Doctor and Patient
How Mindfulness Can Make for Better Doctors
By PAULINE W. CHEN, M.D.
NY Times
Published: October 15, 2009
One night during my training, long after all the other doctors had fled the hospital, I found a senior surgeon still on the wards working on a patient note. He was a surgeon with extraordinary skill, a doctor of few words whose folksy quips had become the stuff of department legend. “I’m sorry you’re still stuck here,” I said, walking up to him.
He looked up from the chart. “I’m not working tomorrow, so I’m just fine.”
I had just reviewed the next day’s operating room schedule and knew he had a full day of cases. I began to contradict him, but he held his hand up to stop me.
“Time in the O.R.,” he said with a broad grin, “is not work; it’s play.”
For several years my peers and I relished anecdotes like this one because we believed we knew exactly what our mentor had meant. All of us had had the experience of “disappearing” into the meditative world of a procedure and re-emerging not exhausted, but refreshed. The ritual ablutions by the scrub sink washed away the bacteria clinging to our skin and the endless paperwork threatening to choke our enthusiasm. A single rhythmic cardiac monitor replaced the relentless calls of our beepers; and nothing would matter during the long operations except the patient under our knife.
We had entered “the zone.” We were focused on nothing else but our patients and that moment.
But my more recent conversations with surgical colleagues and physicians from other specialties have had a distinctly different timbre. ...NYTimes
- Brian Deer, journalist
In the first part of a special BMJ series, Brian Deer exposes the bogus data behind claims that launched a worldwide scare over the measles, mumps, and rubella vaccine, and reveals how the appearance of a link with autism was manufactured at a London medical school
When I broke the news to the father of child 11, at first he did not believe me. “Wakefield told us my son was the 13th child they saw,” he said, gazing for the first time at the now infamous research paper which linked a purported new syndrome with the measles, mumps, and rubella (MMR) vaccine.1 “There’s only 12 in this.”
That paper was published in the Lancet on 28 February 1998. It was retracted on 2 February 2010.2 Authored by Andrew Wakefield, John Walker-Smith, and 11 others from the Royal Free medical school, London, it reported on 12 developmentally challenged children,3 and triggered a decade long public health scare.
“Onset of behavioural symptoms was associated by the parents with measles, mumps, and rubella vaccination in eight of the 12 children,” began the paper’s “findings.” Adopting these claims as fact,4 its “results” section added: “In these eight children the average interval from exposure to first behavioural symptoms was 6.3 days (range 1-14).”
Mr 11, an American engineer, looked again at the paper: a five page case series of 11 boys and one girl, aged between 3 and 9 years. Nine children, it said, had diagnoses of “regressive” autism, and all but one were reported with “non-specific colitis.” The “new syndrome” brought these together, linking brain and bowel diseases. His son was the penultimate case.
Running his finger across the paper’s tables, over coffee in London, Mr 11 seemed reassured by his anonymised son’s age and other details. But then he pointed at table 2—headed “neuropsychiatric diagnosis”—and for a second time objected.
“That’s not true.”
Child 11 was among the eight whose parents apparently blamed MMR. The interval between his vaccination and the first “behavioural symptom” was reported as 1 week. This symptom was said to have appeared at age 15 months. But his father, whom I had tracked down, said this was wrong.
“From the information you provided me on our son, who I was shocked to hear had been included in their published study,” he wrote to me, after we met again in California, “the data clearly appeared to be distorted.”
He backed his concerns with medical records, including a Royal Free discharge summary.5 Although the family lived 5000 miles from the hospital, in February 1997 the boy (then aged 5) had been flown to London and admitted for Wakefield’s project, the undisclosed goal of which was to help sue the vaccine’s manufacturers.6
Unknown to Mr 11, Wakefield was working on a lawsuit,7 for which he sought a bowel-brain “syndrome” as its centrepiece. Claiming an undisclosed £150 (€180, $230) an hour through a Norfolk solicitor named Richard Barr, he had been confidentially 8 put on the payroll two years before the paper was published, eventually grossing him £435 643, plus expenses.9
Follow this link to continue reading this part 1.
Part 2 (Published on Jan 11, 2011)
Part 3 (Published on Jan 18, 2011)
The Editorial on this article...Fiona Godlee et al. BMJ 2011