Role In Medical Practice Research Articles

Sources of Ethical Conflict in Medical Housestaff Training: A Qualitative Study

Medical ethics and professionalism have come to play an increasingly important role in medical practice since the 1980s, but there still is widespread concern about unethical and unprofessional behavior. This survey, based on in-depth interviews held in 2001 with 31 internal medicine residents in 1 traditional and 1 primary care residency at Yale University, was intended to identify the work-related ethical conflicts experienced by these medical house officers. The interviews, which took 18 to 60 minutes, used a standardized guide with probes for clarification and additional detail. Without exception, the participants reported having uncomfortable, improper, unethical, or unprofessional experiences with patients. In 90% of cases, the respondent had been directly involved. These experiences were classified into 5 broad categories: 1) Telling the truth. Many ways of manipulating information were used to avoid telling patients the truth, including delaying or omitting information and, in some instances, lying. These behaviors were variably ascribed to pressure from attending physicians, families, peers, or patients themselves. Relevant topics were diagnoses, prognoses, and statements about how experienced residents were with specific procedures. 2) Respecting patients' wishes. Residents sometimes were unable to ensure that the patient's wishes were respected because of disagreement on the part of the medical team, the patient, or the family about what the patient truly wished and what was in the patient's best interest. 3) Preventing harm. Several residents were distressed by having to accept the risks inherent in needed treatments or procedures. Occasionally, there was concern about the risk arising from the resident's limited experience with a given procedure. 4) Managing the limits of one's competence. Some residents felt inadequately prepared to perform their duties and were uncertain of what to do about it. They often were concerned about how their attending physician, peers, and patients would perceive the situation. Some residents felt it necessary to act as if they were more experienced than they believed they actually were. Some had trouble acknowledging their shortcomings. 5) Addressing the performance of others that is perceived as inappropriate. Residents experienced conflict when they viewed a peer's or an attending physician's performance as inadequate or inappropriate. They were uncertain about whether to challenge, intervene, or report the behavior while at the same time being accepted and approved by their colleagues. Hopefully, the challenges faced by medical residents will lead to better education in ethics and professionalism. Ultimately, residents must learn when compromising ethical standards might be acceptable and when it is not.

Internet Use by Physicians and Its Impact on Medical Practice—An Exploratory Study

Internet use by physicians has played a vital role in medical practices for many years. A number of related studies have emerged to examine the impact of Internet use on medical practice. However, there is yet to be a comprehensive study on the impact of Internet use by physicians on their medical practice. This study examines a preliminary step to explore the major implications of physicians' Internet use on the traditional areas, such as health education and learning, physician-patient relationship, and medical marketing. Barriers to Internet use are also investigated. Implication of use of the Internet in the medical practice and limitations of this study are discussed as well.

Placebo effect and placebos: what are we talking about? Some conceptual and historical considerations.

Placebos and the placebo effect have always been present in medical history. However, they have not received the same consideration over the years. Somewhere between art and science, the placebo historical references come from Ancient Egypt and cross over the major civilisations, beliefs and scientific advances. The use of placebo as a methodological tool has assumed a leading role in the last 50 years and has become an important role in controlled clinical trials, the main element of the "evidence-based-medicine" paradigm. Knowledge of the conceptual and historical considerations of placebo may help to understand its role in medical practice. Even without a consensual definition, and assuming that the placebo effect does not seem to be fully dependent on a placebo administration, one issue seems unquestionable: the placebo effect is present in clinical practice and in clinical trials, no matter which name we choose to call it.

Psychotropic mushrooms and plants

There are a lot of medical applications of psychotropic plants. However, there are many more mushrooms and plants with psychotropic effects considered useless by scholar medicine. The resulting regulations make the users criminal law breakers. Depending on the Zeitgeist there had been experiments with hallucinogenics in a medical setting. Normally psychotropic mushrooms and plants play no role in medical practice. However, the use of datura by youths can lead to emergency situations, so this problem will be dealt in more details.

