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Biomedical subjects

E V Boisaubin

Publications and source records attributed to E V Boisaubin.

At least 19 recordsLinked to original sources
PubMed2001

Identifying and assisting the impaired physician.

An impaired physician is one unable to fulfill professional or personal responsibilities because of psychiatric illness, alcoholism, or drug dependency. Current estimates are that approximately 15% of physicians will be impaired at some point in their careers. Although physicians may not have higher rates of impairment compared with other professionals, factors in their background, personality, and training may contribute and predispose them to drug abuse and mental illness, particularly depression. Many physicians possess a strong drive for achievement, exceptional conscientiousness, and an ability to deny personal problems. These attributes are advantageous for "success" in medicine; ironically, however, they may also predispose to impairment. Identifying impairment is often difficult because the manifestations are varied and physicians will typically suppress and deny any suggestion of a problem. Identification is essential because patient well-being may be at stake, and untreated impairment may result in loss of license, health problems, and even death. Fortunately, once identified and treated, physicians often do better in recovery than others and typically can return to a productive career and a satisfying personal and family life.

Denial, Psychological↗
PubMed2000

Seeing patients and life contexts: the visual arts in medical education.

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.

Art↗
PubMed1999

Integrating early clinical experience curricula at two medical schools: lessons learned from the Robert Wood Johnson Foundation's Generalist Physician Initiative.

The University of Texas Medical Branch and Eastern Virginia Medical School have created community-based generalist clinical experiences early in the first two years of medical school as part of The Robert Wood Johnson Foundation's Generalist Physician Initiative. This article describes these experiences and related curricula, outlining the common elements and differing approaches at the two institutions. It discusses the success of the new curriculum, presenting information from performance measures and surveys of students, clerkship directors, and faculty involved in the programs, and it describes further evaluative studies being planned. The authors discuss nine lessons learned and their conclusion that early clinical experience with generalist physicians is an important element of generalist curriculum reform. It improves student satisfaction with the first two years' experience and provides a structure for teaching patient-centered, integrated clinical medicine, which is important in the general professional education of all students. Whether or not the long-term goal of increasing students' interest in generalist careers is realized, incorporating early clinical experiences with generalists into a curriculum has positive effects on students, faculty, and the overall curriculum.

Curriculum↗
PubMed1996

Treatment for obesity.

Explore the source record for details and available documents.

Adrenergic Uptake Inhibitors↗
PubMed1993

Legal decisions affecting the limitation of nutritional support.

The withholding of nutritional support from patients is one of the most controversial issues in modern medical ethics and law. Withholding support from a consenting, terminally ill patient is the simplest case situation to defend, but patients in a persistent vegetative state or irreversible, chronic illness, require more careful deliberation. Regarding this issue, five primary principles have been utilized in legal decision making. These include: futility, autonomy, integrity of health professionals, states interests, balancing benefits versus harm and quality of life. The two landmark legal cases which have set the tone for most other court decisions are Paul Brophy and Nancy Beth Cruzan. Both cases clarified the right of competent adults to refuse nutritional support, even if life-saving. In the Cruzan case, however, states were given the authority to request clear and convincing evidence for the previous wishes of the incompetent patient. In summary, competent patients entering a hospice program should make informed decisions about their desires for feeding, as they do with other treatment decisions. Optimally, those wishes should be codified into an advance directive and a proxy decision maker named. If a patient is not competent, and without previously expressed wishes, immediate family members are usually consulted for what they believe are the patient's best interests. Last, although limitations of care for terminally ill children fall under the same general guidelines as for adults, the "Baby Doe Rules" are a complicating factor.

Coma↗
PubMed1993

Advance directives on hospital admission: a survey of patient attitudes.

A survey of 200 outpatients using an anonymous, self-administered questionnaire revealed that 18% had already completed an advance directive. Only 5% had received information concerning advance directives from their physicians. Eighty-seven percent stated they would not be offended if, on admission to the hospital, they were to be asked whether they had completed a living will. Eighty-eight percent would view such a policy as showing evidence of positive concern by the hospital on their behalf. Only 2% consistently gave a negative response to a proposed policy of hospitals providing information concerning advance directives on admission, and a similar percentage was totally opposed to their use. Of those who had completed an advance directive, 50% had secured the only copy in a safety deposit box. This information, as well as the Patient Self-Determination Act of 1990, which will as of December 1, 1991 require hospitals to provide patients with information about advance directives, creates a new framework for the more efficient use of these important but underused documents.

Adolescent↗
PubMed1991

Hypercalcemia of advanced malignancy: decision making and the quality of death.

