48 results on '"Wayne Shelton"'
Search Results
2. Professional Identity Formation in Medical Education: Some Virtue-Based Insights
- Author
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Daniel T. Kim, Megan K. Applewhite, and Wayne Shelton
- Subjects
General Medicine ,Education - Published
- 2023
3. The Place of Bioethics in Philosophy: Toward a Mutually Constructive Integration
- Author
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Wayne Shelton, Daniel T. Kim, and Pierce Randall
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Issues, ethics and legal aspects ,Health Policy - Published
- 2022
4. A review of 'Caregiving, Carebots, and Contagion'
- Author
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Wayne Shelton
- Subjects
Caregivers ,Humans ,General Medicine - Abstract
How far can smart machines, or carebots, go in performing the profoundly intimate human work of patient caregivers? How will mechanization alter how we understand the essential features of the human task of caregiving and the role of the caregiver? It is these complex questions, with real world implications, that this article discusses in reviewing "Caregiving, Carebots, and Contagion" by philosopher and bioethicist Michael Brannagan.
- Published
- 2022
5. Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics
- Author
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Lisa Campo-Engelstein and Wayne Shelton
- Subjects
Students, Medical ,Health (social science) ,Virtue ethics ,020205 medical informatics ,education ,Identity (social science) ,Face (sociological concept) ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Virtues ,ComputingMilieux_COMPUTERSANDEDUCATION ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Ethics, Medical ,030212 general & internal medicine ,Curriculum ,ComputingMilieux_THECOMPUTINGPROFESSION ,Health Policy ,Professional development ,humanities ,Professionalism ,Medical training ,Hidden curriculum ,Engineering ethics ,Psychology ,Education, Medical, Undergraduate - Abstract
We describe a virtue ethics approach and its application in a four-year, integrated, longitudinal, and required undergraduate medical education course that attempts to address some of the challenges of the hidden curriculum and minimize some of its adverse effects on learners. We discuss how a curriculum grounded in virtue ethics strives to have the practical effect of allowing students to focus on their professional identity as physicians in training rather than merely on knowledge and skills acquisition. This orientation, combined with a student-generated curriculum, is designed to prepare students to identify and face challenges during their clinical years, further nurturing their professional growth. In short, a four-year integrated ethics and professionalism curriculum intentionally centered on cultivating virtuous physicians may alleviate, and even counteract, the effects of the hidden curriculum in the clinical years of medical training.
- Published
- 2021
6. Discharge Challenges
- Author
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Wayne Shelton
- Published
- 2022
7. Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics
- Author
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Wayne Shelton and Lisa Campo‑Engelstein
- Published
- 2022
8. When a Chronically Ill Patient Disagrees with the Discharge Recommendation: The Limits of Patient Autonomy
- Author
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Wayne Shelton
- Subjects
Patient discharge ,medicine.medical_specialty ,business.industry ,Health Policy ,MEDLINE ,Patient Discharge ,Issues, ethics and legal aspects ,Chronic disease ,Patient autonomy ,Chronic Disease ,medicine ,Humans ,Intensive care medicine ,business ,ComputingMilieux_MISCELLANEOUS ,Healthcare system - Abstract
This is a patient in the relatively early stages of a serious chronic disease requiring ongoing vigilant management if acute complications are to be minimized. In today's healthcare system, we see ...
- Published
- 2021
9. Physicians' End of Life Discussions with Patients: Is There an Ethical Obligation to Discuss Aid in Dying?
- Author
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Yan Ming Jane Zhou and Wayne Shelton
- Subjects
Physician-Patient Relations ,Terminal Care ,Health (social science) ,Palliative care ,Euthanasia ,Health Policy ,media_common.quotation_subject ,Death with dignity ,Medical law ,organization ,Issues, ethics and legal aspects ,Nursing ,Informed consent ,Philosophy of medicine ,organization.non_profit_organization ,Humans ,Conversation ,Obligation ,Psychology ,End-of-life care ,media_common - Abstract
Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying (AID) processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients have the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID (in qualifying states) during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options.
- Published
- 2020
10. Were the 'Pioneer' Clinical Ethics Consultants 'Outsiders'? For Them, Was 'Critical Distance' That Critical?
- Author
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Bruce D. White, Wayne Shelton, and Cassandra J. Rivais
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Consultants ,education ,0603 philosophy, ethics and religion ,Professionalization ,03 medical and health sciences ,Professional Competence ,0302 clinical medicine ,Ethicists ,Humans ,Medical humanities ,030212 general & internal medicine ,Sociology ,Objectivity (science) ,Referral and Consultation ,health care economics and organizations ,business.industry ,Health Policy ,06 humanities and the arts ,Bioethics ,Public relations ,Applied ethics ,United States ,humanities ,Issues, ethics and legal aspects ,Ethics, Clinical ,Professionalism ,Professional ethics ,Normative ,060301 applied ethics ,Clinical Ethics ,business ,Medical ethics - Abstract
"Clinical ethics consultants" have been practicing in the United States for about 50 years. Most of the earliest consultants-the "pioneers"-were "outsiders" when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became "insiders" very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient "critical distance" for appropriate reflection about the complex medical ethics dilemmas of the day if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field.
