Thursday, April 21, 2011

After Reading Ch. 5....

Chapter 5 focuses on the role of vision, and "noticing what you see" in medicine.

a) How would you feel about being treated by a visually impaired doctor (assuming you were not facing a life-threatening crisis or having surgery)?
b) Explain how the story of Kowalski illustrates the main point of the chapter.

29 comments:

  1. a. I have to admit, I think I would initially be a little apprehensive about being treated by a visually impaired doctor. Having read this chapter of the book, though, I think I've gained a better understanding of how touch, not just sight, is used by doctors and how important it is to finding a patient's diagnosis, which I think would probably make me feel a little less nervous about the situation. But I would probably still feel a certain amount of uncertainty because it would be something I had never experienced before.

    b. The story of Kowalski illustrates the main point of the chapter because it shows how sight, though critical in making a diagnosis, isn't of much use if the doctor doesn't see the key symptom that will lead him/her to a diagnosis. In Kowalski's case, Dr. Stoppard only recognized the rash as an important symptom after he heard about Still's and began actively watching for its symptoms to manifest themselves in the patient. Doctors use sight a lot in their job, but they can miss things if they aren't looking for the right thing in their patient.

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  2. A) a really wouldn't care because blind peoples other senses are said to be enhanced because they have to depend on them and use them so much. so, in a way it may be advantageous to have certain blind doctors.
    b) the main point of the chapter was about sight and how doctors have to "learn" how to see and find the important things in what you saw. but an underlying point is that to "see" for doctors doesn't require vision but attention to the body and your other senses namely touch. that is how dr kowalski functions.

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  3. Emma Vinella-BrusherApril 21, 2011 at 9:11 PM

    a) I actually don't really think I would mind being treated by a visually impaired doctor. This is partially because, like Micha said, people with vision problems often have other heightened senses that somewhat make up for their blindness. I would also be okay with it because since we're assuming I wouldn't have a chronic illness or anything, whatever I had would be adequately diagnosed through touch alone, and sight wouldn't really be necessary.
    b) The main point of the chapter is to demonstrate that while vision is typically seen (pun not intended) as a vital part of the diagnosis process for doctors, it's not entirely necessary. The general belief is that someone needs to have properly working eyes (like Kowalski doesn't) in order to truly "see" something, but there are actually various ways of "seeing," and it's important that doctors see small details as well as the big picture. Some of the most important clues to assessing what's wrong with a patient can be discovered entirely without the use of eyesight.

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  4. a) I think I would be a little nervous at first if the doctor treating me was visually impaired, as I would worry about the quality and thoroughness of my treatment. I think I would be afraid that the doctor would miss something because he/she wouldn't be able to observe visually some symptom of mine. However, if the doctor proved himself/herself to be a competent and able doctor, I think, given time, I wouldn't mind at all.

    b) The main point of the chapter is that you don't have to be able to see in the literal sense of the word in order to truly "see" the symptoms and diagnose a patient. There are different ways of "seeing" that doctors have to learn, and those methods of "seeing" are equally as or sometimes more important than literally seeing.

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  5. a) Obviously I would feel a little uneasy if, for surgery, I was assigned a blind doctor (where sight is fairly critical). However, the example Sanders uses is a doctor who is mostly in treating muscle pains; things that can be felt or heard. That means that he is able to carry out his job fine. Same with psychiatry. I wouldn't mind (and probably wouldn't notice) a blind doctor.

    b) The main point of the chapter is that seeing is one thing, but interpreting is another. The rash is simply passed off as a skin infection, instead of the key ingredient in the successful diagnosis. Even with the info, it is necessary to connect the dots (Sherlock Holmes style) to determine what is actually happening.

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  6. a) I would obviously be uncomfortable with a blind doctor, but I would be more accepting of it depending on which circumstances I would be in. If I were going into surgery, I'd rather have a doctor who has sight than one without. But if I went in for a physical or psychiatric exam, I probably wouldn't notice/wouldn't be apprehensive about having a blind doctor.

    b) The main point of the chapter is that although sight may be necessary for seeing certain symptoms, understanding and correctly diagnosing a disease given those symptoms is another. This chapter is trying to prove that a blind doctor can catch symptoms another doctor may have seen and missed because the blind doctor can realize the connection between a symptom and a disease and make the correct diagnosis.