The tyranny of diagnosis: specific entities and individual experience.

The articulation and acceptance of specific disease entities constitute one of the most important intellectual and cultural events of the past two centuries. This notion is central to how we organize health care delivery, think about ourselves, debate and formulate social policy, and define and manage deviance. Diagnosis is indispensable to linking specific disease concepts with doctor and patient and the social and economic institutions shaping such clinical interactions. Disease is a social entity, not an array of ideal types. The history of medicine is partly the story of how disease entities have become social entities, accumulating the flesh of diagnostic and therapeutic practice, social expectation, and bureaucratic reification. Despite criticism of reductionist medicine in the West and less focus on disease entities and mechanisms, our social response still depends on this concept of sickness. But this concept can no longer remain invisible if we are to understand contemporary medicine as both a social and a technological system.

BALANCING DIVERSION CONTROL AND MEDICAL NECESSITY: THE CASE OF PRESCRIPTION DRUGS WITH ABUSE POTENTIAL

Narcotics and other prescription drugs play a significant and legitimate role in medical practice. The illicit use of prescribed medicines, however, remains a major problem. This paper examines the effectiveness of two drug diversion control programs, multiple copy prescriptions programs (MCPP) and electronic data transfer (EDT) systems, and their impact on medical practice. Current evidence demonstrates that these programs decrease prescription drug use, with much of the decrease due to declines in inappropriate use. MCPPs appear more effective than EDT in preventing diversion. More research is needed, however, to assess their effects on medical practice, particularly patient quality of care. [Translations are provided in the International s Section of this issue.]

Pain Recollection after Chest Pain of Cardiac Origin

Memory for pain is an important research and clinical issue since patients ability to accurately recall pain plays a prominent role in medical practice. The purpose of this prospective study was to find out if patients, with an episode of chest pain due to suspected acute myocardial infarction could accurately retrieve the pain initially experienced at home and during the first day of hospitalization after 6 months. A total of 177 patients were included in this analysis. The patients rated their experience of pain on a numerical rating scale. The maximal pain at home was retrospectively assessed, thereafter pain assessments were made at several points of time after admission. After 6 months they were asked to recall the intensity of pain and once again rate it on the numerical rating scale. The results from the initial and 6-month registrations were compared. In general, patients rated their maximal intensity of chest pain as being higher at the 6-month recollection as compared with the assessments made during the initial hospitalization. In particular, in patients with a high level of emotional distress, there was a systematic overestimation of the pain intensity at recall.

Rituals and roles in medical practice.

Rituals and roles in medical practice.

Use of Benzodiazepines in the Community

Background: Although benzodiazepines are the most commonly prescribed psychotropic medications in the United States, considerable controversy surrounds their proper role in medical practice. Methods: Data from the household section of the 1987 National Medical Expenditure Survey were analyzed to estimate the prevalence and general characteristics of adults who purchased benzodiazepines in 1987. Results: An estimated 6.2% (10.9 million) of the adult population purchased benzodiazepines in 1987. In nearly half (47.0%) of the purchases, the use of benzodiazepines perceived by the patient did not correspond to a labeled or literature-supported unlabeled use. Multivariate analysis disclosed that benzodiazepine use was predicted by sociodemographic factors (white race, female gender, age older than 64 years, and unemployed work status), pharmacologic factors (use of an antidepressant), mental health factors (high levels of anxiety), and general health factors (poor general health, cardiac disease, arteriosclerosis, health-related work impairment, and trouble walking one block). Conclusions: These data indicate that benzodiazepine use is less prevalent than previously reported and suggest that there has been a recent decline in use. A marked discrepancy exists between why people perceive they purchase benzodiazepines and the recognized uses of these medications. (Arch Intern Med. 1994;154:1235-1240)

