BACKGROUND: An array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students\' awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students\' reflection on the way in which social position modulates their relationship to patients.
METHODS: As part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students\' assignments (n=76), applying a thematic analysis framework.
RESULTS: Medical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students\' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias.
CONCLUSIONS: Gender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.

This essay challenges the idea of progress as technological development in relation to medicine by focusing on people rather than things. It analyzes how the prevalence of such an idea of progress leads contemporary societies to a technofetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use, that the main motive of technological development is unlimited profit, and the priority developments are those that enhance social control which maintains the status quo. Intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and acting of human beings in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life, which contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the latest creation of technofetishism, which deposits vital attributes in technology, and that its use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization that is conducive to the development of inquisitive, critical, and collaborative skills that promote permanent improvement, whose distant horizon is dignified progress: the spiritual, intellectual, moral, and convivial sublimation of collectivities in harmony with the planetary ecosystem.
Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta: que la realización de las potencialidades tecnológicas depende de sus formas de uso; que el móvil principal del desarrollo tecnológico es el lucro sin límites y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

This essay questions, with regard to medicine, the idea of progress as technological development by focusing on people rather than things. It analyzes how the predominance of such an idea of progress converts today\'s societies to techno-fetishism that degrades community life and medical practice, contributing to the medicalization of social life. It is argued that the realization of technological potentialities depends on their forms of use; that the main motive of technological development is unlimited profit and that priority developments are those that enhance the social control that maintains the status quo. The intelligence as an intelligence quotient is criticized by proposing it as an attribute of the human being as a whole, manifested in the ways of thinking and proceeding of people in their circumstances, where affectivity and critical thinking are essential for their development; it is emphasized that its antecedent is the harmonic concert of planetary life that contrasts with the prevailing human disharmony. It is proposed that artificial intelligence is the most recent creation of techno-fetishism that deposits vital attributes in technology and that its forms of use will accentuate the degradation of human and planetary life. Another idea of medical progress is proposed, based on forms of organization conducive to the development of inquisitive, critical and collaborative skills that promote permanent improvement, whose distant horizon is dignifying progress: spiritual, intellectual, moral and convivial sublimation of collectivities in harmony with the planetary ecosystem.
Este ensayo cuestiona, a propósito de la medicina, la idea de progreso como desarrollo tecnológico al centrarlo en las personas y no en las cosas. Se analiza cómo el predominio de tal idea de progreso convierte a las sociedades actuales al tecno-fetichismo que degrada la vida comunitaria y la práctica médica contribuyendo a la medicalización de la vida social. Se argumenta que la realización de las potencialidades tecnológicas depende de sus formas de uso, que el móvil principal del desarrollo tecnológico es el lucro sin límites, y que los desarrollos prioritarios son los que potencian el control social que mantiene el statu quo. Se critica la idea de inteligencia como cociente intelectual al proponerla como atributo del ser humano como un todo, manifiesto en las formas pensar y proceder de las personas en sus circunstancias, donde la afectividad y el pensamiento crítico son imprescindibles para su desarrollo. Se destaca que su antecedente es el concierto armónico de la vida planetaria contrastante con la disarmonía humana imperante. Se plantea que la inteligencia artificial es la más reciente hechura del tecno-fetichismo que deposita en la tecnología atributos vitales, y que sus formas de uso acentuarán la degradación de la vida humana y planetaria. Se propone otra idea de progreso médico basado en formas de organización propicias para el desarrollo de aptitudes inquisitivas, críticas y colaborativas que impulsen la superación permanente, cuyo horizonte lejano es el progreso dignificante: sublimación espiritual, intelectual, moral y convivencial de las colectividades en armonía con el ecosistema planetario.

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Cancer therapy, especially for tumors near sensitive areas, demands precise treatment. This review explores photodynamic therapy (PDT), a method leveraging photosensitizers (PS), specific wavelength light, and oxygen to target cancer effectively. Recent advancements affirm PDT\'s efficacy, utilizing ROS generation to induce cancer cell death. With a history spanning over decades, PDT\'s dynamic evolution has expanded its application across dermatology, oncology, and dentistry. This review aims to dissect PDT\'s principles, from its inception to contemporary medical applications, highlighting its role in modern cancer treatment strategies.

