The heat produced by some endoscopes is sufficiently great to cause thermal injury to tissues. Awareness of the temperatures produced by these endoscopes should prompt clinicians to actively cool their endoscopes during a procedure, before any thermal injury is caused.
The term ‘minimally invasive’ was coined in 1986 to describe a range of procedures that involved making very small incisions or no incision at all for diseases traditionally treated by open surgery. We examine this major shift in British medical practice as a means of probing the nature of surgical innovation in the twentieth century. We first consider how concerns regarding surgical invasiveness had long been present in surgery, before examining how changing notions of post-operative care formed a foundation for change. We then go on to focus on a professional network involved in the promotion of minimally invasive therapy led by the urologist John Wickham. The minimally invasive movement, we contend, brought into focus tensions between surgical innovation and the evidence-based model of medical practice. Premised upon professional collaborations beyond surgery and a re-positioning of the patient role, we show how the movement elucidated changing notions of surgical authority.
Sixty-nine per cent of patients undergoing primary surgery experienced post-operative numbness. Twenty-six per cent had continued numbness after at least eight months' recovery, but only 3 per cent were constantly aware of the deficit. Of those with an ongoing deficit, 78 per cent felt there had been a reduction in the severity, and 67 per cent in the area size, over time. Recovery appeared to be slightly worse in revision cases.
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In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific ‘character’. In the late nineteenth century, an ideal of the medical student as ‘born not made’ was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of ‘character’ becomes ‘characteristics’. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors’ education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.
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