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Biomedical subjects

R M Coe

Publications and source records attributed to R M Coe.

At least 55 records · Page 3Linked to original sources
PubMed1977

The 'new' medical student: another view.

In this paper the authors examine some evidence concerning admission of a "new" type of student to medical school. Such students have been described as more socially concerned and committed to reform of the health care system than students of the 1950s. The hypothesis was that the new type of student was a temporary phenomenon, influenced by transitory sociopolitical events which had little impact on the institutionalized processes of medical education. Data consisted of responses to selected attitude statements by successive entering classes of medical students in one school of medicine from 1970 to 1975. Data were collected a second time from graduating seniors in 1974 and 1975 (entering classes of 1970 and 1971). The same information was collected from physician preceptors in 1975. Results suggest partial support for the hypothesis of decreasing liberalism among entering freshman after 1973, increasing conservatism among graduating seniors, and a high level of conservatism among physicians. Some exceptions to these trends are noted.

Achievement↗
PubMedDate not supplied

Achieving consensus on withdrawing or withholding care for critically ill patients.

OBJECTIVE: To examine the decision-making process to withhold or stop life support. DESIGN: Survey. SETTING: Medical intensive care unit of a tertiary care center. PARTICIPANTS: Physicians and families of 15 critically ill patients; in seven cases patients also participated. MEASUREMENTS: Meetings between physicians and family members concerning a decision to withhold or stop treatment of a critically ill family member were tape-recorded. Transcriptions of the meetings were analyzed for 1) process: how the physician introduced the need for a decision, framed the likely outcomes of options, and closed on a decision; 2) what decision was made; and 3) the outcome; died, discharged home, or discharged to another institution. RESULTS: The concept of "patient's wishes" was a central orientation point for the negotiation of consensus regarding withholding or withdrawing therapy even when the patient was not a participant. Physicians tended to provide a direct and unambiguous introduction, give equal weights to options during decision framing, but narrow the options during decision closure to correspond to their judgments. Not every decision was consistent with the physician's judgment. CONCLUSIONS: Decision making to withhold or withdraw life-support therapy from critically ill persons involves complex, difficult processes. Successful management of the tension among life extension, quality of life, patient autonomy, and social justice requires better understanding of these processes.

Adult↗