- Published
- 2018
11. Empowering Patients with Alzheimer's Disease To Avoid Unwanted Medical Care: A Look At The Dementia Care Triad
- Author
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Wayne Shelton, Evelyn M. Tenenbaum, Kevin Costello, and David P Hoffman
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medicine.medical_specialty ,030214 geriatrics ,business.industry ,General Neuroscience ,Newly diagnosed ,Disease ,medicine.disease ,Medical care ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,Triad (sociology) ,0302 clinical medicine ,Family medicine ,mental disorders ,medicine ,Dementia ,030212 general & internal medicine ,Geriatrics and Gerontology ,business - Abstract
Patients with Alzheimer’s disease and other types of dementia with acute medical problems, who have lost capacity and are without advance directives, are at risk of being over treated inhospitals. To deal with this growing demographic and ethical crisis, patients with dementia need to plan for their future medical care while they have capacity to do so. This article will examine the role of each member of the dementia care triad and how to empower the patient to participate in planning future medical care. A case will be made that physicians have the same professional disclosure obligations to dementia patients as they do to all other capable patients with terminal illnesses. Because there is little consensus about what facts should be included in a diagnostic disclosure, this article will offer a proposal to empower newly diagnosed patients with dementia with capacity to plan for their future medical care.
- Published
- 2018
12. The Process to Accredit Clinical Ethics Fellowship Programs Should Start Now
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Wayne Shelton and Bruce D. White
- Subjects
Medical education ,Process (engineering) ,business.industry ,Health Policy ,MEDLINE ,06 humanities and the arts ,0603 philosophy, ethics and religion ,03 medical and health sciences ,Issues, ethics and legal aspects ,0302 clinical medicine ,Medicine ,060301 applied ethics ,030212 general & internal medicine ,Clinical Ethics ,business ,Accreditation - Published
- 2016
13. Structuring a Written Examination to Assess ASBH Health Care Ethics Consultation Core Knowledge Competencies
- Author
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Jane Jankowski, Bruce D. White, and Wayne Shelton
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Certification ,Writing ,Professionalization ,Professional Competence ,Ethicists ,Surveys and Questionnaires ,Virtues ,Health care ,Pedagogy ,Humans ,Medicine ,Ethics Consultation ,Core Knowledge ,business.industry ,Health Policy ,Conflict of interest ,Professional-Patient Relations ,Bioethics ,Issues, ethics and legal aspects ,Ethics, Clinical ,Professional ethics ,Engineering ethics ,business ,Licensure - Abstract
As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities (ASBH) has published core knowledge competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models-both objective and written-must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization.
- Published
- 2014
14. In Particular Circumstances Attempting Unproven Interventions Is Permissible and Even Obligatory
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Wayne Shelton, Bruce D. White, and Luke C. Gelinas
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Issues, ethics and legal aspects ,Health Policy ,Law ,MEDLINE ,Psychological intervention ,Psychology - Abstract
I shall do less whenever I shall believe what I am doing hurts the cause, and I shall do more whenever I shall believe doing more will help the cause. I shall try to correct errors when shown to be...
- Published
- 2015
15. Realistic Goals and Expectations for Clinical Ethics Consultations: We Should Not Overstate What We Can Deliver
- Author
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Bruce D. White and Wayne Shelton
- Subjects
Issues, ethics and legal aspects ,Psychotherapist ,Health Policy ,Moral distress ,Moral emotions ,Clinical Ethics ,Psychology ,Social psychology - Abstract
The article by Professor Fiester (2015) expresses concern about the long-term moral distress or negative moral emotions, both aspects of moral residue, that linger in some stakeholders’ experiences...
- Published
- 2015
16. A New Look at Medicine and the Mind-Body Problem: Can Dewey’s Pragmatism Help Medicine Connect with Its Mission?
- Author
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Wayne Shelton
- Subjects
Pragmatism ,Education, Medical ,Mind–body problem ,John dewey ,business.industry ,Health Policy ,media_common.quotation_subject ,Perspective (graphical) ,MEDLINE ,General Medicine ,United States ,Epistemology ,Philosophy ,Issues, ethics and legal aspects ,History and Philosophy of Science ,Law ,Dualism ,Humans ,Medicine ,Ethics, Medical ,business ,Psychophysiology ,media_common - Abstract
This article discusses how the paradigm of Cartesian mind-body dualism has shaped the cultural and institutional life of modern science and medicine. John Dewey (1859-1952) made this case in a speech to the New York Academy of Medicine in 1927, "Preoccupation with the Disconnected," an expanded version of which was published as "Body and Mind" in the Bulletin of the New York Academy of Medicine in January 1928. From the perspective of Dewey's broader philosophy, the most urgent aspect of mind-body dualism is of a practical, not theoretical, nature. Medicine at present has an opportunity in both education and practice to reconcile internally disparate trends that result from mind-body dualism and to renew its mission.
