On visibility: AIDS, deception by patients, and the responsibility of the doctor.
(49/750)
Contrary to the usual discussion of lying or deceiving in medical ethics literature where the lying or deceiving is done by the doctor or surgeon, this paper deals with lying or deceiving on the part of the patient. Three cases involving HIV-infected male homosexual or bisexual persons are presented. In each case the patient deceives or wants the doctor to deceive a third party on his behalf. Are such deceptions or lies expressions of compassion? Are they in the patient's best interests? Do they compromise the doctor's integrity? It is submitted that societal attitudes towards male homosexual acts were internalised by the men described in these cases. Thus, a dichotomy was created between the private life and the public image. Fear of condemnation by the doctor or others restricted communication towards the goal of the maintenance of the patient's health. The lack of trust which inhibits truth-telling results in mutual and progressive isolation and impedes the provision of optimal care. (+info)
Cancer prevention in underserved African American communities: barriers and effective strategies--a review of the literature.
(50/750)
African Americans suffer significantly more cancer morbidity and mortality than the white population. In order to decrease this differential, it is critical to understand the particular barriers to health and health care that underserved African Americans face. It is also important to identify the critical components of effective cancer prevention programs for this population. The barriers that impede care for underserved African Americans have been identified as: 1) inadequate access to and availability of health care services; 2) competing priorities; 3) lack of knowledge of cancer prevention and screening recommendations; 4) culturally inappropriate or insensitive cancer control materials; 5) low literacy; 6) mistrust of the health care system; and 7) fear and fatalism. Effective programs must incorporate community participation, innovative outreach, use of social networks and trusted social institutions, cultural competence, and a sustained approach. Programs that include these strategies are much more likely to be effective in reducing cancer incidence. Cancer ranks second only to cardiovascular disease as the leading cause of death in the United States. For the majority population, cancer incidence and prevalence have declined in recent years and cure rates for certain cancer diagnoses have improved. This can be attributed to progress in the development and implementation of prevention, early detection, and treatment strategies. However, despite these gains, medically underserved African American populations have not fared as well. When African American-white mortality rates are compared, African Americans are 1.3 times more likely to die of cancer than the general population. Data from the Bureau of Health Information, Wisconsin Department of Health and Family Services indicate that from 1996 to 2000, cancer accounted for 33% of deaths in African Americans aged 45-64 and 34% of deaths for those aged 65-74. To decrease the disparities in cancer morbidity and mortality between the African American and white population, it is critical to understand the particular barriers to health and health care that African Americans face. This paper is a literature review of the barriers that low-income African American populations confront in obtaining needed cancer prevention and detection and the characteristics of programs that have been effective in reaching these populations. (+info)
Assessing the cultures of medical group practices.
(51/750)
BACKGROUND: The culture of medical group practices is gaining increasing attention as one of the most important organizational factors influencing the costs and quality of health care. Based on organizational theory, we propose that the culture of the practice differs depending on size, ownership, location, and the number of medical specialties. METHODS: A survey was sent to 1223 physicians in 191 clinics in the upper Midwest. The clinic response rate was 77%. The survey instrument identifies 9 culture dimensions, each with 3 to 6 measurement statements. RESULTS: Smaller clinics had higher scores on 6 of the 9 dimensions. Physician-owned clinics had higher scores on 4 of the 9 dimensions, whereas system-owned clinics had a higher score on only 1 dimension. Only 1 dimension differed among the locations. Single-specialty clinics had higher scores on 4 dimensions and multispecialty clinics had higher scores on 2 dimensions. CONCLUSION: Our data confirm the contention that the culture of medical group practices varies considerably; to a degree, this variance is as predicted by organizational theory. The culture changes as group practices become larger and more complex through diversification into multispecialty practices or become part of larger health care systems. (+info)
Improvement, trust, and the healthcare workforce.
(52/750)
Although major defects in the performance of healthcare systems are well documented, progress toward remedy remains slow. Accelerating improvement will require large shifts in attitudes toward and strategies for developing the healthcare workforce. At present, prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce in reinventing the system. This requires a workforce capable of setting bold aims, measuring progress, finding alternative designs for the work itself, and testing changes rapidly and informatively. It also requires a high degree of trust in many forms, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. A new healthcare workforce strategy, founded on these principles, will yield much faster improvement than at present. (+info)
The relationship between continuity of care and trust with stage of cancer at diagnosis.
