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Many doctors write for consumer publications. Even more would like the chance to do so. This article explains how to bridge the gap between writing scientific papers and writing for the popular press, and offers realistic guidance on how to find a way into this competitive market.
Johann Friedrich Struensee was born in 1737 in the German town of Halle where he graduated as doctor of Medicine at the age of 19. In 1757 he was appointed to be town physician in the big Danish town Altona, close to Hamburg. There he had a large medical practice among the poor, but he also succeeded in curing some important persons, which influenced his further career. During his eleven years in Altona he made many friends among the liberal circles and evolved an extensive writing of medical and social publications, where he called for reforms of housing, of hygiene, of fresh air and a sounder living. He organised a delivery clinic for single mothers and took care of the orphans. His opinions met with furious opposition from older doctors, whom he attacked for their greed and ignorance. In 1768 he was appointed to be the danish king Christian VII's physician during the kings visit to England. King Christian was mentally disturbed with fits of violence and confusion, but Struensee succeeded in gaining his confidence and after return to Denmark he was soon to be the absolute ruler of the country during three years. He started an intensive reform period with total freedom of the press, abolished peasant slavery and the death penalty, got rid of nepotism in the civil service, where only real competence should decide. He put an end to the great waste of money for luxury and superfluous staff in the court and in military units in order to improve the heavily indebted Danish economy. His reforms affronted many important persons and he never succeeded in gaining the confidence of the ordinary people, whose benefit he struggled for. By a sudden revolt Struensee's adversaries arrested him and forced the week and frightened king to sign the doctor's death sentence which was carried out April 28 1772 in spite of his noble document of defence.
Until the time Numan took on his professorship at the newly established Veterinary School in Utrecht in 1822, he had lived in the Province of Groningen. In order to understand why the minister of Public Education appointed a village doctor from the north of the country as professor for the practice of veteriary medicine, and after some years as director of the school, it was felt essential to investigate his earlier life period. The main sources used are two obituaries, resp. written by his son who was a professor of Law at Groningen University, and by his friend prof. Willem Vrolik who was the secretary of the Academy of Science, supplemented by family histories and some archival research. After a short description of his descent, youth adn education follows the main part devoted to his writings, his medical practice and membership of the Provincial Medical Commission and the Commission for Agriculture. In an appendix some genealogical data are presented on the family of his wife and their children. Alexander lost his father, who was a minister of the Reformed Church, when he was ten years old. He received his education in the circle of family members. A brother of his father, also a minister, teached him Greek and Latin. After this uncle had left the province, he lived in the home of another minister who teached him the modern languages. As this man was involved in politics of the Baravian Republic, young Alexander was exposed to many discussions on the polity of the State. After his mother had remarried with a medical doctor, this man, and also his brother who had a medical practice in another part of the province, complemented the education with an introduction in the sciences. Experiences in their dispensaries, where some knowledge of botany and chemistry could be obtained, and discussions when accompanying them on their visits to patients, were decisive in the choice of his profession. Only at the age of twenty he entered the Medical Faculty of Groningen University. Thanks to the elaborate preparatory studies, he was able to finish in three years. In 1804 he defended his thesis on a pharmaceutical subject. Immediately afterwards he set up practice in a village nearby the town of Groningen. He married two years later Catharina Dorothea Star Lichtenvoort, daughter of a wealthy lawyer. They had two children, a son born in 1807, and a daughter, born in 1808. Alexander built a flourishing medical and obstetrical practice, extending over a very large area, he teached apprentices in his dispensary, translated articles and a book by C.W. Hufeland and published case histories from his own practice. Several lectures given at local scientific societies were published. One deal with his thoughts on and experiences with animal magnetism, a topic very much en vogue in those days, especially in the Groningen Medical Faculty. In 1812 his translation of Allenmeines Viehazneibuch by J.N. Rohlwes was published, showing his interest in veterinary matters. As a book appeared not to be satisfatory enough for the needs of the Dutch farmers, he was invited by the board fo the 'Society for Public Welfare' (Maatschappij tot Nut van het Algemeen) to write an adapted version. This handbook (first ed. 1819) would receive many editions throughout the 19th century. This book together with his capacities as a teacher, his broad interests in medical and agricultural affairs, great scientific curiosity and appreciation by colleagues met in the several commissions made him an obvious candidate for the new post in Utrecht. Although he felt it difficult to leave his beloved homeland and terminate his practice, he felt great pride in accepting the post that would give him the opportunity to found a new discipline in his country. To be useful to society was one of the great motives of his life.
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The writing of a business plan is not the most important part of formulating a plan. Much more important is the consultation and dialogue with interested parties that should precede the writing stage. This article identifies the pitfalls that might snare the uninformed.
