ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Modern medical ethics has effected dramatic changes in medicine. Yet teaching medical ethics still presents many challenges. The main teaching methods used—inpatient ethics consultations, courses, and case conferences—have notable weaknesses. In addition, the attitudes and knowledge gaps of some learners may hamper these methods further. To encourage open discussion of the challenges, we outline our current approach to teaching medical ethics. We teach with the conviction that ethics instruction gives physicians vital knowledge not available from science. Our teaching addresses ethical issues directly relevant to residents and students, emphasizes a few important concepts, and nurtures learners’ critical reasoning skills. Our teaching also tries to use scarce faculty time efficiently. However, we believe successful medical ethics teaching requires medical schools to commit significant material and moral support. We hope the discussion here encourages medical ethics teachers everywhere to describe the challenges they face and to collaborate on finding solutions.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Although clinicians without a sense of history may not be condemned to repeat the past, the historical record offers many informative lessons. For one thing, history demonstrates the changing nature of scientific knowledge; current understandings of health and disease may prove as ephemeral as earlier discarded theories. In addition, history reminds us that social and cultural factors influence how physicians diagnose and treat various medical conditions. When attempting to teach the history of medicine at academic medical centers, instructors should be innovative as opposed to comprehensive. Students and residents are likely to find recent historical issues to be more relevant, particularly when such material can be integrated into the existing curriculum. Provocative topics include depictions of medicine in old Hollywood films, the contributions made by famous physicians at one’s own institution, and historical debates over controversial events, such as the Tuskegee syphilis study and the use of lobotomy in mental institutions in the 1950s.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Literature and medicine share an inherently enduring relationship. Doctors turn to literature—both its plots and its forms—to understand what occurs in their patients’ lives, to increase their own narrative competence, to interpret accurately the texts of medicine, to develop empathy, and to deepen their capacities for reflection and self-knowledge. Together, these skills, attitudes, and bodies of knowledge contribute to the effective practice of medicine. Literature is now taught in almost three quarters of the medical schools in the United States. Different goals, agendas, and methods are appropriate at each developmental stage of a physician’s training, from the premedical curriculum to the continuing education of a practicing physician. A vigorous and growing scholarship and body of experience is propelling the field of literature and medicine to understand all the more clearly how acts of reading and acts of writing might illuminate acts of doctoring.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In many ways, the practice of medicine has been a visual science from the time of the early Renaissance anatomists to the high-speed scanners of today. But images of patients and their anatomical parts do not necessarily lead to an understanding of their problems. Meaning must follow the sensory experience and be coupled with reflection. The visual arts, therefore, can be used to help physicians in training increase their observational and interpretive skills. Works by classic and contemporary artists can be used to increase awareness of the complex nature of human beings and their conditions, which lie beneath the appearances. In addition to painting, television, motion pictures, and printed media may also be used in classroom settings to educate. Medical schools that do not have accessible fine arts or humanities programs may form allegiances with local artists to increase communication and understanding between these disciplines.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Practicing medicine well requires recognizing the breadth of human experience and attending to the psychological and sociocultural dimensions of patients as well as their physical needs. Central to the concerns of anthropology are the shared beliefs and values expressed in social practices and traditions that give meaning to everyday life. The relevance of anthropology for biomedical practice and research is grounded in the discipline’s emphasis on contextual meaning and its unique strategies for data gathering. In this article, we briefly review the field of anthropology and the discipline of medical anthropology. We argue for incorporating anthropological concepts and methods in medical training, and summarize anthropology’s role in medical education over the past century. Finally, we present ideas for including anthropology in the medical curriculum, proposing curricular goals and content, and teaching settings and techniques. An anthropological orientation can foster trainee self-awareness, help trainees prepare for the diverse perspectives they will encounter in our pluralistic society, and facilitate critical analysis of biomedicine and its systems of care.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Medical school curricula for too long have ignored the obvious and important changes in the economics and delivery of health care in the United States. Medical students, who become the practicing physicians of the future, and their patients have suffered because of this academic malaise. Most new physicians are even more confused than their patients about how to navigate outpatient managed care, how to practice efficiently (after being taught that more is better), and how to uphold their sacred trust with their patients in the context of institutionally based medicine. After summarizing relevant historical events, we discuss how we hope to begin making up for lost time by tackling the issue of necessary curriculum change at the University of Pennsylvania Health System.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundFocal segmental glomerulosclerosis (FSGS) is a common primary glomerulopathy in African Americans. In this report, we present data on 40 African American patients with FSGS from our medical center.MethodsPatients were identified from a review of all charts seen in our conservative management renal clinic in 1996, a review of renal biopsy rolls (1994–1998), and a review of patients entering the end-stage renal disease (ESRD) program with a primary diagnosis of FSGS (1993- 1997). Charts were reviewed for demographic, biopsy, and treatment data. Patients who were observed for at least 4 months (range, 4–125 months) were included. ESRD was used as the primary endpoint (n = 12). Data were analyzed using univariate and multivariate Cox hazards and Kaplan-Meier survival analysis. Twenty-four patients were treated with angiotensin-converting enzyme (ACE) inhibitors. Similarly, 24 patients were treated with corticosteroids for a mean of 8.75 ± 2.6 months and a total dose of 9.3 ± 2.2 g.ResultsOn univariate analysis, factors found to be significant determinants for reaching ESRD were the initial creatinine (P= 0.0001), interstitial fibrosis (P= 0.032), the percentage of globally sclerosed glomeruli (P= 0.0018), and the mean arterial blood pressure over the course of follow-up (P= 0.05). Neither the ACE inhibitors nor the corticosteroids had a significant impact on reaching ESRD. The patients reaching ESRD (n = 12) were analyzed separately. The mean time from biopsy to ESRD was 24.7 ± 9.8 months. ACE inhibitors prolonged renal survival (P= 0.023), but steroids did not. Initial creatinine was the only factor found to be a significant determinant for ESRD.ConclusionsWe conclude that FSGS is common in African Americans. Early diagnosis and blood pressure control are important, but the beneficial effects of steroids and ACE inhibitors in this population are still unclear.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundPrior approval programs have been used to control spiraling costs of Medicaid, but they are rarely formally assessed. We evaluated the effect of a change in Indiana Medicaid’s policy (effective October 1, 1993) requiring prior approval to pay transportation costs.MethodsWe performed a historical cohort study comparing the health care utilization of Medicaid patients during the first 6 months of 1993 versus the first 6 months of 1994. Subjects included all Medicaid patients who visited any inpatient or outpatient site affiliated with an inner-city public hospital in the first 6 months of 1993 (N = 23,015) and 1994 (N = 23,707).ResultsThese Medicaid patients made 82,961 visits in the first 6 months of 1993 and 79,809 visits in the first 6 months of 1994. Visits to hospital-based primary care clinics declined 16% (P< 0.001), which was partially offset by a 7%increasein visits to neighborhood health centers (P≤ 0.001). Emergency and urgent visits fell by 8%; visits for medication refills fell by 18% (P< 0.001 for each). Hospitalizations increased slightly in 1994, with no change in the number of inpatient days. There was no change in inpatient or outpatient nontransportation charges. There were no systematic reductions in selected aspects of preventive care. However, there were fewer emergency and urgent visits among patients with reactive airway disease.ConclusionsRequiring prior approval for transportation was associated with reductions in visits for primary care visits and refilling prescriptions without measurable short-term effects on charges or selected clinical parameters. Neighborhood health centers partially ameliorated the decline in primary care visits.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID