Town Physician Research Articles

Abstract PO1-11-03: Women with Metastatic Disease: Modeling a Clear and Well-Defined Announcement Pathway

Abstract Introduction: The announcement of the diagnosis of metastatic breast cancer is a key step in enabling the patient to fully understand her disease and the various treatment options, and thus to be more involved in her management and follow-up. However, according to the « Croyances et réalités 2 » survey conducted in 2021 among 269 French patients with metastatic breast cancer, 38% of them felt that they "did not fully understand" the information given by their doctor during the announcement consultation. Objective: The objective of this work is to model an optimal pathway for the announcement of metastatic breast cancer based on precise guidelines and good coordination between the different actors, in order to ensure that all patients have the necessary information and support. Method: A scientific committee composed of 4 French oncologists from 4 different centers initiated a collaborative process to propose, after discussions, precise guidelines for the announcement of metastatic breast cancer. Results: A set of 13 concrete guidelines were suggested by the expert group (Table 1). The central aspect is to build a specialized and flexible support, adapted to the needs of the patient, without ever hiding the truth about her disease. The announcement process must be adapted to the patient's history (recurrent or immediately metastatic), but also to the organization and resources available in the health care institution. The experts recommend a model of announcement process in two stages, separated by a few days. First, the oncologist announces what the entry into metastatic disease represents, followed by a repeat of the announcement by a nurse trained in the specificities of metastatic breast cancer, in order to have the patient reformulate her understanding of the disease and treatment. In a second phase, a new consultation allows to present the next therapeutic steps and ensure a coordinated intervention of the different health care professionals involved: doctors, nurses, pharmacists and supportive care specialists as needed. The offer of supportive care should be flexible and it is recommended that questionnaires should be made available to the patient to help identify her precise needs. The experts recommend that this second consultation be conducted jointly by an oncologist and a nurse. Subsequently, the town physician and pharmacist must be contacted to ensure the relay in the accompaniment of the patients in partnership with the cancer care center, and thus to ensure a good sharing of information on the patient's follow-up. To help the establishment of this dynamic announcement model, the experts gave advice on implementation: training the professionals involved in the process through theoretical training and role-playing, increasing the amount of time spent on the announcement consultation, and setting up a library of online or physical information materials to share with the patient. Finally, it is recommended that the financing of this process be prepared at the institutional level before its effective implementation in order to ensure its sustainability. Conclusion: Organizing a consultation for the announcement of metastatic breast cancer is essential to optimize the experience of the announcement and support. It must be a structured, funded and coordinated process between different health professionals specially trained for this approach. Table 1: Summary of guidelines for a metastatic breast cancer notification pathway. Citation Format: Florence Dalenc, Séverine Guiu, Marie-Ange Mouret-Reynier, Nathalie Quenel-Tueux. Women with Metastatic Disease: Modeling a Clear and Well-Defined Announcement Pathway [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-03.

From Contract Surgeon to Town Doctor: The Life and Legacy of Dr. Martin Light Herr

Objectives The life and legacy of Dr. Martin L. Herr of Lancaster, PA helps to correct the popular perception that contract surgeons in the Civil War were nothing more than quacks and butchers when in fact they proved to be courageous and competent physicians essential to give medical care to overwhelming numbers of casualties. Methods Personal papers and archives of ML Herr in the Lancaster Historical Society (Lancaster, PA) were reviewed. Results ML Herr obtained his medical training and degree while serving as a contract surgeon during the Civil War. He transformed that experience to become a community leader and town physician and surgeon. His legacy helps to restore the reputation of contract surgeons to the honor they deserve. Conclusions Dr. ML Herr served both his fellow man and his community with distinction during the Civil War and in civilian life. He left the army, his country, the people of Lancaster, his family, and his profession better off because of his presence.

