Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

Mentoring in the Academic Medical Setting: The Gender Gap

Mentoring is an essential part of success in the academic medical center. The provision of effective mentoring is key to the success of the increasing numbers of women entering medicine. However, the gender distribution within the hierarchy of medicine has not changed in that the power still resides with men in the system. Currently, men are attempting to mentor women, and so as the proportion of women in medicine continues to grow, they will become more influential in this setting and will become increasingly responsible for providing mentoring to men. In either case, effective communication across gender lines is an essential aspect of the mentoring process. Psychologists in academic medical settings can provide guidance to faculty and staff on the critical aspects of social development and communication, which may affect how women and men are mentored and the success of this mentoring process, whether across or within gender lines.     

在西方医药审判中的一个亮点--科学哲学

科学证据不仅在司法审判中起着极其重要的作用,而且在科研成果的评价中也是不可取代的,但是在审判和科研成果评估中,对“科学是什么”这样一个更深层次的问题－科学哲学问题,历来没有得到应有的重视,通过美国止吐药本涤汀前后历时20年的审判历程,突出科学哲学在医药审判实践中的地位。     

达尔文医学与中医学

达尔文医学是博物学（进化论）传统与生理医学传统（终因和近因生物学）最后的结合,尝试着对这门新兴学科作出理论基础和研究内容的建构。在此基础上,达尔文医学与中医学的可通之处在如下三个层次上作出了探讨：医学理念的整体性,理论基础的哲学思辨性和学科结构中的修辞性。     

The Future of Psychology in Academic Health Care Centers

A promising opportunity exists to continue psychology's move beyond its traditional mental health emphasis into a general health care discipline. Abundant empirical evidence supports that psychologists treat a wide array of physical disorders as well as psychological components of medical problems. The immediate issues confronting psychology's full emergence into the health care world are discussed and recommendations are offered to assure the success of this initiative. Office of the Senior Vice President and Provost     

A Method for Introducing the Concepts of Chaos Theory to Medical Students

Chaos theory is beginning to find applications in the field of medicine. The theory of chaos should be introduced to students to help them as they make the transition from learning the scientific literature to actually applying this newly acquired knowledge in clinical situations. Chaos theory will give the students a powerful conceptual framework from which they can better understand the limits of predictability in clinical situations. Failure to understand the limits of predictability in chaotic natural systems will invariably lead to frustration in both patients and physicians.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Incurable suffering from the “hiatus theoreticus”? Some epistemological problems in modern medicine and the clinical relevance of philosophy of medicine

Up to now neither the question, whether all theoretical medical knowledge can at least be described as scientific, nor the one how exactly access to the existing scientific and theoretical medical knowledge during clinical problem-solving is made, has been sufficiently answered. Scientific theories play an important role in controlling clinical practice and improving the quality of clinical care in modern medicine on the one hand, and making it vindicable on the other. Therefore, the vagueness of unexplicit interrelations between medicine's stock of knowledge and medical practice appears as a gap in the theoretical concept of modern medicine which can be described as Hiatus theoreticus in the anatomy of medicine. A central intention of the paper is to analyze the role of philosophy of medicine for the clarification of the theoretical basis of medical practice. Clinical relevance and normativity in the sense of modern theory of science are suggested as criteria to establish a differentiation between philosophy of medicine as a primary medical discipline and the application of general philosophy in medicine.     

Measuring depressive symptomatology of patients referred to a behavioral medicine clinic: Concordance of self-report measures

We measured depressive symptomatology of 134 outpatient veterans treated within a Behavioral Medicine Clinic utilizing three reliable instruments with depression subscales: Minnesota Multiphasic Personality Inventory (MMPI), Derogatis Stress Profile (DSP), and Symptom Checklist 90—Revised (SCL-90-R). Results indicate that although the instruments correlate significantly, they differ in sensitivity to depression and are clinically discordant. The MMPI classified a substantially higher number of patients as depressed than either the DSP or SCL-90-R. The present study argues that the discrepancy in clinical concordance and sensitivity of the three depression scales has considerable implications for psychologists concerned with the assessment and treatment of depression.     

The trauma triangle

Recent research supports the hypothesis that more active engagement of the patient in occurring illnesses improves quality of life and probably even life expectancy.In this study experience and theoretical knowledge from psychotherapy is transplanted to clinical practice in order to improve the physician's engagement in the patient-disease relationship. By defining severe and long-term illnesses as a psychotrauma, the transfer of the psychotherapeutical model leads to the creation of a new triangular relationship: patient-illness-doctor. Practical examples are used as illustrations for the conceptual differences between psychotherapy and clinical medicine. Options for dialogue show the difference between adaptation (learning to live with) and adjustment (active coping strategies and controlling). The hypothesis is that a better dialogue will reduce illness-related stress, giving the patient better and more effective access to personal psychic and physical support systems.