Ethical problems in clinical practice

Ethics is about judgment, which is rarely black and white. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice.     

Women doctors in urban general practice: the doctors

A large study of general practitioners in Manchester showed that women doctors were younger than men doctors, and few were single handed or worked in deprived inner city areas. They had closely similar patterns of care to their male colleagues, and although they worked slightly fewer hours in surgery, they had almost identical consultation times per patient. Women general practitioners were less active in politics and education than men.     

医生职业用语中的伦理问题

论述了医生职业语言的基本特征，分析了诊断和治疗过程两个环节中医患语言的基本特征，总结了医生职业用语基本的伦理原则。     

Family doctors: their choice of practice strategy

The economic decisions taken by family doctors in one family practitioner area in the north of England were examined. There was evidence of a differential response to professional and economic incentives by a group of "high investing" practices. On five indicators of improvement in practice 32% of the practices accounted for 71% of the positive scores. Nearly all the high investing practices were in affluent areas; they were on average larger and had younger partners than the other practices. The high investing practices also faced more financial problems. There was evidence that older doctors with long lists of patients had a different strategy of income maximization. Innovation in primary care is not determined by attitude alone but also by objective factors such as age, location, and size of the practice.     

Women doctors in urban general practice: the patients

A large study from a representative sample of general practitioners in Manchester showed that women doctors saw more women patients than men doctors, especially in the childbearing age group. They saw a similar range of diagnoses as men doctors, though they saw more women patients for cervical smears, contraception, and breast disorders. Preventive health care may not be adequately provided for these in practices without a woman partner.     

乡村医生专业诊断学课程改革的探索与实践

作为临床医学（乡村医生）专业的核心课程,诊断学应以培养学生对常见疾病的诊断及鉴别诊断能力为课程教学目标,以接诊各系统常见疾病患者为工作任务贯穿的各项诊断方法为主线设计课程内容,对不同的教学对象、教学内容采用多样化的教学方法与手段,提升教学质量,改革课程考核内容和目标突出学生职业能力与知识应用能力的培养[1-2]。     

基于慢性病诊疗实践的参与式社区医生培训效果评价

目的：了解社区医生慢性病的诊疗知识水平,并对基于常见慢性病诊疗实践的交互式小组培训模式的效果进行评价。方法2013年7月～2014年6月,对义乌市13家社区卫生服务中心的194名社区卫生服务中心一线工作人员及社区卫生服务站的责任医师进行慢性病诊疗知识问卷调查,并实施小班化互动式“二组二段式”新型培训模式,对培训效果进行评价。结果（1）社区医生慢性病综合防治及社区管理能力水平较低,接受新型培训模式的医生慢性病危险因素知识及社区综合管理知识的平均答对率由31.8%提高到59.0%（P＜0.01）。（2）接受新型培训模式的医生对高血压病、糖尿病和冠心病规范化诊疗水平、康复知识及社区管理知识的平均总分在培训前后均显著提高（P＜0.01）。结论“以问题为中心,以病例为引导”的“二组二段式”小班化互动式新型社区医生慢性病规范化诊疗知识的培训模式简单实用,明显提高社区医师对慢性病的诊疗水平,可在社区医院或基层培训机构全面推广。     

Family doctors and innovation in general practice

Family doctors have been presented with changes in government policies and incentives in a recent white paper on primary care. Little work has been done, however, to find out how general practitioners respond to such measures. The response of general practitioners to professional and economic incentives was examined in relation to the location of the practice and the characteristics of the practitioners in seven different areas of England. The areas represented urban, rural, affluent, and deprived communities. The overall response rate was 74%, but the response varied among the areas, being poorest (64%) in an inner city area. Practices were subdivided as innovative, traditional, or intermediate, according to whether they employed a nurse and participated in the cost rent scheme and the vocational training scheme. Innovative practices were defined as fulfilling two of these criteria and traditional practices as fulfilling none; the remainder were classed as intermediate. The results showed that these three types of practice had distinct strategies that were related to financial constraints and the local population. Innovative practices had more partners and were often located in rural or affluent suburban areas; traditional practices had fewer partners and were more common in urban and working class areas. Innovative practices seemed to be in the best position to increase their services, and hence their incomes, in response to the recent proposals in the white paper. Practices in areas of developmental difficulty (predominantly urban but not necessarily inner city areas) had been less able to respond to existing incentives and had a smaller margin available for developing their services. In view of the effect of local constraints of economics and population on the strategy of practices, concentrating resources for primary care in local budgets for working class and urban areas may be preferable to extending the system of charging fees for services provided by family doctors.     

儿童整形外科临床教学的实践及体会

在儿童整形外科的临床教学实践中，笔者积累了如下经验：①通过有效的教学手段，使学生认识本专业的诊治范围和目的；②在医疗活动中培养学生的人道主义精神和良好的医患沟通能力；③强化学生对本专业疾病的诊断能力并掌握主要畸形的治疗时机选择；④根据整形外科的特点，着力训练学生的外科基本操作技能。     

留学生心内科见习带教的实践体会

临床见习是医学院校留学生临床教学的重要组成部分,针对其特点,选择一批业务水平高、英语能力强的医师和在读博士担任教学工作.课前制定教学计划,进行语言准备,设计完成教案,选择好病例;见习中从小节抓起,采用PBL教学法,重视病史采集和体格检查的教学,重视临床思维能力等的培养;最后就见习中存在的问题提出了一些建议.     

深圳市实施临床住院医师规范化培训临床技能统一考核的探索与实践

对深圳市实施临床住院医师规范化培训临床技能考核进行总结探索,认为临床住院医师规范化培训不仅理论课要统一考核,临床技能同样需要统一考核。在实践中有一些体会,对今后工作有所借鉴。     

应对严峻的市场:个体医生奋力求生

在缅因州，穷人公共医疗保险服务部对医生的工作量提出了更高的要求，而给他们的保险陪付反而降低了，医生们为了保证诊所的运行想尽一切办法。     

应对严峻的市场:个体医生奋力求生

为了说明他们所处的境遇,缅因州的一些个体诊所的医生经常引用他们的一个同事的辛酸经历.