The advice of a doctor

The article I read this week was written by a doctor, Peter A. Ubel. In this article he discusses the role of the doctor in the decision making of their patients. "Medical decisions these days are increasingly recognized as being more than simply medical, with the right choice depending in part on the patient's preferences...According to this new paradigm of preference-sensitive decision-making, doctors like me shouldn't tell patients what to do, but rather should educate our patients about the risks and benefits of their options." He goes on to describe an instance in which he disregarded his role as unbiased educator and gave his own personal advice, telling a patient with cancer that he should keep smoking because the cancer is incurable and it will help with the stress. Also, explaining to the patient and his wife that being with each other and the rest of their family is the most important thing for him. 

I believe it is important for a doctor to play the role of educator and let the patient decide. There are so many options available these days that it would difficult for a doctor to determine exactly what works best for each individual. It would be a heavy burden on the doctor if they picked the one that ended up having terrible effects, so it is best to let the patient weigh out there options. I also feel that a doctor can and should step out of this role and offer advice every once in a while. When people have diagnoses that are hard to deal with sometimes a doctor has to be that mediating guide, instead of a medical dictionary. The hard part is knowing when it is right to do so.

Electronic Health Records

In this article in the New York Times the author Walecia Konrad brings up the fact that Obama has put forth a plan to spend 19 billion dollars on electronic medical records. The appeal of having electronic medical records is seamless communication, which would "improve the quality of health care and help reduce dangerous medical errors. And by improving the efficiency of medicine, it might also help curb the nations skyrocketing health care costs." The article states that the intentions are all good, but it will be a while before this idea is able to be fully integrated. If your medical care provider doesn't already provide you with an electronic medical record of yourself, which chances are they don't since only 9% of hospitals, then you are on your own in making it. The author says when he tested out four online health record medical files, Google Health Records, Microsoft Healthvault, RevolutionHealth Health Record, and WebMd Personal Health Record, it proved to be challenging. In order to complete it you would have to do a lot of research and digging in your physicians filing cabinet. Later in the article it also states that personal files done by the patient can be dangerous for doctors to use because their could be errors and omissions. 

With news of the presidents plan, Google and Microsoft have been working on becoming the leaders in the technology, "but progress is being slowed by incompatible technologies, privacy concerns and resistance by many health care providers to installing expensive electronic systems.

I feel that the principles behind the technology are all good and I definitely see the large potential benefit, but in order for this to work properly it will require full cooperation on the part of the patient and medical facilities. It would definitely be great if they could just type in some ones name in the system and get all their past medical history, especially if the person is unconscious or unable to give the proper information needed. For me though, I will sit back and wait until my medical providers take the initiative. 

Real Age

After doing the questionnaire it calculated my real age to be -2.6 which makes my age drop from 20.1 to 17.5. I found this to be a pretty interesting survey. I agree with many of the questions they used to judge age, but I also feel that they need more questions to get a basis. Many of the questions seem like they are designed to find problems, which they can find a prescription for, as the New York Times article suggests. I can't say that I agree with them allowing  pharmaceutical companies use the results as a marketing tool, but overall I feel it is a valuable site. It makes the person taking the survey take inventory of their everyday activities and health choices, and then when it gives the results it informs the individual on what they may be doing incorrectly. It provides them with simple solutions to problems that they may not have noticed, or that they thought were okay. It never hurts to be aware. As far as pharmaceutical companies go, I think the site should protect the members. If an individual is clearly at risk for certain problems, inform the of this and give them the option of receiving the advertisements of pills which could help them. I feel it should be a choice though, not something people are duped  into.