Our knowledge of medical practice in medieval Islam is still scanty. It is mostly derived from normative sources, textbooks and deontological texts, which rather depict an ambitious ideal to be followed than the social reality of the average physician. Moreover, deontological regulations in Arabic medical literature are to a large degree shaped by traditional conceptions. The present article, which is based on three so-called mirrors for physicians dating from the 9th to the 12th century AD, attempts to give a provisional outline of possible Greek sources beyond the well-known Hippocratic writings on medical ethics and deontology and a first assessment of topics which seem to be original with the Arabic authors.
Preparation, submission, and presentation of an abstract are important facets of the research process, which benefit the investigator/author in several ways. Writing an abstract consists primarily of answering the questions, "Why did you start?" "What did you do?" "What did you find?" and "What does it mean?" A few practical steps in preparing to write the abstract can facilitate the process. This article discusses those steps and offers suggestions for writing each of an abstract's components (title, author list, introduction, methods, results, and conclusions); considers the advantages and disadvantages of incorporating a table or figure into the abstract; offers several general writing tips; and provides annotated examples of well-prepared abstracts: one from an original study, one from a method/device evaluation, and one from a case report.
In Pediatric Oncology in Germany, 90% of the patients are treated according to multicenter clinical trials, which means an enormous effort for documentation in the participating clinics. In order to enable multiple use of data for patient records as well as for clinical trials a computer-based documentation system for pediatric oncology (DOSPO) is being developed, which can be used nationwide. DOSPO currently comprises a minimum basic data set, which represents the common core of all multicenter trials and which has been approved by the German Society for Pediatric Oncology and Hematology (GPOH). It is intended to enhance the documentation by specific items of each clinical trial. Functions for computer-aided chemotherapy planning and medical report writing have already been implemented in the documentation system. Various centers in Germany are currently validating the system in routine use.
Medical mistakes often are responsible for patient injury and suffering, but not all such mistakes are negligent. In the United States, injured patients have recourse to legal action under the common law. The medical malpractice tort trial system is intended to provide compensation for patients who have been negligently injured and to deter future negligent acts by physicians. The deterrent function of torts largely rests on practitioners' capacity and willingness to internalize, or 'process', the lessons of tort trials. However, physicians' willingness or ability to process the tort deterrent signal, while widely assumed in much contemporary legal writing on medical malpractice, has never been empirically verified. This study is a qualitative assessment of how practicing physicians process the tort deterrent signal. We interviewed a random sample of 47 internists, surgeons, and obstetrician/gynecologists from New York State as part of the Harvard Medical Practice Study. The interviews reveal three notable findings: physicians in our sample largely define medical negligence by reference to moral qualities of the practitioner; they claim that lawyers and the legal process of tort trials lack the moral authority to guide medical practice; and finally, while they consequently reject the lessons of lawyer-dominated, confrontational tort trials, they indicate that they would respond more favorably to hospital-based, physician-led, educational quality-control measures. Based on these findings, we identify several potential impediments to the receipt and processing of the tort deterrent signal by individual physicians and we suggest that the interview results support the notion of institutional liability for medical malpractice.
A common method in the teaching of epidemiology at the London School of Hygiene and Tropical Medicine is 'paper critique'. This refers to a close reading of published research articles, in which students are asked to assess their coherence and validity. The intention is to improve the students' analytic and writing skills, as well as acting as a form of summative assessment. In this paper, the author links his experience of this method to concepts such as rhetoric, myth and semiology, and uses them to try to develop paper critique as an educational method.
The evolution of a policy disallowing patients' use of alternative therapies in a health system is described. The pharmacy and therapeutics (P&T) committee at Children's Hospital of Michigan, a part of the Detroit Medical Center (DMC), was asked to review the appropriateness of allowing inpatients to bring in and use alternative therapy products during their hospitalization. Recognizing the interest of consumers in alternative medicines and patients' growing involvement in their own care, the committee drafted a policy that allowed patients to continue taking dietary supplements after being admitted to the hospital. If the physician had no concerns about potential toxicities or drug interactions for a particular product, he or she would write a medication order allowing it to be used. Purchasing and administering the products were deemed the responsibility of the patient or the family. However, many issues concerning supplements remained unresolved, including questions about safety, efficacy, dosing, drug interactions, ethical conflicts, and liability. Ultimately, the P&T committee decided that the potential risks associated with alternative therapies outweighed potential benefits and adopted a policy disallowing the use of alternative therapies by hospitalized patients. The policy was eventually implemented at all eight DMC hospitals. A health system responded to patients' desire to continue their use of alternative therapies during hospitalization by drafting a policy allowing such use. However, concerns related to safety, efficacy, ethics, and liability led to the abandonment of the liberal policy and implementation of a highly restrictive one.
Increased communication from significant others and perceived interpersonal support correlated with reduced student drinking during the first 12 weeks of medical school. Writing brief essays on any subject of personal interest which were read, annotated and quickly returned by a faculty member correlated with reduced student drinking during the final 12 weeks of the first year.
