Patient-centered care for chronic illness is founded upon the informed and activated patient, but we are not clear what this means. We must understand patients as subjects who know things and as agents who do things. Bioethics has urged us to respect patient autonomy, but it has understood this autonomy narrowly in terms of informed consent for treatment choice. In chronic illness care, the ethical and clinical challenge is to not just respect, but to promote patient autonomy, understood broadly as the patients' overall agency or capacity for action. The primary barrier to patient action in chronic illness is not clinicians dictating treatment choice, but clinicians dictating the nature of the clinical problem. The patient's perspective on clinical problems is now often added to the objective-disease perspective of clinicians as health-related quality of life (HRQL). But HRQL is merely a hybrid transitional concept between disease-focused and health-focused goals for clinical care. Truly patient-centered care requires a sense of patient-centered health that is perceived by the patient and defined in terms of the patient's vital goals. Patient action is an essential means to this patient-centered health, as well as an essential component of this health. This action is not extrinsically motivated adherence, but intrinsically motivated striving for vital goals. Modern pathophysiological medicine has trouble understanding both patient action and health. The self-moving and self-healing capacities of patients can be understood only if we understand their roots in the biological autonomy of organisms. Taking the patient as the primary perceiver and producer of health has the following policy implications: 1] Care will become patient-centered only when the patient is the primary customer of care. 2] Professional health services are not the principal source of population health, and may lead to clinical, social and cultural iatrogenic injury. 3] Social justice demands equity in health capability more than equal access to health services.

This volume is intended to help practicing therapists and counselors, as well as students of these professions, to explore more fully and systematically the processes of self-improvement in their work and lives. It captures the reader's interest by discussing some of the therapist's personal and professional challenges in a refreshingly honest way. The book deals with a number of standard areas of self-supervision, such as self-monitoring and working with mentors, and provides a framework and a process for examining one's own strengths and weaknesses, then taking steps to improve excellence across a host of domains.

This straightforward guide to taking patient history comprehensively covers all of the commonly seen OSCE scenarios within the current undergraduate medical curriculum. The Easy Guide to Focused History Taking for OSCEs includes introductory chapters with general OSCE guidance, mapping onto the Calgary-Cambridge model. These include tips from recently qualified doctors and highly respected physicians and surgeons who commonly examine OSCEs, as well as a sample OSCE marking scheme. The book then covers 56 histories based on presenting complaints - more than any other text on the market - thoroughly testing both knowledge and examination technique. Each history is based around the exam requirements, with mnemonics, 'red flag' symptom boxes and list-based breakdowns to aid prompt recall. Common and serious differentials are highlighted, as well as investigations to help rule out the serious conditions. Each section concludes by outlining key aspects for each differential diagnosis as well as a list of investigations and management options. With this book, every student will be well equipped to tackle any clinical problem, in the OSCE examination and also in their continued professional practice.

This unique and comprehensive atlas by an expert practioner provides an innovative pictorial guide to flexible bronchoscopy, one of the most exciting and challenging procedures in respiratory medicine today. Includes the very latest procedures and techniques Comprehensive coverage, guides you through the range of anatomical and pathological possibilities A step-by-step guide to the use of bronchoscopic techniques, interpretation of images and differential diagnoses Integrates naked eye, bronchoscopic and radiological anatomy to give you a thorough understanding of the procedure Numerous full colour illustrations and sound practical advice make this a key text for learning and refining your technique The book will be invaluable to those training in respiratory medicine, plus also specialist respiratory nurses and practising pulmonologists who wish to expand their practice and knowledge of the technique.

