PubMed Health⌕ Search

Biomedical subjects

J Z Sadler

Publications and source records attributed to J Z Sadler.

15 recordsLinked to original sources
PubMed1997

Recognizing values: a descriptive-causal method for medical/scientific discourses.

While much discussion in bioethics, philosophy of science, and philosophy of medicine concerns the proper handling and uses of value considerations, there has been little discussion about how to identify or recognize values in medical/scientific discourse. This article presents a heuristic method for identifying values in such discourses. Values are defined as descriptions or conditions that guide human action and are praise- or blameworthy. Values manifest themselves in discourses in one or more of three dimensions: linguistic, causal, and descriptive; each with distinctive "subtypes". By recognizing the various ways that values manifest in discourses, a "values scholar" can ask relevant questions of the discourse and thereby come to recognize potential evaluative meanings in the discourse. Numerous examples are provided from the author's own research program. Strengths, limitations, and paths to developing the model are briefly discussed.

Bioethics↗
PubMed1997

The philosophy of psychiatry: who needs it?

Many a psychiatrist has said that he did not want to burden himself with a philosophy and that this science had nothing to do with philosophy. But the exclusion of philosophy would nevertheless be disastrous for psychiatry: firstly, if we are not clearly conscious of our philosophy we shall mix it up with our scientific thinking quite unawares and bring about a scientific and philosophic confusion. Secondly, since in psychopathology in particular the scientific knowledge is not all of one kind, we have to distinguish the different modes of knowing and clarify our methods, the meaning and validity of our statements and the criteria of tests- and all this calls for philosophic logic ... To sum up: If anyone thinks he can exclude philosophy and leave it aside as useless, he will be eventually defeated by it in some obscure form or another.

Culture↗
PubMed1997

Teaching ethics using small-group, problem-based learning.

Ethics is the emphasis of our first-year Introduction to Clinical Medicine-1 course. Introduction to Clinical Medicine-1 uses problem-based learning to involve groups of seven to nine students and two facilitators in realistic clinical cases. The cases emphasize ethics, but also include human behaviour, basic science, clinical medicine, and prevention learning issues. Three cases use written vignettes, while the other three cases feature standardized patients. Groups meet twice for each case. In session one, students read the case introduction, obtain data from the written case or standardized patient, identify the case's ethical problems, formulate learning issues, discuss ways to resolve the moral conflicts, and assign research responsibilities. In session two, students discuss their assigned learning issues and specify and justify clinical actions to address the case's ethical dilemmas. Following three cases, groups write an essay discussing what they learned and describing how they would approach and resolve the case's learning issues.

Education, Medical, Undergraduate↗
PubMed1994

On values in recent American psychiatric classification.

The DSM-IV, like its predecessors, will be a major influence on American psychiatry. As a consequence, continuing analysis of its assumptions is essential. Review of the manuals as well as conceptually-oriented literature on DSM-III, DSM-III-R, and DSM-IV reveals that the authors of these classifications have paid little attention to the explicit and implicit value commitments made by the classifications. The response to DSM criticisms and controversy has often been to incorporate more scientific diversity into the classification, instead of careful inquiry and assessment of the principal values that drive the nosologic process. Implications for psychiatric science and future DSM classifications are discussed.

Forecasting↗
PubMed1993

Critical thinking in preclinical course examinations.

PURPOSE: To examine the relationship between preclinical medical school course examinations and critical-thinking skills by correlating examination results with the Watson-Glaser Critical Thinking Appraisal (WGCTA), an 80-item critical-thinking inventory. METHOD: The 196 students in the class of 1993 at the University of Texas Southwestern Medical Center at Dallas Southwestern Medical School were given the WGCTA during the second half of their freshman year. A composite WGCTA score and five subtest scores were calculated for each student. The course examinations were 25 tests, each with a majority of multiple-choice items, from courses given during the first two years of the school curriculum. The students' undergraduate grade-point average (GPAs), medical school GPAs, and Medical College Admission Test (MCAT) scores were also included in the analysis. Pearson product-moment correlations were calculated between the students' WGCTA scores and their examination scores, MCAT scores, and GPAs. RESULTS: Sixteen of the examinations--in the behavioral sciences, psychiatry, ethics, pathology, introduction to clinical medicine, genetics, endocrinology, and cell biology--had significant positive correlations with the WGCTA, as did MCAT scores and first-year GPAs. Correlations were more robust with the WGCTA subscales for interpretation (18 examinations), evaluation of arguments (15), and deduction (13), and less robust with the subscales for inference (7) and recognition of assumptions (3). CONCLUSIONS: The results suggest that objective multiple-choice examinations can at least partially reflect critical-thinking skills.

Educational Measurement↗
PubMed1992

Clinical problem solving and the biopsychosocial model.

