Journal of general internal medicine
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Perceptions of the certification standards of the American Board of Internal Medicine (ABIM) and the qualities of care provided by certified and non-certified practicing internists are reported from surveys of ABIM Board members, internal medicine program directors, and samples of third-year residents, practicing internists, nurses, and hospital administrators. ABIM pass rates were estimated accurately and viewed as appropriate. ⋯ Perceived deficiencies of internists giving low-quality care were nearly identical to those of non-certifiable residents. The results support ABIM's initial certification process and suggest that a written examination with well chosen standards would be useful for experienced internists.
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Some of the physician's most difficult decisions involve whether to give cardiopulmonary resuscitation (CPR). Current research, hospital policies, and case law provide little guidance for these decisions, but medical ethics offers three useful principles. All three are based on patients' wishes. ⋯ Finally, if CPR will serve no therapeutic goals defined from the patient's wishes, it should not be given. Applying these principles requires a sympathetic, directed history which elicits the patient's wishes relevant to resuscitation. This article uses an actual case and a simple algorithm to show how these principles promote ethically sound resuscitation decisions.