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Biomedical subjects

M Siegler

Publications and source records attributed to M Siegler.

At least 145 records · Page 8Linked to original sources
PubMed1978

A legacy of Osler. Teaching clinical ethics at the bedside.

The teaching of clinical medicine at the bedside is an enduring legacy of the Oslerian revolution in American education. The advantages of teaching clinical ethics at the bedside including dealing with actual cases to maximize personal accountability, reinforcing the relationship between technical competence and ethical decisions, involving the entire health care team, and possibly decreasing the resistance of the medical profession to formal medical ethics. The proposal to teach clinical ethics at the bedside is intended to indicate a primary role for ethicists and clinicians at different stages in the medical curriculum. During the preclinical years of medical school, ethicist-philosophers, assisted by clinicians, should assume primary responsibility for teaching medical ethics. During the clinical years, physicians, assisted by clinically informed ethicist-philosophers, should accept the primary obligation to teach clinical ethics at the bedside.

Bioethical Issues↗
PubMed1978

Perioperative diabetic consultation: a plead for improved training.

To determine the clinical and educational impact of an academic general internal medicine consultation service, the investigators selected as a model the perioperative management of diabetes mellitus. They analyzed 17 consultative episodes over two years by retrospective medical record review to identify patterns and shortcomings. Most patients were elderly black females with maturity-onset diabetes mellitus exhibiting numerous past diabetic complications and other active general medical problems. Major findings included common failure to define the consultation purpose or document adequately follow-up visits, incomplete professional adherence to published guidelines for perioperative diabetic management, and correlation between failure to document the consultant's own physical examination and failure to reach new conclusions. Median cost for consultant-recommended tests was $179 (range $82 to $552) without clear linkage between medical care process and outcome. Consultative skills must be taught more effectively if medical consultations are to have maximal impact.

Adult↗
PubMed1975

Pascal's wager and the hanging of crepe.

Hanging of crepe refers to one type of strategy employed by physicians in communicating prognoses to families of critically ill patients. This approach offers the bleakest, most pessimistic prediction of the patient's outcome, presumably in an effort to lessen the family's suffering if the patient dies of his illness. Certain similarities exist between this technic and that used by Pascal, the 17th-century philosopher, in formulating his wager on the belief in God, in that both attempt to develop "no-lose" strategies, in which chances for "winning" are maximized. A detailed analysis of these strategies indicates that neither is truly "no-lose," and that both contain inherent disadvantages. Prognostication, an alternative approach to physician-family communication, appears to be strategically and morally superior to the hanging-of-crepe strategy.

Attitude of Health Personnel↗