Surgery: An Illustrated History

This illustrated history of surgery is a surprising treat: a delightful, readable, descriptive account of surgery's evolution from the Stone Age extending well into the 20th century. The text is supported by an outstanding collection of paintings, photographs, surgical instruments, and so forth, many from museums throughout the world. There are 368 illustrations in all, 102 in full color. The unusually informative legends are, for the most part, the efforts of Jeremy Norman and could well stand alone if issued under separate cover. Although I have more than a passing interest in medical history, I confess that most of the illustrations are new to me. Dr Rutkow has recognized the societal role of medical practice and its parallel evolution with humankind's development. In a novel approach, he includes extant medical knowledge prior to the beginning of the Middle Ages in one category, treats the Middle Ages, Renaissance, and 17th, 18th,

Position emission tomography at the turn of the century: A perspective

Nuclear medicine translates advances in molecular biology into the care of patients. In the future, diseases will be characterized at the molecular rather than the cellular level, often before detectable structural changes have occurred. Position emission tomography (PET) will play a major role in the study of intercellular communication by making it possible to characterize the actions of "molecules with messages." Diseases will be characterized by defects in intercellular communication. Treatment will be planned based on molecular abnormalities, and the response to treatment will be monitored with molecular probes. PET studies of the brain, heart, and cancer will be extended to all organs of the body. Pharmacology will be strongly influenced by PET because most drugs act by stimulating or blocking "recognition sites" on the surface of cells. In the next century, will single photon emission computed tomography (SPECT) makes PET unnecessary? The answer is no, because both PET and SPECT will have achieved a permanent role in medical practice; both make it possible to examine regional in vivo chemistry in human beings. Carbon-11 and fluorine-18 will continue to lead the way, but many drugs, and some body constituents such as proteins, can be radiolabeled with iodine-123 and technetium-99m. Today, PET is limited by the need to make one's own radiotracers. This is likely to change when regional radiopharmacies become widespread.(ABSTRACT TRUNCATED AT 250 WORDS)

Selective encoding and retrieval of affective words during exposure to aversive stimulation

It has been demonstrated that memory for pain plays an important role in medical practice. Since affect is an integral component of the pain experience, it is possible that pain may produce effects on memory that parallel those engendered by emotion. This investigation examined whether acute pain selectively influenced the encoding and retrieval of affective words. The results indicated that the experience of pain significantly decreased the encoding of positive words and significantly increased the retrieval of negative words previously seen, regardless of whether they were accompanied by a painful experience. Thus, pain interferes with memory of positive events by disrupting their encoding and facilitates the memory of negative events through selective retrieval of those events.

Variations in resource utilization—The role of medical practice and its economic impact

Several studies have indicated that differences in medical practice are often an important factor behind variations in resource utilization. ‘Practice’, in medical contexts, is used as a comprehensive expression for what is regarded to be adequate care, considering science and proven experience, as well as present resources, demography, organization, and other given conditions. However, experience shows that routines and practice, even under similar conditions (resources, organization, etc.) often vary significantly among departments within the same medical discipline. In this more restricted sense, variations in practice might depend on different—more or less well-founded—opinions among physicians concerning what constitutes appropriate length of stay, level of care, and technology. With examples from some specialities (e.g. general surgery, obstetrics and gynecology), we demonstrate this ‘model’ and the economic impact of practice variations. Our conclusion is that there are opportunities for achieving greater benefit from existing resources, i.e. increasing efficiency, through reallocation and alternative utilization of resources, altered practice.

