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Biomedical subjects

W L Holleman

Publications and source records attributed to W L Holleman.

10 recordsLinked to original sources
PubMed2000

Continuity of care, informed consent, and fiduciary responsibilities in for-profit managed care systems.

The replacement of fee-for-service systems by managed care systems offers opportunities for cutting medical costs, integrating health care delivery systems, and improving communication among physicians. Before these benefits can be realized, however, a number of problems must be addressed. First, managed care systems must find ways to foster continuity of care in a market that has thus far proved unstable. Second, managed care systems must find ways to protect the patient's right to fully informed consent even while educating patients about the importance of cost-effectiveness and why certain treatments might not be included in their health plan. Third, managed care systems must find ways to promote physicians' fiduciary responsibilities to patients and to respect physicians' clinical judgments even while creating legitimate incentives to provide cost-effective health care.

Adult↗
PubMed1994

The homeless visit: enhancing residents' understanding of patients who are homeless.

BACKGROUND: With their interest in providing continuous, comprehensive care, family physicians are well-suited to treat persons who are homeless. Yet family practice residents most frequently encounter homeless patients in crowded public hospitals where time constraints and competing philosophies of patient care create suboptimal conditions and encourage the development of cynical attitudes and behavior patterns. EDUCATIONAL INTERVENTION: To address these problems, the Department of Family Medicine at Baylor College of Medicine in Houston developed a homeless visit program in which second-year residents spent one half day at a day center for the homeless. Residents interview the center's homeless clients, address their medical and psychosocial problems, and review each client's case with a faculty physician. Residents have the opportunity to explore the underlying causes of homelessness, the impact of homelessness on clients' health and well-being, and the bureaucratic barriers that homeless individuals must overcome to regain entry into the health care system. PROGRAM EVALUATION: After the first year, the program was evaluated to assess whether its original objectives had been met. Each of the second-year residents reported that the experience had been worthwhile. They recommended that the program expand the number of half days spent with homeless patients and the ancillary personnel, equipment, and supplies available. Each of these changes has been implemented and the program continues to thrive and improve. CONCLUSION: The homeless visit serves as a successful model for resident programs willing to devote as little as a half day in a 3-year curriculum toward training residents to better understand the intricate relationship between homelessness, physical and emotional needs, and an environment that simultaneously promotes illness and hinders medical attention.

Curriculum↗
PubMed1993

Impact of the Americans with Disabilities Act on family physicians.

The Americans with Disabilities Act of 1990 prohibits discrimination against persons with disabilities in employment, government services, public accommodations, public transportation, and telecommunications. This article reviews the impact of the law on the practice of family physicians. Pre-employment medical evaluations are prohibited by law, but medical evaluations may be performed after an offer of employment and before job assignment has been made. Employment may be conditional on results only if medical confidentiality is protected, and exclusionary criteria are job related, applied universally, and do not discriminate against individuals with disabilities. The law provides that persons with disabilities will have equal access to medical care, through prohibiting discrimination based on disability and through the design and construction of medical offices. The law requires physicians who are covered by the law to make reasonable accommodations so that qualified employees and applicants can perform the essential functions of a job.

Persons with Disabilities↗
PubMedDate not supplied

Preemployment evaluations: dilemmas for the family physician.

Preemployment evaluations present primary care physicians with numerous medical, ethical, and legal dilemmas. These examinations are especially problematic for community-based primary care providers unaccustomed to standards used by physicians in occupational settings. In response to a mailed questionnaire, 255 family physicians and general practitioners described their current methods of performing these examinations. Forty percent reported that employers routinely provide no information about the job for which the prospective employee is being evaluated. Respondents differed according to number and type of laboratory tests routinely included as part of a preemployment evaluation and in the proportion of prospective employees disqualified on the basis of the examination. Twenty-four percent reported no disqualifications, and 34 percent disqualified 5 percent or more. The percentage reporting medical and psychological information also varied. One-half routinely reported alcohol and drug abuse to employers, and of these, only one-half obtained a waiver for the release of such information. Five of every 6 physicians believed that it was more important to "tell the truth to the employer" than to "protect the interests of the employee." Our findings show that no consensus exists among the primary care physicians in our survey about the performance of preemployment evaluations. Because this can have serious consequences to workers, employers, and physicians, we propose guidelines for primary care physicians who perform preemployment evaluations.

Adult↗
PubMedDate not supplied

School and work release evaluations.

Increasingly high levels of absenteeism for minor illnesses and injuries have created serious problems for American schools and industries. Short-term absenteeism also creates serious ethical and professional dilemmas for primary care physicians who routinely perform school and work release evaluations. Through an inductive analysis of three typical cases, these problems are identified. The major ethical issues involved are discussed, including truth-telling, confidentiality, and a confusion of the professional boundaries of medicine, education, and industry. Through a deductive analysis, it is shown that the conventional approaches to school and work release evaluations fail to achieve satisfactory results. To circumvent these problems, three solutions are proposed: primary care physicians can refuse to do such evaluations, inform the patient of the purpose and rules of the encounter, or perform evaluations only in the context of treatment.

Absenteeism↗