Jahn-Teller effect in VCl4.

A theoretical study is made of the Jahn-Teller and other properties of vanadium tetrachloride. Relativistic effective core potentials and corresponding valence spin-orbit operators are used with Gaussian atomic orbitals to compute self-consistent-field and spin-orbit configuration-interaction wave functions. Energy-surface parameters, electronic excitation energies, vibronic energy levels, and g factors are computed. Electron correlation is shown to have a substantial effect on the Jahn-Teller properties. As have others, we find the Jahn-Teller effect in VCl4 to be of the dynamic form.

Medical students' attitudes toward pain and the use of opioid analgesics: implications for changing medical school curriculum.

BACKGROUND: Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. METHODS: We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal traits that predicted opiophobia. RESULTS: The professionalization process of medical training may reinforce negative attitudes. Psychologic characteristics were associated with reluctance to prescribe opioids, and fears of patient addiction and drug regulatory agency sanctions. CONCLUSIONS: Consistent attitudes were found in senior medical students with preferences for certain specialty areas and the practitioners of their future specialties, suggesting a "preselection" effect. Higher scores on reliance on high technology, external locus of control, and intolerance of clinical uncertainty were associated with higher scores on one or more of the three dimensions of opiophobia. Implications for medical education are discussed.

Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative.

BACKGROUND: Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline. METHODS: A 59-item survey was used to measure physicians' attitudes, knowledge, and psychologic factors that contribute to pain management practices. RESULTS: Overall, a significant number of physicians in this survey revealed opiophobia (prejudice against the use of opioid analgesics), displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. There were significant differences among groups of physicians based on size of geographic practice area and medical discipline. CONCLUSIONS: New educational strategies are needed to overcome these barriers and to improve pain treatment in routine medical practice. The effect of practice milieu must be taken into consideration.

Measuring medical students' reluctance to prescribe opioids for cancer pain.

Among 644 senior medical students a 14-item scale which was internally consistent indicated no change over the 6 years of testing in intent to reserve opioids for terminally ill.

Measuring social desirability among senior medical students.

The purpose of the study was to assess the role of medical students' social desirability scores on influencing their attitudes toward either a geriatric or hypochondriac patient. To carry out this investigation, we developed a social desirability scale that was domain-specific for medicine. Students' medical social desirability scores predicted negative attitudes and beliefs toward the geriatric but not the hypochondriac patient. This difference suggests that medical students find it acceptable to dislike the hypochondriac as a patient but not the elderly person. Social desirability scores were inversely related to Machiavellan scores, suggesting that medical students with a Machivellian response pattern tended to view their role as a physician in a less idealized way. Students who scored highest on social desirability tended to choose obstetrics-gynecology for their future career and those with the lowest scores either pathology or surgical subspecialties. Research with this scale should help access social desirability's role in medical students' in managing the impression they leave with patients.

Is obstetrics-gynecology a primary care specialty?

Suddenly everyone wants more primary care physicians. For several years, we collected data from senior medical students to relate their attitudes and beliefs about several clinical problems common to primary care to their choices of residencies. Because the Texas Medical Association's Special Committee on Primary Care included obstetrics-gynecology as a primary care specialty, we reviewed our data to see if the personal traits and professional role characteristics of seniors choosing obstetrics-gynecology differed materially from those of seniors choosing family medicine, internal medicine, or pediatrics. Results of this analysis put obstetrics-gynecology about as firmly in the primary care group as if the experimental design had planned it that way.

Uncertainties and ambiguities: measuring how medical students cope.

To develop psychometric measures specific to the ambiguities encountered in medicine and determine their value in predicting medical students' attitudes towards patients and their choice of residency, we administered to senior and first-year medical students a 25-item Likert-type questionnaire to assess their intolerance of ambiguity (ITA). Factor analysis yielded two dimensions that were converted to scales: 'Aversion to uncertainties in clinical medicine' (ITA1) and 'Preference for highly structured training environs' (ITA2). First-year students scored higher on ITA1 and lower on ITA2 than seniors. An excessive reliance on high-technology medicine, a negative orientation toward psychological problems, and Machiavellianism predicted ITA1. ITA1 was the best predictor of senior medical students' negative attributional style toward hypochondriac, geriatric and chronic pain patients. The following rank order of seniors' career choice was predicted by ITA1 scores: internal medicine, psychiatry and family medicine (lowest); radiology, surgery and anaesthesiology (highest). And by ITA2 scores: surgery, obstetrics and gynaecology, and surgical subspecialties (lowest); radiology, psychiatry and anaesthesiology (highest). We concluded that personality traits and role characteristics which predict 'Aversion to uncertainties in clinical medicine' are maladaptive to managing many primary care patients, and this mismatch is reflected in seniors' residency choice.

