Postmodernist theory and the physician-patient relationship

The author discusses the postmodernist claim that the grand theories have lost credibility, even in the field of medical science and practice. Rather than representing a shared reality among physician and patient, illness represents two quite distinct realities — the meaning of one being significantly and distinctively different from the meaning of the other. However, existential clinical narratives can function as important bridges between the world of the patient and the world of the physician. Such narratives provide important information regarding the patient's biographical situation and, particularly, the personal and cultural meanings which are a function of the biographical situation. At the same time, these narratives provide physicians with useful information for the practice of medicine.     

Casuistry in medical ethics: Rehabilitated,or repeat offender?

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.     

The logic of the medical research article

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding the nature of the logic of the medical research article may help avoid erroneous conclusions.     

The potential of medicine as a resource for philosophy

In addition to the neglect of philosophy by medicine, emphasized in a recent editorial in this journal, there has been an equally important neglect of medicine by philosophy. Philosophy stands to gain from medicine in three respects: in materials, the conceptual difficulties arising in the practice of medicine being key data for philosophical enquiry; in methods, these data, through their problematic character, being ideally suited to the technique of linguistic analysis; and in results, the practical requirements of medicine placing a direct demand for progress on philosophical theory. The future of the relationship between philosophy and medicine depends on the development of a positive two-way trade between them.     

Rarely Occurring Headaches and Rarely Occurring Blindness: Is Rarely=Rarely? The Meaning of Verbal Frequentistic Labels in Specific Medical Contexts

In three experimental studies, factors were examined which might influence the interpretation of verbal frequentistic labels in a specific context (i.e. side effects of medical drugs). In Study 1, we directly assessed subjects' numerical equivalents of three verbal labels (recommended for use by the German Federal Health Agency), which were embedded in stylized leaflets for medical drugs; we compared the estimates with those obtained in a context-free situation. The major findings were that (1) subjects' numerical equivalents for the verbal labels were clearly lower in the context condition than in the context-free situation, (2) subjects'; interpretations appeared to depend on the seriousness of the side effects, but (3) this dependency disappeared when explicit base rates were provided. In Studies 2 and 3, we indirectly examined the influence of the seriousness of the side effects, their frequency, and of the mode of expression (verbally versus numerically) by asking for risk judgments for and choices between drugs. Results of particular importance were that (1) seriousness and frequency of side effects had the same influence on judgments and choices but the mode of expression had no significant effect on either judgments or choices; (2) when subjects’ individual numerical equivalents of verbal labels were used in the leaflets, numerically described drugs were judged equally risky as verbally described drugs but were significantly preferred for consumption. These findings have theoretical relevance for research on the processing of verbal and numerical frequentistic expressions as well as a number of practical implications for the communication of medical information.     

Context and the inverse base rate effect

Recent categorization research set in abstract medical diagnosis contexts has demonstrated an ‘inverse base rate effect’, whereby subjects make diagnoses which are consistent with base rates when presented with some sets of symptoms, but inconsistent with base rates when presented with other sets of symptoms. This paper reports three experiments which demonstrate that whether or not the inverse base rate effect is observed depends on the context in which categorization takes place. Inverse base rate effects are replicated in the abstract medical diagnosis context used in prior research, but not in a relatively realistic financial auditing setting, a less realistic financial auditing setting, or a very abstract generic setting. These results indicate that the inverse base rate effect may not generalize to applied settings, suggesting that interventions designed to mitigate the inverse base rate effect should not be instituted without first determining the existence of the effect in the particular setting in question.     

在内科临床中落实生物心理社会医学模式

社会心理因素与内科疾病的发生、发展和治疗效果关系密切,临床工作中忽视社会心理因素的作用可能导致严重后果。内科医生应积极拓展自身的知识技能,继而把对社会心理因素的重视落在实处,体现在病历中。完整的病史采集又需要加强医患沟通,如此才能真正发现和解决患者的社会心理问题。     

整体护理与新医学模式

整体护理作为当代护理的基本工作模式和护理学发展的基本趋势,是与生物心理社会医学模式的确立直接相联系的。在临床护理中,落实新医学模式,是推行整体护理所必需的。在整体护理中落实新医学模式应从转变护理人员观念、整体护理规范化、改变护理队伍的知识和技能结构、提供护士职业道德水平等方面做起。     

在新医学模式指导下预防碘缺乏病

碘缺乏病严重危害人类健康,是最大的、可预防的智力损伤因素。通过“社会动员”,推动防治碘缺乏病（ＩＤＤ）“轮子”运转,使我国消除ＩＤＤ事业有了巨大进步。目前存在的问题可能会影响到该事业的可持续发展。对此,提出一些建议。