Terry A. Travis

The Obsessive personality

Submission to a physicians authority is humiliating for the obsessive patient, because he fears the physicians rejection and his own loss of autonomy. Therefore, management of illness in the obsessive patient is most satisfactory when the physician-patient relationship is one of mutual participation.

The attitudes of physicians toward prolonging life.

A brief questionnaire concerning the care of terminally ill patients was distributed to all physicians in the state of Iowa. The response to it suggests that Iowa physicians believe that terminal patients often realize that they are dying, though they rarely speak of it. Nearly half of those physicians revealed that they frequently omitted life-prolonging procedures or medications in the care of these patients. Likewise, close to half indicated that with some increased sharing of responsibility for decisions in this area, they might increase the frequency of this particular practice. In contrast, the vast majority expressed opposition to change in social attitudes which would permit physicians to hasten death. An analysis of responses to the questionnaire revealed the influence of experience upon the attitudes and practices of Iowa physicians. With greater exposure to terminal patients they more readily discussed a patients prognosis with him, more often received requests for interruption of treatment, and more frequently omitted life-prolonging measures.

Further evidence of construct validity of standardized patient‐based performance examinations

The purpose of this study was to gather additional evidence pertinent to the construct validity of standardized patient‐based clinical performance examinations. Specifically, the study determined whether students who indicated they had previously read about, seen, or worked up a case on the examination performed differently on that case from those students who had not. Overall, it was found that students with previous reading or direct experiences with cases on the test tended to have higher case mean scores on those cases than those who had not. These results demonstrated that scores on standardized patient‐based performance examinations are sensitive to the examinees’ various learning experiences.

Assessment of Uniqueness of Information Provided by Postencounter Written Scores on Standardized-Patient Examinations

The complete clinical encounter station uses two testing methods in the assessment of clinical competence: checklists completed by standardized patients (SPs) who record actions students performed on history and physical examination and written responses by students to a series of written questions designed to elicit findings they see as pertinent to the problem, their working hypotheses, their plans for laboratory findings, and their diagnoses and management plans. Given that the critical part of any SP station is the standardizedpatient encounter and that the postencounter session needed for the student to answer the written questions increases the time required to administer an already lengthy examination, questions have been raised about the need for written questions in addition to SP checklists in the clinical encounter station. Thus it is important to determine if the written scores are providing additional, nonredundant information over and above that provided by the checklist scores. The results of this study showed only moderate overlap between the checklist and written scores. The mean checklist-written correlation across 83 SP cases was .13, and the mean correlation between the average checklist and written scores across six classes of medical students was .32. The mean of the correlations across the six classes, disattenuated for measurement error, was only .57. The results provide strong evidence that the written scores provide unique information, in addition to that provided by checklist scores.

The psychopathic personality. One of a series.

An expert at manipulating interpersonal relationships, the psychopath may attempt to misuse the relationship with the physician for his own gain. The physician should be familiar with the psychopathic personality because of the serious trouble such patients can cause him as well as others.

False‐negative and false‐positive rates resulting from measurement error for a mastery examination using standardized‐patient cases

Standardized‐patient (SP) examinations are being used increasingly for the identification of examinees who have mastered the clinical competencies deemed necessary for the practice of clinical medicine. Hence, it is of critical importance to evaluate the psychometric properties of the mastery decisions—in particular, the false‐negative and false‐positive rates associated with these pass‐fail decisions. In this article, methods are described for estimating the false‐negative and false‐positive rates resulting from measurement error for a mastery examination. These rates, as well as the reliabilities of the pass‐fail decisions based on a recently adopted standard‐setting procedure, are reported for data for six classes of senior medical students. The methods for determining the false‐negative rate, in particular, provided valuable information for our faculty about the effectiveness of the new standard‐setting procedure for minimizing false‐negative decisions for our SP‐based examination.

The Hostile-Dependent Personality: Last of a series

The hostile-dependent person is in a state of lasting dissatisfaction with himself, and the sick role is a ready-made vehicle for this dissatisfaction. In treating such a patient, the physician should listen carefully and patiently to complaints, give emotional support and reassurance, and remain calm when confronting inconsiderate, baiting behavior.

Personality disorders: an introduction.

Patients with a personality disorder exhibit fixed, lifelong patterns of behavior that normal persons exhibit to a lesser extent. Ability to identify such exaggerated behavior patterns can help the physician to manage more skillfully difficult physician-patient relationships.

The Paranoid Personality: One of a Series

Viewing the world about him as hostile and menacing, the paranoid individual uses characteristic traits to cope with that world and avoid a retreat into fantasy. On initial contact, the physician must be alert to the ways this patient reveals himself and subsequently must tactfully establish rapport to facilitate treatment.

The Hysterical personality

When the hysterical persons immature, dependent needs are not met, she is prone to present physical complaints that simulate organic illness. Unless the physician recognizes the hysterical personality, all his therapeutic efforts with such a patient ultimately fail.