Medical Care Practitioners Research Articles

Clinician's Guide to Mental Illness

Article AbstractFrom our regular book review column.One might wonder whether a paperback guide to mental illness warrants a price of nearly $35.00. Clinician's Guide to Mental Illness aims to provide a review of common adult mental and substance use disorders that is both comprehensive and practical. It is written for mental health and primary medical care practitioners. The chapters are authored by a multidisciplinary group of research-practitioners and clinicians from Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center.

Australian general practice and the meeting of needs for mental health care.

This report, drawing on a national epidemiological survey conducted in 1997, examines the role of Australian medical general practitioners (GPs) in responding to needs for mental health care. We analysed data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB). The NSMHWB employed clustered probability sampling of all Australian adults, and 10,641 participants were interviewed. The field questionnaire included modules of the Composite International Diagnostic Interview, and instruments assessing disability, service utilisation and perceived needs for care. Eighty-four percent of people with a mental disorder consulted a GP in the year prior to survey, but only 29% consulted in relation to a mental health problem. GP services were seen as more responsive to needs for medication, counselling and information than needs for social interventions and skills training. People with perceived needs for counselling were more likely to consult with other providers, either as alternative or additional consultations to those with a GP. Counselling needs were reported as less well met when people saw a GP alone than when consulting other service providers. Many people with mental health problems attend primary medical care practitioners without presenting these problems to their physicians. When they do present, perceived needs for medication are rated as well met, but there is substantial unmet perceived need for interventions in social and occupational domains. Perceived needs for counselling are less well met where the GP is the sole provider. To close these identified gaps calls for improvements in primary care physicians' skills and effective collaborative models with other providers.

Verbal Exchange Structure of General Practice Consultations with Patients Presenting Psychological Problems

The consultations of 88 patients presenting with psychological problems to primary care medical practitioners were tape- recorded, coded, and factor- analyzed to identify their constituent verbal exchanges. A verbal exchange is a set of speech act categories that tend to occur together and are used for some subtask within an encounter. The verbal exchange structure of these consultations replicated that of previously studied medical consultations except that they had some distinctive features in common with previously studied psychotherapy sessions. Patient- centered exchanges called Social Exposition and Emotional Exposition, which may serve psychotherapeutic purposes, were relatively prominent in those consultations rated relatively positively by patients and by external raters.

Economic evaluations of drug therapy: attitudes of primary care prescribing advisers in Great Britain

All health authorities in Great Britain have both medically or pharmaceutical qualified staff to advise both the authority and the local primary care medical practitioners about drug use and prescribing. This study used a piloted postal questionnaire to assess the attitudes of these advisers to economic evaluations of drug therapy, and their perceptions of the barriers to achieving cost effective prescribing by use of these evaluations. There was a 65% response rate to the questionnaire. Economic issues were rated by advisers to be less important than clinical issues, but were considered at most meetings between advisers and primary care medical practitioners. Advisers wished to consider true cost effective prescribing but often felt obliged to consider drug acquisition costs and risks of budgetary overspends. The perceived inflexibility of existing structures within the British National Health Service and the lack of credibility of the evaluations (often perceived as pharmaceutical industry marketing) were the major barriers to the application of the evaluations. The paper concludes that advisers were keen to use economic evaluations to promote cost effective prescribing but were impeded by the perceived bias of existing studies and by rigid current NHS structures.

Changing the health care workforce: lessons from foundation-sponsored programs.

Changing the health care workforce: lessons from foundation-sponsored programs.

Acute appendicitis in children.

A prospective study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis. Most children presented with typical features of acute appendicitis (70%) or peritonitis (28%). Atypical presentation was uncommon and occurred only in seven young children, masquerading as intestinal obstruction, gastroenteritis or urinary tract infection. Prolonged delay in surgery was associated with a rise in incidence of late appendicitis (gangrenous and perforated appendicitis). This rise was especially marked 37 h after onset of symptoms. The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early. Surgeons contributed very little to the delay. High risk factors for postappendectomy sepsis were young children under 6 years old, late appendicitis, obese patients, inferior systemic antibiotic regimes and inexperienced surgeons. Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly. They were not especially prone to postappendectomy sepsis; they had the same degree of appendicitis compared with older children. Measures to decrease the postappendectomy morbidity are suggested.

Dictionary of American Medical Biography

Did you know that Albert Abrams wrote two important medical texts before delving into flights of fancy with electronic gadgetry; that William Osler was an active leader in the public health movement; and that Elizabeth Blackwell was a professor of obstetrics and gynecology? With the assistance of dozens of subject specialists, such facts have been assembled by Kaufman, Galishoff, and Savitti in their exciting new work, Dictionary of American Biography . This volume, comprised of more than 1,200 sketches, is a comprehensive reference work containing information on persons of national, state, and local importance, whether physicians or other medical care practitioners. Considering the numbers of capable health practitioners in the United States, the editors did a careful and painstaking job of selecting the subjects. The Dictionary documents the maturation of American medicine by presenting profiles of noteworthy American practitioners of the early colonies and progressing to major figures from the past

The Cripple Liberation Front Marching Band Blues

Lorenzo Wilson Milam has written a graphic but heartrending description of his travels through the hills and valleys of medical care and rehabilitation after contracting polio in 1952. We are with the author as he is admitted to a chronic disease hospital, where he endures the agony of twice-daily electric muscle stimulation and exercises administered by Miss Bland, a physical therapist, and the shredding of his dignity by ward nurse Stumpf and her colleagues. He would have been left to the tender mercies of these medical care practitioners and their leader, Dr Jackyl, who views each patient as an untapped source of revenue to be surgically exploited, were it not for the intervention of his mother, who arranges for him to be transferred to Warm Springs Medical Center. At Warm Springs, Milam undergoes an uplifting of his physical and mental status. He describes this as People like me, who have

Occupational Disability: The Approaches of Government, Industry and the Universities

The outcome of a series of projects conducted by the Applied Psychology Department, University of Aston in Birmingham, England, Occupational Disability easily meets the editors' stated objectives: to spot-survey what is known about this subject and to begin to bridge the many interdisciplinary gaps with a view toward stimulating an integrated approach. It will fuel the already accelerating and broad-based interest in the medical, legal, social, and economic aspects of disability. The title's reference to the approaches of government, industry, and, particularly, the universities should not lead medical care practitioners to conclude hastily that this book is primarily a statement on social policy. While several chapters illustrate the enormous impact of occupational disability, the reader can look forward to a core of valuable information and innovative suggestions in two important areas relatively neglected by the traditional medical teaching and practice models: the evaluation of impairments by physicians as part of

The primary medical care practitioner's attitudes toward psychiatry: An Israeli study

General practitioners are important to the delivery of mental health care because they perform three important functions, as an identifier, as a referral agent and as a caregiver. This study investigates the importance of the attitudes G.P.s hold on their performance of two of these functions. screening and referring. Relying on items developed in previous investigations, four measures of attitudinal dimensions are developed using factor analysis: Belief in Psychogenesis, Psychiatric Fatalism, Referral Reluctance and G.P. as Caregiver. These attitude dimensions are then related to the functions of screening and referral. Three major findings emerge from the results. First, the attitudinal dimensions uncovered are empirically distinct, suggesting that no single pro-to-anti psychiatry is present. Second, attitudes play a role in the screening of cases. A G.P. is more likely to identify cases if he believes in the psychogenesis of physical disorders, and is not concerned that identification and referral will lead to negative consequences for the patient. Third and finally, attitudes do not play a strong role in the referral of cases once they have been identified as such. The findings are presented and interpreted by referring to the sensitive position G.P.s occupy between the public and the psychiatrist.