ER assignment

I went to the ER at SOCH today to sit and record notes for the assignment. I figured when I walked in I would tell them why I was there and they would let me stay, this was not the case. The way the ER is set up, there is a window right at the entrance, with the initial nurse who takes down your information, and you have to go down the hall about 10 feet and make a right to get in the waiting room. When the receptionist nurse saw me I told him why I was there, and he told me I couldn't be there because it violates HIPAA laws, but he would ask security. Then a larger woman who was also a nurse came and told me what happens behind those doors is confidential. I told her I wasn't asking to go behind the doors I was just going to sit in the waiting room, but apparently that wasn't allowed either, so I was told I had to leave. I just looked up the HIPAA laws to see why I was made to leave and this is what I found: 

How Is This Information Protected 

• Covered entities must put in place safeguards to protect your health information.
• Covered entities must reasonably limit uses and disclosures to the minimum necessary to accomplish their intended purpose.
• Covered entities must have contracts in place with their contractors and others ensuring that they use and disclose your health information properly and safeguard it appropriately.
• Covered entities must have procedures in place to limit who can view and access your health information as well as implement training programs for employees about how to protect your health information.

Information meaning a patients medical information. So I guess this entity, SOCH, deems it necessary to not allow outside parties into the ER as a method to safeguard the medical information of their patients.

"Study: Triathlons can pose deadly heart risks"

I was listening to the radio this morning and they brought up an article that had been published by the Associated Press entitled "Study: Triathlons can pose a deadly heart risks." After finding it on the internet, I read it, and personally I find it a little funny that they would even do a study on something like this. The premise of the article is that triathlons place added stress on the heart, most specifically the swimming portion which is done in cold lakes or rivers. Many of the people who get involved in triathlons are not frequent swimmers, but are doing the triathlon because it is for a charity. Also, there is the problem that anyone can sign up for a triathlon. The study found that the risk of sudden death during a triathlon is 15 out of a million. I feel that this number is pretty low considering how strenuous a triathlon actual is. People who sign up for a triathlon should know that there is an inherent risk associated with participating and should adequately prepare for the stress that will be placed on their bodies. All this study proves is, if you are going to participate in a triathlon, you should properly prepare for the task.

Treating patients with multiple illnesses

This week in the New York Times I picked an article by Siri Carpenter, which discusses the problem with treating patients with multiple illnesses. In most cases when you are working with an elderly patient and they are coming to you with an ailment, it is more than likely that they have other conditions as well that don't relate to one another. The article sites an example of an 84 year old woman named Mazie Piccolo who has "congestive heart failure, an abnormal heart rhythm, arthritis, osteoporosis, high cholesterol, high blood pressure, gastric reflux, and depression." For a doctor it is very hard to treat a person like this, so what they do is treat just the ailment the patient has come in for. Instead of looking at all of her conditions, they prescribe her medication for the one disease, but this pill could worsen the other conditions. Plus, with every doctor prescribing a medication for the one specific disease, there could be a deadly concoction placed in your body when taking them all. Doctors are not afforded the information needed to treat multiple condition patients because there are no studies done for these individuals. "A 2007 study found that 81 percent of the randomized trials published in the ,most prestigious medical journals excluded patients because of coexisting medical conditions." This means that when a doctor prescribes a medication they know it will fix that problem, but are unaware of how it will interact with coexisting problems. 

Personally, I feel that when a doctor treats a patient they should look at the patient as a whole and not a set of individual illnesses, but if they aren't afforded the tools to do so, I don't know how they can. Testing should be done because a majority of elderly have multiple conditions not just one. The problem with that is, testing a prescriptions effects on multiple conditions is very costly and it would be nearly impossible to account for the hundreds of possible combinations of illnesses out there. So I feel it is almost unrealistic, but companies should not exclude patients with coexisting medical conditions so they can see the different variables at work. Doing so may help give them an idea of different effects that may occur.

Prostate Screenings

The article I found this week online at New York Times was in more of a question and answer format, and I believe it was an interactive piece that people could post questions about and the author would answer them and that is why it is in this format. It is by Tara Parker-Pope and it discusses PSA testing, a blood test, as a means for testing for prostate cancer. I chose this topic because it relates to men, not so directly to myself because I won't have to worry about this test for another 20 some odd years and by then they will probably have new more accurate tests, but my dad is in his mid 40's and will be thinking about these tests sometime in the near future. 

