Search

Background: A high level of pain catastrophizing has negative influences on outcomes in many surgical disciplines. Our purpose was to determine whether surgeons are able to accurately identify high catastrophizing in orthopedic patients after routine clinical consultation. Methods: In this prospective study, English-literate patients aged 18 years or older were assessed by 1 of 11 orthopedic surgeons. Patients completed the Pain Catastrophizing Scale (PCS), and the surgeon rated each patient as having a high or low level of catastrophizing after the clinical encounter. We calculated accuracy and agreement of surgeon assessment with the PCS at a cut-off score of 30 (score > 30 = high level of catastrophizing) and used multivariate testing to determine whether patient age or sex, surgeon experience or subscores of the PCS (rumination, magnification and helplessness) influenced surgeon accuracy. Results: Among 203 patients (109 women and 94 men), the mean PCS score was 18.4 (standard deviation 12.9), with no sex difference and no significant correlation to patient age. Of the 40 patients who scored 30 or more on the PCS, 22 (55%) were not identified as having high levels of catastrophizing by their surgeon. Accuracy was 0.72, and agreement was 0.2. Female patients were more likely than male patients to be identified as high catastrophizing regardless of PCS score (odds ratio 2.0, 95% confidence interval 1.04-4.0). Conclusion: Surgeons were not able to accurately identify patients with high levels of pain catastrophizing during routine initial consultation. In considering which patients may most benefit from interventions to improve coping and reduce catastrophizing, explicitly measuring pain catastrophizing will be required. Contexte : Un niveau élevé de dramatisation face à la douleur a une influence négative sur les résultats dans plusieurs disciplines chirurgicales. Notre objectif était de déterminer si les chirurgiens orthopédistes sont capables d'identifier avec précision un niveau élevé de dramatisation de la douleur chez les patients après une consultation clinique de routine. Méthodes : Au cours de cette étude prospective, des patients capables de communiquer en anglais âgés de 18 ans ou plus ont été évalués par un de 11 chirurgiens orthopédistes. Les patients ont répondu au questionnaire PCS (Pain Catastrophizing Scale), une échelle de mesure de la dramatisation face à la douleur, et après la consultation clinique, le chirurgien assignait à chaque patient un niveau faible ou élevé de dramatisation. Nous avons calculé la justesse et la concordance de l'évaluation du chirurgien avec le score PCS, avec un score seuil de 30 (score > 30 = niveau élevé de dramatisation) et utilisé un test multivarié pour déterminer si l'âge ou le sexe, l'expérience du chirurgien ou certaines sous-échelles de la PCS (rumination, amplification et sentiment d'impuissance) influaient sur le jugement du chirurgien. Résultats : Sur 203 patients (109 femmes et 94 hommes), le score PCS moyen a été de 18,4 (écart-type 12,9), sans différence liée au sexe ni corrélation significative avec l'âge des patients. Sur les 40 patients ayant obtenu un score de 30 ou plus à l'échelle PCS, 22 (55%) n'ont pas été identifiés comme présentant des niveaux élevés de dramatisation par les chirurgiens. La précision a été de 0,72, et la concordance de 0,2. Les patientes étaient plus susceptibles que les patients d'être identifiées comme présentant un niveau élevé de dramatisation, indépendamment du score à l'échelle PCS (rapport des cotes 2,0, intervalle de confiance à 95% 1,04-4,0). Conclusion : Les chirurgiens ont été incapables d'identifier avec précision les patients présentant des niveaux élevés de dramatisation face à la douleur durant la consultation initiale de routine. Pour savoir quels patients sont plus susceptibles de bénéficier d'interventions visant à améliorer leurs capacités d'adaptation et réduire la dramatisation, il faudra des mesures précises du niveau de dramatisation face à la douleur., Mounting evidence suggests that factors other than objective disease severity or technical success of a surgical intervention can influence surgical outcomes. Among these factors is a catastrophizing coping style. High [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2010.01.009 Byline: Enid Montague Abstract: A patient's trusting attitude towards technology used in their medical care may be a predictor of acceptance or rejection of the technology and, by extension, the physician. The aim of this study was to rigorously determine the validity of an instrument for measuring patients' trust in medical technology. Instrument validity was established based on a framework, which included test and data evidence for validity assessment. The framework for validity assessment evaluates the instrument on content, substantive, structural, generalizability, external and consequential aspects of validity. The results of the current study show that the instrument is reliable and valid for assessing a patient's trust in obstetric medical technology. Author Affiliation: Industrial and Systems Engineering Department, University of Wisconsin-Madison, 3217 Mechanical Engineering, 1513 University Avenue, Madison, WI 53706, USA Article History: Received 12 January 2009; Accepted 23 January 2010

The objective of this study was to assess the effect of a biopsychosocial intervention on patients' feelings of well-being, perceptions of health and health indicators before and after treatment in [...]

