“Do Your Homework…and Then Hope for the Best”: The Challenges that Medical Tourism Poses to Canadian Family Physicians’ Support of Patients’ Informed Decision-Making

Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Conclusions Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad

Saving Africa: A critical study of advocacy and outreach initiatives by university students

This exploratory qualitative study reports on the perspectives of students belonging to campus clubs at one Canadian university who conduct advocacy activities on issues that relate to Africa. Our study focuses on a particular social action (advocacy) that takes place in a particular social site (university campus), with the aim to critically examine how students think about their advocacy work, what they see as appropriate practices, and their sense of the ethical issues around advocacy. Five themes emerged from our analysis of the interviews: 1) Knowledge about the issues; 2) Oversimplification; 3) Homogenisation; 4) Trade-offs and competition; and 5) Ethical engagement. Our findings indicate that the motivation for success and popularity became influential factors in the way that student-led advocacy initiatives were set out to be effective in the university setting. Advocacy activities thus became fraught with the oversimplification of issues, resulting in work that reinforced prevailing stereotypes about Africa. Such approaches to advocacy can propagate paternalistic and totalising images of Africans as helpless and waiting to be 'saved'

Political Self-characterization of U.S. Medical Students

BACKGROUND: There have been no prior studies of the political self-characterization of U.S. physicians-in-training, and little is known about physicians’ political leanings or the critical relationship between medical issues and political orientations of physicians and physicians-in-training. METHODS: All medical students in the class of 2003 at 16 nationally representative U.S. schools were eligible to complete three questionnaire administrations (at freshman orientation, entrance to wards, and senior year). RESULTS: Among these medical students, 5% self-characterized as politically very conservative, 21% conservative, 33% moderate, 31% liberal, and 9% as very liberal.” Being male, white, Protestant, intending to specialize in Surgery or anesthesiology/pathology/radiology, or currently or previously being married significantly (P ≤ .001) increased the likelihood that a student self-identified as very conservative or conservative. Disagreement or strong disagreement with the statements, “I’m glad I chose to become a physician” and “Access to care is a fundamental human right,” were also both associated with being very conservative or conservative. Being more liberal was reported by blacks and Hispanics; those intending to become ob-gyns, psychiatrists, and pediatric subspecialists; and atheists, Jews, and adherents of eastern religions. CONCLUSIONS: U.S. medical students are considerably more likely to be liberal than conservative and are more likely to be liberal than are other young U.S. adults. Future U.S. physicians may be more receptive to liberal messages than conservative ones, and their political orientation may profoundly affect their health system attitudes

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern

Which New Approaches to Tackling Neglected Tropical Diseases Show Promise?

This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expense of attention to the social determinants of disease. Burton Singer argues that this represents another example of the inappropriate “overmedicalization” of contemporary tropical disease control. Peter Hotez and colleagues, in contrast, argue that the best return on investment will continue to be mass drug administration for NTDs

Medical educators’ experience of anticipated curricular change to case/problem-based learning and its relationship to identity and role as teacher

Little is known about medical educators' experience of curricular change to problem-based learning and its relationship to identity and role as teacher. The adoption of novel approaches to teaching and learning in medical education requires educators to consider a significantly different role and responsibilities as teacher. This possibly will require substantial changes in ways of thinking about education. Those involved in such curricular reform are challenged to understand better how complex interactional processes and epistemological positions affect educators involved in change. This study used a phenomenographic research approach to explore and describe how the phenomenon of the experience of curricular change is interpreted by those who teach within one curriculum and are being moved to another. Essentially, the aim was to determine where a sampling of ten medical educators are in the position of curricular change and how they are trying to find their identity and role within it. Findings present how the educators experienced, explained and dealt with change, and how they framed their experience and made sense of it. As such, this study found how at times participants resisted change, how they supported it, and shifted ground within it. The educators' interpretations of curricular change and understanding of identity and role as teacher were facilitated by and dependent upon their criterion for judging the legitimacy of change. In articulating their thoughts, participants focused their discussions on issues of effectiveness. The term effectiveness was classified as a theme from which emerged the following categories: (1) beliefs about teaching, learning and evaluation; (2) the perceived time cornmitments required to plan, implement and sustain the new curriculum; and (3) administrative and political influences effecting curricular change. These were the three different, yet interlinked categories or influences that mediated the educators' responses to the different situations within the phenomenon of curricular change.Dentistry, Faculty ofGraduat

Discursive constructions of social responsibility

There is a widespread concern that the dental health care system in North America sustains an inequitable opportunity for accessing care. In response, the term social responsibility appeared in the dental literature, but it is not clear how it is understood and enacted, particularly within the context of a growing desire to enhance access to oral-health care through an affordable, equitable and practical system of delivery. Using an interpretive ethnographic approach, and the analytical and critical techniques of discourse analysis, I studied how 34 participants, comprising dental educators, dentists in private practice, and those in leadership and governance of dentistry, spoke about and accounted for social responsibility in relation to their sense of how the dental health care system operates or should operate and why they see and do things in one way and not another. Competing professional, social, economic, and political views unveiled the moral and practical explanations the participants used to justify their position on social responsibility in dentistry. My findings reveal four competing discursive constructions of social responsibility in dentistry, situated within discursive spaces intersected by individual and collective notions of social responsibility on the one hand, and the acceptance and challenge of the status quo on the other. Each space occupies a range of accounts to explain, rationalize and justify particular viewpoints on social responsibility. The responsibility to treat pain, regardless of compensation, was a social responsibility that was held sacrosanct, and considered a widely accepted code among dentists generally and within dentistry in particular. It provided an agreed upon discursive space in talking and thinking about social responsibility. Problems emerged when particular discursive constructions of social responsibility took on a sense of what was considered so 'natural' and conclusive so as to be unassailable from any other position. There is an obvious tension between competing discourses and the associated constraints and challenges of accepted and dominant norms within dentistry, and the participants' sense of their rights and responsibilities.Graduate and Postdoctoral StudiesGraduat