Caring for medical students as patients

Article Abstract:

Medical students are highly educated and have a sophisticated knowledge of medicine. However, a number of problems may prevent them from receiving good medical care. First, they may ignore or deny their own physical and psychological problems, or try to diagnose and treat themselves because of overconfidence or reluctance to seek help. Second, medical students, like other health-care workers, are at increased risk for developing stigmatized problems such as alcohol and drug abuse, and AIDS. Third, treatment is often provided by their teachers, friends, and colleagues in the students' training institution, leading to possible conflicts of interest. Potential breaches of confidentiality (either because hospital employees necessarily see the records or because physicians are used to discussing cases with each other), possible loss of a job due to real or perceived psychological or physical problems, and lack of insurance coverage for care outside of the training institution come between the student and good medical care. Abortion, sexually transmitted diseases, and depression could cost students their jobs in certain institutions. Recently another issue has surfaced: the problem of caring for medical students who are positive for exposure to the AIDS virus. Communication between medical students and physicians can be complicated when the level of clinical competence of the student is misjudged, or when the student is afraid to admit to ignorance. And, of course, doctors are no more objective and intellectual about their own health than anyone else. The suicide rate is higher among medical students, and for women the rate is two to three times higher than for women in the general population. Intervention programs to detect students at risk for depression and suicide are needed. Also, institutional guidelines should determine the treatment of students who abuse alcohol or drugs, or are otherwise impaired. Health insurance should guarantee confidentiality by allowing treatment outside the facility where the student works. Finally, doctors can learn empathy and good communication skills through the experience of being patients themselves. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Health aspects, Medical students

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A survey of sued and nonsued physicians and suing patients

Article Abstract:

the number of medical malpractice lawsuits is rising at a troubling rate despite efforts to implement controls. The number of annual claims per 100 physicians had risen from 2.5 in 1975 to 16 in 1984, resulting in a corresponding increase in the premiums that physicians must pay on medical liability insurance. Premium payments increased from $5,800 in 1982 to $10,500 in 1985, a rise of almost 45 percent. To assess the impact of malpractice actions on doctor-patient relationships, as well as to formulate suggestions for legal reform, researchers surveyed 642 sued and nonsued doctors and suing patients. Results of the study indicate that physicians who were more involved with their patients tended to be angrier, more tense and depressed as a result of legal action brought against them by a patient than were physicians who were less involved with their patients. Even physicians who had not been sued reported ordering more tests and consultations, and refusing certain cases on the basis of fears about malpractice litigation. These results suggest a deterioration of the doctor-patient relationship, but it may be the case that a poor-doctor patient relationship precedes malpractice litigation. The study also found that a significant misunderstanding between a doctor and a patient exists prior to the initiation of a lawsuit. Improved doctor-patient communications were seen as the most effective means of preventing malpractice claims by almost two-thirds of the survey respondents. This suggests that an early intervention system, one that improves communication at an important time, may help prevent malpractice litigation. Such a system could provide a forum for discussion and problem resolution before a patient resorts to legal action. An early- intervention system that has been in place in the United Kingdom (UK) since 1981 is reviewed.

Physician and patient, Physician-patient relations, Surveys, Malpractice, Actions and defenses, Litigation

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'Cookbook' medicine

Article Abstract:

Recently there has been an emphasis on the development and enforcement of clinical standards to ensure the quality and effectiveness of various medical interventions and to help guide the decisions and actions of medical practitioners. Both private and public third parties, which pay for health care, want to be assured that the care purchased for their beneficiaries is both appropriate and effective. Physicians and other health care providers have a professional and ethical interest in maintaining the quality of care. Clinical standards may be used for quality assurance and legal purposes. However, there are several fears and apprehensions concerning standard setting, especially as regards potential legal implications. The issues raised are: (1) it is impossible to set quality standards in medicine; (2) appropriate organizations such as medical specialty societies may be afraid to set standards out of fear of their own liability: (3) standards will be used against physicians in malpractice cases; (4) formally published standards will be misinterpreted by the public, thereby creating unreasonable expectations and increasing potential liability; (5) standards will lead to the standardization medical practice; and (6) explicit standard setting will not eliminate the malpractice problem. These objections to establishing quality standards in medicine are evaluated from a legal perspective. If formal clinical standards are accepted by the medical profession for reasons of patient care and legal purposes, additional challenges and questions remain and must also be addressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Medical care

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