A Postcard for Annie by Ida Jessen

Reviewed by: A Postcard for Annie by Ida Jessen Elaine Margolin Ida Jessen A Postcard for Annie Trans. Martin Aitken. Brooklyn. Archipelago Books. 180 pages. IT'S HARD NOT to become hooked by Ida Jessen's stubbornness; her refusal to tidy things up for us. This sixty-year-old Danish author harbors no illusions about women's troubled relationships with men; nor does she hold out hope for the muchtalked-about benefits of female self-discovery and empowerment. She knows women have no clue as to what pushes them into failing relationships and even less insight as to why they remain. In her wonderful new collection of stories, A Postcard for Annie, we hear the collective howl of women falling hard upon the ravages of middle age, which has exacerbated their bitterness, grief, and loneliness. In an earlier stellar work, "A Change of Time," a woman visits her dying husband in the hospital only to find he is always sleeping when she arrives. The nurse fills her in, but she can't help thinking something is amiss. She will soon be a widow at fifty, and although her marriage has been one without laughter or intimacy, she fears for the future. He is the town's physician, and for reasons that remain mysterious to her, he always took umbrage with her inability to come up with a quick retort in conversation. "Human kindness is my nourishment and my fatigue," she thinks. "Why is it not sufficient? I have more than most." The book is set in a form of diary entries where, even in this personal space, she remains restrained. Jessen doesn't allow her to condemn her husband outright. Instead, she circles her sadness, always considering that perhaps there is something she doesn't see. This insecurity is present in most of Jessen's characterizations. In one of the captivating stories in her new collection, a woman named Tine is frustrated by her husband who is refusing all her advances: "Beautiful underwear, she's tried that. She's tried beautiful. She's tried intelligent, good, and loving. She's tried funny, naughty, and wild." But nothing has worked. She retreats to her son's room and thinks how long it has been since he left home; but her thoughts wander back to her husband. Jessen often seems to consider children as nothing more than an afterthought, transitory beings that are no longer essential. She keeps rethinking about how they first fell in love and how overwhelming it felt: "Once, they existed. Love existed, hope existed, and faith existed. As if, suspended in that bashful and benign state of being, they each knew they were lovingly anticipated." But now there was a void where wonderment once was. Jessen knows better than to have her characters perform autopsies on their dying love affairs; she knows the pointlessness of such endeavors. In another tale, "An Excursion," Tove is a successful businesswoman who reupholsters furniture and sells material for curtains. On a random day at an antique fair, she finds herself captured by a yellow floor vase whose color was precisely the shade of yellow that had always overwhelmed her: "Even now, in the home she had made as an adult, she possessed very little that was yellow, as if she were afraid of overdosing, just as she would rarely go to the doctor, fearing herself at bottom to be a hypochondriac." Behind her, a man was staring at her looking at the vase, and soon enough they were intricately caught up in each other's lives. She learned to cook to please him and liked when he called her "honey." But soon enough things shifted and she heard that when she spoke to him her voice was timid, her laughter more restrained. But she couldn't address the thought of leaving him, because she knew that "without him she was shapeless." Ida Jessen is a master chronicler of the messiness that overtakes the female mind. She writes unburdened by polemics of any kind. Her characters are vividly drawn—sometimes eccentric, and at other times ordinary—but they seem strangely authentic to us. We see ourselves in almost all of them. Jessen never...

Impotence and the Natural Explanation of Bewitchment: Wolfgang Reichart’s Medical Case Report on the Loss of “potentia coeundi”

Abstract Wolfgang Reichart (1486-c. 1547) was a humanist and a town physician of Ulm. His work consists of a largely unpublished collection of nearly 600 texts. So far, it has been claimed that this compilation only consists of letters and poems. However, we have found a medical treatise, wherein Reichart discusses a case of impotence, its pathophysiology and therapy. One of the crucial aspects in this text is the relationship it describes between witchcraft and medicine. The patient claims that his condition is the result of bewitchment. Reichart accepts witchcraft as a possible aetiological explanation, but claims that since the processes triggered by witchcraft are still natural, the patient can be cured by natural means. Thus, Reichart’s approach is an important contribution to the history of medicine and to the history of science of the early modern period. We provide the first edition, translation, and commentary of the text.

The Pathophysiology and Therapy of Erectile Dysfunction in a Newly Discovered Treatise by Wolfgang Reichart (1486–circa 1547)

A newly-found treatise by Wolfgang Reichart (1486-circa 1547), town physician of Ulm, challenges the contemporary view that bewitchment as a cause of impotence defies any natural explanation. To understand the pathophysiological concept and therapy of erectile dysfunction in Reichart's treatise by examination of his sources and previous concepts. Source analysis of Reichart's treatise by comparison of the pathophysiological concepts and therapy of erectile dysfunction with original texts of the Corpus Hippocraticum (5th-3rd century BC) and Constantinus Africanus (11th century). By using rational thinking and medical knowledge mainly drawn from antiquity, especially Constantinus Africanus, Reichart shows that a supposed supernatural cause for impotence can be explained by reason and natural means. Reichart's treatise changes the view of bewitchment as cause of impotence. He makes eclectical use of previous concepts to explain his patient's condition. From the Middle Ages on, bewitchment was accepted as a cause for erectile dysfunction. Usually, physicians of that time accepted this etiology and advised a treatment based on theological concepts. Reichart challenges this view by emphasizing reason and medical knowledge as crucial for treating the patient, rejecting supernatural treatment approaches. In the 16th century, a type of rational thinking and medical knowledge emerges, which puts supernatural explanations into question and aims at treating patients with natural means. The analysis of Reichart's treatise is a much-needed contribution to understanding the historic development of pathophysiological concepts of and therapeutic measures for impotence, which is yet underresearched.