There were two tests done, one in the U.S. and one in Europe, both coming to the conclusion that PSA testing can be very unnecessary. Prostate cancer is very slow developing, so even if you do get the cancer their is always the chance that you live a full healthy life before you feel any full effects of the cancer. Plus the blood test isn't completely effective, just because the test indicates that you have a heightened amount of PSA's in your blood stream does not indicate that you have or will have the cancer it just means that you have a higher risk. This screening is meant as a way to catch cancer before it happens, but if it comes back positive then you could undergo procedures that leave you "impotent and incontinent." The test shows that PSA screening is effective in detecting the cancer, but "finding those cancers early doesn't reduce your risk of dying from the disease." The worst part in my opinion is that they found many people received unnecessary treatment due to the screening, which means they probably became sterile from the treatment that they didn't even need to begin with. In conclusion, doctors say that even though the test shows that this screening is not necessarily accurate it doesn't mean people should not get the test because it is effective at finding the cancer. Instead, doctors say that you should still discuss it with your physician and make the decision yourself.

Doctor in Iraq

When we talked about Doctor Pryor in class, something that was never brought up but I was thinking about was the brothers comment on how he was still trying to find out what happened to his brother. The brother mentions trying to track down a fellow doctor on the internet who had posted about the incident online, but had no success. It almost seems as though the army is trying to cover it up, although I'm sure they only give the minimum information to all families, when an individual dies, and never give them the full facts. I found this part of the article interesting though because I see the family as being somewhat anti-war as well, because they did not want him to go back into the war plus Pryor himself showed feelings of antiwar when talking about the kids being in war. So, I still can't understand why they would dishonor his wishes of having a normal burial. It is possible that they are opting for an army memorial because they want to get rid of those anti-war feelings and believe he died for a purpose and it could also be that they want some clarity on how he died.

Sleeping

I work full time overnight at BJ's in Manahawkin. Working overnights means that I rarely sleep at a regular time, two nights a week I sleep regularly, 3 days a week i sleep between 8 am and 2pm, and 2 days a week I sleep from 5-10pm. So when I saw the title of this article "Distractions may shift, but sleep need don't" I thought I would check it out to see what I am doing to my body. 

It turns out that the article didn't answer this question for me directly, but I did find it interesting. This article, unlike any article I have read thus far, was geared less towards the medical information and more to the life of the author. She included a poem, quotes from peter pan, and her personal experience with putting her children to sleep. It turns out the average person, from adolescence through teenage years, requires about 9 hours of sleep per night. But as you get older it becomes more and more difficult to get to sleep at early hours. This is due to your bodies seratonin levels, which turn on later after puberty, meaning you don't get tired until later. I can only imagine how screwed up my circadian rhythm is  because I have no rhythm to my sleep patterns. I have always been a big fan of sleep to, I was never one for falling asleep in the middle of the night, I liked going to sleep relatively early. With the distractions of computer and televisions in kids rooms these days though, I am sure it is increasingly more difficult for children to sleep. When I become a parent my kids definitely won't have a TV in the room.

Day of Scholarship

On the day of scholarship I went to four sessions, but I'm only going to talk about 3. The first session I went to was "Police Suicide an Evolutionary Perspective," by far the most interesting session of the 4. In this session he applied the theory of suicide, hypothesized by Decatanazaro, to the suicides of police. Decatanazaro says that you will commit suicide if we are not reproductively successful in heterosexual relationships, or you perceive yourself to be a hinderance on the genetic success of your relatives. Christopher DeSantis the person speaking in the session explained that he found police have many marital problems as a result of their jobs. They have a high incidence of divorce and because of their status in society they have an us versus them mentality. They tend to abuse alcohol, which applies to the theory because it affects family relationships. Plus, their position requires to make split second decisions, which they can be scrutinized for, this also places a burden on the family because the name is now associated with the wrong decision. 

The second session I sat through was " Hip Hop and Identity: Examining African American Teens." I didn't find this to apply to our class or interesting, so I'm not going to write about it.