- Published
- 2013
17. Health Care Ethics Committees as Mediators of Social Values and the Culture of Medicine
- Author
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Cynthia M. A. Geppert and Wayne Shelton
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medicine.medical_specialty ,Health (social science) ,Social Values ,media_common.quotation_subject ,education ,Culture ,Impartiality ,Nursing ,Informed consent ,Health care ,Medicine ,Humans ,Military medical ethics ,Ethics Consultation ,media_common ,business.industry ,Nursing ethics ,Health Policy ,Bioethics ,Hospitals ,Organizational ethics ,Issues, ethics and legal aspects ,Ethics, Clinical ,Ethics Committees, Clinical ,business ,Delivery of Health Care ,Medical ethics - Abstract
Health care ethics committees may fail in their role as mediators if their members lack impartiality, independence, or expertise in policy formation.
- Published
- 2016
18. The Role of Communication and Interpersonal Skills in Clinical Ethics Consultation: The Need for a Competency in Advanced Ethics Facilitation
- Author
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Wayne Shelton, Cynthia Geppert, and Jane Jankowski
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Aged, 80 and over ,Male ,Adolescent ,Social Values ,Negotiating ,Communication ,Decision Making ,Emotions ,Dissent and Disputes ,Social Skills ,Social Facilitation ,Professional Competence ,Professional Role ,Ethics, Clinical ,Ethicists ,Brain Injuries ,Humans ,Family ,Female ,Referral and Consultation ,Aged - Abstract
Clinical ethics consultants (CECs) often face some of the most difficult communication and interpersonal challenges that occur in hospitals, involving stressed stakeholders who express, with strong emotions, their preferences and concerns in situations of personal crisis and loss. In this article we will give examples of how much of the important work that ethics consultants perform in addressing clinical ethics conflicts is incompletely conceived and explained in the American Society of Bioethics and Humanities Core Competencies for Healthcare Ethics Consultation and the clinical ethics literature. The work to which we refer is best conceptualized as a specialized type of interviewing, in which the emotional barriers of patients and their families or surrogates can be identified and addressed in light of relevant ethical obligations and values within the context of ethics facilitation.
- Published
- 2016
19. The Effect of a Family Support Intervention on Physician, Nurse, and Family Perceptions of Care in the Surgical, Neurological, and Medical Intensive Care Units
- Author
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Rachel Hinerman, Karen Sigond, Gary L. Bernardini, Wayne Shelton, Crystal Dea Moore, Deborah Baofeng Wang, and Jane Dowling
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Adult ,Male ,medicine.medical_specialty ,Surgical nursing ,Attitude of Health Personnel ,Critical Illness ,Family support ,Critical Care Nursing ,law.invention ,Ambulatory care ,Nursing ,Professional-Family Relations ,law ,Surveys and Questionnaires ,Critical care nursing ,Intervention (counseling) ,Intensive care ,Outcome Assessment, Health Care ,Health care ,medicine ,Humans ,Aged ,Quality of Health Care ,Patient Care Team ,Analysis of Variance ,business.industry ,Continuity of Patient Care ,Length of Stay ,Middle Aged ,Intensive care unit ,Patient Discharge ,Intensive Care Units ,Self-Help Groups ,Cross-Sectional Studies ,Family medicine ,Female ,Perception ,business - Abstract
Many patients in the intensive care unit (ICU) have predictable medical and discharge outcomes, but some trajectories are marked with medical uncertainty. Stressed family-surrogates receive multiple medical updates from a variety of personnel. These circumstances can lead to confusion, which may result in conflicts and dissatisfaction with care. This study examined the effects of adding a family support coordinator to the surgical, neurological, and medical ICUs on family, physician, and nurse satisfaction with communication and care. A quasi-experimental design was conducted in 2 sequential phases (baseline and intervention). The data sources were 2 surveys: (1) Family Satisfaction Survey and (2) Nurse and Physician Perception and Satisfaction Survey. Family Satisfaction Survey data, a combined data set, were collected in the 3 ICUs. Nurse and Physician Perception and Satisfaction Survey data were collected from the attending physicians and critical care nurses in the medical and neurological ICUs. Results show that family ratings of satisfaction with ICU team communication and care generally increased as a result of the intervention. Overall, physician and nurse perceptions of communication and care did not change as a result of the intervention.
- Published
- 2012
20. A Comparison of General Medical and Clinical Ethics Consultations: What Can We Learn From Each Other?
- Author
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Cynthia M. A. Geppert and Wayne Shelton
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Service (business) ,medicine.medical_specialty ,Medical consultation ,Consultants ,business.industry ,education ,MEDLINE ,General Medicine ,Medical care ,Special Article ,Ethics, Clinical ,Family medicine ,Health care ,Ethics Consultation ,Internal Medicine ,Humans ,Medicine ,Ethics, Medical ,Critical assessment ,Clinical Ethics ,business - Abstract
Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed.
