PEDIATRICIAN'S POINT OF VIEW

Medical care for rural populations is an important problem facing the medical profession nationally and locally. The mechanism for solution lies in the existing American Medical Association and California Medical Association committees on rural medical service and further development of “local health councils.”Additional emphasis on training of physicians for general practice is essential through medical school graduate and postgraduate periods.The problem of providing additional adequately equipped and staffed hospitals must receive much consideration.Recognizing that passiveness invites aggressive non-medical agencies to foster bureaucratic dictation inimical to the practice of medicine, the rural physician must act through medical and community organizations to correct weaknesses in the structure of medical practice.     

MEDICINE AT MID-CENTURY

The Public Relations Committee of the California Medical Association recognizes that medical public relations is a reflection of every event in each doctor''s office, every action or inaction of each medical society and every public utterance of each doctor speaking officially or unofficially. The importance of good medical public relations has been emphasized repeatedly through the years in various actions of the Council and the House of Delegates of the California Medical Association.The goal of the medical profession is, through all its activities, including public relations, to achieve and preserve the best medical care for every individual.     

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.     

The Medical System in Ghana

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women’s health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.     

Whither malpractice litigation?

Existing tort reform has produced moderating effects on some states, particularly California. Continued escalation of claims frequency, however, and average paid-claim costs mean that other remedies will have to be sought if the professional liability problem is to be solved. Many sources, including the American Medical Association, have proffered radical changes, but most of these changes will cost more than physicians and hospitals can afford. Therefore, the availability of additional funds will determine the next stage of reform. In the meantime, physicians must become more expert in medical staff peer review if they expect to successfully affect future developments.     

Issues and Challenges in Research on the Ethics of Medical Tourism: Reflections from a Conference

The authors co-organized (Snyder and Crooks) and gave a keynote presentation at (Turner) a conference on ethical issues in medical tourism. Medical tourism involves travel across international borders with the intention of receiving medical care. This care is typically paid for out-of-pocket and is motivated by an interest in cost savings and/or avoiding wait times for care in the patient’s home country. This practice raises numerous ethical concerns, including potentially exacerbating health inequities in destination and source countries and disrupting continuity of care for patients. In this report, we synthesize conference presentations and present three lessons from the conference: 1) Medical tourism research has the potential for cross- or inter-disciplinarity but must bridge the gap between researchers trained in ethical theory and scholars unfamiliar with normative frameworks; 2) Medical tourism research must engage with empirical research from a variety of disciplines; and 3) Ethical analyses of medical tourism must incorporate both individual and population-level perspectives. While these lessons are presented in the context of research on medical tourism, we argue that they are applicable in other areas of research where global practices, such as human subject research and health worker migration, are occurring in the face of limited regulatory oversight.     

Ecole d'été de l'A.C.E.M.I.—Ha?ti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

The Role of a Medical Faculty in Reorganizing Family Practice to Meet Current Community Needs

There exists a crisis in the delivery of medical services, particularly by family doctors of whom there is an apparent shortage.A study of family practice in Kingston, Ontario, and in the nearby countryside indicates three critical needs in family practice: professional assistants for the family doctors, efficient office facilities and new methods of delivering family medical care in rural areas. The Faculty of Medicine at Queen''s University has involved itself in a study of these matters and is developing a program to help solve them, by research into the nature of the problems and into methods for alleviating them, by keeping practising physicians informed through research reports and the continuing education program of the Medical School, by the development of pilot projects, and by the evaluation of new services aimed at these problems, independently launched by physicians in the community. Pilot projects to date include two designed to study the use of registered nurses as doctor assistants and another which involves the organization and operation of a university-sponsored community health centre. Last, but by no mean least, the Provincial Government is continually briefed on all these activities.     

Guidelines for medical practice: 2. A possible strategy.

The recognition that much current medical practice is based on incomplete scientific evidence has led to calls for the generation of guidelines for optimal patterns of practice. These guidelines must be developed from a synthesis of existing scientific data ideally obtained from randomized clinical trials. However, at present we may have to rely on less satisfactory data and the views of experts in the field. The primary purpose of these initiatives must be to improve patient care. The Ontario Medical Association has made recommendations on how such guidelines should be produced, and in a recent survey a substantial majority of family physicians supported them. There is general agreement that the coordinating body should be independent of government and other interested parties. In addition, the medical profession must have the primary role, and a number of medical organizations should also be represented. We propose a possible structure for a group charged with developing guidelines for medical practice at a provincial level and on an experimental basis. Recommendations are made on its membership, function and relationship with other organizations. The identification and diffusion of justifiable, scientific practice patterns will help reduce waste of scarce resources, maintain the role of the profession as guardian of the quality of care and ultimately benefit the patient.     

