Showing papers in "Journal of Health Care for the Poor and Underserved in 1999"
TL;DR: Although women in women-only programs had more problems, they spent more time in treatment and were more than twice as likely to complete treatment as compared with women in mixed-gender programs.
Abstract: This study compared the characteristics of 4,117 women treated in publicly funded residential drug treatment programs in Los Angeles County between 1987 and 1994 by pregnancy status and program gender composition, that is, women-only and mixed-gender programs. A logistic regression analysis determined the predictors of program completion. Women in women-only programs were more likely than women in mixed-gender programs to be pregnant, homeless, or on probation; to use methamphetamines; to use alcohol; and have prior drug treatment. Pregnant women were younger, more likely to be homeless, had fewer years of drug use, were more often referred by other service providers, and were less likely to have injected drugs or have prior drug treatment than non-pregnant women. Although women in women-only programs had more problems, they spent more time in treatment and were more than twice as likely to complete treatment as compared with women in mixed-gender programs.
90 citations
TL;DR: A review of the scholarly and applied literature published between 1970 and 1993 on health and health care access problems among racial and ethnic minority group members living in rural U.S. areas suggests that research does not yet permit any clear understanding of the underlying structures and processes that give rise to racial health disparities.
Abstract: This paper provides a review of the scholarly and applied literature published between 1970 and 1993 on health and health care access problems among racial and ethnic minority group members living in rural U.S. areas. Results on the distribution of specific illnesses and diseases, and utilization of medical services are summarized for two major minority groups--African Americans and Hispanic Americans. Findings generally document the expected pattern of rural and minority disadvantage. A review of the conceptual and methodological limitations of existing research suggests that research does not yet permit any clear understanding of the underlying structures and processes that give rise to racial health disparities. Very little is known about the health of rural minorities living in some areas of the country, for example, the west north central United States (Kansas, Missouri, Nebraska, Iowa, North Dakota, South Dakota and Minnesota).
90 citations
TL;DR: Findings indicate that the medically vulnerable are more likely to be disabled and to experience poorer health than the nonmedically vulnerable and the uninsured and Medicare recipients without supplemental insurance experienced fewer physician visits.
Abstract: Employing the Andersen/Neuman model of health behavior, this research compares the medically vulnerable (elderly, poor, and uninsured) with their less vulnerable counterparts with regard to (1) health and disability status, (2) likelihood of physician use, and (3) (among users) amount of physician use. Data were from the Oklahoma Behavioral Risk Factor Surveillance Survey and the Area Resource File. Findings indicate that the medically vulnerable are more likely to be disabled and to experience poorer health than the nonmedically vulnerable. The uninsured are less likely to have seen a physician in the past year. Among those who have seen a physician in the past year, the uninsured and Medicare recipients without supplemental insurance experienced fewer physician visits. The results point to inequalities in the distribution of physician care that may be exacerbated by federal policies that are currently under consideration.
81 citations
TL;DR: The essential elements of tracking and follow-up of marginalized populations, which are collection of contact information, thorough organization of tracking efforts, attention to staff training and support, use of phone and mail follow- up, and attention to safety concerns are reviewed.
Abstract: Maintaining study cohorts is a key element of longitudinal research. Participant attrition introduces the possibility of bias and limits the generalizability of a study's findings, but with appropriate planning it is possible to sustain contact with even the most transient participants. This paper reviews the essential elements of tracking and follow-up of marginalized populations, which are (1) collection of contact information, (2) thorough organization of tracking efforts, (3) attention to staff training and support, (4) use of phone and mail follow-up, (5) use of incentives, (6) establishing rapport with participants, (7) assurance of confidentiality, (8) use of agency tracking, (9) use of field tracking, and (10) attention to safety concerns. Diligent application of these tracking strategies allows researchers to achieve follow-up rates of 75 percent to 97 percent with vulnerable populations such as homeless, mentally ill adults, injection drug users, and runaway youth.
79 citations
TL;DR: The authors maintain that patient participation is necessary for compliance and that a naturally occurring therapeutic alliance between physician and patient incorporates factors such as lifestyle, family, and living circumstances and an awareness of the culturally unique needs of minority patients.