- Published
- 2012
21. For Lack of a Better Plan: A Framework for Ethical, Legal, and Clinical Challenges in Complex Inpatient Discharge Planning
- Author
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Terese Seastrum, Robert N. Swidler, Jane Jankowski, and Wayne Shelton
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Male ,medicine.medical_specialty ,Health (social science) ,media_common.quotation_subject ,Medical law ,Legal advice ,medicine ,Humans ,Justice (ethics) ,Psychiatry ,health care economics and organizations ,Aged ,media_common ,Aged, 80 and over ,business.industry ,Health Policy ,Middle Aged ,Models, Theoretical ,Viewpoints ,Patient Discharge ,humanities ,Issues, ethics and legal aspects ,Intervention (law) ,Ethics, Clinical ,Risk analysis (engineering) ,Work (electrical) ,Philosophy of medicine ,Female ,business ,Autonomy - Abstract
This article proposes a new theoretical framework for analyzing complex inpatient hospital discharge dilemmas. Each component of the framework is defined, illustrated with a hypothetical case, and discussed from legal,ethical and practical problem solving viewpoints. Patients who lack reasonable and safe discharge plans invariably challenge existing interpretations of autonomy, capacity, and justice. Such cases often require legal advice and sometimes intervention from the judicial system when alternatives are exhausted. As an extension of previous work on discharge planning (Swidler et al., 2007), this work strives to provide medical professionals with an organized way of approaching inpatient discharge barriers and to encourage new ways of considering and designing healthcare policy both to reduce discharge delays and also better to serve patients.
- Published
- 2009
22. A Process and Format for Clinical Ethics Consultation
- Author
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Robert D. Orr and Wayne Shelton
- Subjects
General Medicine - Published
- 2009
23. The Role of Social Work in the ICU
- Author
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Susannah L. Rose and Wayne Shelton
- Subjects
Counseling ,Social Work ,medicine.medical_specialty ,Health (social science) ,Decision Making ,Psychological intervention ,MEDLINE ,End of life decision ,Quality of life (healthcare) ,Nursing ,Intensive care ,Humans ,Medicine ,Family ,Life-span and Life-course Studies ,Family distress ,Intensive care medicine ,Patient Care Team ,Terminal Care ,Social work ,business.industry ,Communication ,Intensive Care Units ,business ,Psychosocial ,Stress, Psychological - Abstract
The costs associated with Intensive Care Units (ICUs) are high and at times invasive ICU care may not be beneficial, particularly for those patients admitted to ICUs who have little hope of recovery. The process of clarifying medical goals for these patients is often facilitated by addressing psychosocial factors. Social workers in the ICU are uniquely qualified to assess and address many of the complex psychosocial circumstances and can clarify potential misperceptions, enhancing communication among patients (if capacitated), their families, and the medical team members. This can not only help improve quality of life for very sick and dying patients in the ICU and their families, but may also reduce the likelihood of decision-making conflicts from arising. Further studies need to be done to investigate the effectiveness of social work interventions in reducing family distress, avoiding care that is unwanted by patients, and demonstrating cost-saving benefits.
- Published
- 2006
24. Factors Influencing Length of Stay in the Intensive Care Unit
- Author
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Susannah L. Rose, Glenn McGee, Sophia Socaris, Ann E. Rutter, Wayne Shelton, and David A. Gruenberg
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Specific risk ,Psychological intervention ,MEDLINE ,General Medicine ,Critical Care Nursing ,Intensive care unit ,Unit (housing) ,law.invention ,law ,Critical care nursing ,Health care ,Emergency medicine ,Medicine ,business ,Intensive care medicine - Abstract
• Background Long stays in the intensive care unit are associated with high costs and burdens on patients and patients’ families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit. • Objective To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay. • Methods Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life. • Results The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay. • Conclusions Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients’ families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.
- Published
- 2006
25. Putting the Conversation about Gun Ownership and Safety in Context
- Author
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Wayne Shelton
- Subjects
Firearms ,media_common.quotation_subject ,MEDLINE ,Poison control ,Context (language use) ,complex mixtures ,01 natural sciences ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,parasitic diseases ,Injury prevention ,Internal Medicine ,Humans ,Medicine ,Conversation ,030212 general & internal medicine ,0101 mathematics ,media_common ,business.industry ,Communication ,Ownership ,010102 general mathematics ,technology, industry, and agriculture ,Human factors and ergonomics ,Perspective ,Wounds, Gunshot ,business ,human activities - Abstract
Recent debate on whether physicians should discuss gun ownership with their patients has centered on determining whether gun injuries are an issue of health or safety, and on protecting patient privacy. Yet, physicians’ duties span personal health, public health, and safety spheres, and they often must address private patient matters. To prioritize gun safety and reduce gun injuries, the primary policy-driving question should be: will physician counseling on gun ownership effectively reduce gun-related injuries without interfering with the physician’s other treatment obligations or compromising the physician–patient relationship? Existing data on physician-initiated conversations with patients about guns support a positive prevention effect. However, it is critical that physician-initiated discussions of safe gun practices are not motivated by, nor convey, disapproval of gun ownership. To be ethical, respectful, and efficient, the conversation should be standard between primary care providers and all of their patients (not limited to patient subsets); questions and education should be limited to topics of gun-ownership risks and storage practices; and the conversation must be framed without bias against gun ownership.
