Male Physicians Research Articles

Gender-based differential management of acute low back pain in the emergency department: A survey based on a clinical vignette.

Women may receive suboptimal pain management compared with men, and this disparity might be related to gender stereotypes. To assess the influence of patient gender on the management of acute low back pain. We assessed pain management by 231 physicians using an online clinical vignette describing a consultation for acute low back pain in a female or male patient. The vignette was followed by a questionnaire that assessed physicians' management decisions and their gender stereotypes. We created an online clinical vignette presenting a patient with acute low back pain and assessed the influence of a patient's gender on pain management. We investigated gender-related stereotyping regarding pain care by emergency physicians using the Gender Role Expectation of Pain questionnaire. Both male and female physicians tended to consider that a typical man was more sensitive to pain, had less pain endurance, and was more willing to report pain than a typical woman. These stereotypes did not translate into significant differences in pain management between men and women. However, women tended to be referred less often for imaging examinations than men and were also prescribed lower doses of ibuprofen and opioids. The physician's gender had a modest influence on management decisions, female physicians being more likely to prescribe ancillary examinations. We observed gender stereotypes among physicians. Our findings support the hypothesis that social characteristics attributed to men and women influence pain management. Prospective clinical studies are needed to provide a deeper understanding of gender stereotypes and their impact on clinical management.

Influence of Job Satisfaction, Job Stress, Job Identity, and Job Values on Turnover Intention among Male Physician Assistant Nurses

Influence of Job Satisfaction, Job Stress, Job Identity, and Job Values on Turnover Intention among Male Physician Assistant Nurses

Factors that Influence Healthcare Professionals' Intentions towards Biosimilars.

Background: Physicians often prescribe original biologic products to patients who have not used them before and are reluctant to switch to biosimilars. Biosimilars are highly similar versions of already-approved biologics, but healthcare professionals typically hesitate to transition patients from the original products to biosimilars. This study aims to investigate the factors that influence U.S. healthcare professionals' intentions to use biosimilars. Methods: A cross-sectional study was conducted. 510 participants were eligible healthcare professionals (279 physicians and 231 pharmacists). The theory of planned behavior (TPB) is used to identify which factors affect healthcare professionals' intentions. Descriptive statistics, chi-square, and the logistic regression model tested the TPB constructs as predictors of intentions toward biosimilars. Results: Among 279 physicians, most were aged 61 and above, with high (n = 142) and low (n = 137) intentions. Male physicians constituted 71% of the population. Attending physicians (66.3%) showed consistent perceptions towards biosimilars, primarily in the private sector (76.3%). Pharmacists (n = 231), a higher percentage of females demonstrated higher intentions compared to males (35.5% vs. 28.1%); the majority were community pharmacists. Associations between years of practice and intentions were significant. Positive correlations existed between beliefs and intentions, except for normative beliefs. Conclusions: This study revealed diverse attitudes among healthcare professionals towards biosimilars in the USA. Pharmacists and physicians, especially those with limited experience, require ongoing education on biosimilar manufacturing pathways. This education supports the appropriate use of biosimilars and helps standardize federal and state legislation.

Does gender affect medical decisions?

It is rarely the case in medical practice that differences between female and male physicians can be described under ceteris paribus conditions. Physicians self-select their type of practice, patients self-select physicians, and physicians are expected to account for both the context and the characteristics of their patients when providing medical treatment. As a result, reported gender differences in medical practice can have several alternative interpretations. A key question, therefore, is whetherthe treatment of a given patient is expected to depend on the gender of the physician. To address this question, we quantify gender effects using data from an incentivized laboratory experiment, in which Chinese medical doctors and Chinese medical students choose medical treatment under different payment schemes. We estimate preference parameters of females and males assuming decision makers have patient-regarding preferences. We cannot reject the hypothesis that gender differencesin treatment choices are absent. The differences between preference parameters of females and males are not statistically significant, and there is no evidence that the degree of randomness in choices differs between genders. The absence of gender effects in the laboratory, where choice context is fixed, provides nuance to previous findings on gender differences, and highlights the general difficulty of separating individuals’ behavior from their context.

