Journal of general internal medicine
-
Comparative Study
Code status documentation in the outpatient electronic medical records of patients with metastatic cancer.
Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records. ⋯ Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.
-
Minority women are more likely than white women to choose tubal sterilization as a contraceptive method. Disparities in rates of unintended pregnancy may help explain observed racial/ethnic differences in sterilization, but this association has not been investigated. ⋯ Minority women, who more frequently experience unintended pregnancy, may choose tubal sterilization in response to prior experiences with an unintended pregnancy.
-
An African American male to female transgender patient treated with estrogen detected a breast lump that was confirmed by her primary care provider. The patient refused mammography and 14 months later she was diagnosed with metastatic breast cancer with spinal cord compression. ⋯ Analysis suggests dissociation between the patient's social and biological identities, fear and fatalism around cancer screening, and legitimization of injectable hormones. This case emphasizes the importance of eliciting and interpreting a patient's conceptions of health and illness when discordant understandings develop between patient and physician.
-
Comparative Study
Hand-off education and evaluation: piloting the observed simulated hand-off experience (OSHE).
The Observed Simulated Hand-off Experience (OSHE) was created to evaluate medical students' sign-out skills using a real-time assessment tool, the Hand-off CEX. ⋯ The online version of this article (doi:10.1007/s11606-009-1170-y) contains supplementary material, which is available to authorized users.