Turf Issues Research Articles

First person profile: Raymond Sawaya, MD: The founding chair of the neurosurgery department at The University of Texas MD Anderson Cancer Center, Dr. Sawaya has nurtured a generation of specialists and helped to advance the field.

First person profile: Raymond Sawaya, MD: The founding chair of the neurosurgery department at The University of Texas MD Anderson Cancer Center, Dr. Sawaya has nurtured a generation of specialists and helped to advance the field.

Growing Academic Physiatry: The Comparative Impact of Baruch Grants to Harvard Medical School and Columbia College of Physicians and Surgeons. Part I

Growing Academic Physiatry: The Comparative Impact of Baruch Grants to Harvard Medical School and Columbia College of Physicians and Surgeons. Part I

Professional midwifery in Guatemala: A qualitative exploration of perceptions, attitudes and expectations among stakeholders

BackgroundDespite recommendations that women give birth with a skilled birth attendant (SBA), 70% of births in Guatemala occur outside health facilities with informally trained traditional birth attendants (TBAs). To increase SBA in rural, indigenous communities, a professional midwifery school accredited by the government is scheduled to open in 2017. Drawing from Filby's model on barriers to the successful integration of professional midwifery into health systems, this paper aims to identify threats - and facilitators-toward professional midwifery's re-introduction in Guatemala. MethodsTo elucidate perceptions, attitudes and expectations towards professional midwifery, qualitative, in-depth interviews were conducted with 32 physicians, nurses, and TBAs in six health centers and with key decision makers and professional midwives (PMs) in Guatemala City. We conducted open and axial coding in Atlas.ti and performed normative comparisons of participants’ attitudes, perceptions, and expectations with the National Vision for professional midwifery and relative comparisons within and across disciplinary subgroups. ResultsUnprompted, physicians, nurses and TBAs were unable to correctly define professional midwifery. Yet, when professional midwifery was defined for them, they expressed willingness to work with PMs, seeing them as a needed human resource, instrumental in providing intercultural care and strengthening facility relationships with TBAs. Some stakeholders anticipated resistance toward PMs due to provider turf issues. Notable differences in expectations among all groups included ideas for supervision of and by the PMs and the PM's role in monitoring women and conducting births in communities alongside TBAs. ConclusionsFacilitators to professional midwifery's success include national political will, stakeholders' uniformity of vision, and the potential for improved intercultural care. Barriers are mostly professional in nature, including impediments to autonomous practice by PMs, hierarchical challenges, and turf issues. A specific road map addressing the identified barriers is needed for professional midwifery to succeed in reducing maternal health disparities in Guatemala.

Remedial theology: An exploration into the factors-Religious conviction, mysticism and wellbeing.

Spirituality and religion have been seen as beneficial, harmful, and irrelevant to health. An effort was made to examine the recent research on this topic. The focus was on: defining spirituality and religion both conceptually and operationally. The rapidly accumulating evidence on spirituality further confirmed that personal spirituality has important influences on healthcare outcomes however it is difficult to integrate into daily medical practice. However medical spirituality was studied as a distinct interdisciplinary with its own well-developed body of clinical evidence, clinical skill and with well-defined clinical boundaries. An effort was made to integrate the new knowledge, and help anticipate developing "turf issues."

System-level intersectoral linkages between the mental health and non-clinical support sectors: a qualitative systematic review.

