White Physicians Research Articles

Physician breach of patient confidentiality among individuals with human immunodeficiency virus (HIV) infection: patterns of decision.

To determine whether the sex, race, or sexual preference of a patient infected with immunodeficiency virus (HIV) influences a physician's decision to breach patient confidentiality, Tennessee primary care physicians were mailed a questionnaire containing a case study in which an HIV-infected patient presented a risk to a third party. Eight different descriptions of the sex, race, and sexual preference of the hypothetical patient were distributed randomly among the physicians, one description to each physician. The physicians were asked to decide whether to maintain confidentiality, notify the health department, or inform the patient's partner. Responses of 199 White male physicians were analyzed using an unconditional saturated logistic regression model. The odds ratios for these physicians saying they would send the patient's antibody status to the health department extend from 18.4 (95 percent confidence interval: 1.3, 260.1) for Black homosexual males to .5 (95 percent CI: 0, 11.5) for White homosexual females. The odds ratios for White male physicians saying they would inform the patient's partner range from 7.5 (95 percent CI: .8, 69.2) for Black heterosexual males to 1.0 (reference category) for Black homosexual females. The results suggest that when physicians decide to protect a third party by breaching an HIV-infected patient's confidentiality, their decision may be influenced in some cases by the race, sex, and sexual preference of the patient.

White House physician Lee to be active in health policy.

White House physician Lee to be active in health policy.

Why Not Share the Secrets of Good Health?

MOST physicians enjoy good health.¹In the United States, the age-standardized death rate for white male physicians is 75% of that for all white men.²Female physicians have a death rate that is 84% of average. In the past few decades, mortality rates for physicians have declined faster than the rate for the population at large. In England and Wales, physicians had only average mortality rates until 1950. Over the next 20 years, however, their death rates fell steadily when compared with those of the general population.³ Avoidance of cigarettes is a major factor in physicians' good health. In the United States, only 21% of male physicians smoke, compared with the national average of 39%. Sixty-four percent of physicians who formerly smoked have quit.⁴Studies of British physicians have indicated that the primary factor responsible for their lowered mortality was their success in giving up cigarette

Bad Blood: The Tuskegee Syphilis Experiment

From 1932 until 1973, more than 400 black men with syphilis were followed up without treatment in the Tuskegee Syphilis Study of the Public Health Service. After this study was publicized in 1972, James H. Jones, a historian, began the study of its origins and evolution, which comprises Bad Blood . Jones begins in the 19th century with evidence, drawn from their writings, of the racial prejudice that white physicians shared with society at large. In particular, white physicians maintained that promiscuity led to allegedly more prevalent and more severe syphilis in blacks. As transmissible agents of disease came to be understood, physicians began instead to regard syphilis as a disease to which all infected were equally susceptible (although many physicians continued to hold that the disease was manifest differently in whites and blacks). In the early 1930s, a philanthropic organization, the Rosenwald Fund, cooperated with the PHS in several ventures

Causes of Death among Anesthesiologists

The causes of death among anesthesiologists from 1930 through 1946 were determined and compared to the causes of death for contemporaneous physicians as well as anesthesiologists in later eras. Names of US white male anesthesiologists listed in the annual Directories of Anesthetists compiled by the International Anesthesia Research Society were searched for in the death files of the American Medical Association. Among those listed in the Directories 274 deaths were located. Causes were ascertained for 269 deaths and 259 causes were verified from death certificates. The leading causes of death of anesthesiologists and other physicians of the same era were cardiovascular-renal diseases and malignant neoplasms. The death rate from all causes was lower among anesthesiologists than among contemporaneous white men and other physicians. Death rates among anesthesiologists from 1930-1946 were similar to those among anesthesiologists in 1947-1956, but greater than those for 1957-1971. Among deaths from malignant neoplasms, those of the digestive organs were the most frequent and those of the respiratory tract the least. Anesthesiologists practicing in the earlier part of this century had lower death rates and they were less likely to die of malignant neoplasms than contemporaneous white men. The death rates for these anesthesiologists were similar to those for anesthesiologists during 1947-1956, but greater than rates observed for anesthesiologists during 1957-1971. This suggests that exposure to the fluorinated anesthetic agents introduced in the mid-1950s may not be an important health hazard.

