disembodied

No abstract

there cannot be treatment without judgement

No abstract

The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol

Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications.Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes.Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description.Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future.

Medical Commentary on Pheby, J. (2020). a rare ecstatic rawness EJPCH 8 (3) 406-408

No abstract

a rare ecstatic rawness

No abstract

Personhood and Disorders of Consciousness: Finding Room in Person-Centered Healthcare

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement.

Medical Commentary on Pheby, J. (2020). there is nothing wrong with you. EJPCH 8 (3) 410-412

No abstract

there is nothing wrong with you

No abstract

Psychiatry, power and the person

Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one’s own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.