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How doctors think

David S Moore
Why do we grow up to have the traits we do? Most 20th century scientists answered this question by referring only to our genes and our environments. But recent discoveries in the emerging field of behavioral epigenetics have revealed factors at the interface between genes and environments that also play crucial roles in development. These factors affect how genes work; scientists now know that what matters as much as which genes you have (and what environments you encounter) is how your genes are affected by their contexts...
December 1, 2016: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
Robert M Kliegman, Brett J Bordini, Donald Basel, James J Nocton
The scientific process of analysis and deduction is frequently, often subconsciously, used by physicians to develop a differential diagnosis based on patients' symptoms. Common disorders are most frequently diagnosed in general practice. Rare diseases are uncommon and frequently remain undiagnosed for many years. Cognitive errors in clinical judgment delay definitive diagnosis. Whole-exome sequencing has helped identify the cause of undiagnosed or rare diseases in up to 40% of children. This article provides experiences with an undiagnosed or rare disease program, where detailed data accumulation and a multifaceted analytical approach assisted in diagnosing atypical presentations of common disorders...
February 2017: Pediatric Clinics of North America
Anas Mustafa Ahmed Salim, Arwa Hassan Ahmed Elhada, Bashir Elgizoli
OBJECTIVE: The principal aim of this study was to explore the self-perception of clinical pharmacists of their impact on healthcare in Khartoum State, Sudan, how they think doctors perceive their impact, exploring the obstacles that clinical pharmacists are facing, and identifying what clinical pharmacists recommend for a better clinical pharmacy practice in Sudan. METHODS: This was an exploratory cross-sectional study that employed a qualitative method. Individual, in-depth interviews were conducted with a convenient sample of 26 clinical pharmacists working in 14 governmental hospitals in Khartoum State, Sudan, in March 2016...
October 2016: Journal of Research in Pharmacy Practice
Valeria Markova, Gro M Sandal
Objective: Refugees are at high risk of experiencing mental health problems due to trauma in their pasts and to acculturation stress as they settle in a new country. To develop efficient health services that meet the needs of refugees from different regions, an understanding is required of how they make sense of and prefer to cope with mental health problems. This study aims to investigate lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. Methods: The study used a mixed-method design with a vignette describing a moderately depressed person based on ICD-10 criteria...
2016: Frontiers in Psychology
Ashley N D Meyer, Hardeep Singh
No abstract text is available yet for this article.
September 26, 2016: BMJ Quality & Safety
Faye Gishen, Sophia Whitman, Deborah Gill, Rhiannon Barker, Steven Walker
BACKGROUND: Training to be a doctor and caring for patients are recognized as being stressful and demanding. The wellbeing of healthcare professionals impacts upon the wellbeing and care of patients. Schwartz Centre Rounds (SCRs), multidisciplinary meetings led by a trained facilitator and designed for hospital staff, were introduced to enhance communication and compassion, and have since been widely adopted as a way of fostering compassion. The continuum of education suggests that medical students need to develop these attributes in conjunction with resilience and maintaining empathy...
2016: BMC Medical Education
Subhankar Chatterjee, Anjan Adhikari, Dibakar Haldar, Payel Biswas
BACKGROUND: The addition of research-oriented medical education (ROME) to the existing curriculum could promote logical thinking, rapid literature search and a better understanding of research methodology. Creation of research temperament could lead to innovations in healthcare. We assessed the perception, awareness and practice of ROME among undergraduate students. METHODS: We conducted a cross-sectional survey among 234 students of R.G. Kar Medical College, Kolkata selected by the simple random sampling technique...
March 2016: National Medical Journal of India
E Paternotte, F Scheele, T R van Rossum, M C Seeleman, A J J A Scherpbier, A M van Dulmen
BACKGROUND: Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour. METHODS: Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient...
2016: BMC Medical Education
Ben Kotzee, Agnieszka Ignatowicz, Hywel Thomas
Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor-like kindness, fairness and good judgement-have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education and throughout the medical career...
August 24, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
Felicity L Bishop, George T Lewith
OBJECTIVES: To explore how patients conceptualise acupuncturists, the meanings ascribed to the therapeutic relationship and valued therapeutic behaviours. DESIGN: Qualitative study. Semi-structured face-to-face interviews explored patients' experiences of acupuncture. A diverse sample of 35 participants took part; they had used acupuncture for a variety of predominantly chronic conditions. Inductive thematic analysis was used to identify themes. SETTING: Southern England...
