Patients In Medical Settings Research Articles

Patients Are From Mars, Doctors Are From Venus: Patients Prefer Placebos and Paternalism; Doctors Don't

Current medical ethics, law, and education all emphasize patient empowerment and shared decision making as a means of avoiding paternalism. But what if doctors are paternalistically deciding that patients may not choose paternalism by forcing them to be involved when they would rather just feel better and leave it to the professionals? Two separate surveys were administered to a cross section of adult Americans through Amazon's Mechanical Turk to measure attitudes toward paternalism in various scenarios. This review discusses the results of these surveys and how they may be implemented in order to better understand how to interact with patients in medical settings.

Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers

Background:Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised...

Across the great divide: Introduction to the special issue on psychology in medicine

Health psychology has made limited progress becoming an accepted part of mainstream medical research and practice. Although abundant efficacy research has generated considerable evidence-based interventions that are effective primary medical interventions or adjuncts to other medical treatments, evidence of acceptance within medicine and especially primary care is meager. This special edition of the Journal of Clinical Psychology is an effort to assist movement in this area. It is a combination of commentaries concerning aspects of clinical collaboration within primary care, a discussion of issues that are barriers to implementation, and a wide range of research efforts supporting models of collaborative interventions between health psychology and primary care. It also identifies mechanisms that may account for the effectiveness of certain types of interventions. Taken as a whole the volume supports the importance and viability of clinical health psychology research and practice in an area of fundamental importance--the general health of patients in medical settings--the location where most people present psychological problems and receive treatment in response.

Update on consultation–liaison psychiatry (psychosomatic medicine)

Current issues in consultation-liaison psychiatry, which is now labeled psychosomatic medicine as a formal subspecialty by the American Board of Psychiatry and Neurology, are discussed. There is continued interest in how to best manage depression and anxiety in a primary-care setting. Collaborative care that utilizes a psychiatrist within the treatment center, as well as case management by a nurse, have been reviewed and meta-analyses suggest it is an efficient and effective approach. The diagnostic issues within psychosomatic medicine are also an area of concern as the Diagnostic and Statistical Manual of Mental Disorders, 5 edition, is in the planning stages. How to improve both the reliability and validity of somatoform disorders will be a major challenge. Organ transplantation is a clinical challenge for patients, donors and healthcare providers. Issues in assessment and management continue to evolve. Ethical questions also arise due to the shortage of available organs. Psychosomatic medicine continues to manage patients in medical settings that cut across a continuum from primary-care to complex medical and surgical centers. The clinical problems containing a medical-psychiatric interface offer a clinical challenge but also an area for new knowledge and better interventions.

Physician attitudes toward treatment of depression in older medical inpatients

Objectives: To better understand low treatment (<50%) and psychiatry referral rates (<10%) of depressed older medical patients, we examined medical physicians’ characteristics, attitudes and practices regarding treatment. Methods: Physicians caring for a consecutive series of 1000 depressed older patients during medical hospitalization and/or after discharge were asked about their general attitudes and behaviors related to the treatment of depression in older patients. Results: Of 422 physicians responding to questionnaires, less than half (48%) usually started more than two patients a month on antidepressants. Even fewer (14%) referred more than two patients a month for counseling; 37% usually referred none. Only 11% referred more than two patients a month to psychiatrists; nearly 40% usually referred none. Antidepressants, counseling, and psychiatric referral were seldom thought very effective. Physicians out of their training and those in primary care specialties (especially family practice) were more likely to treat patients. Common reasons for not treating these patients were perceived resistance to treatment (62.3%), lack of time (61.1%), uncertainty of depression diagnosis (56.2%), belief that patients couldn’t afford treatment (50.5%), and concern about medication/disease interactions (58.8%). One-third (33.5%) emphasized that they were unsure about treatment effectiveness and one-third (34.4%) that they were poorly prepared to treat depression in older patients. Non-white physicians were more likely to refer to psychiatrists. Conclusions: Many older depressed patients in medical settings are not treated or referred. Physician experience and specialty may affect the decision to treat, and physician race may affect the decision to seek consultation. Therapeutic nihilism may be influential.

Should Health Professionals Allow Reporters Inside Hospitals and Clinics at Times of Natural Disasters?

Journalists and health workers need to carefully consider whether it is ethical to show images of patients in medical settings, or of dead bodies in morgues.

An Assessment of Suicide in an Urban VA Medical Center

This study characterizes those patients of an urban VA Medical Center (VAMC) who had committed suicide. A cause-of-death search of the 1,075 veterans from the VAMC's case rolls who died during 1998 was conducted. For confirmed and suspected suicides, a chart review was conducted, noting psychiatric history and recent contact with the VAMC. Nineteen patients were either confirmed or suspected suicides. Few of these patients had made recent contact with the VAMC, although the majority of them had received psychiatric services from the VA at some time. The proportion of deaths due to suicide was similar in African American and White patients. Rates of suicide were elevated, primarily because of the high proportion of patients receiving psychiatric treatment. Elderly suicides were less likely to have had psychiatric services or previous psychiatric diagnoses than were younger suicides. Patients with past contact with psychiatric services may be especially at risk of suicide, particularly as contact with these services diminishes. Elderly patients in medical settings with undiagnosed or undertreated psychiatric disorders are also likely to have elevated risk for suicide. These findings demonstrate the importance of acknowledging that risk factors for suicide are specific to sites or populations; this information can be used in allocating resources for developing site-specific strategies for prevention.