Hypercalcemia is a common complication of certain advanced malignancies and although not therapeutically difficult, its presence raises complex ethical issues. Treatment of this condition is most easily justified when the patient is not terminal, the benefits are tangible, and the patient agrees with therapy. Withholding treatment is defensible medically, legally, and morally when a terminal situation is present, when drawbacks exceed the benefits, and when an informed patient declines therapy. Hypercalcemia is one of a number of conditions of dying that can be controlled by the physician. The physician's decision to treat such a condition, in part, depends upon his or her view of a good death. Further study is needed to clarify and avoid those situations of dying which involve suffering. Physicians must begin this difficult analysis and dialogue if they are to fulfill their obligation to minimize suffering in all patients.

Ethics, Medical↗
PubMed1991

Ethical and legal issues in the treatment of patients with AIDS.

For the foreseeable future in Texas, AIDS will present a formidable challenge to practitioners, medically and ethically. Testing should continue to focus on individuals in high-risk groups, although some professionals encourage broader, voluntary screening. Because the disease is currently fatal, physicians and patients need to address decisions concerning life-sustaining treatment before the disease becomes advanced. Two new acts, the revised Texas Natural Death Act and the new Durable Power of Attorney allow parties to plan ahead rationally with legal protection. Other new pieces of legislation, passed by the 71st Texas Legislature, address timely issues such as consent for testing, notification of others, protection of health care workers, and guidelines for insurance companies. Physicians may have a moral and professional obligation to treat AIDS victims, although this is not mandated by current state law.

AIDS Serodiagnosis↗
PubMed1990

Evaluation of a hospital admission HIV antibody voluntary screening program.

Voluntary screening for the presence of human immunodeficiency virus (HIV) is recommended by the healthcare profession. The optimal settings to accomplish screening have not been established. We evaluated an admission HIV screening program in a large private hospital to assess advantages and disadvantages in this setting. In a three-month study period, 4,535 of 8,868 patients (51%) admitted to the hospital agreed to HIV testing. Serum specimens from 500 patients who refused testing were blindly, anonymously tested. The seroprevalence of the patients agreeing to (0.26%) and refusing (0.60%) testing was not statistically different (p = .12). There were 12 HIV cases discovered; ten (83%) of these were known to be in a high-risk group at the time of admission. Eighty-five percent of patients interviewed were in favor of this screening program. Difficulties associated with confidentiality or consent were not evident. Calculated charges of testing for each HIV case discovery was $14,550. There was no evidence that this screening program provided for a more effective infection control policy to prevent nosocomial HIV transmission. A hospital admission HIV screening program can be implemented, can meet with favorable patient opinion and can detect previously unknown HIV-positive patients. Hospitals are an efficient and practical setting for HIV testing. The benefit of this program appears to be greater for the patient than hospital or healthcare worker. Cost-benefit analyses will identify optimal candidates to be screened in different hospital populations.

Attitude to Health↗
PubMed1990

Practice standards: implications for the internist.

Pressure for national standards of medical practice is increasing from cost control initiatives, medical malpractice liability, and the desire to simplify complex practice problems. Good standards need to be academically sound, focused enough to be clinically useful, yet flexible enough to allow for the realities of practice. Standards have already been created by several professional societies, including anesthesiology and cardiology in internal medicine. Although physician education is primary, controlling the use of expensive new technologies is an unwritten but important secondary goal. While standards have reduced malpractice liability in some professional groups, some clinicians are concerned that standards will be too academic and unrealistic. Currently, third-party payers are watching the development of practice standards but are hesitant to use them as criteria for determination of reimbursement. The federal government has a major interest in practice standards as a means of both monitoring quality of care and controlling costs. A number of agencies are studying the development of standards and their implications for use. Recent articles questioning the usefulness of common diagnostic tests and even the routine physical examination have raised concern among internists that restriction of practice and reimbursement will follow. Some evolving standards, such as screening for breast cancer, seem to ignore the realities of clinical practice and may generate more cost than they save. Internists need to provide input as standards are developed to guarantee appropriateness and feasibility.

Costs and Cost Analysis↗
PubMed1989

The assessment and treatment of pain in the emergency room.

A broad spectrum of painful conditions presents to the modern emergency center (EC). The three most common categories are acute, self-limited disorders; chronic medical or surgical syndromes with acute exacerbation; and psychic pain syndromes in which the etiology cannot be easily ascertained. Many factors may differentiate pain from suffering, and physicians should educate patients not only about the nature of their condition and its prognosis, but also about anticipated discomfort. Clinical concerns in the EC include physicians' tendency to undertreat or even ignore pain, the need for appropriate but flexible dosage schedules, and physicians' concern about masking important signs and symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently the safest and most effective group of oral analgesics. Important factors for drug selection include efficacy, dosage, lack of side effects, and cost. Two special groups of patients, those with psychic pain syndromes and those with drug-seeking behavior, can create problems for the physician. Patients with chronic pain syndromes need special follow-up but do not benefit from additional analgesic drug therapy. Patients who seek and abuse drugs can be difficult to identify, may have true underlying medical pathology, and should not be given narcotic prescriptions.

Adult↗