A "Springer Series on Medical Education" book

"This is a book about the origins, design, implementation, and effects of the [Primary Care Curriculum at the University of New Mexico School of Medicine]. It is also so much more. It is a first-person account of a moving human experience, in which somes deeply caring people search for ways to provide a humane, effective learning experience for students who are seen as preparing to be practitioners of a humane, changing profession....In the 1920s, Gertrude Stein observed that the United States was now the oldest country in the world, for it was the first to join the twentieth century. Perhaps, we must now view the University of New Mexico's PCC as among the oldest programs in medical education, for it may prove to have been one of the first to join the twenty-first century."--Hilliard Jason, MD, EdD, Director, National Center for Faculty Development in the Health Professions, University of Miami School of Medicine

When confronted by the concerns of human sexual function or dys function, American medicine finds itself well impaled on the horns of a dilemma. Currently it is acceptable medical practice to treat sexual dysfunctions, disorders, or dissatisfactions that arise from psy chogenic etiologies, endocrine imbalances, neurologic defects or are side effects of necessary medication regimes. In addition, implanta tion of penile prostheses in cases of organic impotence is an increas ingly popular surgical procedure. These clinical approaches to sexual inadequacies, accepted by medicine since 1970, represent one horn of the dilemma. The opposite horn pictures the medical profession firmly backed into a corner by cultural influences. For example, when hospital admissions occur, a significant portion of the routine medical history is the section on system review. A few questions are asked about the cardio-respiratory, the genito-urinary, and the gastro-intestinal sys tems. But in a preponderance of hospitals no questions are permitted or, if raised, answers are not recorded about human sexual functioning. Physicians tend to forget that they are victims of cultural imposition first and of professional training a distant second."

The encounter between patient and physician may be characterized as the focus of medicine. As such, the patient-physician relationship, or more accurately the conduct of patients and physicians, has been the subject of considerable comment, inquiry, and debate throughout the centuries. The issues and concerns discussed, apart from those more specifically related to medical theory and therapy, range from matters of etiquette to profound questions of philosophical and moral interest. This discourse is impressive with respect both to its duration and content. Contemporary scholars and laypeople have made their contribution to these long-standing discussions. In addition, they have actively addressed those distinctively modern issues that have arisen as a result of increased medical knowledge, improved technology, and changing cultural and moral expectation. The concept of the patient-physician rela tionship that supposedly provides a framework for the conduct of patients and physicians seemingly has taken on a life of its own, inviolable, and subject to norms particular to it. The essays in this volume elucidate the nature of the patient-physician relationship, its character, and moral norms appropriate to it. The purpose of the collection is to enhance our understanding of that context, which many consider to be the focus of the entire medical enterprise. The con tributors have not engaged in apologetics, polemics, homiletics, or em piricism."

This book has been specifically designed to help GP trainees pass the compulsory AKT examination. Each topic has been skilfully refined to correlate directly with primary care and the RCGP curriculum, revealing how and why critical appraisal and evidence based medicine are essential for good medical practice throughout a career as an independent, knowledgeable, caring and thoughtful general practitioner. It includes invaluable preparation suggestions and an overall outline of the AKT, an introduction to statistics and qualitative methods, quantitative methods, epidemiology, common research methods and outcomes, useful tests used in epidemiological studies, research ethics, measures of mortality and economic analyses. Each chapter features unique, topic specific questions to reinforce comprehension, with an entire final chapter devoted to sample questions, comprehensively testing expertise and developing confidence. Ideal for revision and self-examination, RCGP AKT: Research, Epidemiology and Statistics gives GP trainees vital edge when preparing for the AKT.

After putting down this weighty (in all senses of the word) collection, the reader, be she or he physician or social scientist, will (or at least should) feel uncomfortable about her or his taken-for-granted commonsense (therefore cultural) understanding of medicine. The editors and their collaborators show the medical leviathan, warts and all, for what it is: changing, pluralistic, problematic, powerful, provocative. What medicine proclaims itself to be - unified, scientific, biological and not social, non-judgmental - it is shown not to resemble very much. Those matters about which medicine keeps fairly silent, it turns out, come closer to being central to its clinical practice - managing errors and learning to conduct a shared moral dis course about mistakes, handling issues of competence and competition among biomedical practitioners, practicing in value-laden contexts on problems for which social science is a more relevant knowledge base than biological science, integrating folk and scientific models of illness in clinical communication, among a large number of highly pertinent ethnographic insights that illuminate medicine in the chapters that follow."

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries 5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ( 8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics ll]."

