Justice - a course at Harvard

Kirkus Review: A Harvard law professor explores the meaning of justice and invites readers on a journey of moral and political reflection, “to figure out what they think, and why.” Does a veteran suffering from post-traumatic stress disorder “deserve” the Purple Heart? Should the U.S. government formally apologize and make reparations for slavery? Is it wrong to lie to a murderer? Following the taxpayer bailout of the company, are executives at insurance giant A.I.G. still entitled to their bonuses? Should a professional golfer afflicted with a severe circulatory condition be allowed to use a golf cart during tournaments? Are you obliged to surrender your criminal brother to the FBI? Although Sandel (The Case Against Perfection: Ethics in the Age of Genetic Engineering, 2007, etc.) concedes that answering the many questions he poses, bound up “with competing notions of honor and virtue, pride and recognition,” is never easy and inevitably contentious, it’s necessary for a healthy democracy. “Justice,” he writes, “is inescapably judgmental.” Using three approaches to justice—maximizing welfare, respecting freedom and promoting virtue—the author asks readers to ponder the meaning of the good life, the purpose of politics, how laws should be constructed and how society should be organized. Using a compelling, entertaining mix of hypotheticals, news stories, episodes from history, pop-culture tidbits, literary examples, legal cases and teachings from the great philosophers—principally, Aristotle, Kant, Bentham, Mill and Rawls—Sandel takes on a variety of controversial issues—abortion, same-sex marriage, affirmative action—and forces us to confront our own assumptions, biases and lazy thought. The author has a talent for making the difficult—Kant’s “categorical imperative” or Rawls’s “difference principle”—readily comprehensible, and his relentless, though never oppressive, reason shines throughout the narrative. Sparkling commentary from the professor we all wish we had.

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Evaluation of Thyroid Function in Health and Disease

Evaluation of Thyroid Function in Health and Disease

Canada's Health Care System - Poor Value for Tax Dollars

Are you more impressed by your physician's clothes and car than by his/her healing skills? Something to think about - your taxes are paying for this. From the Fraser Institute

A Country Doctor - Short Story by Kafka

Many patients find that their experiences with physicians are nightmarish or Kafkaesque.
In this story, a doctor undergoes torment.





Strip his clothes off, then he'll heal us,
If he doesn't, kill him dead!
Only a doctor, only a doctor.

Then my clothes were off and I looked at the people quietly, my fingers in my beard and my head cocked to one side. I was altogether composed and equal to the situation and remained so, although it was no help to me, since they now took me by the head and feet and carried me to the bed. They laid me down in it next to the wall, on the side of the wound. Then they all left the room; the door was shut; the singing stopped; clouds covered the moon; the bedding was warm around me; the horses' heads in the open windows wavered like shadows. "Do you know," said a voice in my ear, "I have very little confidence in you. Why, you were only blown in here, you didn't come on your own feet. Instead of helping me, you're cramping me on my deathbed. What I'd like best is to scratch your eyes out." "Right," I said, "it is a shame. And yet I am a doctor. What am I to do? Believe me, it is not too easy for me either." "Am I supposed to be content with this apology? Oh, I must be, I can't help it. I always have to put up with things. A fine wound is all I brought into the world; that was my sole endowment."

Dunning-Kruger: Does your doctor suffer from this condition?

"Kruger and Dunning set out to test... hypotheses on human subjects consisting of Cornell undergraduates who were registered in various psychology courses. In a series of studies, they examined self-assessment of logical reasoning skills, grammatical skills, and humor. After being shown their test scores, the subjects were again asked to estimate their own rank, whereupon the competent group accurately estimated their rank, while the incompetent group still overestimated their own rank. As Dunning and Kruger noted,

Across four studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although test scores put them in the 12th percentile, they estimated themselves to be in the 62nd.

Meanwhile, people with true knowledge tended to underestimate their competence. A follow-up study suggests that grossly incompetent students improve both their skill level and their ability to estimate their class rank only after extensive tutoring in the skills they had previously lacked.

They won Ig Nobel Prizes in Psychology in 2000 with their report Unskilled and Unaware of It: How Difficulties in Recognizing One's Own Incompetence Lead to Inflated Self-Assessments."

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Also see Downing Effect

A Doctor's Rx for CEO Decision Makers

A Doctor's Rx for CEO Decision Makers
by Jerome Groopman, MD

From the essay:

Doctors, like business leaders, make mistakes. Some errors are purely operational. A pint of blood is mistakenly transfused into Joan Smith rather than Jane Smith, and Joan goes into shock. A young doctor writes an incorrect dose of chemotherapy on an order sheet, and a woman with breast cancer dies from the toxic effects of overtreatment. A neurosurgeon operates on the wrong side of the brain because an X-ray was mislabeled as "right" rather than "left." These kinds of errors make headlines, trigger lawsuits, and terrify patients and their families; in the academic world, such mistakes prompted the Institute of Medicine to publish the landmark article "To Err Is Human" in 1999. Leaders in health care took the IOM recommendations to the business world for solutions. Lessons learned in high-risk industries such as air travel and nuclear energy were applied to hospitals. Anyone who has recently had a medical procedure or treatment has benefited from the checks and double checks that have become routine. To ensure that the right patient receives the intended care, health care professionals, like airline pilots, now follow strict protocols.

