Rethinking the history of peptic ulcer disease and its relevance for network epistemology

Dismissive medicine and gaslighting of patients by physicians - A bioethics lens

OBJECTIVES

This Discussion paper seeks to raise awareness of the phenomena of dismissive medicine (DM) and medical gaslighting (MG) and their underlying threats to principles of Bioethics. DM refers to mistreatment and negative patient-physician interactions. In most studies on DM, patients perceived physicians as invalidating their illness, as uniformed, as blaming and stigmatizing them, misunderstanding their condition, insensitive, rushing the visit, refusing to discuss pain, rude, and failing to maintain eye contact, listen, and to provide appropriate information about causes and treatments. A special case of DM is MG, referring to the experience of patients when their medical complaints and suffering are discounted, doubted, questioned, second guessed, or denied by physicians causing patients self-doubts. DM and MG may occur, at times, unintentionally Durbhakula and Fortin [1] and Fielding-Singh and Dmowska [2], resulting in severe ramifications. Surprisingly, existing reports focused on the clinical, economic, psychological, and emotional ramifications of DM and MG (Braeuninger-Weimer et al., 2019; Burke, 2019; Street et al., 2019; Merone et al., 2022; Claréus and Renström, 2019; Sheehan, 2020; Turan et al., 2019; Penner and Paul, 2017; Au et al., 2022; Dolezal, 2022; Shapiro and Hayburn, 2024; Fuss et al., 2024; Hunt, 2022) [3-15], rather than on the infringement of bioethics, which is the focus of this Discussion paper.

CONCLUSIONS

DM and MG not only cause patients to feel stigma, prejudice, shame, and blame, and develop fear of seeking clinical help but also, constitute infringements of beneficence, non-malfeasance, respect for patient right of autonomy, and distributive justice in patient care. This Discussion paper calls for more education about the implicit ethical aspects of these phenomena and policy modifications to efface DM and MG.

Epistemic humility meets virtual reality: teaching an old ideal with novel tools

The pace of scientific advancements in medicine, driven by artificial intelligence as much as by novel biotechnologies, demands an ever-faster update of professional knowledge from physicians and collaboration in interdisciplinary teams. At the same time, the increased heterogeneity of patients' lifeworlds in socially and culturally diverse societies requires healthcare professionals to consider diverging personal and cultural perspectives in their treatment recommendations. Both developments require conveying to students a professional virtue that can be summarised as epistemic humility-a teaching process which, we argue, can and should be supported by novel technologies. By embedding students in realistic scenarios, virtual reality can play a crucial role in teaching medical students a stance of epistemic humility. Such stance implies acknowledging the limitations of one's knowledge as well as taking individual patients' perspectives and experiences seriously. In this sense, epistemic humility can also provide a crucial step towards tackling epistemic injustice and biases in medicine. We discuss how teaching epistemic humility with virtual reality tools can succeed and suggest the development of novel teaching tools that make use of this technology to immersively enable moral growth. Our paper thereby contributes to the emerging field of digital bioethics, calls for more work in the area of experimental bioethics and informs ongoing debates on how medical ethics teaching can prepare future physicians for the challenges of tomorrow's practice of medicine.

Gaslighting of Inpatients-A threat to nursing care and a violation of relational autonomy

Background Medical gaslighting refers to the mistreatment that patients experience following interactions with clinicians when their medical complaints and suffering are discounted, doubted, questioned, second-guessed, or denied, resulting in self-doubts of patients and psychological ramifications. This research focuses on the ethical aspects of medical gaslighting among hospitalized patients by nurses.Research QuestionWhat are the nursing care and nursing ethics perspectives concerning medical gaslighting? Research DesignA narrative review.Research MethodInterpretation of two narrative interviews with each participant through the lenses of nursing ethics.Participants14 hospitalized patients, males and females, ages 30-81, from the majority group in the population.ContextLengthy hospitalizations.Ethical considerationsEthical approval was granted; all participants signed an informed consent form for participation and publication.FindingsPatient experiences demonstrate medical gaslighting by nurses, violating relational autonomy and resulting in delayed care.DiscussionMedical gaslighting contradicts ethics of care, the professional values of nursing, and patient-centered care constituting obstacles to respectful patient-nurse relationships and to relational autonomy.ConclusionsMedical gaslighting is a profoundly concerning ethical phenomenon that adversely affects patient well-being and trust in nursing as a significant profession in a just society.

Toward an understanding of collective intellectual humility

The study of intellectual humility (IH), which is gaining increasing interest among cognitive scientists, has been dominated by a focus on individuals. We propose that IH operates at the collective level as the tendency of a collective's members to attend to each other's intellectual limitations and the limitations of their collective cognitive efforts. Given people's propensity to better recognize others' limitations than their own, IH may be more readily achievable in collectives than individuals. We describe the socio-cognitive dynamics that can interfere with collective IH and offer the solution of building intellectually humbling environments that create a culture of IH that can outlast the given membership of a collective. We conclude with promising research directions.