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  7. A) I would definitely be worried about a blind doctor, but I think in the end the choice to accept the blindness really depends on what you have to go to the doctor for. If you have a rash, that’s something the doctor needs to look at and observe to diagnose, not something that the doctor can understand simply by touching it. If, however, I had some sort of joint pain or other “touchable” problem, I would be fine with a blind doctor, as long as he or she was skilled with the physical examination.
    B) This story completely supports the concept of noticing what you see. Because none of the doctors were looking for a rash, none of them saw it. I think the most interesting part of the story is the one intern who did see the rash. Although he wrote it down, he didn’t make any effort to suggest that it might be a problem. This is a clear case of seeing something but not noticing it. In addition, all the other doctors who read that chart probably saw not only the rash itself but also the description of the rash that one intern wrote down, but still they did not consider that it might be important.

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  8. A) I would be more accepting of having a blind doctor if the problem I was being treated for was psychiatric rather than physical or something that needed to be seen to be interpreted thoroughly. I think this chapter so clearly describes the problems doctors have even when they can see that if a doctor was without such a crucial sense, it would just be that much more likely that they would miss something. On the other hand, if this doctor had gone through the process of getting certified as a doctor, they must have had to compensate for it in some way, so they may be even better qualified than a doctor who could see.

    B) This is such a classic case of looking versus seeing. Everyday people look at things but don't really see them, don't really interpret them. If you go into something not expecting to see certain things, most likely, even if they are right in front of you, you won't see them. I read a book about the strange ways in which the brain works and it discussed this concept in an experiment. People were asked to watch a video on the computer of two teams playing basketball, one team in black shirts and the other in white, and count how many times the white team passed the ball. Their eyes were tracked on the screen to see where they were looking during the duration of the video. About half way through, a man in a gorilla suit came onto the screen for about a minute and stood there, in the center, in plain site, pounding on his chest. When asked after the video if they had seen anything out of the ordinary, less than half remarked on the man in the gorilla suit. These people didn't expect to see a gorilla in the middle of a basketball game, so even though their eyes were tracked to be looking right at it, the majority of them didn't see it. This is just like the case of the intern and the rash. And then even if the doctors who reviewed the chart, looked at this note of the rash, but didn't really see it as a potential concern.

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  9. 1.I personally would be very uncomfortable with a blind or optically impaired physician examining me. Even after reading these last few chapters and understanding the importance of touch in medical diagnosis, i don't think I could get over the fact that the person who needs to figure what's wrong with me can't physically see what he/she is doing will always cause anxiety for me. For me, I would have in the back of my mind that the doctor is doing something wrong because he/she can't see properly and eventually misdiagnosis my problem.

    2.The main point that Kowalsi makes in this chapter is the difference between seeing something and actually noticing something. The key example presented being the rash that the intern, as well as other doctors, noticed but did not relay the information to the other doctors. This miscalculation of the situation ultimately lead to the overlooking of the rash, which would have otherwise solved the case faster.

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  10. a) I would rather not have a blind doctor (unless as a psychiatrist). The doctor described in this chapter seemed to do his job well, but I would still feel uneasy because there are some symptoms that have to be seen. However, doctors who do not notice what they see could be just as bad as those who cannot see.

    b) People notice things that they are looking for, that are within their expectations. The story about Kowalski illustrates this point. When the doctors were not looking for symptoms of Still's disease, they took no notice of his rash.

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  11. a) when i go in for a check-up, the majority of my examination involves sight. my doctor looks in my ears, down my throat, at my eyes, ect. For that reason, the idea of having a blind physician seems absurd. The elements of my regular examination would be insignificant. The only aspect of my check-up that would remain would be the questions my doctor always asks at the end of our appointment, which would make me feel like she wasn't getting enough information to recognize any irregularities.

    b) In this chapter, Dr. Sanders emphasizes the distinction between seeing and interpreting. The doctor who suggested Stills had not seen the patient. He was able to diagnose using only, as Dr. Wainapel said, "[his] ears, and most importantly, [his] brain." Sight is not the sole sense that doctors must rely on in their practice. Dr. Wainapel's success demonstrates that, and the doctor who diagnosed Kowalski furthered that point.

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  12. I would not want to be treated by a blind doctor. Even if simply talking was sufficient for the disease for which I was being treated, I would feel too uneasy and not confident enough in my doctor’s ability to “see” the whole picture. A blind doctor, no matter how attentive and careful he might be, will always run the risk of missing a crucial detail; I would not be willing to take such a risk with my own health.

