Making peace with your "difficult patient".
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Adaptation, Psychological↗
Biomedical subjects
Howard Tandeter
Publications and source records attributed to Howard Tandeter.
Treatment of plantar warts with oral valacyclovir.
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Acyclovir↗
The family medicine clerkship over the past 10 years at Ben Gurion University of the Negev.
BACKGROUND: Most medical teaching takes place in the academic hospital setting and students continue to have little exposure to community-based medicine. DESCRIPTION: The Goldman School of Medicine of the Ben-Gurion University of the Negev is a 6-year program. The 6-week family medicine clerkship takes place in the 5th year. It includes experience with home care, patient and family centered care, ongoing comprehensive responsibility, common office clinical skills, and specific organization of practicing in the community. At the end of the clerkship, students are asked to complete anonymous feedback forms to evaluate the clerkship, its formal curriculum, and the teachers. EVALUATION: Over the last 3 years, 157 general course evaluation forms were returned (84.4% compliance). The mean general evaluation and satisfaction score was 3.4 out of 4, ranking it very high compared to other clerkships in our medical school. In the same time period, 176 specific teachers evaluation forms were returned, with a mean score of 4.6 (2=weak; 5=excellent), compared with a mean score of 4.5 in 1,485 teachers evaluation forms from other clinical clerkships. CONCLUSIONS: As the focus of patient care shifts to the community, the focus of medical teaching should follow the same route. We hope that our experience will help in promoting this change and in developing new ideas for teaching family medicine and primary care.
Clinical Clerkship↗
[The creation of a national faculty development program in Israel for family physicians].
University Departments from many countries recruit their faculty members for academic duties without prior formal training (specific for their jobs). This has been the common approach in Israel. Other countries however, have created faculty development (FD) programs to help new faculty accomplish their new tasks. This article describes the creation of the first National Faculty Development Program in Israel for Family Physicians. The main goals of a comprehensive FD program are to improve vitality in education, promote academic excellence and develop professional and organizational leadership. In 1998, the Israeli Society of Teachers in Family Medicine decided to develop a National Program to deal with basic FD requirements. Family Physicians and educationalists worked together at its development and cooperated in co-teaching. The program was launched in 2001 and we are now in the process of evaluating the first year and the development of the second course. We chose a format similar to the program from the University of Toronto. Twenty-three family physicians enrolled in the course. Half of the participants were born and trained in medicine in Israel. After completing the first year of this program, both participants and teachers provided positive feedback and requests were received for a second course for new participants.
Education, Medical, Continuing↗
Teaching geriatric assessment in home visits: the family physician/geriatrician attachment.
BACKGROUND: Geriatric clinical clerkships in Israel teach mostly about the hospitalized elder patient with almost no ambulatory experience. Meanwhile, primary care physicians provide most of the health care to the elderly in the community. This article describes an innovation in the curriculum of the 5th-year family medicine clerkship at the Goldman Medical School of Ben-Gurion University in Israel designed to improve the teaching of geriatrics in the ambulatory setting. DESCRIPTION: During the clerkship, family physicians perform a home visit to one of their home-ridden elderly patients with a small group of medical students. During this visit, a geriatrician from the local hospital is included to the group for teaching purposes. EVALUATION: Most students rated this experience positively as did the family physicians and geriatricians who participated in this experience. CONCLUSIONS: This liaison-attachment teaching experience allows the students to learn aspects of geriatrics that are spared during their geriatric clerkship, allows the family physician to use this opportunity as a consultation for homebound patients, and allows the tertiary care geriatrician to teach in the community.
Ambulatory Care↗
Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders.
BACKGROUND: Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization. OBJECTIVE: Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders. METHODS: Forty-one frequent clinic attenders (> or =2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and described the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again. RESULTS: Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making > or =10 visits during the 15 month follow-up was smaller (10%) than among controls (33%). CONCLUSIONS: The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.
Adult↗
Clinical and laboratory profile of febrile respiratory infections in general practice.
BACKGROUND: Respiratory tract infection (RTI) is a common diagnosis in the primary care setting. The aim of the study was to characterize the clinical course and laboratory manifestations of febrile RTI in Israeli adults presenting to primary care clinics. METHODS: A prospective study over a 3-month winter period in 3 urban university primary care clinics of 122 consecutive adult patients seen by their family practitioners. All participants were interviewed and had chest radiographs, tests of oxygen saturation, and blood tests. RESULTS: Study group included 122 adults (mean age, 44.8 +/- 14.2 years; men, 38%). Fever lasted for a mean of 4.0 +/- 1.7 days, and the mean number of days off work/activities was 5.3 +/- 1.0. Pneumonia was clinically suspected in 33 patients (27%), but documented in 7 (6%). Antibiotics were given to 94 patients (77%). The group of treated patients had a lower mean oxygen saturation (P <.05) and a higher erythrocyte sedimentation rate (P <.05). Blood tests were found to be abnormal, although not clinically significant, in some patients, and all resolved spontaneously. CONCLUSIONS: RTIs are usually of short duration with a benign course where laboratory blood tests have no clinical implication. Radiographs may distinguish the 6% of patients having pneumonia from the 27% with suspected cases.
Adult↗