The Bitter Pill podcasts: Recent Episodes
Mallika Sekhar
How do doctors think and take clinical decisions during times of prolonged uncertainty?
'The Bitter Pill' podcasts explore this theme using examples from the 1980's when patients with hemophilia contracted HIV and hepatitis from their treatment with blood plasma. For four years, between 1982 and 1985 hemophilia doctors struggled with the challenges posed by HIV in their patients and how to modify their treatments. This is a critical period in medical history because of the suffering and death of so many people brought on by medical treatment.
The aim of this podcast series is to learn about the serious dilemmas of health professionals in the 1980s and help reflect on clinical practice. They will provoke the listener - the medical student and contemporary health professionals - to contextualise situations that are universal in medical practice across cultures.
Mallika Sekhar MBBS, MD, FRCPath, FRCP is a physician and haematologist trained in India and The U.K. She is currently a Consultant Haematologist at the Royal Free Hospital and UCL Hospitals and Honorary Associate Professor at University College London. https://www.royalfree.nhs.uk/services/staff-a-z/dr-mallika-sekhar/
Italy has a distinctive place in the world of Haemophilia. In this episode, we hear the reflections of two physicians from Italy as they talk about the difficulties they experienced as doctors and how being part of the solution sustained them through the difficult years.
Through the years of evolving knowledge, how did doctors think, feel, and communicate? How did optimism and reassurance work? How was knowledge handled? And how do they feel about it now? In this episode, we hear them talk about how they dealt with those years. We hear about what the younger doctors thought about their senior colleagues. We hear about the impact of those years now.
How do doctors share decision-making with their patients?
This episode addresses paternalism, patient-centredness, and the axes of shared care in practice, including the care of the dead. It then discusses the notion of clinical freedom and the role of professional networks in shaping thought and practice. It ends with comments on the precautionary approach in medicine and the changing perception of negligence.
The severity of the AIDS epidemic differed across countries. In this episode, we explore events in the Netherlands. The Netherlands had a relatively low level of severity and three haematologists discuss how that situation may have come about. One of them, a trainee doctor at that time, reflects on her experience and how it has shaped her as a doctor and a teacher, and why memories matter. The episode ends with a reflection on the nature of apology.
Once HIV was recognized as an evolving problem in their patients, haemophilia doctors had to make decisions on how to modify their treatments, how to balance safety with effectiveness. This period lasted a couple of years while heat treatment technology was developed as an effective means of eliminating HIV in donated plasma.
This episode deals with the dilemmas in evaluating treatment options and making decisions about treatment during this period of evolving knowledge. When presented with the same level of data and evidence, how do our decisions differ?
Stay tuned for next Sunday's episode 'Amsterdam'.
What are the dilemmas confronting a doctor in testing for an infection about which knowledge is still evolving? We heard from Professor Allain in the previous episode on how he was a 'good soldier' as he grappled with the problem of how to communicate results to his patients.
In this epidode we take a deeper look at this essential aspect of clinical care. When a new test becomes available for a newly identified infection, how are medical responses shaped? What have we learnt from the 80s?
Stay tuned for next Sunday's episode 'Decision time'.
The societal impact of transfusion-transmitted infection of HIV varied across countries. In this episode, we discuss the impact in France. Professor Jean-Pierre Allain talks about the clinical and personal predicaments of that time.
This episode is a brief introduction to the series. What the series is about, why I made it and why it matters.