scholarly journals The downgrading of pain sufferers’ credibility

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Mar Rosàs Tosas
Keyword(s):  
Chronic Pain ◽  
Medical Care ◽  
Tissue Damage ◽  
Medical Humanities ◽  
Healthcare Professionals ◽  
Epistemic Injustice ◽  
The West ◽  
Clinical Benefits ◽  
Widespread Belief ◽  
Epistemological Model

Abstract Background The evaluation of pain remains one of the most difficult challenges that healthcare practitioners face. Chronic pain appears to affect more than 35% of the population in the West, and indeed, pain is the most common reason patients seek medical care. Despite its ubiquity, studies in the last decades reveal that many patients feel their pain is dismissed by healthcare practitioners and that, as a result, they are denied proper medical care. Buchman, Ho, and Goldberg (J Bioethic Inq 14:31-42, 2017) point to this phenomenon as a form of “epistemic injustice”: an unfair and harmful downgrading of credibility affecting some individuals and groups, which prevents them from receiving appropriate and beneficial medical care. Methods By exploring the existing literature on this downgrading of patients’ credibility written by healthcare professionals and scholars in medical humanities, I identify and examine the reasons patients are often not believed about their pain and why healthcare is too-often unhelpful or hurtful to people presenting with chronic pain. I also explore to what extent it is possible to forge an alternative epistemological model. Results I suggest that most of the causes of this downgrading of patient’s credibility result from either the difficulty in communicating pain or the widespread belief that pathology is always the result of objective tissue damage. I examine whether pain has to be effectively communicated and have an objective cause in order for it to be deemed credible. In the end, I argue that in the case of pain, both communication and objectivity are highly problematic. Conclusions I conclude by suggesting that, although alternative epistemological models might be impossible to build, believing patients has both moral and clinical benefits, and this warrants further research.

Patient care and clinical trials in gynecological oncology: Implications of the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5564-5564
Author(s):  
Sara Nasser ◽  
Christina Fotopoulou ◽  
Murat Guktekin ◽  
Desislava Dimitrova ◽  
Philippe Morice ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Medical Care ◽  
Patient Care ◽  
Healthcare Professionals ◽  
Clinical Pathways ◽  
Trial Participation ◽  
Early Stage Disease ◽  
Gynecological Oncology ◽  
Cardiopulmonary Support ◽  
The Impact

5564 Background: This is a prospective international Survey to evaluate the impact of the COVID-19 Pandemic on the management of patients with gynecological malignancies from the multidisciplinary physicians' perspective, with particular focus on clincial infrastructures, and trial participation. Methods: The anonymous online survey consisted of 53 COVID-related questions. It was sent to all healthcare professionals in gynaecological oncology centres across Europe and the Pan-Arabian region from April 2020 to October 2020. All healthcare professionals treating women with gynecological cancers were able to participate in the survey. Results: A total of 243 answers were collected from 30 different countries. The majority (73%) of participants were gynecological oncologists from university hospitals(71%) with at least an Intensive care unit with cardiopulmonary support available at their institutions. Most institutions continued to perform elective surgeries only for oncological cases (98%). Patients had to wait on average 2 weeks longer for their surgery appointments compared to previous years(range 0-12 weeks). Cases that were prioritised for surgical intervention across all tumors (Ovarian, Endometrium, Cervical) were early stage disease (74%), primary situation (61%), and good ECOG status (63%). The radicality of surgery did not change in the majority of cases (78%) across all tumor types. During the pandemic, only 38% of clinicians stated they would start a new clinical trial. 45% stated the pandemic has negatively impacted the financial structure and support for clinical trials. 79% do not routinely screen patients included in trials for SARS CoV2. Overall, approx. 20% of clinicians did not feel well informed regarding clinical pathways for COVID-19 patients throughout the pandemic. The majority preferred regular updates and training via Webinars (75%), followed by tumorboards and interdisciplinary conferences (45%). 30% of clinicians stated that they are currently experiencing difficulties in providing adequate medical care due to staff shortage. Conclusions: Despite well-established guidelines for patient care and performing clinical trials in gynecological oncology, the COVID-19 pandemic has impacted clinical research, and financial structures. Longer waiting times for operative interventions, less support for clinical trials and concerns regarding provision of adequate medical care and triaging patients are very real. This survey underlines the necessity for building robust emergency algorithms tailored to gynecological oncology patients in the future.

