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Biomedical subjects

T E Quill

Publications and source records attributed to T E Quill.

49 records · Page 3Linked to original sources
PubMed1984

The medical interview: a core curriculum for residencies in internal medicine.

A core curriculum for teaching medical interviewing is presented that enhances the internist's skills in a broad range of interactions with patients. Learning these skills is now left to chance and is often deficient. Four objectives are developed: patient-centered interviewing and treatment; an integrated (biopsychosocial) approach to clinical reasoning and patient care; personal development of humanistic values; and psychosocial and psychiatric medicine. Teaching options include real and simulated encounters with patients, observation with discussion, and use of groups. A general strategy for implementing the curriculum at the local level requires the intellectual and financial support of the dean and department chairman, and a multidisciplinary faculty committed to developing, implementing, and evaluating the curriculum. At many programs, faculty development will be necessary.

Curriculum↗
PubMed1983

Partnerships in patient care: a contractual approach.

A contractual approach to forming a partnership between doctor and patient is presented in both theoretical and practical terms. Four basic contractual assumptions underly the doctor-patient relationship: both the doctor and the patient have unique responsibilities; the relationship is consensual, not obligatory; both doctor and patient must be willing to negotiate; and each must gain something in the encounters. Clinical examples are used to show practical implications of this model. Although explicit contracts are not needed for all patients, a contractual analysis of doctor-patient interactions helps both participants share the responsibility for patient care.

Adult↗
PubMedDate not supplied

The medicalization of normal variants: the case of mitral valve prolapse.

Mild mitral valve prolapse, hypoglycemia, irritable colon, and premenstrual syndrome are examples of anatomico-physiologic phenomena that largely overlap with normal. Such "overlap syndromes" become labeled disease entities by the medical community through a process called medicalization. This report uses mitral valve prolapse (MVP) to exemplify the effects of medicalization on patients, physicians, and society. Ascertainment bias and insufficient controlled clinical studies have led to the description of a clinical entity replete with false associations (e.g., mitral valve prolapse syndrome) and overly pessimistic prognostication (e.g., risk of sudden death or endocarditis), leading to clinical overreaction, overtreatment, and unnecessary induction of disability. Though some physical complications may be prevented by recognizing severe MVP, there is substantial risk of iatrogenic harm by attributing complex symptoms and illness behavior to mild MVP, which is probably a normal variant. A three-dimensional analysis of illness experience is presented that may be of use in conceptualizing the clinical approach to overlap syndromes such as mild MVP. Conservative criteria for the diagnosis of significant MVP have been developed at the National Institutes of Health. Treatment of patients with mild MVP must emphasize that it is a normal variant without serious consequences. Because the risks of overmedicalization are so substantial, the impact of diagnostic labels on individual patients and society must be analyzed continually.

Adult↗
PubMedDate not supplied

Health-care seeking by men in their spouse's pregnancy.

This study compares the health-care seeking by 212 married male members of a health maintenance organization of 36,000 whose wives were pregnant, with a group of 212 " nonexpectant " married men matched for age, number of prior children, and HMO membership. Retrospective, blind chart review was used to examine the number and timing of medical visits and the types of symptoms, diagnoses, testing, and treatments recorded over the 21-month period surrounding and including each wife's pregnancy. Contrary to prior reports, the expectant fathers had a significantly lower group visit rate during the nine months of pregnancy when compared to their visit rates before conception and after delivery (p less than 0.01). The control group had a constant visit rate over the same time intervals. The types of symptoms and diagnoses recorded in the medical record over time were comparable in the two groups. The study suggests that expectant fatherhood, a clearly defined psychosocial event for a male, significantly influences health-care seeking but not the types of symptoms presented or diagnoses made.

Adaptation, Psychological↗
PubMedDate not supplied

Peaked "T" waves with tranylcypromine (parnate) overdose.

A case of tranylcypromine (Parnate) overdose is presented in which the main toxic effects were headache, obtundation, hypertension, and diffusely peaked T-waves on ECG. The latter effect, which occurred in the absence of hyperkalemia, has not been previously associated with monoamine oxidase inhibitors (MAOI). Recent case reports of tranylcypromine toxicity are briefly reviewed, confirming the potential for hypertension, hypotension, shock, hyperpyrexia, intracranial hemorrhage, agitation, hyperkinesis, coma and death in association with overdosage, or concomitant ingestion of sympathomimetic substances or other drugs. These ECG changes add to the worrisome list of potential toxicities in an era in which MAOI are finding increased clinical use.

Adult↗
PubMedDate not supplied

Incurable suffering.

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Ethics, Medical↗