Shall Organized Medicine be Unified, or Separate?

At present, physicians in California who choose to join organized medicine do so through their county medical societies, and membership in the California Medical Association and the American Medical Association is then automatic. At the March meeting of the CMA House of Delegates, question was raised whether membership in CMA, and the AMA, or both should remain automatic.The House requested an ad hoc committee to cause a "poll and its attendant statements to be developed by May 21 for copy distribution to component medical societies and printing in the CMA membership news media-with mailing of the official questionnaires to the society members on September 1, 1971." Members will be asked to express their opinions by ballot in September.The Speaker of the House appointed an ad hoc committee of the House to conduct this informed opinion poll of the membership. The committee has met to set ground rules, prepare accurate pro and con statements and write the poll questions-in accord with the directions of the House action.The Informed Membership Opinion Poll Committee, with the advice of Decision Making Information, Inc., an independent consultant, prepared statements regarding unified and separate membership in CMA and AMA from comments which were solicited from every county medical society. A statement by legal counsel for the California Medical Association on the structural relationship of AMA, CMA and component societies, and the statements on unified or separate membership prepared by the committee appear on the following two pages.     

2009 Society for Medical Anthropology Conference: Changing Anthropology,Changing Society

Fifty years after the founding of the field of medical anthropology, the Society for Medical Anthropology of the American Anthropological Association held its first independent meeting on September 24-27, 2009, at Yale University.Fifty years after the founding of the field of medical anthropology, the Society for Medical Anthropology of the American Anthropological Association held its first independent meeting on September 24-27, 2009, at Yale University in New Haven, Connecticut. The conference, Medical Anthropology at the Intersections, drew an international audience of more than 1,000 scholars.In her opening remarks, program Chair Marcia Inhorn noted that medical anthropology has been interdisciplinary since its inception. This assertion was supported at a roundtable discussion, Founding Medical Anthropology and the Society for Medical Anthropology, which featured four of the field’s founders.Asked to identify the factors that led to the development of medical anthropology, the panelists emphasized the role of changes in the practice and landscape of medicine in the late 1950s and early 1960s in the United States. According to Hazel Weidman, who helped spearhead the Society for Medical Anthropology, medical personnel sought social scientists’ guidance in the new clinical environments created by the increasing involvement of U.S. physicians in global development work and by the community-oriented approach to mental health encouraged by the Community Mental Health Act of 1963. The novel inclusion of lifestyle as a determinant of health at this time also played a role, according to Clifford Barnett. Norman Scotch, author of a 1963 review that had helped define medical anthropology as a field, noted that physicians at the time were very interested in the possible applications of the social sciences to medicine [1,2]. Joan Ablon recalled that this emphasis on application led some academic anthropologists to dismiss the medical anthropologist as a “handmaiden to the doctors.” Despite such resistance, interest in medical anthropology as a sub-field was clearly growing among anthropologists. When Weidman helped organize the first gathering of medical anthropologists at an anthropology conference in 1967, attendance was twice what was expected. Panel organizer Alan Harwood noted that the Society for Medical Anthropology transformed its newsletter into a professional journal, Medical Anthropology Quarterly, in 1983. According to Inhorn, the society has 1,300 members today.For the panelists, medical anthropology’s potential for application makes it a compelling scholarly pursuit. As Barnett stated in explaining his decision to work in anthropology: “If you know how a society works, you can change it.”     

Focus: Preventive Medicine: Race,Racism, and the Policy of 21st Century Medicine

This perspective describes three new policies passed at the November 2020 Special Meeting of the American Medical Association House of Delegates. These policies (1) denounce racism as a public health threat; (2) call for the elimination of race as a proxy for ancestry, genetics, and biology in medical education, research, and clinical practice; and (3) decry racial essentialism in medicine. We also explore the social and institutional context leading to the passage of these policies, which speak directly to the harmful legacy of racism in America, and its insidious impact on the healthcare system.     