    The story of Kowalski illustrates the main point of the chapter by giving an example of a doctor not seeing an important symptom of Still’s disease because that disease was not part of the expected diagnosis. Throughout Mr. Kawolski’s stay at the hospital, his doctors assumed that his fever was the result of a bacterial infection. They searched diligently for the telltale signs of an infectious disease but found none. Only when they were alerted to the possibility of Still’s disease as a diagnosis did they look for a rash, and indeed they found one. Moreover, Kowalski’s doctors had noticed a rash in the earlier stages of treatment, but had not thought anything of it because the rash hadn’t fit their expectations. When they were looking for the rash, the doctors were able to make use of it because, this time, they were looking for it.

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  13. The only doctor (knock on wood) that I have had steady contact with is my pediatrician. Now, at my age and with my knowledge, I think I would be fine with having a visually impaired doctor. Especially having read this chapter, I do now think that there are even benefits from having someone who is not blinded by sight (word choice…). I feel like too many doctors rely on sight and do not get hands on. A doctor who has to rely on touch and your story might be able to create a more accurate image of my illness and possibly come to a conclusion of a remedy more quickly. However, if I were choosing a pediatrician for my newborn child, I don't think I would choose a blind doctor over one with regular vision.

    I feel like this point has been driven into the ground at this point. Sanders has made it quite clear that unless you realize that a physical examination and an attention to all details is necessary, you are not practicing the safest and most effective form of medicine. Here, more specifically, sight is the target. Instead of waiting for a diagnosis of a rash, go and find the thing by looking at the patient.

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  14. Mirabella El BazeMay 1, 2011 at 6:16 PM

    a) I would be a bit apprehensive about having a visually impaired doctor, because I would be afraid that he/she would miss something crucial that is only distinguishable by sight. However, a blind doctor may be a better listener and pay more attention to the details of what I am saying. In the end, I would prefer to not have a blind doctor examine me since he doesn't have the capacity to potentially notice certain things.

    b) The story of Kowalski intends to illustrate the difference between sight and recognition. For doctors, including Dr. Stoppard, seeing is sense used a lot on the job. However, they can fail to notice the most important thing necessary for making their diagnosis, In Dr. Stoppard's case, he only recognized the rash after becoming aware that he should be watching for Still's symptoms to substantiate.

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  15. 1. I would feel a bit concerned about having a blind doctor. We depend so heavily on our site that I imagine certain diagnosis are much easier with vision. However, blind doctors would also be able to make up with their lack of vision with their other senses. In the end, I probably would feel a little uneasy if I were to have a blind doctor in real life, but thinking from a purely logical stand point, someone who is blind could probably be a very effective doctor.

    2. The chapter differentiates between vision in an every day sense and the special vision or seeing techniques that a doctor uses to make a diagnosis. The story of Kowalski illustrates the difference. Dr Stoppard sees the problems, in the every day sense of the word, but he did not notice the important aspects of the problem necessary to make a diagnosis.

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  16. a) i think i would not want to be treated by a blind doctor if i was going through something major like surgery. However, if it were something minor like muscle pain, i would be perfectly fine with a blind doctor. my security with a blind doctor would also depend on the recognition said doctor has received. If he or she was highly recommended, id more than likely be fine with them.

    b)What Kowalski's story shows, is that even though sight is very useful and often necessary, our minds can blind/override our sight, as Dr Stoppard's did. Had Stoppard been more open minded, he probably would have recognized the rash much more quickly. Had those who looked at the charts been more open minded, they may have discussed the potential dangers of this rash, rather than just disregarding it.

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  17. Katalina CabreraMay 1, 2011 at 10:59 PM

    1. I would say that the concept of a blind physician as presented in the book is fairly appealing. The man has a lot of experience under his belt, and seems to have a legitimate routine for overcoming his limitations. However, I think this may be a phenomenon largely specific to this one person. There are not many blind physicians in the U.S. for a reason--as Sanders pointed out, this is one of the only fields that could allow for this disability. So on the whole, I would say that I prefer a sight endowed doctor unless it's this man in particular.

    2.Kowalski's story illustrates the differences between day-to-day observation and interpretation. Dr. Stoppard does not take note of the rash as he is not in the mindset that Sanders argues in favor of. He only takes the cue when he realizes that he should be noticing Still's symptoms. This really emphasizes the point that Sanders makes earlier that we see what we want to see, and often don't correctly process the visual data we are given.

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  18. Ingrid Adamson-SmithMay 1, 2011 at 11:06 PM

    I never imagined that a visually impaired doctor could be so successful, and I think I would therefore be a bit nervous about being treated by one. It seems that being able to evaluate the physical manifestations of the symptoms that a patient describes would be vital to a diagnosis. So much more information can be picked up through visuals than through words. However, especially in fields like Wainapel’s that are not “time sensitive” and in which picking up every detail is not vital to the patient’s life, it seems like sight is not as necessary as I had presumed. I think now I am a bit more open to the possibility.

