Journal of general internal medicine
-
Medical decision-making involves choices, which can lead to benefits or to harms. Most benefits and harms may or may not occur, and can be minor or major when they do. Medical research, especially randomized controlled trials, provides estimates of chance of occurrence and magnitude of event. ⋯ It follows that the practice of aiming for universal implementation of standardized guidelines is irrational and unethical. Irrational because the possibility of benefits is implicitly valued more than the possibility of comparable harms, and unethical because guidelines remove decision making from the patient and give it instead to a physician, committee or health care system. This essay considers the cases of cancer screening and diabetes management, where guidelines often advocate universal implementation, without regard to informed choice and individual decision-making.
-
Randomized Controlled Trial Comparative Study
Young adults at risk for excess alcohol consumption are often not asked or counseled about drinking alcohol.
Excessive alcohol consumption is most widespread among young adults. Practice guidelines recommend screening and physician advice, which could help address this common cause of injury and premature death. ⋯ Despite practice guidelines, few young adults are asked and advised by physicians about excessive alcohol consumption. Physicians should routinely ask all adults about their drinking and offer advice about levels that pose health risk, particularly to young adults.
-
Comparative Study
Through our eyes: exploring African-American men's perspective on factors affecting transition to manhood.
Premature mortality and disparities in morbidity observed in African-American men may be associated with factors in their social, economic, and built environments that may be especially influential during the transition to adulthood. ⋯ CBPR and photovoice are effective methods to engage young, African-American men to identify and discuss factors affecting their transition to manhood, contextualize research findings, and participate in intervention development.
-
Comparative Study
Cost implications of ACGME's 2011 changes to resident duty hours and the training environment.
In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) will implemented stricter duty-hour limits and related changes to the training environment. This may affect preventable adverse event (PAE) rates. ⋯ Implementation decisions greatly affect the cost. Unless PAEs decline substantially, teaching hospitals will lose money. If PAEs decline modestly, the requirements might be cost-saving or cost-effective to society.
-
Comparative Study
Career satisfaction in primary care: a comparison of international and US medical graduates.
International medical graduates (IMGs) have substantial representation among primary care physicians in the USA and consistently report lower career satisfaction compared with US medical graduates (USMGs). Low career satisfaction has adverse consequences on physician recruitment and retention. ⋯ After adjusting for a number of variables previously shown to have an impact on career satisfaction, we were unable to identify additional factors that could account for or explain differences in career satisfaction between IMGs and USMGs. In light of the central role of IMGs in primary care, the potential impact of poorer satisfaction among IMGs may be substantial. Improved understanding of the causes of this differential satisfaction is important to appropriately support the primary care physician workforce.