Psychiatric illness in physicians.

Psychiatric illness and behavioural problems among physicians are reviewed in this paper. Some studies suggest that the medical profession has a high rate of alcoholism, drug abuse and marital discord. As well, physicians appear to commit suicide and to seek admission to psychiatric institutions more frequently than comparable populations. Considered as etiologic factors in psychiatric illness among physicians are the role strain inherent in the profession and the personality development of individual practitioners prior to their entering medical school. The review concludes with suggestions for an improved approach to treatment and prevention.     

Human temperament and choice preference between probability of the goal achievement and the goal value

The purpose of this work was to experimentally ascertain the relationships between human formal-dynamic properties (temperament) and characteristics of his/her motivation sphere associated with the choice of a profession. Thirty eight students of a sports institute (aged 19-28) took part in the study. The formal-dynamic properties were assessed with the help of Rusalov's Questionnaire. The motivation of the choice of profession was assessed with the help of the specially developed test questionnaire. Two main components of choice motivation were identified: the value of the profession and probability of mastering this profession. It was found that persons of sanguine temperament (with a higher capacity for work, mobile and quick) are oriented primarily to the value of profession, while persons of melancholic temperament to the probability of mastering this profession.     

The clinical psychologist; his role in private medical practice

The independent diagnosis and treatment of mental and nervous disorders according to California law constitutes practicing medicine. By this yardstick, an increasing number of clinical psychologists are entering the private practice of medicine. The medical profession has not provided through its leadership the opportunity for clinical psychologists to utilize their skills in a legitimate and supervised way in the treatment of private patients, nor has the medical profession taken sufficient interest in modern methods of treating patients with psychogenic disorders. If the psychiatric team is a feasible and practical approach to spreading the base of psychiatric treatment in hospitals and clinics, it should be applicable to private practice settings too. In the team setting, the psychologist can render great assistance to the physician in the diagnosis and treatment of patients with psychogenic disorders without compromising the principle that the primary responsibility for the patient is the physician's. By virtue of his training and experience, it is the psychiatrist who is best qualified to supervise the work of the psychologist; and until such time as the medical profession is better acquainted with psychotherapeutic techniques, the employment of psychologist assistants should be (according to good medical practice) left to the psychiatrist. The need for some regulation of the use of the title "psychologist" is increasing in order to protect the public from quacks who pose as psychologists. However, any law which is directed toward elimination of the quack should specifically define psychotherapy and contain provisions for its use under adequate medical supervision. The medical profession is obligated to take its traditional role in providing the best possible treatment for patients who are in need of it, and psychotherapy is an inherent part of treatment.     

Role of Semen Cryobanking in American Medicine

In the United States there is little public policy regulating the activities of semen cryobanks. The medical profession has also been conspicuously silent on this aspect of medical practice. The potential benefits of semen cryobanking are enormous, yet like all other technologies its application (particularly commercially) may produce unexpected and unwanted consequences. It is suggested that a co-operative effort is needed between public officials and the medical profession to establish standards and guidelines which would maximize the benefits of this technique.     

生物医学工程的精要、责任和展望

作为工程学的直属分支,建立生物医学工程学科的主要目的不是为了开辟一个新的科学研究领域,而是为了借助工程学的方法来解决生物医学领域所面临的实际问题,以及借助工程师们所接受的专业训练、所拥有的专业知识、所具备的工作技巧来提高医疗服务的质量和效果。工程学与生物医学的结合已取得了一些具有里程碑性质的成果。在中低收入国家,例如中国,生物医学工程有责任保证合理使用专业技术,为低廉、可靠、有效的医疗服务提供支持。本文将根据可预见和不可预见的学科发展限制和困难,对学科发展的现实目标和责任进行严肃、冷静地讨论。     

Homophobia among doctors.

Homophobia creates stress for gay men and women. An interview study of 28 doctors, 20 gay and eight non-gay, was performed to assess whether homophobia is strong among the medical profession, the stress it causes, and whether the advent of AIDS and HIV infection has increased the stress. The doctors, recruited by word of mouth and by a letter in the medical and gay press, were asked about their own attitudes to homosexuality and AIDS. Only one (non-gay) doctor thought that there was no prejudice against gay doctors in the medical profession. The gay doctors certainly perceived prejudice, which they claimed caused them extra stress; the advent of AIDS had increased this stress to an extent. Doctors who had not openly declared themselves to be gay feared doing so because of the effect on their job prospects, but those who had declared themselves openly reported less stress than previously. Homophobia clearly exists within the medical profession. Non-gay doctors should use the power of the profession to challenge homophobia in the profession and in society. HIV infection could then be treated as a purely medical condition; sufferers would receive wider understanding and the pressures of extra workload could be more equally shared.     

