Of ethics and education: strategies for curriculum development.
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Biomedical subjects
Publications and source records attributed to D Aldridge.
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There is an increase in suicidal behaviour in the western world providing a major challenge to health care providers. There is an increase in the number of suicides among elderly people in Europe. The problem of suicides among elderly people is in itself a social problem, not solely a medical one. The general practitioner may be the only source of social contact for the elderly. Elderly individuals often present their problems to doctors as somatic complaints; these complaints must not be taken at face value but understood as expressions of psychosocial and social distress. The rise in suicide rates among young people is also alarming. The warning signs of escalating distress in adolescents are known and a treatment programme coordinating medical initiatives, such that recidivism of suicidal behaviour in adolescents is reduced, is necessary. The general practitioner is urged to sense when the problem presented by the individual stems from a source which is predominantly social, and to suggest an appropriate solution which may entail a family intervention. The general practitioner is in the front line of treatment and he or she may be better advised to treat both the social situation and the individual person in cases of attempted suicide. Medical initiatives must incorporate aspects of social medicine whereby community solutions are found for the management of individual distress. Social disruption, isolation, conflict and neglect are the doors to the house of despair. While medicine must respond to those who enter that house, it is the social level at which we must be the architects of change. People will die.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study investigated suicides by people aged ten to 19 in Newfoundland and Labrador from 1977 to 1988. It is the first study of suicide in the province to use the records of death from all eight hospital pathology departments in the province and from the office of the Chief Forensic Pathologist. Cases were selected for the study using standardized criteria, independent of the manner of death recorded on the death certificate. A suicide rate of 4.37 per 100,000 was found. This rate and the age- and sex-specific suicide rates are lower than the official figures for Canada but higher than those reported in earlier Newfoundland studies. The rate for males was nearly five times the female rate, and the rate for people aged 15 to 19 was nearly six times that of people aged ten to 14. Suicide rates for Labrador were higher than for the island portion of the province for both Native and for non Native adolescents. Extremely high rates of suicide were found only among the Native population living in Northern Labrador, while none were recorded for Native people elsewhere. Firearms accounted for 54% and hanging for 33% of all suicides. Thirty percent of suicides occurred on a Saturday. Only 36 of the 63 deaths included in this study were designated as suicide on death certificates. The higher rate of under-reporting of suicide than in other jurisdictions suggests that official rates may not be useful for comparisons. The reasons for the high rate of under-reporting are discussed.
The natural science base of modern medicine influences the way in which medicine is delivered and may ignore the spiritual factors associated with illness. The history of spirituality in healing presented here reflects the growth of scientific knowledge, demands for religious renewal, and the shift in the understanding of the concept of health within a broader cultural context. General practitioners have been willing to entertain the idea of spiritual healing and include it in their daily practice, or referral network. Recognizing patients' beliefs in the face of suffering is an important factor in health care practice.
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Cancer involves change in individuals and families. Family practitioners are in a unique position to meet the needs of families where cancer is present. By coordinating differing therapeutic interventions and developing therapeutic support within the community the physical, psychological, social and spiritual needs of those who are dying, and the needs of their families, can be met.
With current moves towards an emphasis on the 'whole' patient rather than fragmenting the person into organ systems research methods need to be developed which reflect that emphasis and direct us in our endeavour as clinicians. It is possible to have a descriptive science of human behaviour which can be based upon clinical consultations. In this way the clinician is required to act as a clinical anthropologist as well as a clinical epidemiologist.
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