Michael A. Simpson

Studying death: Problems of methodology

Abstract The methods and problems of research in relation to the psychology of death are reviewed, including ethical difficulties, the conceptual poverty and oversimplification of most rating systems, and an overemphasis on anxiety and fear rather than other dimensions or multidimensional techniques. It is suggested that more attention be paid to studying the changes resulting from death education or therapy and their relation to modes of denial.

Occupational Hazards in Medical Education

Attention to public health issues, to occupational and work-place health hazards, has never been substantial within medical schools. When such issues are discussed, the examples used often seem remote and less than cogent to medical and nursing students. Yet highly relevant instances are available very close at hand, and deserve closer study. Hospitals and medical schools may be very concerned about the promotion and maintenance of health elsewhere, but there is reason to believe that they do not provide a healthy work environment for their own students and staff. In America, attention is beginning to be focussed on these concerns, as shown by a recent leading article’ in The New Physician (Journal of the American Medical Student Association): controversy over new and stricter standards of tolerable levels of ethylene oxide in hospitals; studies of possible carcinogenic and mutagenic effects of the ubiquitous formaldehyde and formalin exposure in medical schools; the start of programmes administering hepatitis B vaccine to medical students and residents as ‘high-risk groups’ for that disease; and the imminent publication of the Federal government’s first comprehensive health and safety manual for hospital workers, which is expected to emphasize concerns that the health risks of hospital workers have been underestimated. Other areas of current concern include radiation hazards (although precautions and protections are generally defined and available, they are not always followed or used appropriately); back strain from lifting patients; exposure to infections and to violent patients; inhalation of and skin contamination by toxic substances, dyes, xylene, Freon, needle puncture wounds, anaesthetic waste gases; and falls, fires and crime. For example, what is the extent and effect of cumulative casual x-ray exposure, from portable x-ray machines, on the many hospital workers who do not wear exposure indicators or protective garments? The forthcoming Health and Safety Manual for Hospital Workers, due to be published by the National Institute of Safety and Health (NIOSH), identifies a range of infectious diseases as occupational hazards in hospitals and medical schools, including hepatitis €3. tuberculosis, cytomegalovirus, rubella, mumps, herpetic whitlow, chickenpox, mononucleosis, respiratory syncytial virus, and influenza. A recent study found that 12.2 per cent of new house staff showed serological evidence of previous hepatitis B infection, as well as a significant proportion of recent converters of tuberculosis skin tests. An Ontario study found tuberculosis morbidity to be higher among medical house-staff than in any other group of hospital workers, and nearly seven times higher than the population average. Reproductive risks from exposure to potential teratogens and embryotoxic agents, especially among pregnant students and housestaff, rarely receive serious attention. Mutagenic effects can occur in both men and women. Then there are the more widely recognized

The Lady Vanishes …. or Getting Rid of the Body

When a death occurs in a public institution such as a hospital, one of the problems that arises is how to dispose of the body in a manner congruent with the way in which death itself is conceptualized and handled in the institution. There is general agreement that the body should be prepared and moved in a seemly and proper fashion, and according to due procedure. By looking at these procedures, we can gain a clearer conception of current professional attitudes towards death.

The Problem with POMR

In this article, Dr Michael Simpson argues the case against unquestioning acceptance of problem orientated medical records, in reply to the article which appeared in the last issue of Medicd Teacher (1979, 1, 147-1511.