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Biomedical subjects

L M Candib

Publications and source records attributed to L M Candib.

16 recordsLinked to original sources
PubMed2001

How will family physicians care for the patient in the context of family and community?

Difficulties caring for patients in the context of family and community stem from problems of power and vulnerability. Patients are disempowered in relation to physicians and to the medical care system. Physicians are disempowered in their ability to provide comprehensive relationship-centered care to individuals and families because of economic constraints on medical care and limits on continuity of care. Individual patients are also vulnerable to abuses of power within their families because of physical and sexual abuse; the recognition of such abuses and appropriate interventions for them requires awareness of the gender ideology that underlies interpersonal abuses of power. Families and communities can be disempowered because of vulnerabilities related to race, ethnicity, poverty, and homelessness. The additive effects of these vulnerabilities have created health disparities that are a hallmark of inequities in our country's medical system. Opportunities to teach students to recognize and address these disparities abound within medical education. Participatory training and educational action projects can prepare learners to lead us toward a more just and egalitarian medical system with the potential to change the context of family and community in which we care for patients. However, systematic commitment from educational programs is necessary to produce activated clinicians, teachers, and researchers to achieve these changes.

Child↗
PubMed1998

Complex posttraumatic stress disorder: evidence from the primary care setting.

Sexual abuse is a common problem among female primary care medical patients. There is a wide spectrum of long-term sequelae, ranging from mild to the complex symptom profiles consistent with the theories of a posttraumatic sense of identity. Generally, the latter occurs in the context of severe, chronic abuse, beginning in childhood and often compounded by the presence of violence, criminal behavior, and substance abuse in the family of origin. In this study we search for empirical evidence for the existence of a complex posttraumatic stress syndrome in 99 women patients at 3 family practice outpatient clinics who report a history of sexual abuse. A structured interview was administered by trained female interviewers to gather data on family history and psychiatric symptoms and diagnoses. Empirical evidence from cluster analysis of the data supports the theory of a complex posttraumatic syndrome. The severity gradient based on symptoms roughly parallels the severity gradient based on childhood abuse and sociopathic behavior and violence in the family of origin, with the most severely abused subjects characterized by symptom patterns that fit the description of a complex posttraumatic stress syndrome.

Adult↗
PubMedDate not supplied

Health-related quality of life and symptom profiles of female survivors of sexual abuse.

OBJECTIVES: To determine the association between severity of sexual abuse and psychiatric or medical problems in a sample of female patients from primary care medical settings and to assess the relationship between sexual abuse severity and health-related quality of life before and after controlling for the effects of a current psychiatric or medical diagnosis. DESIGN: Structured interview and self-report questionnaire. SETTING: Three family practice outpatient clinics. SUBJECTS: A total of 252 women selected by somatization status using a screen for unexplained physical symptoms. MAIN OUTCOME MEASURES: Patient assessment after administering the Medical Outcomes Study 36-item Short-Form Health Survey and self-report medical problems questionnaire; the quality-of-life scale developed by Andrews and Withey; Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, diagnoses and symptom counts from the Diagnostic Interview Schedule; the Dissociative Experiences Scale; and the modified Dissociative Disorders Interview Schedule. RESULTS: A history of sexual abuse is associated with substantial impairment in health-related quality of life and a greater number of somatized symptoms (P < .001), medical problems (P < .01), and psychiatric symptoms and diagnoses (P < .001). In regression analyses, sexual abuse severity was a significant predictor of high scores on 6 of the 8 subscales of the Medical Outcomes Study Short-Form Health Survey (P < .05) and all of the quality-of-life subscales developed by Andrews and Withey (P < .01), with average decrements of up to 0.41 SDs for moderately abused women and 0.56 SDs for severely abused women. Furthermore, sexual abuse severity remained a significant predictor of high scores on the subscales mental health (P < .05), social functioning (P < .05), and quality of life (P < .05), even after adjusting for the presence of several common psychiatric diagnoses. CONCLUSIONS: Female primary care patients with a history of sexual abuse have more physical and psychiatric symptoms and lower health-related quality of life than those without previous abuse. In addition, a linear relationship exists between the severity of sexual abuse and impairment in health-related quality of life, both before and after controlling for the effects of a current psychiatric diagnosis.

Child↗
PubMedDate not supplied

Ways of knowing in family medicine: contributions from a feminist perspective.

Feminist psychologists have recently drawn a distinction between separate and connected knowing, two different ways of finding out about the world. Family medicine practice uses connected knowing to discover, through empathy, what another person may be experiencing; in contrast, family medicine research, in order to gain academic credibility, relies on separate knowing, typical of scientific thinking. These two ways of knowing have been variously described by Bruner as paradigmatic vs. narrative, by Kuzel as rationalistic vs. naturalistic, and by Stephens as seeing vs. hearing. The two ways of knowing vary in their use of context, time span, believability, and empathy. Family medicine, in a parallel with women who are finding their voice in a world which has not respected them, must come to blend the two ways of knowing. We can begin reframing our research questions by drawing on knowledge of our intimate, long-term connections with patients, thus underscoring the importance of the knower and the relationship with the known.

Family Practice↗
PubMedDate not supplied

Doctors having families: the effect of pregnancy and childbearing on relationships with patients.

Family physicians care for patients in all stages of the life-cycle, while at the same time proceeding themselves through the course of adult development. The purpose of this study was to examine, from the doctor's point of view, changes in the doctor-patient relationship resulting from the physician's pregnancy and child-bearing. Five faculty family physicians participated via individual interviews and group discussion. Two women without children, the clinical psychologist interviewer, and other faculty family physicians joined in the review of the interviews and the group discussion. Comprehensibility, reciprocity, mutuality, identification, credibility, availability for long-term relationships, nurturing, and support emerged as themes in the evolution of relationships with patients. The process of examining the effect of childbearing on our relationships with patients unexpectedly revealed how the dual expectation of career and motherhood causes colleagues without children to feel inadequate. On the other hand, the study itself had the positive effect of facilitating the resolution of long-standing tensions among group members. We conclude that becoming mothers, a significant life change, had a transforming effect on our clinical work with patients and that studying this effect as a group fostered growth in the relationships among the participants.

Adult↗
PubMedDate not supplied

The family approach at each moment.

In this paper I have demonstrated some of the skills involved in an approach to the entire family at each moment. I have focused on a family approach in well child care, episodic care for children, and adolescent pregnancy and have demonstrated how such an approach is essentially preventive. The traditional relationship of the family physician with individuals, usually women and mothers, creates an implicit alliance with the symptom bearer which may work contrary to the goals of treatment. Avoidance of hidden alliances and open communication with all members of the family permit the doctor to engage with families in a relationship which is both preventive and therapeutic.

Adolescent↗