1. The Milgram experiments of the 1960s are a terrifying example of how willingly people follow the orders of a respected authority figure. Hierarchy and power in medicine may cause ethical dilemmas. A consultant describes being on a ward round as a medical student and seeing a pregnant 14 year old girl being denied a termination. The doctor in charge thought she should be taught a lesson, and his word was final. This sort of absolute rule is rare now, but hospital is still a place where orders are expected to be followed. When was the last time you did something you were told to do but didn’t agree with? And what did you do?
Student BMJ 2009;17:b122
2. Rape is a medical emergency, and victims should be treated within 72 hours, reports Aditi. This three day window must be used to prevent and treat sexually transmitted infections, prevent unwanted pregnancy, and begin trauma counseling. But there must be a change in attitude among healthcare professionals for this to be possible. Medical students’ attitudes towards rape victims showed the needs of male victims are less well recognized. Researchers also reported that students were more judgmental of non-stereotypical victims of rape, as decided by the researchers—for example, a woman in a bar who met her perpetrator earlier that evening—than women who fit the stereotype—a woman attacked while jogging in the park.
Student BMJ 2009;17:b1224
Student BMJ 2009;17:b1035
3a). What is it about the process of diagnosis that eludes critical evaluation? Clinicians make millions of diagnoses every day, and making the right one is central to effective treatment and accurate prognosis. Great diagnosticians tend to be forgiven their other human failings, if the television portrayal of rude but brilliant Dr Gregory House is anything to go by, which suggests that much of the prestige of medicine is bound up with the ability to diagnose. Yet we know surprisingly little about the thought processes behind successful diagnosis.
BMJ 2009;338:b1662
3b). GPs agreed on the stages and the strategies used, but how they used them differed. For instance, one GP used clinical prediction rules for common cases such as chest infection and sore throat; others used them in rarer, more serious conditions seen in primary care, such as deep vein thrombosis.
Some GPs used a cognitive forcing strategy, whereby plausible alternative diagnoses were not considered once a diagnosis had been reached (a common cause of diagnostic error). Others were unaware of or avoided this strategy.
BMJ 2009;338:b946
4. In a few years, the advent of an artificial pancreas could transform diabetes care. The crucial step in developing such a device is to close the loop between the continuous glucose monitor and the insulin pump with a computer algorithm that calculates the need for delivery of insulin.
Once the artificial pancreas reaches us, the nanotechnology of glucose responsive insulin won’t be far behind, and results of stem cell research—the ultimate biological solution for people with diabetes—may also soon follow.
JAMA 2009;301:1525-7
5. Red Leaves Say, "Bug Off!" Come autumn, leaves exchange their lush greens for deep reds, but why? Scientists have puzzled over this transformation for more than a century. Now a new study of aphids and apple trees in Proceedings of the Royal Society B reinforces the theory that the red hue wards off insects looking for a leafy snack or a place to nest.
Science 24 April 2009: Vol. 324. no. 5926, p. 449
Posts