The third session was "Encouraging Communication in a course on Consciousness," which applied to our class because she talked about her class where she required her students to post, our class does this as well. She started by giving a little background on the psychology course she teaches. Also, she described two problems she has in her class, everyone comes from different majors, and only 2 or 3 people get involved in class discussions consistently. For her class she decided to give them online homework, requiring 2 posts per week on a set of questions she posted, and 3 entries per week for journals on their own lives. I think she felt this would increase class discussion, but it didn't turn out that way. In the end of the semester she took an anonymous poll in class to see why there wasn't as much class discussion as she had hoped.  People were dissatisfied with limited topics and felt journal entries were to much and uncomfortable to write. This semester she made journal entries optional and added more topics. So far there has been more class discussion, but she doesn't attribute it to the changes. She feels it just has to do with the group of students this semester.

The last session I sat through was about the Institutional Review Board, "Its Role and Function." This pertained to me because I plan on getting my doctorates and will have to do studies that they will be approving. Their main objective is to protect the rights of the subjects you will be using for testing, and to promote research investigations designed to develop or contribute to knowledge populations. The speaker went through the different parts of the proposal, emphasizing that the goal of the researcher is to maximize the possibility of compensation, while minimizing the risk. How much risk and benefit are involved in the study play a major role in the approval of the proposal. 

Free Antibiotics

It has been an abnormally busy past week for me so I am just getting to my posts now, I apologize for the tardiness. 

In the article "Free Antibiotics May Contribute to Drug Resistance" by Tara Parker-Pope, she brings up the recent country wide pharmacy give-aways of antibiotics. This has doctors worried that bacteria will become resistant to the drugs if people continue to take them to solve every health issue they encounter. We have all heard that bacteria evolve quickly and develop resistances. For example, anti-bacterial soap and agent which many bacteria have become resistant to. Another example is Mersa the staff infection bacteria that is drug resistant. Therefore, this issue can be very serious because we want to be able to take medication that works. If we continue to take antibiotic anytime we get the sniffles than eventually our antibiotics will be obsolete. Plus, antibiotic should not be taken for colds and flus because they are viral not bacterial, but free medication is to tempting, so people take the antibiotics to fix their virus. People must be careful with there drug use or it will affect their health for the future.

After Abuse, Changes in the Brain

It is a well known fact that children who are abused have a higher "risk of developing mental problems later in life."(1) This is the basis of the information presented in the article written by Carey Benedict in this weeks health section of the New York Times. In the past 10 years researchers have been running tests on animals showing that affectionate mothering allows the offspring to respond better to stress. The affection shown by the mother actually has the affect of altering genes in the child making it better suited for stressful situations, and this child then passes that trait on to the following generation. They have now found these same results in the brains of humans. By studying the brains of "12 people who committed suicide and who had difficult childhoods" and "12 people who had committed suicide and who had not suffered abuse or neglect as children." (1) In the brains of the 12 abused they found genetic alterations which suggest that they are more "biologically sensitive to stress." (1) They had 40 percent less of the receptors needed to clear cortisol, the hormone that circulates through the body when stressed. 

This study is very interesting. I never thought that abuse would actually affect your genes, but finding this out is a really good advancement in medicine. If they can pinpoint this genetic malfunction in people they may be able to prevent a lot of suicides. I think it should also be an eye opener to the parents, as well. Because when you abuse your kids this study proves it has a much more permanent affect than they think.

Randy Pausch

After watching Randy Pausch give his last lecture and reading part of his book, I found myself contemplating how I would handle the same situation. All in all I feel that he handled it pretty well. He is right that his children are to young to remember him for the rest of their lives, and if I were him I would want my children to have something to remember me by. In my opinion there is no better way to be remembered than to have a book published. Now his kids have something to read whenever they want. When they have a rough day and need some encouraging words from their father they can open the book and find comfort. As far as the last lecture video goes, now the kids have more than just a picture to look at to remember what their dad looks like, they get to see their dad in motion doing what they love. 

