Monday, December 18, 2006

Issue 1: Trial of Error

In our first issue, we are introduced to some of the leading characters of Medthics. Dr. Garg, the attending physician of a medical ward, Anish, the senior resident physician, and Harmon, the junior medical student. The hierarchy of the characters are established and we are given insight into the behavioral interactions of our characters amongst each other and towards their patients.

Addressing Specific Issues:
Our first issue has received some feedback from readers and as author of this particular story, I'd like to take the time to clarify some issues brought up.

1) Pneumothorax?
At the end of the story, the junior medical student confesses to having caused a pneumothorax in the patient.

What is a pneumothorax?
A pneumothorax is an unnatural air space surrounding the lung usually due to some form of trauma (like a knife stab wound to the chest) which causes air to rush in during inhalation and restricts the lung from expanding (this can be fatal since a person would be unable to breath.)

A pneumothorax can also be inadvertently caused by the removal of a chest tube (chest tubes can be used to drain excess fluids surrounding the lungs). The removal of a chest tube (if not timed properly with an air tight seal) can allow for the opportunity for air to rush through the preexisting hole thus causing the pneumothorax.

2) What is ethically wrong with the events in the story?
As the title of these series of stories indicate, Medthics is intended to address issues pertaining to ethics in the medical field. We've had readers state that there isn't a clear ethical "problem" presented in the story.

While it would be more characteristic to discus about issues pertaining to the "classical" topics of abortions and euthanasia, ethical scenarios in medicine are rarely so blatantly obvious. In fact, many of the so-called classical examples of unethical behavior as portrayed in popular media are often over-exaggerations of subtle behaviors of a clinician that is taken in the wrong context and blown out of proportion. This makes for excellent drama, but is hardly realistic.

What I tried to portray in this particular issue are subtleties of clinician behavior that are more attuned to what actually occurs in the real clinical world.

Had this story been written from the patient's brother (Rohit) point of view, then the emphasis would have been placed on the attending's (Dr. Garg) untimely choice of answering his cell phone while breaking bad news and the subtle apathetic social gestures that might be conveyed to the brother and fellow clinicians.

Yet, this story is seen from the junior medical student's point of view and as such, the behavior of the attending is seen as simply one of many events that the medical student witnesses. The day simply moves on. The emphasis of the story, thus, is focused on the medical student's doubt at the ending of the story in which he is unable to convey his feelings to his lay friend about the path of being a doctor.

Thus, what I've tried to illustrate is what actually occurs rather than a stylized version of what MIGHT occur.



Anonymous said...

I enjoyed reading this first issue although I was a little confused at times until I read the synopsis etc. later. I agree with you on the fact that there are so many little ethical issues that come up during real clinical practice that we don't hear of very often. I am eager to read more about these non-classical examples of ethical problems. Thanks for sharing your views. Have you seen the movie "A Scanner Darkly?"

Anonymous said...

While reading the first issue, I was oblivious to all the small ethical problems medical professionals encounter on a regular basis. I am very impressed with how you guys are shedding light on these small, but equally important issues. An original idea that I will enjoy reading in the future. Really appreciating the synopsis to clarify things.


Medthics said...

Thanks for the comments everyone (both in person and posted here)!

Just to add to the above synopsis that may not have been obvious:
On page 3 of the story, we tried to illustrate a common behaviour that pops up in the medical field with our character, "Rohit" looking straight at the group while they were discusing his brother's case aloud.
Something of an interesting fact is how common it is for patients/family members to be fully aware of the conversations clinicians and staff have outside of their rooms when they're rounding on patients. Sometimes a clinician's overuse of technical jargon isn't a sure way of preventing patients/family members from fully understanding about what's going on. People can suprise you about the amount of knowledge they possess.

Clinicians are fully aware that it's poor form to talk about patients in ear shot of the actual patient/relative, yet it's something that still occurs.

We're thrilled that this graphic short is being read by such a wide community already! It's our goal that somewhere down in the future these shorts can be enjoyed by anyone!

Unknown said...

Awesome work Harmon! Your team has done a great job in conveying the unaltered realities of daily medical practice. I think there’s definitely a niche for this sort of thing since most other media simply show extreme/exaggerated cases that are not part of daily clinical practice. I really like the comicized versions of real pictures…looks great! As for my critical feedback, I understand your intent in trying to make this a realistic portrayal of clinical practice, but from a reader’s point of view, I think it needs more explanation built into the story…It might be nice to incorporate the info in the synopsis into the story conveyed through the characters. I also don’t really understand how this is an “ethical” problem…I would call it more of an ‘accident’ due to inexperience…which can happen to anyone in any kind of work. It might be a good idea to clarify/setup the ethical problem in the story itself, rather than describe it in the synopsis. Overall, for a first issue, I think it’s still a great piece of work. I’m looking forward to reading issue 2 in the near future…Happy New Year to you all! Cheers!