Concerns about fragmented mental health service delivery persist, particularly for people with severe and persistent mental illness. The objective was to review evidence regarding outcomes attributed to system-level intersectoral linkages involving mental health services and non-clinical support services, and to identify barriers and facilitators to the intersectoral linkage process. A systematic, qualitative review of studies describing attempts to coordinate the activities of multiple service agencies at the policy, program or organisational level was conducted. Electronic databases Medline, PsycINFO and EMBASE were searched via OVID from inception to July 2012. Of 1593 studies identified, 40 were included in the review - 26 in adult and 14 in vulnerable youth populations. Identified mechanisms to promote positive system-level outcomes included: interagency coordinating committees or intersectoral/interface workers engaged in joint service planning; formalised interagency collaborative agreements; a single care plan in which the responsibilities of all agencies are described; cross-training of staff to ensure staff culture, attitudes, knowledge and skills are complementary; service co-location; and blended funding initiatives to ensure funding aligns with program integration. Identified barriers included: adequacy of funding and technology; ensuring realistic workloads; overcoming 'turf issues' between service providers and disagreements regarding areas of responsibility; ensuring integration strategies are implemented as planned; and maintaining stakeholder enthusiasm. System-level intersectoral linkages can be achieved in various ways and are associated with positive clinical and non-clinical outcomes for services and clients. Some linkage mechanisms present greater implementation challenges than others (e.g. major technology upgrades or co-location in geographically remote areas). In some instances (e.g. co-location) alternative options may achieve equivalent benefits. Publication bias could not be discounted, and studies using high-quality research designs are scarce. The limited information base applicable to system-level integration argues strongly for the evaluation of the models that evolve in the rollout of the national Partners in Recovery initiative.

The Turf and Baggage of Nursing and Medicine: Moving Forward to Achieve Success in Interprofessional Education

Interprofessional education has been identified as a core competency in nursing, medicine, dentistry, pharmacy, and public health. Students and trainees who learn with, from, and about one another in an interdisciplinary learning environment develop the skills necessary for team-based care. Faculty and experienced clinician preceptors are integral to this process because they develop curricula, interact with learners, and role model behaviors, yet most faculty and clinical preceptors were educated in a uniprofessional manner and bring to the table years of history and lived experiences. These turf and baggage issues are often subtle but influence our learners and invariably affect the care of the patient.

Turf Issues in Radiology and Its Subspecialties

Turf issues in medicine affect policy, practice, and, most importantly, patients. This article explores turf issues from several perspectives. The issue and scope of the problem is first discussed, followed by a brief history of turf delineation. Contributing and connected factors are considered, taking into account some consequences of turf battles and their impact on related topics. Finally, this article focuses on proposed strategies to successfully confront the questions, if not overcome the problems encountered. To better inform the deliberation and strengthen the credibility of any conclusions, the evidence and controversies must be regarded from beyond merely the radiology perspective.

Establishing an Outside Film Reading Service/Dealing With Turf Issues: Unintended Consequences

Establishing an Outside Film Reading Service/Dealing With Turf Issues: Unintended Consequences

First Hospital-Based Pain and Palliative Care Program in Hawaii

variations in programs and generalizing back to theorized relationships with the organizational environment (healthcare system), service technology (interdisciplinary palliative care), and implementation process factors. IV. Results. Implementation barriers include staffing deficits, organizational culture, futile care, resistance, knowledge deficits, stigma, difficulty communicating, disciplinary tension, and turf issues. Implementation facilitators include executive support, innovation champion, micro and macro observability, strategic planning, and communication networks. V. Conclusion. Palliative care challenges the dominant culture of the hospital because of a perceived conflict with curative care. Moreover, the interdisciplinary nature of palliative care transgresses traditional hierarchies. Executive support and a physician champion, in addition to including users in the implementation process, and increasing opportunities for observability of outcomes, are among the best ways to overcome resistance to palliative care. VI. Implications for Research, Policy, or Practice. Capitated financing mechanisms (or global budgets) provide an incentive to implement palliative care. These findings should be considered in shaping healthcare reform efforts to accommodate the aging population and the concurrent increases in chronic illness, disability, and unpredictable disease trajectories. The conceptual model was useful in understanding the implementation of this health services innovation within multiple levels of context.

