PubMed Health⌕ Search

Biomedical subjects

S Eisenthal

Publications and source records attributed to S Eisenthal.

At least 19 recordsLinked to original sources
PubMed1998

Medical residents evaluate their medical school training in psychosocial care.

A questionnaire was sent to all 77 general medical residents at one teaching hospital (18 primary care and 59 the traditional program), to investigate retrospectively their psychosocial training in medical school. 62 complete surveys (81%) were returned. The training was rated good by 62% of the residents and important for psychosocial practice by 45%. In ambulatory settings, supervisors were rated as supporting the doctor-patient relationship (79%) and spending time on psychosocial problems (65%). In inpatient settings, spending time on psychosocial problems was not widely supported (36%). Training to interview was rated far from optimal by 49% of the residents. Psychosocial attitudes in residency did not have substantial correlations with training. In the choice of residency program, what distinguished residents in primary care from those in the traditional program was the positive ratings given their supervisors' psychosocial orientation, but not the supervisors' nor the residents' psychosocial competency or weeks spent in training. In sum, the two most potent influences on psychosocial orientation appear to be positive role models and the clinical setting.

Education↗
PubMed1994

Orientation of medical residents to the psychosocial aspects of primary care: influence of training program.

PURPOSE: To describe the attitudes of residents in general medicine to the psychosocial dimensions of primary care and to evaluate the influences of selected variables. METHOD: A cross-sectional analysis-of-variance design (two training programs involving residents in all three residency years) was used in the analysis of 21 psychosocial attitude items from a survey questionnaire completed by general medicine residents. In 1991-92, 77 general medicine residents in ambulatory care group practices associated with the Massachusetts General Hospital were surveyed. Eighteen of the residents were in a primary care program (PCP), and 59 were in a traditional medicine program (TMP). RESULTS: The overall response rate was 82% (63 of 77 residents), with slightly lower rates for four items. The residents' attitudes to the psychosocial role of the primary care physician were positive but with reservations: 55 (87%) endorsed asking psychosocial questions, while only 28 (44%) indicated that most internists felt competent to diagnose and treat. Most residents did not feel defensive about enacting the role (neither uncomfortable asking questions in ambulatory care settings, 58, 92%; nor nosey, 56, 89%; nor personally interfering, 47, 76%). Fifty-two residents (83%) perceived patients to be receptive to psychosocial questions, yet 31 (49%) indicated that patients were resistant to psychosocial attributions, and 48 (76%) indicated that patients need to be prompted to talk about life problems. The clearest and strongest influence on attitudes was setting: ambulatory care over inpatient (p < .0001). Overall, the responses of the residents from the PCP and TMP were more similar than different. CONCLUSION: The residents accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to carry it out, and assigned it a secondary priority in patient care. To interest residents in primary care, more training should be based in ambulatory care settings and more emphasis should be placed on improving residents' competency in psychosocial skills.

Attitude of Health Personnel↗
PubMed1993

Treatment-related fatigue and serum interleukin-1 levels in patients during external beam irradiation for prostate cancer.

To define changes in sleep and subjective fatigue associated with localized radiation treatment, and to determine their relationship to interleukin-1B (IL-1), we prospectively followed 15 men, none of whom were depressed during 8 wk of radiation treatment for localized prostate cancer. Each patient rated fatigue daily on a visual analogue scale, recorded hours slept, and completed the Beck Depression Inventory weekly. Serum IL-1, taken at baseline and Fridays, was measured by quantitative enzyme immunoassay. Ranked weekly mean fatigue scores for each subject increased at week 4 (mean, 17 fractions, 1.8 Gy) then plateaued and rose in weeks 6 and 7. In week 6, the last week of full volume radiation, subjects slept most compared to all other weeks including week 7 when treatment was coned down. Ranked serum IL-1 tended to rise between weeks 1 and 4, as fatigue scores rose. These data suggest that localized radiation treatment is associated with increased fatigue and sleep requirement independent of depressive symptoms. Relative serum IL-1 changes may be one signal for the systemic reaction and subjective fatigue associated with the acute effects of radiation.

Aged↗
PubMed1992

Fatigue syndrome due to localized radiation.

