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Biomedical subjects

J E Sabin

Publications and source records attributed to J E Sabin.

9 recordsLinked to original sources
PubMed1991

Clinical skills for the 1990s: six lessons from HMO practice.

Clinical practice in health maintenance organizations (HMOs) currently has many of the features that will become increasingly common in the managed-care environment in which mental health treatment will be provided in the 1990s. HMO policies calling for cost containment, attention to outcomes, practice audits, and treatment guidelines create distinctive demands on clinicians regarding their focus of attention, clinical stance, and professional role. The author identifies six crucial skills that can help clinicians meet these demands effectively: population-oriented practice management, population-oriented program development, ability to apply an adult developmental model, command of a broad repertoire of methodologies, ethical analysis, and advocacy. He uses brief case examples to illustrate how these skills may be used in managed-care settings.

Clinical Competence↗
PubMed1990

Joseph Hersey Pratt's cost-effective class method and its contemporary application: some problems in biopsychosocial innovation.

Problems reflecting the stress of illness and the illness of stress account for 20-50% of medical visits and an unquantified but substantial portion of the billions of dollars spent annually on tests and procedures (Stoeckle et al. 1964). The "high-tech" form of practice, favored so powerfully by American medicine and supported so lavishly by financial incentives, produces limited benefits in this domain of suffering and medical care. In an era of increasing panic about the runaway cost of health care, medicine desperately needs cost-effective forms of "low-tech" treatment for patients with psychosomatic conditions and the emotional dimensions of chronic and recurrent illness. Between 1905 and 1955 Joseph Hersey Pratt (1872-1956), an eminent Boston internist and professor of medicine, developed what appears to have been a highly efficient, class-based method for treating such patients in an empathic and biotechnically sound manner. Pratt pioneered his technique in the Emmanuel Church Tuberculosis Class between 1905 and 1923, the work for which he is best known. Seven years later he adapted the method for treatment of patients with chronic psychosomatic conditions, and from 1930 to 1955 he again appears to have achieved considerable success in a highly efficient manner in what was called the Thought Control Class at the Boston Dispensary. Although the treatment of tuberculosis has of course been totally transformed by antibiotics, psychosomatic conditions and the emotional dimensions of chronic illnesses like tuberculosis form an ever larger component of the suffering seen in general medical practices. For this reason, a historical study of Pratt's techniques, theories, and the fate of his innovations may provide practical guidance for contemporary health care practice.

Boston↗
PubMed1978

The therapeutic relationship in neighborhood psychiatry: impact of clinical setting on clinical practice.

The relationship between psychotherapist and patient in neighborhood mental health practice differs in important ways from the therapeutic relationship established in other clinical settings. Obviously, no matter where therapist and patient meet, their personality characteristics and the clinical methodology will shape the relationship between them. Most clinical approaches emphasize personality and technique--therapists of all schools are trained to scrutinize these aspects of psychotherapy. But therapists are generally less well prepared to comprehend the clinical impact of the organizational setting itself (Newton and Levinson, 1973). Consequently, the practitioner may not recognize how much the system in which he works influences the way he and his patient relate to each other.

Community Mental Health Services↗
PubMed1975

Translating despair.

The author reviews two cases of suicide by Spanish-speaking patients who were evaluated and treated by English-speaking psychiatrists using a translator. He suggests that the patient's emotional suffering may be selectively underestimated when the clinician works by means of translation. The diagnosis may emphasize psychotic features of the illness and minimize the affective component; consequently the risk of suicide may be underestimated.

Affective Symptoms↗
PubMed1975

Integrating community psychiatry into residency training.

Beginning in 1969 a training program in community psychiatry was developed in a psychiatric hospital that had become a community mental health center with responsibility for a catchment area. Initially the program focused on individual supervision of psychiatric residents in their work with inpatients from the catchment area. The inadequacies of that approach led to assigning residents to spend four hours each week in a comprehensive neighborhood health center. Later they were also assigned to interdisciplinary inpatient teams led by community psychiatry supervisors. The authors describe the evolution of the program, report the results of an evaluation, and present some conclusions about training in community psychiatry.

Attitude of Health Personnel↗