The book was definitely a good memento for his children, the video was also a good memento, but I think that was more of a personal thing for him (one of his "head fakes"). Human nature is to want to be remembered, wanting to leave a legacy and to be remembered for all their accomplishments. The last lecture itself was a catering to these human needs. Yes it was a message to his kids to chase their dreams no matter how unlikely they may seem, but it was as much for him as it was for them.

Vitamins

In the article "Vitamin Pills: A False Hope?" by Tara Parker-Pope brings to light three resent studies, which have all shown no benefit from taking high doses of vitamins. Studies have even shown that excessive amount of certain vitamins can be harmful. For instance, higher lung cancer rate with high doses of beta carotene, and a 5% higher rate of mortality in antioxidant users in a study of 181,000 participants. They suggest the problem is that it is not the specific vitamins in our fruits and vegetables that make them beneficial, it is the combination of the entire food. Next on the agenda for study are whole food extracts. In this article some doctors say they can't understand why despite the evidence that vitamins don't prevent diseases so many people take them. 

I find this article to be very interesting because I am a vitamin user. Although, they say vitamins present not benefit, when I take them I feel more energized and healthier, but I take vitamin B's which weren't focused on in this article. I have a few problem with the studies mentioned because there is not enough information, there are a lot of outside factors that could effect all these tests like a persons diet and exercise levels. I feel that if you are a person who engages in vigorous activity and uses your supply of nutrients than vitamins are important to help replenish those nutrients, there is only so much time in the day to eat. People continue to buy the vitamins because taking them can't hurt. Even though studies show in some cases to much of a good thing can be bad, these aren't high percentages. Plus, they say we receive just enough nutrients from a well balanced diet, but in the hustle and bustle of the times many people are eating fast food and not getting that balanced diet they prescribe. So why not take vitamins?

The Man Who Mistook his wife for Hat

I found this whole story to be very interesting and I think a lot of it had to do with the person Dr. P was. Despite the fact that he was unable to see the whole of an object he still remained very artistic and highly skilled in song. It is fascinating that when one part of the brain fails the rest of it functions without a hitch. As for the narrator of the story, if I were him I would have done more for the man. Maybe have tried to find the route of his problem and fix it. I feel that the transformation his artwork took shows that whatever condition he had it was gradual so that might lead to an explanation. He could rule out a recent blunt trauma because of that. At the same time that I feel he should have followed and solved the case, I also see why he made his decision not to. Dr. P didn't actually feel that he had a problem, to the question "What seems to be the matter?" Dr. P said "nothing that I know of, but people seem to think there's something wrong with my eyes." And to the next question of "But you don't recognise any visual problems?" He replied "No, not directly, but I occasionally make mistakes." Dr. P's condition was not really affecting his life. His life was art and music, which his condition wasn't affecting at all. If the narrator did stay on the case and find a tumor or something else that needed to be removed, that may have affected his artistic and then it would have had an affect on his life. Dr. P was not hindered by his condition in any way so there was no need to correct it. 

Robert Coles, Randy Testa, Joseph O'donnell, Penny Armstrong, and M. Brownell Anderson (2002). A Life in Medicine. New York, New York. The New Press 

Diet the natural way

In the article I just read it was the title that first caught my eye. "Natural diet pills laced with drugs," so automatically i thought hardcore drugs, but that was not the case. Despite my disappointment, I was still appalled by the fact so many diet pills have been falsifying their ingredients. The article focuses primarily on the diet pill starcaps which has been on the market for over 2 years. It contains the drug bumetanide, which is a "potent diuretic" and also is used to mask steroid use. A few professional football players have filed a lawsuit against them because taking the diet pill caused them to fail drug tests, which test for bumetadine. 