For centuries the analysis of the heart rhythm has belonged to the foundations of medical art. We know that doctors in ancient Tibet used the interpretation of the heart rate to draw prognostic conclusions-somehow a modern rationale-that deserves further attention. The rapid advancement of science is providing more and more information about the details, but the subatomic resolution of structures hides the risk and the complex procedures are fragmented into static impressions. The same has happened to the ECG. The revolutionary development, acknowledged by the Nobel Prize for Einthoven, ledfromtheanalysisofthedynamicheartratetothestaticanalysisofthe heartstream curve. It is only with the ECG Holter recording over longer periods that the cardiologists rediscovered the old dynamic. With the continuous recording of the heart rate and its periodicity, it became accessible to a new dimension, a dim- sion that requires technically well-de?ned foundations for accurate data coll- tion, detailed knowledge of the electrocardiologic particularities of arrhythmia, and medical knowledge for the translation of the results into a diagnostic synthesis. With the ECG Holter the issue is no longer just to detect an arrhythmia, but also to determine dynamic circumstance in which the critical event occurred. In fact, we investigate the trigger, the event, and the context, and we have to integrate all of that information within the clinical picture, from the pathology right through to the symptom-indeed a multi-dimensional task.

Recent advances in medicine for resuscitation and care have led to an increased number of patients that survive severe brain damage but who are poorly responsive and non-communicative at the bedside. This has led to a striking need to better characterize, understand, and manage this population who present a real challenge for the assessment of pain and for planning treatment. This edited collection provides clinicians with a guide to recent developments in research on pain perception and assessment, and the detection of consciousness and communication in patients with disorders of consciousness (DOC). With contributions from leading global researchers, the book gives an overview of issues concerning the assessment of pain. It also covers the development of suitable tools both to improve pain management and to detect consciousness and communication in these patients, to influence their prognosis and treatment, and their quality of life. Methodological and ethical issues concerning the implication for future research are also considered. The book will be an invaluable guide for clinicians, medics and therapists working in rehabilitation and acute care, particularly in the demanding field of pain perception, pain assessment and detection of consciousness and communication in patients with DOC. It will also be useful for students and researchers in neuropsychology and medical sciences.

This new reissue of Hands On, first published in 1994, will be welcomed by all complementary and alternative medical students and practitioners. This book presents a concise approach to clinical examination in a practical and straightforward manner, and includes step-by-step illustrations of a variety of examination techniques together with checklists designed to help students and practitioners elicit clinical information from their patients quickly and efficiently.

Examining children presents unique challenges for trainees and new doctors in paediatrics. Paediatric patients vary greatly in age and development, often find it difficult to describe their symptoms, and can behave unpredictably in clinical settings. Clinical Examination Skills in Paediatrics helps MRCPCH candidates and other practitioners learn effective history taking and fundamental examination techniques. Clear and concise chapters-with contributions from a team of paediatric specialists-demonstrate the clinical examination and questioning techniques used in daily practice. Emphasis on the intellectual processes involved in decision making assists both trainees preparing for a formal examination as well as new clinicians faced with a difficult diagnostic problem. Topics include cardiovascular and respiratory examination, examining a child with a neuromuscular disorder, musculoskeletal examination, and taking history from a child with diabetes and a rheumatological condition. Includes access to a companion website containing high-quality videos that demonstrate techniques, procedures and approaches Features commentary by experienced practitioners which offer observations and deductions at each stage of the examination process Offers tips for communicating effectively with the patients using appropriate lay terms Helps translate the symptoms and signs experienced by patients into medical-speak Covers all the skills tested in the MRCPCH Clinical exam Clinical Examination Skills in Paediatrics is the perfect study and reference guide for paediatrics trainees, MRCPCH candidates, foundation doctors, allied healthcare professionals, and anyone looking to improve their clinical and communication skills in paediatrics.

For courses in orthopedics, physical therapy, athletic training, and physical examination, in programs for healthcare providers including physicians, nurses, athletic trainers, physician's assistants, physical therapists, and occupational therapists. This is the field's most comprehensive evidence-based guide to clinical tests for orthopedic physical examination. It presents complete explanations and photography visualizing all commonly used physical exam tests for all body regions, including both neurological screening tools and conventional tests. The quality of research supporting each test is assessed using the QUADAS quality instrument, which analyzes the extent to which bias may have influenced diagnostic values. Diagnostic values are reported wherever they exist, and summary "Utility" scores are provided for each test based on the authors' interpretation of the research and their use of the tests in clinical practice. This edition adds 200 new tests, presents valuable clusters of tests, and contains two entirely new chapters: one on visceral assessment and medical screening, and another on temporomandibular examination.

