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Biomedical subjects

J F Burnum

Publications and source records attributed to J F Burnum.

At least 19 recordsLinked to original sources
PubMed1993

Medical diagnosis through semiotics. Giving meaning to the sign.

Physicians are engaged in incorporating quantitative methods for making clinical decisions into their practices. An acquaintance with semiotics, the doctrine of signs, may complement this project. A sign stands for something. We communicate indirectly through signs, and by interpreting what signs mean we make sense of our world and diagnose and understand our patients. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and staring eyes into thyrotoxicosis. Characteristically in diagnosis, beginning with an unstable inference, we test and otherwise ask questions likely to produce signs that support (or discredit) our hypothesis. In a literary sense, we join with the author to clarify and rewrite the text; creative interpretation is the key. Diagnosis is concluded through narration, by the meaning that is revealed by telling the story of the patient. Diagnosis will succeed only to the extent that we respect the principles and caveats of sign interpretation. The sign is both the key to the unknown and the master impersonator. The sign and its meaning are usually not the same; meaning has to be inferred. Because interpretations are made subjectively, they are circumscribed by the experience and bias of the clinician. Moreover, the contexts in which the sign appears shape the meaning of the sign and may change it altogether.

Clinical Competence↗
PubMed1989

The misinformation era: the fall of the medical record.

Medical record information has become less reliable than ever before despite the electronic information revolution in medical care and the authority medical records have been accorded in our society. Long flawed by errors introduced by medical personnel, patients, and machines, medical records have had a further decline in credibility as a result of the loss of confidentiality and the imposition of well-meaning but unrealistic cost-control regulations on medical practice. Medical records are being distorted and fashioned to keep clinically important but sensitive personal information about patients from public view. To comply with standards of care and a reimbursement system blind to biologic diversity, medical records are being forced to address only the technical side of care. Until these deficiencies are corrected, our increasing dependence on medical records should be balanced by increasing skepticism about the value of the information they contain.

Confidentiality↗
PubMed1986

Medical vampires.

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Bloodletting↗
PubMed1984

Dialect is diagnostic.

Folk medical language, as spoken in western Alabama, contains medical dialect terms that have an ancient lineage, with structure and meaning very similar to those of their earliest roots. The dialect has precise medical meanings and is used with astonishing accuracy by patients. Terms and phrases are often diagnostic as well as colorfully descriptive. An appreciation of medical dialect makes practice more fun, history taking and diagnosis easier, and lessens misunderstandings with patients. It sharpens the physician's senses to every level of what patients feel and say, verbal and otherwise. An appreciation of dialect heightens respect for patients and gives the physician a sense of continuity with cultures and ages past. Understanding and respect for medical dialect can be a powerful aid to patient care.

Alabama↗
PubMed1982

Diagnosis of depression in a general medical practice: observations on "lack of pizzazz," the "blahs," and other complaints.

Patients rarely admit that they are depressed, and the signs and symptoms may be subtle. We need not miss the diagnosis, however, if we listen carefully to the patient's compliants and trust our own clinical acumen. When should we refer depressed patients to a psychiatrist? When we do not have the time that the patient deserves and when the depression is severe. Of 76 patients with depression in my practice, I referred about 12% (9). Can we forget about general medicine once the diagnosis of depression is made? Emphatically not. Major physical disease was present in 75% (57) of my depressed patients, and virtually all had a potpourri of baffling physical symptoms that required careful diagnostic analysis.

Back Pain↗
PubMed1978

The worried sick.

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Attitude to Health↗
PubMed1977

The malaise in internal medicine.

Internists today are discomforted by uncertainty of identity, governmental interference with practice, total responsibility for patients' health, and by waning of faith in science. As personal "caring" physicians, internists are secure in primary care but should maintain their distinctive scholarly leadership as master clinicians and consultants. Humanism and science are one in patient care. Future practice patterns depend on physicians themselves participating in policy decisions for inevitable controls and rationing of government financed health services. The public must understand that good health depends not only on physicians but also on a better society and what people are willing to do for themselves. Western culture has been shaken by the cruel paradoxes of progress and technology. But, human choice not science is at fault, and only wisdom in the use of science will save us.

Decision Making↗