In the 21st century world,people mostly behave with business mentality without considering moral obligations in society.In this behavioral change,the service market,particularly the medical care service market,has app...In the 21st century world,people mostly behave with business mentality without considering moral obligations in society.In this behavioral change,the service market,particularly the medical care service market,has appeared to be vulnerable.Because of supplying medical care services,the doctor or hospital receives capitation payments,fees-for-services,risk pool settlements,incentive payments or other fees.However,today it is probably the most criticized profession in world economy country-wise such as Bangladesh.Sometimes doctors here are blamed for requiring unnecessary tests of patients for doctors’own monetary gains.In some cases,doctors’efforts are assumed to relate to pharmaceutical products promotion by writing lengthy prescriptions.Some groups claim that today doctors spend less time on each patient.All these interactions justify claiming that a patient works for a doctor when the patient visits a doctor for medical care services.Here the existence of“asymmetric information”dominates the medical care market where doctor takes advantages in multiple facets.It causes market inefficiency that creates negative economic externalities-deadweight loss.Improving medical education with special emphasis on ethical aspects and soft skills in communication is considered important in order to reduce the magnitudes of today’s dilemma in the medical care service market.Also,strict enforcements of medical care provisions and ethical code of conduct among all health works can be instrumental.Finally,the answer to the question“Are medical care services becoming money-making machines under physicians’headship in the 21st century business-driven world?”depends on who are asked.But the reflections of today’s medical care market in economy of Bangladesh are no deniable,which deserves to be studied further curtailing the magnitudes of the problem.展开更多
BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases...BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury;2-inform Chief-of-Gastroenterology;and 3-immediately intervene to abort endoscopy to protect patient.Syndromic features require further study.展开更多
Making a pledge under oath has been used throughout history to affirm one's allegiance to a cause or code of conduct. Now the practice is being used in China to combat the rampant corruption sweeping the country.
The authors think that a geoethical approach to the geospheresociety relationship is necessary in the epoch in which we live.Geoscientists have to improve their awareness of the geoethical dimension and the importance...The authors think that a geoethical approach to the geospheresociety relationship is necessary in the epoch in which we live.Geoscientists have to improve their awareness of the geoethical dimension and the importance for sustainable development of their work in geosciences.The introduction of a Hippocratic-like oath for young geoscientists-“the geoethical promise”-could be a way for this purpose.A draft text is proposed for discussion.展开更多
文摘In the 21st century world,people mostly behave with business mentality without considering moral obligations in society.In this behavioral change,the service market,particularly the medical care service market,has appeared to be vulnerable.Because of supplying medical care services,the doctor or hospital receives capitation payments,fees-for-services,risk pool settlements,incentive payments or other fees.However,today it is probably the most criticized profession in world economy country-wise such as Bangladesh.Sometimes doctors here are blamed for requiring unnecessary tests of patients for doctors’own monetary gains.In some cases,doctors’efforts are assumed to relate to pharmaceutical products promotion by writing lengthy prescriptions.Some groups claim that today doctors spend less time on each patient.All these interactions justify claiming that a patient works for a doctor when the patient visits a doctor for medical care services.Here the existence of“asymmetric information”dominates the medical care market where doctor takes advantages in multiple facets.It causes market inefficiency that creates negative economic externalities-deadweight loss.Improving medical education with special emphasis on ethical aspects and soft skills in communication is considered important in order to reduce the magnitudes of today’s dilemma in the medical care service market.Also,strict enforcements of medical care provisions and ethical code of conduct among all health works can be instrumental.Finally,the answer to the question“Are medical care services becoming money-making machines under physicians’headship in the 21st century business-driven world?”depends on who are asked.But the reflections of today’s medical care market in economy of Bangladesh are no deniable,which deserves to be studied further curtailing the magnitudes of the problem.
文摘BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury;2-inform Chief-of-Gastroenterology;and 3-immediately intervene to abort endoscopy to protect patient.Syndromic features require further study.
文摘Making a pledge under oath has been used throughout history to affirm one's allegiance to a cause or code of conduct. Now the practice is being used in China to combat the rampant corruption sweeping the country.
文摘The authors think that a geoethical approach to the geospheresociety relationship is necessary in the epoch in which we live.Geoscientists have to improve their awareness of the geoethical dimension and the importance for sustainable development of their work in geosciences.The introduction of a Hippocratic-like oath for young geoscientists-“the geoethical promise”-could be a way for this purpose.A draft text is proposed for discussion.
