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At least 289 records · Page 16Linked to original sources
PubMed1977

Is there a stethoscope in the house (and is it used)?

A survey was conducted in Rochester, NY, of the attitudes and practices of psychiatrists (both in private practice and fulltime academic settings), psychiatric residents, internists, and fourth-year medical students concerning physical examinations of psychiatric patients. Thirteen percent of the psychiatrists frequently perform an initial physical examination on their inpatients and 8% frequently do an initial physical examination on their outpatients. These percentages are much larger for the resident groups. A very high percentage of all respondents report that they feel a physical examination of psychiatric patients is important especially when the patient is receiving medication. The largest number of psychiatrists report that they omit the physical examination because the patient has been referred to them after a physical examination by another physician or they refer the patient for such an examination. A notable percentage of psychiatrists in this sample report that they do not feel competent performing a physical examination.

Attitude to Health↗
PubMed2003

Care of the dying doctor: on the other end of the stethoscope.

The challenges of caring for a dying doctor reflect both common issues in helping the terminally ill and unique problems in working with a physician-patient. The dying doctor must deal with a familiar environment and set of problems from a radically different perspective and must negotiate overlapping and conflicting personal and professional roles. Some of the cardinal virtues of physicians--professional identity, expertise, perfectionism, selflessness, and stoicism--may pose both strengths and liabilities in the patient's role. The treating physicians may also encounter new strains in caring for a colleague. They must guard against both overinvolvement and underinvolvement, and, as with all dying persons, they must serve as a guide through unfamiliar territory for dying patient and family--a companion who is not afraid to listen to or explore the most upsetting matters, a person who can speak frankly when others may be ignoring "the horse on the dining room table." The case of Dr B, an internist dying of myelofibrosis and congestive heart failure, whose son is also a physician, offers the reader the opportunity to reflect on these challenges and to draw lessons about how to best care for fellow physicians at a time of great need. We suggest strategies for negotiating the patient-physician relationship when the patient is also a physician.

Attitude of Health Personnel↗
PubMedDate not supplied

A 'stethoscope' for the physician manager--conditions for clinical accountability in the Nordic setting.

An increasing interest in requiring clinical accountability, i.e. direct economical and managerial involvement of physicians, can be witnessed in the US and the UK, representing two extremes on the axis of private versus public service provision. The development is also taking place in the Nordic countries alongside a 'decentralisation' of financial and managerial decision making to smaller units. The essay discusses possibilities to introduce clinical accountability on the Nordic scene. As a background to the analysis, clinical accountability is defined in terms of production targets, budget limits and preset standards of quality of care. Arguments for not using clinical outcome as result measure are presented. The product analogy is suggested as a means for the physician manager to control both clinical policies and resource management. The conclusion is that the possibilities to introduce clinical accountability in the Nordic countries probably are better than in the US or UK, for the following reasons: physician attitudes, interpreted indirectly by shown interest in management training are not unfavourable; the organisational structure with physicians in a line organisation gives the financially accountable Department Head professional as well as managerial authority; management policy stressing decentralisation increases autonomy and stimulates interest to involve in management; product control information is readily available through reliable information systems. Obstacles are also identified. Finally it is argued that the organisation structure found in Nordic countries enables clinical accountability still preserving clinical freedom in the singular doctor patient relation.

Denmark↗