Neurohospitalists: Challenges for the Integration of a New Field: A Neurointensivist's Perspective

A new field of Neurohospitalist medicine is developing. The roots of this field are firmly in the field of Neurology. The development of the field however, may follow the path of its predecessor hospitalist medicine. It is therefore important to study the history of Internal Medicine and hospitalist medicine in order to understand where the field may be headed. The field of Internal Medicine and medical education has undergone a metamorphosis over the past several decades. Historically, patients would be admitted to a hospital for medical evaluation. During this evaluation teams of residents with the attending physician would admit, evaluate, diagnose, and embark on an extensive treatment strategy. As average life expectancy increased, and newer technologies developed, the cost of caring for patients in an in-patient hospital setting became increasingly burdensome. Nationally, increasing health costs became a serious strain on the economic health of most industrial countries. Subsequently, the inpatient evaluation and treatment of most medical diseases became cost prohibitive and moved toward a more cost effective outpatient setting. The movement of medical evaluations to the outpatient setting provided a challenge to internal medicine education. Residencies needed to mirror practice to appropriately prepare residents for their eventual post training place in internal medicine. Subsequently, internal medicine residencies have increased their outpatient requirements over the past few decades. This, however, has occurred during a time of mandated decreasing residency work hours and increasing in-patient volume and acuity. A solution for many of these residencies was the development and implementation of medical hospitalist programs and fellowship. The development of Neurohospitalist programs appears to be following a similar path as internal medicine. Dr. Meschia has noted similar erosion in the in-patient experience of neurology residencies compared to changes that occurred in internal medicine programs (Meschia, 2010). Practice patterns have also shown parallels to Internal Medicine. Today many neurological diseases are evaluated and managed in the outpatient setting. Neurology inpatient services have also displayed a greater number of medical problems and complications. In addition to these findings, the development and expansion of “acute neurology” and more specifically, the use of intravenous tissue plasminogen activator and the development of interventional procedures has increased the need for immediate neurological expertise. This need has superseded financial models to compensate and accommodate the necessary people and resources to adequately treat this patient population. The development of the field of hospital neurology may provide a solution to this problem. The neurohospitalist can provide timely care for acutely ill neurological patients and can relieve neurology practices the need to cover an emergency room or a sick hospital population. Thus, there is a strong economic incentive for the development of the field. This rosy scenario for the neurohospitalists, however, has many potential pitfalls and questions. How will neurohospitalists be organized? What skills will be needed or required for practice? Dr. Likosky's survey of neurohospitalists found that the majority of these physicians do not see patients in an outpatient setting (Likosky et al., 2010). Who will follow the patient once they have left the hospital? How will neurohospitalists be reimbursed? These are only a few of the questions a young field will need to address as it develops. Each of these questions and issues has potential difficulties. One model for Neurohospitalist development is to have the neurohospitalist hired by a group practice. Reimbursement would be established by the group and patient follow up would be covered by the group. However, what if the neurohospitalists are hired and salaried by the hospital? as is the growing trend in medicine. Coordination with outside practices will take considerable skill. Inevitably “turf issues” will arise. Similarly what will happen when a neurologic emergency occurs when a patient is not covered by the neurohospitalists practice? Who will the emergency room physicians call when an outside neurologist or physician is unavailable or delayed? Most neurologists and physicians may be grateful for this help; however, so may patients who may wish to leave the outpatient neurologists practice to join the practice of the physician who cared for them during their crisis who may or may not have an outpatient practice. A majority of neurohospitalists in Likosky's survey came from either a stroke or neurocritical care background (Likosky et al., 2010). This may represent selection bias of the survey or of individuals who chose to spend their time in the hospital. However, neurohospitalists should be able to provide consultative roles in all areas of the hospital including the intensive care units (ICUs). The neurohospitalists may be able to complement both the general neurologists and neurointensivists by dividing services, procedures, or consultations when necessary. Again a certain level of political skill may be needed to navigate these areas.

Developing an Information Management System for Public and Specialized Transportation Providers of Illinois: A Web-Based, Interactive System