Medicine, morals and money have, for centuries, lived in uneasy cohabitation. Dwelling in the social institution of care of the sick, each needs the other, yet each is embarrassed to admit the other's presence. Morality, in particular, suffers embarrassment, for it is often required to explain how money and medicine are not inimical. Throughout the history of Western medicine, morality's explanations have been con sistently ambiguous. Pla.o held that the physician must cultivate the art of getting paid as well as the art of healing, for even if the goal of medicine is healing and not making money, the self-interest of the craftsman is satisfied thereby [4]. Centuries later, a medieval medical moralist, Henri de Mandeville, said: "The chief object of the patient ... is to get cured ... the object of the surgeon, on the other hand, is to obtain his money ... ([5], p. 16). This incompatibility, while general, is not universal. Throughout history, medical practitioners have resolved the problem - either in conscience or to their satisfaction. Some physicians have been so reluctant to make a profit from the ills of those whom they treated that they preferred to live in poverty. Samuel Johnson described his friend, Dr. Robert Levet, a Practiser of Physic: No summons mock'd by chill delay, No petty gain disdain'd by pride; The modest wants of ev'ry day The toil of ev'ry day supplied [3].

This book constitutes a status report on health conditions (including nutrition and freshwater supply) in the Pacific Island Nations. The report is based on investigations carried out over the past decade by the Pacific Science Association and includes ethnic, demographic, historic, economic, political, climatological and ecological aspects. As such, it will serve as an important decision-making tool with respect to criteria for future development, taking into account the very special carrying capacities of the island territories concerned.

Before a separate Department of Medical Humanities was formed, the editors of this volume were faculty members of the Department of Pediatrics at our medical school. Colleagues daily spoke of the moral and social problems of children's health care. Our offices were near the examining rooms where children had their bone-marrow procedures done. Since this is a painful test, we often heard them cry. The hospital floor where the sickest children stayed was also nearby. The physicians, nurses, and social workers believed that children's health care needs were not being met and that more could and should be done. Fewer resources are available for a child than for an adult with a comparable illness, they said. These experiences prompted us to prepare this volume and to ask whether children do get their fair share of the health care dollar. Since the question "What kind of health care do we owe to our children?" is complex, responses should be rooted in many disciplines. These include philosophy, law, public policy and, of course, the health professions. Representing all of these disciplines, contributors to this volume reflect on moral and social issues in children's health care. The last hundred years have brought great changes in health care tor children. The specialty of pediatrics developed during this period, and with it, a new group of advocates for children's health care. Women's suffrage gave a political boost to the recognition of children's special health needs.

Mental retardation in the United States is currently defined as " ... signif icantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the development period" (Grossman, 1977). Of the estimated six million plus mentally retarded individuals in this country fully 75 to 85% are considered to be "func tionally" retarded (Edgerton, 1984). That is, they are mildly retarded persons with no evident organic etiology or demonstrable brain pathology. Despite the relatively recent addition of adaptive behavior as a factor in the definition of retardation, 1.0. still remains as the essential diagnostic criterion (Edgerton, 1984: 26). An 1.0. below 70 indicates subaverage functioning. However, even such an "objective" measure as 1.0. is prob lematic since a variety of data indicate quite clearly that cultural and social factors are at play in decisions about who is to be considered "retarded" (Edgerton, 1968; Kamin, 1974; Langness, 1982). Thus, it has been known for quite some time that there is a close relationship between socio-economic status and the prevalence of mild mental retardation: higher socio-economic groups have fewer mildly retarded persons than lower groups (Hurley, 1969). Similarly, it is clear that ethnic minorities in the United States - Blacks, Mexican-Americans, American Indians, Puerto Ricans, Hawaiians, and others - are disproportionately represented in the retarded population (Mercer, 1968; Ramey et ai., 1978)."

A solid knowledge base and good clinical skills don't necessarily guarantee examination success in the long case OSCE. This book is the ultimate guide for medical students needing to combine their knowledge and skills with an ability to interpret the clinical findings, the proficiency to present them clearly and the confidence to deal with the examiners questions. Adopting a proven, highly effective approach, this revision aid uses role play with simulated patients to hone clinical examination and presentation skills. The fifty cases are divided into six areas: cardiology, respiratory, abdomen, neurology, musculoskeletal and surgery. Written by successful candidates and examiners, the guide poses a number of important and commonly asked examination questions for each case to assist in preparation and confidence, and model answers are provided to ensure an understanding of exactly what is required. Working in groups or independently, students will welcome the large, colourful format, the breakdown of marking schemes, an overview of examiners expectations, a guide to presenting clinical findings and innumerable 'insider' tips throughout. See accompanying video here: https://www.youtube.com/watch?v=Cvr4y-NykUU