This book draws on fields as diverse as biochemistry, physiology, pharmacology, psychology, psychiatry, and ethology, to form a fascinating synthesis of information on the nature of fear and of panic and anxiety disorders. Dr. Marks offers both a detailed discussion of the clinical aspects of fear-related syndromes and a broad exploration of the sources and mechanisms of fear and defensive behavior. Dealing first with normal fear, he establishes a firm, scientific basis for understanding it. He then presents a thorough analysis of the development, symptoms and treatment of fear-related syndromes. Phobic and obsessive-compulsive disorders are examined in detail. The book is illustrated with examples of fear and defensive behavior in other living organisms. By drawing provocative analogies between animal and human behavior, it sheds new light on the origins of fears, phobias, and obsessive-compulsive problems, as well as on their treatment by drugs and psychological means. Clinical psychologists, ethologists, and anyone interested in the mechanisms of behavior will be fascinated by this authoritative study. The text is intriguing and informative, and the bibliography of over 2,100 entries makes it an invaluable reference.

Medical Short Cases for Medical Students is intended to help medical s tudents with their preparations for medical short case examinations an d through this process to enhance the depth and breadth of their knowl edge of clinical medicine as well as their clinical skills. Though par ticularly useful to students during their final clinical exams, it wil l also be of interest to more junior students, particularly those who face medical short case clinical exams in their early clinical years. It aims to be useful whether the exam format is of the traditional sty le or more modern variations such as the Object, Structured, Clinical Examination (OSCE).

Patient-Centered Medicine: A Human Experience emphasizes the health professional's role in caring for patients as unique individuals by focusing on the patients' psychological and social realities as well as their biological needs. The book concerns itself with caring for the whole patient, and outlines the basic principles involved in developing a biopsychosocial approach to medical practice. This is a volume of guidelines that will help medical students and clinicians develop and master basic attitudes and skills essential to providing empathic and comprehensive medical care. As Norman Cousins writes in the foreword, 'The authors understand and repeatedly demonstrate in this book, that the patient-physician relationship is a powerful, sometimes mysterious, frequently healing interaction between human beings. It is the person of the doctor and the presence of the doctor-just as much and frequently more than-what the doctor does that creates an environment for healing. The physician represents restoration. The physician holds the lifeline.' Since the book's original publication by University Park Press in 1984, greater awareness and acceptance of the biopsychosocial model has occurred, and medical schools are now working to fully integrate psychosocial education into the clinical curriculum.

The vital signs are, by definition, the measurements of the body's most basic functions. So far, the essential number of signs that must be measured is not clear as some references consider that the body temperature, blood pressure, pulse rate and breathing rate are sufficient but other sources consider that the measurement of other variables, such as the respiratory effort and oxygen saturation, are also crucial to determine the health of the person. This book is not intended to define the critical vital signs but presents the correlation of these measurements with other variables as well as the proposition of new methods to determine these variables. It also proposes some innovative applications that relay on these signs in a way to monitor and help the human being. Thus, this book presents six chapters that deal first with the correlation between the physical training and the blood pressure level among adults as well as the stress effects for nurses on their vital signs. Added to that, the influence of the vital signs to predict and detect epileptical seizure and the analysis of neural mechanisms of major depressive disorders will be also presented. As for the other chapters, they go into some engineering applications related to vital signs as the development of a smart syringe pump that monitors the patient's crucial parameters and the introduction of a novel system that monitors the driver's health and notifies health care providers in case the driver has any health failure in order to prevent cars accidents.

