- Email: [email protected]
The patient's role in clinical decision-making
47 certificates of patients with cancer in Cuyahoga County, Ohio (1957-1974), revealed that 35,381 patients ( 6 5 % ) died in acute and chronic care hospitals, 8,251 patients ( 1 5 % ) died in nursing homes, and 11,242 patients ( 2 0 % ) died at home. Trends over the 18-year period demonstrated a shift from patients dying at home to patients dying in nursing homes. The hospital care of dying cancer patients remained unchanged during the study period. An analysis of 33 consecutive patients dying of cancer over a six-month period in an acute care hospital in Cuyahoga County showed an average length of stay of 20.1 days, during which only palliative care was provided. The cost benefit of home care/hospice programs is related to the final hospital stay of the dying cancer patient. THE ROLE OF THE HEALTH PROFESSIONAL
16) The patient's role in clinical decision-making BRODY, D. S. Dept. Int. Med., Temple Univ. Sch. Med., Philadelphia, Pa., U.S.A. Ann. Intern. Med. 93(5), 718-722, 1980 Practicing physicians must frequently make decisions about how much they wish to encourage patient participation in clinical decision-making and how to respond to rational patient demands that do not coincide with their own decisions. These are difficult ethical dilemmas with no indisputable or universal solutions. The traditional concept of the doctor-patient relationship places the patient in a passive, compliant role. The patient's only obligation is to seek competent help and cooperate with the physician. A number of factors have contributed to the continued dominance of the traditional doctor-patient imbalance of power. Despite these factors, there seems to be a great deal of public dissatisfaction with health care delivery in the United States; demands for more patient autonomy are increasing. This paper discusses the concept of mutual participation, presents an approach to encouraging patient participation in clinical decisionmaking, and considers its theoretical advantages. 17) The clinical approach to the homosexual patient OWEN, W. F., JR. Dept. Med., Univ. California, San Francisco, Calif., U.S.A. Ann. Intern. Med. 93(1)I, 90-92, 1980 Since publication of the Kinsey report more than 30 years ago, which estimated that 10% of the white American male population was predominantly or exclusively" homosexual, several studies have indicated
_FIRST ('~IIART~R/1 o=ql
that heterosexuals and homosexuals cannot be distinguished on the basis of psychological adjustment or sexual response. Recent studies have also indicated the absence of homosexual stereotypes; homosexual men and women are quite diverse in the way they organize their lives sexually as well as socially. The implication of this finding for physicians is that a complete history, including sexual history, is necessary in any patient, regardless of sexual orientation, to determine factors that may be placing the patient at an increased risk for disease. Additionally, the primary care physician may be called upon by the homosexual patient to provide psychosexual counselling or treatment of sexual dysfunctions. Certain verbal and nonverbal signals may facilitate or inhibit the relationship between the physician and the homosexual patient. Homosexual patients may need special reassurance about confidentiality in the doctor-patient 9relationship and about the physician's respect for their life-styles and significant relationships.
EVALUATION
18) Evaluation of a patient education manual ANDERSON, J. E., MORRELL, D. C., AVERY, A. J., and WATKINS, C. J. St. Thomas's Hosp. Med. Sch., London SE1 7EH, United Kingdom Br. Med. J. 281(6245), 924-926, 1980 A randomized controlled trial-has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared wit.h a control group. A sample of the mothers in each group was subsequently followed up by an interview during which a questionnaire was administered. This was designed to measure the mother's knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mothers had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before the interview. The important result was a decline in new requests for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational program designed to increase their knowledge about the management of illness.
16) The patient's role in clinical decision-making BRODY, D. S. Dept. Int. Med., Temple Univ. Sch. Med., Philadelphia, Pa., U.S.A. Ann. Intern. Med. 93(5), 718-722, 1980 Practicing physicians must frequently make decisions about how much they wish to encourage patient participation in clinical decision-making and how to respond to rational patient demands that do not coincide with their own decisions. These are difficult ethical dilemmas with no indisputable or universal solutions. The traditional concept of the doctor-patient relationship places the patient in a passive, compliant role. The patient's only obligation is to seek competent help and cooperate with the physician. A number of factors have contributed to the continued dominance of the traditional doctor-patient imbalance of power. Despite these factors, there seems to be a great deal of public dissatisfaction with health care delivery in the United States; demands for more patient autonomy are increasing. This paper discusses the concept of mutual participation, presents an approach to encouraging patient participation in clinical decisionmaking, and considers its theoretical advantages. 17) The clinical approach to the homosexual patient OWEN, W. F., JR. Dept. Med., Univ. California, San Francisco, Calif., U.S.A. Ann. Intern. Med. 93(1)I, 90-92, 1980 Since publication of the Kinsey report more than 30 years ago, which estimated that 10% of the white American male population was predominantly or exclusively" homosexual, several studies have indicated
_FIRST ('~IIART~R/1 o=ql
that heterosexuals and homosexuals cannot be distinguished on the basis of psychological adjustment or sexual response. Recent studies have also indicated the absence of homosexual stereotypes; homosexual men and women are quite diverse in the way they organize their lives sexually as well as socially. The implication of this finding for physicians is that a complete history, including sexual history, is necessary in any patient, regardless of sexual orientation, to determine factors that may be placing the patient at an increased risk for disease. Additionally, the primary care physician may be called upon by the homosexual patient to provide psychosexual counselling or treatment of sexual dysfunctions. Certain verbal and nonverbal signals may facilitate or inhibit the relationship between the physician and the homosexual patient. Homosexual patients may need special reassurance about confidentiality in the doctor-patient 9relationship and about the physician's respect for their life-styles and significant relationships.
EVALUATION
18) Evaluation of a patient education manual ANDERSON, J. E., MORRELL, D. C., AVERY, A. J., and WATKINS, C. J. St. Thomas's Hosp. Med. Sch., London SE1 7EH, United Kingdom Br. Med. J. 281(6245), 924-926, 1980 A randomized controlled trial-has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared wit.h a control group. A sample of the mothers in each group was subsequently followed up by an interview during which a questionnaire was administered. This was designed to measure the mother's knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mothers had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before the interview. The important result was a decline in new requests for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational program designed to increase their knowledge about the management of illness.