    The story of Kowalski illustrated the point that simply “seeing” is not enough – doctors must know what to gather from what they see. It shows the importance simply looking versus understanding and comprehending.

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  19. a. I think I would be very nervous about going to a visually impaired doctor. My whole concept of a doctor, before reading this chapter, is of a person who does visual examinations. However, I have learned that the ability to understand what one hears and what one feels is so much more important to a doctor than being able to see. Of course, I still don’t think I would be comfortable going to a doctor who is blind. I think I would need to test them somehow before I could trust them. If my blind doctor could carry out his job effectively without sight, I think I could learn to trust him or her.
    b. The main point of the chapter is that to be a good doctor, seeing is not enough. A good doctor not only sees, but also acknowledges, interprets, and understands what he sees. The story of Kowalski is of a doctor who did not realize the importance of one piece of information that had been noted. It was not for a lack of sight, because someone had noted it, but for a lack of understanding of the importance of the symptom. One has to create a larger picture of the actual disease by putting all the little pieces of evidence together, much like Sherlock Holmes.

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  20. a) I personally would prefer not to be treated by a blind doctor for a very intense procedure such as surgery. However, if I was in for minor symptoms, i would be perfectly fine with a blind doctor.
    b) The story of Kowalski shows us the difference between sight and recognition. For doctors, sight is used a lot on the job, but they can fail to notice the most important things in making a diagnosis. Dr. Stoppard only recognized the rash after becoming aware that he should be watching for Still's symptoms to substantiate.

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  21. Honestly speaking I would not feel completely confident being treated by a doctor with vision problems. Not only is sight helpful in making a diagnosis, but also it can sometimes be necessary. That being said, if I were being treated for a minor, nonthreatening ailment, I would not be opposed to obtaining advice from a visually impaired doctor. There might even be advantages to having a blind doctor because a blind doctor might be less influenced by potentially faulty ideas that he or she has come up with based entirely upon his or her initial visual impression of the patient. Sight can be worthless if doctors can only see what they expect to see.
    In the case of Michael Kowalski, the resident in charge of his case was initially unable to diagnose him because the doctor had not seen the symptoms that were necessary for a diagnosis. In this case, the crucial symptom was a rash on the patients backside. The doctor initially thought Kowalski had Lyme disease or potentially a couple different ailments, none of which had a rash as a symptom. Since the doctor was not looking for a rash, he did not notice it, and he did not initially think it was important. It turns out Kowalski did have a rash, and it was the key symptom that pointed the doctors towards a proper diagnosis of Still's disease. The doctors eyes were worthless because they were not looking for the correct signs. One of the key themes in chapter 5 is the idea that doctors rarely utilize their true powers of observation. They look for what they expect to see, and they filter everything else out.

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  22. a)
    I would be fine going to a visually impaired doctor as long as the doctor specialized in a field that did not require vision. Examples of fields that do not require vision include psychiatry and physical rehabilitation.
    b)
    Kowalski's case supports the main point of the chapter, that perceiving and interpreting are not the same as seeing. Kowalski's rash had been noted early in his visit to the hospital, but no one had taken note or associated the rash with his symptoms. Ultimately, the doctors had to know what to look for before they perceived that his rash was a symptom of Still's.

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  23. a. I would definitely be skeptical. True, I am not facing surgery a life-threatening problem, but still, a visually-impaired doctor is not what I want. I could easily find a capable doctor who has no visual problems. I hate to say it, but I feel having 100% vision is mandatory for being a doctor, no exceptions. (unless the field does not require vision of of course)

    b. Kowalski's story supports the main idea of the chapter that to be a good doctor one must not just be able to see and observe, but also to interpret, acknowledge, and understand. The story is of a doctor who observed a rash, but did not know how to connect it to anything else. Finally, they figured that the rash was a symptom of Still's, but this story shows that there is a lot more to being a doctor than vision.

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  24. Alright so my answers are a lot shorter because my first answers ended up being deleted somehow and this upsets me.
    a. Despite knowing that doctors without sight may have alternative senses that are much more acute, I would be skeptical when first being treated by a visually impaired doctor. Although this chapter is all about looking being different from seeing, I would be worried that with this impairment I may end up like the Parkinson's patient who may not have been diagnosed had it not been for the social worker who could see. Not being able to see will most definitely limit the specialties a doctor can pursue, but if they find a specialty that does not rely on sight, more often than not, doctors with impaired sight will be far more observant than those with perfect vision.
    b. The Kowalski story is proof that a successful doctor must not rely on one sense; he/she must not simply be able to see the current state of a patient, but also be able to comprehend the symptoms and understand the information that can be touched, smelled or seen. Doctors must not rely mainly on one sense or intuition, because by doing so they are unconsciously overlooking information that may help them crack the case. You can't always believe everything you see.

