5/14/2007
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Wolfberg wrote in the same journal last month, for years medical students performed pelvic examinations on anesthetized women who had not given consent because senior obstetricians said it was the best way to learn internal anatomy. A student recently told me he had examined a patient and concluded that she might have a severe abdominal disorder. Students and residents are now expected to provide routine feedback positive and negative about their supervising physicians at the close of their rotation. "What our study shows," he continued, "is that interventions even without a vaccine can be effective in blocking transmission. At a 1965 seminar on the future of higher education, the first vice-chancellor of Monash, J.A.L.
Better still, Niall knew him as a child. Biography, as Ian Donaldson showed in his essay 'Matters of Life and Death: The Return of Biography' (ABR, November 2006), is now a plastic, responsive, democratic and, yes, reputable art, capable of all sorts of liberties and latitude. By 1990 the now standard model of an Australian university had emerged: large, comprehensive, multi-campus and research-based. Canberra would decide how many Commonwealth-supported students could be enrolled at each university and what disciplines they were to study.
Carnegie Mellon offers American rather than Australian degrees. Dawkins announced that the Commonwealth would only support institutions with a minimum of 2000 full-time students. Dr Neville Buch, Christina Buckridge, Professor Simon Marginson, Professor Vin Massaro and Donald Speagle all provided helpful comments. During 2006 Minister Bishop has allowed institutions to begin this process, while Labor has proposed a formal mechanism, a negotiated compact between Canberra and each university, acknowledging different roles, missions and circumstances. Each soon resembled in basic organisation, courses offered and academic mission the original universities in Sydney and Melbourne.
Eventually, she became his research assistant on a biography of Archbishop Mannix. Financial pressures reinforced similarities across institutions. For foreign entrants, offering home-country credentials bypasses some of the more onerous accreditation procedures imposed by Australian governments. Free tertiary education would end, with students now subject to a Higher Education Contribution Scheme (HECS). From our starting point in 1966 until the start of the 1990s, the non-university tertiary sector supported an array of institutional types: colleges, institutes, conservatoria. Finding him there during life seemed illicit; peeking into his bedroom window. Finding him there after death seemed imperative. In our last meeting, before he stopped coming to appointments, he told me that he had joined the site to meet friends. Finding him there during life seemed illicit; peeking into his bedroom window.
Finding him there during life seemed illicit; peeking into his bedroom window. I typed his name into MySpace, feeling covert and slightly criminal. Nor, apparently, was that unseen self writing back.
By now, of course, the messages had no recipient, and the friends my patient had made were writing to one another. The unquestionably normal person, whose photograph still looked as though it were reading its e-mail messages from the opposite side of the Web page, had already fled to find peace, or reconciliation or relief, I don't know. This new division of labor established hierarchies. Last were the medical students, who spent the most time with patients but were most assuredly at the bottom of the heap. Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. Although this practice made many students uncomfortable, most were afraid to speak up. What should a medical student do in such a situation? One possibility is to take the matter up with a more senior doctor. Still, it will be hard to change the unfortunate perception that constructive feedback, even for a patient's benefit, is whistle-blowing. "What our study shows," he continued, "is that interventions even without a vaccine can be effective in blocking transmission.
What's much less certain is whether society is prepared to bear the costs of implementing such intrusive and costly measures for the months that would be required to manufacture a vaccine." I typed his name into MySpace, feeling covert and slightly criminal. On the opposite side of the screen, there were scrolls of e-mail messages that other MySpace members had sent him: friendly, uncapitalized, hallucination-free greetings.
They were an introduction to a man I had not properly known. The last dozen messages on the screen were exactly the same. I had gone on the site only a day after his death, but his cyberobituary must have traveled faster. On the top were the senior physicians who made rounds on the wards once or twice daily. Next were the overworked residents, who essentially lived in the hospital while training. On the opposite side of the screen, there were scrolls of e-mail messages that other MySpace members had sent him: friendly, uncapitalized, hallucination-free greetings. The last dozen messages on the screen were exactly the same. Modern medical education can be traced to a series of reforms that began in the late 19th century. One of the most notable occurred at the Johns Hopkins University School of Medicine, where educators initiated a formal system to train students on the clinical wards.
Finding him there after death seemed imperative. I typed his name into MySpace, feeling covert and slightly criminal. The messages had this in common: They were all written to a correspondent who led an unquestionably normal life.
But he had ignored his hallucinations long enough to write of a different yet equally true self here, and he had found friends who identified him not by psychiatric symptoms but by astrological sign. In this world, he was a Pisces, not a schizophrenic.
The last dozen messages on the screen were exactly the same. At the same time, professors at Johns Hopkins and elsewhere instituted early versions of modern residency training programs, in which residents newly minted doctors learned their profession on the wards from attending physicians and, in turn, taught students. This new division of labor established hierarchies. Next were the overworked residents, who essentially lived in the hospital while training. The resident was a good doctor, she said, and so she had given him the benefit of the doubt. The student admitted that he was far from positive that something was seriously wrong. After all, in each of these examples, patients are at risk of harm, something that physicians must avoid at all costs.
Fortunately, medical educators are increasingly recognizing the dilemmas that doctors in training confront when they witness behavior that makes them uncomfortable. Students and residents are now expected to provide routine feedback positive and negative about their supervising physicians at the close of their rotation. On the opposite side of the screen, there were scrolls of e-mail messages that other MySpace members had sent him: friendly, uncapitalized, hallucination-free greetings.
Some voiced hopes of meeting one day, some had comments about other correspondents on the site, some sent good wishes on relevant holidays. I had thought of him as struggling under the constant hold of hallucinations.
