NEJM Audio Summary - Oct 13, 2011

TIME TABLE

00:50 | A Bird's-Eye View of Fever
01:14 | Incidence of Adenocarcinoma among Patients with Barrett's Esophagus
03:02 | The Problems with Surveillance of Barrett's Esophagus
04:02 | Somatic SF3B1 Mutation in Myelodysplasia with Ring Sideroblasts
05:29 | Breast-Cancer Adjuvant Therapy with Zoledronic Acid
06:47 | Oil-in-Water Emulsion Adjuvant with Influenza Vaccine in Young Children
08:21 | Adult Primary Care after Childhood Acute Lymphoblastic Leukemia
10:09 | Case 31-2011 — A 55-Year-Old Man with Oligometastatic Lung Cancer
11:56 | “Pay for Delay” Settlements of Disputes over Pharmaceutical Patents
13:42 | Bariatric Surgery in Adolescents
15:34 | The Coming Explosion in Genetic Testing — Is There a Duty to Recontact?
17:21 | Rethinking Health Care Labor
19:20 | The New Language of Medicine
21:05 | Tropical Calcific Pancreatitis
22:03 | Myotonia of the Tongue

NEJM BLOGGERS

• 内科開業医のお勉強日記「小児インフルエンザワクチン：水中油型エマルジョンアジュバントの有効性」
• 呼吸器内科医「乳幼児に対するOil-in-Water EmulsionアジュバントMF59添加インフルエンザワクチンの有効性」

EXCERPTED SCRIPT

"The New Language of Medicine", a perspective article by Pamela Hartzband from Beth Israel Deaconess Medical Center, Boston.
In the new language of medicine, patients are “customers” or “consumers”; doctors and nurses are “providers.”  These descriptors have been widely adopted in the media, medical journals, and even on clinical rounds. Yet the terms are not synonymous. The word “patient” comes from patiens, meaning suffering or bearing an affliction. Doctor is derived from docere, meaning to teach, and nurse from nutrire, to nurture. These terms have been used for more than three centuries.
The words we use to explain our roles are powerful. They set expectations and shape behavior. This change in the language of medicine has important and deleterious consequences. The relationships between doctors, nurses, or any other medical professionals and the patients they care for are now cast primarily in terms of a commercial transaction. The consumer or customer is the buyer, and the provider is the vendor or seller. To be sure, there is a financial aspect to clinical care. But that is only a small part of a much larger whole, and to people who are sick, it's the least important part. The words “consumer” and “provider” are reductionist; they ignore the essential psychological, spiritual, and humanistic dimensions of the relationship — the aspects that traditionally made medicine a “calling,” in which altruism overshadowed personal gain. Reducing medicine to economics makes a mockery of the bond between the healer and the sick. 

COMMENT

医学と経済学は非常に似ていると思うことがある。使用者のプリンシプルによって益にも害にもなり得る。例えば、彼の国では2008年にノーベル経済学賞受賞のポール・クルーグマンは、反ブッシュの先鋒であって、New York Timesへの投稿"Patients Are Not Consumers"がスクリプトの元のアメリカ版「患者様問題」を扱った俯瞰記事でも引かれている。顧みて、此岸の国では社会的な責任を果たそうとする経済学者が希少なのか、マスコミにシャットアウトされているのか、耳目にする機会が少ないように思う。参考までに、他のいくつかのポール・クルーグマンの論文は、山形浩生さんのページで和訳を読むことが出来る。