Transformations in self-understanding in surgeons whose treatment efforts were not successful

Article Abstract:

A situation that surgeons must frequently encounter is failure and death, and the fact that often nothing may be done to help the patient. The development of defense mechanisms by surgeons, such as distancing and isolation, has been the subject of previous research. This study was proposed to assess the behavior of these surgeons in conjunction with dying patients. A group of 20 male surgeons were evaluated for their reactions to treatment failures. Reports regarding their surgeons were collected from patients whose surgery was not successful and who were expected to die soon. Forty patients participated; half were followed by the surgeon and the other half were not. Reactions of the surgeons were observed where the relationship was maintained; the doctors saw the patient on a monthly basis even after they were no longer involved in treatment. These reactions were compared with the doctor-patient relationships in which contact was not maintained, and where after the surgical treatment was finished, the patient was referred back to the original physician. Characteristics of the surgeons who did not maintain the relationship included a sense of isolation, a sense of guilt, development of denial, and a sense of meaningless in their work. On the whole, the doctors were unable to rid themselves of a sense of guilt and continued to feel uncomfortable about the situation. Feelings reported by the doctors where the relationship with the patient was continued included a strengthened sense of sharing and community, healing by forgiveness, self-acceptance and openness, and a sense of renewal or rebirth. In these relationship pairs, both the patient and doctor reported that an emotional healing process occurred; the patients were able to forgive the doctor for failing, and themselves for not being 'good' patients; likewise, the surgeons were able to forgive themselves for failing and to experience the patient's forgiveness. A new insight was achieved by the doctors and many reported that a kind of 'energy' was drawn from the experience. The positive effect that was achieved may be considered comparable to the effects of successful psychotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Terminal care, Death, Surgeons, Loss (Psychology)

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Long-term outcome of antidepressant treatment for bulimia nervosa

Article Abstract:

Bulimia nervosa is an eating disorder characterized by recurrent binge eating with a feeling of lack of control over the behavior. This is followed by self-induced vomiting, the abuse of laxatives, or strict dieting, along with persistent concern with body shape and weight. Over the past 10 years, there have been several studies of the treatment of bulimia with antidepressant medications; most have reported this treatment to be helpful. However, the long-term effects of such treatment have not been investigated. The present study was carried out in an attempt to replicate the finding that antidepressant medication is an effective treatment for bulimia nervosa and to assess the long-term effects of such treatment. Of 80 patients studied, 39 receive a placebo and 41 received 200 milligrams per day of the antidepressant desipramine. After three weeks (phase 1), patients whose binge-eating was still not under control were given 300 mg/day of desipramine or placebo. Patients who responded to desipramine were maintained on their dose for an additional 16 weeks (phase 2), after which, those who remained well were randomly assigned to six months of desipramine or placebo (phase 3). Patients saw a psychiatrist weekly for the duration of the study and kept a binge-eating diary that was used to measure outcome. In the first phase of treatment, desipramine was superior to placebo in bringing binge-eating under control. At the finish of the study, patients taking desipramine had a average decrease in binge-eating of 47 percent compared with a 7 percent increase in binging among those taking placebo. However, 29 percent of those treated with desipramine who were able to enter phase two relapsed within the 16-week period, and too few patients participated in phase three for the data to be analyzed. It is concluded that desipramine is an effective treatment for bulimia nervosa, but its long-term efficacy is questionable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Bulimia, Antidepressants, Desipramine

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Orphanages: an idea whose time has come again?

Article Abstract:

Orphanages have received a lot of attention as a feasible alternative to the existing system of long-term institutional care for children and the traditional view that the biological family unit should be preserved at all costs. It is common knowledge in the medical community that orphanages lost favor as an acceptable child care system after World War II due to studies asserting that mother-infant separation and institutional care were hampering child development. It is time to discard stereotypic perceptions and past experiences and reconsider orphanages as a child care option.

Editorial, Management, Child care, Institutional care, Foster home care, Orphans, Orphanages

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