August 2016: Complementary Therapies in Medicine
Jay M Baruch
Traditional skills and expertise are not enough to prepare future physicians for the complexity, instability, and uncertainty of clinical practice. Responding and making meaning from ill-defined or unusual problems calls for, even demands, creativity. In this article, the author suggests expanding the traditional role of doctor as science-using, evidence-based practitioner to include that of doctor as a "maker" (creator) and artist. Such a reimagining requires a shift in how we view medical knowledge and patients' stories, as well as a new appreciation for "not-knowing" as a generative, creative space in medicine...
July 19, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Lydia de Lasson, Eva Just, Nikolaj Stegeager, Bente Malling
BACKGROUND: The transition from student to medical doctor is challenging and stressful to many junior doctors. To practice with confidence and professionalism the junior doctors have to develop a strong professional identity. Various suggestions on how to facilitate formation of professional identity have been offered including the possible positive effect of group-coaching courses. The purpose of this study was to explore how group-coaching might facilitate professional identity formation among junior doctors in the transition period...
2016: BMC Medical Education
Alberto Giubilini, Sharyn Milnes, Julian Savulescu
In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education...
2016: Journal of Clinical Ethics
Åke Blomqvist, Colin Busby
The way in which we pay for long-term care (LTC) services is going to come under enormous pressure as Canada's baby boomers age. Once baby boomers start to turn 75, in 2021, the demand for LTC services will see a sharp upward trend. A number of independent projections have demonstrated how this will put pressure on the public finances in coming years. It should be concerning to Canadians that we have not publicly discussed how we will make the tough choices to cope with these pressures. Moreover, it's equally troubling that our provincial LTC systems already are unable to cope with the current level of demand for services, with less than a decade before the first wave of boomers enter age groups where demand for LTC is high, and alternate level of care patients, made up mostly of frail elderly, occupying over 15% of Canadian hospital beds on a daily basis as they await care elsewhere...
2016: HealthcarePapers
Naomi Elliott, Karen Farnum, Michelle Beauchesne
UNLABELLED: Although graduates of doctor of nursing practice (DNP) programs are expected to demonstrate competence in advanced clinical scholarship, mentoring, and leadership, little is published about how team debate on a global health care topic supports DNP student learning and skill development. PURPOSE: This article reports on an illuminative evaluation of DNP student learning experiences of team debate in the context of a 2-week international school program in Ireland...
May 2016: Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing
Anas Mustafa Salim, Bashir Elgizoli
OBJECTIVE: The principal aim of this study was to explore the self-perception of community pharmacists of their professional identity and roles and how they think patients and doctors perceive them. The study also aimed at exploring their opinions regarding role expansion and how they assess their capabilities. METHODS: This is an exploratory study that employed qualitative method. Individual, in-depth interviews were conducted with a purposive sample of 50 community pharmacists working in Khartoum State, Sudan, from October to November 2015...
April 2016: Journal of Research in Pharmacy Practice
Nicolae Morar, Natalia Washington
This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must be reoriented...
May 2016: Hastings Center Report
Yakov Shapiro, Nicholas John, Rowan Scott, Nadia Tomy
Economic, political, and ideological landscapes have impacted the practice of psychiatry throughout its evolution as a medical discipline. Despite enormous scientific advances over the course of the past century, many psychiatrists continue to operate with a split Cartesian picture of mind versus brain and entrenched ideological positions ranging from biological "chemical imbalance" to rigidly followed manualized psychotherapy approaches, both of which frequently result in fractured clinical care. With the impact of systemic economic and political pressures in Canada and the United States, the attention to the doctor-patient relationship has taken a back seat to high-volume practices, computerized assessment tools, and the focus on evidence-based treatments for behaviorally defined syndromes in the Diagnostic and Statistical Manual of Mental Disorders that often come at the expense of the patient's experience of his or her illness...
May 2016: Journal of Psychiatric Practice
Heather E Dillaway
There is a dearth of comparative information about how women from diverse social locations think about, talk about, and experience the various types of reproductive aging. In this article I analyze racial-ethnic differences in attitudes toward surgically induced menopause (hysterectomy) utilizing data from an interview study of 130 menopausal women. African American women in this study were more suspect of doctors' initial offers of hysterectomies than European American women, with the former group of interviewees still fearing a legacy of racial-ethnic discrimination within medical institutions...
October 2016: Journal of Women & Aging
D Cohen, S J Winstanley, G Greene
BACKGROUND: Understanding of doctors' attitudes towards disclosing their own mental illness has improved but assumptions are still made. AIMS: To investigate doctors' attitudes to disclosing mental illness and the obstacles and enablers to seeking support. METHODS: An anonymous, UK-wide online survey of doctors with and without a history of mental illness. The main outcome measure was likelihood of workplace disclosure of mental illness. RESULTS: In total, 1954 doctors responded and 60% had experienced mental illness...
July 2016: Occupational Medicine
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