Transportation coordination involves service coordination, planning coordination, and financial coordination. A scan of the literature indicates that transportation coordination efforts are hampered by a lack of understanding about existing services, turf issues, and inadequate funding. One solution to address this problem is by providing comprehensive information management systems (IMS) to all stakeholder groups that are part of the regional and state transportation arena. Various federal programs acknowledge the importance of coordination and make it a mandatory precursor to applying for funding. The level of coordination required for successful application for funding from these programs makes the need for such information systems extremely important. The Urban Transportation Center at the University of Illinois at Chicago is developing a web-based interactive IMS (TRANPRO) for the public and specialized transportation services in Illinois; the IMS features a provider inventory and other service-related information along with the requisite demographic information. The TRANPRO IMS includes public and specialized transportation data in the form of projects funded by Sections 5307, 5311, and 5310; the Downstate Operating Assistance Program; Job Access and Reverse Commute; New Freedom grants; and Title IIIB and Title XX programs for seniors as well as other known human-service transportation providers operating within the state. This paper explains the development of the IMS, the data assimilated, and the various uses of the system to facilitate coordinated planning, mobility management, and help with the grant application process. TRANPRO will benefit different stakeholder groups, including the administrators of funding programs (for example, the department of transportation), human-service transportation coordinators, mobility managers, and other stakeholders in coordination of services.

The Need for a "Mental Health Home"

Back to table of contents Previous article Next article LetterFull AccessLetterJames McCreath Ph.D.James McCreath Ph.D.Search for more papers by this authorPublished Online:1 Jul 2009https://doi.org/10.1176/ps.2009.60.7.993AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleThe Need for a "Mental Health Home"To the Editor: In the April issue Drs. Smith and Sederer ( 1 ) do a terrific job presenting a rationale for the "mental health home." There is no doubt that our fragmented behavioral health system is inadequate for individuals most at risk. There is no reason to think that the public's demand that general hospitals substantially improve both process and outcomes shouldn't apply to the behavioral health industry. The coordination and delivery of behavioral health services must improve, and the mental health home concept warrants a close look. At the heart of the model the authors see "generalists working with the entire individual and coordinating care among a range of behavioral and rehabilitation service providers." I couldn't agree more, although an empathic relationship is a must, and no one framed this better than Deitchman ( 2 ), who felt that the "chronic client in the community needs a 'traveling companion not a travel agent,'" or Lamb ( 3 ), who advocated for "therapist-case managers." Coordination without an empathic worker-consumer relationship is bound to fall short of expectations for improved service delivery. Coordination will also fall short if the mental health home team's added value is limited to advocacy. Advocacy is helpful but not adequate to overcome the system's numerous structural weaknesses. Achieving continuity of care for individuals most at risk would require the team to have resources and authority to acquire services.In 2007 Jersey City Medical Center's Behavioral Health Center established a "clinical home" pilot for adults with co-occurring disorders and histories of high recidivism and treatment nonadherence (I was vice president for behavioral health at the time). Every behavioral health program—partial hospital, outpatient department, emergency department, residential facility, and intensive case management—can function as a clinical home. The clinical home duties are above and beyond that program's routine services and are considered "enhanced." The pilot assigns "navigators" to consumers with high use of emergency or inpatient services who will not accept community-based services or are ineligible for intensive case management or assertive community treatment. The evidence to date is that the clinical home reduced recidivism and enhanced treatment adherence for consumers whom the system had given up on.The model is unique in that the clinical home clinician (or team) follows the consumer through all services. If the partial hospital accepts responsibility for a consumer and that consumer needs hospitalization, the partial hospital worker follows the consumer through the inpatient stay. If the emergency department is the clinical home and the consumer wants partial hospitalization, the emergency department worker escorts the consumer to the program until linkage is established. Consumer choice must supersede program and system concerns.One reason that the pilot works is that all the services are under one agency. No doubt this model would create potentially insurmountable turf issues in multiagency systems, but there can be no minimizing the value of a mental health home, where one team has the resources and authority to acquire services valued by the consumer. Certainly the mental health home warrants significant demonstration project funding.Dr. McCreath is president and chief executive officer of Hall-Brook Behavioral Health, Westport, Connecticut.

Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

BackgroundFoundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties.MethodsWe interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points.ResultsParticipants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability.ConclusionParticipants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact.

Negotiating the challenges of multidisciplinary responses to sexual assault victims: Sexual assault nurse examiner and victim advocacy programs

The purpose of this study was to examine Sexual Assault Nurse Examiner (SANE) programs' relationships with victim advocacy organizations. A national telephone survey was conducted of randomly selected SANE programs, all of which served adults, and some of which also served adolescents and children. Nearly one-third of 231 participants reported that SANEs in their program had experienced conflicts related to roles and boundaries with victim advocacy organizations at some point during the program's history. The most frequently mentioned conflicts involved professional autonomy, control, or turf issues. Future researchers should address personnel, organizational, and structural factors that facilitate collaborative relationships between SANE and victim advocacy organizations.