For cancer patients, fatigue is a disturbing symptom caused by many factors. Since fatigue is the most common side effect of localized radiation to the breast, this treatment provides a unique opportunity to follow patients prospectively as they develop one type of fatigue. We evaluated the effect of radiation treatment in 15 women with Stage I or II node-negative breast cancer who were otherwise healthy. Fatigue, contrary to our hypothesis, did not increase linearly with cumulative radiation dose over time. It dropped from the first to second week and rose in the third week. The cumulative effects reached a plateau in the fourth week (after an average of 17 fractions), which was maintained during the remaining weeks of treatment. Within 3 wk after treatment, fatigue had diminished. No patient had sustained depressive symptoms. Cardiopulmonary exercise capacity in 5 patients at 6 and 12 wk did not change from just before radiation. Other markers, including reverse triiodothyronine and pulse change with orthostatic stress, did not correlate with subjective fatigue nor cumulative radiation in 15 patients. The curve of the fatigue syndrome during treatment conforms to the adaptation of the organism to a continuing stress and begins to describe a mild fatigue syndrome associated with radiation.

Adult↗
PubMed1990

The nature of patients' requests for physicians' help.

This report describes patients' requests for help in two outpatient settings--one, a general medicine practice (GMP); the other, a medical walk-in unit (WIU). Interview data were collected in 1981 from 200 patients prior to their visits with the doctor. Patients were asked, "How do you hope the doctor (or clinic) can be of help to you today?" Their responses were written down verbatim. A coding system was devised that described the specificity, focus, and form of each request in order to provide the clinician with a classification for recognizing these request elements and responding to them. Specificity (precision) was identified from the response to "What do you hope the doctor will do for you?" The focus (objective) was described by four categories: problem, treatment, relationship, and administration; the form (intervention), by five categories: somatic, cognitive, affective, advice, and instrumental. Patterns of requests differed in the two settings. In the WIU, the pattern of requests had a problem focus with a form split between the cognitive (wanting an explanation) and the somatic (wanting a medical procedure); in the GMP, treatment was the focus, with a somatic form. The overall results indicate the varied requests of medical outpatients that express their perspectives about their illnesses. This classification of requests should be useful to physicians in eliciting and responding to their patients' requests.

Communication↗
PubMed1984

Ethnicity in the reported pain, emotional distress and requests of medical outpatients.

Relationships of patients' ethnicity to their reported pain, emotional distress and requests were investigated. When patients aged over 60 years were compared. Italian-Americans were found to more frequently report pain than were Anglo-Americans; however, this difference was not replicated in the younger patients of Italian and Anglo backgrounds. In addition to patients' age, their sex also was found to mediate the relationship of ethnicity to the expression of pain. In particular, older female Italian-Americans were likely to report pain while, in contrast, older male Anglo-Americans were not. Age and sex may be important mediators of ethnic differences because older and female patients may carry on ethnic traditions more than do younger and male patients. Ethnicity was not found to be significantly related to emotional distress and requests.

Communication↗
PubMed1983

Process analysis of two dimensions of the negotiated approach in relation to satisfaction in the initial interview.

This study examined relationships between patient and clinician satisfaction ratings and the use of a negotiated approach to the initial psychiatric interview. Two dimensions of the negotiated approach were distinguished--mutuality in making treatment decisions and mutuality in communicating explanatory information. Forty-four patients sampled from a larger pool of 158 patients in a walk-in clinic of a large, urban general hospital participated in the study. At the conclusion of clinical interviews, three kinds of satisfaction ratings were obtained--those of patients' satisfaction, clinicians' perceptions of patients' satisfaction, and clinicians' own satisfaction. Transcripts of patients' audiotaped interviews with these clinicians were independently rated on each of the 10 negotiated approach process measures, comprising five measures of each process dimension. Patient satisfaction was found to be associated with explanatory processes--being given clear and complete explanations concerning the recommended treatment plan, its rationale, and its link to the patient's complaints, and with decision-making processes-stating a request before the start of the disposition phase and having the clinician pursue consensus with the patient on the clinician's recommended treatment plan. None of the negotiation variables was significantly correlated with clinician satisfaction. Moreover, clinicians appeared to be inaccurate in their perception of the sources of patient satisfaction. The study's findings suggest that two sources of strain between the clinician and the patient that may adversely affect the outcomes of their initial interview are the divergence in their value systems concerning initial interview processes and the clinician's misreading of the patient's perspective.