- Published
- 2016
26. Putting Children at Risk in the Name of Religion
- Author
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Wayne Shelton and Bruce D. White
- Subjects
medicine.medical_specialty ,business.industry ,Health Policy ,Gender studies ,06 humanities and the arts ,0603 philosophy, ethics and religion ,03 medical and health sciences ,Issues, ethics and legal aspects ,0302 clinical medicine ,Medicine ,060301 applied ethics ,030212 general & internal medicine ,Critical congenital heart disease ,business ,Psychiatry - Abstract
The risk of a newborn having critical congenital heart disease (CCHD) is about 1 out of 100 babies, making it the most common birth defect. If this condition goes undetected, the consequences for t...
- Published
- 2016
27. [Untitled]
- Author
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Wayne Shelton and John A. Balint
- Subjects
Psychoanalysis ,Conceptualization ,business.industry ,media_common.quotation_subject ,education ,Public relations ,Psychiatry and Mental health ,Clinical Psychology ,Fiduciary ,Alliance ,Agency (sociology) ,Doctor–patient relationship ,Stewardship ,Psychology ,business ,Function (engineering) ,Anonymity ,media_common - Abstract
There has been growing concern about the effects on the patient-physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called "double agency." Various authors have proposed ways to restore patient centeredness to the patient-physician interaction. We have previously discussed the need to establish a patient-physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug "doctor"; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient-physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.
- Published
- 2002
28. A survey of healthcare industry representatives' participation in surgery: some new ethical concerns
- Author
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Jeffrey Bedard, Crystal Dea Moore, and Wayne Shelton
- Subjects
Adult ,Endoscopes ,Male ,Surgeons ,Internet ,Lasers ,Oral Surgical Procedures ,Health Care Sector ,Ophthalmologic Surgical Procedures ,Middle Aged ,Surgical Instruments ,United States ,Anesthesiology ,Surgical Procedures, Operative ,Surveys and Questionnaires ,Humans ,Urologic Surgical Procedures ,Female ,Orthopedic Procedures ,Clinical Competence ,Cardiac Surgical Procedures - Abstract
To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives.A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery.A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon.HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery.
- Published
- 2014
29. [Untitled]
- Author
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Wayne Shelton
- Subjects
Value (ethics) ,Issues, ethics and legal aspects ,Politics ,Scope (project management) ,business.industry ,Philosophy of medicine ,Law ,Psychological intervention ,Normative ,Medicine ,General Medicine ,business ,Law and economics - Abstract
This paper attempts to provide a descriptive theoretical overview of the medical futility debate. I will first argue that quantitative data cannot alone resolve the medical futility debate. I will then examine two aspects of medical futility, which I call the prospective and immediate, respectively. The first involves making prospective factual and value judgments about the efficacy of proposed medical interventions, while the latter involves making value judgments about ongoing medical conditions where the clinical data are clear. At stake is the nature and scope of individual rights. Thus, I maintain there is an undeveloped aspect to the medical futility debate and, briefly, analyze two political perspectives which give rise to different understandings of medical futility. The view that I will defend is that only a system with defined collective goals can accommodate a normative concept of medical futility. These larger questions are the value options which, if unaddressed, may be settled by default of economic grounds.
- Published
- 1998
30. Forgoing Medical Treatment in Severe Facial Trauma
- Author
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Etienne Phipps and Wayne Shelton
- Subjects
Adult ,Facial trauma ,medicine.medical_specialty ,Treatment Refusal ,Central nervous system disease ,Ethicists ,medicine ,Humans ,Family ,Mental Competency ,Facial Injuries ,Patient Care Team ,Brain Diseases ,Ethics Committees ,Medical treatment ,business.industry ,medicine.disease ,Dissent and Disputes ,Group Processes ,Surgery ,Withholding Treatment ,Personal Autonomy ,Ethics Consultation ,Quality of Life ,Female ,Wounds, Gunshot ,business ,Medical Futility - Published
- 1997
31. Fair Treatment of Alcoholic Patients in the Context of Liver Transplantation
- Author
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John A. Balint and Wayne Shelton
- Subjects
Moral Obligations ,medicine.medical_specialty ,Attitude of Health Personnel ,Contempt ,medicine.medical_treatment ,Medicine (miscellaneous) ,Context (language use) ,Liver transplantation ,Morals ,Toxicology ,Resource Allocation ,Liver Cirrhosis, Alcoholic ,Humans ,Medicine ,Ethics, Medical ,Creatures ,business.industry ,Patient Selection ,General surgery ,Beneficence ,Liver Transplantation ,Surgery ,Transplantation ,Psychiatry and Mental health ,Personal Autonomy ,Humanity ,business ,Liver Failure - Abstract
Dealing as we do with poor suffering humanity, we see the man unmasked, exposed to all the frailities and weaknesses, and you have to keep your heart soft and tender lest you have too great a contempt for your fellow creatures. Sir William Osler
