The evolution of medicine as a profession. A 75-year perspective.

The profession of medicine has changed dramatically in 75 years. Despite the commitment of individual practitioners to the highest ideals of professionalism, the profession itself has lost privilege, power, and public reputation. It has been toppled from the high moral ground of professionalism. This has happened not so much because individual clinicians have abandoned that ground, but largely because others have occupied it--primarily complex organizations that have developed public mandates to regulate and oversee health care. The issue is not one of unfeeling physicians--it is one of a health care system that has evolved so as to limit medicine's autonomy. This changing system places new constraints and pressures on the physician-patient relationship. The question we are left with is whether medicine can regain its professionalism. How do we reform a system that, by its complexity, has become amoral? The only way is for physicians to re-assume a stout position of advocacy--advocacy for individual patients in a complex and frightening system of care, advocacy for patients as a class of people in a political system that seeks to restrict care, advocacy for patients in a world of environmental and epidemic threats. Such advocacy requires an equally strong moral commitment to the principles of service. Acting in the patient's best interest is not enough. It requires that the profession avoid the appearance of blatant self-interest at every turn. It requires a revised commitment to political activism in the interest of service to patients as a community. The costs are extremely high--but the alternative, physicians-as-technicians and medicine as a slave to corporate and government interests, is hardly acceptable.

Measurement of hope in a community-based older population.

This study conceptually and empirically examined two hope scales with a community-based sample of older adults. These findings suggest that the two hope scales used in this study measure Global Hope and Interactive Hope. However, these results also suggest unique characteristics of hope that should be incorporated into future studies of hope with older adults.

The impact of computer systems in a medical environment.

The acceptance and proliferation of computer technology in health care has not been as rapid as many expected. Research in this area suggests that several factors are related to computer acceptance including social network processes, attitudes toward computers, and personality characteristics. Potential implications for the field of magnetic resonance imaging are discussed.

Adapting to the implementation of a medical information system: a comparison of short- versus long-term findings.

This study compares short and long-term responses of a panel of hospital employees to the introduction of a Medical Information System. Personality attributes, education, age, and the person's work shift consistently affected the quality of employee adaptation.

Professions, families, and control in the management of the cadaver organ donor.

In times of medical crisis, control over the treatment process is vested with the patient's attending physician. The role of the other members of the treatment team is clearly supporting of the physician while the patient's family exercises little or no influence over the treatment process. In certain "rare" events, the traditional roles are suspended and control of the process is, at lest temporarily, shifted to an outside group of health professionals. The process of cadaver organ donor donation is presented as an example of the suspension of traditional role responsibilities and the delegation of control to an external agent. Through direct observation of role interaction, in-depth interviews with medical personnel and a survey of critical care nurses, this process of shift in control is examined. Although the issues of time and the locus of control serve to constrain this process, the decision to accept or decline the request for organ donation ultimately lies with the patient's family. Under these rare circumstances, the family is asked to suspend their beliefs regarding life and death in favor of a new set of norms introduced by this external agent.

Medical information system training: an analysis of the reactions of hospital employees.

Six months after the implementation of a medical information system (MIS) employees were questioned concerning their evaluation of the training they received. Wide variability is observed in the range of employee responses to questions addressing their: satisfaction with the training experience, desire for any additional training, ease of learning to use the system, and level of felt competence in currently using the system. The results of stepwise regression analyses of the response patterns indicate that personality traits, attitudes toward automation, and work history variables are key factors in explaining why employees have different reactions to training.

Implementation of a medical information system: evaluation of adaptation.

A study was conducted to explain variability in hospital employee responses to the implementation of a medical information system. Results showed that 28 to 35 percent of the variance in adaptation was explained by the predictor variables, and that the significant variables were attitudes toward computers in general, role ambiguity, personality attributes, the person's work shift and previous history of job mobility.