Murray and Lopez (1997) predict that by the year 2020 the top two contributors to the burden of disease worldwide will be ischemic heart diseases and depression. More than five [...]

Byline: Ami Rokach (1) Keywords: cancer; illness; loneliness; multiple sclerosis; terminal illness Abstract: Loneliness is a universal phenomenon, and its pain is intensified by a diagnosis of a terminal illness. The present study is an investigation of the strategies used by patients with Multiple sclerosis (MS), by individuals diagnosed with cancer, and by the general population to cope with loneliness. Three hundred and twenty nine MS patients, 315 cancer patients, and 391 participants from the general population answered a 34-item questionnaire. Results indicated that with the exception of Reflection and acceptance, Distancing and denial, and Increased activity, the three groups cope with loneliness significantly differently. Author Affiliation: (1) The Institute for the Study and Treatment of Psychosocial Stress, 104 Combe Ave., Toronto, ON, Canada, M3H 4J9 Article History: Registration Date: 11/08/2006 Received Date: 19/05/2006 Accepted Date: 09/08/2006 Online Date: 27/09/2006

Objective: Patterns of successive saccades and fixations (scan paths) that are made while viewing images are often spatially restricted in schizophrenia, but the relation with cannabis-induced psychosis has not been [...]

Objective: To evaluate a Better Outcomes of Mental Health Care Access to Allied Psychological Services Program for general practice patients referred for high-prevalence mental disorders. Methods: Participants were South Australian general practitioners (GPs; n=26) and their patients referred for treatment of high-prevalence psychological disorders, of whom 229 provided baseline measures, 106 provided post-treatment measures, and 85 provided follow-up data three months after termination of treatment. Interventions were Focused Psychological Strategies supplied by mental health specialists; outcome variables included GP satisfaction, patient satisfaction, psychological distress, life impairment, and health service usage. Results: Satisfaction with the treatment program was high for both the GPs and the referred patients. Patients who attended three or more treatment sessions showed reduced distress and disability, and gains were maintained three months later. Health service usage declined with acceptance of referral regardless of treatment experience. Conclusions: Lack of controls and missing data were methodological weaknesses. Results support the effectiveness of integrated primary mental health care to reduce psychological distress and disability, while impact on service usage warrants further investigation. Implications: Reduction of suffering and increased economic productivity may both result from this public health initiative to increase access to effective treatments for common chronic mental conditions. Key words: Mental disorders, depression, program evaluation, primary health care, delivery of health care.

You ask me: what is life? That is like asking: what is a carrot? A carrot is a carrot and that's all there is to it. --Anton Chekhov He wakes [...]

The traditional model of medical ethics minimizes the particular, ever-changing, concrete realities of patients" lives in favor of general, invariable, abstract principles. Narrative ethics offers a powerful complement to that [...]

This paper analyzes 'empathy' and 'sympathy' as situated practices, sequential processes that are coconstructed by the participants in the situation. The data consists of 228 sequences of patients' descriptions of their problematic experiences and professionals' responses to them in videorecorded general practice and homeopathic consultations. One deviant case, in which the practitioner shows compassion to the patient in an exceptional way, is subjected to detailed analysis. It is argued that both professionals and patients orient to a degree of professional neutrality in these situations, but also that affiliative practices can be adjusted to the otherwise problem-governed course of the consultation. These orientations seem to address questions similar to those of theoretical distinctions made between the terms empathy and sympathy.

Recently, the Medical College of Ohio in Toledo received a $1.9 million gift, with the stipulation that it be used to teach medical professionals interpersonal skills. The gift came from [...]

