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Parenting today is virtually synonymous with worry. We want to ensure that our children are healthy, that they get a good education, and that they grow up to be able to cope with the challenges of modern life. In our anxiety, we are keenly aware of our inability to know what is best for our children. When should we toilet train? What is the best way to encourage a fussy child to eat? How should we protect our children from disease and injury? Before the nineteenth century, maternal instinct-a mother's \"natural know-how\"-was considered the only tool necessary for effective childrearing. Over the past two hundred years, however, science has entered the realm of motherhood in increasingly significant ways. InPerfect Motherhood,Rima D. Apple shows how the growing belief that mothers need to be savvy about the latest scientific directives has shifted the role of expert away from the mother and toward the professional establishment. Apple, however, argues that most women today are finding ways to negotiate among the abundance of scientific recommendations, their own knowledge, and the reality of their daily lives.

In the nineteenth century, infants were commonly breast-fed; by the middle of the twentieth century, women typically bottle-fed their babies on the advice of their doctors. In this book, Rima D. Apple discloses and analyzes the complex interactions of science, medicine, economics, and culture that underlie this dramatic shift in infant-care practices and women's lives. As infant feeding became the keystone of the emerging specialty of pediatrics in the twentieth century, the manufacture of infant food became a lucrative industry. More and more mothers reported difficulty in nursing their babies. While physicians were establishing themselves and the scientific experts and the infant-food industry was hawking the scientific bases of their products, women embraced \"scientific motherhood,\" believing that science could shape child care practices. The commercialization and medicalization of infant care established an environment that made bottle feeding not only less feared by many mothers, but indeed \"natural\" and \"necessary.\" Focusing on the history of infant feeding, this book clarifies the major elements involved in the complex and sometimes contradictory interaction between women and the medical profession, revealing much about the changing roles of mothers and physicians in American society. \"The strength of Apple's book is her ability to indicate how the mutual interests of mothers, doctors, and manufacturers led to the transformation of infant feeding. . . . Historians of science will be impressed with the way she probes the connections between the medical profession and the manufacturers and with her ability to demonstrate how medical theories were translated into medical practice.\"—Janet Golden, Isis

Has postmodern American culture so altered the terrain of medical care that moral confusion and deflated morale multiply faster than both technological advancements and ethical resolutions? The Ethos of Medicine in Postmodern America is an attempt to examine this question with reference to the cultural touchstones of our postmodern era: consumerism, computerization, corporatization, and destruction of meta-narratives. The cultural insights of postmodern thinkers—such as such as Foucault, Deleuze and Guattari, Lyotard, Baudrillard, Bauman, and Levinas—help elucidate the changes in healthcare delivery that are occurring early in the twenty-first century. Although only Foucault among this group actually focused his critique on medical care itself, their combined analysis provides a valuable perspective for gaining understanding of contemporary changes in healthcare delivery. It is often difficult to envision what is happening in the psychosocial, cultural dynamic of an epoch as you experience it. Therefore it is useful to have a technique for refracting those observations through the lens of another system of thought. The prism of postmodern thought offers such a device with which to “view the eclipse” of changing medical practice. Any professional practice is always thoroughly embedded in the social and cultural matrix of its society, and the medical profession in America is no exception. In drawing upon of the insights of key Continental thinkers such and American scholars, this book does not necessarily endorse the views of postmodernism but trusts that much can be learned from their insight. Furthermore, its analysis is informed by empirical information from health services research and the sociology of medicine. Arnold R. Eiser develops a new understanding of healthcare delivery in the twenty-first century and suggests positive developments that might be nurtured to avoid the barren “Silicon Cage” of corporate, bureaucratized medical practice. Central to this analysis are current healthcare issues such as the patient-centered medical home, clinical practice guidelines, and electronic health records. This interdisciplinary examination reveals insights valuable to anyone working in postmodern thought, medical sociology, bioethics, or health services research.