Abstract: Medical training has traditionally focused on diagnosis and treatment of disease, with the notion that if these two factors are satisfactorily managed, the desired outcome will inevitably follow. When it does not, failure is often blamed on patient noncompliance. Failure of patients to return for follow-up visits or comply with medication regimens has been shown to be a major barrier to the delivery of effective medical care. However, effective clinical decision making requires that physicians skillfully address not only the biomedical aspects of diseases and their management, but also the sociobehavorial characteristics of patients. The authors maintain that patient participation is necessary for compliance and that a naturally occurring therapeutic alliance between physician and patient incorporates factors such as lifestyle, family, and living circumstances and an awareness of the culturally unique needs of minority patients. Integration of these factors into professional decision making and practical management plans will enhance patient compliance.
77 citations
TL;DR: Results showed that the medical problems for which the homeless sought treatment were often a reoccurring problem for which treatment had been previously received and community-based services sensitive to the needs of the homeless are likely to cost communities less money while providing better services to the homeless.
Abstract: This study examined the health problems and utilization patterns of homeless individuals (n = 292) seeking medical services in a small, southern community Results showed that the medical problems for which the homeless sought treatment were often (726 percent) a reoccurring problem for which treatment had been previously received The most prevalent medical problem was upper respiratory infection (47 percent), likely exacerbated by the high rate (73 percent) of cigarette smoking found among the sample More than half (514 percent) of the participants had used other medical services in the past month Despite these high rates of utilization, the homeless may, in fact, be underutilizing appropriate preventive medical services, waiting until the medical problem becomes serious before seeking treatment, and overutilizing emergency rooms for nonemergency care Community-based services sensitive to the needs of the homeless are likely to cost communities less money while providing better services to the homeless
65 citations
TL;DR: It was found that in comparison with Medicaid patients, the privately insured patients who are treated with antidepressants are more likely to receive the newer selective serotonin reuptake inhibitors (SSRIs) rather than the older tricyclic antidepressants (TCAs).
Abstract: Mentally ill Medicaid recipients represent a population that may be vulnerable to limited access to adequate treatment for their mental illness In this study, depressed Medicaid recipients were compared with those with private insurance Also examined were racial differences among the Medicaid recipients in the treatment of depression It was found that in comparison with Medicaid patients, the privately insured patients who are treated with antidepressants are more likely to receive the newer selective serotonin reuptake inhibitors (SSRIs) rather than the older tricyclic antidepressants (TCAs) In the Medicaid group, African Americans are more likely to receive TCAs than are white patients Privately insured patients are more likely to receive psychotherapy than are Medicaid patients There is a higher rate of continuous therapy on initial antidepressants in the privately insured group Results suggest that depressed Medicaid recipients' access to quality mental health care is restricted Also, among depressed Medicaid patients, there are racial differences with regard to depression treatment
52 citations
TL;DR: The extent to which the health disparity between African Americans and whites has been reduced is assessed and an extensive list of barriers to reducing the disparity are presented from the scientific literature and strategies for reducing the three health problems are recommended.
Abstract: African Americans suffer disproportionately from several major health problems associated with high morbidity and mortality. The 1985 DHHS Secretary's Task Force Report on Blacks and Other Minorities identified six major disease categories of excess deaths for African Americans compared with whites by applying the lower death rate for whites to the American population. The report provided a stimulus for public and private action to begin to address the health disparities between minority and nonminority populations. This article examines three of the leading causes of death for African Americans and assesses the extent to which the health disparity between African Americans and whites has been reduced. The three leading causes of death for African American males are diseases of the heart, cancer, and HIV infection/AIDS. The conditions are the same for African American females except stroke replaces HIV infection. Three health outcomes measures are discussed: life expectancy, excess death rates, and years of potential life lost. A widening of the gap between the races was found for diseases of the heart and HIV infection for males and for cancer for females. An extensive list of barriers to reducing the disparity are presented from the scientific literature and strategies for reducing the three health problems are recommended.
52 citations
TL;DR: This review identifies the most important areas of needed research and makes recommendations for the development of a research agenda on cancer control and literacy.
Abstract: Low literacy may be an important predictor of increased cancer risk and poor participation in cancer control programs. Results of the National Adult Literacy Survey indicate that about 90 million individuals, slightly less than half of the U.S. adult population, demonstrate low or limited literacy skills. In contrast, the average health education brochure, pamphlet, or instruction sheet requires a 10th-grade or higher level of reading ability to be understood. Guidelines exist for the development of more readable printed materials; studies have also found that nonprint approaches such as video education are viable alternatives to printed materials. Research on patient populations indicates that educational approaches targeted to low-literacy groups can be effective in reaching individuals with cancer control information. This review identifies the most important areas of needed research and makes recommendations for the development of a research agenda on cancer control and literacy.
