[Show abstract][Hide abstract] ABSTRACT: Balint Group seminars were developed by Michael and Enid Balint based on the application of psychological principles in a group setting for the purpose of developing an improved understanding of the doctor-patient relationship. This article focuses on the development and application of the Balint method to the training of resident physicians (particularly Family Physicians) within the United States. An effort is made to describe the practicalities of resident physician Balint training (e.g., size, frequency, duration of such groups), conceptual underpinnings (e.g., biphasic nature of patient identification, disease versus illness concept, transference/counter-transference, over-identification, under-identification, biphasic nature of physician empathy), and pedagogic goals (mastering empathic skills inherent in being a good doctor) of residency-based Balint groups. In aggregate, this article provides a useful framework for behavioral science educators interested in applying the Balint seminar method to resident physician training. The authors encourage both the continued study and educational application of the Balint seminar method in the training of physicians both within and outside of the United States.
Full-text · Article · Nov 2013 · The International Journal of Psychiatry in Medicine
[Show abstract][Hide abstract] ABSTRACT: Medical non-adherence is multifactorial: cost, convenience, side effect profile, and cognitive impairment are all implicated in medical nonadherence. We explore impaired executive function (EF) as a cause for medical non-adherence when other causes can be ruled out. EF describes the coordination and manipulation of higher-order cognitive processes involved in problem-solving, planning, and decision-making. EF has three components: working memory, mental flexibility, and inhibitory control. The latter, inhibitory control, when impaired will affect an individual's ability to make choices to produce long-term benefits, in favor of short-term gratification. When applied to adults with chronic diseases, like diabetes, that require lifestyle modification and, at times, complicated medical regimens to forestall long term complications, an intact EF has a role in adherence. EF development is protracted with behavioral corollaries observable from early childhood. Thus, teachers, family physicians, and pediatricians will be the professionals to first encounter and manage such individuals. We suggest screening tests for children in the doctor's office to detect impaired EF, and postulate a cognitive behavioral therapeutic approach for adults with uncontrolled DM and impaired EF.
Full-text · Article · Jan 2011 · The International Journal of Psychiatry in Medicine
[Show abstract][Hide abstract] ABSTRACT: Using a theoretical cultural competency model, the effectiveness of a cultural compe- tency learning assignment was examined to determine: 1) students' cultural competency levels as reflected through the assignment, and 2) the effectiveness of the assignment as a cultural compe- tency learning activity. Third-year family medicine clerkship students completed a required pro- ject to research and reflect upon a patient's "cultural belief." Applying a model of cultural compe- tence development, a content analysis of written project reports determined what level of cultural competence was expressed by students' reflections. Results indicated16% of students were at "no insight", 18% at "minimal emphasis" and 66% at "acceptance." While many students expressed an "acceptance" competence level, not all students expressed the desired level of acceptance about the role of cultural beliefs in medical care. Application of a cultural competency theory to assess learners permits educators to frame performance changes within the context of competency achievement and determine if desired levels of competency have been achieved. As the racial and ethnic composition of nations continues to change, the need for physicians to prac- tice medical care that accepts, appreciates and ac- commodates cultural differences has become essen- tial.1-3 In turn, medical school curricula are recogniz- ing the need for increased emphasis on issues of cul- tural sensitivity in medicine and addressing the need to incorporate cross-cultural education through a va- riety of approaches.4,5 These include: 1) experiences designed to promote self-reflection about bias and the need to appreciate differences in health values, be- liefs and behaviors; 2) activities that provide knowl- edge about particular cultural groups' health values, beliefs and behaviors; and 3) methods to develop skills for effective cross-cultural approaches with patients. 6
No preview · Article · Jan 2009 · Medical Education Online
[Show abstract][Hide abstract] ABSTRACT: We evaluated whether a one-year, multifaceted quality improvement intervention improved adherence to 13 clinical guidelines for lipid screening, hypertension management, and diabetes management among White and African-American adult patients.
An academic family medicine center.
Six faculty physicians and a clinical pharmacist participated between July 1, 2002, and June 30, 2003. Data from 2860 patients' electronic medical records were abstracted.
