What Are Doctors For? A Call for Compassion-Based Metrics as a Measure of Physician Value.

Modern measures of physician value are couched in terms of productivity, volume, finance, outcomes, cure rates, and acquisition of an increasingly vast knowledge base. This inherently feeds burnout and imposter syndrome as physicians experience an inability to measure up to unrealistic standards set externally and perceived internally. Ancient and modern wisdom suggests that where populations fail to flourish, at root is a failure to grasp a vision or true purpose. Traditional philosophical conceptions of a physician's purpose center around compassion, empathy, and humanism, which are a key to thwarting burnout and recovering professional satisfaction. New compassion-based metrics are urgently needed and will positively impact physician well-being and improve population health.

The heart of anaesthesiology: revitalising humanism in the age of technology.

Technological innovation has greatly aided modern medicine, and anaesthesiology in particular, but also contributes to dehumanising influences that promote physician burnout and dissatisfaction among patients. Here we advocate for a profound reaffirmation of humanistic principles-empathy, compassion, and communication-in perioperative medicine. We propose adaptable strategies to bolster humanism in practice, such as curricular offerings, simulation training, role modelling, and recognition. As perioperative technologies continue to evolve, the threat of depersonalisation in anaesthetic care looms, making commitments to humanism a crucial precondition for healing in the communities in which we work and live.

Integrative Care Model of Complementary Therapies and Humanizing Practices in Primary Health Care: Qualitative Meta-synthesis.

Context: The World Health Organization (WHO) seeks to support member states in providing Traditional, Complementary, and Integrative Medicine (TCIM) services within Primary Health Care (PHC). Health professionals' offer of and referral to complementary therapies and humanizing practices can encounter some difficulties due to both conventional medical knowledge and institutional organizations. An integrative care model of complementary therapies and humanizing practices may be a strategy to overcome such difficulties. Objective: The study aimed to identify an integrative care model of complementary therapies and humanizing practices and to determine their influence on PHC. Design: The research team performed: (1) a qualitative meta-synthesis based on data from two systematic reviews that included more than 15000 professionals from 18 countries, and (2) qualitative research conducted with 24 participants, professionals from the South and Southeast regions of São Paulo, SP, Brazil. Setting: The study occurred at the Paulista School of Medicine at the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. Results: The analysis of the integrative care model resulted in two syntheses: (1) that PHC is offering complementary therapies and humanizing practices that have had a positive and subjective influence on PHC and (2) complementary therapies and humanizing practices improve PHC's service quality and resolvability and reduce medicalization. Conclusions: The work process in PHC may pose difficulties for the provision of integrative and holistic care yet promoting a model to integrate complementary therapies and humanizing practices with conventional medicine in health services may improve PHC and the perceptions of health professionals, managers, and patients about the positive and subjective effects of these practices.

Examining nurses' humanistic behaviour ability and empathy levels in clinical practice: A descriptive and exploratory study.

BACKGROUND: It is critical for nurses to provide healthcare services to healthy/sick individuals with a humanistic approach and with empathy. AIMS: This research aimed to determine nurses' humanistic behaviour ability, empathy levels and related factors in clinical practice. DESIGN: A descriptive cross-sectional and exploratory study. METHODS: Probability sampling method was used, and 337 nurses working in two public hospitals were included in the study. Data was collected using the Humanistic Practice Ability of Nursing Scale and the Empathy Level Determination Scale. Structural equation model analysis and descriptive statistics were used to evaluate the hypothesised model. This study adhered to the STROBE checklist for reporting. RESULTS: Nurses' humanistic ability and empathy level in nursing practices were found to be above average. Both the ability to act humanely in nursing practices and their empathy levels were found to be significantly higher in nurses who were married and had children. A significant relationship was found between empathy levels and humanistic behaviours. Accordingly, nurses' empathy levels positively affected their humanistic care behaviours, and the model established between the two concepts was found to be statistically appropriate. CONCLUSIONS: Nurses' empathy levels positively affect their ability to act humanistically. The result of the model established between the two concepts also supports this. Care strategies should be developed that consider factors that will improve empathetic and humanistic behaviours in nurses and maximise individualised care practices. IMPLICATIONS FOR THE PROFESSION: Increasing the awareness of nurses about the factors affecting humanistic behaviours and empathic attitudes while caring for individuals in clinical practice, will contribute to improving the quality of nursing care.