 Personally, I have never felt that diet pills actually worked other than as a placebo to make people feel they are getting thinner. For many people controlling their weight is very difficult and they feel, hey why not try the diet pill and see if it works, so it is messed up that they are persuading people to put unapproved substances into their bodies. An event like this also makes you question the ingredients of other over the counter supplements you are purchasing at your local GNC. All these diet pills guarantee results and seduce you with advertisements, robbing you of your money and health. I think it is criminal. At this point, the article says the FDA has little control over what is put on the shelves because they aren't allowed to test it until it actually reaches the shelf. A scary thought considering I thought the FDA was trying to protect us, but they are kept in the dark until it is unveiled to the public. The only real way for the FDA to do its job is to test it before it hits the sales floor. Plus, it is up to the company to make the recall if the FDA discovers it is hazardous. This current law needs to be revised immediately, so every person trying to make an easy buck isn't allowed to put frauds on the market.

Sorry

Okay, I just looked at the class website and realized I missed an assignment. Although it is late, which I apologize for, I am doing it now.

First off, I can relate with the "Should Johnny Play Linebacker?" article because I have fallen victim to head trauma multiple times in my life. I was a football player, but only sustained one head injury and it was minor. I can relate to the players playing through their injury though, you never want to be taken out of the game. Plus, others will say your faking it or you could have played through it. So if you can stand it you play through it thats just the way it is. There is always some one trying to take your spot and you can't allow that to happen. Anyway, the sport where I had frequent concussions was dirt bike racing. I have been racing dirt bikes since I was 8 and have had 2 concussions where I can't remember the whole day, and about 3 or 4 others that weren't as bad. The weird part about concussions is they don't always affect you right away. In on incidence I got up from the crash (with help from some others), started my bike and went back to my trailer. After that the rest of the day is a blank and my parents said I couldn't remember what day it was or where I was at. The only thing I can hope for now is that my future doesn't hold a quick onset of Alzheimer's. I guess only time will tell.

In the article "What your loneliness is telling you" the author addresses how being lonely can effect your health. I feel that this is 100% true because when I was younger there were times when I felt lonely, and there wasn't a worse feeling. Especially since when your lonely all you do is wallow in your own loneliness. I believe that our current society lends itself to a lonelier existence just as the author suggests. People have phones glued to their head or are on the computer clicking away to someone they have never even met before. All person to person contact is gradually diminishing. I myself have never been technologically inclined, and am rarely on the internet, which is why this assignment is late. I have always been a person that likes to be in the presence of others, its a warming feeling that you don't get from a computer screen. All in all, the mind is a powerful tool, so when you are lonely which has a large psychological aspect, than it is going to effect your body.

"The state of the STD" article shows that STDs are on the rise, which could be as the article suggests because of more testing being done. Although, I do believe that is a factor I have a different theory. Telling someone you have a STD is no more comfortable than it used to be and it never will be, so many times those who know aren't going to share the information with a one night stand that they will never get to see again when their primal instincts are running the show. Plus, many diseases don't show symptoms right away so some don't even know. Moreover, there is the fact that getting tested is scary especially for men, no one wants to know even if they think they have it because they would rather deny the facts. Now that I have stated those points I get to my reason for the increase, the pill. More and more women are getting on the pill because of its obvious benefits, but the pill means no condom and no protection from disease. One plus of the pill is that before getting the pill women are tested, so they know they are not infected. But the problem is the afore mentioned men who never get tested. In this day and age we are plenty savvy when it comes to preventing contraception, but when it comes to disease we'd rather have a heightened stimulation than a latex Jimmy Hat.

2-3-09

In this article by Amanda Schaffer she addresses a new finding in the medical world. They have found that mother's cells transfer to their fetuses, specifically affecting the immune system in the fetus. "The mother's cells slip across the placenta, enter the fetus's body and teach it to treat these cells as its own." The mothers cells are helping the fetuses cells learn so that they understand how to distinguish between outside threats and itself. They have found high levels of T-cells in the lymph nodes of fetuses suggesting that they turn off the immune system so it does not attack the fetus as if it is a foreign invader. Researchers believe this explains why when a mother is a donor to her child the body rarely rejects it, so this could be very helpful in transplants. As of now when a patient receives a transplant they have to take drugs to suppress their immune systems, but if they could utilize this new information of natural maternal suppressants patients may no longer have to become dependent on drugs. This also sheds light on the transmission of infectious diseases to infants; the suppressants could be the reason that there are not very high incidences of infection transmission. This new discovery raises many interesting questions and possibilities.