Association of primary care visit length with outpatient utilization, continuity, and care processes.

Little is known about how variation in the scheduled length of primary care visits can impact patients' patterns of health care utilization. To evaluate how the scheduled length of in-person visits with primary care physicians (PCPs) was associated with PCP and patient characteristics, outpatient utilization, and preventive care receipt. This retrospective cohort study examined data from a large American academic health system. PCP visit length template was defined as either 15- and 30-min scheduled appointments (i.e. 15/30), or 20- and 40-min scheduled appointments (i.e. 20/40). Of 222 included PCPs, 85 (38.3%) used the 15/30 template and 137 (61.7%) used the 20/40 template. The 15/30 group had higher proportions of male (49.4%, vs. 35.8% in the 20/40 group) and family medicine (37.6% vs. 21.2%) physicians. In adjusted patient-level analysis (N = 238,806), having a 15/30 PCP was associated with 9% more primary care visits (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 1.03-1.14), and 8% fewer specialty care visits (IRR, 0.92; 95% CI, 0.86-0.98). PCP visit length template was not associated with significant differences in obstetrics/gynaecology visits, continuity of care, or preventive care receipt. In interaction analyses, having a 15/30 PCP was associated with additional primary care visits among non-Hispanic White patients (IRR, 1.10; 95% CI, 1.04-1.16) but not among non-Hispanic Black patients. PCPs' choices about the scheduled length of in-person visits may impact their patients' specialty care use, and have varying impacts across different racial/ethnic groups.

Innovative telemedicine technology usage in rare diseases management in primary care in a COVID-19 pandemic era: Lessons learnt and recommendations for future practice

COVID-19 affected routine healthcare significantly and impaired the capability of healthcare organizations to deliver quality healthcare to achieve expected patient outcomes, including the care of patients with rare diseases. The rationale for this review is to highlight the important contribution of telemedicine technology to improving care quality of patients with rare diseases in a pandemic era. Aims and Objective: To explore the role and impact of telemedicine digital technology usage and user satisfaction in patients with rare diseases in the last two years since the COVID-19 pandemic. Methodology: An electronic database search was conducted using the PRISMA guide with search terms ‘telemedicine’ and ‘rare diseases’ in the last 2 years since the COVID-19 pandemic. The final search identified about 10 papers after screening, applying the exclusion criteria and sorting for eligibility and relevance. Results: Of the 10 papers reviewed, 6 were research articles while 4 were review articles. For the research papers there were 5239 participants or responders in total, with 1476 (28.2%) patients, 50 (0.01%) carers and 3713 (70.9%) clinicians and workers. The average age recorded by 4 of the research papers was 43.4 years while one paper particularly emphasized that telemedicine digital technology was used preferably by clinicians below 50 years of age. 52.5% of Clinician and Worker participants in 2 Studies were Male while 47.5% were Female, while only 22% of patient participants were Male, with 78% being Female. One paper recorded the proportion of patients who used telemedicine as 22.8 %, a second recorded the highest proportion of clinicians’ telemedicine usage as 59.8%, a third paper concluded the highest number of carers who were satisfied with telemedicine usage was 90%, with 58% also supporting its usage and a fourth recorded that 86% of patients were satisfied with its usage. However, another paper recorded that 26% of clinicians (psychiatrists) were not keen to use telemedicine. Conclusion: This review concludes that there is some evidence that telemedicine digital technology is a viable option and can be a long-term solution to primary care patients’ access to quality care in the post-pandemic era, including patients with rare diseases. International collaboration of clinicians via electronic or digital platforms will enhance quality of care, especially targeted to younger male physicians below the age of 50. Guidelines and protocol for its use within governmental laws and legal boundaries need to be strictly followed to ensure patient safety, reduce waiting times and achieve positive patient outcomes.

Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014

BackgroundJapan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors.MethodsWe analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience.ResultsThe number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas.ConclusionFemale physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.

Physician Perceptions of Cannabidiol (CBD) and Cannabis in Sports Medicine and Performance.

There is growing evidence regarding cannabinoid use in sports medicine and performance, especially cannabidiol (CBD). This study aims to determine if sports medicine physicians are recommending cannabinoids for therapeutic purposes, as well as analyze perceptions of cannabinoids within sports medicine and performance. Physician members of the American Medical Society for Sports Medicine (AMSSM) completed an anonymous survey on demographics, CBD and Cannabis recommendations, as well as attitudes toward cannabinoid products within sports medicine. Factors associated with CBD and cannabis recommendations as well as perceptual differences were found using multivariate regression modelling. Responses from 333 physicians were recorded. The following groups were less likely to agree with allowing cannabis for recreational purposes: female gender (coeff. = 0.79 (0.33-1.25), p=0.001), increasing age (coeff. = 0.04 (0.02, 0.07), p < 0.001), and rural respondents (compared to baseline urban, coeff. = 1.16 (0.36, 1.95), p=0.004). Similarly, these three factors were associated with a higher likelihood of disagreeing with WADA removing cannabis from the prohibited substance list and with the NCAA allowing CBD use by collegiate athletes (p ≤ 0.045). CBD was less likely to be recommended by pediatricians, rural physicians, and academic physicians (p ≤ 0.030). Male physicians and younger physicians were less likely to identify cannabis as performance-enhancing (p ≤ 0.042). Sports medicine physicians have varying views on cannabinoids. While sports medicine physicians generally have favorable attitudes toward CBD and cannabis, these perceptions appear to be significantly affected by age, practice type, and gender.

“As [Healthy] Women Should”

Abstract Expanding the discussion highlighting the role of slavery in the production of medical knowledge beyond the much more extensively studied Atlantic world and the nineteenth-century US South, this article explores the exploitation of enslaved women’s bodies as clinical subjects in fifteenth-century Iberia. Menstrual disorders figured prominently among “hidden defects” cited in slave warranty suits filed by disgruntled buyers across the late medieval Mediterranean world. Reflective of their heightened interest in female physiology during this period, university-trained male physicians were the expert witnesses most frequently called on to resolve disputes concerning what an enslaved woman’s lack of menses meant. Through a close analysis of “expert” testimony in seven lawsuits filed before the court of the Justicia Civil in Valencia in the 1440s, the slave market emerges as a site offering unparalleled opportunities for physicians to directly touch and probe female genitalia. Insofar as they could be poked and prodded with relative impunity, the bodies of enslaved women bought and sold in late medieval Mediterranean markets were instrumental to the expansion of learned gynecological knowledge.

Coronary microvascular function in male physicians with burnout and job stress: an observational study

BackgroundAs a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that is at least as high as that of other professionals. This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events.MethodsThirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on coronary flow reserve (primary outcome) and two additional measures of coronary microvascular function in the same model while adjusting for age and body mass index.ResultsBurnout and job stress were significantly and independently associated with endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow response, and hyperemic myocardial blood flow (r partial = 0.28 to 0.35; p-value = 0.008 to 0.035). Effort-reward ratio (r partial = − 0.32 to − 0.38; p-value = 0.004 to 0.015) and overcommitment (r partial = − 0.30 to − 0.37; p-value = 0.005 to 0.022) showed inverse associations with these measures.ConclusionsIn male physicians, burnout and high job stress showed opposite associations with coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications and temporal relationships between work-related variables and coronary microvascular function. Future studies should include burnout and job stress for a more nuanced understanding of their potential role in cardiovascular health.

