A Way Forward

2021 ◽  
pp. 111-142
Author(s):  
Paul K.J. Han
Keyword(s):  
Medical Care ◽  
System Level ◽  
Culture Of Medicine ◽  
Care Education

Chapter 6 concludes the book by offering a vision for how to promote uncertainty tolerance in medicine. It identifies various system-level strategies, spanning medical care, education, and research, that can foster humility, flexibility, and courage and thereby help build uncertainty tolerance into the structures and processes of healthcare. The chapter examines how these processes can ultimately enable uncertainty tolerance to become part of both the worldview of individual clinicians and patients, and the overarching culture of medicine. The chapter makes the case that uncertainty tolerance in medicine ultimately requires the adoption of a worldview that affirms the necessity and value of uncertainty, and enables us to transcend it.

The Role of Income and Race/Ethnicity in Experiences with Medical Care in the United States and United Kingdom

2008 ◽  
Vol 38 (4) ◽  
pp. 671-695 ◽  
Author(s):  
Jason Schnittker ◽  
Mehul Bhatt
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Care ◽  
United Kingdom ◽  
Health Insurance ◽  
Medical Care ◽  
Health Care Systems ◽  
The United States ◽  
System Level ◽  
Race Ethnicity

Inequalities in experiences with medical care are well-known in the United States, but little is known about the shape of such inequalities in other countries. This study compares a broad spectrum of experiences in the United States and United Kingdom. Furthermore, it focuses on two of the most important dimensions of inequality, race/ethnicity and income, and two of the most widely discussed system-level factors, health insurance and emphasis on primary care. Two general conclusions are reached. First, there are broad income-based inequalities in medical care in both the United States and United Kingdom. These inequalities persist even after controlling for health insurance, including private medical insurance in the United Kingdom. Race is also related to experiences with medical care, although the effects of race are more particular and contingent than are those for income. In particular, the mapping of racial/ethnic inequality differs considerably between the United States and United Kingdom, reflecting their different sociocultural climates. Second, the health care system, especially primary care, plays a limited role in ameliorating inequalities in care, but plays a strong role in elevating the average level of quality within a country. Because inequalities in medical care reflect broader social processes, they are durable across very different health care systems and contexts.

scholarly journals Understanding Engagement with a Physical Health Service: A Qualitative Study of Patients with Severe Mental Illness

2019 ◽  
Vol 64 (12) ◽  
pp. 872-880 ◽  
Author(s):  
Osnat C. Melamed ◽  
Indira Fernando ◽  
Sophie Soklaridis ◽  
Margaret K. Hahn ◽  
Kirk W. LeMessurier ◽  
...  
Keyword(s):  
Mental Illness ◽  
Health Service ◽  
Qualitative Study ◽  
Physical Health ◽  
Health System ◽  
Medical Care ◽  
Severe Mental Illness ◽  
System Level ◽  
Factors Influencing ◽  
Obesity And Diabetes

Objective: Individuals with severe mental illness (SMI) are disproportionally affected by medical comorbidities, resulting in poor physical health and premature death. Despite this, care for chronic medical conditions is suboptimal, and there is limited research that explores this phenomenon from the patient’s perspective. The aim of this study was to identify barriers and facilitators of engagement with a physical health service experienced by individuals with SMI. Methods: Adults with SMI were recruited from a large psychiatric hospital and offered referral to a physical health service focused on the prevention and treatment of obesity and diabetes. Interviews were conducted at referral, 3, and 6 months. Data from 56 interviews of 24 participants were analyzed using the framework method to identify factors influencing engagement. Results: Barriers to engagement were identified at individual, medical program, and health system levels. Factors influencing the individual experience included difficulty in care coordination, affective symptomatology, and ability to bond with providers. Factors at the program level included difficulty adjusting to the clinic environment and the inability to achieve treatment goals. Factors at the system level included challenges in attending multiple appointments in a fragmented health system, lack of social support, and financial constraints. Conclusions: This qualitative study suggests that traditional models of medical care for chronic conditions pose challenges for many individuals with SMI and contribute to health disparities. Adaptation of medical care to populations with SMI and close collaboration between medical and mental health services are necessary to improve medical care and, subsequently, health outcomes.

The Problematic Nature of Education in Palliative Care

1993 ◽  
Vol 9 (4) ◽  
pp. 5-10 ◽  
Author(s):  
Christopher R. James ◽  
Roderick D. Macleod
Keyword(s):  
Palliative Care ◽  
Medical Care ◽  
Symptom Control ◽  
Care Education ◽  
Palliative Care Education ◽  
Psychological Demands

As the need for palliative care increases, palliative care is emerging as a field of medical care in its own right. At the same time there are many aspects of palliative care that are problematic, particularly in palliative care education. The aspects reviewed here include: (a) the lack of a long tradition and adequate concep-tualization of palliative care; (b) the significance of psychological, emotional, and spiritual aspects; (c) the importance of but inadequate understanding of symptom control; (d) the fact that palliative care is not curative in the accepted sense; (e) its multiprofessional nature; (f) the range of different settings of palliative care; and (g) the fact that palliative caregivers have to perform their duties in situations where the emotional and psychological demands on them may be immense. A number of general issues relevant to palliative care education are also reviewed.

scholarly journals Complements or substitutes? Associations between volumes of care provided in the community and hospitals

2021 ◽  
Author(s):  
Yiu-Shing Lau ◽  
Gintare Malisauskaite ◽  
Nadia Brookes ◽  
Shereen Hussein ◽  
Matt Sutton
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Fixed Effects ◽  
Community Care ◽  
Community Services ◽  
System Level ◽  
Hospital Services ◽  
Primary Medical Care ◽  
Fixed Effects Regression ◽  
Primary Care Activity

AbstractPolicymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

scholarly journals Challenges in medical care, education and support of children with hearing loss

2013 ◽  
Vol 56 (6) ◽  
pp. 735-742
Author(s):  
Aiko Nakatsu ◽  
Makoto Hashimoto ◽  
Kazuma Sugahara ◽  
Kenji Yamashita ◽  
Takuo Ikeda ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Medical Care ◽  
Care Education ◽  
Children With Hearing Loss

Rehabilitation Literature, 1950-1955

PEDIATRICS ◽  
1957 ◽  
Vol 20 (1) ◽  
pp. 172-172
Keyword(s):  
Medical Care ◽  
School Administrators ◽  
Exceptional Children ◽  
Handicapped Children ◽  
Care Education ◽  
Alphabetical Listing ◽  
Welfare Workers

The book indexes and annotates 5,214 periodical articles, pamphlets and books relating to the medical care, education, employment, welfare and psychology of handicapped children and adults. It brings together in one alphabetical listing, by subject, references published in the 6-year period, January, 1950, to December, 1955. The bibliography has been compiled for use primarily by physicians, occupational, physical, and speech and hearing therapists, nurses, welfare workers and administrators, school administrators and teachers of exceptional children psychologists, vocational counselors and employment personnel, and by students entering these professions.

Sign in / Sign up

Export Citation Format

Share Document