Early American Stoves

The curricula for preparing music specialists has remained largely unchanged for decades. In this time, most professions have moved toward preparing specialists while the music education profession has moved toward preparing generalists. The author examines how this is unrealistic and out of touch with the times and the future. Furthermore, the author argues that it is demeaning to our art form, teaching profession, and most important, future students. He proposes a plan for change to update music teacher training.     

The changing role of veterinary expertise in the food chain

This paper analyses how the changing governance of animal health has impacted upon veterinary expertise and its role in providing public health benefits. It argues that the social sciences can play an important role in understanding the nature of these changes, but also that their ideas and methods are, in part, responsible for them. The paper begins by examining how veterinary expertise came to be crucial to the regulation of the food chain in the twentieth century. The relationship between the veterinary profession and the state proved mutually beneficial, allowing the state to address the problems of animal health, and the veterinary profession to become identified as central to public health and food supply. However, this relationship has been gradually eroded by the application of neoliberal management techniques to the governance of animal health. This paper traces the impact of these techniques that have caused widespread unease within and beyond the veterinary profession about the consequences for its role in maintaining the public good of animal health. In conclusion, this paper suggests that the development of the social sciences in relation to animal health could contribute more helpfully to further changes in veterinary expertise.     

The Role of the University in Modern Society

President Odegaard here presents some stimulating thoughts for medical educators and for other members of the medical profession. Although a historian by profession, he has considerable familiarity with medical matters from his membership in the Citizens Commission on Graduate Medical Education (Millis Commission), the President''s National Advisory Commission on Health Manpower and the Natonal Advisory Health Council.     

The short history and tenuous future of medical professionalism: the erosion of medicine's social contract

The profession of medicine is based on a shared set of tacit and explicit agreements about what patients, doctors, and society at large should be able to expect from each other, a social contract that defines the profession. Historically, the development of this set of agreements depended upon the creation of social organizations that could speak for the entire profession. Over the last several decades, however, the perceived need for these organizations, and especially the umbrella organization for the profession, the American Medical Association, has waned. The reasons for this are complex, but the consequences are significant: an eroding social contract, fragmentation, lack of cohesion and integrity, and loss of the public's confidence. The present social contract is one-dimensional, overly simplistic, and failing to sustain the public's trust. To address these problems, a renewed social contract is necessary. Although this renewed contract should be based on foundations similar to the original, it must directly confront such contemporary challenges as resource allocation and conflicts of interest. Equally as important, to reinvigorate our social contract more physicians will need to come to grips with a basic truth: to sustain professionalism we need a strong, unified professional association.     

Socio-Economics of Medical Care, Report of Bureau of Research and Planning

Interest in the area of medical socio-economics has largely come about due to the proliferation of social welfare programs and advances in the distribution of health services in the private sector of the economy. The increasing role of our government has also been a stimulus. With the advent of new techniques for the financing of care, a large volume of institutional literature has appeared delving into issues which range from the role of the medical profession in the evaluation of quality of medical care to the measurement of demand for and prepayment of numerous types of health care services. Since the area of medical socio-economics is not considered "pure" enough to be categorized as a discipline, the range of periodicals, government and non-government publications and books, in which data are found, is vast. This report will briefly describe some of the more important sources of data in the area of medical socio-economics. Major emphasis is given to the literature which provides current statistical data on the operational aspects of public and private programs providing health care services, and ancillary activities which affect the market for health care activities. Leading publications of governmental and other community agencies are cited to illustrate the range of materials available to the public and to the medical profession.     

Specialist registration: a critical look at the proposals of the Merrison report.

In the general euphoria over the many views in the Merrison Report that the profession welcomed too little attention has been paid to what has been said about specialist registration. The report contains several basic confusions and a serious misunderstanding of the nature of specialist medical training and practice. It makes several cardinal errors in thinking that some notorious problems related to NHS staffing are also related to a lack of an effective specialist register, and it shows how the creation of such a register would largely destroy the authority of the colleges and faculties. Nowhere in the report is there any convincing argument to show that specialist registration would confer advantages sufficient to outweigh the disadvantages. To let specialist registration in the UK slip in on the irrelevant coat tails of EEC requirements would be a grave dereliction of the long-term interests of medical practice and patient care. The General Medical Council is holding a conference in which this topic is to be discussed on 24 February 1976 and it is still not too late for the profession to think again on this topic.     

Doing what the patient orders: maintaining integrity in the doctor-patient relationship

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician....I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment....     

Doctors Have no Right to Refuse Medical Assistance in Dying,Abortion or Contraception

In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.     

Ecological skills: mind the gap(s)

Anecdotal evidence indicated that there is a shortage of ecological skills. A three year project has been established by the profession, the Institute of Ecology and Environmental Management (IEEM), which runs from May 2008 until April 2011, to examine the issue and to make recommendations. Botany and plant sciences are used as a case study to provide an illustration of what is happening in part of the sector.     

Naming the problem that has no name: creating targets for standardized drugs

Many of the most common types of mental health problems that are found in outpatient psychiatric and general medical practices are diffuse, undifferentiated, and amorphous. Before the 1970s this lack of specificity did not conflict with the dominant theories and treatments of the American psychiatric profession or the demands of third party insurers and regulators. However, since that time the legitimacy and solvency of the psychiatric profession has come to depend on the perception that it treats specific disease entities. The establishment of the DSM-III in 1980 provided American psychiatry with many standardized disease entities that could be precisely measured, quantified, and abstracted from their particular contexts. In the late 1980s, these entities became the targets of the new class of psychoactive drugs, the Selective Serotonin Reuptake Inhibitors. Professional, political, economic, and cultural forces that arose in a particular historical era account for the standardization of mental illnesses.     

Contingent Fees in Medical Malpractice Litigation—A Qualitative Assessment

The medical profession has experienced high liability insurance premiums accompanied by widespread use of contingent fees in medical malpractice litigation. It is worthwhile, therefore, to assess qualitatively the merits of contingent fees, the evidence suggesting that they are associated with unjustified litigation and their implications for the medical and legal professions.     

Advocacy and community: the social roles of physicians in the last 1000 years. Part I

Over the last 1000 years, the practice of medicine in the Western world has been shaped by extraordinary transformations -- in the organizational structures of healthcare delivery, the changing concepts of disease and illness, and the ethical and social issues posed to a growing and diversified profession. Some critical aspects that characterize contemporary Western medicine -- as professionally defined, highly organized and regulated, and scientifically and technologically based -- have emerged only within the last 200 years. For most of its history, medicine was practiced without these distinctions -- but precursors to many current tensions can be traced back to Hippocratic times. In the last millennium, medicine developed in tandem with emerging political ideologies and social structures, and the roles of physicians evolved to respond to the needs of individual patients, the profession, and society at large. As medicine became increasingly effective, it was harnessed into the political objectives of promoting social cohesion and productivity. Professional regulation and social mechanisms for the equitable distribution of healthcare became significant considerations for the profession and society. In this brief 3-part history, we will trace the major organizational, conceptual, and political changes that, together, by the year 2000, created a profession with responsibilities of advocacy for individual patients in concert with attention to the needs and demands of all the individuals in the larger community.     

Focus: Preventive Medicine: Patient Safety Functions of State Medical Boards in the United States

The state medical board system in the United States plays a crucial role in promoting patient safety and is a primary vessel through which policymakers are able to regulate healthcare. The system’s origins, and how it has evolved in tandem with the practice of medicine generally, have heavily shaped its current structure and scope of activities. In particular, the ethos of a largely self-regulated profession has corresponded to a heavy physician influence. In light of this influence, maintaining legitimacy continues to require careful efforts by the state boards to avoid any perceived professional protectionism.     

Professional certification in ecological restoration: improving the practice and the profession

Given increasing investments in ecological restoration around the globe, there is a need to develop standards of practice to improve professional training and encourage the highest quality of performance possible. Although professional certification is a mechanism for promoting and improving the profession, until now certification has not been available to individuals who practice ecological restoration. The Society for Ecological Restoration (SER) is launching a professional certification program in early 2017. The program requires professional experience, a knowledge base in five broad subject areas, understanding of the foundations of the profession, and adherence to a code of ethics. The SER certification program will certify both practitioners (Certified Ecological Restoration Practitioners [CERPs]) and practitioners‐in‐training (Certified Ecological Restoration Practitioners‐in‐training [CERPITs]).