Physician views on practicing professionalism in the corporate age.

Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman's thesis and education for both students and physicians requires a major overhaul.

The development of professionalism: curriculum matters.

The authors propose that professionalism, rather than being left to the chance that students will model themselves on ideal physicians or somehow be permeable to other elements of professionalism, is fostered by students' engagement with significant, integrated experiences with certain kinds of content. Like clinical reasoning, which cannot occur in a vacuum but must be built on particular knowledge, methods, and the development of skills, professionalism cannot flourish without its necessary basis of knowledge, methods, and skills. The authors present the need for an intellectual widening of the medical curriculum, so that students acquire not only the necessary tools of scientific and clinical knowledge, methods, and skills but also other relevant tools for professional development that can be provided only by particular knowledge, methods, and skills outside bioscience domains. Medical students have little opportunity to engage any body of knowledge not gained through bioscientific/empirical methods. Yet other bodies of knowledge-philosophy, sociology, literature, spirituality, and aesthetics are often the ones where compassion, communication, and social responsibility are addressed, illuminated, practiced, and learned. To educate broadly educated physicians who develop professionalism throughout their education and their careers requires a full-spectrum curriculum and the processes to support it. The authors sketch the ways in which admission, the curriculum (particularly promoting a sociologic consciousness, interdisciplinary thinking, and understanding of the economic/ political dimensions of health care), and assessment and licensure would function.

A bi-directional theory of addiction: examining coping and the factors related to substance relapse.

The results from this study supported a bi-directional theory of addiction for a sample of Black, inner-city, working-class, male substance abusers. Using structural equations modeling, at 6 months posttreatment we found that (a) the reciprocal effect emotional and psychological distress and substance relapse had on one another existed within the context of their bi-directional relationship with social instability, and (b) effective coping skills and resources moderated the negative effects that emotional and psychological distress, social structure, and substance relapse had on one another. These findings led us to three suggestions treatment professionals can use to counteract recidivism.

Homelessness, negative affect, and coping among veterans with gambling problems who misused substances.

Compared with other populations with addictions, pathological gamblers have higher levels of negative affect and poor coping. A total of 154 formerly homeless veterans who misused substances were assessed six months after treatment to determine whether those with a gambling problem (N = 22) had more negative affect and poorer coping than those without a gambling problem and whether they were more likely to have unstable housing and employment. The veterans with a gambling problem had significantly higher levels of negative affect and poorer coping but did not differ from the other veterans in housing and employment stability.

A comparison of pathological gamblers to alcoholics and cocaine misusers on impulsivity, sensation seeking, and craving.

Consecutive admissions (N = 843) to the Brecksville Veterans Addiction Recovery Center with a primary diagnosis of pathological gambler, alcoholic, or cocaine misuser were compared for differences on impulsivity, sensation seeking, and craving. In contrast to alcoholics and cocaine misusers, gamblers scored significantly higher on impulsivity and inability to resist craving; however, gamblers were not significantly higher than either alcoholics or cocaine misusers on sensation seeking. These findings suggest a need to address high impulsivity and inability to resist cravings in treatment and relapse prevention for gamblers.

Linda.

We tend to define pastoral care and medical intervention in very limiting terms. Too often we are more concerned with the delivery of the product than we are with the manner in which it is received. This paper looks at the experiences of a young woman with cancer and how she sought a certain personal component to the pastoral care she received and the medical treatments she was willing to accept. She fought to be treated as an individual, to be respected as a person with her own values, and to be given the right to make her own choices. This paper is presented from the patient's perspective.

Death, sin, and God's judgment.

Grief is difficult for everyone, including the professional. And yet resolving grief is necessary for life to be comfortable and productive. This paper looks at the story of a young man and how unresolved grief, inappropriate guilt, and uncontrollable despair colored every phase of his life. It also demonstrates the tragedy when grief is allowed to remain in denial and resolution comes too late.

A journey in pastoral care: A case study.

What is pastoral care? Many health professionals are not clear about the role of the chaplain on the health care team. This article addresses the question by using an actual case study to demonstrate how the chaplain interacts with the patient and the value of this interaction to the well-being of the patient. It attempts to define, by example, pastoral care.