Some Considerations on a Patient's Sense of Immortality: Bringing a Human Dimension to the Process.

One of the most frequent, although widely understandable, reactions of people diagnosed with an incurable tumor is represented by incredulity, anger, and the denial of the impossibility of a definitive cure. Often, a picture of intense anxiety quickly takes over, overlapping the ever-growing collective hysteria of modern society, the result of a complex cultural mechanism in which technocracy often prevails over thought, introspection, and, in a broader sense, humanism. In this health drama, all actors often complain of formal inaccuracies while paying little attention to substantive ones. We argue that a more human emphatic patient-family-doctor relationship training to consider the undeniable progress of medicine and the fragility of all of us.

Notes on [post]human nursing: What It MIGHT Be, What it is Not.

With this paper, we walk out some central ideas about posthumanisms and the ways in which nursing is already deeply entangled with them. At the same time, we point to ways in which nursing might benefit from further entanglement with other ideas emerging from posthumanisms. We first offer up a brief history of posthumanisms, following multiple roots to several points of formation. We then turn to key flavors of posthuman thought to differentiate between them and clarify our collective understanding and use of the terms. This includes considerations of the threads of transhumanism, critical posthumanism, feminist new materialism, and the speculative, affirmative ethics that arise from critical posthumanism and feminist new materialism. These ideas are fruitful for nursing, and already in action in many cases, which is the matter we occupy ourselves with in the final third of the paper. We consider the ways nursing is already posthuman-sometimes even critically so-and the speculative worldbuilding of nursing as praxis. We conclude with visions for a critical posthumanist nursing that attends to humans and other/more/nonhumans, situated and material and embodied and connected, in relation.

Thinking through critical posthumanism: Nursing as political and affirmative becoming.

As a rejection and continuous reframing of theoretical humanism, critical posthumanism questions and imagines the human condition in the current context, aligning it with nonhuman and more than human entities, past and future. While this philosophical approach has been referenced in many academic disciplines since the 1990s, it has been gradually garnering interest among nursing scholars, leading to questions such as what it means to be human and what it means to be a nurse in the here and now. As a deeply ethical and political project, posthumanism, which we associate with poststructuralist concepts of power and resistance, questions the formation of posthuman subjects who more accurately reflect complex times, characterized by capitalistic commodification of life-human and nonhuman. In this article, we aim to explore how the ontological and epistemological underpinnings of critical posthumanism, specifically through Rosi Braidotti's works, can be useful to understand a posthuman subjectivity that favors affirmative actions aimed at actualizing our world in becoming. Through examples in nursing practice, education, and research, we will explore not only how critical posthumanism allows us to frame transformations in the current situation that we are embedded in as nurses and more generally as beings but also how these examples allow us to move beyond critique to the actualization of affirmative actions that correspond to the creation of new worlds.

Toward an ontology of the mutant in the health sciences: Re/defining the person from Cronenberg's perspective.

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the 'person' or 'patient' that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken-for-granted definitions and assumptions of the 'person' from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the 'person' in nursing and beyond. Cronenberg's work explores bodily transformation and mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of 'the person'. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming-mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles.

Critical ethnography and its others: Entanglement of matter/meaning/madness.

