ABSTRACT
INTRODUCTION: With changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents. METHODS: The authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes. RESULTS: 225 faculty (48.6%) and 131 residents (43.8%) across the three programs responded. Responses yielded themes in five domains: Physician Actions, Physician Attitudes, Physician Identity, Physician Qualities, and Quality of Patient Care. All groups identified themes of advocacy, communication and care coordination, decision-making, follow through, knowledge, leadership, attitudes of going 'above and beyond' and 'the buck stops here', responsibility, serving as primary provider, demonstrating initiative, and providing the best care as central to ownership. Residents and faculty had differing perspectives on 'shift work' and transitions of care and on resident decision-making as elements of ownership. DISCUSSION: This study expanded and enriched the definition of patient care ownership. There were more similarities than differences across groups, a reassuring finding for those concerned about a decreasing understanding of ownership in trainees. Findings regarding shared values, shift work, and the decision-making role can inform educators in setting clear expectations and fostering ownership despite changing educational and care models.
Subject(s)
Antipsychotic Agents/adverse effects , Benzodiazepines/adverse effects , Bipolar Disorder/drug therapy , Hypertriglyceridemia/chemically induced , Lipids/blood , Adult , Anticonvulsants/therapeutic use , Aripiprazole , Bipolar Disorder/blood , Clonazepam/therapeutic use , Commitment of Mentally Ill , Humans , Hypertriglyceridemia/blood , Lamotrigine , Male , Olanzapine , Piperazines/therapeutic use , Practice Guidelines as Topic , Quinolones/therapeutic use , Triazines/administration & dosage , Weight Gain/drug effectsABSTRACT
Case reports of mothball ingestion have shown that paradichlorobenzene, the organic compound found in mothballs, can induce multiple organ effects, including encephalopathy. Psychiatrists are often involved in these cases due to presumed depression. Diagnosis is frequently delayed and/or inaccurate due to the inability to obtain a full history. A delay in diagnosis may result in an inappropriate treatment plan. We present a case involving a woman who ingested mothballs due to Pica emphasizing the importance and challenges of getting a thorough history. Barriers include cultural differences, shame and obtaining collateral information.
Subject(s)
Chlorobenzenes/poisoning , Depression/diagnosis , Encephalitis/chemically induced , Insecticides/adverse effects , Medical History Taking , Adult , Chlorobenzenes/administration & dosage , Diagnosis, Differential , Eating , Encephalitis/diagnosis , Female , Humans , Insecticides/administration & dosage , PicaABSTRACT
Since its beginnings in the mid-1970s, the field of psycho-oncology has developed rapidly. A substantial body of literature has evolved toward identifying key issues for psychiatric treatment and care management of cancer patients. The spectrum of cancer care encompasses patient experiences through initial diagnosis, active treatment, after-care and survivorship, as well as palliative care and end-of-life. This article highlights recognition and management of psychiatric syndromes in the context of cancer care.
Subject(s)
Mental Disorders/diagnosis , Mental Disorders/psychology , Neoplasms/psychology , Disease Management , Humans , Mental Disorders/therapy , Neoplasms/therapy , Palliative Care/methods , Terminal Care/methodsABSTRACT
BACKGROUND: Fatigue, both during and subsequent to treatment, is a ubiquitous and debilitating phenomenon for patients undergoing treatment for cancer of all types. OBJECTIVE: This review will focus on understanding the complex neurobiological mechanisms underlying the phenomenon of cancer-related fatigue (CRF) and their relevance for various treatment routes. METHOD: The review will describe the prevalence of CRF, differential diagnosis, consideration of neurobiological mechanisms, and routes for intervention. DISCUSSION: The review will provide suggestions for future study and research, and a future article will describe behavioral and educational strategies psychiatrists may use in alleviating cancer fatigue.
Subject(s)
Fatigue/etiology , Neoplasms/complications , Brain/physiopathology , Fatigue/drug therapy , Fatigue/physiopathology , Humans , Psychiatry/methodsABSTRACT
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Background and Objectives: Regimens incorporating hematopoietic stem cell transplantation (HSCT) have become widely utilized in disease treatments, particularly for cancer. These complex treatment programs also expose patients to central nervous system (CNS) toxicities from chemotherapy, irradiation, infection, metabolic effects and immunosuppression. Methods: Relevant recent medical literature from Medline and bibliographies in pertinent publications are reviewed with a focus on those cases and studies pertaining to neuropsychiatric effects of HSCT. Results: High rates of neuropsychiatric sequelae occur on a continuum from acute to chronic. Adverse outcomes include focal CNS deficits and severe global manifestations such as seizures, encephalopathy and delirium. More graduated effects on cognition, energy and mood are frequently seen, impacting patient function. Conclusions: Additional research on neuropsychiatric outcomes and treatment interventions is needed in the HSCT setting. Risks for neuropsychiatric deficits should be part of an ongoing informed consent discussion among treating physicians, patients and families (AU)