Although, it is sad that they made this discovery by studying aborted fetuses, it rises so many new possibilities for the future. Who knows, as they learn more and more about the transmission of cells, they may be able to prevent infections for newborns, and maybe even use the information to cure some diseases. I'm not to sure what is actually defined as stem cell research, but I believe this borders on it, and it is an issue I'm not sure where i stand on, but the benefits are clear and it is great to see that a negative can be such a positive. 

1/27- nytimes

The article I have chosen for this week is entitled "Another Potential Benefit of Cutting Calories: Better Memory." A recently published study shows that caloric intake could very well have a direct effect on retention of information. In this study they had three groups of people, those that cut calories by thirty percent, those that ate healthy fats, and those that made no changes what-so-ever. After three months of following their respective diets they took tests that involved memorizing words, and in this test the low caloric intake group soared above the rest, making on average a 20 percent improvement. The scientists found these results very intriguing due to the high statistical differences. Although these results are not concrete evidence of improved memory, it is just more benefit to a lowered caloric intake. I found this information to be very interesting because I am very interested in fitness and nutrition. Secondly, in college it is important to call upon your retention skills on a day to day basis, and if there is a healthy alternative that works it would be noteworthy. 

Illness narratives: fact or fiction?

First off, I found this essay to be confusing and hard to follow.

In this paper the author begins by explaining the importance of medical narrative in the past, how that was stifled, and how it has found rapid growth in the present, now being seen for its value in the sociological and anthropological sense.  In this writing the author breaks medical narrative down into multiple descriptions " `contingent narratives' which address beliefs about the origins of disease, the proximate causes of an illness episode, and the immediate effects of illness on everyday life; `moral narratives' that provide accounts of (and help to constitute) changes between the person, the illness and social identity, and which help to (re) establish the moral status of the individual or help maintain social distance; and `core narratives' that reveal connections between the lay person's experiences and deeper cultural levels of meaning attached to suffering and illness." He then discusses how these definitions have arisen and each narratives purpose in the life of the patient with the illness. Medical narrative serves many purposes in the life of the terminally ill. They use narrative as a way to explain how they contracted their illness, or what caused their illness, and then use it to explain to others, and verify to themselves. Also, it serves as a description of themselves, because their illness then becomes a part of them, it can also be used as an excuse as to why they are unable to do what they used to do, or makes them seem more heroic when they are still able to do it. Lastly, in the end they attempt to change the story righting past wrongs and trying to improve themselves, so any stories told of them in the future will carry a positive connotation. 

I feel that this paper did well exploring the multiple uses of medical narrative and properly allocating stories to represent their explanations. 

The definition I have drawn from this is, a story cultivated by the sick to explain their condition, glorify their current existence through struggle, and personally define the "self."

The Clash of Meanings: Medical Narrative and Biographical Story at Life's End

This article is concerned with whether or not it is right to artificially preserve a declining life. Back before medical technology was exponentially advanced, when a persons health declined death was almost always inevitable, and you cherished the final moments together, recounting the joyous memories, and paying your respects to your loved one. With medical technology so advanced these days the final days of a persons life are turned into months or even years, where family members are forced to grapple with wether they are making the right decision, plagued with doubt. We have come to a point where we can preserve the physical being, when the soul is long past ready to embark to the heavens. This is a difficult situation for all sides though, because physicians are there to preserve life, and can only offer uncertainties instead of concrete answers. Families don't know what to do with those uncertainties, will they get better, should we at least give them a chance to get better, how can we preserve such a miserable existence it is immoral, is it even an existence being in such a terrible state? And they are forced to make these decision without knowing what their loved one truly wants because they are no longer of sound mind. 

