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Biomedical subjects

Joseph A Carrese

Publications and source records attributed to Joseph A Carrese.

9 recordsLinked to original sources
PubMed2006

Refusal of care: patients' well-being and physicians' ethical obligations: "but doctor, I want to go home".

Honoring patients' wishes becomes difficult when doing so threatens their well-being. In this article, the case of a hospitalized elderly woman is presented. The patient, ready for discharge, insists on returning home, yet she is bedbound and lacks adequate social support and financial resources to manage safely. The medical team, troubled by this situation, requests an ethics consultation. The article discusses several issues related to the difficult ethical problem posed by this case, including a brief historical review of the patient's role in decision making, current thinking about patients' rights vis-à-vis patients' well-being, assessing patients' capacity to make sound decisions, consideration of physician values, and, finally, responding to patients' refusal of care.

Activities of Daily Living↗
PubMed2006

The inescapable relevance of bioethics for the practicing clinician.

KEY POINTS: 1. Historically, medical ethics focused on the proper conduct of physicians as members of a profession. 2. Bioethics has emerged as a distinct field over the past several decades and has a broader scope than traditional medical ethics. The field of bioethics includes research ethics, public health ethics, organizational ethics, and clinical ethics. 3. Several factors contributed to the emergence of bioethics, helping to shape it, including the following: abuses of human subjects in research; advances in medical therapeutics and medical technology; and complex societal changes. 4. Principlism is an important approach to ethics, and in bioethics it includes the following core principles: respect for autonomy; beneficence; nonmaleficence; and justice. 5. Clinical ethics is a major part of bioethics and is concerned with ethical issues encountered in the care of patients. 6. Clinicians should recognize that every interaction between a doctor and a patient has a moral component, and that competency in bioethics is required to competently practice medicine. 7. Deficiencies exist in bioethics knowledge and performance among practicing clinicians and trainees; therefore, bioethics education is needed for learners at all levels (i.e., medical students, trainees, and practicing clinicians). 8. Bioethics is a dynamic, multidisciplinary field with several dedicated journals, a national organization, and numerous centers and institutes. 9. Important scholarly work in bioethics, both empirical and conceptual, is being conducted and disseminated, providing important information for practicing clinicians.

Bioethical Issues↗
PubMed2005

Racial and socioeconomic differences in the weight-loss experiences of obese women.

Focus groups stratified by race and socioeconomic status were used to examine obese women's experiences with weight-loss methods. Six themes emerged: failure of weight maintenance, use of psychological and spiritual approaches, role of family influences and societal expectations, role of African American subculture, method affordability, and racial differences in weight-loss methods. Tailored weight-management interventions for women, particularly African Americans and those of low socioeconomic status, should account for features of African American subculture and address affordability concerns, include maintenance strategies that incorporate psychological and spiritual principles, and target family attitudes and behaviors.

Adult↗
PubMed2004

Self-doctoring: a qualitative study of physicians with cancer.

BACKGROUND: Self-doctoring is providing oneself care normally delivered by a professional caregiver. Expert authors warn physicians not to self-doctor, yet cross-sectional studies document that physicians frequently do. Explanations for this disparity remain speculative. OBJECTIVE: To better understand the circumstances when physicians did and did not doctor themselves and the reasoning behind their actions. DESIGN: Qualitative semistructured interview study of 23 physician-patients currently or previously treated for cancer. RESULTS: Participants had multiple opportunities to doctor themselves (or not) at each stage of illness. Only 1 physician recommended self-doctoring, although most reported having done so, sometimes without realizing it. Participants' approaches to their own health care created a continuum ranging between typical physician and patient roles. Participants emphasizing their physician role approached their health care as they would approach the care of their own patients, preferring convenience and control of their care to support from professional caregivers. Participants emphasizing their role as patient approached their health care as they thought a patient should, preferring to rely less on their own abilities and more on their providers, whose support they valued. Most participants balanced both roles depending on their experiences and basic issues of trust and control. Importantly, subjects at both ends of the continuum reported unanticipated pitfalls of their approach. CONCLUSION: Our findings showed that participants' health care-seeking strategies fell on a continuum that ranged from a purely patient role to one that centered on physician activities. Participants identified problems associated with overdependence on either role, suggesting that a balanced approach, one that uses the advantages of both physician and patient roles, has merit.