Byline: Chanita Hughes Halbert (1), Marc D. Schwartz (2), Lari Wenzel (3), Steven Narod (4), Beth N. Peshkin (2), David Cella (5), Caryn Lerman (6) Keywords: perceptions of stress and confidence; genetic testing; BRCA1 and BRCA2 Abstract: The objectives of this study were (1) to describe perceptions of stress and confidence following genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations and (2) to identify predictors of these processes. Participants were 130 high-risk women affected with cancer who received BRCA1/2 test results. Individual difference characteristics and interpersonal factors were measured by self-report before genetic counseling and perceptions of stress and confidence were evaluated by self-report 1 month following disclosure of test results. BRCA1/2 test results had a significant effect only on perceptions of stress ([beta] = 0.38, p = 0.0001), while trait anxiety had a significant effect on both perceptions of stress ([beta] = 0.44, p = 0.0001) and confidence ([beta] = -0.41, p = 0.001). These results suggest that interventions designed to address perceptions of stress related to medical decision-making and familial concerns may need to be targeted to BRCA1/2 mutation carriers and individuals who are highly anxious. Author Affiliation: (1) Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA (2) Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA (3) Department of Medicine, Epidemiology Division, University of California -- Irvine, Irvine, California, USA (4) The Centre for Research in Women's Health, Women's College Hospital, Toronto, Canada (5) Center on Outcomes, Research and Education, Northwestern University, Evanston, Illinois, USA (6) Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA Article History: Registration Date: 29/12/2004

Objectives. Complementary and alternative therapies have become popular with patients in Western countries. Studies have suggested motivations for patients' choosing a wide range of complementary therapies. Data on the expectations of patients who use complementary therapy are limited. We assessed the expectations of patients who use complementary therapy. Methods. Patients attending a British National Health Service (NHS) outpatient department that provided acupuncture, osteopathy, and homoeopathy were asked to complete a qualitative survey. Results. Patients expected symptom relief, information, a holistic approach, improved quality of rife, self-help advice, and wide availability of such therapies on the NHS. Conclusions. Physicians' understanding of patients' expectations of complementary therapies will help patients make appropriate and realistic treatment choices.

ABSTRACT The measurement of the impact of skin diseases on patients' quality of life is important. This review explains the reasons for this, explains the main methods of measuring quality [...]

Byline: Paul T. G. Davies (1), Chris J. Glynn (2), Miriam A. Kadry (3) Keywords: Chronic daily headache; Intractable headache; Headache clinic; Patients' expectations Abstract: Abstract We audited the expectations of patients referred to a combined headache clinic from a specialist headache clinic and a pain relief unit due to the intractable nature of their headache. Our aim was to assess the expectations of definitive diagnosis for the cause of headache, as well as the acceptance of its symptomatic management. We reviewed the notes of all patients referred to the combined clinic over a 2-year period from January 1998 to January 2000. It has been standard practice in the clinic to document patients' expectations of definitive diagnosis for the cause of their headache and for its symptomatic treatment. Fifty-two patients (29 women, 23 men mean age, 40.5 years range, 15--76 years) were referred to the combined clinic over the two years. These patients had been selected from a total of 460 new patients seen in the specialist headache clinic over this period. All patients had been reviewed by at least one consultant neurologist. Nearly all suffered chronic daily headache of mean duration 8.25 years (range, 1--40 years). Only three patients suffered from migraine as well. Forty patients (77%) were still concerned about the cause of their headaches 13 (33%) of these wanted further investigations. Fourteen (27%) of the original 52 patients were discharged from the clinic, 9 (17%) were satisfied and accepted symptomatic management of their headache, 5 patients (10%) were unsatisfied and were still looking for a cause for their pain. Five more patients (10%) who demanded further investigations failed to keep follow-up appointments. The remaining 33 patients (64%) accepted symptomatic management within the clinic. One in five patients (20%) attending a tertiary referral clinic for symptomatic treatment of chronic headache did not want symptomatic treatment. They wanted to know the cause of the headache and be provided with a cure. This observation is important when one is assessing outcome measures, because 20% of these patients did not want symptomatic management, the only treatment on offer. Author Affiliation: (1) Department of Neurology, Radcliffe Infirmary, Oxford, UK (2) The Pain Relief Unit, Churchill Hospital, Oxford, UK (3) Department of Anaesthesia, West Middlesex Hospital, Twickenham, London, UK Article History: Received Date: 08/11/2002 Accepted Date: 18/04/2003

