Departments of Physical Medicine and Rehabilitation must be established in all university faculties of medicine to provide training at both pre- and postgraduate levels.
Medical students should receive at least 25 hours of lecture-demonstrations in appropriate centres. Composite case presentations to students, which would allow the physiatrist and the paramedical personnel each to discuss their role in diagnosis, prognosis and treatment, are advocated.
Vocational considerations for the future physiatrist, including the duration of his training, the program of study and the type of examinations proposed, are discussed briefly.
相似文献The primary goal of rehabilitation of younger individuals is usually vocational. In the older group this goal or objective is, by and large, secondary. This does not minimize, however, the value of medical and social services in the rehabilitation of older persons. The simple ability to care for his own personal needs can do much to help the elderly disabled patient regain his dignity and self-respect and remove his fears of becoming a burden on his family or society.
相似文献Psychological factors and the patient's personality “style” influence the development and course of every disease, complicating diagnosis and effective treatment. It is a basic requirement that a good working alliance be established between patient and physician. This is assisted by comprehensive history taking, which clarifies the lifesetting in which the illness began, the patient's personality and his habitual reactions of emotional regression under stress. It will also point up errors introduced by the patient, omissions, and distortions in offering the subjective data which the physician must evaluate.
Seven major personality types and appropriate physician responses are outlined: the dependent demanding oral patient, the orderly controlled obsessive, the dramatic seductive hysteric, the long-suffering masochist, the querulous paranoid, the overbearing narcissist and the aloof withdrawn schizoid.
The non-psychiatrist can resolve complex and puzzling medical problems if he has an increased awareness of how emotional forces complicate illness and if he can exploit comprehensive history taking to the full.
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下载免费PDF全文 The use of this intensive treatment method is described in six drug addicts. Successful results were achieved in four patients who have been followed up for two to five years. The treatment program, the preliminary investigations and the follow-up procedures are described.
Particular reference is made to the brain self-stimulation studies of Olds and others in animals, and those of Heath in man. A hypothesis is advanced to explain the various aspects of the clinical picture in both psychotic illness and drug addiction.
The intensive method of treatment should be considered for drug addicts whose prognosis is otherwise poor. Further investigations along the lines of the proposed hypothesis might be profitable in other types of abnormal and maladaptive behaviour.
相似文献This case is discussed by a professor of haematology, a director of a regional blood transfusion service, a medical defence specialist, a consultant in geriatric medicine, and finally by a member of a university department of moral philosophy.
All the medical commentators agree that a very large sum of money was spent in treating this patient, particularly in buying supplies of commercially produced factor VIII which also carries attendant medical risks. But while this is so, it is also argued that the doctors in charge of the case could have done no other as the fatal outcome could not have been foreseen and a doctor's duty is to treat his patient to the best of his ability, even though in this case the patient was elderly and in the hospital concerned other projects had to be cancelled.
The `battle' of the treatment of the aged versus the young is touched upon by all the contributors but it is left to the moral philosopher to examine it more closely and incidentally to direct attention to the nature of the National Health Service which is neither a paternalistic system nor an insurance scheme (thought to be so by some to be a more palatable notion) but a welfare scheme in which the state forces its citizens to do things for the general good. For the moral philosopher age is irrelevant to the debate. Perhaps the consultant in geriatric medicine should have the last word: if the patient had been in the hands of a single general physician or geriatrician, he says, he would have been seen as a whole person and the arguments surrounding the case with hindsight would never have arisen.
相似文献Recent advances in radiotherapy techniques have permitted treatment of a greater proportion of patients with laryngeal carcinoma by this means, with encouraging results. Results of a survey in the Toronto area suggest that radiotherapy should be used as primary treatment in early and intermediate stages of the disease; radical excision combined with radiotherapy is indicated for treatment failures among early cases and for those with far-advanced disease or carcinoma outside the larynx proper. With this program five-year survival rates are comparable to those achieved when laryngectomy is the primary treatment used, and two-thirds of those who survive maintain laryngeal function.
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立足山西省，通过对医药信息资源的战略思考，试图从医药信息资源的评估内容分析、评估体系的内容分析以及建立评估体系的关键问题等方面建立医药信息资源评估体系，并提出建立该体系所具有的重要的战略意义和现实意义。
相似文献Medical teaching and practice is still basically as it has been developed in the West and so overseas doctors trained in Britain take with them not only the medical knowledge and skills but also the attitudes of the West when they return to their own countries. Consequently they wish to settle in the towns and practise as consultants when the real medical problems in many of the developing countries are those of a rural population needing health care rather than treatment in what have been called `disease palaces'. As speakers made clear, a new responsibility must fall on those training doctors from overseas in the British medical schools to fit them not for the dream world of the sophisticated medical scene but for the realities of working in often badly equipped clinics and dealing with common conditions such as malnutrition and other problems of maternity and child health.
The symposium also included discussions as to why British doctors wished to emigrate. Money seemed to be the most compelling motive, but opportunities were being limited for their migration for economic and political reasons.
Finally, a look at the whole of the medical scene in Britain: perhaps the standard sought in Britain both by the doctor and the patient is too high and too individualistic. Events will show if this be true.
相似文献 下载免费PDF全文 Our data show that many isoimmunized pregnant women are delivered in hospitals that have infrequent experience with this problem, and by physicians who have little experience with this disease.
The physician referral pattern, in regard to maternal isoimmunization, indicated that the more severely affected patients were managed by specialists, particularly those attached to teaching hospitals. However, 25% of the infants treated by exchange transfusion were managed by nonspecialists in nonteaching hospitals.
Hospital record search, used as a method of medical audit and as a source of data for comparison with physician reports, did not result in dependable or complete information. Rates of disagreement between items from two data sources, physician report and hospital record, were frequently very high. Our experience suggests that comparison of these two data sources is not an ideal method of assessment of quality of care.
A smaller caseload of isoimmunized pregnant women will result from the present prevention program. Nevertheless, cases will continue to occur. Our work supports the conclusion that a program of continuing education covering the diagnosis and management of hemolytic disease of the newborn is still necessary.
相似文献As the title suggests, the dilemma consists of a conflict of loyalties as regards who should be protected first, from whom and why. The medical problem presented was one of termination of pregnancy, but a new ethical issue arose when the patient consulted another doctor in a neighbouring practice. It is this doctor - Dr Winterton - who puts his dilemma to the conference for discussion.
Those taking part were Dr Winterton, Dr Crew, Dr Jamieson, Dr Lamb, Dr Anderson, Dr Smith. All names in this Conference have been altered except that of the Chairman, Dr Higgs. The discussion was recorded at a residential course for general practitioners.
相似文献Recommendations for improvements in medical care have been made; these include research into various conditions, an increased number of specialist visits and the inclusion of Churchill Hospital in a residency training program. Other recommendations relate to community planning, community sanitation and employment opportunities.
相似文献Although prepared specifically for public health workers, this article has direct relevance to the future of the medical profession as a whole. In view of the present intense interest in the future pattern of health care in Canada, the viewpoint of a physician with a dual background in public health and medical school administration and teaching is considered to be particularly pertinent.
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