35 citations
TL;DR: Inner-city physicians described significant access, quality of care, and other barriers in providing state-of-the-art primary care for asthma and recommended that eliminating financial barriers to care is the most important required policy action.
Abstract: This article describes physician perspectives on barriers to quality primary care experienced by inner-city children with asthma and presents policy recommendations to reduce these barriers. The authors interviewed 30 physicians who take care of children with asthma in an inner-city Latino neighborhood, conducted a qualitative analysis of interview themes, and used a consensus group method to recommend policy actions. Inner-city physicians described significant access, quality of care, and other barriers in providing state-of-the-art primary care for asthma. Physicians recommended that eliminating financial barriers to care, including lack of health insurance and/or comprehensive health coverage for necessary medications and equipment, is the most important required policy action. In addition, inner-city physicians recommended that medical care and public health programs provide bilingual education for children with asthma and their families and train primary care physicians about how to provide effective asthma care to children with asthma in the inner city.
34 citations
TL;DR: On the whole, low- Income women were found to experience considerable barriers to care; however, uninsured low-income women have significantly more trouble obtaining care, receive fewer recommended services, and are more dissatisfied with the care they receive than their insured counterparts.
Abstract: This study was undertaken to assess how low-income women with Medicaid, private insurance, or no insurance vary with regard to personal characteristics, health status, and health utilization. Data are from a telephone interview survey of a representative cross-sectional sample of 5,200 low-income women in Minnesota, Oregon, Tennessee, Florida, and Texas. On the whole, low-income women were found to experience considerable barriers to care; however, uninsured low-income women have significantly more trouble obtaining care, receive fewer recommended services, and are more dissatisfied with the care they receive than their insured counterparts. Women on Medicaid had access to care that was comparable with their low-income privately insured counterparts, but in general had significantly lower satisfaction with their providers and their plans. Future federal and state efforts should focus on expanding efforts to improve the scope and reach of health care coverage to low-income women through public or private means.
TL;DR: Access to care is diminished for those who lose Medicaid coverage, even for persons attending community health centers, and willingness to purchase new insurance is diminished.
Abstract: Welfare reform has raised fears that Medicaid recipients will lose coverage, yet efforts to insure the poor via waiver programs may fall short. A telephone sample of 351 enrolled and terminated members of a Medicaid managed care plan based in community health centers were asked about insurance status, source of care, willingness to purchase new insurance, and access. Of terminated families, 78 percent had one member without insurance, 93 percent retained a regular source of care (vs. 96 percent enrolled), and 86 percent retained the same source as before losing coverage. Only 11 percent of uninsured respondents were willing to pay $200 per month and 57 percent to pay $50 per month for replacement coverage, and they were more likely to report problems getting prescription medications and obtaining treatment for serious symptoms and to go without care because of the expense. Access to care is diminished for those who lose Medicaid coverage, even for persons attending community health centers.
TL;DR: In this low-income setting, AFDC and Food Stamp benefits are associated with higher food expenditures, higher anthropometric levels, but inferior diets, and female-headed households spend more on food expenditures than other households, after controlling for other individual- and household-level characteristics.
Abstract: This study tests the hypotheses that the participation in the Aid to Families with Dependent Children (AFDC) and Food Stamp programs has a positive impact on children's nutritional status, after controlling for other potentially important household- and individual-level characteristics. The analysis is based on the responses of a health facility survey of 246 pairs of low-income mothers and children in New Orleans. The results indicate that participation in the AFDC and Food Stamp programs is associated with increased anthropometric status of children, but the foods consumed by children in families receiving welfare benefits were of significantly lower nutritional value than foods consumed by other children. Among the study's conclusions are the following: (1) in this low-income setting, AFDC and Food Stamp benefits are associated with higher food expenditures, higher anthropometric levels, but inferior diets, and (2) female-headed households spend more on food expenditures than other households, after controlling for other individual- and household-level characteristics.
TL;DR: Relying on the basic precepts of Buddhism, the dominant religion of many southeast Asian populations in the United States, the health belief model is utilized to demonstrate how recognizable, acceptable religious constructs can be integrated into the content of HIV prevention messages.
Abstract: Asian Pacific Islander communities in the United States have experienced an alarming increase in HIV infection over the past few years, possibly due to a lack of knowledge and the relative absence of appropriate educational interventions. The authors propose a new approach to the development of HIV prevention programs in U.S. southeast Asian communities. This article reviews the cultural and economic factors that may facilitate HIV transmission within these communities. Relying on the basic precepts of Buddhism, the dominant religion of many southeast Asian populations in the United States, the health belief model is utilized to demonstrate how recognizable, acceptable religious constructs can be integrated into the content of HIV prevention messages. This integration of religious concepts with HIV prevention messages may increase the likelihood that the message audience will accept the prevention messages as relevant. This nuanced approach to HIV prevention must be validated and refined through field research.