Performance reports and lists of patients eligible for each guideline measure were generated. Interventions targeted patients who needed improvement. Statistical analyses used generalized estimating equations to determine the intervention effect.
Significant improvements occurred in blood pressure control for all adults (OR= 1.44) and those with hypertension (OR=1.82), measures of total cholesterol (OR=1.10) and high-density lipoprotein cholesterol (OR= 1.27) for all patients, and measure of low-density lipoprotein cholesterol (OR=2.01) and blood pressure control (OR=1.71) for patients with diabetes mellitus. Significant decline was seen in measures of blood pressure for all patients (OR=.60). After adjusting for patient demographic factors, provider variability, and comorbidities, race was not associated with the change observed in any of the measures from baseline to follow-up.
Even though a multifaceted intervention can improve process of care measures for Whites and African Americans, further studies are needed to improve outcome measures, especially in African Americans.
No preview · Article · Feb 2006 · Ethnicity & disease
[Show abstract][Hide abstract] ABSTRACT: Mentoring can be a key component contributing to the success of faculty. We investigated the attitudes of family medicine department Chairs toward mentoring, with emphasis on mentoring female and minority faculty. This qualitative inquiry used semi-structured interviews with 13 Chairs of US departments of family medicine. Although most Chairs felt that mentoring had value, a minority of our sample had formal mentoring programs. Multiple mentors were suggested for female and minority faculty to meet both their personal career and content needs. Availability of senior faculty is a key resource. Until more senior women and minority faculty are available, cross-gender and cross-ethnicity mentoring will need to be utilized.
[Show abstract][Hide abstract] ABSTRACT: Little research has examined the link between premedical community service and subsequent community service undertaken in medical school.
This study examined the relationship between applicants' community service history with reported community service experiences during medical school.
Admission files were retrospectively reviewed and community service hours during medical school were totaled for 2003 graduates at the study institution. Data were analyzed using descriptive statistics, chi-square tests, and logistic regressions.
Applicants who were women, had volunteered with multiple types of organizations, and volunteered more than 2 years were all significantly more likely, chi2 p < .05, to have provided greater community service hours during medical school than others.
Aspects of applicants' community service histories, particularly the number of different types of organizations served and length of service, appear related to their subsequent community service involvement in medical school. Admissions committees may wish to provide additional consideration to such applicants.
No preview · Article · Feb 2005 · Teaching and Learning in Medicine
[Show abstract][Hide abstract] ABSTRACT: The Association of American Medical Colleges has recommended addressing spirituality in the medical curriculum.
To evaluate the impact of a spiritual history-taking curriculum on the skills, knowledge, and attitudes of 1st year medical students. The study implemented a spiritual history-taking curriculum in the 1st year of medical school that included reading assignments, practice history taking, and standardized patient (SP) scenarios with spiritual content. It assessed students' performance in three ways: (a) using a videotaped SP interview, (b) a survey of students' attitudes regarding incorporating patients' religious and cultural views into medical decision making, and (c) a written test question on their first examination.
Students (146) took part in the medical school's spirituality curriculum, which included participation in videotaped interviews; 98% completed the initial survey, and 75% completed the follow-up survey. On the final videotaped SP interview, 65% of students were able to recognize the patient's spiritual concern according to trained faculty observers. On the attitude survey, there was an increased desire to accommodate patients' beliefs, although the magnitude of the increase was generally quite small. Ninety-four percent of students answered the test question correctly.
Spiritual history taking can be integrated effectively into the existing history-taking curriculum in 1st year medical training.
No preview · Article · Feb 2004 · Teaching and Learning in Medicine
[Show abstract][Hide abstract] ABSTRACT: Professional values and behavior are conveyed to students through both formal and informal curricular activities.
This study examined 1st-year students' observations of community-based physicians' behaviors during a community-based clinical experience.
First-year students completed a 14-item instrument regarding their community-based physicians' behavior with patients. Responses were on a 5-point scale (1 = never, 5 = all of the time). Descriptive statistics were computed.
119 students completed the instrument (87% response rate). Students rated aspects of physicians' demeanor with patients highest (mean ranges 4.7-4.57). The lowest rated item was the physician's view of his or her professional role (M = 3.39), eliciting patients' ideas about illness and treatment (M = 3.55), and modeling interviewing techniques learned in class (M = 3.71).