Skin problems in blacks receive scrutiny

In the last five years, there has been a growing movement to educate physicians about dermatologic conditions of blacks and other darkly pigmented people. And for the third successive year, the topic of black dermatology has attracted attention at the annual meeting of the American Academy of Dermatology (AAD). Physicians who discuss these problems share a basic concern: to make practitioners aware that black patients need different or more moderate treatment for many skin conditions. Traditionally even dermatologists confuse normal with abnormal in black skin, and most textbooks concentrate on the skin of whites, except to note diseases unique to particular genetic groups. By and large, conditions and complications that are manifested differently in the heavily pigmented populations are overlooked. Furthermore, white physicians overwhelmingly dominate the specialty of dermatology. Counting residents, there are fewer than 90 practicing black dermatologists in the nation. This lack of input by black professionals has

Access to Health Care in a Southern Rural Community

This case study of utilization of health care services in a rural southern community is the first of a series of reports dealing with access to care in this community. The most striking findings were the low utilization of physician and dental services compared with national standards (particularly by the black population) and the infrequent use of private physicians by blacks. Possible explanations for these findings are the short time interval since integration of services after Medicare and Medicaid legislation, the short supply of primary care physicians, especially black, in this community, and the reluctance of white physicians to accept Medicaid patients. We postulate that while employment and social mobility have improved greatly for blacks, established methods of medical and dental practice have changed slowly.

The pelvic examination and the Black gynecologist

Questionnaires designed to measure levels of patient comfort with regard to the procedures in a pelvic examination were administered to 144 women immediately after their examinations. White women reported equal comfort with both white and Black gynecologists. These findings were not dependent on the educational level of the white women. Assuming that reported feelings of comfort could be equated with patients' level of confidence toward the gynecologist, white women in this sample were as comfortable with the Black gynecologist as with the white physician. Black women, however, showed significantly less confidence in the Black physician. Implications of these findings are discussed.

Effect of microwave oven on implanted cardiac pacemaker.

To the Editor.— Although the effects of external radio-frequency radiation on implanted cardiac pacemakers have received much attention in the literature (Lichter I, Borrie J, Miller WM: Radio-frequency hazards with cardiac pacemakers. Brit Med J 1 :1513, 1965; Carleton RA, Sessions RW, Graettinger JS: Environmental influence on implantable cardiac pacemakers. JAMA 190 :938, 1964; Siddons H, Sowton E: Cardiac Pacemakers . Springfield, Ill, Charles C Thomas Publisher, 1967, pp 99-102), to our knowledge high-frequency stimuli from microwave ovens have not previously been reported to interfere with pacemaker function. We have recently observed such an interference. Report of a Case.— A 68-year-old white male physician developed complete A-V block during November 1969. The patient subsequently experienced dyspnea and pedal edema, but did not develop syncope. On Nov 24, 1969, a ventricular sensing pacemaker (Medtronic Corporation, Model #5841) was implanted through the left external jugular vein; the pulse generator was placed in a

The Ideology of Negro Physicians: A Test of Mobility and Status Crystallization Theory

Mobility and status crystallization theory are both based on the assumption that status discrepancies create strains and difficulties for the individual and lead to various forms of compensatory behavior. Despite the obvious similarity between these two concepts, virtually no attempt has been made to disentangle their independent effects in empirical research. Furthermore, mobility and status crystallization theory appear at certain points to be incompatible, since they lead to contradictory statements about the ideology of Negro physicians. In the present study multivariate analysis was used to compare the effects of mobility and status inconsistency on the political and economic views of Negro and white physicians practicing in New York City. The crystallization model provides a much better fit for the data than does mobility, and it appears to be a more promising concept.

Alveolar rhabdomyosarcoma of paranasal sinuses and orbit.

Although rhabdomyosarcoma is the third most common tumor found in children, rhabdomyosarcoma of the paranasal sinuses and orbit is an infrequent tumor in adults. 1,2 In the case herein reported an alveolar rhabdomyosarcoma which arose from the paranasal sinuses of a 26-year-old white physician illustrated several unusual features. Although the tumor arose in the paranasal sinuses, the presenting symptoms were those of retrobulbar neuritis secondary to sinusitis. Another unusual feature was the observation of a histologic change in the character of the tumor following radiation and chemotherapy. Report of a Case A 26-year-old white male physician was first seen by one of us (O.H.D.) because he had observed a sudden decrease of vision in the right eye on awakening that morning. The visual acuity in the right eye was decreased to 20/100. A paracentral scotoma may have been present, but this could not be demonstrated with certainty. (Several weeks later,

Race, Status, and Interaction between Patients and Hospital Personnel

FOR MANY years sociologists have done research on race relations in the United States, especially between Negroes and whites. In the past decade, hospitals and the health professions have also been popular objects of sociological inquiry. But thus far, there has been relatively little study of race relations in health organizations.? Although some attention has been paid to the contribution of low-status hospital workers to the therapeutic process, the extent to which the race of the low-status worker may influence the contribution has not been studied.2 This paper presents some data contrasting patient perceptions of subprofessional low-status Negro hospital workers with patient perceptions of the professional high-status white hospital staff.3 The data suggest that from the patient's point of view (1) Negro aides, orderlies, housekeepers, food service personnel, etc. are more effective in meeting the patients' needs for expressive care than white nurses and physicians; and (2) these individuals' low status, Negro race, and sub-professional affiliation directly contribute to their effectiveness. If supported by further research, these hypotheses would have important implications for the sociology of race relations and for professional practice in patient care. Procedure and Setting The data were collected in a study of the role of the hospitalized patient from the patient's point of view. During the initial stages of this project, interviews were conducted with a sample of patients (N = 85) on several wards at one hospital. In addition to the attending physician's permission, to be included in the sample patients had to be white, American born, between the ages of forty and sixty, must have had

