Medicine as a career: Choices and consequences

Medicine has traditionally been regarded as a rewarding career both financially and socially. How true, however, is that tradition in today's world of rising costs and decreasing revenues? The educational debt of the physician-in-training is steadily increasing, and currently does not affect specialty choice. As the cost of medical education continues to rise, the applicant pool begins to shrink, thereby possibly affecting the quality of future physicians. Once the physician has completed training however, the majority enjoy a positive return on investment. Their incomes generally fail to remain ahead of inflation, and therefore, have remained within a narrow band of $40,000 in 1970 dollars. Finally, the demand for physician services cannot be attributed solely to either the consumer (patient) or to the supplier (physician). Rather, the demand for medical services appears to be a unique combination of the two. In conclusion, medicine still is an attractive career path, but the choices and consequences are becoming much more demanding.     

AN ANALYSIS OF AND INTERVENTION IN THE SEXUAL TRANSMISSION OF DISEASE

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing “occasion cards” for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.     

Sex differences in attribution for occupational success

A study was conducted to both test and extend Deaux's (Sex: A perspective on the attribution process. In J. H. Harvey, W. J. Ickes, & R. F. Kidd, (Eds.), New directions in attribution research, Volume 1. Hillsdale, N.J.: Erlbaum, 1976) expectancy model of sex-linked differences in attribution for success. Specifically, it was hypothesized that female occupational subjects would attribute success more to the unstable causes of effort and luck, as well as the stable internal cause of interpersonal skill, while male occupational subjects would make higher attributions to the stable causes of ability and task ease. This hypothesis was supported for the causes of effort, luck, and task ease. Additionally, a comparison between sex differences in attribution occurring within a nonpersonal vs. personal frame of reference showed three of the expected sex differences in attribution to be stronger in the latter condition. Moreover, it was shown that this difference was largely accounted for by changes in females' rather than males' attributions. A final hypothesis, namely, that males would perceive themselves as more successful in their occupations than females, was not confirmed.     

The role of the clinical psychologist on a burn unit in a general teaching hospital

This paper reviews the core skills that a clinical psychologist brings to a burn unit and suggests a model for optimal psychological management of burn patients, families, and staff. Recovery from a burn injury involves three stages that comprise (a) acute treatment of severe medical complications, (b) adjustment to hospitalization, and (c) long-term rehabilitation. Each stage contains numerous issues that the clinical psychologist should monitor and manage. Assessment of patients at risk, early intervention, and specialist management are highlighted as critical components of effective psychological management of burn injury in a multidisciplinary team context.     

Style and responsibility: Medicine in postmodernity

To what extent can postmodern developments be observed in modern medicine and which theories of postmodern philosophy can we draw on with regard to medicine's theoretical problem? This article explores these questions with special emphasis on the epistemological status of medicine, the concept of disease, and the anthropological model. It is examined whether medicine's inherent duty to act can be questioned in the light of the plurality that characterizes postmodernity. It is concluded that, according to postmodern philosophy, medicine should be characterized by a justified variety of paradigms. Cooperation within the variety must continue to be guaranteed, always in favor of the constitutive moral duty of medicine.     

Medical crisis counseling: A new service delivery model

The diagnosis or exacerbation of a chronic illness, the aftermath of a serious accident, or worries about future in the context of illness or debilitating injury are all examples of medical crises that pose significant coping challenges. Too often, traditional approaches to psychotherapy have been unable to respond the most urgent needs of people confronting such crises. Medical crisis counseling is a specialized approach to addressing the needs of individuals and families confronted by the difficulties of coping with losses or changes, as well as the challenge of living with long-term illness. This paper describes the medical crisis counseling model in contrast with other more traditional intervention approaches.     

Teaching psychological knowledge and skills to family physicians

Psychological problems (e.g., anxiety, depression, substance abuse) are prevalent in primary care medical settings. Family physicians (FPs) treat more patients than any other primary care medical specialists. Thus, FPs can play an extremely important role in providing psychological services to their patients. In contrast to other specialists (e.g., internists, obstetricians), FPs are required to complete behavioral science training in their residencies. In this paper, we describe standard undergraduate, graduate, and postgraduate training of FPs. We present our unique program for teaching psychological principles and skills to family practice residents at the University of Kansas Medical Center. And finally, we introduce an instrument, the Interview Rating Scale (IRS), for evaluating the interviewing skills of physicians and residents.     

Teaching medical staff psychological concepts via a hospital newsletter

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities. Rehabilitation goals therefore, must be based on psychological, as well as physical, capacities. A one-page, user-friendly newsletter was designed to illustrate basic psychological principles via case vignettes. The topics of fear, countertransference, and resistance were selected as critical issues staff frequently encounter in their work with patients. The newsletters provided the staff with basic conceptual tools for effectively treating patients, and the work of psychologists was demystified. The newsletter format is proposed as a creative adjunct to didactic teaching.Copies of the newsletter Insight can be obtained by request from Dr. Gold.