- Published
- 1997
32. When Patients Choose Unwisely at the End of Life: What are the Obligations of Physicians?
- Author
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Wayne Shelton
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Family medicine ,Alternative medicine ,medicine ,Omics ,business ,End-of-life care - Published
- 2013
33. Regaining the initiative. Forging a new model of the patient-physician relationship
- Author
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John A. Balint and Wayne Shelton
- Subjects
Freedom ,Control (management) ,Social Environment ,Trust ,Truth Disclosure ,Resource Allocation ,Paternalism ,Nursing ,Health care ,Humans ,Medicine ,Ethics, Medical ,Social Change ,Physician-Patient Relations ,business.industry ,Health Policy ,Beneficence ,General Medicine ,History, 20th Century ,United States ,Therapeutic relationship ,Patient Rights ,Alliance ,Models, Organizational ,Personal Autonomy ,Sociology of health and illness ,Patient Participation ,business ,Delivery of Health Care ,Social responsibility - Abstract
The patient-physician relationship has undergone major and increasingly rapid changes in the past 40 years. It has moved from a relationship based on physician paternalism, through one of patient autonomy, to one where the patient and the physician's authority and control over the patient's care are facing significant threats from outside sources. In this article, we examine the historical and social forces that have contributed to these changes and the effects these forces have had on the traditional models of the patient-physician relationship. We present arguments to support our proposal for a patient-physician alliance in the community based on mutual education of physician and patient about health and illness, values and persons, social responsibility, beneficence, trust, and a degree of paternalism. We believe such an alliance offers the best hope for patients and their physicians to regain the initiative in guiding the evolution of health care in a way that preserves the essentials of the therapeutic relationship. (JAMA. 1996;275:887-891)
- Published
- 1996
34. HCEC pearls and pitfalls: suggested do's and don't's for healthcare ethics consultants
- Author
-
Joseph A, Carrese, Armand H Matheny, Antommaria, Kenneth A, Berkowitz, Jeffrey, Berger, Joseph, Carrese, Brian H, Childs, Arthur R, Derse, Colleen, Gallagher, John A, Gallagher, Paula, Goodman-Crews, Ann, Heesters, Martha, Jurchak, Christine, Mitchell, Nneka, Mokwyune, Kayhan, Parsi, Tia, Powell, Kathleen E, Powderly, Tarris, Rosell, Wayne, Shelton, Martin L, Smith, Jeffrey, Spike, Anita, Tarzian, and Lucia, Wocial
- Subjects
Ethics Committees ,Ethicists ,Ethics Consultation ,Humans ,Ethics, Medical ,Bioethics ,United States - Abstract
Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.
- Published
- 2012
35. The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit
- Author
-
Sophia Socaris, Jane Dowling, Jian Gao, Crystal Dea Moore, and Wayne Shelton
- Subjects
Adult ,Male ,Family support ,Family satisfaction ,Surgical intensive care unit ,Critical Care and Intensive Care Medicine ,law.invention ,Nursing ,law ,Professional-Family Relations ,Intervention (counseling) ,Medicine ,Humans ,Consumer behaviour ,Aged ,Patient Care Team ,Surgical Intensive Care ,business.industry ,Communication ,Health Care Costs ,Consumer Behavior ,Length of Stay ,Middle Aged ,Intensive care unit ,Hospital Charges ,Intensive Care Units ,Female ,business ,Cost of care - Abstract
The study examined the effect of adding a full-time family support coordinator to the surgical intensive care unit team on family satisfaction, length-of-stay, and cost in the surgical intensive care unit.A quasi-experimental design was conducted in two phases: baseline (8 mos) and intervention (10 mos) phases. Data on family satisfaction, length-of-stay, and costs from both phases were collected.The intervention added a new role, the family support coordinator, to the surgical intensive care unit team. The family support coordinator functioned as a liaison between the patient's family and the health care team.The results revealed that generally the intervention was associated with increases in family satisfaction with communication for all surgical intensive care unit team members, with physicians, social workers, and respiratory care therapists showing increases in significance. The largest increase was for physician communication (p = .0034). Families also rated their perceptions of the quality of care provided to their family members by various members of the surgical intensive care unit team. Mean ratings increased for all areas of care, with respiratory and nursing care showing the largest increases. Families' perceptions of the care and treatment they received during the stay of their family member showed increases in all areas of satisfaction between baseline and intervention, particularly those areas most related to the intervention.The implementation of the family support coordinator intervention increased family satisfaction across a range of parameters. Although there were decreases in length-of-stay and costs, they were not statistically significant. Further research is needed to determine whether intervention refinement could produce lower length-of-stay and costs.