(53/750)
BACKGROUND AND OBJECTIVES: While continuity of care has been associated with an increased rate of cancer screening, it is unclear if continuity leads to earlier detection of cancer. This study examined the relationship between continuity of care and trust in one's physician with stage of cancer among newly diagnosed colorectal and breast cancer patients. METHODS: A total of 119 newly diagnosed cancer patients (97 breast, 22 colorectal) were surveyed in face-to-face interviews. The relationship between continuity of care and trust with the patient's primary care physicians prior to diagnosis were examined in relationship to the patient's stage at diagnosis via Spearman correlations and chi-square analyses. A stepwise logistic regression model was computed to examine the best predictors of stage at diagnosis. RESULTS: Half of the patients reported that their cancer was found through screening. Continuity of care prior to diagnosis was related to receiving mammography. Continuity of care was not, however, significantly related to earlier detection. Trust in one's primary care physician was related to earlier detection among both the entire sample of patients with colon and breast cancer and among a subsample of women with breast cancer. In a multivariate model, only detection through screening and trust predicted stage of diagnosis. CONCLUSIONS: Continuity of care is not related to earlier detection of cancer, while trust with a regular physician was associated with earlier detection of cancer. (+info)
Ethnicity/race, paranoia, and hospitalization for mental health problems among men.
(54/750)
OBJECTIVES: I tested the hypothesis that Black men with high levels of distrust (i.e., mild paranoia) are at greater risk of hospitalization for mental health problems than their White counterparts. METHODS: Secondary analysis was conducted of data from a subsample of 180 men in an epidemiological study. Mental health hospitalization was the outcome and ethnicity/race, mild paranoia, and their interaction were main predictors in a logistic regression analysis. The ethnicity/race by mild paranoia interaction tested the study hypothesis. RESULTS: The ethnicity/race by mild paranoia interaction was statistically significant. Contrary to the hypothesis, Black men with mild paranoia were less likely to be hospitalized. CONCLUSIONS: Black men's lack of trust regarding the mental health system may cause them not to seek services. Factors critical to increasing their trust are acknowledgment of racial biases in the mental health system and sincere efforts to eliminate racial disparities in mental health treatment. (+info)
The relationship between motivation to volunteer, gender, cultural mistrust, and willingness to donate organs among Blacks.
(55/750)
The relationship between motivation to volunteer, gender, cultural mistrust, and the willingness of blacks to donate their organs, as well as the organs of relatives, was explored. Participants consisted of 107 black students attending a university located in the southwest. All participants were given the Volunteer Functions Inventory (VFI), Cultural Mistrust Inventory (CMI), Organ Donation Questionnaire (ODQ), and a background information questionnaire. It was found that individuals with low scores on the VFI and high scores on the CMI were less willing to consent to donating their organs. Also, females and individuals with high CMI scores were less willing to permit the recovery of organs from relatives. Some theoretical and applied implications for mental health professionals are suggested. (+info)
Development and testing of the health care system distrust scale.
(56/750)
BACKGROUND: Distrust of the health care system may be a significant barrier to seeking medical care, adhering to preventive health care and treatment regimens, and participating in medical research. OBJECTIVE: To describe the development and psychometric testing of an instrument (the Health Care System Distrust Scale) to measure distrust of the health care system. METHODS: Scale development involved 2 phases. In Phase 1, a pilot instrument was developed based on a conceptual model of health care-related distrust. Draft items were created using focus group sessions with members of the general public, literature review, and expert opinion. Draft items were pilot tested with 55 individuals waiting to be assigned to jury duty at the Municipal Court of Philadelphia. A priori, candidate items for elimination or revision included those with >5% missing data, extremely low or high interitem or item-total correlations, or those having a negative effect on the scale's internal consistency. In Phase 2, we conducted a survey of 400 prospective jurors to assess the reliability and validity of the final scale scores. RESULTS: In Phase 1, a 10-item scale was constructed that included 4 items measuring honesty, 2 items measuring confidentiality, 2 items measuring competence, and 2 items measuring fidelity. The participants in Phase 2 had a mean age of 41 years. Forty-three percent were African-American, 45% white, and 4% Hispanic. Scores on the Health Care System Distrust scale ranged from 12 to 46 with a possible range from 10 to 50. The mean score was 29.4 with a standard deviation of 6.33. No item had over 5% missing data. Internal consistency (Cronbach's alpha) was 0.75. Item-total correlations ranged from 0.27 to 0.57. Principal components analysis revealed 1 general component accounting for 32% of the variance. Nine of the variables had loadings higher than 0.40. As predicted, distrust of the health care system was higher among African Americans than whites and was inversely correlated with trust in personal physicians. CONCLUSIONS: Initial testing suggests that we developed an instrument with valid and reliable scores in order to measure distrust of the health care system. Future research is needed to evaluate the validity and reliability of the Health Care System Distrust scale among diverse populations. This instrument can facilitate the investigation of the prevalence, causes, and effects of health care system distrust in the United States. (+info)