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Biomedical subjects

J D Stoeckle

Publications and source records attributed to J D Stoeckle.

At least 37 records · Page 2Linked to original sources
PubMed1990

The nature of patients' requests for physicians' help.

This report describes patients' requests for help in two outpatient settings--one, a general medicine practice (GMP); the other, a medical walk-in unit (WIU). Interview data were collected in 1981 from 200 patients prior to their visits with the doctor. Patients were asked, "How do you hope the doctor (or clinic) can be of help to you today?" Their responses were written down verbatim. A coding system was devised that described the specificity, focus, and form of each request in order to provide the clinician with a classification for recognizing these request elements and responding to them. Specificity (precision) was identified from the response to "What do you hope the doctor will do for you?" The focus (objective) was described by four categories: problem, treatment, relationship, and administration; the form (intervention), by five categories: somatic, cognitive, affective, advice, and instrumental. Patterns of requests differed in the two settings. In the WIU, the pattern of requests had a problem focus with a form split between the cognitive (wanting an explanation) and the somatic (wanting a medical procedure); in the GMP, treatment was the focus, with a somatic form. The overall results indicate the varied requests of medical outpatients that express their perspectives about their illnesses. This classification of requests should be useful to physicians in eliciting and responding to their patients' requests.

Communication↗
PubMed1989

Primary care and diagnostic testing outside the hospital.

This article enumerates and describes the wide range of sites at which primary care is now offered; analyzes the impact of diagnostic testing procedures used in locations outside the doctor's office, such as imaging centers, hospices, and nursing homes; and looks at the effect of this decentralization on patients and medicine.

Ambulatory Care Facilities↗
PubMed1988

Corporatization and the social transformation of doctoring.

Corporatization of health care is dramatically transforming the medical workplace and profoundly altering the everyday work of the doctor. In this article, the authors discuss recent changes in U.S. health care and their impact on doctoring, and outline the major theoretical explanations of the social transformation of medical work under advanced capitalism. The adequacy of the prevailing view of professionalism (Freidson's notion of professional dominance) is considered, and an alternative view, informed by recent changes, is offered. While the social transformation of doctoring is discussed with reference to recent U.S. experience, no country or health system can be considered immune. Indeed, U.S. experience may be instructive for doctors and health care researchers in other national settings as to what they may expect.

Economic Competition↗
PubMed1988

Adult patient-dentist relationship.

The author considers the adult patient dentist relationships from three vantage points: (1) the relationships of medical and dental practitioners; (2) the dynamic and anatomy of dental encounters; and (3) the essentials of clinical work, in which relationships are important.

Adult↗
PubMed1988

Reflections on modern doctoring.

Physicians today are concerned that changes in the organization of medical care may greatly reduce their control of the practice of medicine. Evidence of the effects of three of these changes--the rapid corporatization of practice, the increased use of medical technology, and the use of information technology in clinical decision making--suggests that doctors are losing much of the autonomy that previously characterized their profession. Physicians complain not only about regulatory constraints and loss of income, but also about how changes in the health care system have critically altered the doctor/patient relationship and lessened the interpersonal rewards of the profession.

Delivery of Health Care↗
PubMed1987

Disease, lifestyle, and consanguinity in 58 American Gypsies.

Medical data on 58 Gypsies in the area of Boston, Massachusetts, were analysed together with a pedigree linking 39 of them in a large extended kindred. Hypertension was found in 73%, diabetes in 46%, hypertriglyceridaemia in 80%, hypercholesterolaemia in 67%, occlusive vascular disease in 39%, and chronic renal insufficiency in 20%. 86% smoked cigarettes and 84% were obese. Thirteen of twenty-one marriages were consanguineous, yielding an inbreeding coefficient of 0.017. The analysis suggests that both heredity and environment influence the striking pattern of vascular disease in American Gypsies.

Adolescent↗
PubMed1986

The training of physicians outside the hospital.

The current ambulatory training of medical residents in the primary care program and the traditional program of the Massachusetts General Hospital, Boston, are described. All residents are assigned to work in a single medical group practice unit during their three years of training. Block outpatient rotations make up 32% of the primary care program and 6% of the traditional program schedules, while total ambulatory experiences, including weekly continuity sessions, make up 39% and 15%, respectively. Several components are important for a successful program. Above all is a vigorous group practice providing a sizable panel of patients with complex clinical problems from which residents can learn. Also important are financial support from the hospital and government or private grants and a commitment to outpatient teaching by the medical and nonmedical specialty staff.

Boston↗
PubMed1985

A seminar in 'Plain Doctoring'.

Plain Doctoring is an elective, preclinical seminar on the phenomenology of the patient and the physician. Home visits by students serve as the major text for examining the patient's experience of illness and treatment and for reflecting on the process of attending to patients. Readings in the humanities complement the house calls. The students, the patients, and the seminar instructors have all commented favorably on the seminar.

Curriculum↗
PubMed1984

Ethnicity in the reported pain, emotional distress and requests of medical outpatients.

Relationships of patients' ethnicity to their reported pain, emotional distress and requests were investigated. When patients aged over 60 years were compared. Italian-Americans were found to more frequently report pain than were Anglo-Americans; however, this difference was not replicated in the younger patients of Italian and Anglo backgrounds. In addition to patients' age, their sex also was found to mediate the relationship of ethnicity to the expression of pain. In particular, older female Italian-Americans were likely to report pain while, in contrast, older male Anglo-Americans were not. Age and sex may be important mediators of ethnic differences because older and female patients may carry on ethnic traditions more than do younger and male patients. Ethnicity was not found to be significantly related to emotional distress and requests.

Communication↗
PubMed1983

Tips, status and sacrifice: gift giving in the doctor-patient relationship.

This study examines the gifts physicians receive from their patients. Internists in a hospital-based group practice kept diaries of gifts received and were interviewed about their responses and the reasons which they ascribed to the patient's gift-giving. It describes how physicians avoid reciprocating, categorizes the nature of gifts and, for the special instance of manipulative gifts, how these may be defused. Patient gifts are found to be reciprocations for some action on the part of the physician, which the patient, in turn, perceives as a gift. Three categories of gifts, according to their nature and timing, are: (1) gifts as 'tips', given to promote personalized service, to assure the continued interest and the tolerance of the physician; (2) gifts to address the status imbalance in the doctor-patient relationship, either by imposing a non-professional identity on the physician or by redeeming status lost in the sick role; (3) gifts as a sacrifice to the physician who exercises his power on the patient's behalf.

Age Factors↗