However, operational mistakes account for only a small percentage of medical errors. The overwhelming majority reflect poor thinking. In fact, 15% to 20% of all medical conditions are misdiagnosed. A middle-aged man's indigestion, treated with antacids, turns out to be a heart attack; a child's chronic headache is due not to "family stress" but to a brain tumor; a grandmother's fading memory is not early Alzheimer's disease but vitamin B12 deficiency. Such diagnostic errors reflect shortcomings in physicians' thinking rather than technical mistakes. In 2007, a national conversation began in the medical field about how best to address these errors of judgment. Business practices were not the solution this time; in fact, CEOs and other senior managers would do well to adopt the strategies that physicians are pursuing.

Senior doctors, like CEOs, traditionally have cast themselves as confident, autonomous decision makers; they take pride in their rapid analyses and sure-footed recommendations. Their judgments filter through the hierarchy in much the same way that decisions in a company are disseminated from the corner office. However, in sharp contrast with most businesses, hospitals convene regular meetings where all faculty and trainees—from the chief to the beginning medical student—revisit cases that had poor outcomes. At these forums, participants are beginning to dissect doctors' misguided thought processes, not just discuss bodily organs. This shift has required that even the most esteemed physicians acknowledge their fallibility in an effort to teach others and to improve themselves.

Medicine is drawing on the work of cognitive scientists—particularly Amos Tversky and Daniel Kahneman, who three decades ago explored the benefits and risks of heuristics, or shortcuts in thinking. Heuristics help to explain the 15% to 20% of cases where we get it wrong. My extensive research on misdiagnoses shows that even the most seasoned physicians are highly susceptible to anchoring error, or seizing on the first bit of clinical information that makes an impression. Similarly, all doctors recall dramatic past cases of theirs and mistakenly apply them to the case at hand, a so-called availability error. Another cognitive trap is attribution error, whereby a physician relies on a stereotype to which he attributes all of his patient's complaints. Menopause, old age, and stress are common categories that physicians glibly invoke as explanations for vague symptoms without digging more deeply for other causes. Contrary to the image of the doctor as authoritarian, dismissive of criticism, and resistant to self-analysis, physician leaders are starting to welcome the insights of cognitive science to help them avoid errors of judgment, in part because they have recently seen the benefits of rectifying operational errors. By making themselves vulnerable, physician leaders have now begun to encourage those lower down in the hierarchy to question decisions more freely and think more broadly.

"...hospitals convene regular meetings where all faculty and trainees—from the chief to the beginning medical student—revisit cases that had poor outcomes..."
We wish...

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MTBI Rehabilitation: The Patient's Perspective

A useful article for those who are putting their lives back together after medical error.

MTBI Rehabilitation: The Patient's Perspective
by
Constance Miller, MA
October 27, 1998

A Presentation made to the
Consensus Development Conference on
Rehabilitation of Persons with Traumatic Brain Injury
National Institutes of Health
Bethesda, MD

My interest in Mild Traumatic Brain Injury, MTBI, grew out of my own MTBI in a 1982 car accident. Prior to that life changing event I enjoyed a full, rich lifestyle that included women's rights and health care advocacy as well as a brief career as a university professor.

On that fateful day in 1982, I bumped my head in a car crash and my world turned upside down. When I came to I felt as though I had been disembodied, disconnected from myself and my past. The sensation was one of being outside of my body; viewing myself from afar. It was as though my head was in the clouds and my feet were planted in some strange yet familiar place.

There were blank spots in my memory and gaps in my consciousness. Words eluded me and my thoughts were frequently out of control. Sounds were muffled and sometimes irritating, and worst of all, nothing made sense. I thought to myself, this is spooky, suddenly for some unknown reason the world had become a strange and scary place.

Instinctually, I felt that something was very wrong although I was hard pressed to get others to confirm my impressions. I desperately needed answers. Much to my horror, the answers that were offered were the wrong answers. It did not take long for me to realize that my very life was at stake. In the blink of an eye I had been transformed from a vital, mid-career professional to one of the undead.

Essentially, life as I had known it no longer existed for me. I had become a mere shadow of my former self. Yet something in myself propelled me onward as I launched into the task of creating a new self and a new identity out of the wreckage of my life. Fortunately, my pre-injury accomplishments enabled me to unlock the mystery of MTBI, and create a new life for myself.

I was relieved to find that the answers to the mysteries of MTBI were known to medical science. I applied what I learned to restoring myself and to selecting and educating my doctors and lawyers. Then, I put everything into a self-help guide called From The Ashes. Then I founded the Head Injury Hotline to advise people on the syndrome, on good care providers, on legal options, and on social and career services available to them.

Continues at Link
Brain injury checklist symptoms may match those of thyroid problems.