Beginning with a critical examination of the humanist assumptions of critical ethnography, this article interrogates and surfaces problems with the ontological and epistemological orientations of this research methodology. In drawing on exemplar empirical data from an arts-based project, the article demonstrates the limitations in the humanist-based qualitative research approach and advances a postdualist, postrepresentationalist direction for critical ethnography called entangled ethnography. Using data from a larger study that examined the perspectives of racialized mad artists, what is demonstrated in this inquiry is that the entanglement of bodies, objects, and meaning-making practices is central to working with the ontologically excluded, such as those who find themselves in various states of disembodiment and/or corporeal and psychic distribution. We propose the redevelopment of critical ethnography, extended by entanglement theory (a critical posthuman theory), and suggest that for it to be an inclusive methodology, critical ethnography must be conceptualized as in the process of becoming and always in regeneration, open to critique, extension, and redevelopment.

No evidence that belief in conspiracy theories is negatively related to attitudes toward transhumanism.

Transhumanism is a movement that emphasizes the improvement of the human condition by developing technologies and making them widely available. Conspiracy theories regularly refer to the allegedly transhumanist agenda of elites. We hypothesized that belief in conspiracy theories would be related to more unfavorable attitudes toward the transhumanist movement. We examined this association through two pre-registered studies (based on two French samples, total N after exclusion = 550). We found no evidence of a negative relationship between belief in conspiracy theories and attitudes toward transhumanism. This null result was further corroborated by Bayesian analysis, an equivalence test, and an internal mini meta-analysis. This work plays a precursory role in understanding attitudes toward an international cultural and intellectual movement that continues to grow in popularity and influence.

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices.

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

The New Mythology of the Body and the Transformation of the Therapeutic Space.

BACKGROUND: The history of medicine has flowed in the wake of knowledge and social perceptions about the body and corporeality. There is no idea of health without reference to the notion of body (although "health" can have other meanings, figuratively). Considering the same history, the body was the subject of numerous segregations and categorizations due to which it was and is a "social object" and a "political object." In turn, the spatial and cultural framework was the environment and determinant of the medicine development which is not only a science but also an inter-human interactive practice. AREAS OF UNCERTAINTY: In this article, we will analyze the current social (re)construction of the notions of body and space by referring to the technological and structural changes that are manifested in medicine and society and their ethical implications. DATA SOURCES: A review of the specialized literature was performed in June-July 2023, using keywords like human enhancement, therapeutic enhancement, transhumanist medicine, ethics from PubMed, Scopus, Web of Science, and Google Scholar, and official documents issued at the international level (World Health Organization, European Commission). ETHICS AND THERAPEUTIC ADVANCES: This literature review suggests that few practical solutions to human enhancement, both curative and preventive, whether cognitive or physical, have been approached entirely from an ethical point of view. The historical evolution of the concept of human enhancement has led to debates between "transhumanists" and "bioconservatives" depending on how they relate to the improvement of the human condition without or with reticence interventions to improve human capabilities being related to various interventions, from pharmacological, surgical ones to those in the field of genetics, nanomedicine, or cybernetics. In addition to the technical aspects, which are often the major concern of researchers and those applying new technologies, there are also ethical and legislative aspects, to better understand the impact that the dynamics and diffusion of these processes have on the evolution of the human species. CONCLUSIONS: In interference with these technologies, the body is exposed to possibilities of change and evolution with colossal (expected) social impact that can change norms and values that have been stable for centuries. Social space and place are also proving to be "processes in the making'" for which we need to detect what developments are possible or have already imposed themselves as a trend in the social and medical world.

A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

[Humanization of Assistance; Building the path from the university]. / Cuidados en salud humanizados: Construyendo camino desde la universidad.

