Biomedical subjects
M G Secundy
Publications and source records attributed to M G Secundy.
Strategic compromise: real world ethics.
In this essay the Co-chair of Ethics Working Group 17 of the Health Care Task Force discusses the formation, organization processes and activities of the group, and provides an analysis and critique of the experience. It is suggested that the creation of the group and its inclusion in the process made a social statement which legitimized ethics as a significant part of public policy deliberations. At the same time, major questions are raised about the role of ethics in public policy arenas in which strategic compromise becomes the order of the day. Balanced and objective involvement may be illusory. Ethics, like informed consent, is a process, not an event and is ever evolving. Those who attempt to bring ethical considerations to the world of public policy have an obligation to think carefully about what should constitute an appropriate theoretical framework, make efforts to determine what is unique about ethics, and consider mechanisms for the various ethics disciplines to work effectively together. From this experience, the author developed a personal commitment to focus upon the critical importance of universal coverage for all Americans.
Health care utilization patterns of hypertensive and diabetic African American elderly.
An interdisciplinary team of researchers conducted a pilot study of the African American elderly in a major urban setting to determine factors influencing health care utilization patterns of patients with hypertension or diabetes. The data collected included household composition, family and social networks, histories of depression, self-esteem, health locus of control, locus of control, activities of daily living (ADLs) and health care utilization. Final analysis revealed significant correlations between ADLs, self-esteem, depression, locus of control, social support systems and health care utilization patterns. Economic factors were significantly correlated with ADLs especially regarding poverty as the critical variable in the well-being of elderly African Americans. The data revealed significant indicators for future study relative to assisting the elderly in maintaining their independence. There is also a need for controlled longitudinal studies on the impact of economic status on the overall health of aging minorities.
Psychosocial issues. Unanswered questions in the use of bone marrow transplantation for treatment of hemoglobinopathies.
PURPOSE: This article addresses some of the psychosocial issues of bone marrow transplantation for treatment of hemoglobinopathies. The central focus is on the importance of attending to the experiences of minority patients and their families. Findings of recent studies relative to issues of bone marrow donation provide some framework for this analysis. PATIENTS AND METHODS: Unanswered questions are posed by hypothetical parents to raise critical questions and to highlight the importance of truly informed consent in shared decision making. CONCLUSIONS: Recommendations for researchers and care-givers are for more personal contacts and dialogues with patients and families. There should also be involvement in grass roots activities, with attention to assessing the efficacy of bone marrow transplantation, as well as emphasizing minority representation in the process.
Balancing communication skills and clinical assessment.
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An important beginning.
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Coping with words and song: the New Orleans jazz funeral.
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A sense of tragedy: medicine, the profession.
The author reviews the position of several ethicists who address the conflicts inherent in the medical profession as it confronts new technologies, societal diversity, and pluralism. Definitions of appropriate mechanisms of self-regulation within an increasingly legalistic environment are discussed.
Physician perceptions of problems in the care of elderly patients.
A survey of family physicians in the District of Columbia and family practice residents and academic internists in a university hospital was undertaken to examine attitudes, perceptions of problems, and decision-making processes relative to the care of the elderly patient.Physicians report having more problems with elderly patients, although when compared with reports of perceptions of problems with nonelderly patients, there are no significant statistical differences. There is also no evidence of patterns of significant statistical differences between black and white physicians in their perceptions of problems in care of the elderly. Implications for medical education are reflected in physician acknowledgment of need for assistance in management of both elderly and nonelderly patients for most facets of psychosocial dimensions of care and in their concerns for negative societal conditions. The rationale for current curricular emphasis in the nation's medical schools upon geriatrics and human values in medicine appears to be supported by this exploratory study.
Ethical dilemmas in office practice: physician response and rationale.
A survey of black and white family physicians in the District of Columbia is described. The survey provides insight into decision-making processes and the ability to recognize ethical dilemmas in medical practice. Comments were elicited to hypothetical case vignettes typical of ethical conflict in office practice. Findings note physician ability to recognize ethical dilemmas in day-to-day aspects of medical practice. Methods of decision making and rationale for decisions made, however, appear to be inconsistent, nonuniversal, and individualistic without evidence of specific models or criteria. No significant differences were noted between black and white physicians. The need in physician training for clarification and development of criteria is evident.
Allocation of scarce resources: some problems.
This paper presents an overview of current philosophical perspectives and societal trends in relation to allocation of scarce resources. An analysis and comparative assessment of various positions of current philosophers, theologians, and bioethicists is provided. Currently proposed cost containment measures at the federal level require that black health professionals particularly pay attention to these proposals specifically as related to allocation of resources. The ways in which cost containment and/ or modification of resource allocation will affect health care delivery, specifically for the black community, must be carefully examined. This article may suggest some approaches for individual and group response to the continuing dialogue and to the allocation process itself. The equitable distribution of health care, particularly scarce new technologies, will be one of the greatest problems facing society in the next 20 years.
Bereavement: the role of the family physician.
Much has been written regarding attitudes of patients, families, and physicians in managing death and subsequent grief reactions. Here at Howard University College of Medicine, we are constantly aware of our educational responsibility to insure that our students and residents achieve certain levels of awareness, acquire certain basic and specific information, and be afforded an opportunity to ventilate and discuss issues of death, dying, and bereavement as they relate to their current or future encounters with patients and their families. We are specifically interested in the roles and responsibilities of the family physician.
Factors in patient/doctor communication: a communication skills elective.
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Clinical experiences for freshmen and sophomore medical students. An educational innovation.
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