Images of physicians in literature: medical Bildungsromans

Factors Influencing Physician Prognosis: A Scoping Review

Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician's personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research.

Highlights

Literature on discrepancies in physician's prognostication is heterogeneous and sparse.Literature shows that physicians are mostly pessimistic regarding patient outcomes.Literature shows that a physician's personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies.Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic.Physicians early in their training were more pessimist than more experienced physicians.

Shame-to-cynicism conversion in The Citadel and The House of God

This article considers the dynamics of shame and cynicism in A J Cronin's The Citadel (1937) and Samuel Shem's The House of God (1978). The protagonists of both novels are forced into shameful situations. Their response to these situations is increased cynicism. This results in a feedback loop: cynicism begets shame, which, in turn, causes more cynicism. Drawing on Bonnie Mann's work on shame-to-power conversion, the article suggests that the novels stage a shame-to-cynicism conversion, which anticipates possible links between cynicism and shame in medical education. The overwhelming success of both novels in shaping the popular imaginary of healthcare professionals means that this dynamic, far from being isolated to the novels, might speak to shared concerns in the education scholarship.

The Psychologica-Bildungsroman: Exploring Narrative Identity, Audience Effect and Genre in Autobiographies of Trainee-Psychologists

Applicants to training courses in professional psychology are routinely required to submit an autobiography or life story as part of the selection process. What we are curious about is when several autobiographies, despite each presenting their own idiosyncratic identity, share commonalities. Nine autobiographies of successful applicants to a training course in professional psychology were analysed using an experience centred approach to narrative analysis. Specific influence of audience effect, development of a narrative identity, and genre were focused on in the analysis. We conclude that narratives represent a specific form of the Bildungsroman as a coming-of-age into the profession of psychology and propose that autobiography as part of the selection process can be utilised effectively as a precursor to the training of professional psychologists.

Literature and medicine: a problem of assessment

BACKGROUND

"Literature and medicine" is increasingly common in medical schools but not within medical education research. This absence may relate to it not being problematizable in the quantitative way in which this psychometrically-oriented community tends to conceptualize research questions.

METHOD

Databases were searched using relevant keywords. Articles were evaluated using methodologies appropriate to their fields. The resulting information was structured around a framework of construct-appropriate assessment methods.

RESULTS

Literature and medicine is intended to develop skills as potential proxy outcomes for important constructs. Proposed tools to assess these skills are difficult to evaluate using the field's traditional quantitative framework. Methodologies derived from the qualitative tradition offer alternative assessment methods.

CONCLUSION

The medical education research community should take on the challenges presented by literature and medicine. Otherwise, we run the risk that the current evaluation system will prevent important constructs from being effectively taught and assessed.

Portrayal of negative qualities in a doctor as a potential teaching tool in medical ethics and humanism: Journey to the End of Night by Louis-Ferdinand Celine

Fictional stories about physicians and patients are increasingly used as a powerful teaching resource for medical students. Very often, but not exclusively, stories of physicians as positive role models are selected to teach students virtues and ethical values. Negative role models are rarely used and if so, physicians are rather described as medical quacks in such fiction then exhibiting primarily a corrupted character. I suggest that a fictional story that presents exclusively a negative role model of a physician could also be a valuable, admittedly difficult, teaching resource to demonstrate the consequences of absolute loss of ethical standards and virtues in physicians. A not widely known example of this genre is Louis-Ferdinand Céline's (1894-1961) novel Voyage au bout de la nuit (Journey to the End of the Night), published in 1932. Having a strong autobiographical background, the novel described the adventures of the medicine student, Ferdinand Bardamu, during the first world war, in the African colonies as a trader, in the United States of America as factory worker, and later after finishing his education, as a doctor for the poor. Unfortunately, Dr Bardamu develops an unprofessional, even criminal behaviour, and may serve as a negative role model for the virtues of physicians. This article will familiarise the reader with the novel and its physician author.

The House of God : another look

Since its publication in 1978, Samuel Shem's The House of God has sold over two million copies in over 50 countries. While it has remained popular among medical students, its value as a literary text to promote critical reflection on self and profession continues to be unrecognized in professional spheres. In spite of the ongoing conditions in medical training that prompted Shem's satirical novel, The House of God continues to evoke negative responses from academic medicine and has even been dismissed as "dated." This article examines the novel, its reception by academic medicine, and the relevance of its satire through an analyses of articles, reviews, and letters, along with Shem's observations on the novel and its controversies. Finally, the future of The House of God is proposed.