Adult↗
PubMed2003

Serving as a physician role model for a diverse population of medical learners.

PURPOSE: Medical learners look to role models to better understand the values, attitudes, behaviors, and ethics of the medical profession. This study examined issues related to physicians serving as role models for diverse medical learners. METHOD: Between September and November 2000, in-depth semi-structured 30-minute interviews were conducted with 29 highly regarded role models, as judged by medical house officers at two large teaching hospitals in Baltimore, Maryland. Interview transcripts were independently coded and compared for agreement. Content analysis identified several major categories of themes that were examined and conceptually organized. RESULTS: The informants identified issues that relate to role modeling for diverse medical learners. Subcategories under the domain of similarity facilitates role modeling included learners prefer role models similar to them, role modeling is easier when the learner resembles the teacher, and minority physicians may be better role models for minority learners. Under the domain role modeling when physician-teachers and learners are different were the subcategories extra effort may be necessary, success promotes and inspires confidence, and role modeling across diversity is an achievable objective that should be pursued. The final domain, approaches to differences between physician-teachers and learners, encompassed embrace diversity, act as a consultant and refer when necessary, and minimize and disregard all differences. CONCLUSIONS: The results of this study should draw attention to these issues and may serve as a stimulus for teaching physicians to consider a broader range of options for successful interactions with medical learners who are different from them.

Adult↗
PubMed2002

Excellence in role modelling: insight and perspectives from the pros.

BACKGROUND: Role modelling is an effective teaching method in medical education. We sought to better understand role modelling by examining the insights of respected physician role models. METHODS: We conducted 30-minute in-depth interviews with 29 highly regarded role models at 2 large teaching hospitals. We coded the transcripts independently, and compared our coding for agreement. Content analysis identified several major categories of themes. RESULTS: The informants identified specific characteristics related to role modelling. Subcategories under the domain of personal qualities included interpersonal skills, a positive outlook, a commitment to excellence and growth, integrity and leadership. Under the domain of teaching, the subcategories were establishing rapport with learners, developing specific teaching philosophies and methods, and being committed to the growth of learners. Subjects thought there was some overlap between teaching and role modelling, but felt that the latter was more implicit and more encompassing. Being a strong clinician was regarded as necessary but not sufficient for being an exemplary physician role model. Perceived barriers to effective role modelling included being impatient and overly opinionated, being quiet, being overextended, and having difficulty remembering names and faces. Physician role models described role modeling consciousness, in that they specifically think about being role models when interacting with learners. Subjects believed that medical learners should emulate multiple role models. INTERPRETATION: Highly regarded physician role models possess personal qualities, teaching abilities and exceptional clinical skills that outweigh their own barriers to serving as effective role models. Many of these positive attributes of role models represent behaviours that can be modified or skills that can be acquired.

Adult↗
PubMed2002

Planning for death but not serious future illness: qualitative study of housebound elderly patients.

OBJECTIVE: To understand how elderly patients think about and approach future illness and the end of life. DESIGN: Qualitative study conducted 1997-9. SETTING: Physician housecall programme affiliated to US university. PARTICIPANTS: 20 chronically ill housebound patients aged over 75 years who could participate in an interview. Participants identified through purposive and random sampling. MAIN OUTCOME MEASURES: In-depth semistructured interviews lasting one to two hours. RESULTS: Sixteen people said that they did not think about the future or did not in general plan for the future. Nineteen were particularly reluctant to think about, discuss, or plan for serious future illness. Instead they described a "one day at a time," "what is to be will be" approach to life, preferring to "cross that bridge" when they got to it. Participants considered end of life matters to be in the hands of God, though 13 participants had made wills and 19 had funeral plans. Although some had completed advance directives, these were not well understood and were intended for use only when death was near and certain. CONCLUSIONS: The elderly people interviewed for this study were resistant to planning in advance for the hypothetical future, particularly for serious illness when death is possible but not certain.

Advance Directives↗