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  25. A) i want to say that i wouldn't' care because im sure those other heightened senses would make up for their lack in vision and because they must be pretty good if they're still a doctor, but i know i would be a little worried. it's like when the wife pleaded to a doctor to not have a resident to a life-saving surgery for her husband, since more things could go wrong and it's just not as comfortable.
    b) The story of Kowalski illustrates the main point of the chapter by showing how sight (the sense) isn't what makes a successful diagnosis. Doctors need to learn to see the other important indictors by using other senses, besides just sight and touch. Doctors can miss things if they aren't looking for the right thing (or looking for the wrong thing).

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  26. a) Before reading this chapter, I recognize that I would be pretty averse to being treated by a blind doctor. I know I would jump to the assumption that he/she would be unable to gather all the vital information that sight allows at a check-up. However, after this chapter I would be far more willing to have a check up done by a blind doctor. I think it's fascinating how other equally important skills necessary for a doctor, like touch and listening, are heightened for people like Dr. Wainaple. Also, I am curious if this actually makes the doctor a more accurate doctor in various ways because the doctor is more aware of the not as perceptible qualities that a patient might have.

    b) The story of Kowalski illustrates the main point of this chapter by giving a real life example of how not knowing certain things, or approaching a situation with expectations already in mind can easily blind someone from the answer. It also shows that doctors cannot rely on purely sight, as well as only their intuition, because it hinders them from truly understanding what is wrong with a patient, and consequently makes it far more difficult for doctors to be able to diagnose and treat patients.

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  27. To be completely honest, I will have to say that going into a situation like that would have me filled with fear and excitement. Before I would go, I would definitely ask around to see how proficient this doctor was, and I would be definitely intrigued on how well he can diagnosis and treat whatever problem I have. In the ene,d I'm sure that a blind doctor would be okay as long as he/she knew what she/he was doing. I've been treated by a doctor with one eye, why should another be that much different? Especially if the person was a professional, I would probably be fine with it. I mean in order to gain a license to perform his/her practice, the person would have had to meet all of the qualifications. THerefore, in order to become a doctor, the person must have been able to treat efficiently (hopefully, no affirmative action).

    The story of Kowalski (which is a fantastic name btw) demonstrates that sight, something we see (no pun intended) as essential in order to understand a situation or illness isn't really everything. My father is color blind, and while he might not see the difference between red and green, he definitely can see differences in other colors that I can't really tell unless i'm looking closely at it. There's no reason for ANY doctor to rely on just one sense. Instead, try to be a jack of trades. It's like eating food. YOu don't want to just shove it down your throat (and possibly choke) Instead let it stay in your mouth chew it, and move it around (your tongue's taste buds are separated by different types, salty, sweet, sour, umami, etc.

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  28. 1. I feel like my comfort with a blind doctor would depend on what the doctor's specialty was. For example, I would not trust a blind surgeon to operate on my heart. However, for a field which would involve mostly reading test results and giving diagnoses based on them, I would be comfortable with a blind doctor.

    2. The story of Kowalski is a prime example of how doctor can still be successful and treat his patients by using other senses to compensate for his lack of one. Also, it proves that despite patients' expectations of what a successful doctor should have available to him, a skilled doctor can still more often than not get the correct diagnosis and treat the patient effectively.

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  29. 1) I'd be pretty nervous to be treated by a blind doctor. I'd question him every step of the way just because he's blind and sight seems to be pretty important in the field of medicine. If I had the choice, I probably would refuse to be treated by a blind doctor, no matter the circumstance. Although I personally wouldn't want to be treated by a blind doctor, the doctor in this chapter seemed more than capable of being a physician. Even though he was blind, he didn't seem to act differently than you'd expect your doctor too. After reading about his training and credentials, I felt more comfortable with the idea of a blind doctor, but still wouldn't want to be treated by one.

    2) Kowalski's case illustrates the main theme of sight not always being helpful. In Kowalski's case, the doctor evaluates and treats Kowalski based on his outwards appearance and symptoms. He was initially test for lyme disease or meningitis based on how he looked. In the end, he ended up having an entirely different issue. While sight is important, it can also hinder a doctor from treating his patients.

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