During the decade from 1977 to 1986, four models of care pertaining to ambulatory medicine and certain aspects of clinical epidemiology were proposed. All were concerned with the frequently heard accusation that medicine was becoming dehumanized by being overly dependent on powerful new technologies. Some of the authors went so far as to suggest that the view, according to which medical science must restrict itself to "hard" data of the kind provided by the serum multichannel analyzer, should be considered outdated and, in fact, unscientific. Their plea was to develop a science of the clinical encounter that would shift the emphasis from explication to prediction and management, the latter term being virtually synonymous with decision making. For this change to come about, they wrote, it would be necessary to collect "soft" data on such subjects as family relationships, psychic traits and states, perceptions of life quality, patient expectations and many others. We believe that some of these subjects as well as the models themselves were anticipated in the writings, both medical and fictional, of Weir Mitchell, nearly a century earlier. This paper, after presenting a brief overview of the career of a colorful and commanding figure from the annals of American medicine, will seek to illustrate his extraordinary farsightedness as a practitioner of primary care and his relevance for some aspects of clinical epidemiology. Because the attempts to link his ideas to modern concepts are ours, we accept the possibility that, here and there, we may have read things into his writings that he did not intend.
This paper focuses on using the grounded theory method to study social psychological themes which cut across diverse chronic illnesses. The grounded theory method is presented as a method having both phenomenological and positivistic roots, which leads to confusion and misinterpretations of the method. A social constructionist version and application of grounded theory are introduced after brief overviews of the method and of the debates it has engendered are provided. Next, phases in developing concepts and theoretical frameworks through using the grounded theory approach are discussed. These phases include: (1) developing and refining the research and data collection questions, (2) raising terms to concepts, (3) asking more conceptual questions on a generic level and (4) making further discoveries and clarifying concepts through writing and rewriting. Throughout the discussion, examples and illustrations are derived from two recent papers, 'Disclosing Illness' and 'Struggling for a Self: Identity Levels of the Chronically Ill'. Last, the merits of the method for theoretical development are discussed.
OBJECTIVE: Experience with implementation and operation of a patient data management system on an intensive care unit. METHODS: Patient data management system "Intensive Care Manager" (ICM, Dräger Medical). Anaesthesiologic ICU (surgical patients only) of an academic teaching hospital. RESULTS: ICM was installed without problems and is used in routine patient treatment. The system is running reliably, availability was 99.87 % during the last 8 months. CONCLUSION: Documentation has become better and more detailed with comparable time spent. More secondary diagnoses have been recorded since ICM was implemented. Special "views" related to organ systems allow to monitor organ dysfunction more easily and facilitate treatment decisions. Review of textual information needs to be further optimised. Writing of medical reports is ideally supported by ICM. Using ICM is advantageous for doctors, nurses and patients.
Dr. Braceland discusses his 13-year tenure (1965-1978) as Editor of the American Journal of Psychiatry, noting that he took office during a period of social turmoil that in many ways resembled the decade of the Journal's founding 134 years ago. He describes the advantages and disadvantages of the peer review system he introduced to the Journal and states that this approach is essential in a time of ultraspecialization. He reviews the crafts of editing and writing for medical journals, both of which are brightened by clarity and brevity. As to the future of medical journals, he considers reports of their demise premature, while acknowledging the problems they face. Dr. Braceland briefly considered a "rocking chair" approach to his retirement from the Editorship, but the Editor Emeritus will instead continue to provide whatever assistance he can to his colleagues.
BACKGROUND: It has been estimated that 1-2% of US inpatients are harmed by medication errors, the majority of which are errors in prescribing. The UK Department of Health has recommended that serious errors in the use of prescribed drugs should be reduced by 40% by 2005; however, little is known about the current incidence of prescribing errors in the UK. This pilot study sought to investigate their incidence in one UK hospital. METHODS: Pharmacists prospectively recorded details of all prescribing errors identified in non-obstetric inpatients during a 4 week period. The number of medication orders written was estimated from a 1 in 5 sample of inpatients. Potential clinical significance was assessed by a pharmacist and a clinical pharmacologist. RESULTS: About 36200 medication orders were written during the study period, and a prescribing error was identified in 1.5% (95% confidence interval (CI) 1.4 to 1.6). A potentially serious error occurred in 0.4% (95% CI 0.3 to 0.5). Most of the errors (54%) were associated with choice of dose. Error rates were significantly different for different stages of patient stay (p<0.0001) with a higher error rate for medication orders written during the inpatient stay than for those written on admission or discharge. While the majority of all errors (61%) originated in medication order writing, most serious errors (58%) originated in the prescribing decision. CONCLUSIONS: There were about 135 prescribing errors identified each week, of which 34 were potentially serious. Knowing where and when errors are most likely to occur will be helpful in designing initiatives to reduce them. The methods developed could be used to evaluate such initiatives.