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Perspective
Critical Moments — Doctors and Patients
I lost myself in the very properties of [my patients'] minds, for the moment at least, I actually became them . . . so that when I detached myself from them at the end of intense concentration over an illness that was affecting them, it was as though I was awakening from sleep. For the moment I…
Editorial
The Healing Power of Listening in the ICU
Critical care services are highly valued because they can often restore function in patients with acute life-threatening illnesses. In this context, advances in medical science have led to increased expectations for favorable outcomes of episodes of critical illness, even when the patient has…
Original Article
A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU
Having a loved one die in the intensive care unit (ICU) is an extraordinarily stressful event. The patient is usually unable to communicate with the family or with ICU staff. Qualitative and quantitative studies of families in this situation have identified effective communication between…
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The death of a loved one in an intensive care unit is an emotionally trying experience. These investigators compared a proactive end-of-life conference with family members, including the provision of an informational brochure, with a customary conference; outcomes were reported by family members 90 days after the loved one's death. Family members who participated in the intervention conference had improved outcomes, as compared with those who participated in the standard conference.
Correspondence
Delirium in Hospitalized Older Patients
To the Editor: In their study of the prevention of delirium in hospitalized older patients (March 4 issue), Inouye et al. provide data on the cumulative incidence of delirium as a function of the length of hospitalization that suggest that prolonged exposure to the hospital environment itself is a…
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Legal Issues in Medicine
Restricting Doctor–Patient Conversations in Federally Funded Clinics
We have come to accept, as a matter of both law and medical ethics, that open and honest discussion is crucial to the doctor–patient relationship. We accordingly deplore the practice in Plato's Greece whereby, for slaves, "verbal communication between healer and patient was reduced to a minimum."…
Special Article
Illness and Invulnerability
On Thursday, February 28, 1980, during the second term of my exchange year in the Department of Philosophy at the University of Kent, Canterbury, I had just finished having my customary "elevenses" with a colleague when I noticed a small, brief, but quite vivid flash of light in my left visual…
Medical Intelligence
Relieving Parental Anxiety: John Warren's 1792 Letter to the Father of a Burned Child
IN a 1792 letter from the Boston physician John Warren to the father of a burned child one finds much that can still serve as a standard for the profession's responsibility to relieve parental anxiety. Dr. Warren was 39 years old when he penned his letter to Mr. John Templeman, who was the father…
Special Article
Determinants of Medical Care — A Plan for the Future
ALTHOUGH I am licensed to practice in Minnesota, Canada and the British Isles, I have never really been a practicing physician. My life's work has been in research. I am a professional research worker earning my living by doing experiments. The life of an experimenter is devoted to reviewing the…
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