Leading Physicians in Unique Settings
Mindi K. McKenna, Perry A. Pugno, William H. Frist in Physicians as Leaders, 2018
Within the U.S. Military, physicians are often called upon for leadership through a variety of roles, ranging from administrative roles in military medical institutions to managing the health and well-being of both soldiers and noncombatants in the theater of warfare. These physician leaders face pressures of personal danger, uncertain resources, and unpredictable conditions of monotonous boredom and frantic chaos. Nevertheless, physician leaders in the military must balance the priorities of the well-being of their troops, the safety of their coworkers and the ethical obligations to provide the greatest good for the greatest number. “As a physician in the U.S. Army Reserves, I’ll soon receive orders to report either to Iraq or to Fort Hood in Texas. If sent to Iraq, I’ll care for soldiers. If sent to Texas, I’ll care for soldiers’ families. It doesn’t really matter to me, because either way I’ll be using my gifts to help people. I consider it an honor to do my duty and to serve my country. I go where I’m called.”Gary Morsch, md Family and Emergency Medicine Physician, U.S. Army Reserves Founder, Heart to Heart International
Grasping emergency care through pop culture
Alan Bleakley in Routledge handbook of the medical humanities, 2019
After graduating undergraduate and graduate medical education, the real lessons of being an emergency physician begin. New physicians must accustom themselves to taking full responsibility for everything that happens in the department and to be highly functional in a myriad of highly complex and unpredictable situations. Healthcare metrics, measuring profit and volume, replace grading systems based on mastery of meaningful concepts and knowledge (Branch et al. 2017). House, M.D (2004) comments that: “treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable.” Thinking of patients in terms of profit and volume can contribute to a shift towards a hostile viewpoint of patients. Physicians have become de-centred in healthcare, losing control of their practice. Formularies determine which drugs can be prescribed. Insurance executives dictate who gets seen, what tests can be ordered and what procedures can be performed. Politicians make laws that direct care options. Administrators track the metrics with consequence and prescribe management pathways and protocols that can influence physician decision-making (Derlet et al. 2016). Physicians are even forced to shuffle patients to waiting areas of the hospital, pending dispositions dependent on insurance approval of necessary operations and therapy (Article 99, 1992).
Development of palliative medicine in the United Kingdom and Ireland
Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita in Textbook of Palliative Medicine and Supportive Care, 2015
Identified barriers to providing palliative care in the ED include lack of education of emergency clinicians in the key concepts in palliative care, lack of knowledge of available resources, time constraints of the ED, challenges of the physician-patient relationship, family dynamics, overstepping the traditional role of the ED, and legal concerns and comfort level of the treating physician (Table 125.2). Â 23,56 Research into providing palliative care in the ED is evolving. Research to date has focused on what patients can best be served by providing palliative care in the ED, what the ideal role of the emergency physician should be, how providing palliative care in the ED affects healthcare utilization, and educating emergency providers on the fundamentals of palliative care. Â 57
Relationship based care – how general practice developed and why it is undermined within contemporary healthcare systems
Published in Scandinavian Journal of Primary Health Care, 2019
The big and highly specialised hospital offers both the breadth and depth of medicine, but to make the combination of breadth and depth come into its own, there is still a need for specialists that have an overview and are capable of making judgements beyond the limits of their narrow expertise, and who see the necessity to cooperate with other specialists and staff [20]. The emergency physician is the generalist of the acute stage of a disease or a trauma. In the USA, the former common model in which the family physician kept his or her overall responsibility even for the in-patient, is gradually substituted by the employment of hospital generalists – hospitalists [21]. In the Swedish discussion the suggestion has come up to integrate geriatrics, general medicine and general practice into an overall activity – ‘Generalistic medicine’ [22].
Norepinephrine may improve survival of septic shock patients in a low-resource setting: a proof-of-concept study on feasibility and efficacy outside the Intensive Care Unit
Published in Pathogens and Global Health, 2022
Paolo Bima, Carmen Orlotti, Okot Godfrey Smart, Fulvio Morello, Mattia Trunfio, Luca Brazzi, Giorgia Montrucchio
This observational study was conducted at Dr. Ambrosoli Memorial Hospital, Kalongo, Agago District, Uganda which is a countryside non-referral hospital of about 270 patient capacity divided into general medical, surgical, pediatrics, and obstetrical-gynecological wards. As it often occurs in sub-Saharan Africa, drug availability is limited and non-constant, there are no automatized and/or invasive monitoring systems nor central venous catheters. Supplemental oxygen is administered through a reduced number of low-flow oxygen concentrators. Staff is composed by nurses, physician assistants, general medical doctors and two experienced surgeons, but the hospital usually lacks an intensivist or emergency medicine physician. In the medical ward there is usually one physician every 20 patients and one nurse every 10 patients. The available clinical work-up includes full blood count, creatinine, and electrolytes, malaria rapid antigen test and blood film, HIV rapid test (and CD4+ count), hepatitis B surface antigen, Gram stain of body fluids, colorimetric reactive strips for urine and other body fluids, basic radiologic investigations (ultrasound and x-rays). Microbiologic cultures and blood lactate measurement are not available.
Twelve tips to maximise medical student learning during emergency medicine placements
Published in Medical Teacher, 2021
Holly N. Hellawell, Harry Kyriacou, Anoop S. Sumal
Students receive valuable clinical experience in the ED, linked with improved confidence, knowledge of disease management (Avegno et al. 2012), and examination performance (Cevik and Abu-Zidan 2019). Medical students can also provide valuable assistance to the ED in return. This may be through hands-on work such as performing practical skills or making a patient comfortable, or indirectly, as pairing an emergency physician with a medical professional in training has been shown to increase overall productivity (Bhat et al. 2014). The more a student involves themselves with the emergency team, the more teaching and experience they will receive. However, as reported by medical students working in lower-income countries and resource-poor settings (Wiskin et al. 2018), students may be responsible for providing emergency care whilst practising alone (Obermeyer et al. 2015). Students should never be expected to perform tasks out of their capabilities (General Medical Council 2016), nor should they feel pressured to undertake a more senior role. If you feel uncomfortable, politely decline, explain your role and reservations, then seek senior advice.
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