Byline: Jennifer H. Goldberg (1), James N. Breckenridge (2,3), Javaid I. Sheikh (2,3) Keywords: medical patients; depression; anxiety; age Abstract: This study examined whether symptoms of depression and concomitant anxiety differed between older and younger medical outpatients referred to a behavioral medicine clinic. In a sample of 178 male veterans aged 21--83 years, older adults (aY=60 years) reported lower overall depressive symptoms on the Beck Depression Inventory (BDI) and anxiety symptoms on the State-Trait Anxiety Inventory than did younger adults (&lt 60 years). Depressive symptoms were highly prevalent. Among older adults, 60.0% scored 10 or higher on BDI and 33.8% scored 16 or higher. Among younger adults, 70.8% scored 10 or higher on BDI, and 48.7% scored 16 or higher. The age difference in overall depressive symptoms was driven by cognitive--affective symptoms. While older adults had lower cognitive--affective symptoms than did younger adults, the two groups did not differ on somatic-performance symptoms. These results suggest the importance of assessing cognitive--affective depressive symptoms in both older and younger male medical outpatients. Author Affiliation: (1) Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California (2) Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California (3) VA Palo Alto Health Care System, Palo Alto, California Article History: Registration Date: 05/10/2004

You can talk about your patients' stool and urine, and you have no difficulty mentioning genitalia if the subject is, say, vaginitis or testicular cancer. But if you're like most [...]

Byline: Akinori Masuda (1), Takashi Nakayama (2), Takao Yamanaka (3), Yasuyuki Koga (4), Chuwa Tei (1) Keywords: chronic fatigue syndrome; prognosis; multidisciplinary treatment; cognitive--behavioral therapy Abstract: The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome (CFS, n = 9) and noninfectious CFS (n = 9) was clarified. After treatment, natural killer (NK) cell activity increased in the postinfectious CFS group but did not recover to within normal range in the noninfectious CFS group. In the postinfectious CFS group, physical and mental symptoms improved, and 8 patients returned to work. In the noninfectious CFS group, symptoms did not improve, and only 3 patients returned to work. The prognosis of postinfectious CFS group was better than that of noninfectious CFS group. Classification of CFS patients into postinfectious and noninfectious groups is useful for choosing the appropriate treatment in order to obtain better prognosis. Author Affiliation: (1) First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan (2) The Department of Psychosomatic Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan (3) National Institute of Fitness and Sports, Kanoya, Japan (4) Nishi Kyusyu University, Japan Article History: Registration Date: 12/10/2004

Byline: Gretchen A. Brenes (1), Stephen R. Rapp (1), W. Jack Rejeski (2), Michael E. Miller (3) Keywords: optimism; pessimism; physical functioning; osteoarthritis Abstract: Dispositional optimism has been shown to be related to self-report measures of health and well-being, yet little research has examined the relationship between optimism and more objective measures of functioning. The purpose of this study was to examine the relationship between optimism and pessimism and objective physical functioning. Four hundred eighty community-dwelling older adults with knee pain completed a measure of optimism and pessimism and were observed performing four daily activities (walking, lifting an object, climbing stairs, and getting into and out of a car). Results indicated that pessimism was significantly related to performance on all four tasks (p &lt .001), while optimism was related to performance only on the walking task (p &lt .05), after controlling for demographic and health variables. Author Affiliation: (1) Department of Psychiatry &amp Behavioral Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, 27157-1063 (2) Department of Health and Exercise Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157 (3) Department of Public Health Sciences, Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157 Article History: Registration Date: 12/10/2004

Byline: Debra V. McQuade (1) Keywords: arthritis; illness perception; workplace; social support Abstract: In the present study, 340 college subjects evaluated the job performance of hypothetical workers of varying health status, to test the hypothesis that workers with rheumatoid arthritis (RA) are more negatively perceived than other workers (paraplegic, healthy) despite equivalence in age, sex, education, job history, and time off from work for medical reasons. Results indicated that workers with RA are perceived as having significantly poorer interpersonal job skills and are deserving of significantly poorer scores for overall job performance, although no differences were obtained in the ratings of their job commitment or job expertise. The suggestion is made that an unfavorable social reaction to RA patients in the workplace is one factor that impairs the development of social support for these patients at work and contributes to their inflated disability rate. Author Affiliation: (1) Department of Psychiatry, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, 03756 Article History: Registration Date: 12/10/2004

Adjustment to illness is influenced both by individual resources and the support available from a marital partner. In this study of 61 male heart patients and their wives, patients' self-rated health and the agreement between patient and spouse ratings of the patients' health were investigated as contributing to patients' psychosocial well-being. Patients' positive self-rating of health and also spouses' rating that concurred with their own self-rating were related to greater well-being among patients. The advantage to patient well-being of shared spouse appraisals beyond patients' own health appraisal extends the growing literature indicating the predictive utility of individual subjective health appraisals by demonstrating the added value of the perceptions of spouses who share the illness context.