Computer-stored medical records. Their future role in medical practice

Computer-stored medical records. Their future role in medical practice

Preventive care attitudes of medical students

Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: (a) the relative importance of 20 specific preventive services to the practice of medicine and (b) the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction. Areas for which little consensus existed regarding the ability of physicians to provide the service were: life style modification, occupational health/safety education, risk factor analysis, genetic counseling and exercise/physical fitness programs. Overall, the results indicated that both entering and third-year medical students have very similar and somewhat positive attitudes about preventive care services in general. Both groups placed a high degree of importance on the same five preventive care services. These were: health counseling/education, smoking cessation, immunization, cancer detection education and blood pressure control. They were, however, somewhat skeptical about the adequacy of present medical education for preparing physicians to provide the services. Such knowledge about the attitudes of students toward preventive care and about effects of curricula on the evolution of these attitudes should assist medical educators as they evaluate and, if necessary, restructure medical education covering preventive care.

Women in medical school and beyond.

The increasing proportion of female students in Australian medical school warrants an appraisal of the particular factors which may influence their success in their undergraduate and post-graduate careers. Past shortages of medical manpower are giving way to a projected over-abundance of doctors in the near future. New South Wales has three medical schools, and in 1979 women constituted a significant percentage of the total number of students entering the first year. In the Newcastle school that percentage has exceeded 50. Because the majority of women combine their careers with child-bearing and child-raising, they face special problems in medical shcool and beyond. The fulfilment of dual roles frequently creates significant conflicts for women, but there are signs that women are gradually overcoming such conflicts. In fact, some male students are now beginning to question their tradition of full-time commitment to a stressful profession with little free time left for their families or other interests. To make the best use of medical manpower, planning towards more flexible training schemes and more innovative roles in medical practice is essential. Women in particular can help one another by co-operation and imaginative planning.

HYPNOSIS IN MEDICAL PRACTICE

Hypnosis has a role in medical practice as an adjunct to many therapies. A brief review of the history, theory, induction procedures, phenomena and practice of hypnosis is given. The use of hypnosis in the therapy of anxiety is illustrated by a report of a 44-year-old woman suffering from an aeroplane phobia.

Considerations in the Handling of Radium Sources

Since 1961 eight States have assumed licensing and regulatory powers from the Atomic Energy Commission over “by-product, source, and special nuclear material” under an Act passed by Congress in 1959. This law has accelerated development, in the States, of radiation control programs to encompass all forms of ionizing radiation, including radium which has played a major role in medical practice. A recommendation of the National Advisory Committee on Radiation (NACOR) was made to investigate the practicality and means by which less hazardous but equally effective radioactive materials can be utilized in medicine. Acting upon this recommendation, the Division of Radiological Health, United States Public Health Service, sponsored a Conference with members of the medical profession for the mutual exchange of information on radium and radium substitutes. Those invited to participate were representatives from the appropriate medical societies and prominent therapeutic centers, as well as interested parties in the Atomic Energy Commission. The Division of Radiological Health presented a summary of its radium studies. This included information obtained from a review of past radium incidents and accidents and experience of State health agencies with radium problems. The participants were then encouraged to comment on the material presented, based on their own personal experiences, and to propose possible solutions. The conclusions formulated by the Conference were accepted unanimously by the participants and will serve as valuable guide lines in radium management for the medical profession, the State and local health departments, and the United States Public Health Service. Conclusions Of Conference 1. All naturally occurring radionuc1ides, including radium, radon, mesothorium, etc., as well as accelerator-produced radionuc1ides, should be subject to the same radiation protection regulations as are reactor-produced radionuclides. 2. Because of the special contamination hazards associated with radium, due to its physical and chemical properties, minimum standards of source design, construction, and testing should be established for this radionuclide by a body of appropriate experts. 3. A suitable substitute for radium, with less contamination hazard, is desirable. Because of the large body of clinical experience accumulated with radium, substitute sources should be made available which conform to the dimensions and dose distribution patterns of existing radium sources. Cesium137 sources seem capable of satisfying these requirements. For temporary interstitial treatments where flexibility and shielding are important considerations, iridium 192 is the isotope of choice at the present time. For permanent implantation, gold 198 is a suitable substitute for radon. The use of radium plaques should be discontinued; strontium- 90 plaques furnish a suitable substitute.