TL;DR: Given that resources to provide primary health care services and outreach to the homeless are becoming more difficult to secure and that the size of the homeless population is not expected to diminish, the most efficient methods of serving this high-risk group should be designed with regard to the greatest unmet needs.
Abstract: Substantial literature and clinical experience has drawn the association between homelessness and elevated medical need.1\"5 Since the mid-1980s, many programs from both private and public sources have provided health care for the homeless, usually in urban settings. Few would claim, however, that such efforts have been sufficient to provide more than a small fraction of medical care that is needed. Given that resources to provide primary health care services and outreach to the homeless are becoming more difficult to secure and that the size of the homeless population is not expected to diminish, the most efficient methods of serving this high-risk group should be designed with regard to the greatest unmet needs. Unmet need, however, is difficult and expensive to measure directly without substantial clinical data. Qn the other hand, indirect measurement of unmet medical need may be a more suitable approach in a resource-poor environment. Also, inferences of unmet need can be obtained by analysis of medical care utilization by different risk groups among the larger homeless population. Under the assumption that primary care utilization tends to reduce the need for emergency room use and hospitalization, it would be expected that subgroups of the homeless that utilize relatively few primary care services would also experience more hospitalizations or emergency room services. Wright and Weber2 indicated that many of the emergency room visits by homeless persons in their study were initiated for medical problems that could have been taken care of in a primary care setting, if the individuals had been able to obtain routine health care services. Other investigators have consistently discussed the substitution of emergency room visits for routine and consistent medical care by homeless persons who do not benefit from public medical insurance.6\"9 Subgroups using more of these latter categories of care would be characterized as having greater relative unmet medical need than those whose principal medical care utilization is based on consistent clinical or primary care services. Access to care has been recognized as one of the fundamental challenges to homeless adults since the onset of the modern recognition of the problem in the early 1980s. The Robert Wood Johnson Foundation and many other mainstream sources of influence and research have focused their efforts on the issue
TL;DR: Most centers had established formal relationships with training institutions but generally had limited involvement with course planning, and most centers had offered training to students from many disciplines, with nursing and medicine the most frequent.
Abstract: Increasing demand for health professionals with training in ambulatory and primary care practice is placing stress on existing train- ing site capacity. Community health centers can serve as model training sites, offering comprehensive multidisciplinary health care services and teaching clinician role models. In this study, 32 Illinois community and migrant health centers and federally qualified health centers were surveyed to assess their involvement with training in the past three years. Thirty centers had offered training to students from many disciplines, with nurs- ing (27 centers) and medicine (24) the most frequent. Most centers had established formal relationships with training institutions but generally had limited involvement with course planning. Continued participation will likely require adequate funding, with some centers also seeking stronger institutional relationships and better integration of community health issues. Educators and policy makers may need to tA¤te a more active role in supporting centers, acquiring funds, and other enabling factors.
TL;DR: The dynamic nature of the American identity is presented, along with implications for differential health status, and a critical leadership role for the public health profession is proposed as urgently needed and as yet incompletely embraced.
Abstract: Racial and ethnic disparities in health status are persistent phenomena well described in the arena of public health. Such disparities are perhaps best understood in their full social, political, and historical context. While recognizing the rich literature on social determinants of health, this paper provides a specific discussion of the status of "the minority" in the United States. The dynamic nature of the American identity is first presented, along with implications for differential health status. Next discussed are emerging paradigms in research and intervention that incorporate the dynamic nature of the American identity as both an explanation and an opportunity for remedy of health status disparities. Finally, a critical leadership role for the public health profession is proposed as urgently needed and as yet incompletely embraced.
TL;DR: It is shown that rural veterans have a case mix and a reduction in health status similar to that of VA hospital-based patients, and planners should account for this health reduction when planning the kinds of facilities and services needed in rural areas.