An Artificial Intelligence System for Computer-Assisted Menu Planning

Planning nutritious and appetizing menus is a complex task that researchers have tried to computerize since the early 1960s. We have attempted to facilitate computer-assisted menu planning by modeling the reasoning an expert dietitian uses to plan menus. Two independent expert systems were built, each designed to plan a daily menu meeting the nutrition needs and personal preferences of an individual client. One system modeled rule-based, or logical, reasoning, whereas the other modeled case-based, or experiential, reasoning. The 2 systems were evaluated and their strengths and weaknesses identified. A hybrid system was built, combining the best of both systems. The hybrid system represents an important step forward because it plans daily menus in accordance with a person's needs and preferences; the Reference Daily Intakes; the Dietary Guidelines for Americans; and accepted aesthetic standards for color, texture, temperature, taste, and variety. Additional work to expand the system's scope and to enhance the user interface will be needed to make it a practical tool. Our system framework could be applied to special-purpose menu planning for patients in medical settings or adapted for institutional use. We conclude that an artificial intelligence approach has practical use for computer-assisted menu planning. J Am Diet Assoc. 1998;98:1009-1014.

Tobacco use among pediatric cancer patients: recommendations for developing clinical smoking interventions.

The current status of tobacco use among young cancer patients and the acute and chronic complications associated with tobacco use in these patients is reviewed. Studies report that adolescent cancer survivors use tobacco as much as their peers who have never been treated for cancer, despite the adverse consequences of engaging in this unhealthy habit. Health care professionals have the opportunity and responsibility to incorporate tobacco counseling as a routine component of medical care delivery. Nurse/physician-delivered smoking interventions have been found to promote smoking cessation in adults, although little effort has been devoted to the development of similarly effective smoking interventions for pediatric cancer patients who smoke. Components of existing smoking prevention/cessation curricula from successful school-based interventions and physician-delivered smoking interventions can be adapted and tailored to pediatric cancer patients in medical settings. Smoking interventions that educate patients about their increased vulnerability to tobacco-related consequences, relative to their healthy peers, may have an enhanced impact. Guidelines for conducting a comprehensive assessment of tobacco use and implementing smoking interventions with pediatric cancer patients is provided. Strategies for modifying the cancer patient's perceived vulnerability to tobacco-related consequences is also discussed.

Suicide in the Medical Patient

According to the statistical abstract of the United States for 1982-1983, there were 1,913,800 deaths in the United States in 1979. Twenty-seven thousand, or 1.4 percent of those deaths were by suicide, yielding a suicide rate of 11.9/100,000/year. The rate was highest (39.2/100,000) for white males sixty-five years and over and lowest (0.1/100,000) for black females between five and fourteen years. It is generally accepted that physical illness is a risk factor for suicide. If this is true, then in caring for persons with significant physical illness, physicians are dealing with a population at increased risk of suicide. In its opening section, this article will review the evidence that points to a positive correlation between suicide and physical illness. Next the association between specific illnesses, such as peptic ulcer and cancer, and suicide will be examined. Third, risk factors associated with the occurrence of suicide in medical-surgical hospitals will be reviewed. Fourth, the occurrence of suicide in relationship to medical procedures will be discussed. Fifth, the evaluation and management of suicidal patients in medical settings will be briefly considered. This review will not consider the relationship between physical illness and attempted suicide.

Psychological symptoms among Chinese in urban Hong Kong

Clinical observations on Chinese mental patients suggested that somatization was a common mode of symptom presentation. One explanation attributed to the phenomenon was that Chinese tend to suppress or deny their feelings. The present study took the data on the 22-item Langner Scale collected as part of the Hong Kong Biosocial Survey and reanalyzed the responses of 3925 Chinese subjects in terms of Crandell and Dohrenwend's subscales. Results showed that among these urban Chinese, report of psychological symptoms on the Langner Scale was higher than that of psychophysiological, physiological and ambiguous symptoms. Significant differences in subscale scores were found among five subject variables: age, sex, education, socioeconomic status and total number of reported symptoms. Within each subgroup of the subject variables, scores on the psychological subscale was significantly higher than scores on the other three subscales. These findings disputed the contention that Chinese in general tend to deny their emotions. Somatization among Chinese mental patients in medical settings and report of psychological symptoms by Chinese may not be mutually exclusive phenomena. A more meaningful examination of the somatization concept should include investigation of the conceptualization of mental illness among Chinese, the channels chosen for help and symptom presentation in different settings.

Group psychotherapy for medical patients

The view that physical and mental health are reciprocally and inseparably related is well accepted today. Physicians in almost all specialties are confronted daily with patients for whom no organic cause for presenting symptoms is discernible, patients whose emotional reactions aggravate existing physical disorders, and patients whose impaired physical functioning frequently result in reduced psychologic functioning. In 1905, Dr. Joseph Pratt, a Boston internist, recognized the psychologic component in somatic disease and included group therapy techniques in his treatment of tuberculosis patients. Although these group meetings had a primarily educational and inspirational focus. Pratt felt that group members found a “common bond in a common disease”, and firmly believed that the group experience contributed to the overall success of his treatment regime. Since Pratt's classic 1907 paper, 1several reviews have reported advances in the use of group psychotherapy in nonpsychiatric medical settings. Thomas's 2 1943 review of the group therapy field reported in detail on Pratt's followers and others who extended group psychotherapeutic methods to patients in medical settings. Stein 3 updated Thomas's review and also discussed relevant theoretic issues such as the unique advantages of group psychotherapy in the treatment of psychosomatic illnesses. This article will present studies published since Stein's review within a conceptual context that focuses on therapeutic ingredients of group treatment procedures for patients with ongoing medical problems. In addition, difficulties with leading such groups, and the necessity of more systematic research will be discussed.