Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.

“Obligated to Keep Things Under Control”: Sociocultural Barriers to Seeking Mental Health Services Among Veterinary Medical Students

Research reveals veterinary medical students and professionals are at increased risk for mental health problems such as depression, anxiety, and suicidality, yet many individuals in distress do not seek professional mental health services. Although some barriers to accessing services have been identified, other factors, including how professional culture influences service underutilization, are poorly understood. In this study, we used a mixed-methods approach to investigate 573 veterinary students’ perceptions of barriers to seeking mental health services and potential mechanisms to lessen them. We identified four barrier themes: stigma, veterinary medical culture and identities, services, and personal factors. Participants’ suggestions for reducing barriers to seeking help related to three themes: culture, services, and programmatic factors. We compared perceptions of barriers based on the severity of participants’ self-reported symptoms of depression and anxiety and found that participants with severe depression, compared with participants with mild depression, were more likely to perceive barriers related to veterinary medical culture. The results of this study provide a deeper understanding of veterinary students’ barriers to seeking mental health services and, in particular, how these barriers, as both individual and sociocultural phenomena, are often interrelated and mutually reinforcing.

Persian Treatises on Āyurveda: The Shaping of a Genre

This article examines the translation of foreign materials into post-Abbasid Muslim medical culture by looking at the production of Persian works dealing with Ayurvedic medicine. From the 14th century onwards, the composition of Persian texts on Āyurveda emerged in South Asia as a new genre of writing, which was actually a composite genre including various kinds of texts. The Muslim physicians incorporate the other’s learning not by rejecting the principles of their receiving culture but rather by empirically applying the logic of their principles in understanding the foreign environment and the receiving culture. The composition of new texts on Āyurveda in Persian constitutes a prominent aspect of this engagement as well as a central element of the creation of a Persianised version of Ayurvedic treatment more likely to be circulated among Indian Muslim physicians. The Persian treatises apply new linguistic and cognitive categories to the analysis of the translated material; the interpretation based on the criteria of the receiving culture is added to, and sometimes replaces, the criteria of the source culture.

Empathy in patient care: from ‘Clinical Empathy’ to ‘Empathic Concern’

As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such as dehumanization and detached concern as well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate around cognitive empathy and affective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of ‘empathic concern’, a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301–311 engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners.

Treatments of Eye Diseases in Malay Medical Manuscript Ramuan Obat EAP153/9/4

The Malay medical manuscript Ramuan Obat EAP153/9/4 is a Malay medical manuscript from Riau Archipelago in today’s Indonesia. It appears to focus on eye diseases and treatments. This study aims to evaluate if the traditional medicines and interventions in the manuscript can be supported scientifically. Critical transliteration and data extraction were performed by applying philological method in identifying and categorising the diseases and interventions. The materia medica was analysed by comparing scientific reports presented in PubMed and Google Scholar, and matching each ingredient to the intended purpose as indicated in the manuscript. The manuscript contains both physical and spiritual interventions amounting to 28 formulations for 7 different types of eye disease. Half of the materia medica and their use in Ramuan Obat EAP153/9/4 could be supported by contemporary scientific evidence. The lack of contemporary scientific evidence for other materia medica, on the other hand, could be attributed to the lack of scientific research on them rather and not necessarily a deficiency in effectiveness. More scientific studies would need to be carried out to validate the safety and efficacy of formulations contained in Malay medical manuscripts as the content could potentially lead to new drug discovery. Apart from scientific gains, the study could also contribute to the preservation of Malay medical culture and heritage.

НАРОДНЫЕ ЗНАНИЯ СЕМЕЙСКИХ БУРЯТИИ О СИМПТОМАХ БОЛЕЗНЕЙ

Несмотря на достижения научной медицины, в ХХI веке этнографы продолжают фиксировать информацию об обращениях русских к знахарям. Современная традиционная народная культура демонстрирует востребованность у русского народа лечения магическими способами. Соответственно возникает вопрос, как люди определяют, к кому им нужно обратиться за помощью, к знахарю или к врачу? На какие признаки своего самочувствия они ориентируются? Симптомы болезней в данном этнологическом исследовании рассматриваются в качестве компонента традиционной народной культуры русских. Такой подход предпринят для того, чтобы сравнить народно-медицинскую культуру старообрядцев Бурятии (семейских) с другими традициями русских европейской части России в сфере знаний признаков болезней, излечиваемых знахарями. При сравнении выяснилось, что обнаруженные в 90-е годы ХХ века народные знания семейских о симптомах часто аналогичны общерусским, наблюдавшимся этнографами и врачами в конце ХIХ – начале ХХ веков. Известные старообрядцам Бурятии симптомы болезней по своей информативности бывают двух видов. Исходя из видовой принадлежности симптома, болезни, излечиваемые у семейских магией, подразделяются на две группы: физически явные и материально неощутимые. Изучение знаний о симптомах также показало разницу между традиционной народной культурой и научной медициной в родо-видовом соотношении болезней и в том, какие состояния считаются заболеваниями. Despite the achievements of scientific medicine, in the ХХI century Russians still recourse to healers according to the ethnographic data. Modern traditional folk culture demonstrates the popularity of treatment by magic among the Russians. This raises the question of how people decide whether they should turn to a healer or a doctor. What symptoms are they guided by? The present study considers symptoms of diseases as an element of the traditional Russian folk culture. This approach allows us to compare the folk medical culture of the Buryat old believers (Semeyskiye) with other traditions of Russians of the European part of Russia concerning the diseases cured by healers. It was found that the folk understanding of the symptoms among the Semeyskiye revealed in the 90-s of the XX century is often similar to general Russian knowledge observed by ethnographers and doctors in the end of the XIX century– beginning of the XX century. The symptoms and the diseases known to the old believers of Buryatia that can be cured by magic fall into two categories: physically obvious and materially imperceptible. The study revealed the difference between traditional folk culture and scientific medicine in type and variety of diseases and what conditions are considered diseases.

BECOMING A PHYSICIAN: A QUALITATIVE ANALYSIS OF MEDICAL STUDENTS’ PERSPECTIVES ON THEIR ACADEMIC ENVIRONMENT, WELL-BEING AND MENTAL HEALTH

Background: Medical students are a population at higher risk for psychological distress and mental health disorders when compared to the general population. Evidence-based interventions to promote well-being are available, but the rates of anxiety, burnout, depression, and suicide are not decreasing as expected. This scenario can lead to poor academic outcomes and lower assistance capability. Students are frequently targeted in interventions, but the academic environment itself is seldomly a target. Qualitative research is an insightful approach in deriving a deeper understanding of phenomena that are suitable to culture-sensitive interventions. Objective: To explore student’s perception of medical school and their understanding of which factors underly the path from well-being to impaired mental health. Methods: A qualitative exploratory study was performed. Focus groups and in-depth interviews were conducted, comprising students from all medical school years. Grounded theory was used to analyze data, and Consolidated Criteria for Reporting Qualitative Research were followed. Feedback from participants and through external supervision were conducted in ensuring saturation, reliability, and coherence. Results: Five main categories were identified: socioeconomic aspects, university environment (including culture, institutional functioning, and relationships), training issues, career demands, and mental health. Both personal and environmental factors were highlighted as contributors and stressors. Conclusion: A medical career appears to be related to a culture of omnipotence where excellence is frequently misconstrued as perfection. The complex relations between personal and environmental factors demand comprehensive strategies. Institutional rules could be adapted to avoid enhancing excessive competition. In some cases, individual assistance is needed. Inclusion of the academic community’s perspective and targeting the negative aspects of the medical culture seem essential to move forward in the field of mental health and person-centered learning.