Community-based physicians reinforce many professional values associated with positive role-modeling aspects of the physician-patient interaction.
No preview · Article · Feb 2004 · Teaching and Learning in Medicine
[Show abstract][Hide abstract] ABSTRACT: Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.
No preview · Article · May 2003 · American family physician
[Show abstract][Hide abstract] ABSTRACT: Alopecia can be divided into disorders in which the hair follicle is normal but the cycling of hair growth is abnormal and disorders in which the hair follicle is damaged. Androgenetic alopecia is the most common cause of hair loss in women. Other disorders include alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias. The diagnosis is usually based on a thorough history and a focused physical examination. In some patients, selected laboratory tests or punch biopsy may be necessary. Topically administered minoxidil is labeled for the treatment of androgenetic alopecia in women. Corticosteroids and other agents are typically used in women with alopecia areata. Telogen effluvium is often a self-limited disorder. Because alopecia can be devastating to women, management should include an assessment for psychologic effects.
No preview · Article · Apr 2003 · American family physician
[Show abstract][Hide abstract] ABSTRACT: This study examined the simple behavior on the part of hypertensive patients of having their blood pressure checked at a retail store. We found that hypertensive patients checked their blood pressure frequently using these automated machines, believe them to be accurate, and frequently make health care decisions based on the reading they obtain. The inaccuracy of these machines is apparently not widely known. It is therefore incumbent on physicians to be aware of technologies that are in use by their patients. Patients need to be educated about the appropriate use and potential or harm that results from misuse of these technologies. Physicians might encourage their patients to invest in a home blood pressure monitor that they can bring with them to their visit to calibrate against the physician's own machine.
No preview · Article · May 2002 · Journal of the South Carolina Medical Association (1975)
[Show abstract][Hide abstract] ABSTRACT: The lost production of estrogen and progesterone is the hallmark of ovar- ian senescence and subsequent menopause. This hormonal decline is accompa- nied by ubiquitous changes throughout the body. Replacement of estrogen through hormone replacement therapy (HRT) traditionally has been used to address these changes. HRT is used to treat the symptoms of menopause (e.g.,hot flashes,vagi- nal dryness,urinary incontinence) and also has been used to prevent some of the chronic illnesses that develop in the sixth and seventh decades of life. The decision to use HRT is one all women face as they reach perimenopause. The subject has been well covered in print media and on the Internet,so by the time they visit their doctors,most women have given some thought as to how they feel about this important issue. Although some women may have made up their minds,many women want a physician or other health provider to help them in- terpret what they have read or heard,weighing the benefits and risks of HRT for the individual. Issues of compliance,perceived vulnerability and risk,and potential side effects should be a part of every conversation. Most women who leave their physicians' offices with prescriptions for HRT are not taking them a year later. Aside from women who have a personal or strong family history of breast cancer or who are at risk for thromboembolic disease, there may be different reasons for declining or discontinuing HRT. Many women fear the risk for malignancy that accompanies HRT. Other women do not want reg- ular bleeding to resume,no matter how briefly,or are fearful of purported side ef- fects such as weight gain or breast tenderness. Some women object to HRT on social or cultural grounds. They feel that this natural life transition is being med- icalized and taken away from their control. Alternative approaches are viewed as safer or more individualized. 80 If,after a discussion of the pros and cons of HRT,a woman decides to avoid traditional HRT,her physician should be willing to
No preview · Article · Mar 2002 · Clinics in Family Practice
[Show abstract][Hide abstract] ABSTRACT: Sleep problems are common in childhood. A distinction is made between problems in which polysomnography is abnormal (i.e., the parasomnias, sleep apnea and narcolepsy) and problems that are behavioral in origin and have normal polysomnography. The parasomnias--sleep terrors, somnambulism and enuresis--appear to be related to central nervous system immaturity and are often outgrown. Obstructive sleep apnea syndrome (OSAS) is frequently missed in children and can often be cured through surgery. Behavioral sleep problems may be overcome after parents make interventions. Physicians can be of great assistance to these families by recommending techniques to parents that have been shown to be effective.
No preview · Article · Feb 2001 · American family physician