Adult↗
PubMed1979

"Adherence" and the negotiated approach to patienthood.

A study was conducted on adherence to treatment referrals made in the psychiatry walk-in clinic of a general hospital. One hundred thirty patients were administered the patient request form, a general information questionnaire, and a postinterview evaluation questionnaire. Information on adherence was obtained from the hospital records. Forty-one percent of the patients adhered to the treatment referral. Adherence was significantly related to negotiation, as predicted. Another significant predictor of adherence was the patient's getting the plan he wanted. Adherence was not found to be related to demographic measures or scores on the patient request form. The index of negotiation also correlated significantly with the patient's evaluation of the interview, replicating previous findings. The relationship of adherence and negotiation is discussed.

Adult↗
PubMed1978

Are there social class differences in patients' treatment conceptions?

Traditionally, lower-class individuals who have sought psychiatric help have been hampered in their efforts by classrelated inequities in the delivery of psychiatric services. A common explanation for this phenomenon has been that the treatment conceptions of lower-class individuals are "inappropriate." This report presents theoretical and research evidence challenging this notion. A review of the literature from 1954 through 1974 yielded no good evidence that lower-class patients need, expect, or want treatments incongruent with those of upper-middle-class therapists. An experimental study of the requests for help made by 278 walk-in clinic patients confirmed this observation. Patient requests, as measured by an 84-item, self-rated questionnaire, were largely independent of social class. It was concluded that social class differences in treatment disposition and outcome cannot be attributed to social class differences in patients' treatment conceptions. The possibility that methodological and sociological factors can account for the discrepancies between the findings of this study and past studies is discussed. Strategies for minimizing treatment biases against lower-class patients and for maximizing treatment effectiveness with higher-class patients are also suggested.

Adolescent↗
PubMed1977

Evaluation of the initial interview in a walk-in clinic. The clinician's perspective on a "negotiated approach".

A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patient's instrumental objective of participating in the treatment planning. The sharpest divergence between the clinician's and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of setting, and the implication for the delivery of services.

Adolescent↗
PubMed1976

Evaluation of the initial interview in a walk-in clinic. The patient's perspective on a "customer approach".

There have been different models on how to conduct the initial psychiatric interview in a walk-in clinic. A "customer approach" has been developed which stresses: a) eliciting and understanding the requests that patients have regarding how they hope to be helped; and b) negotiating a treatment plan with the patients. We evaluated this customer approach from the perspective of the patient. The first hypothesis was supported. The patient's perception of the clinician's utilization of the customer approach correlated positively and substantially with measures of outcome, especially feeling satisfied and helped. The second hypothesis was also supported. Utilization of the customer approach continued to correlate positively and substantially with outcome even when patients did not get the disposition originally wanted. We discussed the clinical significance of the customer approach especially in regard to patient objectives in the initial interview--a treatment plan vs. symptom relief.

Adolescent↗
PubMed1976

Disposition decisions in a walk-in clinic: social and psychiatric variables.

The success of a walk-in clinic in providing care without regard to social and diagnostic factors is measured in a study of 391 patients. Results indicate that acceptance or nonacceptance into the clinic system were unrelated to social class or diagnosis, although these factors did influence referrals to specific clinic resources.

Adolescent↗
PubMed1976

Attitude of psychiatric residents toward patient requests.

The authors assessed residents' comfort in dealing with 14 previously identified types of patient requests in inpatient, outpatient, and acute service settings. First-year residents expressed significantly more discomfort than more experienced residents on 11 categories. They were also significantly less comfortable in the acute service than the inpatient setting. All residents expressed more comfort dealing with dynamic, psychological, and "nonsevere" requests. These findings suggest a need to teach residents specific therapeutic responses to various categories of requests and to evaluate the desirability of starting the residency experience on an acute service.

Attitude of Health Personnel↗