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PubMed1985

Why case reports?

Explore the source record for details and available documents.

Medical Records↗
PubMed1997

[Prescription of stimulants for hyperactive children: a pilot study of incentives and constraints on parents, teachers and physicians].

The scientific consensus on the use of stimulants to treat "hyperactive" or ADHD-diagnosed children amounts to recognizing a calming effect on children's disruptive behavior and better performance of repetitive tasks, both in the short-term. Long-term effects remain unknown. Still, in Québec, prescription of stimulants to children of welfare recipients nearly tripled between 1990 and 1994, reaching a prevalence of 11.9%. Using a systemic model integrating three approaches (medicalization of deviance, political economy, and strategic analysis), we conceptualized the decision to prescribe as the result of interactions involving different actors holding unequal power and seeking to further their interests. We attempted to establish the defendability of this model by means of in-depth interviews with five parents, four primary school teachers and three physicians in prolonged contact with a hyperactive child receiving stimulant medication. Data from the interviews reveal the omnipresence of the medical model in the hyperactivity treatment system, although teachers rather than physicians appear as the engine of this medicalization. According to parents and physicians, teachers identify and "diagnose" children, propose the use of medication to parents and, in some cases, the school requires that doctors write a prescription. Doctors admit that medical evaluation of referred children is often inadequate. For their part, teachers stress the growing difficulties of their task and the lack of psychosocial supports in the schools. Our respondents' comments highlight the divergent interests of the actors involved as well as each actor's own perception that he or she wishes to act differently but lacks any real choice other than opting for medication. These limited observations should be validated in further studies. They suggest that the current system functions irrationally and that we should not expect it to act in the best interests of children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

[Anton Chekhov--physician and writer. Physicians in his novels].

Anton Pavlovich Chekhov (1860-1904) was a doctor and a writer. He practised medicine in a rather sporadic manner throughout his life, and his main occupation was his authorship. His collected works comprise 581 items of a narrative type, 17 plays, a narrative and a treatise of his voyage to Sakhalin, a number of articles and about 4,000 letters. This paper describes the doctors who appear in 83 of his short stories and associated material, and shows how Chekhov's medical background influenced his writing.

Famous Persons↗
PubMed1998

The early history of tuberculosis in central East Africa: insights from the clinical records of the first twenty years of Mengo Hospital and review of relevant literature.

SETTING: Mengo Hospital, in present day Kampala, Uganda, 100 years ago. OBJECTIVE: To determine the presence of tuberculosis in the Bagandan population of central East Africa and elsewhere in Africa at the time of early explorations by Europeans. DESIGN: The case records kept by Albert Cook for two decades beginning in 1897, 35 years after the first visit of Speke to this region, were reviewed for evidence of tuberculosis among Bagandans. Writings of other contemporary medical observers were reviewed for evidence of tuberculosis in pre- and early-colonial Africa. RESULTS: Well documented cases of tuberculosis were observed by Cook beginning in 1897. A minimum total of 93 cases of tuberculosis were included in 26 806 admissions to Mengo Hospital from 1897 through 1916. No secular trend in the prevalence of tuberculosis among patients admitted was apparent. A review of the prior literature concerning tuberculosis in precolonial Africa suggests that tuberculosis may have been present in several regions prior to European exploration, but was probably absent elsewhere. CONCLUSIONS: The concept of all of Africa and all of the people of Africa as virgin soil for tuberculosis is rooted in an archaic Eurocentric view of Africa, and cannot be supported today by available data.

Africa↗
PubMed2004

Personal illness narratives: using reflective writing to teach empathy.

Reflective writing is one established method for teaching medical students empathetic interactions with patients. Most such exercises rely on students' reflecting upon clinical experiences. To effectively elicit, interpret, and translate the patient's story, however, a reflective practitioner must also be self-aware, personally and professionally. Race, gender, and other embodied sources of identity of practitioners and patients have been shown to influence the nature of clinical communication. Yet, although medical practice is dedicated to examining, diagnosing, and treating bodies, the relationship of physicians to their own physicality is vexed. Medical training creates a dichotomy whereby patients are identified by their bodies while physicians' bodies are secondary to physicians' minds. As a result, little opportunity is afforded to physicians to deal with personal illness experiences, be they their own or those of loved ones. This article describes a reflective writing exercise conducted in a second-year medical student humanities seminar. The "personal illness narrative" exercise created a medium for students to elicit, interpret, and translate their personal illness experiences while witnessing their colleagues' stories. Qualitative analysis of students' evaluation comments indicated that the exercise, although emotionally challenging, was well received and highly recommended for other students and residents. The reflective writing exercise may be incorporated into medical curricula aimed at increasing trainees' empathy. Affording students and residents an opportunity to describe and share their illness experiences may counteract the traditional distancing of physicians' minds from their bodies and lead to more empathic and self-aware practice.

Curriculum↗
PubMed2003

Patient perspectives of medical confidentiality: a review of the literature.

OBJECTIVE: To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN: Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS: Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS: Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients.

Awareness↗
PubMedDate not supplied

[The concept of chronicity and degeneration in neurology].

Chronic degenerative diseases hold a special place in current medicine due to the impact they have in the patient, the familiar and medical environment, and by its social, financial and work related repercussions. Even though medical literature includes numerous scientific writings that approach diverse aspects of these diseases, just a few of them deal with historical or conceptual questions. Following the historical evolution that medical language has undergone will allow us to approach and to study in depth both scientific and medical knowledge. The aim of this study was analyze, from a historical perspective, how two concepts: chronic and degeneration, that have a single origin, are used differently and have a different meaning, nowadays have been combined to describe diseases with an underlying biological process, generally known as degenerative, and which in addition share a temporal condition. In this sense chronic degenerative diseases offer medicine new challenges and different ways to approach them.

Chronic Disease↗