In this article the author takes the stand that "end of life care without technologies for life prolongation will produce a 'dignified' and 'meaningful' death." The author uses medical narrative, citing 2 specific stories, to illustrate the confusion modern day technology has placed on those final days of life. In both cases the patients have lost mental functions and physical functions due to stroke, and the families are put in the representative position of the loved one.

Both stories tug at the heart strings and demonstrate the technologies used to preserve life.

The author gives their own definition of medical narrative, I use the term narrative in a well-recognized sense, meaning accounts from individuals that portray their subjective experience, including a sense of intention, explanation, and emotion. Social scientists have borrowed the concept of narrative from the traditional humanities and view it as an expansive tool through which to articulate how individuals construct meaning and negotiate their worlds."

"Television Drama and Popular Film as Medical Narrative

The author of this article takes a clear stand on the issue of Television Dramas and their effect on society. A position which is clear in the closing paragraph. "Medical narrative in the form of television drama and popular film provides health care decision-makers with an important avenue for moral learning. The visual element of this narrative form enhances the perception of particulars and engages the viewer emotionally as well as cognitively. Moreover, aesthetic distance in the experience of medical drama permits emotional identification accompanied by critical reflection so that medical decision-making for oneself and one's loved ones may become better informed by a consideration of alternative choices and their consequences within the institutional setting."

If I had to describe this article I would describe it as a persuasive, the author takes a position and provides reasons for it, and also takes opposing remarks and refutes them. The author looks at the positive side of medical narrative through television, glorifying it for its informative value to the public. It allows the viewer to visually and emotionally immerse themselves in a fictional situation that may be valid to their life, or could be valid in the future. Although, they get emotional involved in the stories of the show, they aren't actually attached to that situation, and looking at it from an outside perspective can make a more informed decision. In real life situations our emotions take control of us and cloud our decision making processes, but seeing it on T.V. we can make more logical decisions and apply those decisions in the future. The author also promotes the fact that medical dramas promote awareness and can stimulate conversation and preparation among families so they are not dumbfounded by a medical decision in their life. The author advocates televisions depiction of medical narrative as a valuable educational tool in all aspects. Stating, "By providing viewers with accurate information concerning various treatment options and their consequences, important advances may be made toward the empowerment of patients and surrogate decision makers."

After reading this article I believe the definition of medical narrative i can draw from it is, an informative story which evokes emotion, and brings awareness to the reader/viewer through thought stimulation.

1/20 "Science Times"- Mono

The title of the article is "Students Still Getting Mono After All These Years."

I chose this article because over the weekend I went to U of Penn to visit my friend Pete for his birthday and he explained to me that his mother and younger brother both had mono. So I thought it would be interesting to brush up on some facts about the disease, because although I have heard of many people having it I really no nothing about it except how it is contracted.

The main focus in this article is how little consideration the Epstein-Barr virus, "mono", is given in the medical world. Some doctors are concerned that it is not given enough attention, due to the fact that the disease has become "trivialized." There is only so much money out there for medical research and mono is put at the back of the line. It's symptoms include "severe fatigue, fever, sore throats, swollen glands and enlarged spleen." But for many people the virus lays dormant in your system for life never showing any symptoms, another reason why people feel it is not important to research. For some symptoms can be very painful though, and since there is no cure for the disease, your only option is to wait it out and endure the pain. The article features a 13 year old girl who had mono and suffered an inflamed abdomen, and the only thing she got for it was a steroid shot to reduce the inflammation, the rest was an agonizing waiting game. In 99.9 percent of cases patients get better though. Doctors such as Joseph Pagano feel that more research need to be done to develop a cure, but as of now the majority feel it's not important. 

Personally I feel that as the years progress mono will become more and more of an issue, and eventually it will be recognized for its seriousness and allocated funds. With drinking games such as beer pong, and the many card games, mono is no longer a chance encounter, it will eventually become a widespread epidemic.