Re: Doctor Who Decalog Pdf Free
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Strategies to improve doctor-patient communication may have a beneficial impact on patient's illness experience and mood, with potential favorable clinical effects. We prospectively tested the psychometric and clinical validity of the Decalogue, a tool utilizing 10 communication recommendations for patients and physicians. The Decalogue was administered to 100 consecutive patients referred for a cardiologic consultation, whereas 49 patients served as controls. The POMS-2 questionnaire was used to measure the total mood disturbance at the end of the consultation. Structural equation modeling showed high internal consistency (Cronbach alpha 0.93), good test-retest reproducibility, and high validity of the psychometric construct (all > 0.80), suggesting a positive effect on patients' illness experience. The total mood disturbance was lower in the patients exposed to the Decalogue as compared to the controls (1.4 12.1 versus 14.8 27.6, p = 0.0010). In an additional questionnaire, patients in the Decalogue group showed a trend towards a better understanding of their state of health (p = 0.07). In a cardiologic ambulatory setting, the Decalogue shows good validity and reliability as a tool to improve patients' illness experience and could have a favorable impact on mood states. These effects might potentially improve patient engagement in care and adherence to therapy, as well as clinical outcome.
Which of the Ten Commandments is under discussion in the second part of the Dekalog? We might be forgiven for thinking that it is adultery, or even murder, as many of the Dekalog stories contain an overlap in the Commandments. Once you break one Commandment, it is easy to break another.
Krzysztof Kieślowski offers no clues, as he did not wish for discussion of any of the Dekalog stories to be limited to a narrow interpretation. In most of the stories he is not saying that breaking a Commandment is necessarily wrong, or even right. Still we can loosely assign a Commandment to each part, and this time the Commandment is: Thou shalt not take the name of the Lord thy God in vain.
Two characters dominate the story. Both have the chance to decide the life of another. Is it right to play God and intervene in a manner that will affect the happiness, or even existence, of other people? Are there circumstances in which it is wrong to not play God? What if other people need you to do so?
The first of the two characters mentioned is an ageing hospital doctor (Aleksander Bardini). Like the Christian god, he is not given a name in the story. He lives in the inhospitable high-rise apartment complex, where all the central characters in the Dekalog dwell. The doctor has an apartment to himself, and lives alone with his bird, and his plants.
We might think that the doctor is an unfriendly and unsympathetic person when we first see him. He does show warmth to his cleaning lady, and slowly imparts the story of his life to her in instalments. None of this warmth is present during a brief exchange he has with Dorota Geller (Krystyna Janda), a violinist who lives in the same building.
There are two ethical problems here. Should Dorota have a child, knowing there is a danger her husband will recover, or should she terminate her pregnancy, with the risk that her husband will die, and she will lose the chance to be a mother? As Poland is a Catholic country, there is the added problem about whether abortion is morally wrong or not. It is not just the marriage of Dorota that is at stake; it is also the life of an unborn child.
Then there is the dilemma of the doctor. Should he avoid playing God, and giving Dorota a decisive answer either way, knowing that she will either end her pregnancy unnecessarily, or else she will have a child that she cannot explain to her husband if he recovers? However what does a doctor do when a patient needs him to help her with her choice? Should he give her the best answer that he can?
Discussion of God or religion is rare in the Dekalog. Asked whether he believes in God, the doctor only affirms that he has a private god. We learn more about the doctor from his conversations with his cleaner, and as is often the case in Kieślowski stories, the more we discover about a character the more we begin to empathise with them.
Has the doctor made the right decision? Should he have remained impartial? Or told her that her husband would survive? The ending is ambiguous. In a manner familiar to anyone who has seen Three Colours: Blue, the camera tracks across the characters, cutting between them but in a seamless manner that connects their fates: the troubled doctor, the unhappy wife, and the husband struggling to survive.
Kieślowski focuses on a bee that has fallen in a glass of preserved strawberries that Dorota brought for Andrezj. The bee struggles for its life, like Andrezj, then finally climbs out of the glass, seemingly against the odds.