- Published
- 2010
36. Difficult hospital inpatient discharge decisions: ethical, legal and clinical practice issues
- Author
-
Robert N. Swidler, Wayne Shelton, and Terese Seastrum
- Subjects
Male ,education ,Decision Making ,Home Care Services, Hospital-Based ,Personal autonomy ,Medicare ,Angina Pectoris ,Principle-Based Ethics ,Nursing ,Alzheimer Disease ,Social Justice ,Diabetes Mellitus ,Medicine ,Humans ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,Health Policy ,Beneficence ,food and beverages ,Hospital based ,Social justice ,Patient Discharge ,United States ,Clinical Practice ,Issues, ethics and legal aspects ,Caregivers ,Ethics, Clinical ,Personal Autonomy ,Ethics, Institutional ,Female ,Safety ,business ,Ethical analysis ,Ethical Analysis - Abstract
Every day, in every hospital, hospital staff members, patients, and families wrestle with critically important discharge decisions. Those decisions can raise complex issues with significant ethical...
- Published
- 2007
37. The Role of Empirical Data in Bioethics: a Philosopher's View
- Author
-
Wayne Shelton
- Subjects
Virtue ethics ,Casuistry ,Philosophy ,Utilitarianism ,Beneficence ,Bioethics ,Feminist ethics ,Medical ethics ,Epistemology ,Deontological ethics - Abstract
How many textbooks or introductory articles in bioethics begin with a section on ethical theory? Of the many that do, the relevance of basic theories of utilitarianism, deontology, virtue ethics, feminist ethics, casuistry and so on, is assumed. These theories are also considered in light of the well-accepted principles of medical ethics: (1) respect for patient autonomy, (2) beneficence, (3) non-maleficence and (4) justice. Those of us trained in philosophy find these sections on theory terse summations of complex philosophical views. Physicians and nurses, and others not trained in philosophy, sometimes struggle to get their gist, and end up with an ability to make a basic analysis and formulate arguments about ethical problems from each of these perspectives, and to write and discuss the issues that arise with fellow ethicists. But how essential are these theoretical perspectives to the real work of clinical ethics consultants? It is important that we do not forget just how applied and practical that work is.
- Published
- 2007
38. Factors influencing length of stay in the intensive care unit
- Author
-
David A, Gruenberg, Wayne, Shelton, Susannah L, Rose, Ann E, Rutter, Sophia, Socaris, and Glenn, McGee
- Subjects
Intensive Care Units ,Risk Factors ,Communication ,Humans ,Length of Stay ,Severity of Illness Index - Abstract
Long stays in the intensive care unit are associated with high costs and burdens on patients and patients' families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit.To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay.Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life.The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay.Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients' families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.
- Published
- 2006
39. Introduction: Lost Virtue: Professional Character Development and Medical Education
- Author
-
Wayne Shelton and Nuala Kenny
- Subjects
Medical education ,Virtue ,business.industry ,media_common.quotation_subject ,Surprise ,Health care ,Medical profession ,medicine ,Anxiety ,medicine.symptom ,business ,Understatement ,Character development ,media_common ,Confusion - Abstract
No topic in medical education has received more attention and generated more discussion in recent years than that of “professionalism”. In many ways, this should come as no surprise in light of the dramatic technical and scientific advances in medicine, the changing, and often confounding, roles of physicians in complex health care systems, and the growing expectation throughout society that physicians should provide more effective, patient-centered care. Any of these factors alone is sufficient to create anxiety and confusion about basic duties and responsibilities of physicians to patients, the medical profession and to society. In this complex, demanding, commercialized and yet, values-laden, world of health care it is an understatement to say that there are fundamental challenges to what it means to be a medical professional in today's society.
