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Caring for survivors of victimization is very hard work, in ways that are similar to and different from other difficult patient interactions. Careful attention to basic physiologic and psychological needs of the physicians is necessary to tolerate the stress and to prevent the burnout that can accompany this work. In addition, understanding survivors' interpersonal dynamics may help physicians provide better care. Consultation with colleagues is essential to remaining healthy and effective as givers of care. Language: en more...

Dr. Smith’s first patient of the day is a 63-year-old woman, Mrs. Meyer, who has persistent diarrhea and a weight loss of 10 pounds (from 92 pounds to 82 pounds) over 2 months. She is widowed and has three daughters who live in town. When Dr. Smith asked about her past medical history, she indicated that she smokes about two packs per day, consumes about two drinks per day, and has been hospitalized once for an appendectomy and for the births of her three children. more...

• Nine hundred ninety-seven breast biopsies that were performed at one hospital over the five-year period from 1971 through 1975 were reviewed because of a changing pattern in the use of breast biopsies on outpatients who were under local anesthesia. In 1971, 17% of all breast biopsies were performed as outpatient procedures; by 1975, the figure was 60%. In 1971, 5% of all malignant neoplasms were diagnosed by the use of biopsies as outpatient procedures and 30% in 1975. Hospital charges for biopsy on an inpatient basis of benign breast disease were 7.2 times higher than for biopsy on an outpatient basis. Interviews of 102 patients clearly suggested that most patients were satisfied with the outpatient breast biopsy experience. Outpatient breast biopsy under local anesthesia is a safe procedure that is more economical in terms of medical cost, surgeons' time, and patients' time away from home and/or job. Preliminary biopsy of malignant lesions using local anesthesia permits more efficient use of diagnostic procedures to stage the extent of disease prior to treatment. Patient acceptance of breast biopsy as an outpatient procedure under local anesthesia was similar to their acceptance of biopsy on an inpatient basis under general anesthesia. (Arch Surg113:942-946, 1978) more...