The Chronic Pain Policy Coalition

2006 ◽  
Vol 88 (8) ◽  
pp. 279-279 ◽  
Author(s):  
Yvonne Fountain
Keyword(s):  
Chronic Pain ◽  
Acute Pain ◽  
Tissue Damage ◽  
Emotional Aspects ◽  
Unpleasant Experience

The Chronic Pain Policy Coalition (CPPC) parliamentary launch took place on 14 June 2006 at Portcullis House, Westminster. Pain is an unpleasant experience with both sensory and emotional aspects; there can be pain whether or not there is tissue damage. Acute pain has a short and relatively severe course whereas chronic pain is pain that persists for longer than three months or in diseases where pain is always present.

The case of Dr Masajiro Miyazaki: Japanese-Canadian healthcare in World War II

2020 ◽  
Vol 46 (2) ◽  
pp. 135-143
Author(s):  
Letitia B Johnson
Keyword(s):  
World War Ii ◽  
Medical Care ◽  
Healthcare Professionals ◽  
Medical Services ◽  
World War ◽  
The Government ◽  
Japanese Canadian ◽  
The Impact ◽  
Canadian Healthcare

The forcible relocation of Japanese-Canadians (Nikkei) during World War II has been widely examined; however, little scholarly attention has been paid to the impact of relocation on the medical services provided to, and by, the Nikkei. This article highlights the issue of providing sufficient medical care during forcible relocation and the experiences of one Nikkei physician, Dr Masajiro Miyazaki. His story illustrates both the limitations in the healthcare provided to the Nikkei community during relocation and the struggle for Nikkei medical professionals to continue their practice during the war. The agency of the Nikkei—who constantly balanced resistance and adaptation to oppressive conditions—comes to the forefront with this case study. Dr Miyazaki’s personal records of forcible relocation, as well as his published memoir, reveal aspects of the lived reality of one Nikkei physician who was not included in the government discourse, or in the dialogue among his fellow Nikkei physicians, such as inter-racial medical care. It is evident through this case that there was great diversity in the level of medical care which the Nikkei received during their relocation in Canada. Furthermore, Dr Masajiro Miyazaki’s story proves that healthcare professionals, from doctors to nurses’ aides who were both Nikkei and white, provided extraordinary medical services during the forcible relocation, despite significant constraints.

scholarly journals An evolutionary medicine perspective on pain and its disorders

2019 ◽  
Vol 374 (1785) ◽  
pp. 20190288 ◽  
Author(s):  
Randolph M. Nesse ◽  
Jay Schulkin
Keyword(s):  
Chronic Pain ◽  
Tissue Damage ◽  
Mental States ◽  
Preliminary Evidence ◽  
Evolutionary Medicine ◽  
Smoke Detector ◽  
Pain Mechanisms ◽  
Trade Offs ◽  
Pathological Pain ◽  
The Cost

Enormous progress in understanding the mechanisms that mediate pain can be augmented by an evolutionary medicine perspective on how the capacity for pain gives selective advantages, the trade-offs that shaped the mechanisms, and evolutionary explanations for the system's vulnerability to excessive and chronic pain. Syndromes of deficient pain document tragically the utility of pain to motivate escape from and avoidance of situations causing tissue damage. Much apparently excessive pain is actually normal because the cost of more pain is often vastly less than the cost of too little pain (the smoke detector principle). Vulnerability to pathological pain may be explained in part because natural selection has shaped mechanisms that respond adaptively to repeated tissue damage by decreasing the pain threshold and increasing pain salience. The other half of an evolutionary approach describes the phylogeny of pain mechanisms; the apparent independence of different kinds of pain is of special interest. Painful mental states such as anxiety, guilt and low mood may have evolved from physical pain precursors. Preliminary evidence for this is found in anatomic and genetic data. Such insights from evolutionary medicine may help in understanding vulnerability to chronic pain. This article is part of the Theo Murphy meeting issue ‘Evolution of mechanisms and behaviour important for pain’.

scholarly journals GABA RECEPTORS AND PAIN REGULATION

2012 ◽  
Author(s):  
Valerio Magnaghi ◽  
Marcella Motta
Keyword(s):  
Chronic Pain ◽  
Acute Pain ◽  
Tissue Damage ◽  
Gaba Receptors ◽  
International Association ◽  
Emotional Experience ◽  
The Body ◽  
Tissue Injuries ◽  
Pain Regulation

Pain is an adaptive sensation that normally appears as a warning, activated in response to a damage of the organism. Pain serves to protect the organism to further tissue injuries. The International Association for the Study of Pain (IASP) defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (see definition on the IASP homepage at www.iasp-pain.org). Pain can be generally divided into two categories, acute and chronic pain: acute pain is properly a sudden warning pain which signals that something is wrong in the body. If the cause is not removed acute pain may develop in chronic pain, which is persistent and debilitating.