- Published
- 2006
40. The Ethicist in the House: An Overview of Bioethics
- Author
-
Wayne Shelton
- Subjects
medicine.medical_specialty ,business.industry ,Alternative medicine ,medicine ,General Earth and Planetary Sciences ,Engineering ethics ,Bioethics ,Social science ,business ,General Environmental Science - Published
- 2006
41. Preface
- Author
-
Wayne Shelton and John Balint
- Published
- 2005
42. Community as Healing: Pragmatist Ethics in Medical Encounters, by D. Micah Hester. Lanham, MD: Rowman & Littlefield, 2001, 105 pp. $18.95
- Author
-
Wayne Shelton
- Subjects
Issues, ethics and legal aspects ,Pragmatism ,Health (social science) ,Psychoanalysis ,Patient autonomy ,Health Policy ,media_common.quotation_subject ,Sociology ,Bioethics ,Theology ,media_common - Abstract
In Community as Healing , Micah Hester aspires to offer a bold alternative to the theoretical approach that has dominated bioethics since the 1970s. He begins by claiming that the concepts of individual patient autonomy portrayed in the well-known works of Tom Beauchamp and James Childress in Principles of Biomedical Ethics and H. Tristram Engelhardt in The Foundations of Bioethics are inadequate. As he states
- Published
- 2004
43. Empirical Bioethics: Present and Future Possibilities
- Author
-
Wayne Shelton
- Subjects
Issues, ethics and legal aspects ,Health Policy ,Engineering ethics ,Sociology ,Bioethics - Published
- 2009
44. The basis of informed consent for BMT patients
- Author
-
Liva H. Jacoby, B Maloy, E. Cirenza, Wayne Shelton, T Goggins, and J Balint
- Subjects
Need for cognition ,Adult ,Male ,medicine.medical_specialty ,Longitudinal study ,Decision Making ,Disclosure ,Anxiety ,Trust ,Informed consent ,Surveys and Questionnaires ,medicine ,Humans ,Moral responsibility ,Meaning (existential) ,Longitudinal Studies ,Bone Marrow Transplantation ,Transplantation ,Physician-Patient Relations ,Informed Consent ,business.industry ,Beneficence ,Hematology ,humanities ,Surgery ,Comprehension ,Knowledge ,Family medicine ,Female ,medicine.symptom ,business - Abstract
During recent decades the doctrine of informed consent has become a standard part of medical care as an expression of patients' rights to self-determination. In situations when only one treatment alternative exists for a potential cure, the extent of a patient's self-determination is constrained. Our hypothesis is that for patients considering a life-saving procedure such as bone marrow transplant (BMT), informed consent has little meaning as a basis for their right to self-determination. A longitudinal study of BMT patients was undertaken with four self-administered questionnaires. Questions centered around expectations, knowledge, anxiety and factors contributing to their decision to undergo treatment. Although the informed consent process made patients more knowledgeable about the treatment, their decision to consent was largely based on positive outcome expectations and on trust in the physician. Informed consent relieved their anxieties and increased their hopes for survival. Our conclusion was that the greatest value of the informed consent process lay in meeting the patients' emotional rather than cognitive needs. When their survival is at stake and BMT represents their only option, the patient's vulnerability puts a moral responsibility on the physician to respect the principle of beneficence while not sacrificing the patient's right to self-determination.
- Published
- 1999
45. Respect for Donor Autonomy and the Dead Donor Rule
- Author
-
Wayne Shelton
- Subjects
Issues, ethics and legal aspects ,Health Policy ,Law ,Political science ,media_common.quotation_subject ,Bioethics ,Autonomy ,media_common - Abstract
(2003). Respect for Donor Autonomy and the Dead Donor Rule. The American Journal of Bioethics: Vol. 3, No. 1, pp. 20-21.
- Published
- 2003
46. Xpand Nitric Oxide Reactor, L-arginine α-ketoglutarate, And Caffeine Supplementation Effects On Re-oxygenation Of The Calf Muscle
- Author
-
Dale Hubbard, John Kecman, Matthew Overstreet, John J. LaManca, Christina Orcino, Scott A. Mazzetti, Kevin Palmer, Brittany C. Collins, and Wayne Shelton
- Subjects
medicine.medical_specialty ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Arginine ,Calf muscle ,Internal medicine ,medicine ,Re oxygenation ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Caffeine ,Nitric oxide - Published
- 2011
47. The Patient-Physician Relationship: Time to Reimburse What We Preach-Reply
- Author
-
Wayne Shelton and John A. Balint
- Subjects
business.industry ,media_common.quotation_subject ,General Medicine ,Public relations ,Appropriate use ,Discount points ,Payment ,Alliance ,Community model ,Managed care ,Medicine ,Physician patient relationship ,business ,Theme (narrative) ,media_common - Abstract
In Reply. —Dr Hensel raises several interesting points.First, he applies our patient-physician alliance in community model to the case we described in our article. We fully agree with the scenario Hensel describes. This is indeed how we would envisage the working of our model. As Hensel implies, third-party payers, especially managed care organizations, are not yet at the point of responding altruistically or indeed with enlightened self-interest to such situations. At the same time, not all physicians are ready to pursue matters as Hensel describes. We need to undertake significant educational efforts to move in the desired direction on both theme fronts.Second, Hensel is correct in stating that managed care organizations are willing to deny payment for expensive procedures, but are not willing to support the time it takes to educate the patient about the appropriate use of such tests. Again, this is an area where mutual education is needed.
- Published
- 1996
48. Fusulinid fauna of the Horquilla Limestone in the Gunnison Hills, Cochise County, Arizona
- Author
-
Estes, Wayne Shelton, 1928 and Estes, Wayne Shelton, 1928
- Published
- 1968
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