For more than a century, the American medical profession insisted that doctors be rigorously trained in medical science and dedicated to professional ethics. Patients revered their doctors as representatives of a sacred vocation. Do we still trust doctors with the same conviction? InTrusting Doctors, Jonathan Imber attributes the development of patients' faith in doctors to the inspiration and influence of Protestant and Catholic clergymen during the nineteenth and early twentieth centuries. He explains that as the influence of clergymen waned, and as reliance on medical technology increased, patients' trust in doctors steadily declined. Trusting Doctorsdiscusses the emphasis that Protestant clergymen placed on the physician's vocation; the focus that Catholic moralists put on specific dilemmas faced in daily medical practice; and the loss of unchallenged authority experienced by doctors after World War II, when practitioners became valued for their technical competence rather than their personal integrity. Imber shows how the clergy gradually lost their impact in defining the physician's moral character, and how vocal critics of medicine contributed to a decline in patient confidence. The author argues that as modern medicine becomes defined by specialization, rapid medical advance, profit-driven industry, and ever more anxious patients, the future for a renewed trust in doctors will be confronted by even greater challenges. Trusting Doctorsprovides valuable insights into the religious underpinnings of the doctor-patient relationship and raises critical questions about the ultimate place of the medical profession in American life and culture.

In the 21st century, health care has been going through a paradigm shift called digital health. Due to major advances and breakthroughs in information technologies, most recently artificial intelligence, the patriarchy of the doctor-patient relationship has started evolving toward an equal-level partnership with initial signs of patient autonomy. Being an underused resource for centuries, patients have started to contribute to their care with information, data, insights, preferences, and knowledge. It is important to recognize that at its core, digital health represents a cultural transformation, where patient empowerment has likely played the most significant role in driving these changes. This viewpoint paper traces the remarkable journey of patient empowerment from its nascent stages to its current prominence in shaping health care’s future. Spanning over two and a half decades, we explore pivotal moments and technological advancements that have revolutionized the patient’s role in health care. We dive into a few historical milestones, mainly in the United States, that have challenged and redefined societal norms around agency, drawing parallels between patient empowerment and broader social movements, such as the women’s suffrage and civil rights movements. Through these lenses, we argue that patient empowerment is not solely a function of knowledge or technology but requires a fundamental shift in societal attitudes, policies, health care culture, and practices. As we look to the future, we posit that the continued empowerment of patients will play a pivotal role in the development of more equitable, effective, and personalized health care systems. This paper calls for an ongoing commitment to fostering environments that support patient agency, access to resources, and the realization of patient potential in navigating and contributing to their health outcomes with an emphasis on the emerging significance of patient design.

There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.

Physicians assume a primary ethical duty to place the welfare of their patients above their own interests. Thus, for example, physicians must not exploit the patient–physician relationship for personal financial gain through the practice of self-referral. But how far does the duty to patient welfare extend? Must physicians assume a serious risk to their own health to ensure that patients receive needed care? In the past, physicians were expected to provide care during pandemics without regard to the risk to their own health. In recent decades, however, the duty to treat during pandemics has suffered from erosion even while the risks to physicians from meeting the duty has gone down. After exploring the historical evolution of the duty to treat and the reasons for the duty, I conclude that restoring a strong duty to treat would protect patient welfare without subjecting physicians to undue health risks.

The relationship between patients and doctors is at the core of medical ethics, anchoring many important debates in the field. Over the past several decades, this relationship has evolved along three axes — as it is defined in clinical care, research, and society. The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and society. Many of the pivotal discussions of these issues have appeared in the pages of the Journal (see Key NEJM Articles on Medical Ethics). Clinical Care The relationship between patients and doctors in the clinical realm has historically been framed in terms of benevolent paternalism. Until about 1960, most codes of medical ethics relied heavily . . .

In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed. To test an intervention to reduce patients' unmet concerns. Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys. Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania. A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition. After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: \"Is there anything else you want to address in the visit today?\" (ANY condition) and \"Is there something else you want to address in the visit today?\" (SOME condition). Patients' unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys. Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients'; expression of unanticipated concerns not listed in previsit surveys. Patients' unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time.