Abstract: Between 1992 and 1994, the Department of Veterans Affairs (VA) experimented with mobile clinics to provide health care for rural veterans. The objective was to assess the health status of rural mobile clinics' patients and compare this with patients receiving care in VA hospital-based clinics. This study hypothesized that hospital-based clinic patients would be more ill (i.e., have a greater reduction in health status). The Medical Outcomes Study (MOS) Short Form was used to evaluate patients' health status. Most patients sought care for the management of chronic disease. Patients in both groups had similar types of diseases. Mobile clinic patients were as ill as hospital-based patients (i.e., similar health status scores). This study shows that rural veterans have a case mix and a reduction in health status similar to that of VA hospital-based patients. Planners should account for this health reduction when planning the kinds of facilities and services needed in rural areas.
TL;DR: To develop a relevant, community-based prevention campaign, the authors examined, using street-intercept interviews, syphilis-related knowledge, circulation of information, and screening and treatment practices among four hundred residents of two inner-city communities in Houston, Texas, where syphilis case rates exceed city, county, and national averages.
Abstract: To develop a relevant, community-based prevention campaign, the authors examined, using street-intercept interviews, syphilis-related knowledge, circulation of information, and screening and treatment practices among four hundred residents of two inner-city communities in Houston, Texas, where syphilis case rates exceed city, county, and national averages. Although awareness of syphilis was near universal, one-fourth of the respondents thought syphilis was incurable, and a large proportion confused syphilis with other sexually transmitted diseases (STDs), mentioning discharge and burning or itching in the genital area as symptoms. Almost four out of five respondents were aware of free treatment and screening facilities in the local area, yet, less than two of five expressed the intention to get tested within the next month. Only 22 percent had seen or heard anything about syphilis in the past twelve months. The resultant prevention campaign is discussed along with implications for the development of comprehensive STD prevention and control campaigns in similar poor and underserved communities.
TL;DR: Data indicate that, despite targeted, youth-specific, developmentally appropriate and culturally sensitive outreach and intervention efforts, youth of color and high-risk youth are poorly accessing CTS.
Abstract: With the advent of new therapies for HIV, case identification through HIV counseling and testing (CTS) has become critically important. Young women, youth of color, and disenfranchised youth are at significant risk of acquiring HIV. This study describes clients who access CTS at a program of comprehensive care for high-risk youth (aged 12 to 24 years), and assessed, using logistic regression analyses, whether youth at highest risk utilized CTS. Most of the 531 youth were female (72 percent) and nonwhite (60 percent). Sixty-eight percent received CTS. Logistic regression modeling revealed that white race and receiving care at the teaching hospital were the only independent predictors of testing. Data indicate that, despite targeted, youth-specific, developmentally appropriate and culturally sensitive outreach and intervention efforts, youth of color and high-risk youth are poorly accessing CTS. A greater understanding of the barriers to and cultural norms regarding CTS is needed.
TL;DR: Clinique features associated with a lower risk of hospitalization in the year before AIDS diagnosis were associated with five clinic features that facilitate the accessibility of care: evening/weekend hours, case manager, appointments within 48 hours, telephone consultation, and whether the clinic handled urgent care.
Abstract: Specific features of ambulatory care, such as accessibility, may influence hospital use for patients with HIV infection. To identify clinic features associated with a lower risk of hospitalization, 6,280 New York state Medicaid enrollees diagnosed with AIDS in 1987-1992 and managed by one of 157 surveyed clinics were studied. The odds of hospitalization in the year before AIDS diagnosis were associated with five clinic features that facilitate the accessibility of care: (1) evening/weekend hours, (2) case manager, (3) appointments within 48 hours, (4) telephone consultation, and (5) whether the clinic handled urgent care. Hospitalization in the year before AIDS diagnosis occurred for 49 percent of patients. Three of the five accessibility features had unadjusted associations with lower hospitalization rates. The adjusted odds of hospitalization were lower for patients in clinics with extended hours (OR = 0.77, 95% CI = 0.63, 0.93) and for patients in clinics with four or more accessibility features compared with those in clinics with less than two features (OR = 0.67; 95% CI = 0.50, 0.89).
TL;DR: Tennessee's TennCare program, established in 1994, uses a managed care system to address the problem of escalating Medicaid costs while expanding coverage to the chronically uninsured while staying within the projected cost parameters of the Medicaid system.
Abstract: Tennessee's TennCare program, established in 1994, uses a managed care system to address the problem of escalating Medicaid costs while expanding coverage to the chronically uninsured. This paper examined TennCare based on results of survey research commissioned by the state and conducted by the authors. Findings indicated that respondents formerly on Medicaid who had previously indicated a preference for Medicaid were now much more likely to prefer TennCare and were now as satisfied with TennCare as they had been with Medicaid in 1993. TennCare has had some impact on health care behavior, with fewer recipients seeking care at a hospital and more seeking care at a doctor's office or a clinic. At this point, Tennessee's experience with TennCare seems to be successful. Tennessee has been able to fund a fairly significant increase in coverage of the uninsured population while staying within the projected cost parameters of the Medicaid system.
