The Cinema in the Teaching of Medicine: Palliative Care and Bioethics
FABRIC OF THE PATIENT-PHYSICIAN RELATIONSHIP , –56 (Earl E. Shelp ed.,. ); Edmund D. . PATCH ADAMS (Blue Wolf et al. ). You'll recall that Patch Adams is a real life physician who caused a stir by arguing that our healthcare system should not treat disease, but the patient. Patch. Free Essay: The movie Patch Adams, is based on a true story about a man named Hunter Medical Ethics Of The Doctor Patient Relationship.
Not as a Stranger by Stanley Kramer 5. Pressure Point by Hubert Cornfield 6. Whose Life Is It Anyway? The Interns by David Swift 9. Critical Care by Sidney Lumet The cinema is very good at reflecting the materialization, circumstances and individual and social context in which things happen and has proved to be a suitable medium for describing disease as an individual experience and as a social phenomenon, not just as a biological fact or an abstract nosological entity6. As regards the cinema as a teaching element, quite often we opt for using scenes selected from highly pedagogical films and encouraging the participants to see the whole film and other related films in their spare time.
Using a scene from a film that vividly represents a psychiatric disturbance allows us, for example, to avoid the ethical problems confidentiality, achieving permits for the patients to go out, etc.
The object of this approach is to improve lectures and classes with relevant discussions by reducing the time for viewing these films to a minimum.
A fondness for the cinema develops sensitivity capacity for observation and perceptioncreative ability association of ideas, reflections, new ways of thought and the expressive dimension exteriorization of feelings and emotionswhich can be highly significant for exercising medicine, particularly primary health care and thus make it possible to improve the doctor-patient relationship through the details seen. The cinema helps us find ways of interacting with patients which make it possible to learn how to respect autonomy enable them to make informed decisions about eventsdiscover the past as genesis of the present and see the utility of thinking critically in order to break with predetermined schemes.
It contributes towards making what is learned more significant in the sense that it helps to incorporate learned concepts to our own life experience. The cinema has constructed a great deal of fiction that develops around medical life in its whole dimension and we should be grateful for its interest in showing disability, the problems of terminal patients, daily life in hospitals, legal problems, etc. We should bear in mind that the cinema, however, is not a scientific treatise and its scripts are not always adapted to historical and scientific truth and it commits excesses, even in films that do not belong to pure science fiction1.
The scientific elements that appear in films are such with relation to the screenplay; hence it is not unusual for there to be exaggerations and falsehoods.
If it used as an educational tool, a profound analysis must be made of the treatment the film gives to the disease in question, assessing what is real and pointing out which are merely cinematographic devices. Jack MacKee William Hurt Figure 1head of a hospital service in San Francisco is diagnosed with laryngeal cancer and attended in his own hospital. Here he learns for himself that a patient needs a doctor who is not only an expert but who knows how to provide empathy and sympathy.
Lack of information causes a conspiracy of silence that can be damaging although it is presented as an act of love The conspiracy of silence is treated humorously in the film Good Bye, Lenin by Wolfgang Becker where a son who lives in East Berlin after the fall of the wall sets up a farce to make his mother, a very committed communist, with a serious disease, believe that nothing has changed so that her health will not deteriorate more.
It is possible to appreciate the complex situation experienced by patients in films such as Wit by Mike Nichols where the main character Vivian Bearing Emma Thompson Figure 2 faces advanced ovarian cancer with generalised metastasis. She is a highly intelligent English Literature teacher, whose speciality is John Dunne, a metaphysical poet with particular interest in death. With her perfectionist nature, great intellectual rigour and quest for the truth, during her last eight months she has to go through situations common to many patients such as the brusque revelation of her diagnosis or having to decide on her experimental treatment without being prepared for it The film is set in an American hospital where her problem is treated very lavishly from the scientific point of view, with an aggressive treatment, but with little involvement of the health workers in matters beyond her disease, with the exception of one of the nurses.
Vivian shows how she faces her disease, which follows a changing course in which she needs to have certain defensive strategies, such as humour, in order to keep going.
During this time she meditates on her life, dependence, the meaning of not being able to decide or control what is happening to her, and the similarity between the cold and distant behaviour that she had with her students and that of the hospital staff looking after her, and regrets it. She is struck by the lack of empathy of the hospital staff when informing her, asking her for her informed consent for tests and subjecting her to experimental treatment as well as the suffering that patients undergo owing to the long time they have to wait to know the results of their studies She realises how different it is to talk about death in the abstract in poetry and to talk about her life and her death.
The methods she used in the university to extract the truth in what she taught are now no use for achieving a good death. The film also portrays a general practitioner of the family who is elderly. Porto 12 says that the doctor-patient relationship arises and develops during the clinical examination, given its quality depends on the time and attention it devotes to the anamnesis, a task that no machine can perform with the efficiency of the interview.
The diagnostic decision goes beyond the sum of the different results of the complementary tests. The clinical method is characterized by its ability to see the patient as a whole, presenting sensitivity that no other method has. The general practitioner in question is a good example of the fact that the first pillar of research is the physical examination. However and probably because he valued the opinion of his patient that it was a simple throat infection, he ended up missing the cancer diagnosis by not requesting laboratory and imaging tests.
The valorization of scientific knowledge must be accompanied by the humanized reception of the patient, so that the medicine is effective. Patch Adams After attempting suicide, Hunter Adams Robin Williams admits voluntarily in a sanatorium and, while helping other inmates, discovers that he wishes to be a doctor. He started his undergraduate medical course applying unconventional methods to his patients. It also emphasizes the importance of listening to what the patient says and feels at that moment in which he is so vulnerable.
