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Joseph D Bloom

Publications and source records attributed to Joseph D Bloom.

8 recordsLinked to original sources
PubMed2006

A comparison study of career satisfaction and emotional states between primary care and speciality residents.

OBJECTIVE: To evaluate career satisfaction, emotional states and positive and negative experiences among residents in primary care and speciality programmes in 1 academic medical centre prior to the implementation of the Accreditation Council for Graduate Medical Education's (ACGME) duty hour requirements. DESIGN: Cross-sectional survey. MEASUREMENTS: All 581 residents in the academic health centre were asked to participate voluntarily in a confidential survey; 327(56%) completed the survey. RESULTS: Compared to their primary care colleagues, speciality residents had higher levels of satisfaction with career choice, feelings of competence and excitement, lower levels of inferiority and fatigue and different perceptions of positive and negative training experiences. However, 77% of all respondents were consistently or generally pleased with their career choices. The most positive residents' experiences related to interpersonal relationships and their educational value; the most negative experiences related to interpersonal relationships and issues perceived to be outside of residents' control. Age and training level, but not gender also influenced career satisfaction, emotional states and positive and negative opinions about residency. CONCLUSIONS: Less satisfaction with career choice and more negative emotional states for primary care residents compared to speciality residents probably relate to the training experience and may influence medical students' selections of careers. The primary care residents, compared to speciality residents, appear to have difficulty in fulfilling their ideals of professionalism in an environment where they have no control. These data provide baseline information with which to compare these same factors after the implementation of the ACGME duty hours' and competency requirements.

Adult↗
PubMed2006

Civil commitment is disappearing in Oregon.

Over the past 20 years, in Oregon, the number of individuals entered into the civil commitment process has risen, but the number of those actually committed has gone down dramatically. This commentary compares commitment data during a time when the state's population has increased substantially, while commitment rates have dropped by 50 percent. There are many possible factors that have contributed to this decline in commitment rates, including a stricter functional definition of "danger to self or others," but perhaps the most significant reason is the shortage of the acute psychiatric beds that are essential in the commitment process. It is hard not to conclude that civil commitment in this state is headed toward functional extinction.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

The use of the insanity defense as a jail diversion mechanism for mentally ill persons charged with misdemeanors.

Heightened awareness and concern regarding the large number of mentally ill misdemeanants in jails has led to a search for alternatives to jail and to the development nationwide of jail diversion programs for offenders with mental illness. Two such mechanisms-diversion to civil commitment and the use of mental health courts-are briefly reviewed. In Oregon, however, a rather unique mechanism is used to defer mentally ill misdemeanants (in addition to felons) from the criminal justice system: the insanity defense, with subsequent placement of the individual under Psychiatric Security Review Board jurisdiction. Statistics regarding such use from 1978 to 2001 are provided. The authors compare and contrast this jail alternative with both mental health courts and diversion to civil commitment, and discuss questions related to the feasibility of larger-scale use of this mechanism.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Subspecialization in psychiatry: third-generation programs.

Psychiatry, unlike internal medicine, was slow to develop subspecialty certification. For many years, child and adolescent psychiatry was the only major subspecialty recognized by the American Board of Psychiatry and Neurology (ABPN). The situation changed in the early 1990s with the recognition by the ABPN of additional subspecialties of psychiatry including forensic psychiatry. Using the experience of the American Board of Internal Medicine as a guide, this commentary asks what comes next? What are our options as it becomes clear that there is a deepening of knowledge in the field of forensic psychiatry? Are we ready for, or interested in, the development of so-called third-generation certification programs?

Education↗
PubMed2005

Cultural considerations in the criminal law: the sentencing process.

In forensic psychiatry, there is increasing recognition of the importance of culture and ethnicity in the criminal justice process as the population becomes more culturally diverse. However, there has been little consideration of the role of cultural factors in the trial process for criminal defendants, particularly in the sentencing phase of trial. Using a capital murder case study, this article explores the role of cultural forensic psychiatric consultation, focusing on the sentencing phase of trial as the place where the full scope and power of a cultural evaluation can be brought most effectively to the attention of the court. Cultural psychiatric perspectives can enrich a core forensic evaluation and be maximally helpful to the court, by exploring family dynamics and psychological health influenced by cultural history, immigrant and refugee experiences, and sociocultural environment. Specific recommendations and cautions for effective cultural consultation in forensic psychiatry are discussed.

Adult↗
PubMed2004

Physician reporting of impaired drivers: a new trend in state law?

The State of Oregon recently enacted legislation that increases physician responsibility for reporting medically at-risk drivers. The legislation comes at a time when the public is closely scrutinizing the question of the elderly and driving and the role of physicians in the reporting of potentially dangerous drivers. The evolution of Oregon's law is somewhat unique and offers an opportunity to examine what perhaps is to come in other states. The law broadened the role of the physician in assessment and reporting of impaired drivers. It also opened the door for new tort, that of "negligent failure to report," before input from physicians and other health care providers led to important revisions in the final statute. Physicians must look to current statutes to guide the legislative process in their own states, so that new law aimed at maintaining safe highways also preserves the physician-patient relationship and allows for a collaborative assessment of driving skill in the physician's office.

Accidents, Traffic↗
PubMed2004

Thirty-five years of working with civil commitment statutes.

This commentary reflects my 35 years of working with civil commitment statutes, first in Alaska, then in Oregon, and on various committees on the national level. Coming from a background in community and public psychiatry, I have always considered civil commitment to be the most important forensic mental health statute, as the commitment process in any state greatly influences the lives of many severely mentally ill individuals. Over the course of the past 35 years, many changes have occurred in civil commitment law, resulting in the gradual de-emphasis of the importance of these statutes. The ability of clinicians to use these statutes effectively has diminished. Herein, I review some of the areas of conceptual and practical problems related to the use of these statutes and, in effect, make a plea for a re-examination of the importance of civil commitment and for an attempt to fix some of the problems that have led to the loss of effective and rational civil commitment laws.

Civil Rights↗