Educating physicians in home health care

Article Abstract:

Home health care has become more important as hospitals are becoming more and more restricted to acute care. At the same time, are physicians no longer engaging in home health care activities. The lack of physician participation in this important area has led the American Medical Association to recommend the incorporation of home health care training in medical education of all levels. Although this trend is part of an effort to contain spiraling medical costs, patients and their families have shown a preference for home care for both acute and chronic illness. Physicians cite poor reimbursement, inefficient time use, medical liability, and concern for quality of care as barriers to participation. The first two issues, which affect a physician's income, must be addressed. Liability has not yet become a problem and, in fact, litigation may be reduced because patients and families view home care differently. Quality of home care specialists is very likely on a par with hospital staff, although objective assessment measures are not available. Home health care also has significant economic, psychological, and physiological advantages. It is often the best care for the chronically or terminally ill, especially for those with AIDS. Physicians need appropriate skills for patient assessment and to judge the adequacy of family care givers. They should also be able to evaluate the efficacy of home health care, and be knowledgeable about cost reimbursement and community resources, both professional and voluntary. Role models and training will help educate young physicians, but the problem of reimbursement will require policy changes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Finance, Physician and patient, Physician-patient relations, Medical care utilization, Home care services

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Use of animals in medical education

Article Abstract:

The Council on Scientific Affairs of the American Medical Association has reviewed the use of animals in the training of physicians. Experiments performed on animals provide insights into physiology, pharmacology, microbiology, biochemistry, and other biomedical disciplines. The use of animals complements the training of both medical students and also physicians completing training in specialties. In a 1989 survey of physicians conducted by the American Medical Association, 91 percent said they thought the use of animals had been important in their own training, and 93 percent said they felt that the use of animals should continue as a part of medical training. In the opinion of the Council on Scientific Affairs, the use of animals is critical to the proper education of physicians. Although experiments without animals may be considered, substitutions should only be used when no sacrifice of learning results. Schools should describe their policy to students prior to matriculation, indicating that animals will be used in training exercises. The training exercises should be carried out under the supervision of the animal care and use committee at that particular institution. In addition, both good experimental technique and humane considerations should be employed so that the experiments be carried out in a manner that minimizes the pain experienced by the experimental subject. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Social policy, Medical colleges, Medical schools, Animal experimentation, Laboratory animals, editorial

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Educating physicians for population-based clinical practice

Article Abstract:

Medical students should be trained to treat populations of patients rather than individual patients to better prepare themselves to practice medicine in the 21st century. Modern American medical education and practice has been based on the fee-for-service, one-to-one physician-patient relationship. The obligations of the modern physician should be expanded to include a set of physician-population obligations such as those that occur in the prepaid group practice setting. Medical students should be trained to achieve the highest quality of medical care for the lowest cost. They should receive training in the 'population sciences' to learn the epidemiologic basis of disease prevention and treatment. They should be trained to interact with high-risk members of the population who are reluctant to come into the office for treatment. Community-oriented medical insurance and practice has already changed the atmosphere in which most physicians practice.

Medicine, Practice, Medical practice

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