Impotence and belief in witchcraft: a medical treatise by the Ulm town physician Wolfgang Reichart (1486-1547)

HintergrundDer Hexenglaube beeinflusste im 16. Jahrhundert das medizinische Denken und Handeln. Der Ulmer Stadtarzt Wolfgang Reichart (1486–1547) hat in einem bisher unbekannten Traktat die Impotenz eines Patienten mit medizinischen Konzepten rational erklärt.Material und MethodeDer Traktat wurde transkribiert, übersetzt und hinsichtlich seiner Quellen, Struktur und des Inhalts analysiert. Die Ergebnisse wurden mit Johann Weyers (1515–1588) Konzepten verglichen.ErgebnisseReichart erklärt die Impotenz seines Patienten als erworbene Erkrankung, an der Dämonen beteiligt waren. Da Dämonen nur auf natürliche Weise auf den menschlichen Körper wirken, sei die Krankheit auf natürlichem Weg heilbar. Grundlage der Therapie ist ein mittelalterliches pathophysiologisches Konzept, das antike Elemente kombinierte.SchlussfolgerungenReicharts Therapie unterscheidet sich von derjenigen zeitgenössischer Ärzte, weil er den Patienten selbst behandelt und nicht an einen Theologen überweist. Im Gegensatz zu Weyer bietet er ein detailliertes pathophysiologisches Konzept zur medizinischen Erklärung der Impotenz.

Heinrich Steinhöwel (1410/11–1479) als Stadtarzt und Apotheker in der Freien Reichsstadt Ulm

Heinrich Steinhowel (1410/11-1479) was a successful author and translator in the period of the early Humanism. Although occupied with multiple duties as a town physician of the free imperial city of Ulm for over 20 years, there are hardly any traces of medicine in his works, as the medical historian Karl Sudhoff (1853-1938) already noted. So far, little is known about Steinhowel’s medical practice. The objective of the article is to ascertain Steinhowel’s duties as a town physician and to identify his multiple roles in the medical system of his time: the beginnings as a practicing physician, the office of a town physician, and as a pharmacist. In order to find regulations for the medical system of Ulm as well as employment contracts of Steinhowel and contemporaneous town physicians for comparative purposes, extensive archive investigation was conducted in south-western Germany, especially in the municipal archives of Ulm. New results are the specific content of Steinhowel’s contracts as an early-modern town physician, chronological issues in respect to his withdrawal from this office, the ownership of a pharmacy, and his double-role as a pharmacist and supervisor of pharmacies.

‘All men have been considered equal by me’: The attitude of Amatus Lusitanus towards treating gentiles according to his Physician’s Oath

The ancient Jewish law took a strict approach to medical relationships between Jews and non-Jews. The current study deals with the attitude of Amatus Lusitanus (1511–1568), a notable Portuguese Jewish physician towards treating gentiles. The Physician’s Oath of Lusitanus emphasises that as a doctor he treated people from varied faiths and socio-economic status. Lusitanus treated many non-Jews. For instance, he received an invitation from the municipality of Ragusa to serve as the town physician and he accepted this mission. In Anconare, he was called upon to treat Jacoba del Monte, sister of Pope Julius III, and he also prescribed for Julius himself. Amatus Lusitanus was forced to leave his country because of the Portuguese inquisition and wandered in many countries. Despite the hostile religious attitude of his close surroundings, he did not retaliate against his patients and provided medical treatment indiscriminately.

A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study.

BackgroundMobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions.ObjectiveThis study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China.MethodsThe SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group.ResultsFrom the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study.ConclusionsThe mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients.ClinicalTrialClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858International Registered Report Identifier (IRRID)RR2-10.1016/j.ahj.2018.08.015

Venereal diseases in a "general practice" in the 17th and early 18th centuries

The diary of the town physician Johannes Franc (1649-1725), handwritten in Latin, gives-among other diseases-an overview of sexually transmitted infections affecting citizens in Ulm such as syphilis and gonorrhea. Franc reported on his own experiences in the diary and also included many theoretical details on the causes of the diseases and the corresponding therapies, including ethical considerations. Even in ancient times, there are indications of venereal diseases. However, at the latest with the outbreak of syphilis around the year 1495, the treatment and control of the spread of venereal diseases became an important task of medicine. Before gonococci were detected by Neisser in 1879, sexually transmitted diseases were generally seen as asingle disease. However, at the beginning of the 18th century, there were several doctors who treated syphilis and gonorrhea as separate entities. Franc was one of them. Examining the milestones in the history of syphilis and gonorrhea, the present article reviews the existing theories that tried to explain the origins of these diseases. Franc's treatment patterns are illustrated. Franc's case reports indicate afundamental change in the perception of STIs at the end of the 17th/beginning of the 18th century.