The physical examination of the elbow, wrist, and hand can be a complex topic for professionals with all levels of clinical experience. How can advance concepts be taught in a user friendly, clear format, while still providing necessary information for effective diagnosis and treatment of the elbow, wrist, and hand? Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple by Dr. Randall Culp answers these questions. Written by experts, this easy-to-carry book provides a thorough review of the most common pathologic elbow, wrist, and hand conditions, techniques for diagnosis, as well as the appropriate treatment for each condition. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple contains clear photographic demonstrations, tables, sidebars, and charts throughout its pages, allowing a thorough and concise examination of the elbow, wrist, and hand. A glance at what is covered inside: * Physical Examination * Basics and specific tests of the elbow, wrist, and hand * General Imaging * Basics of general imaging of the elbow, wrist, and hand * Common Conditions * Tendinopathy, arthritis, wounds, soft tissue injuries, and more Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple contains essential information to successfully take a complex subject, and bring it to a level that will be welcomed by all orthopedic residents, attendings, physical therapists, athletic trainers, medical students in training, and other health care providers.

The physical examination of the foot and ankle can be a complex topic for professionals with all levels of clinical experience. How can advance concepts be taught in a user-friendly, clear format, while still providing necessary information for effective diagnosis and treatment of the foot and ankle? Musculoskeletal Examination of the Foot and Ankle: Making the Complex Simple by Drs. Shepard Hurwitz and Selene Parekh answers these questions. Written by experts, this easy-to-carry book provides a quick and thorough review of the most common pathologic foot and ankle conditions, techniques for diagnosis, as well as the appropriate treatment for each condition. Musculoskeletal Examination of the Foot and Ankle: Making the Complex Simple contains clear photographic demonstrations, tables, sidebars, and charts throughout its pages, allowing a thorough and concise examination of the foot and ankle. A glance at some of what is covered inside: * Physical Examination * Basics and specific tests of the foot and ankle * General Imaging * Basic interpretation of common imaging modalities of the foot and ankle * Common Conditions * Bunions, toe deformities, Achilles pathology and posterior calcaneal pain, fractures, plantar fasciitis and plantar heel pain, and more Musculoskeletal Examination of the Foot and Ankle: Making the Complex Simple contains essential information to successfully take a complex subject, and bring it to a level that will be welcomed by orthopedic residents, faculty, physical therapists, athletic trainers, medical students interested in musculoskeletal health careers, and other health care providers.

In an era of ever-increasing dependence upon technology, physicians are losing the basic skills of patient examination and taking the medical history. This book describes the scenario in which the physician sits down with a patient to elicit a medical history. For example, how to greet a patient, how to discover the patient's chief concern, how to elicit symptoms, how to manage feelings as the patient and physician interact, and how to choose topics to explore, and use the appropriate word selection, phrasing, and tone of voice. A good history leads to trust and rapport, and also to the determination of the best management of the patient's condition. Dr. William DeMeyer, a well-known physician and author of the major text on the neurologic exam, describes how to take a medical history, and also explains the reasons why it is done in a particular way. The author reviews the actual questions that a health provider should ask and the responses to a patient's answers. More importantly, the author describes how to listen to the patient's real needs as a person, rather than just a repository of symptoms.

This book is a guide for the medical student or recently graduate MD preparing to take the third part (Step 3) of the United States Medical Licensing Exam. As anyone wishing to practice medicine in the United States must take and pass this examination, the potential market is a very large one, with 16,000 new medical school graduates eligible for the exam every year. There are a considerable number of books for the Step 1 Exam (basic sciences) and the Step 2 Exam (clinical medicine) but very few for the Step 3 Exam. It had been common to study for Step 3 using Step 2 materials since both cover clinical medicine, but in recent years the Step 3 exam has separated itself from Step 2, focusing on clinical management of specific medical conditions in a case-scenario fashion. As a result, the few available Step 3 books have become very successful, largely by default. Kevin Schwechten, who has recently taken the Step 3 exam himself and has evaluated the other competing books, has come up with an approach focusing heavily on those questions most commonly asked on the exam, and he follows an outline that is provided by the National Board of Medical Examiners, which is the group that writes the exam. As those taking the exam have just recently graduated from medical school and have been thrown into a very hectic schedule on the hospital wards, with long housr, little sleep, and little time for studying, an effective book for Step 3 must be concise and to the point. Therefore, this book is written not to cover all of clinical management, but to focus on those areas that most ofen appear on the exam. This will be the first book in our effort to produce more books for students preparing for their licensing exams.

