A story/dialogue method for health promotion knowledge development and evaluation.
(1/98)
Arguments have been made in favour of a constructivist or postpositivist approach to health promotion knowledge development and program evaluation, but little has been articulated about what such an approach would look like. This article describes a 'story/dialogue method' that was created with and for practitioners in response to their concerns that much of their practice did not lend itself to a positivist, or conventional, methodology. Derived from constructivist, feminist and critical pedagogical theory, and with roots in qualitative methods, the method structures group dialogue around case stories addressing particular generative practice themes. While intended for practitioner training, organizational development and evaluation, the method to date has been used primarily for training purposes. This article describes the method, provides an example of its application, and discusses its strengths, weaknesses and relevance to health promotion. (+info)
Ambulance notes of a Bellevue Hospital intern: May 1938.
(2/98)
In 1938, as a New York University/Bellevue Hospital intern, I recorded notes on the 384 cases I saw during my 1-month ambulance duty. Although I intended to use them to follow up the clinical course of patients I admitted to Bellevue, the long hours and pressure of work made this ambitious goal unachievable. Sixty years later, after retirement from academic medicine and medical practice at New York University School of Medicine, I found the long-lost notes among my papers. They are of historic interest since they provide insight into aspects of primary and emergency medicine of the era when the therapeutic efficacy of the sulfanilamide class of agents was under investigation, a unique view of the life of an intern just before interns were replaced on ambulances by technicians, and a glimpse of the surprising character of several neighborhoods of pre-World War II Manhattan. The notes also provide the basis for a current analysis of case incidence and treatment by disease category. A description of the confluence of social, economic, and political forces that led to the establishment of the Bellevue Hospital Ambulance Service, the first such urban service in the world, is included. (+info)
Balancing rationalities: gatekeeping in health care.
(3/98)
Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role? Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities. (+info)
That's another story: narrative methods and ethical practice.
(4/98)
This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (+info)
Acculturating human experimentation: an empirical survey in France.
(5/98)
Preliminary results of an empirical study of human experimentation practices are presented and contrasted with those of a survey conducted a hundred years ago when clinical research, although tolerated, was culturally deviant. Now that biomedical research is both authorized and controlled, its actors (sponsors, committees, investigators, subjects) come out with heterogeneous rationalities, and they appear to be engaged in a transactional process of negotiating their rationales with one another. In the European context "protective" of subjects, surprisingly the subjects we interviewed (and especially patient-subjects) were creative and revealed an aptitude for integrating experimental medicine into common culture. (+info)
East and west see eye to eye--an elective report.
(6/98)
A summary of personal experiences encountered as a medical student on elective at an eye hospital in China. It bears witness to the possibility of seamless combination of western and traditional Chinese medical practices in the field of ophthalmology. Included are also the acupuncture points used in the treatment of optic atrophy at this particular eye hospital. Address of eye hospital: Zhongshan Ophthalmic Center 54 South Xianlie Road Guangzhou 510060 China Period of elective: 5th January 2001-11th March 2001. (+info)
Travels in Japan.
(7/98)
Following his attendance at the ICMART meeting, in Myasaki in 1988, the author, a BMAS member, resolved to revisit Japan. He found that acupuncture was widely practised throughout the country; although the patients were in the main elderly. The range of techniques used ranged from TCM to western, and broadly mirrored the styles practised in the West. Most young people in Japan considered acupuncture to be rather old fashioned, and it is postulated that this contrasts with the population seeking complementary medicine in the West. (+info)
The World Trade Center attack. Eye witness: observations of a physician on the outside looking in.
(8/98)
Having personally witnessed the destruction at the World Trade Center on 11 September 2001, this paper presents my personal feelings and observations as an observer of both disaster and terror. Aside from the unimaginable horror as a result of the carnage, a feeling of helplessness was particularly prominent due to the inability to be able to care for casualties since most victims were fatalities. The passage of time has enabled a return to normalcy, however 'normalcy' carries a new definition due to the vastness of the tragedy and the sudden threat of bioterrorism and other weapons of mass destruction. (+info)