A psychologist's stories of doctors who seek to help others but struggle to help themselves From ER and M*A*S*H to Grey's Anatomy and House, the medical drama endures for good reason: we're fascinated by the people we must trust when we are most vulnerable. In Also Human, vocational psychologist Caroline Elton introduces us to some of the distressed physicians who have come to her for help: doctors who face psychological challenges that threaten to destroy their careers and lives, including an obstetrician grappling with his own homosexuality, a high-achieving junior doctor who walks out of her first job within weeks of starting, and an oncology resident who faints when confronted with cancer patients. Entering a doctor's office can be terrifying, sometimes for the doctor most of all. By examining the inner lives of these professionals, Also Human offers readers insight into, and empathy for, the very real struggles of those who hold power over life and death.

Today's physicians are medical scientists, drilled in the basics of physiology, anatomy, genetics, and chemistry. They learn how to crunch data, interpret scans, and see the human form as a set of separate organs and systems in some stage of disease. Missing from their training is a holistic portrait of the patient as a person and as a member of a community. Yet a humanistic passion and desire to help people often are the attributes that compel a student toward a career in medicine. So what happens along the way to tarnish that idealism? Can a new approach to medical education make a difference? Doctors Serving People is just such a prescriptive. While a professor at Rush Medical College in Chicago, Edward J. Eckenfels helped initiate and direct a student-driven program in which student doctors worked in the poor, urban communities during medical school, voluntarily and without academic credit. In addition to their core curriculum and clinical rotations, students served the social and health needs of diverse and disadvantaged populations. Now more than ten years old, the program serves as an example for other medical schools throughout the country. Its story provides a working model of how to reform medical education in America.

“A fascinating journey into the heart and mind of a physician” that explores the doctor-patient relationship, the flaws in our health care system, and how doctors’ emotions impact medical care (Boston Globe) While much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But understanding doctors’ emotional responses to the life-and-death dramas of everyday practice can make all the difference on giving and getting the best medical care. Digging deep into the lives of doctors, Dr. Danielle Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Ofri offers up an unflinching look at the impact of emotions on health care. Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. Ofri also reveals that doctors cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness.

Medical professionalism comprises a set of values, behaviours and relationships that underpin the trust the public has in doctors. This report describes the nature and role of medical professionalism at a time when our healthcare system is undergoing enormous change. Whilst a lack of professionalism is harmful to patient care, the political and cultural environment of health can hamper its exercise. The proposed entry of multiple healthcare providers, the wish for a more equal engagement between patients and professionals, and the burgeoning contribution of science to clinical practice, all impact on medical professionalism. These were among the factors that provided the impetus for the redefinition and description of medical professionalism set out in this report. The report's definition and description have implications across the whole spectrum of medicine. However, six major themes emerged where medical professionalism will have significant implications. These are: leadership, team working, education, career pathways, appraisal and research. Each of these themes carries recommendations directed to national agencies with an essential part to play in taking them forward. [Ed.]

"Many of the goals of South Africa’s new democracy depend on the production of professionals who have not only the knowledge and skills to make our country globally competitive, but also a commitment to working and living here. Despite numerous reforms, the South African health system, ten years into democracy, remains divided: first world private care that ranks with middle income countries internationally at the one end, and at the other extreme, in the rural public sector in particular, conditions that are superior only to the poorest of African countries. Much work has been done to change medical school curricula in line with the primary health-care focus of government policy, and international trends towards problem-based learning. The student profile in medical schools is now not only more representative of the demographics of South Africa, but also reveals a significant increase in female students. Whether these students will stay in the country after graduating, and serve where they are needed most, remains to be seen."--Publisher's website.

Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.

How the authority of medicine is continuously shaped by relationships among physicians, industry, colleagues, and organizations Exploring how the authority of medicine is controlled, negotiated, and organized, Managing Medical Authority asks: How is knowledge shared throughout the profession? Who makes decisions when your heart malfunctions—physicians, hospital administrators, or private companies who sell pacemakers? How do physicians gain and keep their influence? Arguing that medicine’s authority is managed in collegial competition across venues, Daniel Menchik examines the full range of stakeholders driving the direction of the field: medical trainees, clinicians, researchers, administrators, and even the corporations that develop groundbreaking technologies enabling longer and better lives. Menchik takes us into Superior Hospital to witness surgeries and executive negotiations. He moves outside the hospital to watch professional committees craft standards for treatments, case management, and professional ethics. At industry-sponsored meetings, he observes company representatives who train some experienced doctors on their technologies, while deterring others who they think might injure patients. Using an innovative ethnographic approach tying individual actions and their collective consequences, he considers how stakeholders ally across the various venues of medicine, even as they are sometimes pressed into competition within those venues. Menchik finds that these alliances and rivalries strengthen the authority of medicine as a whole. From place to place, and group to group, we see how a medical specialty renews and reinvigorates itself. Beginning within the walls of the hospital, and moving to the professional and commercial venues that shape it, Managing Medical Authority offers an agenda-setting take on the social organization of medical authority.

Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review

All advanced health care systems face severe difficulties in financing the delivery of today's sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables--the autonomy of the state and the strength and cohesiveness of organized medicine--explain this variance. In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult. Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession's clinical autonomy and physicians' incomes.

The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.