Life-sustaining therapy: a model for appropriate use

Article Abstract:

In recent years many techniques and approaches to prolonging the lives of patients have been developed. However, there is no assurance in any given case that these strategies actually benefit the patient. An approach to studying the trade-offs between effectiveness, utility and cost has been developed. The model includes a means of defining when a procedure is futile. Aggressive care may be appropriate when it can lead to an enhanced rate of survival over supportive care. To some degree decisions made between supportive and aggressive care come down to a gamble, particularly when the situation becomes more complex than deciding between death and life. Individual feelings come in to play because some patients would prefer death following supportive management to life following a more aggressive approach. In short, some will choose to die rather than to suffer the pain and indignity that can accompany some aggressive interventions. The mathematical model which is developed attempts to define the medical appropriateness of such a medical gamble. The model defines a threshold where the value of supportive care is equal to the value of aggressive care, the ''medical appropriateness'' threshold. Values below this point are medically inappropriate. To this value, an economic appropriateness threshold can be added, which views the intervention from the viewpoint of society. As an example, the method is applied to a situation which is deemed to be an incident of inappropriate care - the use of cardiopulmonary resuscitation (CPR) for chronically ill older people. The analysis of this situation demonstrates how the probability of survival with aggressive care falls below the level of medial appropriateness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Ethical aspects, Life support systems (Critical care), Life support care

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Medical education and financial assistance programs sponsored by US government agencies

Article Abstract:

Medical students, as well as students in other health-related professions, may find significant sources of financial assistance from various government agencies, including the armed forces. Most often, these programs are intended to obtain the services of health care professionals, and therefore include some sort of service obligation after graduation. The present article lists the various government agencies which provide such assistance and the requirements for such assistance. In addition to the armed services, which collectively provide both scholarships and financial assistance, the Department of the Navy also provides specialized programs. These include residency programs and programs in specialties such as flight surgery and undersea medicine. The Air Force and Army also provide similar programs. The National Science Foundation (NSF) provides numerous fellowships in biological sciences, as well as mathematics, physics, and other disciplines, though actual biomedical research comes under the domain of the National Institutes of Health and not the NSF. Scholarships are also provided by the Public Health Service; PHS scholarships require civil service after graduation as well as a commitment to serve wherever the need for practicing physicians is considered the greatest. The Public Health Service also provides scholarships for students with exceptional financial needs and for disadvantaged students in medicine, osteopathic medicine, and dentistry. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Administrative agencies, Government agencies, Medical education, Student financial aid, Student aid, Student assistance programs

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Sustaining Change in Medical Education

Article Abstract:

Doctors who are faculty members at medical schools must devote more time to teaching if medical education is to continue producing competent doctors. Most academic doctors also treat patients at the clinic or hospital that is affiliated with the medical school. If managed care plans encourage doctors to see more patients, that will leave less time for teaching. Most medical schools receive half of their revenues from patient care. Consequently, the desire to cut costs will also impact medical schools. Medical schools are partly to blame because they have not encouraged their faculty to be good teachers.

Analysis, College faculty, Teaching, Medical colleges, Medical school faculty

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