The doctor- elderly patient relationship is portrayed in an unusual way when Patch helps his roommate, Mitch Philip Seymour Hoffmanto persuade patient Aggie Kennedy Ellen Albertini Dow to eat. Thus, it demonstrates that the humanization in the care and in the reception of the elderly patient is essential tool to be successful in the treatment. Miranda 13in his article on the doctor- elderly patient relationship, argues that the complexity of the human being, the connection between reason and will, feelings and tendencies, their history, their projects and their families are what make the patients biopsychosocial beings.
The more the doctor knows and respects this reality, the better he interacts with his patient; in this case, the frail elderly. This posture is what makes Patch stand out from his colleagues. Requiem for a dream The actress Ellen Burstyn plays the middle-aged character Sara in a melancholy way that shows what the human being is capable to do to achieve their dreams.
The doctor is negligent and does not give attention to Sarah, who develops withdrawal syndrome. Even in the face of this situation, the professional continues to prescribe abusive and unnecessary amphetamines. Amphetamines are stimulants of the central nervous system that can generate euphoria, maintain vigilance, act as anorexigenics and increasing the autonomous activity of individuals.
They were synthesized in the laboratory, sinceto combat obesity, depression and nasal congestion. According to Muakad 14some are can act on the serotonergic system. This becomes clearly noticeable in scenes in which the character presents mood instability, anxiety, verbiage, chills, sweating and insomnia. The continuous use of amphetamine leads Sara to neuronal degeneration and amphetamine psychosis, and the character ends up having constant visual and auditory hallucinations. The doctor-patient relationship portrayed in the film is unacceptable.
There is no care or attention with the patient, establishing only a contract of interests money for illegal prescription between a middle-aged patient who idealizes a dream and a reckless doctor, making her totally dependent of the drug and leading to disastrous consequences.
His doctor and friend Marcello Marcello Ottolenghi quickly examines Gianni when he reports a left shoulder pain radiating to the side of the left upper limb, triggered by physical exertion. He makes the clinical diagnosis of stable angina, but does not request complementary tests, only prescribes medications and changes in lifestyle.
He also takes advantage of the meeting with Gianni, even if he is in this condition, to ask you for your favor: Luigi takes advantage of Gianni. In the relationship between the two, there is the bond of friendship, but the doctor acts irresponsibly, once he submits him to the situation of greater stress, for having to take care of one older woman alone and, in addition, underdiagnoses his health, making therapy difficult.
According to the Medical Code of Ethics, in practicing the profession, the physicians should, in obedience to the ethical principles guiding their activity, ensure and work for the perfect ethical performance of medicine and for the prestige and good reputation of the profession. The article 40 of the aforementioned Code also states: The physician is forbidden to take advantage of situations arising from the doctor-patient relationship to obtain physical, emotional, financial or any other advantage In this movie, the non-valorization of the clinical state presented by Gianni, the patient, and the lack of care and attention can be characterizes as medical negligence, in a situation that, essentially, should be the opposite: The inertia and passivity in front of the picture of angina become even more unpleasant when the doctor overcharges his friend by asking him such a favor.
During the evolution of the disease, among the facts portrayed, he forgets the phone number of the love of his life. The way the physician conducts his care, it is noteworthy the establishment of a relevant trust relationship.
To perform the diagnosis he applies cognition tests involving dates, seasons and car models, with questions asked in a persistent, but gentle way. The person is not only a person, but a corporal person 17says Julian Marias, quoted by Miranda.
We are also our body and therefore we find ourselves limited in time and space. The temporal dimension of the human being is its central feature. Man struggles with time, tries to leave it behind, to be above it - the first way to try to overcome it is to keep memories of the past, and the second is to wish to convert the present into something permanent In this sense, the preservation of the autonomy for the health of the elderly, by stimulating the constant reconstruction of the memory, is of extreme importance.
According to a recent scientific Discovery, exercising can contribute to a brain that resists better to the phisycal shrinkage, in addition to stimulating cognitive flexibility. Shi Mija Jeong-hie Yuna year-old lady, lives in the countryside of South Korea, where she raises her teenage grandson. On a visit to the doctor, she complains of tingling in her right arm and of constant forgetfulness.
The doctor prescribes light exercises for the muscles and requests tests. In addition to completing her pension working as a caretaker of a middle class gentleman who had suffered a stroke, she enrolls in a course of poetry and goes on to attend poetry reading and karaokes.
The doctor-elderly patient relationship in cinema: visions of care
These activities contribute to maintain a productive routine, essential for brain plasticity. Thus, in suggesting the practice of exercises for a year-old woman, the doctor contributed not only to increase her blood flow, but also to the appearance of new vessels and new brain cells 21providing a holistic improvement of the condition.
A positive attitude aids the healing process. A respect and reverence for death is better than treating death as a foe. Give of yourself and you will receive mountains in return. Sometimes the current standards need to be challenged. All patients can open up to you if given the correct prompt. Of course I enjoyed the movie. I would recommend that all medical students view it and embrace the aforementioned lessons. I would caution, however, that life as a medical student is not always as black and white as this movie might lead us to believe.
Patch Adams [Motion Picture]. Zimmerman, Don, editor; Shadyac ,Tom, et al. Directed by Tom Shadyac. Atlas of Human Anatomy. Novartis Pharmaceuticals Corp; This page has been accessed times since Dec.