Titles in the Pocket Tutor series give practical guidance on subjects that medical students and foundation doctors need help with ‘on the go’, at a highly-affordable price that puts them within reach of those rotating through modular courses or working on attachment.  Topics reflect information needs stemming from today’s integrated undergraduate and foundation courses: Common presentations Investigation options (e.g. ECG, imaging) Clinical and patient-orientated skills (e.g. examinations, history-taking) The highly-structured, bite-size content helps novices combat the ‘fear factor’ associated with day-to-day clinical training, and provides a detailed resource that students and junior doctors can carry in their pocket.   Key points New edition of the indispensable guide to performing a neurological examination, regarded the most complicated and difficult physical examination to master Brand-new photos clearly illustrate how to perform an examination in practice Fully-updated text, improved examination sequences and new references to neurosurgery Logical, sequential content: introductory chapters focus on general clinical skills, history-taking and examination. Then chapters which explain the examination of specific systems or regions. Finally, chapters on the examination of stroke and unconscious patients, neurological screening and how best to synthesise findings

Every medical student must be able to take an accurate history and perform a physical examination. This third edition of History and Clinical Examination at a Glance provides a concise, highly illustrated companion to help you develop these vital skills as you practice on the wards. Building on an overview of the patient/doctor relationship and basic enquiry, the text supports learning either by system or presentation of common conditions, with step by step and evidence based information to support clinical examination to help you formulate a sound differential diagnosis. History and Clinical Examination at a Glance features: * Succinct text and full colour illustrations, including many brand new clinical photographs * A new section on the development of communication skills, which explains how to communicate in different circumstances, and with different groups of people * A self-assessment framework which can be used individually, by tutors, or in group practice to prepare for OSCEs History and Clinical Examination at a Glance is the perfect guide for medical and health science students, and junior doctors, as an ideal resource for clinical attachments, last minute revision, or whenever you need a refresher.

From an interdisciplinary author team now including orthopedic surgeons, PM&R specialists, and primary care and sports medicine experts, the second edition of Musculoskeletal Physical Examination: An Evidence-Based Approach educates physicians on how to give the most thorough physical examinations by understanding the "why" behind each type of exam. In-depth coverage of today's newest tests and techniques keeps you current in practice, and a new section titled "Author's Preferred Approach" guides you through difficult areas of examination. Provides complete coverage of every musculoskeletal physical examination. Easy-to-use tables summarize and compare the evidence for specificity and sensitivity of each test for each condition. Utilizes over 200 illustrations to clearly depict each test. Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, images, and references from the book on a variety of devices. You'll also have access to over 100 in-depth videos - many new to this edition - highlighting the latest exam techniques, such as the Thessaly test, Milking test, and Bear hug test. Distinguished author team now includes orthopedic surgeons, PM&R specialists, and primary care sports medicine experts. New section titled "Author's Preferred Approach" guides readers through difficult areas of examination. Thorough updates and revisions made throughout each chapter keep you current in the field. Full-color figures enhance visual clarity.