TL;DR: Focusing on factors such as adjacency to metropolitan areas or population size or density in making managed care policy decisions may be less productive than focusing on the socioeconomic and health system characteristics of an area.
Abstract: The objective of this research was to test the hypothesis that urban-rural differences in managed care availability and enrollment are primarily due to differences in population socioeconomic and health system characteristics rather than geographic location, population size, or density. These two groups of variables were entered into a regression equation to determine which group could best account for the variance in managed care availability and enrollment. In general, the results of these analyses indicated that socioeconomic and health system characteristics did a much better job of explaining differences in managed care availability and enrollment. Therefore, focusing on factors such as adjacency to metropolitan areas or population size or density in making managed care policy decisions may be less productive than focusing on the socioeconomic and health system characteristics of an area.
TL;DR: To address the disparate rates of breast cancer in the authors' society, enhanced efforts in targeting minority groups are obviously needed.
Abstract: Over the past 40 years, increasing numbers of Americans have benefited from breast cancer prevention, early detection, and improved treatment. However, prognosis and survival after the diagnosis of breast cancer are poorer among African American women compared with Caucasian and Hispanic women.1,2 Studies that attempt to explain this disparity have emphasized that African American patients, with the exception of those from upper education/income levels, are more likely to present with a higher stage or more advanced disease.3,4 These patients are also more likely to report some commonly perceived barriers to screening, such as cost and/or lack of medical insurance, lack of access to mammography facilities, the misconception that without symptoms there is no need to be screened, and fewer motivations in their decision to participate. The need for targeting specific populations has been demonstrated in previous studies reporting disparity in the screening rates in women of different socioeconomic levels and cultures.5 Data of mortality by race of all ages show that African American women are more likely to die of breast cancer with a rate of 31.2 per 100,000, compared with a rate of 26.0 per 100,000 for Caucasian women.6 The death rate for breast cancer in American women declined 4.7 percent between 1989 and 1992, but African American women showed an increase in the death rate of 2.6 percent during this same time period.67 Breast cancer awareness and screening are the key factors in the decline. However, to address the disparate rates of breast cancer in our society, enhanced efforts in targeting minority groups are obviously needed.
TL;DR: Norplant is an effective contraceptive for inner-city Latinas; removal rate was higher than in previous reports; side effects or fear of side effects led to removal in more than half the patients by two years' use.
Abstract: This study was a consecutive-case series of138 Latinas (age 16 to 36) who received levonorgestrel implants (Norplant ) in a commu- nity health center between September 1,1992, and December 31,1994, and were observed through September 30,1997. Continuation rate at one year was 70 percent, and 43,28, and 22 percent at two, three, and four years, respectively. Average observation time was 32 months. Most fre- quent reasons for removal were excessive bleeding (34 percent), weight gain (26 percent), hair loss (16 percent), amenorrhea (13 percent), desire for pregnancy (11 percent), and headaches (9 percent). Five women dis- continued due to fear of ill effects, four to undergo sterilization. No preg- nancies occurred while using the method. Norplant is an effective contra- ceptive for inner-city Latinas; removal rate was higher than in previous reports. Side effects or fear of side effects led to removal in more than half the patients by two years' use.
TL;DR: Teaching of altruistic demeanor is most successful using a combination of techniques, which include philosophy, virtue theory, small-group discussions using case vignettes, and the structured objective clinical examination with "standardized patients".
Abstract: The sportscasters' metaphor, "on and off the playing field," is used to describe the altruistic demeanor of good ethical and moral behavior and empathy toward patients that is required of medical students and physicians. It has been noted that these altruistic qualities often compete unsuccessfully with scientific skills and scholarly pursuits. Many schools hold the "White Coat Ceremony" annually and host a chapter of the Honor Medical Society to instill these traits in students. Teaching of altruistic demeanor is most successful using a combination of techniques, which include philosophy, virtue theory, small-group discussions using case vignettes, and the structured objective clinical examination with "standardized patients." On the playing field, current major issues are intellectual honesty, mandatory testing/treatment for HIV/AIDS, abortion, end-of-life issues, and gene therapy. Off the playing field, family, religion, community service, and leadership will immortalize medical students in the mythical Health Care Hall of Fame.