Faith T. Fitzgerald

Appropriate Use of Screening and Diagnostic Tests to Foster High-Value, Cost-Conscious Care

Unsustainable rising health care costs in the United States have made reducing costs while maintaining high-quality health care a national priority. The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs. More judicious use of such tests will improve quality and reflect responsible awareness of costs. Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests-meaning an assessment of whether a test provides health benefits that are worth its costs or harms. To begin to identify ways that practicing clinicians can contribute to the delivery of high-value, cost-conscious health care, the American College of Physicians convened a workgroup of physicians to identify, using a consensus-based process, common clinical situations in which screening and diagnostic tests are used in ways that do not reflect high-value care. The intent of this exercise is to promote thoughtful discussions about these tests and other health care interventions to promote high-value, cost-conscious care.

Medical students’ attitudes toward gay men

BackgroundHealthcare providers’ attitudes toward sexual minorities influence patient comfort and outcomes. This study characterized medical student attitudes toward gay men, focusing on behavior, personhood, gay civil rights, and male toughness.MethodsA cross-sectional web-based anonymous survey was sent to medical students enrolled at the University of California, Davis (N = 371) with a response rate of 68%.ResultsFew respondents expressed negative attitudes toward gay men or would deny them civil rights. More negative responses were seen with respect to aspects of intimate behavior and homosexuality as a natural form of sexual expression. Men and students younger than 25 years old were more likely to endorse negative attitudes toward behavior as well as more traditional views on male toughness.ConclusionsWe show that an important minority of students express discomfort with the behavior of gay men and hold to a narrow construction of male identity. These findings suggest that competency training must move beyond conceptual discussions and address attitudes toward behaviors through new pedagogical approaches.

The Case for Internal Medicine

The failure to fill several prestigious medical house officerships in 1987 and the subsequent steady decline in interest in internal medicine among medical students has led, over the past five year...

From Galen to Xerox: The Authoritarian Reference in Medicine

Excerpt Clarissimus Galen was a Greek physician who lived and practiced in Rome in the second century A. D. He was said to be a skilled practitioner, but he was better known for preferring theory o...

Fearlessly exploring the other: the role of drama in medical training.

Drama has been used as a medium for instruction within medical education, with particular focus on illness-centred performance.1 At the University of California, Davis, faculty from the Department of English and Division of Internal Medicine informally read scenes from various plays alongside medical students in hour-long sessions. Attendant discussion from students and faculty focus on understanding and approaching these characters as ‘patients’. Similar to doctors interacting with Vivian Bearing, diagnosed with terminal ovarian cancer in Edsons Wit , students appreciated empathising with their characters. Additionally, students obtained a novel perspective by reading for a character from a different background. Their feedback from these sessions reveals that this exercise produces a deeper level of understanding characters from a sociocultural perspective rather than a physiological one. Angels in America is a story of homosexuality, religion and politics set during the AIDS epidemic in the 1980s in New York City. This was a period of paranoia for …

Medicine: the greatest of humanities.

Editors’ Preface: Medical humanities could be said to be the discipline of recapturing the best of medicine. In a time of unprecedented tumult in health care delivery, it seems appropriate for this column to provide opportunity for the pioneers in our field to reflect on where we are, where we seem to be going, and what of the past is most important to bring along. This lecture, delivered to the graduating class of the University of California, Davis School of Medicine in the Spring of 2014, is such a reflection.

Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate

It has been proposed that medical organizations adopt neutrality with respect to physician-assisted suicide (PAS), given that the practice is legal in some jurisdictions and that membership is divided. We review developments in end-of-life care and the role of medical organizations with respect to the legalization of PAS since the 1990s. We argue that moving from opposition to neutrality is not ethically neutral, but a substantive shift from prohibited to optional. We argue that medical organizations already oppose many practices that are legal in many jurisdictions, and that unanimity among membership has not been required for any other clinical or ethical policy positions. Moreover, on an issue so central to the meaning of medical professionalism, it seems important for organized medicine to take a stand. We subsequently review the arguments in favor of PAS (arguments from autonomy and mercy, and against the distinction between killing and allowing to die (K/ATD)) and the arguments against legalization (the limits of autonomy, effects on the patient-physician relationship, the meaning of healing, the validity of the K/ATD distinction, the social nature of suicide, the availability of alternatives, the propensity for incremental extension, and the meaning of control). We conclude that organized medicine should continue its opposition to PAS.

An Academic Clinician’s Perspective on the Care of the Geriatric Patient

This paper discusses the role that the personal history plays in a patient’s perception of his or her own illness in the light of the patient’s own personal history. It demonstrates the regrettable modern tendency to regards the patient as the “bearer of a disease” rather than as a human being with personal values and experiences into which their current illness needs to be integrated. I illustrate my point by an exchange between a student and an “attending” and the “attending” and the patient. It represents only one out of unfortunately many such instances in which the pressures of “managed care” and “efficiency” have made truly knowing the patient as an individual with life experiences and personal values much more difficult.

An Academic Internist Looks at Euthanasia

This paper points out that to persons unfamiliar with the context and suffering of dying patients, their loved ones, and last, but by no means least, the health care team can only discuss the very concrete question of euthanasia in an abstract way unaware of the fact that this question must, in the final analysis, be differently addressed in different specific patients and under specific circumstances. This paper poses questions which must be addressed and will rarely find a good answer but at least the best among a series of unpalatable options. It again points out the important and legitimate place that emotions play in decision-making.

New Orleans al Fresco

I had never been a match for her, not in all the years of our friendship and too-infrequent contacts. What, I wondered to myself, would be apt for discussion on this, a landmark birthday? “Have you...