The definitive evidence-based guide to effective patient-centered interviewing Smith's Patient-Centered Interviewing, Fourth Edition is a practical introductory textbook covering the essentials of patient interviewing. The most evidence based-guide available on the topic, and endorsed by the Academy of Communication in Healthcare, this acclaimed resource applies the proven 5-Step approach which integrates patient and clinical centered skills to improve effectiveness without adding extra time to the interview duration. Smith's Patient-Centered Interviewing covers important topics such as:*Patient Education*Motivating for behavior change*Breaking bad news*Managing different personality types*Increasing personal awareness in mindful practice*Nonverbal communication*Using computers in the exam room*Reporting and presenting evaluations The book's user-friendly design features icons, boxed case vignettes, and the use of color to highlight key points. Learning aids include practice exercises in each chapter, a pocket card, lists of essential questions, and graphics that facilitate understanding and retention. If you are in need of an evidence-based text that provides a proven systematic framework for taking an effective history, your search ends here.

Doctors wishing to practice as ophthalmology consultants are required to pass the FRCOphth Part 1 examination administered by the Royal College of Ophthalmologists (RCOphth). This comprehensive revision guide is a key resource for meeting the challenges of this exam. Carefully mapped to the curriculum, and reviewed by twelve leading experts in the field, making it an authoritative guide to the exam. Written according to the latest RCOphth guidance, MCQs for FRCOphth Part 1 reflects recent changes in the subject weighting and examination format. It features 450 MCQs spread evenly across five sections, with detailed solutions and explanations, helpful figures, as well as three mock exams, and further reading to aid self-assessment. Including high quality clinical images, this book also aids the learning of complicated concepts through acronyms, mnemonics, and accessible clarifications. Written by an academic registrar in ophthalmology, this is a must have resource for anyone preparing for the FRCOphth Part 1 examination.

A complex web of factors has created the phenomenon of overdiagnosis: the popular media promotes fear of disease and perpetuates the myth that early, aggressive treatment is always best; in an attempt to avoid lawsuits, doctors have begun to leave no test undone, no abnormality overlooked; and profits are being made from screenings, medical procedures, and pharmaceuticals. Revealing the social, medical, and economic ramifications of a health-care system that overdiagnoses and overtreats patients, Dr. H. Gilbert Welch makes a reasoned call for change that would save us pain, worry, and money.

Musculoskeletal Examination is a user-friendly textbook on the techniques of physical examination. Written by a physiatrist, orthopedic surgeon, and physical therapist, it has a uniquely multidisciplinary approach. Musculoskeletal Examination covers the complete basic examination and basic principles of normal and abnormal musculoskeletal function are fully explained, leading you to the correct differential diagnosis. The new fourth edition is now in full colour throughout and includes over 750 detailed illustrations, X-rays and MRIs, and more than 100 photographs showing examination techniques. It also includes a companion website at www.wiley.com/go/musculoskeletalexam featuring 107 MCQs and links to videos demonstrating key examination methods. Musculoskeletal Examination is perfect as a quick reference guide, while the detailed descriptions and clinically relevant examples of frequently encountered conditions will help even the most novice practitioner gain the understanding necessary to make a correct diagnosis and determine a successful treatment plan. It is ideal for physical therapists, physiatrists, orthopedists, medical students, practitioners, and all those involved in sports medicine and clinical massage.

An understanding of microbiology is essential for both medical students and newly qualified doctors, and is key knowledge for a working doctor. Learning Microbiology through Clinical Consultation introduces the subject with a wealth of life-like case scenarios, each linked with the relevant microbiology. Spanning 14 categories of infection, the cases within the book allow the reader to listen-in on clinical consultations with patients exhibiting an array of symptoms. Each case then describes the examination and the specimen taking techniques. The results of the samples taken in the story provide a clear link to the more technical information on microbiology which is then discussed. The structure of the book is laid out for easy navigation and has clear case-story headings to enable 'just in time learning' between patients, as well as 'just in case learning' when preparing for exams. Learning Microbiology through Clinical Consultation is a highly accessible text that describes the basic science of microbiology within the practice setting in an insightful and informative way. The material is presented in an integrated fashion and is therefore an ideal text for medical students on a systems-based or problem-based course, or for the newly qualified doctor looking to consolidate their knowledge.