西安市雁塔区区域卫生分级诊疗信息平台建设探索

为响应国家卫计委全面推进分级诊疗工作的号召,解决百姓看病难、看病贵以及医疗资源不均衡的问题,西安市雁塔区作为陕西省城市医院分级诊疗首个试点,探索组建了以西安交通大学第一附属医院为核心的区域医疗联合体,并且将区域内各个医疗卫生机构的医疗资源整合在一起,搭建起地方区域分级诊疗信息共享平台。通过区域卫生分级诊疗信息平台的建立,实现了区域内医疗卫生机构基本业务信息系统数据的交换和共享,解决了医疗机构、卫生管理机构“信息孤岛”问题,建立起基层首诊、双向转诊、急慢分治、上下联动的分级诊疗模式,全面带动了陕西省医疗机构分级诊疗工作的开展。     

Confidentiality,ownership and transfer of medical records (update)

The Canadian Medical Association (CMA) regards medical records as confidential documents, owned by the physician/institution/clinic that compiled them or had them compiled. Patients have a right to medical information contained in their records but not to the documents themselves. The first consideration of the physician is the well-being of the patient, and discretion must be used when conveying information contained in a medical record to a patient. This medical information often requires interpretation by a physician or other health care professional. Other disclosures of information contained in medical records to third parties (eg. physician-to-physician transfer for administrative purposes, lawyer, insurance adjuster) require written patient consent or a court order. CMA is opposed to legislation at any level which threatens the confidentiality of medical records.     

Poverty in the United States as Defined by Federal Standards—Report of the Bureau of Research and Planning

The subject of this Socio-Economic Report is of tremendous importance to the medical profession because physicians should be aware that future programs for the expansion of health care services will be based and, in fact, are being based upon information which this Report contains. The relationship between poverty and accessibility of health care services is therefore quite direct. So, too, will be the impact upon the profession and the organization of medical practice.The 1966 amendments to the Poverty Act are concerned with neighborhood health centers and a vast array of other programs which will touch every physician and every community which can be identified by the standards indicated in this Report as low income, poor, or near poor. For this reason the California Medical Association Committee on Welfare Medical Programs, among several others concerned with aspects of this problem, is trying to alert every county medical society of developments as well as of the responsibilities they should assume in working with the Office of Economic Opportunity and other community organizations in providing guidance and leadership in structuring programs compatible with the interests of the public and the health care professions.This Report on poverty presents a current and prospective view of the problems and issues to be faced. Unless physicians see the relationship and join in a community effort to aid in resolving an issue which underlies public policy, we shall be looking back five or ten years from now to point out that we failed to take advantage of opportunities to assist in the development of a rational system of medical care for low-income groups.Individual physicians, component medical societies on a grass-roots level and CMA as a state organization should all be concerned with and aware of the facts.     

Applications and Enrolments at the Western Medical Schools: A Study of Medical Matriculants for 1964

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.The loss of good applicants to the Western medical schools and the 20% overlap of each school''s applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.     

Historical reflections on the changing concepts of disease.

One of the concerns of the Committee on the Role of Medicine in Society of the California Medical Association is the apparent “attitude gap” between medical students and physicians already established in practice. In November 1967, the first of a series of meetings took place between Committee members and senior students from each California medical school. Discussion ranged from curriculum planning to individual and organizational politics, and revealed differences of opinion between students and physicians on such issues as Medicare and the financing of health care for the nation.These discussions suggested to members of the Committee that several clearly defined subject areas were worthy of further investigation. It was decided, therefore, that a questionnaire be sent to medical students and residents, with the goal of gaining a better understanding of the nature and extent of such differences of opinion. Some of the highlights of the findings of this survey are discussed in this Socio-Economic Report.     

Confidentiality,ownership and transfer of medical records

The Canadian Medical Association (CMA) regards medical records as confidential documents, owned by the physician/institution/clinic that compiled them or had them compiled. Patients have a right to information contained in their records but not to the documents themselves. The first consideration of the physician is the well-being of the patient, and discretion must be used when conveying information contained in a medical record to a patient. This medical information often requires interpretation by a physician or other health care professional. Other disclosures of information contained in medical records to third parties (eg. physician-to-physician transfer, lawyer, insurance adjuster) require written patient consent or a court order. The CMA is opposed to legislation at any level which threatens the confidentiality of medical records.