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Biomedical subjects

M Kelner

Publications and source records attributed to M Kelner.

8 recordsLinked to original sources
PubMed1990

Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.

Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Understanding physicians' response to AIDS.

Attempts to comprehend physicians' extreme reaction to AIDS (acquired immune deficiency syndrome) have met with great difficulty since the disease brings into question traditional norms and assumptions. As the medical profession struggles to develop guidelines and policies to help it deal with this disease, it can draw on very little systematic research on the effect of AIDS on physicians' attitudes and practices. We suggest a framework developed from the literature on physicians' and society's response to other disorders that would provide a basis for organizing the ever-increasing amount of information on physicians and AIDS and would guide systematic research aimed at understanding and predicting physicians' participation in the prevention and management of AIDS. Within this framework we consider how characteristics of the disease, elements of the health care system and physicians' attitudes interact to influence clinical and personal practices. AIDS had led to new delineations of physicians' responsibility, modification of prevailing beliefs about physician autonomy and thus a redefinition of the role of the physician in North America.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Informed consent: the physicians' perspective.

Using the current controversy in breast cancer treatment as a model, this paper reports on physicians' attitudes and behavior in the use of informed consent. Findings are based on a survey of 170 oncologists from eight countries and representing three medical specialties. Physician responses indicate that they regarded informed consent as an intrusion into the doctor-patient relationship. Problems identified by the physicians included: decreasingly effective doctor-patient communication; less personalized relationships with patients and curtailed freedom with regard to disclosure procedures. They also viewed the informed consent regulation as having a negative impact on their patient care. The constraints of obtaining informed consent reduced physicians' willingness to participate in scientific experiments. The consent form was seen to highlight their dual role as care-giver and scientific investigator, making them uncomfortable in dealing with patients. These findings demonstrate the ways in which legal restrictions associated with the introduction of new technologies critically affect the practice of medicine.

Breast Neoplasms↗
PubMed1986

Postgraduate medical training, stress, and marriage.

In a pilot study, 20 interviews were conducted with married female interns and residents and their spouses in order to explore both positive effects of spousal support and negative effects of additional role obligations during medical training. The marital state has been shown to be related to lowered levels of stress. Past studies of medical marriage have focused on male physicians and their wives. However, marriage and parenthood impact differently on women than men, and thus on women physicians. To explore these differences, our findings are contrasted with findings on male medical students and their wives by R. Coombs. Compared to our subjects, Coombs found spouses were either housewives or held lower level jobs rather than demanding careers, and consequently our subjects experienced greater difficulty meeting demands of everyday life (cooking, cleaning, child care). Coombs' wives showed greater vicarious identification with the goals and satisfactions of the physician in-training; greater feelings of obligation to nurture, support and make sacrifices on behalf of their spouses; and less resentment toward the current system of medical training. They stressed the nurturing aspect of marital support rather than instrumental aspects. Subjects in both studies feared growing apart but while Coombs' wives feared being outgrown intellectually, our husbands were critical of their wives' narrowness of interests. Subjects in both studies believed marriage provided benefits (intimacy, support, affection, sex) but also complained of the negative impact of exhausting and emotionally draining medical training. Implications of findings for reducing the stress of medical training are discussed.

Adult↗