Visual interpretation of blood glucose test strips.

Patients with type II, non-insulin-dependent diabetes mellitus (NIDDM) typically are middle-aged or older and often have diabetic retinopathy. The visual acuity of these patients also is likely to be reduced beyond what is normally associated with age. Because Medicaid does not reimburse NIDDM patients for a blood glucose meter unless they are insulin-dependent, many low-income diabetes patients are required to monitor their blood glucose levels by visually comparing the color spot on the blood glucose test strip with a series of standard color blocks. Unless patients can accurately assess their blood glucose levels by visual interpretation of the test strips, they will have difficulty maintaining adequate glycemic control. In this study, 60 nondiabetic adults, ages 20 to 78 years, were unable to adequately assess blood glucose levels visually, even under optimal lighting conditions. Younger adults made the same number of errors as older adults, and poor visual acuity and high blood glucose values were associated with more errors. These findings suggest that patients with poor visual acuity or those who read their blood glucose strips in less-than-adequate lighting will make even more errors than our test subjects.

Machiavellianism in medical students.

To be more responsive to the nation's health needs, medical educators should identify those personal qualities associated with effective primary medical care. For this research Machiavellianism was chosen as a tracer character trait opposed to the characteristics embodied in an ideal family physician. A survey was conducted of 167 freshmen from one medical school and 823 seniors from four medical schools, with Machiavellianism scores used to predict their professional role characteristics, attributional style toward patients, and choice of a career specialty. Results showed that 15% of all students scored positively on the Machiavellianism scale. Mean Machiavellianism scores for seniors did not differ from those for freshmen. Men had higher Machiavellianism scores than women. Those students with high Machiavellianism scores relied excessively on high-tech medicine and were externally controlled, intolerant of ambiguity, and authoritarian. Seniors' high Machiavellianism scores predicted a negative attributional style toward geriatric and hypochondriac patients, thereby validating the use of Machiavellianism to measure medical students' indifference to patients and their problems.

AIDS, minority patients, and doctors: what's the risk? Who's talking?

We asked 39 physicians providing primary care for a mostly minority patient population to respond to a questionnaire concerning their attitudes and behavior toward AIDS risk assessment and preventive counseling and to indicate their beliefs concerning patients' knowledge and behavior. Most of the 36 physicians who responded (92%) agreed that physicians must educate their patients about AIDS. They also reported that patients who engage in risk-taking behavior may not know much about AIDS transmission and prevention. Despite these beliefs, these doctors reported that they gave advice to only 11% of their male patients and 14% of their female patients. More than one third of physicians reported feeling uncomfortable talking about patients' sexual preferences and practices. To identify patients at risk and to help prevent AIDS, methods must be found to make physicians more comfortable discussing sexual issues with their patients, especially their minority patients.

Why doctors have difficulty with sex histories.

Studies have shown that physicians' performance has not been as good as it should be in detecting sexually transmitted diseases (STDs) and in counseling patients about their transmission. The AIDS pandemic has underscored the need to find out why this is true. In our study, we identified the major reasons physicians believe other doctors fail to take adequate sex histories. Scales were then developed to measure the three principal reasons given by these physicians: embarrassment, belief that the sex history is not relevant to the patient's chief complaint, and belief by the physicians that they are not adequately trained. When 350 senior medical students were surveyed, 93% thought that knowledge of a patient's sexual practices is an important part of their patient's medical history, but 50% felt poorly trained to take this history and 25% felt embarrassed to ask the necessary questions. To learn why some students score well on these three dimensions and others do not, a limited number of personal attributes were measured and correlated with the scores on these three measures. Shyness and social anxiety as a personal trait predicted which student was most likely to experience embarrassment in taking a sex history. A nonsympathetic view of patients' psychosocial problems was the variable most closely related to the belief that the sex history was of little importance in understanding a patient's problem. Students who believed this most strongly were the same ones who were most homophobic, authoritarian, and had the greatest fear of AIDS infection. The sense of not feeling adequately trained to take a sex history related most strongly to low self-esteem. How these barriers to STD risk assessment might be overcome is discussed.