Opioid dependence and overdose are serious public health concerns. States have responded by enacting legislation regulating opioid-prescribing practices. Through in-depth interviews with clinicians, state officials, and organizational stakeholders, this paper examines opioid prescribing limits legislation (PLL) in North Carolina and how it impacts clinical practice. Since the advent of PLL, clinicians report being more mindful when prescribing opioids and as expected, writing for shorter durations for both acute and postoperative pain. But clinicians also report prescribing opioids less frequently for acute pain, refusing to write second opioid prescriptions, foisting responsibility for patient pain care onto other clinicians, and no longer writing opioid prescriptions for chronic pain patients. They directly credit PLL for these changes, including institutional policies enacted in response to PLL, and, to a lesser degree, notions of \"do no harm.\" However, we argue that misapplication of and ambiguities in PLL along with defensive medicine practices whereby clinicians and their institutions center their legal interests over patient care, amplify these restrictive changes in clinical practice. Clinicians\' narratives reveal downstream consequences for patients including undertreated pain, being viewed as drug-seeking when questioning opioid-prescribing decisions, and having to overuse the medical system to achieve pain relief.

This study examined variation in medical practitioners\' practice-based conceptions of what it means to be a doctor, based on interviews with 30 clinicians who were also medical educators. Participants included general practitioners, surgeons and physicians (non-surgical specialists). Participants were asked to draw a concept map of \'being a doctor\', followed by semi-structured interviews using a phenomenographic research design. Three conceptions were identified, varyingly focused on (1) treating patients\' medical problems; (2) maximising patients\' well-being; and (3) maximising community health. Each conception was distinguished by variation in awareness of six underlying dimensions of being a doctor: (1) doctors\' actions; (2) treatment success; (3) patients\' actions; (4) patients\' well-being; (5) community needs; and (6) social justice. Whilst all participants included dimensions 1 and 2 in their described practice, numerous participants did not include dimensions 3 and 4, i.e. did not take the patients\' role and the impact of patients\' psychosocial context into account in their practice. This is concerning, especially amongst medical educators, given the widely acknowledged importance of patient-centred care in medical practice. Similarly, only some of the participants considered community health needs and felt a broader social responsibility beyond their responsibility to individual patients. These findings highlight aspects of the medical profession that need to be further emphasised in medical training and continuing professional development.

While sexual boundary violations by doctors (SBVs) are viewed with utmost seriousness by disciplinary bodies and tribunals, complaints of SBVs in Australia continue to increase. In 2023, the Australian Health Practitioner Regulation Agency (Ahpra) outlined a \"blueprint\" to protect patients better from sexual misconduct in healthcare: reform being considered in 2024, by Australian health ministers. Few analyses or studies have offered an overview of the prevalence, effects, and causes of SBVs, nor the duties, liabilities, possible disciplinary action against, and potential treatment of, doctors who commit them. This column offers such an overview, and considers, additionally, whether doctors who may have psychiatric disorders associated with their boundary violations would be suitable candidates for treatment. Ultimately, we contend that a purely \"responsive\" approach is inadequate, and preventive measures such as screening and more effective education should be considered in medical schools as a way of reducing the incidence of SBVs.

Since 2023, ChatGPT has been leading a research boom in large language models. Research on the applications of large language models in various fields is also being explored. The aim of this study was to explore the use of ChatGPT/GPT-4 for post-surgery patient follow-up after oral surgery. Thirty questions that are the most commonly asked or may be encountered during follow-up and in daily practice were collected to test ChatGPT/GPT-4\'s responses. A standard prompt was used for each question. The responses given by ChatGPT/GPT-4 were evaluated by three experienced oral and maxillofacial surgeons to assess the suitability of this technology for clinical follow-up, based on the accuracy of medical knowledge and rationality of the advice in ChatGPT/GPT-4\'s responses. ChatGPT/GPT-4 achieved full marks in terms of both the accuracy of its medical knowledge and the rationality of its recommendations. Additionally, ChatGPT/GPT-4 was able to accurately sense patient emotions and provide them with reassurance. In conclusion, ChatGPT/GPT-4 could be used for patient follow-up after oral surgeries, but this should be done with careful consideration of the technology\'s current limitations and under the guidance of healthcare professionals.

BACKGROUND: In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors\' attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors\' EBM-SDM learning and practice; and to examine how supervising consultants\' attitudes and authority impact on junior doctors\' opportunities for EBM-SDM learning and practice.
METHODS: We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors\' EBM-SDM learning and practice.
RESULTS: Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors.
CONCLUSIONS: These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.