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Biomedical subjects

D E Girard

Publications and source records attributed to D E Girard.

At least 19 recordsLinked to original sources
PubMed1992

Alcohol and other substance abuse and impairment among physicians in residency training.

Substance abuse and impairment are serious societal problems. Physicians have historically had high rates of substance abuse, which has been viewed as an occupational hazard. Most authorities agree that the rate of alcoholism among practicing physicians is similar to that among control populations and that the rates of other substance abuse are greater, although some studies have shown no difference. Data about substance abuse among residents in training are limited but suggest that the use of benzodiazopines is greater than that among age-matched peers, whereas the use of alcohol is similar between the two groups. Medical institutions, including those with teaching programs, have legal and ethical responsibilities concerning substance abuse among current and future physicians. Many training programs, however, do not provide educational programs on this subject, do not have faculty trained in substance abuse medicine, and do not have a formal system to address the problem of residents who are suspected or known to be substance abusers. This position paper examines the extent of substance abuse, including alcohol abuse, among physicians in residency training. It outlines approaches to the problem and delineates responsibilities of institutions and residency program directors. Recommendations are made to establish an informational program and a clearly defined, organized process to address the problems of substance abuse among residents. Careful and humane approaches can be used to identify and treat residents with substance abuse problems and thus allowing them to complete their training as competent and drug-free professionals.

Alcoholism↗
PubMed1991

A prospective study of internal medicine residents' emotions and attitudes throughout their training.

To evaluate whether the negative emotions and attitudes that residents develop during internship continue throughout the remaining years of their residency, the authors undertook a four-year prospective study of two classes of internal medicine residents who completed their training in 1985 and 1986 in a residency program based at the Oregon Health Sciences University. Every two to three months over all three years of training, the residents indicated on Likert-type scales their levels of agreement with questions about their career satisfaction and emotional states, and the satisfying and dissatisfying aspects of their residency experiences. Between the internship and the end of their residencies, the physicians indicated significant improvements in their emotions and attitudes. Those experiences identified as satisfying continued to be so, whereas those considered dissatisfying became less so. Although more research of other classes of residents is needed, the findings suggest that while internal medicine internships may be dysphoric, the residents' emotional states and attitudes tend to normalize during the remainder of the residency.

Adult↗
PubMed1988

The doctor-patient relationship during medical internship: the evolution of dissatisfaction.

We prospectively examined perceptions of the doctor-patient relationship among interns in two different internal medicine training programs five times during the internship year. All 59 interns in the University of California, Irvine-Long Beach and the Oregon Health Sciences University Medical Programs participated in the study during the 1982-83 internship year. We serially administered a questionnaire that contained four major items: (1) a choice of one of six empirically developed role paradigms of the doctor-patient relationship; (2) a checklist of positive and negative aspects of internship; (3) a measure of level of satisfaction with the decision to become a physician; and (4) a rating list of mood descriptors. The six role paradigms portrayed a variety of positive and negative aspects of the doctor-patient relationship. At the beginning of the year, the interns were quite positive about the doctor-patient relationship and preferentially endorsed collegial models. As the year progressed, they endorsed significantly fewer positive and more negative models (P less than 0.001). Most respondents endorsed two models, one positive: "expert resource (doctor)--active cooperative participant (patient)" and one negative: "clerk, paperwork processor (doctor)--subscriber, seeker of eligibility (patient)." By the end of the year approximately half of the interns endorsed a positive and half a negative model. Interns selecting a negative model of the doctor-patient relationship identified more negative and fewer positive aspects of internship than those selecting a positive model. Specifically, they significantly more often (P less than 0.001) identified too much paper work and coping with difficult patients as negative aspects of internship.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Hematologic effects of acute and chronic alcohol abuse.

Alcoholism affects 3 to 10 per cent of the American population. Alcohol is toxic to all organ systems. This article summarizes current information about the hematologic sequelae of alcohol abuse. A brief summary of ethanol-related metabolic events is followed by discussion of specific disorders of erythrocytes, leukocytes, platelets, and the immune apparatus.

Acute Disease↗
PubMed1986

The internship--a prospective investigation of emotions and attitudes.

In a prospective survey for changes in emotions and attitudes of all medical interns of The Oregon Health Sciences University (N = 22) at six intervals during the 1982-1983 academic year, both positive and negative emotional changes were noted. Satisfaction with the decision to become a physician decreased during the period, a change that correlated directly with depression and fatigue and inversely with excitement and importance.

Attitude of Health Personnel↗
PubMed1985

Peanut shell colitis.

A 40-year-old physician experienced abdominal pain, loose stools, hematochezia, and anal discomfort with defecation associated with the daily consumption of 15 to 30 whole peanuts, including the shells. Thorough evaluation revealed only nonspecific colitis of the distal portion of the sigmoid colon and inflamed hemorrhoids. Discontinuation of whole peanut ingestion was associated with symptomatic, endoscopic, and histological resolution. In this patient, undigested peanut shells seem to have caused a nonspecific colitis, perhaps as the result of mechanical abrasion of the colonic mucosa.

Adult↗
PubMed1985

Psychosocial events and subsequent illness--a review.

The public readily accepts the relationship between psychosocial events and illness and acknowledges that stress is important in the acquisition of disease. However, scientific documentation of these relationships has not been convincing and many clinicians remain skeptical. In this review we survey selected studies from socioepidemiologic, psychologic and physiologic research, chosen for their methodologic rigor, that help clarify the relationship between psychosocial events and illness. We conclude (1) though difficult to prove, available data support a positive relationship between psychosocial events and illness, and (2) psychologic well-being is important for good physical health.

Disease↗
PubMed1979

Adrenocorticotropin-cortisol axis abnormalities in hemodialysis patients.

The ACTH-cortisol axis was studied in 15 hemodialysis patients. Basal plasma cortisol concentrations were found to be elevated and ACTH to be in the high normal range. Cortisol responded normally to exogenous ACTH, but neither cortisol nor ACTH were suppressed in response to oral dexamethasone. 11-Deoxycortisol and ACTH concentrations did not rise normally in response to either oral or iv metyrapone. We conclude that standard testing of the ACTH-cortisol axis in dialysis patients yields results suggesting Cushing's syndrome.

Adrenocorticotropic Hormone↗