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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/29781428/response-to-metaphorically-or-not-violence-is-not-a-contagious-disease
#1
Gary Slutkin, Charles Ransford, Daria Zvetina
No abstract text is available yet for this article.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29781427/metaphorically-or-not-violence-is-not-a-contagious-disease
#2
Michael B Greene
No abstract text is available yet for this article.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763398/does-family-presence-in-the-trauma-bay-help-or-hinder-care
#3
Benny L Joyner
Family presence during a pediatric resuscitation remains somewhat controversial. Opponents express concern that family presence would be detrimental to team performance and that exposure to such a traumatic event could put family members at risk of posttraumatic stress. Proponents argue that family presence affords families a sense of closure by easing their anxieties and assuring them that everything was done for their loved ones in addition to improving clinicians' professional behavior by humanizing the patient...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763397/-memento-mori-and-photographic-perspective-of-roadside-trauma
#4
David B Nance, Sara Scarlet, Elizabeth B Dreesen
David Nance's photographs invite us to cross the liminal space between road and roadside and to consider the experience that trauma surgeons share with injured patients and the families of the injured and the dead. Just as trauma surgeons use the tools of science and surgery to make order out of the chaos of "the scene," so patients' families use art, found objects, and grief to transform anonymous roadsides into specific, personal remembrances. Bound together by the uncertainties of trauma, we can all stand at the side of the road bearing witness to both the inevitability and unpredictability of death...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763396/the-evolving-surgeon-image
#5
Heather J Logghe, Tyler Rouse, Alec Beekley, Rajesh Aggarwal
The stereotype of the abrasive, technically gifted white male surgeon is ubiquitous among members of the public and the medical profession. Yet modern surgeons are far more diverse and socially adept than the stereotype suggests. While the stereotype is largely a relic of days gone by, it continues to influence patients' expectations and surgeons' interactions with their clinical colleagues. The #ILookLikeASurgeon movement and subsequent #NYerORCoverChallenge demonstrate the changing face of surgery and the roles of social media in resisting the social and cultural force of long-standing stereotypes...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763395/what-is-the-institutional-duty-of-trauma-systems-to-respond-to-gun-violence
#6
Sara Scarlet, Selwyn O Rogers
In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence. However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care. Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context. These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763394/gun-violence-research-and-the-profession-of-trauma-surgery
#7
Allan B Peetz, Adil Haider
The effects of violence are clearly a central component of any trauma surgeon's job. The role trauma surgeons should play in its prevention and advocacy, however, is not clearly defined. In this article, we discuss the statistics and lack of research on gun violence and survey some of the moral frameworks that define a trauma surgeon's professional responsibilities in violence prevention at a practice and a policy level.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763393/defining-community-and-consultation-for-emergency-research-that-requires-an-exception-from-informed-consent
#8
Samuel A Tisherman
Trauma care requires rapid interventions to optimize the chances for survival. Many patients are either in shock or unconscious and are, therefore, unable to provide informed consent even for standard procedures. Research-related interventions must similarly be initiated rapidly with no opportunity to obtain consent from the patient or the patient's legally authorized representative. Federal regulations allow for an exception from informed consent in these circumstances once the investigators complete a process of community consultation and public disclosure...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763392/should-family-be-permitted-in-a-trauma-bay
#9
Matthew Traylor
This essay explores how some of the arguments advanced for and against family presence during cardiopulmonary resuscitation might apply to the question of whether family should be permitted in the trauma bay. While the first section suggests that many of the proposed benefits might apply to family presence during trauma resuscitations, the second section contends that family presence in the trauma bay could detract from the quality of patient care, violate patient privacy, and be psychologically damaging for the witnessing family...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763391/should-trauma-physicians-treat-a-severely-injured-patient-for-the-sake-of-elucidating-preferences-about-organ-donation
#10
Sandra R DiBrito, Macey L Henderson
Organ donation potential is not a motivator of care in the trauma bay, and it is ethically problematic to consider organ donor potential during the active resuscitation of a trauma patient. Despite organ donation being a public good, the role of the trauma physician is to maintain focus on the patient as an individual and to respect a patient's right to life and autonomy. This tenet of medicine is the foundation of the trust that a community and individuals must have in order for the health care system to function...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763390/what-are-ethical-implications-of-regionalization-of-trauma-care
#11
Sandra R DiBrito, Christian Jones
Outcomes for severely injured patients are improved when they are treated at trauma centers. However, interfacility transfers can delay time-sensitive treatments not requiring the resources of tertiary institutions. Regionalized trauma systems allow physicians to decrease delays in care, prevent inadequate treatment, and ultimately reduce preventable deaths. Although precise risks and benefits of triage choices are unknowable, estimating them is a process well known to surgeons. Recognizing patient transfers as integral to optimal care delivery systems, rather than as detracting from them, is essential...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763389/how-should-complex-communication-responsibilities-be-distributed-in-surgical-education-settings