How Physicians and their Non-Physicians Spouses Navigate their Multiple Roles

Relationships that involve a physician and a non-physician professional spouse face many challenges that are similar to those experienced by dual career marriages. However, there are unique demands that are associated with physicians who are married to other professionals. One such challenge is the task of navigating their multiple familial and professional roles. This present study explores how physicians who are married to other professionals confront and navigate the complex environment that is often characteristic of work-family issues in this population. Employing an exploratory qualitative design, 34 heterosexual individuals (17 couples) completed in-depth qualitative interviews. These dyadic interviews included 10 male physicians and 7 female physicians. A multisystemic approach was employed to explore themes that emerged. One major theme, contextual appreciation of the physician’s work demands, and three sub-themes: familial support, non-traditional parenting and domestic roles, and paid help, emerged. These data provide important information for the medical education of physicians with specific emphasis on navigating multiple familial and professional roles when part of dual career marriages. Findings provide implications for physician vitality/health, medical education, and continuing education with a focus on physician marriages.

The COVID‐19 pandemic and primary care appointment availability by physician age and gender

AbstractUsing data generated through simulated patient calls to a national random sample of primary care physicians between February and July 2020, we examine the effects of the first wave of COVID‐19 on the availability of the U.S. primary care physician workforce for routine new patient appointments. As states enacted stay‐at‐home orders, physicians overall became less selective by insurance, and there was a 7 percentage‐point increase in acceptance of patient insurance. Telemedicine appointment offers increased 10.2 percentage points from near zero. However, relative to younger counterparts, physicians older than the sample mean (53.1 years) became 18.1 percentage points less likely to offer appointments and decreased their estimated appointment duration by 7.1 min. Compared to male physicians, female physicians became 10 percentage points more likely to accept new patients. These insights into appointment offers during the first wave of COVID‐19 may help policymakers seeking to ensure an adequate physician workforce during future crises.

Association Between Global Sleep Quality and Coronary Microvascular Function in Male Physicians With Occupational Burnout.

Occupational burnout has been associated with an increased risk of coronary heart disease, although the mechanisms involved are elusive. We investigated whether poor global sleep quality is associated with impaired coronary microvascular function in male physicians, a professional group at increased risk of burnout. Study participants were 30 male physicians with clinical burnout and 30 controls without burnout defined by the Maslach Burnout Inventory. Global sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular functions were quantified with myocardial perfusion positron emission tomography. In multivariable analyses, the interaction between burnout and the PSQI global score was regressed on measures of coronary microvascular function, adjusting for age, body mass index, physical activity, alcohol consumption, and main effects of burnout and PSQI score. The prevalence of poor sleepers (PSQI score >5) was 40% in the burnout group and 10% in the control group. Adjusting for covariates, burnout-by-global PSQI score interactions were observed for myocardial blood flow (MBF) at rest ( r partial = -0.30, p = .025), endothelium-dependent coronary flow reserve ( r partial = -0.26, p = .062), MBF response ( r partial = -0.30, p = .028), and hyperemic MBF ( r partial = -0.34, p = .012). The global PSQI score was inversely associated with these MBF measures in the burnout group relative to the control group. No significant interactions emerged for endothelium-independent MBF. In male physicians with occupational burnout, poor global sleep quality was associated with reduced endothelium-dependent coronary microvascular function, suggesting a mechanism by which burnout may affect cardiovascular health.

Mental health survey of medical personnel during pre-job training in a closed-loop management system during the COVID-19 pandemic.