Delayed Clinical Response to Hemodialysis in a Patient With Uremia

ALTHOUGH THE GENESIS of the toxic state in uremia is not well understood, nearly all of its symptoms may be relieved by adequate hemodialysis. Maximum symptomatic and objective benefit are almost invariably evident within 48 hours of dialysis. This is the report of a uremic patient whose maximum improvement occurred 70 to 96 hours after dialysis. Report of a Case The patient was a 50-year-old white male physician who had chronic renal insufficiency from what was subsequently found to be chronic pyelonephritis with papillary necrosis. Symptoms and signs of uremia (nausea, fatigability, azotemia) were first noted in April 1965. He was admitted to Riverside Methodist Hospital in coma onMay 2. Physical examination revealed a comatose patient whose blood pressure was 160/100 mm Hg and no other abnormal findings. The relevant laboratory findings are recorded in the Table. On May 4, a six-hour hemodialysis was done with the Kolff twin

The Histopathology of Early Central Retinal Artery Occlusion

The classic ophthalmoscopic picture of total central retinal artery occlusion is well known, as is the histopathologic picture of old postocclusive change in the retina and optic nerve. The etiology of central retinal artery occlusion is varied, and is thought to include such diverse mechanisms as atheroma formation, 1 emboli of atheromatous 2 and non-atheromatous nature, 3 spasm of the central retinal artery, dissecting aneurysm, 4 migraine, 5 and foreign body obstruction. 6 The purpose of this paper is to report a case of central retinal artery occlusion in which the patient died 68 hours following his occlusion. Both eyes were subsequently studied histologically. Because postocclusive scarring had not had time to develop, the mechanism by which arterial occlusion had occurred could readily be seen. The associated retinal changes are also reported. Report of Case The patient, a 49-year-old white male physician with a long history of moderate hypertension with

GLAUCOMA ASSOCIATED WITH THE USE OF TOPICAL CORTICOSTEROID. REPORT OF TWO CASES.

Since reading the report of this condition by Dr. Hans Goldmann, 1 I have had the opportunity of studying two cases, the signs and symptoms of which are almost identical to those he describes, namely: (1) moderate to high intraocular pressure, in noninflamed eyes; (2) normal iris angles; (3) atypical loss of peripheral fields; (4) no cupping of nerve heads; (5) no pain. Like his patients, both of mine had been using topical corticosteroid for a protracted length of time. Report of Cases Case 1. —A white male physician, age 50, was myopic, OD—5.00 and OS—3.00 He had a Horner's syndrome of the right eye in 1947 and has had recurrent attacks of iritis, OU, for the past 15 years but with no sequelae and no synechiae. His intraocular pressure has been checked periodically since 1956 and has always been normal. In September, 1962, he came in because

Carcinoma of the Kidney Presenting as a Thyroid Nodule

THE THYROID gland, although a very vascular structure, is an uncommon site of metastatic involvement. Lucke and Schlumberger1found the thyroid involved in metastatic disease in 1.3% of patients on whom autopsies were performed who had renal adenocarcinoma. The over-all incidence of metastatic lesions in the thyroid is 4%. There are a number of cases reported of patients operated on, with a presumptive diagnosis of primary carcinoma of the thyroid, in whom adenocarcinoma of the kidney was later found to be the primary focus of the malignancy. Report of a Case A 40-yr-old white male physician had noted increased tightness of his shirt collars for a period of approximately 6 mo which he attributed to recent weight gain. While shaving, 24 hr before admission, the patient noted a mass over the right lobe of the thyroid gland. He had no other symptoms. Laboratory studies performed on admission included hemogram,

Some vagaries of pheochromocytoma. Four illustrative cases.

Article1 September 1962Some Vagaries of PheochromocytomaFour Illustrative CasesMILTON A. BELL, M.D., WILLIAM S. BLAKEMORE, M.D., EDWARD ROSE, M.D., F.A.C.P.MILTON A. BELL, M.D.Search for more papers by this author, WILLIAM S. BLAKEMORE, M.D.Search for more papers by this author, EDWARD ROSE, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-3-406 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptVariations in the clinical picture of functioning chromaffin tumors occasionally present diagnostic pitfalls. This report describes 4 unusual cases of pheochromocytoma illustrating some vagaries of this disease. They include the occurrence of paroxysmal episodes for more than 26 years, dominating symptoms of peripheral vasoconstriction, severe sweating for 12 years as the chief complaint, and the recurrence of typical crises associated with a presumably metastatic lesion in the humerus, 7½ years after the removal of a pheochromocytoma of the adrenal.CASE REPORTSCASE 1M. B., a 53-year-old white male physician, first noted symptoms at age 28 when he was a...