#12
Bradley M Dennis, Allan B Peetz
Part of any trauma surgeon's job is communicating effectively in difficult, often time-limited, situations. The ability to effectively discuss topics like goals of care in these settings has a direct effect on patient care. Many factors contribute to the complexity of these conversations, including patient, physician, surrogate, and system-specific factors. In responding to the case of Mr. D and Dr. J, we attempt to outline and analyze some of the moral challenges and ethical questions that this professional responsibility poses to trauma surgeons and trainees...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763388/how-should-trauma-patients-informed-consent-or-refusal-be-regarded-in-a-trauma-bay-or-other-emergency-settings
#13
Ashley Suah, Peter Angelos
The precipitous and unexpected nature of trauma requires training health care practitioners to think and act quickly, according to the best medical interest of the patient. The urgency of treatment for trauma patients, who frequently have temporary alterations in their abilities to make autonomous and competent decisions, often results in presumed consent for medically necessary treatment. Academic trauma centers use protocol-based management of injuries to facilitate their simultaneous evaluation by multiple clinicians and to avoid delays in treatment, ensuring that trauma patients receive the best possible care...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671736/exclusion-of-medically-necessary-gender-affirming-surgery-for-america-s-armed-services-veterans
#14
William M Kuzon, Emily Sluiter, Katherine M Gast
Gender dysphoria , the term used in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) to describe distress at the incongruence between one's gender and anatomy, affects approximately 0.6 percent of the population. It is estimated that there are 134,000 Armed Forces veterans in the United States with gender dysphoria. Although gender-affirming surgery is widely accepted as a medically necessary intervention for appropriately selected patients with gender dysphoria, the Veterans Health Administration (VHA) Health Benefits package and VHA Directive 2013-033 specifically prohibit gender-affirming surgery within Veterans Affairs (VA) facilities or using VA funding...
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671735/how-tattoos-can-complement-breast-reconstruction
#15
Lisa Franczak
Tattooing offers expanded possibilities for creative expression for women who have undergone mastectomies and breast reconstruction surgeries. Tattoo techniques for areola restoration, such as repigmentation, do not address breast asymmetry or heavy scarring, but breast tattoos can embolden a woman's sexuality, self-confidence, and sense of body reclamation, as well as strengthen her postsurgical capacity for relating to her breasts and expressing her identity. There are many factors involved when a tattoo artist is asked to design an image for a patient...
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671734/instrumental
#16
Ryoko Hamaguchi
Incorporating classmates' unique one-word reflections on human anatomy and the experience of engaging with the bodies of our anatomical donors, this series captures a diverse spectrum of human emotions surrounding anatomical dissection. Grappling with the humanity of our varied reactions, we related ourselves-ethically and clinically, individually and collectively-to our first "patients" and their critical role in our education and growth as physicians.
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671733/what-should-be-the-surgeon-s-role-in-defining-normal-genital-appearance
#17
Devan Stahl, Christian J Vercler
The recent rise in women seeking cosmetic surgery of their genitalia (labiaplasty) coincides with the increasing number of surgeons posting videos of these operations on social media accounts and websites. Sociocultural influences significantly contribute to our ideas of what constitutes healthy and pathologic, and surgeons have historically played a role in defining "normal" and "abnormal" anatomy. In the nineteenth century, Saartjie Baartman-a woman with a large posterior and unusually long labia minora-was used by physicians to "educate" the public about these differences...
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671732/can-plastic-surgeons-maintain-professionalism-within-social-media
#18
Pablo L Gutierrez, Debra J Johnson
Plastic surgeons have evolved their methods of reaching potential patients by using various forms of social media. Such platforms can educate, inform, and, for some, entertain. Social media now allows consumers to compare themselves to a much wider, if not global, set of peers that might further exacerbate their anxiety regarding their appearance. Plastic surgeons should ensure that use of patient images does not violate privacy or create unreasonable expectations about the results that can be obtained; nor should plastic surgeons' marketing objectify women...
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671731/when-is-advertising-a-plastic-surgeon-s-individual-brand-unethical
#19
Carly P Smith, Daniel George
Advertising a plastic surgery practice on social media is fraught with both practical and ethical challenges. We use an institutional betrayal framework to explore the range of potential harms to patient well-being while also considering the pitfalls of social media activity, especially marketing, for practitioners. We also give consideration to the relative benefits that such online patient-clinician relationships can provide. In our analysis, we draw on specific examples of plastic surgery procedures prominently featured on social media, including the Vampire Facelift® ...
April 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29671730/what-should-be-the-role-of-plastic-surgeons-in-nonanatomic-breast-reconstruction-including-tattooing
#20
Jeffrey H Kozlow
The goal of plastic surgeons performing postmastectomy anatomic reconstruction is to create a breast structure that closely matches the shape and appearance of a patient's native breast. Tattoo artists have helped improve outcomes with nipple-areolar tattooing. Some patients now prefer to have more extensive, nonanatomic designs to help camouflage their scars. Two questions are considered here: What role should plastic surgeons have in supporting or performing nonanatomic reconstruction? And should insurance programs cover nonanatomic breast reconstruction options?...
April 1, 2018: AMA Journal of Ethics
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