The Role of Probiotics in the Eradication of Helicobacter pylori and Overall Impact on Management of Peptic Ulcer: A Study Involving Patients Undergoing Triple Therapy in Bangladesh

Background Helicobacter pylori infection has been identified to cause constantly recurring inflammation, leading to gastrointestinal tract disorders, including carcinoma. The standard triple therapy (STT), used to eradicate H. pylori, includes two antimicrobials and a proton pump inhibitor for two weeks. Other drug regimens have also been developed since H. pylori exhibits antimicrobial resistance. These regimens, including probiotics, have been shown to lower adverse drug reactions (ADR), improve drug adherence, exert bacteriostatic effect, and reduce inflammation. Objective This study intended to explore probiotic intervention for improving eradication rates and mitigating adverse effects while administrating STT.  Methods This prospective study was conducted from May to December, 2021, in the Department of Gastroenterology of Ship International Hospital, Dhaka, Bangladesh, to observe the effects of probiotics inclusion along with STT on H. pylori eradication. A total of 100 patients aged ≥18 years who tested positive for H. pylori were included. The experimental group (n=50) was given STT and probiotics, and the control group (n=50) was given only STT without probiotics for 14 days. Necessary follow-up was done six weeks after treatment. An independent sample t-test, chi-square test, and multiple regression analysis were used for statistical analysis. Result The odds of getting rapid urease test (RUT) negative results from positive were 2.06 times higher (95%CI= 0.95, 3.22, p=0.054) in the experimental group. ADRs were crucially towering in the control group (p=0.045) compared to the probiotics group. The probiotics group had a lower risk of having adverse effects by 0.54 times (95%CI=0.19, 0.84, p=0.032) than the control group. Conclusion Using probiotics and STT together to eradicate H. pylori may lower ADR and improve treatment adherence. It may also help terminate H. pylori infection more effectively. More research is required as H. pylori is very contagious and can ultimately cause life-threatening gastric cancer.

Medical Gaslighting and Lyme Disease: The Patient Experience

Even though there are approximately half a million new cases of Lyme disease in the US annually, according to the CDC, it is often undiagnosed or misdiagnosed, which can result in a chronic, multisystemic condition. Lyme disease is a recognized public health threat and is a designated "notifiable disease". As such, Lyme disease is mandated to be reported by the CDC. Despite this, both acute and chronic Lyme disease (CLD) have been relegated to the category of "contested illnesses", which can lead to medical gaslighting. By analyzing results from an online survey of respondents with Lyme disease (n = 986), we elucidate the lived experiences of people who have been pushed to the margins of the medical system by having their symptoms attributed to mental illness, anxiety, stress, and aging. Further, respondents have had their blood tests and erythema migrans (EM) rashes discounted and were told that CLD simply does not exist. As a result, a series of fruitless consultations often result in the delay of a correct diagnosis, which has deleterious consequences. This is the first study that addresses an extensive range of gaslighting techniques experienced by this patient population.

Efficacy of emotion regulation training on pain intensity and life quality in patients with peptic ulcer disease (PUD)

Aim

Because gastric ulcer is a psychosomatic disease involving many psychological factors like assertiveness and cognitive beliefs, this study aimed to investigate the effectiveness of emotion regulation training on pain intensity and quality of life in patients with peptic ulcer disease.

Background

Gastric ulcer, a recurrent and common disease worldwide, is associated with gastrointestinal symptoms and lower health-related quality of life. Psychological factors and stress have been recognized as important contributors to the onset and duration of gastric ulcer, highlighting the need for effective psychological interventions to improve pain intensity and quality of life in patients.

Methods

The research method was semi-experimental and based on the pretest-posttest control group design, with follow-up after three months. The sample included 46 participants selected by a Purposive Sampling method and placed randomly in the experimental and control groups. At first, simultaneously, and under the same conditions, all the participants responded to the Chronic Pain Grade Questionnaire (CPG) and Quality of Life Questionnaire (SF-12). The emotion regulation training was performed on the experimental group. In the end, both groups were evaluated by posttests, and then they were tracked after three months. To analyze data, the ANCOVA test was applied through SPSS 22.

Results

Findings showed that emotion regulation training was meaningfully effective in decreasing pain intensity and increasing life quality (p<0.01), but after three months interval, no significant changes were found in the results.

Conclusion

Due to the results about emotion regulation training protocol that has successfully reduced pain intensity symptoms in PUD patients and increased life quality, it is suggested that this protocol can be added to other treatments for PUD patients.