ABSTRACT
A consultant psychiatrist on an in-patient psychiatric unit left temporarily for a four-week visit to Australia. Eight of 11 patients under his care developed disturbed behaviour, although all had been stable for many months before. Of the other 11 patients on the same ward, under the care of another consultant psychiatrist, only one developed similar problems over this time. It has already been well established in previous research that loss events, particularly of attachment figures, contribute to psychopathology. However, what loss events the psychiatric unit itself presents to patients, and furthermore how the loss of perhaps more distant but important figures, like consultants or senior psychiatrists, also affect patients has not been previously explored. The neglected issue of the role of authority in the therapeutic relationship as well as in psychiatric illness is discussed. It is suggested that this has important implications for psychiatric practice.
Subject(s)
Forensic Psychiatry , Mental Disorders/psychology , Patients/psychology , Referral and Consultation , Adult , Humans , Length of Stay , Male , Mental Disorders/etiology , Mental Disorders/rehabilitation , Mental Health Services/organization & administration , Middle Aged , Object Attachment , Psychiatric Department, Hospital , RecurrenceABSTRACT
The British Government is implementing some major alterations to the way health services in Great Britain are organised. As well as the introduction of competition between health care providers, their financial interests are to be linked to their output, in efforts to use market forces to increase efficiency and cut costs. This paper looks at the possible impact of these changes of health care organisation on ethical medical practice. This is investigated with particular reference to the country whose health service has embraced most closely these elements of the market--the United States of America. The question to be answered is whether high standards of ethical care are ensured by factors somehow intrinsic to the medical profession, and are therefore immune to changes in the economics of health care. This assumption is shown to be questionable in light of what is known about the determinants of ethical medical practice.
Subject(s)
Ethics, Medical , Resource Allocation , State Medicine/trends , Codes of Ethics , Curriculum , Economic Competition , Education, Medical , Forecasting , Internationality , Patient Selection , Privatization , Professional Misconduct , Social Responsibility , United KingdomSubject(s)
Schizophrenia/history , History, 18th Century , History, 19th Century , Humans , United KingdomABSTRACT
Optimism about the possible clinical applications of monoclonal antibodies has fuelled this burgeoning part biomedical research for nearly a decade. The highest expectations centre on the use of radiolabelled monoclonal antibodies in the diagnosis and treatment of cancer. This paper attempts to evaluate the claims for the new technology. A review indicates that the technique is having a limited impact on the practical management of patients. It is suggested that these limitations are mainly because the expected speed of transfer of the technology from research laboratory to clinic may have been previously exaggerated. In the long term the evidence reviewed in this paper suggests that radiolabelled monoclonal anti-tumour antibodies offer the potential of making the next great step forward in the diagnosis and treatment of cancer.