In Rural Towns, Immigrant Doctors Fill A Critical Need.

Immigrant doctors have helped fill physician shortages for years. In the current political climate, are they welcome?

Reading Books in Natural Philosophy: How Conrad Gessner‘s Commentary on De Anima (1563) was Annotated and Interpreted

Conrad Gessner (1516–65) was town physician and lecturer at the Zwinglian reformed lectorium in Zurich. His approach towards the world and mankind was centred on his preoccupation with the human soul, an object of study that had challenged classical writers such as Aristotle and Galen, and which remained as important in post-Reformation debate. Writing commentaries on Aristotles De Anima (On the Soul) was part of early-modern natural philosophy education at university and formed the preparatory step for studying medicine. This article uses the case study of Gessners commentary on De Anima (1563) to explore how Gessners readers prioritised De Animas information. Gessners intention was to provide the students of philosophy and medicine with the most current and comprehensive thinking. His readers responses raise questions about evolving discussions in natural philosophy and medicine that concerned the foundations of preventive healthcare on the one hand, and of anatomically specified pathological medicine on the other, and Gessners part in helping these develop.

The Scientific Culture of the Baltic Mathematician, Physician, and Calendar-Maker Laurentius Eichstadt (1596–1660)

This paper is devoted to Laurentius Eichstadt, a Baltic astronomer of the generation between Tycho and Hevelius. As a calendar-maker, Eichstadt used and tested the astronomical tables and the planetary theories of his elder contemporaries, Longomontanus and Kepler; as a town physician and gymnasium professor, he taught mathematics and astronomy alongside medicine and natural philosophy in Stettin and Gdańsk. Eichstadt’s indefatigable engagement with theory, practice, and teaching is marked by his continuous reassessment, adjustment, and revision of views in astronomy, physics, and metaphysics, aimed at bringing these fields in better agreement with each other and with empirical observation. Eichstadt’s critical attitude did not prevent him from remaining committed to his scholastic legacy. As a matter of fact, his creative reworking and teaching of astronomy and philosophy bear witness to the long vitality of the northern European scientific tradition rooted in Melanchthonian literacy and Aristotelian philosophy. The work and conceptions of this participant in the astronomical debates of the early seventeenth century offers us an insight into the complex interplay of technical astronomy and metaphysical discourse in a time of transition from a geometrical approach to planetary theory resting on Aristotelian metaphysics to a post-Keplerian physical–mathematical science unifying heavens and earth.

A Case of a Patient/Physician Boundary Issue in Rural Practice and Measures to Avoid or Maintain Dual Relationships.

A Case of a Patient/Physician Boundary Issue in Rural Practice and Measures to Avoid or Maintain Dual Relationships.

Urologische Erkrankungen in einer „Allgemeinarztpraxis“ im 17. und frühen 18. Jahrhundert

Of national medicohistorical importance was the town physician Johannes Franc (1649-1725). His diary written in Latin gives - among other diseases - an overview of urological diseases affecting citizens in Ulm around 1700. It also allows a look into the "workshop" of a scholar who studied contemporary medicine in comprehensive manner. Franc's case reports illustrate a fundamental change in the perception of the patient at the end of the 17th/beginning of the 18th century.

Samuel Holden Parsons Lee (1772–1863): American physician, entrepreneur and selfless fighter of the 1798 Yellow Fever epidemic of New London, Connecticut

Samuel Holden Parsons Lee practised medicine at a time when the germ theory of disease had not yet been proposed and antibiotics remained undiscovered. In 1798 he served selflessly as the only physician in town who was willing to battle the Yellow Fever outbreak of New London, Connecticut. Because he practised at the dawn of the age of patent medicine, unfortunately his name also came to be associated with medical quackery. We argue that his contributions have been grossly underestimated. He compounded and vended medications - including bilious pills and bitters - that were gold standards of the day. Moreover, one preparation for treatment of kidney stones led to his sub-specialization in this field and was met with such success that its sale continued for nearly 100 years after his death. While a talented medical man, Lee also had a knack for business, finding success in trading, whaling and real estate.