Gender Differences in Rural and Urban Practice Location Among Mid‐level Health Care Providers

Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural practices is an important issue influencing health care. To gain further insight into this issue, this study examined how mid-level practice location varied by gender. Semistructured interviews were conducted with a purposive sample of 55 nurse practitioners, physician assistants, and nurse anesthetists in New York State and Pennsylvania. Results suggest that family and community ties played a key role in influencing practice location. Men were particularly drawn to the broad scope of practice and autonomous nature of rural practice. Women in rural areas enjoyed the more personable environment and greater respect from colleagues and patients. Both male and female rural providers preferred their location because there were fewer turf issues, while some women were concerned about being professionally isolated. Meanwhile, both men and women enjoyed the fast pace, specialization, and greater opportunities urban areas had to offer. Recruitment efforts should focus on candidates from rural areas and not underestimate the impact of family in decisions about work location.

Attitudes of and Influences on Residents in English Canadian Radiology Programs Regarding Interventional Radiology: Results of a National Survey by the Canadian Interventional Radiology Association (CIRA)

There has been a North American trend toward reduced application to the subspecialty of Interventional Radiology (IR). Out of fear of a looming manpower shortage, this survey was conducted to better understand awareness and attitudes toward IR by radiology residents-in-training. An anonymous online survey was emailed to the Diagnostic Radiology Residency Program Director/Department Chairperson of each of the 13 English medical schools in Canada, to be forwarded to each respective Radiology Residency Program's radiology residents. The survey was open for a period of 1 month. The survey consisted of 29 questions, which could be answered online using a web-based program. Responses to questions were tabulated and comments recorded. A total of 84 survey responses were received of a possible 333 (25%), including responses from each of the 13 English Programs. Responses regarding demographics, training, careers aspirations and motivations, and influences were collected. Fifty-one percent of respondents reported being either "moderately" or "very" interested in the field of IR; however, only 13% reported intention to perform an IR fellowship. A number of issues were identified as dissuading current radiology residents from pursuing IR, including income, work hours and hours of on-call, and turf issues. A number of issues were identified as factors which prevented residents with an interest in IR from applying to IR fellowships. These must be addressed to increase IR recruitment rates of radiology residents.

The Canadian health care system: Past, present, and future

This review offers American radiologists the information required to understand the Canadian health care system. It includes a brief history of the Canadian system and describes the relationship between health care and the Canadian constitution. A comprehensive appraisal of current conditions addresses the performance of the Canadian system and provides an overview of policy and planning responsibilities for health care across Canada. It includes not only the roles and responsibilities of the federal government and of the provincial and territorial governments in health care, but also those of professional organizations. In this context, significant differences between Canada and the United States are discussed, including: the development of professional fees; billing mechanisms and audits; and medicolegal and turf issues, such as self-referral and imaging by nonradiologists. A description of professional organizations includes the central responsibility of the Royal College of Physicians and Surgeons of Canada for professional training and development, and of national and provincial medical organizations. There are descriptions of medical schools and research organizations as well as federal organizations responsible for health information and technology assessment. Problems encountered in recent years because of the curtailment of health care spending are addressed. The future of Canadian health care is considered in light of a recent report titled Building on Values: The Future of Health Care in Canada. Issues of particular interest to radiologists are emphasized.

Strengthening the collaboration between public health and criminal justice to prevent violence.

Over the last two decades in the United States, public health practitioners, policy makers, and researchers have charted new tenitory by increasingly using public health strategies to understand and prevent youth violence, which has been considered a criminal justice problem. The utilization of public health approaches has generated several contributions to the understanding and prevention of violence, including new and expanded knowledge in surveillance, delineation of risk factors, and prop design, including implementation and evaluation strategies.While public health activities generally complement those of criminal justice, confrontations, challenges and turf issues within this cross-disciplinary enterprise remain inevitable. Continued progress is dependent upon expanded efforts and greater collaboration within both disciplines.

