临床实习存在的问题及其对策

1　临床实习中存在的问题1 1　医疗、教学、科研关系处理不妥 ,导致临床外科实习质量下降 :医科大学附属医院作为医院有其特殊性 ,具有救死扶伤和教书育人两个基本职能 ,要完成教学、医疗、科研三项主要任务 ,三者关系应是相互促进、协调发展 ,医疗是基础 ,科研是动力 ,人才培养是目的。但目前在医院往往是医疗工作作为压倒一切的任务 ,而临床教学则处于明显弱势 ,在制定分配方案、承包制度时 ,仅把医疗任务、经济收入指标作为核算工资、奖金的重要依据 ,而临床教学根本不在考虑范畴之内。1 2　整体规划管理不足致临床实习的盲目性和不合理…     

大医院过度扩张与医疗行业的社会使命

大医院过度扩张已是不争的事实,加速了医疗资源的不合理分配,是造成看病贵的重要原因.医院自身有责任,主管部门与权威媒体实际上在鼓励大医院过度扩张.是医院社会使命重要,还是过度扩张重要,这是培育职业精神、践行社会使命必须做出的艰难抉择.     

公私合营模式在医疗领域中应用的探讨——以镜湖医院在澳门的发展为例

在阐述公私合营模式定义的基础上,以澳门为典型案例介绍了该模式在医疗领域中的具体应用,并从理论上对中国内地实施公私合营的医院管理模式提出相关建议.中国内地在日后推行这种医院管理模式时应特别注意明确私立医疗机构的社会责任和使命、完善相关扶持政策和强化审批与监管制度.     

大医院过度扩张与医疗行业的社会使命

大医院过度扩张已是不争的事实,加速了医疗资源的不合理分配,是造成看病贵的重要原因。医院自身有责任,主管部门与权威媒体实际上在鼓励大医院过度扩张。是医院社会使命重要,还是过度扩张重要,这是培育职业精神、践行社会使命必须做出的艰难抉择。     

特需医疗服务供方意向调查分析

剖析目前特需医疗服务供方所存在的主要问题,初步探讨在我国发展特需医疗服务适宜的承担主体.采用个别访谈和问卷调查的方法对来自不同性质的医院的医护人员和医院管理人员进行了意向调查.结果显示,医院发展特需医疗服务并不是解决医务人员收入问题的有效手段;公立医院发展特需医疗服务势必会对其普通医疗服务带来负面影响.建议在确保大部分公立医院只提供普通医疗服务的基础上,由私立医院和一部分公立医院作为特需医疗服务的承担机构.     

医生服务态度的实证研究

医生的服务态度是医学人文关怀的具体形态.采用自行设计的调查问卷,在江苏省某大型综合性三甲医院对医生服务态度的耐心、专注、语言、神态、情绪、倾听、告知、解释、微笑、共情十个方面进行双向调查.通过统计分析发现,医生的服务态度是影响医患关系的重要制约因素,且医患双方对于医生服务态度表现的评估有显著性差异.服务态度管理是医院管理的重要内容,对服务态度的考核应进入考核体系.服务态度的改善必将有利于医院人文形象的构建,有利于和谐医患关系的构建,有利于医疗质量的提高.     

如何成为一名优秀的骨科医生

目前,由于医疗模式的转变,除了对患者本身疾病的治疗外,患者的满意程度和生命质量也成为衡量治愈率高低的一个标准.因此,加强医护人员培养教育,提升医疗服务质量任重而道远.这篇文章探讨了成为一名优秀的临床医护人员所应具备的品质和能力特征.     

如何书写好内科病历

病历是医疗活动的原始记录或历史记载,是最准确,可信的记录.在现代医院管理中,病历作为医疗活动信息的主要载体,不仅是医疗、教学、科研的第一手资料,而且也是综合评价医院医疗质量、技术水平、管理水平的依据.即病历质量好坏体现医生的学术和品德,体现医院的管理水平和医疗质量.病志书写的水平,是一位医生理论基础、技术水平、临床经验、表达能力、逻辑思维的综合检验.然而现在有些病历,特别是大医院的病历质量不高的原因是工作太忙,病人太多.下级医师对疾病特点了解不够,概念不清楚.上级医师要养成习惯把您心里想的思路说出来,以提问的方式讲更好,这样对下级医生的印象会更深,同时也可以掌握他们是否理解正确了,督促下级医生平时的学习,始终要抓"三基三严",强调临床基本功.本文把内科病历书写中的常见问题一一列出,并具体指导如何改进.     

公立医院“药事服务费”背后的利益博弈与调适

公立医院增设药事服务费是医疗收费的一次重大改革,涉及多方利益.正确、科学调适“利益”问题,事关改革成败.药事服务费利益调适应遵循与医改整体目标相一致、患者利益第一、政府责任以及因地制宜原则.提出伦理调适与政策、经济调适并重;加大行政监管力度;药事服务费制度与现行收费制度改革同步;以此为契机建立新的医院考核评价机制等建议.     

德鲁克医院管理思想研究

德鲁克医院管理思想主要有:医院管理与企业管理没有多大差异;医疗保健是21世纪增长最快、最需要管理的部门;医疗服务需要合理组织及团队精神;评价医疗服务质量的标准是"最佳";医院要实施目标管理并不断致力于变革,通过"专业化"提高效率和效益;医院管理者与员工之间是伙伴关系;信息技术对医疗服务有深刻的影响;医院应实行"职业化"管理.     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

Language,politics and dreams: the challenges of building resilience in refugees

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language – the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.