BACKGROUND: The training of health students regarding good treatment and humanized care is essential; it is a quality benchmark in health care. The relevance of good treatment and humanized care should be consistent with the treatment students receive from teachers and clinical tutors, modeling humanized cultures. However, research shows the normalization of mistreatment of medical and nursing students. A Humanized Training Unit was implemented in a Chilean nursing school, which included promoting a support Program for students by their teachers between 2020 and 2021. AIM: Explore the Program's impact on the exercise of humanized care from the student's perspective. MATERIAL AND METHODS: An intrinsic case study with a qualitative approach, with the objective of 12 semi-structured interviews carried out via Zoom with young people who had been tutored virtually by program teachers for one month and two years during their student period. We performed the data analysis using the constant comparisons method and in compliance with qualitative rigor criteria. RESULTS: The Program positively impacted personal, academic, and professional areas, allowing students to feel cared for by their teachers and recognizing the development of skills transferable to their relationship with users for more humanized care. CONCLUSIONS: The Program is replicable to other careers and institutions, requiring time, disposition, and teacher training, which can be a limitation. The benefits evidenced by our study demonstrate the program's usefulness in promoting cultures of more humanized care in educational and health spaces.

[Phenomenology of moral distress: implications for the humanization of medical education and practice]. / Fenomenología de la angustia moral: implicancias para la humanización de la educación y la práctica médica.

In the healthcare context, moral distress (MD) refers to the negative emotions that arise when a person knows the correct course of action in a given situation but is not able to follow it due to personal, hierarchical or institutional impediments. MD has been related to various professional problems, such as vocational disorientation, low work motivation, depersonalized treatment of patients, abandonment of duties, and changes of specialty or profession. Although this phenomenon has not been sufficiently studied in Chile, it presumably exists and would have even increased during the COVID-19 pandemic, leaving its repercussions unknown. Accordingly, this article has the objectives, firstly, to promote the phenomenological study of MD in our country, considering the importance of preventing its potential adverse impact on the mental health of future professionals, and, secondly, to highlight the need to include narrative approaches in medical education, in order to develop a more holistic approach to understanding patients and their condition of vulnerability. Ultimately, it is expected that addressing the implications of MD in medical education and practice will contribute to its humanization, optimizing the quality of healthcare.

Race, class, caste, disability, sterilisation and hysterectomy.

This interdisciplinary historical paper focuses on the past and current state of diverse forms of surgical hysterectomy as a global phenomenon relating to population control and sterilisation. It is a paper grounded in historical inquiry but is unconventional relative to the norms of historical scholarship both in its wide geographical scope informed by the methodologies of global and intercultural history, in its critique of current clinical practices informed by recent feminist, race, biopolitical and disability studies, and by its engagement with scholarship in health sociology and medical anthropology which has focused on questions of gender and healthcare inequalities. The first part of the paper surveys existing medical, social-scientific and humanistic research on the racial, class, disability and caste inequalities which have emerged in the recent global proliferation of hysterectomy; the second part of the paper is about the diverse global rationales underlying radical gynaecological surgeries as a form of sterilisation throughout the long twentieth century. Radical gynaecological surgeries have been promoted for several different purposes throughout their history and, of course, are sometimes therapeutically necessary. However, they have often disproportionately impacted the most disadvantaged groups in several different global societies and have frequently been concentrated in populations that are already maligned on the basis of race, ethnicity, age, criminality, disability, gender deviation, lower class, caste or poverty. This heritage continues to inform current practices and contributes to ongoing global inequalities of healthcare.

DIDACTIC CULTURE OF MEDICAL UNIVERSITY TEACHERS AND STUDENTS IN THE CONDITIONS OF WAR.