Keywords: benefit-finding; cancer; lupus; psychosocial impact; multiple sclerosis; chronic disease Abstract: Mohr et al. (1999) described the psychosocial effects of multiple sclerosis (MS) from the patient's perspective. Three factors emerged: demoralization, benefit-finding, and deteriorated relationships. The benefit-finding factor suggested that some patients with MS benefited from their illness. We investigated the generalizability of these results by replicating the Mohr et al. study using patients with two diseases, cancer (N = 56) and lupus (N = 31). All participants completed the questionnaire developed by Mohr et al. along with the Profile of Mood States. When the data were analyzed, results showed a three-factor solution very similar to the one reported by Mohr et al. Scores on the demoralization factor were positively related to total mood disturbance and average pain ratings and inversely related to benefit-finding. Conversely, patients who perceived more benefits from their illness suffered less. We conclude that benefit-finding is not unique to patients with MS but occurs in patients with other chronic diseases. Article History: Registration Date: 16/10/2004

Behavioral scientists who study socially important but difficult-to-measure behaviors often rely on self-reports. We evaluated the influence of three experimenter demands - demand for adherence, demand for accurate reports, and demand for accurate reports combined with a prompted recall strategy - on the accuracy of self-reports of adherence to a weeklong prescribed regimen of twice-daily telephone calls. Self-reports of adherence were significantly more accurate in the accuracy demand/prompted recall group (p < .05). The analogue study should be replicated with other regimens and populations to determine the most effective strategies for enhancing the accuracy of self-reports. DESCRIPTORS: adherence, self-reports, measurement, medical regimens

Byline: Heather K. McIsaac (1), Dana S. Thordarson (1), Roz Shafran (1), S. Rachman (1), Gary Poole (1) Keywords: MAGNETIC RESONANCE IMAGING; CLAUSTROPHOBIA; FEAR; ANXIETY Abstract: We examined fear induced by the magnetic resonance imaging (MRI) procedure in 80 adult patients who were undergoing the procedure for the first time. Participants completed self-report measures of claustrophobia, anxiety sensitivity, thoughts about the scan, and pain. Participants were assessed pre- and postscan, and at 1-month follow-up. Twenty-five percent of the participants experienced moderate to severe anx iety during the MRI scan. Prescan scores on the Claustrophobia Questionnaire (CLQ: Rachman and Taylor, 1993) significantly predicted participants' distress during the scan pain and anxiety sensitivity did not. Furthermore, CLQ scores discriminated between participants who reported panic during the scan and participants who did not report panic. A brief screening instrument consisting of six items from the 29-item CLQ is suggested. This brief screening instrument administered prior to the scan may help identify in advance those people who are most likely to experience claustrophobic fear and, in particular, those who panic during the MRI procedure. Author Affiliation: (1) Department of Psychology, University of British Columbia, V6T 1Z4, 2136 West Mall, Vancouver, British Columbia, Canada (2) Department of Psychology, Simon Fraser University, Burnaby, BritishColumbia, Canada Article History: Registration Date: 28/09/2004

Patients suffering from Munchausen syndrome will do everything in their power to provide basis for their complaints. A surgeon's encounter with a Munchausen patient supports this claim. The patient saw the surgeon for an apparent obstruction of bowel movement. However, surgery was not considered an option since her condition improved after every visit. The consistent complaining of the patient drew suspicion from the physician. After checking with the patient's previous doctors, it was found out that the patient deliberately altered her medical records to receive surgical treatment., Spotting this syndrome has gotten tougher, the author says. The new twist? Now patients can "document" their hoax. When patients reveal their symptoms and complaints to us, we assume they're [...]

A hazard of being a physician is encountering patients or their family members who have abusive or violent behavior. Physicians cannot prevent violent attacks from happening, but they can draw up measures to protect themselves when such incidents occur. However, they should never commit actions that will injure these patients because they might also injure themselves in the process. The best course would be to wait until the patients calm down or to call for help when the attacks become uncontrollable., Doctor, I don't care if it is cancer. If you remove my wife's breast, I'm going to blow your brains out!' The general surgeon in Georgia who received that phone [...]