The culture of contemporary medicine is the object of investigation in this book; the meanings and values implicit in biomedical knowledge and practice and the social processes through which they are produced are examined through the use of specific case studies. The essays provide examples of how various facets of 20th century medicine, including edu cation, research, the creation of medical knowledge, the development and application of technology, and day to day medical practice, are per vaded by a value system characteristic of an industrial-capitalistic view of the world in which the idea that science represents an objective and value free body of knowledge is dominant. The authors of the essays are sociologists and anthropologists (in almost equal numbers); also included are papers by a social historian and by three physicians all of whom have steeped themselves in the social sci ences and humanities. This co-operative endeavor, which has necessi tated the breaking down of disciplinary barriers to some extent, is per haps indicative of a larger movement in the social sciences, one in which there is a searching for a middle ground between grand theory and attempts at universal explanations on the one hand, and the context-spe cific empiricism and relativistic accounts characteristic of many historical and anthropological analyses on the other."

The meaning and application of the principle of beneficence to issues in health care is rarely clear or certain. Although the principle is frequently employed to justify a variety of actions and inactions, very little has been done from a conceptual point of view to test its relevance to these behaviors or to explore its relationship to other moral principles that also might be called upon to guide or justify conduct. Perhaps more than any other, the principle of benef icence seems particularly appropriate to contexts of health care in which two or more parties interact from positions of relative strength and weakness, advantage and need, to pursue some perceived goal. It is among those moral principles that Tom L. Beauchamp and James F. Childress selected in their textbook on bioethics as applicable to biomedicine in general and relevant to a range of specific issues ( 1], pp. 135-167). More narrowly, The National Commission for the Protection of Human Subjects of Biomedical and Behav ioral Research identified beneficence as among those moral principles that have particular relevance to the conduct of research involving humans (2). Thus, the principle of beneficence is seen as pertinent to the routine delivery of health care, the discovery of new therapies, and the rationale of public policies related to health care."

CSA Revision Notes for the MRCGP is the ideal book to help you to revise and prepare for the CSA part of the MRCGP exam. The latest edition features new material on: Constipation in adults Cough Dupuytren's contracture Eating disorders Frailty assessment Gender dysphoria Gout Inguinal hernia Prediabetes Starting HRT Varicose veins Visual loss A standardised format is used throughout to help you to improve your: data gathering - a broad range of appropriate questions to ask the patient are provided and red flags are highlighted where appropriate interpersonal skills - each clinical problem is described using terms that you can use in your explanations to patients clinical management - tells you which examinations to consider, which investigations to order, and how to manage each clinical problem based on the latest guidelines and current best practice consultations - to help you practise, every clinical case features a realistic role play scenario.

This is the first volume ever published to examine the objective and subjective qualities of Korean life from both comparative and dynamic perspectives. It presents non-Western policy alternatives to enhancing the quality of citizens' lives, distinguishing Korea as an Asian model of economic prosperity and political democracy. The book is intended for academics, policy makers and the general public interested in recent developments in Korea.

Examining the combined impact of technology and the increasingly competitive market on the delivery and financing of health care, this volume makes a significant contribution to an issue of major importance to the American people. Health care has become a major industry that is changing rapidly and strikingly. This contributor volume focuses on the interplay among technology, the changing environment of health care, and its implications for future technological innovation. Particular focus is placed on the hospital in light of changes in federal funding (Medicare's prospective payment system, using diagnosis-related groups) with its orientation towards cost efficiency and cost-reducing technology. Academics, practitioners, and government personnel involved in hospital management, health care, and policy will find this volume a major resource.

This book is a collection of 18 papers by leading authorities inspired by the 1987 Conference on Health Technology Adoption in a DRG Age. It is divided into four sections: Technology and Health Care Content; Technology and the Health Care Organization; Technology and the Changing Environment; Implications for Technology Policy

This study seeks to resolve differences between various types of political leaders and to link broad historical patterns with the idiosyncratic circumstances of individual lives and careers--to integrate the micro and the macro levels of understanding in the field of leadership studies. To accomplish this task, a vast array of previous scholarship and primary documents has been assembled and drawn into new combinations. Equivalent data on all U.S. presidents enable an unprecedented internal comparison within this select group. Comparison with parallel data, developed for other types of leaders, permits U.S. presidents to be analyzed in comparative perspective for the first time. Against this background, the study creates a unique collection of medical and psychological profiles for the entire set of presidents--a body of data that allows us to discover new combinations and patterns of presidential traits.

American presidents emerged from this study looking very much like other political leaders in terms of social background and preparation for a political career. But contrary to myth, the authors found U.S. presidents to be puzzingly unexceptional--even average--in their personal and career characteristics. For other types of leaders, the authors had found distinctive combinations of traits and experiences that seemed to account for their political leadership roles. For the presidents, such combinations seemed elusive, even confounding. They did conclude, however, that presidential leadership is firmly anchored in the cultural, sociological, and historical contexts from which it emerges.