Engel's biopsychosocial model, while unifying the sciences relevant to medicine under general systems theory, is of limited utility in organizing bedside clinical problem solving. The authors consider this issue in light of the structure and goals of the clinical encounter. The biopsychosocial model is a model for organizing the sciences relevant to medicine; however, medical/psychiatric practice poses problems both within and outside the scientific realm. Since the biopsychosocial model cannot account for clinical problems to which the methods of science do not apply, the authors seek to facilitate biopsychosocial problem solving by proposing a clinical decision-making model that complements the biopsychosocial model. Their model directs the clinician's attention to three core aspects of the clinical encounter: problems of knowledge, ethics, and pragmatics. The authors reconsider Engel's case of Mr. Glover to demonstrate the anticipatory emphasis of the model. Other clinical examples are used to demonstrate the difficulties arising from mistaking one kind of aspect of medicine for another. When these three aspects of medicine are respected equally, a biopsychosocial practice is unavoidable.

Decision Making↗
PubMed1991

The cognitive context of examinations in psychiatry using Bloom's taxonomy.

Psychiatric practice involves complex thinking patterns. In addition to commanding a huge number of facts, the student must learn to manipulate factual knowledge to solve diagnostic problems, develop treatment plans, and critically evaluate those plans. This study demonstrates an empirical method for evaluating the level of cognitive processes tested in multiple choice examinations. Use of Bloom's taxonomy in evaluating test items demonstrated the majority of test items on a psychiatry clerkship examination and a resident in-training examination fell into the most basic cognitive level, that of simple recall. The utility of Bloom's taxonomy is discussed along with implications for medical education.

Cognition↗
PubMed1991

Clinical controversy and the domains of scientific evidence.

The diversity of mental health care "schools" or therapeutic perspectives poses problems in selecting and using any single therapeutic perspective. This article describes the genesis of clinical controversy--that is, how two or more therapeutic perspectives of the same clinical situation can be so different yet not necessarily differ in outcome. Ideas drawn from contemporary philosophy of science show how different "schools" derive separate, incompatible sets of scientific evidence from the same clinical situation. The school or theory determines (in part) not just what evidence is used, but what evidence is actually perceived. The authors conclude by recommending a pluralistic approach to mental health care; they map out some consequences of this pluralism and suggest some strategies for minimizing the disadvantages of "mixing and matching" therapeutic perspectives.

Family Therapy↗
PubMed1989

Hypothesizing and evidence-gathering: the nexus of understanding.

Prior discussion of hypothesizing as a session "guideline" has not fully clarified the derivation of hypotheses. Reviewing relevant philosophy of science literature, the authors develop the notions of evidence and evidence-gathering in systemic family therapy. The authors claim evidence-gathering and hypothesizing are interdependent, reciprocal elements of scientific understanding. The structure of evidence is described along with practical and qualitative rules for collecting and using evidence. This model is applied to a case example illustrating the logic of clinical process. Implications are discussed for family therapy training and supervision.

Data Collection↗
PubMed1987

Ethical and management considerations in factitious illness: one and the same.

The literature on factitious illness raises many ethical problems regarding diagnosis and treatment. The author briefly reviews ethical issues in factitious illness and argues for viewing these patients as autonomous citizens, capable of accepting responsibility for their behavior. Some factitiously ill patients psychologically resemble those with borderline personality disorder, and ethical implications are developed. In a case example, the author illustrates how good clinical management assists with the resolution or prevention of these ethical dilemmas.

Adult↗
PubMed1984

Secondary agoraphobia: two case reports.

Two patients with agoraphobic symptoms and major depressive disorder exhibited dexamethasone nonsuppression. Antidepressant pharmacotherapy was associated with remission of depressive symptoms and DST normalization. This improvement predated remission of agoraphobic symptoms by 1-2 months. It is suggested that agoraphobia was secondary to the depression in both cases.

Aged↗
PubMedDate not supplied

Knowing, valuing, acting: clues to revising the biopsychosocial model.

While remaining influential in education and research in psychiatry and medicine, the biopsychosocial (BPS) model has been criticized for ambiguity in conceptualizing everyday clinical problems. As a multilevel general systems approach, it leaves obscure which system level (cellular, person, family, community, and so on) is most clinically important at any point in time. As a model for psychiatry and medicine, it does not address the practical and moral dimensions of clinical work. This report reviews criticisms and concerns about the BPS model. These criticisms are used to begin a more practicable revision of the model.

Biological Psychiatry↗
PubMedDate not supplied

Rationales, values, and DSM-IV: the case of "medication-induced movement disorders".

The DSM-IV has improved psychiatric diagnostic classification through initiating, among other things, the open disclosure of rationales for nosologic changes. It will be argued that a consideration of values is necessary in justifying nosologic changes, considerations missing from the DSM-IV rationales. In illustration of this, I examine the reasons for including the medication-induced movement disorders (MIMDs) on axis I by using a literature review, then compare the published rationales for including the MIMDs with the DSM-IV Task Force's own guidelines for including categories. Discrepancies are found between the Task Force's guidelines for including categories and the published rationales for including MIMDs. Strict adherence to the Task Force guidelines more strongly supports placing MIMDs in axis III. Discussion emphasizes the importance of value commitments in nosology development.

Akathisia, Drug-Induced↗