With the aim of enhancing prevention and regional control of epidemics, the mental health status of medical personnel was analyzed before the implementation of closed-loop management during the COVID-19 pandemic in the regional hospital representative. In accordance with directives from the unified deployment of the national and regional health bureaus, and following the inclusion and exclusion criteria, from September 2021 to November 2022, all medical personnel assigned to a closed-loop working environment by Guangzhou Panyu Central Hospital were enrolled as research subjects through cluster sampling method. Using a cross-sectional survey method, relevant data such as age, gender, professional title, and mental health status were collected. The Patient Health Questionnaire-9 (PHQ-9) scale, the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Insomnia Severity Index (ISI) scale were administered. Logistic regression analysis was used to study the influencing factors of depression, anxiety, and insomnia. Single factor logistic regression analysis was performed first, followed by multiple factor logistic regression analysis. A total of 500 valid responses were received. Depression was reported by a higher proportion of physicians than nurses. Anxiety was reported by higher proportion of men than women and by a higher proportion of physicians than nurses. Medical personnel under the age of 30 years reported fewer symptoms of insomnia than those over the age of 41 years, and medical personnel with intermediate professional titles reported more severe symptoms of insomnia than junior personnel. There was no significant difference between the results of the three questionnaires for medical personnel from other hospital departments or in the different type of closed-loop work environments. During the pandemic, conducting psychological health assessments for medical personnel undergoing pre-job training in closed-loop management was beneficial for the timely detection of psychological problems. Although this study only conducted a cluster sampling survey and lacked comparative analysis on other medical institutions, it still suggested that it was necessary to strengthen timely psychological counseling and intervention for senior male physicians.

Gender Disparity in Teaching Evaluations of Pediatric Faculty by Residents.

Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments. Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test. Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty. Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine.

Abstract 17343: Coronary Microvascular Function in Physician Burnout and Job Stress

Background: As a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that seems more prevalent among male than female physicians. Aim: This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events. Methods: Thirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on measures of coronary microvascular function in the same model while adjusting for age and body mass index. Results: Burnout and job stress had significant and independent effects on endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow (MBF) response, and hyperemic MBF (r partial: 0.29 to 0.35; p-value: 0.008 to 0.027). Effort-reward ratio (r partial: -0.32 to -0.34; p-value: 0.009 to 0.017) and overcommitment (r partial: -0.29 to -0.35; p-value: 0.008 to 0.027) showed inverse associations with these measures. Conclusions: In male physicians, burnout and high job stress showed opposite effects on coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications. Future studies should include burnout and job stress for a more nuanced understanding of their potential impact on cardiovascular health.

Sick Time: Medicine, Management, and Slavery in Louisiana and Cuba, 1763–1868

Capitalist ideas of productivity became central to medicine under slavery. They shaped how physicians treated enslaved patients, crafted a scientific basis for medicine, and conceived of themselves as professionals. Between the late-eighteenth-century and the mid-nineteenth-century, white male physicians in Louisiana and Cuba distinguished themselves from other healers: first, by aligning with Spanish colonialism, and then, by making themselves essential to a new form of plantation management that used clock-time discipline, hierarchical divisions of labor, and complex accounting systems. These technologies helped planters track the hours and days each enslaved person spent working, eating, sleeping, birthing, suffering from sickness and injuries, and recovering. This in turn enabled precise interpretations of enslaved health in terms of productivity, which was primarily measured in work time and the number of commodities produced. Physicians, who were seeking a rigorous intellectual foundation for medical knowledge production, latched onto planter methods of calculating and controlling enslaved health. One of those methods was what planters and physicians called “sick time,” which was an allotment of time away from work intended to manage illness enough for enslaved people to return to work. However, as physicians used plantation management to cast an air of scientific accuracy over their knowledge, enslaved people reconfigured their own medical practices to make themselves less visible and countable. Fugitive practices involving trees, animals, and natural springs helped enslaved people to heal by taking their own forms of sick time.

A critical issue for primary care practice: knowledge and attitudes of family physicians regarding levothyroxine use

