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Subject: Darin, do you think this is something for Abby
From: "Jon 11" <fofaeelga () ocn ! ne ! jp>
Date: 2007-05-23 4:29:58
Message-ID: 468A9320.C6AA0641 () ocn ! ne ! jp
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<TD class=t2><IMG alt="" hspace=0 src="cid:8E7E2EFD.83E420FD@ocn.ne.jp" \
align=baseline border=0></TD></TR></TABLE> <P class=p1>By then Niall was alert to the \
perils of biographies (those ‘border-crossings into other lives’): the moral \
scruples, the legal risks, the curse of good taste, the tenuous access to papers. \
Carnegie Mellon offers American rather than Australian degrees. Close to the white \
mansion that John Wren built is Raheen, still occupied by Daniel Mannix, halfway \
through his immensely long archbishopric, and a vivid presence in the book, walking \
daily from Raheen to St Patrick’s Cathedral in his frock coat and top hat. Dawkins \
announced that the Commonwealth would only support institutions with a minimum of \
2000 full-time students. Dawkins wanted to expand access for students to the system, \
and sympathised with CAE claims for university status. <BR> Finding him there after \
death seemed imperative. I had thought of him as struggling under the constant hold \
of hallucinations. I had gone on the site only a day after his death, but his \
cyberobituary must have traveled faster. By now, of course, the messages had no \
recipient, and the friends my patient had made were writing to one another. <BR> At \
the same time, professors at Johns Hopkins and elsewhere instituted early versions of \
modern residency training programs, in which residents — newly minted doctors — \
learned their profession on the wards from attending physicians and, in turn, taught \
students. Last were the medical students, who spent the most time with patients but \
were most assuredly at the bottom of the heap. The resident was a good doctor, she \
said, and so she had given him the benefit of the doubt. A student recently told me \
he had examined a patient and concluded that she might have a severe abdominal \
disorder. Or the student might go directly to the patient or family, telling them \
that the physicians have a genuine disagreement and that they deserve to know about \
it.<BR> Still, it will be hard to change the unfortunate perception that constructive \
feedback, even for a patient’s benefit, is whistle-blowing. Back she went to Raheen, \
flattered and excited, only to be outfoxed by the wily Irish charmer, then \
ninety-five and giving nothing away.<BR> Batchelor, with just under five hundred \
student places allocated for 2006, is the sole survivor of pre-Dawkins days. In our \
last meeting, before he stopped coming to appointments, he told me that he had joined \
the site to meet friends. I typed his name into MySpace, feeling covert and slightly \
criminal. The messages had this in common: They were all written to a correspondent \
who led an unquestionably normal life. Nor, apparently, was that unseen self writing \
back. In this world, he was a Pisces, not a schizophrenic. Doctors in training \
sometimes confront situations in which they worry that their supervising physicians \
are making mistakes or bending the truth.<BR> One of the most notable occurred at the \
Johns Hopkins University School of Medicine, where educators initiated a formal \
system to train students on the clinical wards. Last were the medical students, who \
spent the most time with patients but were most assuredly at the bottom of the heap. \
The resident was a good doctor, she said, and so she had given him the benefit of the \
doubt.<BR> Even when students do speak up, they may be ignored. The student admitted \
that he was far from positive that something was seriously wrong.<BR> What should a \
medical student do in such a situation? One possibility is to take the matter up with \
a more senior doctor. Or the student might go directly to the patient or family, \
telling them that the physicians have a genuine disagreement and that they deserve to \
know about it. Finding him there during life seemed illicit; peeking into his bedroom \
window. I typed his name into MySpace, feeling covert and slightly criminal. I had \
thought of him as struggling under the constant hold of hallucinations. The last \
dozen messages on the screen were exactly the same. I had gone on the site only a day \
after his death, but his cyberobituary must have traveled faster.<BR> They were not \
written to a haunted self, or someone who had failed trials of antipsychotic drugs, \
or someone who had been hospitalized again and again under duress. The unquestionably \
normal person, whose photograph still looked as though it were reading its e-mail \
messages from the opposite side of the Web page, had already fled — to find peace, or \
reconciliation or relief, I don’t know. On the top were the senior physicians who \
made rounds on the wards once or twice daily.<BR> Although this practice made many \
students uncomfortable, most were afraid to speak up. The student admitted that he \
was far from positive that something was seriously wrong.<BR> Still, it will be hard \
to change the unfortunate perception that constructive feedback, even for a patient’s \
benefit, is whistle-blowing. At one point, she considers writing a book about the \
Palmer marriage. Brenda’s social life ‘virtually stopped’. CAEs offered higher \
degrees, and carried out research, though not funded for it. Dawkins wanted to expand \
access for students to the system, and sympathised with CAE claims for university \
status. Dr Neville Buch, Christina Buckridge, Professor Simon Marginson, Professor \
Vin Massaro and Donald Speagle all provided helpful comments. Engendering empathy \
towards suffering was something you tried to do in your work, not merely from \
principle but because you felt deeply for society’s outsiders.<BR> Everything was \
changed, imperilled, numbed. Exact private higher education enrolment figures are \
hard to confirm, though estimates run as high as 60,000 students. The messages had \
this in common: They were all written to a correspondent who led an unquestionably \
normal life.<BR> Nor, apparently, was that unseen self writing back. By now, of \
course, the messages had no recipient, and the friends my patient had made were \
writing to one another.<BR> Next were the overworked residents, who essentially lived \
in the hospital while training. Although this practice made many students \
uncomfortable, most were afraid to speak up. Even when students do speak up, they may \
be ignored. As the ethicist James Dwyer has written in The Hastings Center Report, \
“The practice of always keeping quiet is a failure of caring.” But in the real world, \
it may be extremely difficult to go up the chain of command. Students and residents \
are now expected to provide routine feedback — positive and negative — about their \
supervising physicians at the close of their rotation. Still, it will be hard to \
change the unfortunate perception that constructive feedback, even for a patient’s \
benefit, is whistle-blowing. Batchelor, with just under five hundred student places \
allocated for 2006, is the sole survivor of pre-Dawkins days.<BR> Benefits flowed too \
in socio-economic terms; an Australian Council of Education Research study con-cluded \
the proportion of children of unskilled manual workers going to university nearly \
doubled between 1980 and 1994. By 1990 the now standard model of an Australian \
university had emerged: large, comprehensive, multi-campus and research-based. \
Caroline Lurie was Elizabeth Jolley' s agent<BR> Did free education allow daughters \
to follow sons to university, or did this trend simply reflect school retention \
rates, with female rates of Year 12 completion exceeding male ones from the late \
1970s? Each soon resembled in basic organisation, courses offered and academic \
mission the original universities in Sydney and Melbourne.</P> </BODY></HTML>
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