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Primary care medicine, as we know and remember it, is in crisis. While policymakers, government administrators, and the health insurance industry pay lip service to the personal relationship between physician and patient, dissatisfaction and disaffection run rampant among primary care doctors, and medical students steer clear in order to pursue more lucrative specialties. Patients feel helpless, well aware that they are losing a valued close connection as health care steadily becomes more transactional than relational. The thin-margin efficiency, rapid pace, and high volume demanded by the new health care economics do not work for primary care, an inherently slower, more personal, and uniquely tailored service. InOut of Practice, Dr. Frederick Barken juxtaposes his personal experience with the latest research on the transformations in the medical field. He offers a cool critique of the \"market model of medicine\" while vividly illustrating how the seemingly inexorable trend toward specialization in the last few decades has shifted emphasis away from what was once the foundation of medical practice. Dr. Barken addresses the complexities of modern practice-overuse of diagnostic studies, fragmentation of care, increasing reliance on an array of prescription drugs, and the practice of defensive medicine. He shows how changes in medicine, the family, and society have left physicians to deal with a wide range of geriatric issues, from limited mobility to dementia, that are not addressed by health care policy and are not entirely amenable to a physician's prescription. Indeed, Dr. Barken contends, the very survival of primary care is in jeopardy at a time when its practitioners are needed more than ever. Illustrated with case studies gleaned from more than twenty years in private practice and data from a wide range of sources,Out of Practiceis more than a jeremiad about a broken system. Throughout, Dr. Barken offers cogent suggestions for policymakers and practitioners alike, making clear that as valuable as the latest drug or medical device may be, a successful health care system depends just as much on the doctor-patient relationship embodied by primary care medicine.

The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.

Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. The book argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy. How can doctors use empathy in diagnosing and treating patients without jeopardizing objectivity or projecting their values onto patients? The book develops an account of emotional reasoning as the core of clinical empathy. It argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet it argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?

Nortin Hadler's clearly reasoned argument surmounts the cacophony of the health care debate. Hadler urges everyone to ask health care providers how likely it is that proposed treatments will afford meaningful benefits and he teaches how to actively listen to the answer. Each chapter ofWorried Sickis an object lesson on the uses and abuses of common offerings, from screening tests to medical and surgical interventions. By learning to distinguish good medical advice from persuasive medical marketing, consumers can make better decisions about their personal health care and use that wisdom to inform their perspectives on health-policy issues.

The problems faced by medical doctors and automobile mechanics are in some ways quite similar—something isn't working right and must be fixed. They must both figure out the cause of malfunctions and determine the appropriate treatments. Yet, the mechanic has no need to worry about an automobile's psyche; the specific mechanical factors are the only ones that come into play. In health care, however, the factors influencing outcomes are broader, more complicated, and colored by the underlying psychological factors of those involved. These factors have profound effects. Doctors are often influenced by patients' description of symptoms, yet information is often incomplete or inaccurate or colored by the patient's own experiences. The doctor's own demeanor may greatly affect outcomes, as can the doctor's ability to interpret the ever-expanding medical literature. These underlying influences are often not acknowledged, and yet they can have far-reaching consequences. Acknowledging these psychological factors and learning how to overcome them are the first steps in improving communications between doctors and patients and to improving diagnosis and treatment. Here, the authors offer strategies for remedying the situation and moving forward to a better understanding of doctor-patient visits and their outcomes.

With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

Throughout history, physicians have played a vital role in medical discovery. These physician-scientists devote the majority of their professional effort to seeking new knowledge about health and disease through research and represent the entire continuum of biomedical investigation. They bring a unique perspective to their work and often base their scientific questions on the experience of caring for patients. Physician-scientists also effectively communicate between researchers in the \"pure sciences\" and practicing health care providers. Yet there has been growing concern in recent decades that, due to complex changes, physician-scientists are vanishing from the scene. In this book, leading physician-scientists and academic physicians examine the problem from a variety of perspectives: historical, demographic, scientific, cultural, sociological, and economic. They make valuable recommendations that-if heeded-should preserve and revitalize the community of physician-scientists as the profession continues to evolve and boundaries between doctors and researchers shift.

Intimate Relationships in Medical School is for anyone studying the medical sciences who is married or in a committed relationship. Michael Myers-an experienced psychiatrist and clinician- uses several case examples throughout the book which are composites from his practice. Through these and the author′s suggestions and insights, the busy, committed medical student and his or her partner will increase their ability to confront and resolve misunderstandings.

How to Succeed at the Medical Interview provides candidates with a competitive edge. It reduces the likelihood of unexpected questions or situations and helps improve confidence before and during the medical interview. This new second edition includes updated content on changes to the structure of healthcare and how this affects both the application and interview process. It details the types of questions that will be asked at medical interviews and also provides improved guidance for overseas doctors and healthcare professionals and for those seeking to practice abroad. How to Succeed at the Medical Interview is the ideal guide for Foundation Programme trainees, Specialist Registrars and General Practitioner trainees. It is also valuable for healthcare professionals facing competitive medical interviews at any stage of their career.