OBJECTIVE: The aim: To analyse the essence of the concept of "didactic culture", to outline its structure, to describe the peculiarities of the development of the didactic culture of teachers and students in the conditions of war, to characterize the role of information technologies in its formation. PATIENTS AND METHODS: Materials and methods: A number of scientific methods were used in the research: a comparative-historical method to consider retrospectively the concept of didactic culture; bibliographic method to identify the existing source base; content analysis for analytical processing of literature; chronological method to analyse the study of didactic culture in a time sequence; structural and systemic analysis to clarify its specifics at different levels; comparative analysis to establish common and specific features in the system of didactic culture development in different countries; a questionnaire method for studying students' opinions about the structure of speech culture as a component of didactic culture; a method of generalization and specification that contributes to the formulation of conclusions and recommendations on the didactic culture development. CONCLUSION: Conclusions: The didactic culture is considered as a socio-pedagogical phenomenon and an important component of professional and pedagogical culture. The didactic culture development in wartime conditions should be based on the principles of humanism, praxeology and acmeology, with the account of the challenges and features of the information society and the globalized world. In this context, systematic comparative studies will contribute to the use of the experience of other countries, and the development of psychodidactics will allow to approach the understanding of the deep patterns of the process of didactic culture development.

Hydraulic Engineers and Antiquarians: Political Use of the Past in Nineteenth-Century Venice.

The article analyzes the relationship between hydraulics and history in the nineteenth century, often described as a period when the humanities and the sciences split into "two separate cultures." Venice, amphibious city par excellence, is a good starting point for exploring the use of history in water management debates. In the early nineteenth century, humanists and hydraulic engineers came together through multiple disciplinary approaches and in constant confrontation with the Republic of Venice's water policies. In the following decades, while making extensive use of history, these engineers realized and emphasized the diversity of both disciplines' methodologies. This evolution-seen through the writings of renowned hydraulic engineer at the time Pietro Paleocapa-illustrates how history was no longer a source of empirical knowledge but came to be used for rhetorical and political purposes.

The care experience for people undergoing a liver transplantation. Descriptive phenomenological investigation in a Belgian academic hospital / L'expérience des soins des personnes qui vivent une transplantation hépatique. Recherche phénoménologique descriptive au sein d'un hôpital académique belge

This study aims to describe and understand the care experience for people having undergone a liver transplantation in a Belgian academic hospital and the elements of an ideal care experience for them. The descriptive phenomenological method of the « Relational Caring Inquiry ¼ was used with twelve participants whose stories were collected through three semi-structured individual interviews. These interviews gave an overall picture of their care experience, summarized as « the feeling of having benefited from the support of both the body and mind in a Humanist-Caring dynamic, but with difficulties linked to organizational and environmental factors in finding a new balance. ¼ The essence of their ideal care experience consists of « benefiting from the support of both the body and mind by competent professionals, in a Humanist-Caring climate and a dynamic of partnership with the patient, in an institution that is welcoming in terms of its organization and environment. ¼ Based on these results, it seems essential to limit organizational constraints to consolidate the Humanist-Caring dynamic, to develop the patient partnership, and to pay special attention to the patient's relatives, resulting in structured support.

Cette étude vise à décrire et comprendre l'expérience des soins des personnes ayant vécu une transplantation hépatique dans un hôpital académique belge, ainsi que ce qui constituerait pour eux les éléments d'une expérience idéale des soins. La méthode phénoménologique descriptive « Investigation Relationnelle Caring ¼ a été utilisée auprès de douze participants dont le récit a été recueilli, pour chacun, au moyen de trois entrevues individuelles semi-dirigées. Cela a permis d'élucider l'essence globale de leur expérience des soins, résumée comme « le sentiment d'avoir bénéficié d'un accompagnement du corps et de l'esprit dans une dynamique humaniste-caring, mais d'éprouver cependant des difficultés à retrouver un nouvel équilibre, liées à des facteurs organisationnels et environnementaux ¼. Quant à l'essence de leur expérience idéale des soins, elle consiste à « bénéficier d'un accompagnement du corps et de l'esprit par des professionnels compétents, dans un climat humaniste-caring, et une dynamique de partenariat avec le patient et ses proches, dans une institution accueillante sur le plan organisationnel et environnemental. ¼ Partant de ces résultats, il semble important de limiter les contraintes organisationnelles pour consolider la dynamique humaniste-caring, de développer le partenariat patient et de porter une attention particulière aux proches des patients, qui se traduise par un accompagnement structuré.