I use statistical data to describe the populations of malpractice claims in New York and Massachusetts, and in-depth interviews with physicians and claimants to explore the human side of medical malpractice claims. I argue that medical malpractice claims are associated with tertiary medical care delivered within a business setting. Several major themes emerge from my analysis. There is a strong distinction between physicians' and claimants' definitions of medical outcomes. Physicians judge medical outcomes in terms of generally accepted medical practice. In contrast, patients judge medical outcomes in terms of how their lives have changed. Physicians voice their concerns about the uncertainty in the practice of medicine. Marginalization, which occurs when physicians push their patients' personal and social concerns related to their treatment to the periphery, is a major concern of claimants. The physicians' interviews also contain themes of anger, distrust of patients, and defensive medicine; patients' themes include anger, vindication, and deference towards their former physicians. Finally, some physicians and claimants view medicine more as a business rather than as a humanistic institution.

Objectives. The purposes of this study were to (1) characterize the social disability associated with the common psychiatric illnesses of primary care patients in terms of role dysfunction (self-care, family role, social role, occupational role) and (2) establish whether severity of psychiatric illness and disability level show synchrony of change. Methods. A two-stage sample design was employed. In the first state, 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness by their physicians and with the General Health Questionnaire. A stratified random sample (n = 285) with differing probabilities was selected for a second-stage interview. Patients with psychiatric symptons were reinterviewed 1 and 3.5 years later (n = 143). Results. (1) Disability Level among patients was increased (moderately for depression, mildly for anxiety and was associated with severity of psychiatric illness. (2) Most disability was found in occupational and social roles. (3) Change in severity of psychiatric illness was concordant wit change in level of disability and was largely invariant across diagnosis (depression, anxiety, mixed anxiety/depression). At follow-up, disability among improved patients had returned to normal levels. Conclusions. Psychiatric illness in primary care patients is associated with mild to moderate disability, and severity of psychiatric illness and disiability show synchrony of change. (Am J Public Health. 1993;83:385-390), Psychiatric illnesses such as depression and anxiety can cause mild to moderate social disability in some patients treated by primary care physicians. The degree of loss of functioning in social roles may increase with the severity of disease. A study examined the level of disability among patients of primary care physicians with psychiatric illnesses over a three-and-a-half-year period. The level of disability had increased moderately for the patients suffering from depression and mildly for those suffering from anxiety. An increase in disability was associated with an increase in the severity of illness. The level of disability depended on the severity of psychiatric symptoms. Patients whose illnesses improved returned to a normal level of functioning. The patients' occupational and social roles were more affected by disability than their family roles or personal care.

Some patients think that they will not get sick if they follow their physicians' instructions exactly. Physicians should make sure that patients do not have unrealistic expectations about their health. One type of patient with such expectations is the extremist or superachiever, who seems to be euphoric most of the time. Physicians should take an optimistic but a realistic approach toward patients while avoiding overselling the benefits of medical care., I was sitting on the side of Fred's bed in the intensive-care unit. Only 12 hours earlier he'd suffered an acute myocardial infarction and been admitted through the emergency room. [...]

Doctors often have difficulty in understanding why some patients refuse critical care. Those working in clinics serving indigent populations need special compassion for the situations of their patients. Even critically ill patients can have concerns beyond their life expectancy., In this era of rising costs and decreasing funds, it's tough to be a good doctor. The frustrations are particularly acute for those of us who serve a disadvantaged population. [...]

MY PATIENT GOT MAD WHEN I CURED HER "Suffering" from a bleeding disorder and high fever, she seemed proud of here maladies. Then the author discovered her game. It was [...]

WHY I'M THE KIND OF PATIENT YOU'D LOVE TO SEE LEAVE In my previous career as a medical transcriptionist, I got used to hearing physicians describe certain patients as "old [...]

Mr A is a 42-year-old man who presents with substernal chest pain and is found to have had a myocardial infarction. After being evaluated and stabilized in the emergency department, [...]

The biopsychosocial approach is alive and well, benefiting from a much improved name--relationship-centered care--and having been embraced by the mainstream of the medical education establishment. But when it comes to [...]