The "Granny" Midwife: Changing Roles and Functions of a Folk Practitioner

Midwifery, considerably reduced in scope, is still practiced among Negroes in a Southeastern rural region. Seen as a social institution in partial disintegration, marginal to modern medical practices, and subject to powerful official opposition, it permits the study of institutional adaptation to stress. The old midwife practiced with the sponsorship and personal support of the white physician. She was "called" to her occupation and trained through a familial apprenticeship. The new midwife is trained and officially appointed by a Health Center. The old midwife has continued to retain by far the largest share of practice by reliance upon her power and prestige in the Negro community, but urban influences are affecting her clientele, and she is faced with competitors rather than successors.

Diaphragmatico-pericardial tear with intrapericardial herniation of the transverse colon.

Herniation of the abdominal contents into the chest through a diaphragmatic hernia or through a traumatic diaphragmatic tear is not uncommon. The case to be reported here is of special interest because of the rarity of the type of herniation observed, the long delay which preceded the diagnosis, and the unusual fashion in which the clinical and radiological picture simulated cardiac disease. Case Report A 45-year-old white male physician had felt well until May 1946, when he experienced tachycardia, fatigue, and slight dyspnea following moderate exertion. He was overweight and attributed the symptoms to obesity. In 1947 he had an episode of chest pain during exertion in cold weather, which he interpreted as an anginal attack. In 1948, frontal headaches developed. At this time, an enlargement of the cardiac contour was demonstrated roentgenologically, and the patient's past history was obtained. On June 20, 1943, while on service with the Armed Forces in North Africa, he had been in a jeep accident which caused mild cerebral concussion and a fracture of the right clavicle. He also received at that time a heavy blow to the precordial area, producing substernal pain and tenderness which lasted for about six weeks. An electrocardiogram in 1944 was normal. Further roentgenologic study in 1948 and 1949 indicated cardiac enlargement of unknown etiology and the patient was advised by one physician to give up his medical practice and to restrict his activities. From May to September 1950 he was hospitalized elsewhere for extensive observation. Roentgenkymography showed diminished pulsations along the right and left borders of the heart. Venous pressure and circulation times were normal. Bromsulfalein retention was 13 to 15 per cent. No other abnormal findings were elicited. Digitalization was without effect. No definitive diagnosis was reached. Angiocardiography, pericardial paracentesis, and exploratory thoracotomy were recommended but refused by the patient. Admission to the Medical Service of the Veterans Administration Hospital (Bronx, N. Y.) was on Dec. 30, 1950. The pertinent abnormal physical findings included moderate emphysema of the chest, distant heart sounds, a mild diastolic hypertension in both arms (130/95), enlargement of the heart manifested by extension of the cardiac dullness to the anterior axillary line, some enlargement of the liver (two fingers below the costal margin), and a vague “fullness” in the left upper quadrant of the abdomen. A hemogram was normal, as were the sedimentation rate, urinalysis, and serology. Liver function studies showed a thymol turbidity of 8.0 units, and a bromsulfalein retention of 16 per cent, without other abnormalities. An electrocardiogram was normal. A postero-anterior chest roentgenogram (Fig. 1A) showed generalized enlargement of the cardiac contour, while a lateral view (Fig. 1B) showed several radiolucent zones overlying the anterior aspect of the heart just posterior to the sternum.

Fatal aplastic anemia associated with chloramphenicol (chloromycetin) therapy; report of two cases.

Two cases of fatal aplastic anemia in patients receiving chloramphenicol (chloromycetin®) are reported, and the literature is reviewed briefly. In both patients, a 71-year-old widow and a 92-year-old man, an initial course of treatment with the antibiotic was uneventful, but resumption of therapy after an interval of several weeks was associated with hematological complications. <h3>REPORT OF CASES</h3><h3>Case 1.—</h3> R. C. B., a 71-year-old white physician's wife, complained of weakness and a rash on her legs in January, 1952. When examined by one of us (A. A. H.), who had attended her for 15 years, discrete and confluent petechiae and ecchymoses were found in widespread distribution, including the oral mucosa. Except for the purpura, her physical condition was the same as it had been for years. There was no history or familial history of asthma, hay fever, urticaria, or blood dyscrasia. Since 1932 the patient had intermittently followed a dietary