The Promises and Perils of the MHS' Implementation of the Patient-Centered Medical Home

With increasing resource scarcity and rising costs of health care, the Military Health System (MHS) must transform from a chronically inefficient and costly health care system that is overly reliant on specialty care and large institutions into a cost-effective and outcome-based system of health. Over the past 2 decades, the United States has witnessed economically unsustainable rises in health care costs in both the civilian and the federal sectors. 1 During this period, however, the country has seen little improvement in access to and quality of health care. Multiple studies show primary care providers improve health care cost and quality, yet few initiatives have focused on reestablishing the primary care physician as the center of health care delivery. 2 The Patient-Centered Medical Home (PCMH) model rejuvenates the use of primary care providers as the central source of individual medical care. The PCMH is a commonly understood model; it is a modern adaptation of the classic, small town physician practice. Simply put, this is the patient’s home for all things medical. The PCMH uses a team of care providers to deliver continuous and comprehensive primary care and to ensure that the needs of the patient are met. In addition, specific focus is placed on preventive care and population health. Patients have increased access to providers on a continuous basis and can communicate with their care team via modern technology tools, such as secure messaging. Current research indicates improved patient experiences, better coordination of care, and decreased emergency department visits and inpatient admissions. 3 All these improvements are essential for sustainability in today’s economic environment.

Jimmy Volmink: shaping the evidence base in South Africa

Jimmy Volmink: shaping the evidence base in South Africa

Sharing Cases: The Observationes in Early Modern Medicine

This paper examines the rise of an epistemic genre, the Observationes, a new form of medical writing that emerged in Renaissance humanistic medicine. The Observationes (collections of case-histories) originated in the second half of the sixteenth century, grew rapidly over the course of the seventeenth, and had become a primary form of medical writing by the eighteenth century. The genre developed initially as a form of self-advertisement by court and town physicians, who stressed success in practice, over and above academic learning, as a core element of their professional identity. This unprecedented emphasis on practice as a source of knowledge remained a key feature of the Observationes in its subsequent development. As the genre evolved, the original emphasis on therapeutic success gave way to a new focus on the descriptive knowledge of disease through detailed observation. The authorial identity projected by the writers of Observationes was increasingly that of the learned and experienced observer, bent on comparing notes and sharing his cases with the fellow members of the res publica medica. This paper charts the development of the genre, examining how its growth contributed to the new epistemological value of observation in the age of the Scientific Revolution.

PARADIGM SHIFT: MOVING TOWARD ACCESS IN EVERY OFFICE

Dehlendorf and Grumbach should be commended for their recent piece on medical liability insurance for abortion care in family medicine.1 Their work highlights that family medicine physicians are uniquely positioned to provide early abortion care to their patients. Medication abortion and first-trimester aspiration abortion are skills that family medicine physicians can easily incorporate into their practices as a service to their patients. As mentioned by Dehlendorf and Grumbach, it is estimated that 44% of women have an abortion sometime during their life.2 This fact makes early abortion relevant to all primary care physicians, but especially to family medicine physicians, who have clinical training in obstetrics and gynecology. Additionally, in the more rural parts of the United States, family medicine physicians are often the only physicians in town. In the 87% of US counties that do not have an abortion provider, family medicine physicians could be the answer to this unmet need.3 Anthony McWilliams, left, and “L” Lawrence Warren, right, participate in the 2nd Annual Stand Up and Represent National Black Gay Pride march in the West End section of Atlanta, GA, on September 2, 2002. Photograph by Ric Feld. Printed with permission of AP Images. Currently, only 2% of abortions are provided in private doctors' offices.3 The majority are performed in specialty abortion clinics. Patients are often referred to these specialty clinics from the gynecologist or primary care doctor who diagnosed their pregnancy. This is the current model of abortion care in this country. Imagine however, if first-trimester abortions were available in the majority of primary care practices. The paradigm of abortion care in the United States could be fundamentally altered, and the negative stigma of abortion could be lessened. Family medicine physicians have other advantages beyond their physical proximity and training skills: the ability to provide continuity of care and make use of the acquired trust of their patients. In times of crisis, primary care physicians have a unique opportunity to intervene to effect positive change as a result of the relationship they have built with their patients.4 Delivering abortion care in the primary care setting has the potential to improve postabortion family planning and contraceptive services, such as patient selection of intrauterine devices or other highly effective contraceptive methods. Better contraception means fewer repeat abortions, and that is a goal that almost everyone can agree on.5