For the Living: Coping, Caring, and Communicating With the Terminally Ill

Back to table of contents Previous article Next article Book ReviewsFull AccessFor the Living: Coping, Caring, and Communicating With the Terminally IllDennis Martin, R.N., M.S.W.Dennis MartinSearch for more papers by this author, R.N., M.S.W.Published Online:1 Nov 2003https://doi.org/10.1176/appi.ps.54.11.1556AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail For the Living: Coping, Caring, and Communicating With the Terminally Ill is written from the perspective of a Ph.D. candidate in the field of communication at Rutger's University. A central thesis of the book is the author's belief that death has become a marginalized, taboo topic in our modern, secular culture and that it is most frequently isolated in hospital environments that are far removed from people's daily lives. Thus Golubow contends that the average person has very few opportunities to be present during the dying process or to witness death itself.To help make better sense of death's impact on our lives and on how we as a society cope with the foreknowledge that death is inevitable, Golubow has interviewed 12 professionals—two social workers, three nurses, and seven physicians—whose daily lives are spent on oncology wards and clinics. The author maintains that "there are few, if any, individuals and occupations that fully view and exercise with such consistent intensity the human condition of passion, pain, and sorrow than oncology doctors, nurses, and social workers treating terminally ill patients."The 12 interviews are presented initially without analysis, to stand on their own merits. They constitute approximately 75 percent of the body of the text. Golubow then evaluates these interviews from the perspective of "symbolic interactionism," with the belief that this approach will help the reader, whether or not he or she is a professional in the oncology field, gain deeper insight into his or her own understanding and experiences of death and dying. Symbolic interactionism as explicated in For the Living is a theoretical perspective in the field of sociology that posits that individuals' sense of reality and self is socially created through interaction with their world and that who we are, what we feel, and how we see the world is structured as a result of interactive processes between people. The author makes it clear that his readers do not need to adopt this perspective as their own in order to benefit from the book. I did not find the perspective to be particularly helpful or necessary to the appreciation of the interviews.This is a book with serious flaws. The text is rife with blatant grammatical and spelling errors. An unusual amount of time lapsed between the interviews and the book's 2002 publication date: most of the interviews took place almost ten years previously. The past ten years have seen major changes in the development of more effective oncology interventions and in the acceptance and use of home-based hospice services. The roles of nurses and practitioners have greatly expanded. A severe nursing shortage has emerged. Medical school education has begun to more adequately address communication skills and the development of more well-rounded physicians. These changes have diminished some of the book's central theses and have made some of the interviews appear dated.That being said, as someone who has spent more than 14 years literally at the bedside of the dying in the role of both clinical social worker and registered nurse, I did find the interviews to be valid and thoughtful reflections of what it is like to live one's professional life helping people make the journey across the sacred space where life becomes death. The core existential issues remain the same and are well captured in the interviews. Being present at the moment of death never becomes routine. There is constant confrontation with the fact of your own mortality and the vulnerability of your biology to potential cellular ravages. Patients are exceptionally open to and desirous of intimate connections with their practitioners: powerful connections happen with patients, and healthy risk taking occurs with professional boundaries. The need for life away from the ward and the clinic to refresh one's own life force is paramount if one is to remain truly present to the dying without psychically withering. Interdisciplinary turf issues are easily exacerbated. The book's merit rests on the truthful voices of these 12 practitioners, who provide a clear window into life on the front lines of terminal illness for any reader interested in a vicarious experience of the same.Mr. Martin is affiliated with the John C. Corrigan Mental Health Center in Fall River, Massachusetts.by Mark Golubow; Amityville, New York, Baywood Publishing Company, Inc., 2002, 176 pages, $34.95 FiguresReferencesCited byDetailsCited ByNone Volume 54Issue 11 November 2003Pages 1556-1556 Metrics PDF download History Published online 1 November 2003 Published in print 1 November 2003

Ugly turf issues once again?

Ugly turf issues once again?