Beyond Consent: Building Trusting Relationships With Diverse Populations in Precision Medicine Research

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: (1) Address the role of history and experience on trust, (2) engage concerns about potential group harm, (3) address cultural values and communication barriers, and (4) integrate patient values and expectations into oversight and governance structures.     

改变因症就诊的医疗模式搞好慢性呼吸疾病的防控

本文简单介绍了各种慢性呼吸疾病的特点、重要性、病因和发病机理,重点阐述认真搞好三级预防是有效防控慢性呼吸疾病的基础,而目前我国慢性呼吸疾病医疗服务模式是因症就诊,这种医疗服务模式不利于慢性呼吸疾病的管理和控制,必须尽快改变。     

探析流行病防治的哲学思维

本文以现代医学模式为指导,阐述了辩证思维在流行病学研究领域的应用及其必要性。从系统论和具体问题具体分析论述了传染病和慢性病并重和区别对待的疾控观;通过消除病因和医防一体化以控制流行病。最后得出与哲学思维协调发展是流行病防治基本策略的结论。     

宫腔镜发展和应用的哲学思考

宫腔镜技术是现代妇科微创技术,宫腔镜技术的产生和发展是技术目的和技术手段矛盾发展的结果,宫腔镜技术的具体应用过程体现了马克思主义哲学原理的作用。以马克思主义哲学为指导,可使我们在对待宫腔镜应用中的具体问题时,高瞻远瞩,安全、有效地对患者实施诊治,同时,提高自己的综合素质。     

应该发挥医院、医生在慢性病预防中的作用

从必要性分析、可行性分析、预防效果分析及存在的问题等方面探讨在我国必须要发挥医院、医生在慢性病预防中的作用,只有整合医疗资源与疾病预防控制资源,才能更好地预防慢性病。     

医疗文书签字扩大化失去意义的原因分析

随着近年医患关系的紧张,越来越多的医疗工作需要履行签字手续,呈现了签字扩大化的态势。签字扩大化是防御性医疗的一种表现形式,但并未带来医疗纠纷减少,也不是医疗纠纷产生的主要原因,又给医疗工作增加了繁琐程度,而且并未达到知情同意的内涵。所以,签字扩大化失去了其应有的意义。     

人类基因组计划与医学模式

人类基因组计划将为医学科学的发展提供广泛的可能性,并结生物医学带来革命性的变化,但是人类的社会性,疾病产生的非生物因素以及社会及伦理的限制都决定了任何生物医学上的成就,包括人类基因组计划都不能改变生物社会心理医学模式的深刻内涵。     

加速卫生改革迎接入世挑战

中国即将加入WTO。加入WTO后 ,随着中国服务贸易业的对外开放 ,给与健康有关的医疗健康服务带来了前所未有的挑战和机遇。分析我们即将面临的挑战、风险和压力 ,并提出深化卫生改革 ,提高竞争实力的对策。     

Recognizing Racit Knowledge in Medical Epistemology

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at     

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.