Search PubMed⌕ Search

Biomedical subjects

R C Wender

Publications and source records attributed to R C Wender.

7 recordsLinked to original sources
PubMed1996

Preventive care. Steps toward implementation.

Economic, professional, and consumer forces are pushing prevention to the forefront of health care. Providing preventive care is an effective and valuable service physicians offer patients; however, changing practice styles to routinely incorporate preventive care can be difficult. This article discusses strategies to facilitate the implementation of preventive care in office practice and is based on proven techniques that have helped patients change their undesirable behaviors.

Humans↗
PubMed1996

Humor in medicine.

The role of humor in medicine is becoming increasingly apparent. Humor helps individuals narrow interpersonal and cultural gaps, communicate difficult messages, express frustration and anger, and cope with anxiety. Primary care providers need to be able to interpret humor used by patients and can learn to use humor to create a healing environment. This article reviews the roles played by humor in the doctor-patient relationship and provides a brief guide to using one's sense of humor to improve and enrich patient care.

Adolescent↗
PubMed1995

Barriers to effective skin cancer detection.

BACKGROUND: In response to the dramatic rise in melanoma incidence, numerous health care specialists have encouraged primary care providers to increase skin cancer detection efforts. Although primary care providers currently find more melanomas than do dermatologists, many detection opportunities are missed. In addition, primary care providers occasionally incorrectly reassure patients about specific lesions. Nevertheless, there is little evidence that efforts to detect skin cancer are growing. This paper discusses barriers to skin cancer detection and potential ways to increase screening. METHODS: Methods involve the review of the medical literature and the author's synthesis of this information. RESULTS: The principle barriers to skin cancer detection are that it is a low priority in primary care, that the majority of exams do not result in significant findings, and that many providers lack expertise to adequately identify high risk lesions. Lack of reimbursement for preventive care, inadequate time for complete skin exams, and distraction by other health problems also play a role in limiting skin cancer detection efforts. CONCLUSIONS: Relying on primary care-based skin cancer detection as the only means to increase skin cancer identification is an unwise policy. Approaches that may be able to increase skin cancer prevention and detection include increased (1) collaboration between skin cancer specialists and experts in primary care, (2) focus on providers of pediatric care, (3) advocacy for reimbursement of preventive health care, (4) educational efforts for the public to request skin exams, and (5) education directed to providers in high risk areas.

Clinical Competence↗
PubMed1993

Cancer screening and prevention in primary care. Obstacles for physicians.

BACKGROUND: Surveys have demonstrated that primary care physicians are aware of cancer screening and prevention guidelines. However, health primary care providers do not recommend these services for many patients. This introductory discussion describes a new area of clinical study: practice barriers. METHODS: Literature review and the author's synthesis are used to identify major types of obstacles impeding broad implementation of cancer screening and prevention. RESULTS: Practitioners and patients face three types of obstacles: provider-specific obstacles; patient-specific obstacles; and health care delivery system obstacles. Provider-specific obstacles include lack of time, distraction by other health issues, lack of expertise, lack of positive feedback, and disagreement with recommendations. Barriers that chiefly affect screening for the major cancer sites (breast, colon, and cervix) and obstacles affecting preventive counseling also are discussed. Several techniques to help providers overcome obstacles have proven successful in increasing preventive activities. CONCLUSIONS: Efforts to increase cancer screening and prevention must focus on helping providers identify and overcome barriers through acquisition of needed skills, refinement of office time management, implementation of effective reminder systems, and development of appropriate, innovative feedback and reward mechanisms.

Female↗
PubMed1988

Meticulous glucose control in diabetic persons using insulin.

The one advantage a physician has in designing a regimen to control glucose values in a patient with IDDM is that the physiologic mechanism underlying IDDM is homogeneous: All patients are deficient in insulin and tend to be responsive to physiologic amounts of exogenous insulin. Although patients with NIDDM are inherently more stable, the optimal therapy is less clear and physiologic abnormalities must be considered on a case-by-case basis. Maintaining a balance between food intake, exercise, emotions, hormonal changes, and insulin, however, is an ongoing challenge. Only a fraction of IDDM patients are able to achieve excellent control over a long period of time, but it is generally not possible to predict which patients will be able to achieve these goals. Physicians must be patient and persistent in helping patients adhere as closely as possible to a strict diabetic regimen. Psychological, social, and emotional factors must be considered at every visit. Concern over high glucose levels may cause physicians to overlook important emotional events or a family upset that is causing the patient to be less concerned about blood glucose values. If a patient is having trouble adhering to a regimen, the physician should do a complete history and physical examination, with an appropriate differential diagnosis to help address the broad scope of the problem. For most diabetic persons who administer insulin, split, mixed doses given several times throughout the day allow the patient to use a lower total dose and minimize risk of hypoglycemia while improving the potential for glucose control.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