, Shaun who is on the spectrum of autism and suffers from Savant syndrome. He is a brilliantly abled medical professional but his co-workers do not socialize with him due to his condition. The show revolves around Shaun juggling his personal and professional relationships as he helps his patients with his skills while trying to impress the other doctors.
All the publicity makes it easy to forget that Abrams is not some Johnny Pot Seed Come Lately, pimping some trendy area of research just to grab some ink. The truth is that there's not a doctor in the world with more experience dealing with those with AIDS and HIV, because Abrams was there from the very beginning. With doctors Paul Volberding and the late Constance Wofsy, Abrams established San Francisco General Hospital's old Ward 86, now known as the Positive Health Center. The year was 1983, two years after what was then called only the "gay cancer" began cutting its scythe of horror across the nation.
The good doctor, soft-spoken, well-groomed and exuding an exceptional calm, sits in his office in General two floors below the AIDS ward. For a nationally renowned scientist, his office contains not a hint of pretension or inflated ego. As he speaks, he also clearly is eager to get upstairs to his patients, walking the same hallways he's trod for two decades.
Since the feds didn't want to hear anything potentially good about marijuana, Abrams devised an ingenious - and ultimately successful - methodology for gaining approval. He offered up a study on the potential negative interaction between marijuana and protease inhibitors, the antiviral drugs that, taken in combination with others, have helped HIV-infected
"We knew from college that marijuana increased the appetite, and we also knew people were using it out in the community to maintain their appetites, so it was good to have some scientific evidence to back up what many doctors were already seeing for years in their patients who were using marijuana," says Abrams. "It shouldn't have taken so long to get to this point, but I try very hard to separate the politics from the science. My job is to help people."
Helping people is always what Abrams has desired. He has always wanted to be a doctor, "since I found out I couldn't be a tree," he says rather enigmatically. Yet if Abrams had known what lay ahead, he may have, at the very least, considered another career.
In July of 1981 Abrams, now 51, was a young doctor, a cancer specialist heading for Seattle to do bone marrow transplants at the Fred Hutchinson Cancer Research Center. It was part of his fellowship for the University of California at San Francisco. Fellowships follow residencies, so Abrams would soon be in the position of deciding the specifics of his career path.
Abrams found himself in the center of the storm, in exactly the right spot to acquire information because AIDS, or more accurately, HIV, is a retrovirus. It involves the flow of genetic material. Let the doctor explain it:
By 1984, Donald Abrams had the largest AIDS patient load of any doctor in San Francisco, which means that it was quite likely he had the largest load of any doctor in the world. Perhaps someone in New York saw more death - though it matters little when one is seeing death on such a massive scale.
Hospitals and clinics are jammed with excellent, well-meaning doctors of all stripes who found, after a time in the trenches, that working with AIDS cases was too emotionally draining. Moving on to other areas of focus could never be construed as an uncaring decision - for many the decision is paramount to maintaining some sort of emotional equilibrium.
"I hadn't even thought of eclipses in such literal terms, made that connection," Abrams smiles reflectively, "but that's good, that may be a part of my attraction, my spiritual connection to what is at its core a quite predictable scientific event. I like that."
Most studies about good doctors show that high scores on Conscientiousness and Agreeableness correlate with good or stable mental health. The willingness to help is a large part of the factor of Agreeableness. Studies have suggested that well-modulated Conscientiousness and the wish to help are protective against the burnout syndrome. Implied is a heightened psychological resilience.
Goodness implies respect for the value of persons. Attentive listening sets the stage for trying to understand both their perspective and yours. A working hypothesis about diagnoses and a treatment plan emerges for good doctors. As opposed to simply demanding compliance or adherence, a mutual dialog elicits a participatory therapeutic alliance and yields better outcomes. 041b061a72