Objective: Accurate management of hypothyroidism, which is one of the common reasons for referral to primary care, is critically important issue. This study aims to measure the knowledge and attitudes of family physicians (FPs) regarding the use of levothyroxine, which is the main pharmacological agent in the treatment of hypothyroidism.&#x0D; Methods: This prospective and descriptive study was performed on 102 physicians from family health centers in Şanlıurfa province central districts. The researchers created a questionnaire consisting of eight questions; seven of which were multiple choices and one was open-ended, by scanning the guidelines and literature. Data were obtained by face-to-face interview technique. &#x0D; Results: Of the participants, 21 (20.6%) were female and 81 (79.4%) male physicians, and the mean age of the participants was 36.9±8.0 (28-66) years. The work duration as a FP was 6.1±3.3 years. Sixteen (15.7%) of the participants reported that they had never prescribed levothyroxine. Two-thirds of them correctly answered the relationship between levothyroxine absorption and food intake, and 36.3% correctly answered that there would be a difference in absorption between different levothyroxine formulations. However, the rate of correct answers to the question of how to start hypothyroidism treatment in patients over 60 years of age or with coronary artery disease was quite low.&#x0D; Conclusions: The results of this study revealed that FPs in Sanliurfa central districts do not have adequate knowledge about the use of levothyroxine for treatment of hypothyroidism, and they need effective training on this vital issue.&#x0D; duyduklarını ortaya koymuştur.

Constructing the Infant Body: The Intervention of the Educated, Male Physician in Eighteenth-Century Infant Diet

Drawing on medical advice literature, this paper examines the cultural history of the body in infancy in eighteenth-century England. This period saw the increasing professionalization of the medical field, particularly regarding children’s health, as an emerging profession of educated, male physicians sought to establish their exclusive authority on the medical market. As England’s medical market of the time was largely unregulated, these educated physicians competed with apothecaries, midwives, and female nurses for paying customers. Physicians argued that the disorderly, undisciplined nature of the infant body was incongruent with Enlightenment virtues, and therefore required a greater degree of medical management. Emerging out of this discourse were popular advice books which emphasized preventative measures in already-healthy infant patients. They were authored by a growing profession of educated, medical experts and were addressed to a lay audience of parents and child caretakers. This paper examines three immensely popular pamphlets authored by three physicians, Thomas Beddoes, George Armstrong, and William Cadogan. All three emphasized in their tracts the importance of maternal breastfeeding to the infant diet, citing Enlightenment ideals, humoral theory, and even the supernatural elements of breastmilk to support this claim. To bring the child body firmly under the control of the medical establishment, they argued that uneducated, lay practitioners, who were overwhelmingly female, received no formal education in the sciences and thus possessed little understanding of the nuances and complexities specific to the infant body. Parents were also incapable and deficient, at least to some degree, in the formal knowledge necessary to prevent illness in their infant children, and thus should rely on the physician’s expertise regarding the care of the infant body.

A - 85 Neuropsychological and Cultural Elements in the Assessment of Competency to Stand Trial.

Research has highlighted how key cognitive functions underlie abilities within the construct of Competency to Stand Trial (CST). This case study examines the impacts of Mild Neurocognitive Disorder and culture on a physician found incompetent to stand trial. A 62-year-old African-born male physician charged with Health Fraud who was referred for an examination of his CST. His attorneys raised concerns about his rational understanding of the proceedings and his ability to collaborate constructively with them. The client underwent comprehensive forensic, neuropsychological and neurological assessment. Neuropsychological testing revealed low-average intellectual abilities which likely reflected a decline from estimated premorbid levels. Contrary to expected performance given cultural factors, nonverbal intellectual abilities were markedly lower than verbal intellectual abilities. Compromises in multiple domains of cognition including memory were also noted. A referral to neurology revealed moderate atrophy and a mass in the right temporal fossa, in line with a diagnosis of Mild Neurocognitive Disorder with Multiple Etiologies. A causal connection between his cognitive deficits (e.g., compromised reasoning) and competence-relevant abilities (e.g., capacity to waive constitutional rights) was established. The subject was adjudicated incompetent to stand trial and, largely due to neurologic findings, unlikely to attain competency (i.e., non-restorable). This study demonstrates the value of neuropsychological assessment in both the clinical recognition of brain pathology and cognitive dysfunction in the setting of complex legal and cultural issues. Guidelines to address complex competency cases that warrant comprehensive assessment are needed.