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Biomedical subjects

J F Burnum

Publications and source records attributed to J F Burnum.

17 recordsLinked to original sources

The misinformation era: the fall of the medical record.

Medical record information has become less reliable than ever before despite the electronic information revolution in medical care and the authority medical records have been accorded in our society. Long flawed by errors introduced by medical personnel, patients, and machines, medical records have had a further decline in credibility as a result of the loss of confidentiality and the imposition of well-meaning but unrealistic cost-control regulations on medical practice. Medical records are being distorted and fashioned to keep clinically important but sensitive personal information about patients from public view. To comply with standards of care and a reimbursement system blind to biologic diversity, medical records are being forced to address only the technical side of care. Until these deficiencies are corrected, our increasing dependence on medical records should be balanced by increasing skepticism about the value of the information they contain.

Confidentiality

Medical vampires.

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Bloodletting

Diagnosis of depression in a general medical practice: observations on "lack of pizzazz," the "blahs," and other complaints.

Patients rarely admit that they are depressed, and the signs and symptoms may be subtle. We need not miss the diagnosis, however, if we listen carefully to the patient's compliants and trust our own clinical acumen. When should we refer depressed patients to a psychiatrist? When we do not have the time that the patient deserves and when the depression is severe. Of 76 patients with depression in my practice, I referred about 12% (9). Can we forget about general medicine once the diagnosis of depression is made? Emphatically not. Major physical disease was present in 75% (57) of my depressed patients, and virtually all had a potpourri of baffling physical symptoms that required careful diagnostic analysis.

Back Pain

The worried sick.

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Attitude to Health

The malaise in internal medicine.

Internists today are discomforted by uncertainty of identity, governmental interference with practice, total responsibility for patients' health, and by waning of faith in science. As personal "caring" physicians, internists are secure in primary care but should maintain their distinctive scholarly leadership as master clinicians and consultants. Humanism and science are one in patient care. Future practice patterns depend on physicians themselves participating in policy decisions for inevitable controls and rationing of government financed health services. The public must understand that good health depends not only on physicians but also on a better society and what people are willing to do for themselves. Western culture has been shaken by the cruel paradoxes of progress and technology. But, human choice not science is at fault, and only wisdom in the use of science will save us.

Decision Making

Primary care within the academic tradition.

In the rush to train primary-care physicians, the bioscience tradition must remain inviolate. At the same time, however, academic medicine should recognize that the actual practice of medicine has a special content and operational philosophy that is indispensable for patient care and in which, therefore, every student should be versed.

Delivery of Health Care