Psychosocial training in U.S. internal medicine and family practice residency programs.

PURPOSE: Competence in the psychosocial aspects of medical care is necessary for primary care physicians to function effectively. This study investigated the psychosocial training internal medicine and family practice residents receive in U.S. programs. METHODS: In 1996, program directors of all U.S. internal medicine (IM) and family practice (FP) residency programs were surveyed regarding the format, content, and quantity of psychosocial training provided in their programs, their opinions on topics related to psychosocial training, and demographics of their programs. RESULTS: The response rate was 61%. Ninety-nine percent of FP and 62% of IM program directors reported requiring at least one psychosocial training experience. Family practice programs required an average of 352 hours (SD +/- 175; range 27-2,664) of psychosocial training compared with 118 hours (SD +/- 272; range 0-1,050) for IM programs. Most IM and FP program directors expected residents to achieve at least basic competency in virtually all psychosocial topic areas; however, FP programs provided a greater range of psychosocial experiences. FP program directors most often identified psychologists and IM program directors most often identified internists as providing the most psychosocial training in their programs. Both IM and FP program directors considered lack of curricular time to be the main obstacle to development of psychosocial training. CONCLUSION: Residents' competence in psychosocial areas is important to both IM and FP program directors. However, content and time devoted to psychosocial training vary considerably both within and between program types.

Ethics, empathy, and gender in health care.

The changes that have taken place in medicine over the past few decades have challenged our views about the responsibilities and obligations of those providing health care and about their relationships with their patients. The demands brought by technologic advances and economic concerns have tested our ability to practice humane, empathic, and ethical medicine. This paper addresses the connection between ethics and empathy in the context of our current health care system. The author reviews the concept of empathy and argues that ethical medicine is empathic medicine. Since gender differences in health care needs and disparities in treatment have been identified, gender serves to focus some of the issues and exemplify some concerns about empathic and ethical practice.

Emerging issues in medical ethics.

Ethical principles are influenced by personal values and beliefs, and by societal context. They are not immutable. In medicine, as new technologies have developed and changes in health-care delivery have resulted, historically held views about the responsibilities, obligations and relationships between health-care providers and patients have been challenged.

Professional issues for women.

Status, compensation, socialization, mentoring, and assertiveness are discussed, along with peer attitudes and cultural expectations of professional women. Particular attention is paid to the careers of women in academic medicine.

Consequences of rape: clinical and treatment aspects.

Sexual abuse has both short-term and long-term clinical repercussions, including eating disorders, substance abuse, sleep disturbances and psychiatric symptoms, e.g depression, anxiety, phobias and PTSD. This paper will describe short- and long-term responses, including PTSD, and it will consider treatment implications, emphasizing specific aspects of the approach to the sexual abuse victim.

Anxiety, depression, and menstrual symptoms among freshman medical students.

Based on data from a larger longitudinal study of medical students and physicians, this study establishes the incidence of some menstrual symptoms in a nonclinical population of 82 healthy, female, first-year medical students and investigates the correlation of self-reported anxiety and depression scores with these symptoms. Findings show that nearly half reported the frequent occurrence of at least one menstrual symptom that appeared to cause discomfort but did not interfere with performance. The data suggest an association between anxiety and depression scores and certain self-reported menstrual symptoms in this population. The study suggests the need for further investigation of the nature of the relationship between dysphoric moods and menstrual symptoms in healthy women.

Late luteal phase dysphoric disorder (premenstrual syndromes): clinical implications.

The authors present an overview of current knowledge about premenstrual syndrome (PMS), most recently classified as late luteal phase dysphoric disorder in the revision of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. A review of historical reports about the occurrence of PMS, pertinent diagnostic issues, and theories about etiology and treatment are presented. The article concludes with a discussion of the overlap of and relationship between PMS and specific psychiatric disorders, new research directions, and clinical implications of the syndrome.

Psychiatry across borders.

To gain an understanding of the challenges and opportunities confronting mental health professionals throughout the world, the author sent a brief questionnaire to psychiatric leaders in a diverse group of countries. Questions focused on patient care issues, education, and delivery systems. Responses from 13 countries indicated universal concern about the cost of psychiatric care and how it is delivered. Most countries consider health care a national responsibility and provide some form of universal insurance coverage. There is a lack of uniformity in resource distribution and use as well as in standards of care for acute and chronic patients. ICD-9 is the diagnostic classification system used in almost all responding countries, but use of DSM-III is increasing. The author emphasizes the importance of considering national differences and similarities in the delivery of psychiatric services so that professionals around the world can learn from each other's experiences.