Outcome of Transitioning Pediatric Patients with Sickle Cell Disease to Adult Programs.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3743-3743 ◽  
Author(s):  
Samir K. Ballas ◽  
Carlton Dampier
Keyword(s):  
Chronic Pain ◽  
Young Adults ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Medical Care ◽  
Sickle Cell ◽  
Adolescents And Young Adults ◽  
Cell Disease ◽  
Adult Care ◽  
Female Ratio

The transition of medical care of patients with sickle cell disease (SCD) from pediatric to adult providers represents a milestone in their lives. Major concerns among adolescents and young adults about transition include taking responsibility for self, making own decisions, cost of medical care, fear of suboptimal pain management, and reluctance to leave known providers. In this study we present our experience in the process of transition to adult care and its outcome over the last ten years. Adolescents and young adults were given information about the nature of medical care provided by adult internists and hematologists. The sickle cell programs available in the city were described. Moreover, site visits to the hospitals where adult care was to be provided were arranged. During these visits, adolescents and young adults had the chance to meet the hematologist and other potential providers and ask questions, visit the emergency room, the clinic, and the sickle day unit if applicable. Patients were empowered to choose the program to which they wished to be transitioned. During the last 10 years, 90 adolescents and young adults (See Table) with SCD (Sickle Cell Anemia [SS], Hemoglobin SC Disease, and Sickle Thalassemia [ST]) were transitioned to the adult sickle cell program of Thomas Jefferson University. Age of transition varied between 18 and 25 years. Eighteen patients (20%) died. Age at death was 24.9 ± 2.95 years and the male/female ratio was 10:8. Complications of sickle cell disease after transition included leg ulcers, stroke, avascular necrosis, anxiety, depression, and priapism. Nineteen patients (10 males, 9 females) were employed. Twenty-nine (32%) patients developed chronic pain syndrome and its sequelae. Many patients failed to achieve their childhood goals. The data show that a significant number of patients die within 10 years after transition. The quality of life of survivors is suboptimal and drifts into issues of chronic pain management in the adult environment. Identifying these issues may provide predictors that identify children at risk to have undesirable outcomes after transition. Aggressive management and refining the process of transition should improve the outcome after transition. Distribution of the Transitioned Patients SS SC ST Total Male 31 8 4 43 Female 34 8 5 47 Total 65 16 9 90

Yoga and Managed Care: A Cautionary Tale

2010 ◽  
Vol 20 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Bo Forbes
Keyword(s):  
Managed Care ◽  
Social Workers ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Cautionary Tale ◽  
The West ◽  
Yoga Therapy

As IAYT takes mindful steps toward Yoga therapy accreditation, it does so amidst a new healthcare climate in the West. Just a decade ago, most healthcare providers viewed Yoga as recreation or exercise rather than education or treatment. Now, many physicians, nurses, psychologists, social workers, and other healthcare professionals regard Yoga with open curiosity, if not respect. Some even practice Yoga themselves, or recommend group classes and private sessions to their patients and clients.

Analysis of medical care pathways in patients with chronic pain

2008 ◽  
Vol 1 ◽  
pp. 14-15
Author(s):  
A. Berghöfer ◽  
E. Schulte ◽  
H. Hagmeister ◽  
M. Schenk ◽  
A. Kopf ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Care ◽  
Care Pathways

scholarly journals Expectations and Perceptions of Healthcare Professionals for Robot Deployment in Hospital Environments During the COVID-19 Pandemic

2021 ◽  
Vol 8 ◽  
Author(s):  
Sergio D. Sierra Marín ◽  
Daniel Gomez-Vargas ◽  
Nathalia Céspedes ◽  
Marcela Múnera ◽  
Flavio Roberti ◽  
...  
Keyword(s):  
Medical Care ◽  
Positive Attitude ◽  
Healthcare Professionals ◽  
Medical Community ◽  
Positive Perception ◽  
Low Level ◽  
Design And Implementation ◽  
General Terms ◽  
Hospital Environments ◽  
Level Of Knowledge

Several challenges to guarantee medical care have been exposed during the current COVID-19 pandemic. Although the literature has shown some robotics applications to overcome the potential hazards and risks in hospital environments, the implementation of those developments is limited, and few studies measure the perception and the acceptance of clinicians. This work presents the design and implementation of several perception questionnaires to assess healthcare provider's level of acceptance and education toward robotics for COVID-19 control in clinic scenarios. Specifically, 41 healthcare professionals satisfactorily accomplished the surveys, exhibiting a low level of knowledge about robotics applications in this scenario. Likewise, the surveys revealed that the fear of being replaced by robots remains in the medical community. In the Colombian context, 82.9% of participants indicated a positive perception concerning the development and implementation of robotics in clinic environments. Finally, in general terms, the participants exhibited a positive attitude toward using robots and recommended them to be used in the current panorama.

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