In fact Dorota has arguably already made the paradoxical choice to both keep the child and stand by her husband, so perhaps the doctor cannot be blamed too much. She angrily rejects an attempt by a friend of her husband to return his climbing gear, as this would acknowledge that Andrezj will no longer need it.
Dorota ignores phone calls from her lover, who is in another country. As in Three Colours: Red, this spatial distance between the two lovers reflects a growing emotional distance. She makes it clear to him that she might abort the child and will not be travelling to see him, even though she knows these decisions will end their relationship. Her lover helplessly says that he does not understand her.
There is no specific colour scheme in Dekalog: Two. Rooms are often shadowy and not well-lit, but not too dark either. Kieślowski employs several metaphors. Dorota cuts the leaves from a plant, leaving it looking shorn and half-dead, in contrast to the doctor who nurtures his plants.
We often see Dorota smoking, reflecting her anxious and passionate personality. Sometimes we see the flare of the match as it bursts into flame. Andrezj stares at the cracks in a wall where water drips through, reflecting his tenuous hold on life, and perhaps the possibility he will break through.
As in other parts of the Dekalog, no easy answers are offered. Still there is something optimistic about the ending. Dorota chooses love and life, even when she is uncertain of the consequences of her decision.
She hounds him outside of work and home (he amusingly finds himself trying to give her the slip when she tails him in her car) and upon coming home one evening, the near-immediate doorbell prompts him to turn around a family photo, such is his confidence that Dorota will be the unexpected visitor.
So if the doctor does believe in God (or at least a God), or indeed the Commandments have any bearing on our lives, what persuades him to swear on a falsehood when provoked (Thou shalt not take the name of the Lord thy God in vain)? Here we find the moral greys of the issue.
As with most episodes of Dekalog, water figures into the visual tapestry. At the hospital, extreme closeups are granted to the dripping interiors, hardly instilling confidence in the quality of the treatment. The drips are witnessed by Andrzej alone, who has precious little else to occupy his senses whilst languishing in a pained delirium. The water seems in from unforgivably massive cracks in the plaster, occasionally dripping onto his face, momentarily stirring him from his reverie.
Water is not the only liquid that becomes subtly important to this episode. As with much of the Dekalog, milk, often symbolic of motherhood, finds its way into the story when we see the doctor going out to purchase it in the morning, then drinking it in his apartment later. In true Kieslowskian fashion, had he not happened to venture out when he did to make such a purchase, he and Dorota might not have made any connection as it is doubtful she would know his address otherwise, given that she essentially roots to the spot from before he leaves to his return. Note that Dorota, the questionable expecting mother, is never seeing drinking it.
When Barbara sits with the doctor for his storytelling, they imbibe tea together, making the enterprise less formal, despite his dispassionate report. Dorota intentionally smashes a full glass at home during of her long dark nights of the soul, simply to create some sort of impact that would at least break the monotony or to vent some frustration like she did with the houseplant.
The communication between physician and patient is a fundamental moment, in hospital and day-surgery setting, to learn important anamnesis information for the diagnosis, to establish a therapeutic relationship and so to protect treatment adherence of patient, and to inform patient and his/her relatives about disease course. Several obstacles impede these aims: the lack of an adequate formation of physician, during his/her study course, about verbal, para-verbal and non-verbal communication principles. The leanings is that of referring to a personal sensibility, that could be more or less present. The continuous pressure about the need of a contraction of hospitalization and waiting times for outpatient services that collides, at least apparently, with the possibility to have satisfying places to talk with patients. The lack of ambiental setting adequate to communicate to the patient and his/her relatives information often emotionally hard about disease.
Since many years, ASF has been sensitive to these problems, and has founded a Narrative Medicine Laboratory which conducted several research projects: in particular, NaMe (Narrative Medicine) project, and NaMe2 project (semi-structured interviews to patients, and analysis of videotaped talks physician-patient), that concentrated in Cardiology, Oncology and Emergency unit. Starting from these experience, we tried to summarize some practical advices concerning the correct communication approach from both doctor and patient. We analyzed, together with a psychologist and sociologist group, videotapes of cardiological visits conducted during NaMe2 project. From this analysis emerged interesting observations that, linked to the clinical everyday experience, induced to draft this Decalogue of aspects not to forget in physician-patient communication.
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