reference librarian comments, March 2000
| On Doctoring MEDLINE searches, with reference librarian comments, March 2000 |
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=====> YOUR QUESTIONFor a paper on professionalism to be submitted to the lancet ( I am a co-author):
How has increased accountability and the loss of autonomy (inherent in professionalism) affected physician's relationships with patients.
I am taking an Anglo-American comparative perspective.
=====> YOUR SEARCH-STRATEGY1 *Social responsibility/ results=680
2 from 1 keep 4 results=1
3 *Social responsibility/ results=680
4 "beresford eb".au. results=2
5 (Physicians, Ethics and the allocation of resources).ti. results=0
6 "williams jr".au. results=101
7 Physician-patient relations/ results=9364
8 Time factors/ results=151212
9 Social responsibility/ results=1955
10 Managed care programs/og,st,lj,td,ut [Organization & results=3672
Administration, Standards, Legislation & Jurisprudence,
Trends, Utilization]
11 7 and 8 and 9 and 10 results=0
12 7 and 8 and 9 results=1
13 Conflict of interest/lj [Legislation & Jurisprudence] results=85
14 7 and 13 results=11
15 Health care rationing/ results=2769
16 Professional autonomy/ results=1975
17 7 and 16 results=41
18 9 and 16 results=32
19 10 and 16 results=55
20 13 and 16 results=1
21 15 and 16 results=13
22 from 21 keep 2-3,6-9,13 results=7
23 from 19 keep 13-14,24,29,49 results=5
24 from 18 keep 7,17,21 results=3
25 from 17 keep 6,18 results=2
=====> MY COMMENTS
First: Thanks for participating in the assignment.
Second: I can see that you're bopping around MEDLINE, feeling fairly confident. You're using MeSH terms, selecting subheadings, and playing, which is crucial to do...
Third: yours is a tricky question. I decided to try the search myself. And I took a different approach, on purpose. Have a look:
Medline 1991 to January 2000
#
Search History
Results
1
exp *professional autonomy/
1255
2
exp physician-patient relations/
9499
3
1 and 2
20
4
limit 3 to english language
20
5
from 4 keep 1-20
20
Results of your search (set 4): limit 3 to english language
Citations available: 20
Citations displayed: 1-20<1>
AN 97016195
AU Clark CC.
IN College of Staten Island/City University of New York, USA.
TI Except in emergencies: AMA ethics and physician autonomy.
SO Cambridge Quarterly of Healthcare Ethics. 5(3):440-3, 1996 Summer.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<2>
AN 99118510
AU Warren MG. Weitz R. Kulis S.
IN Department of Sociology, Arizona State University, Tempe 85287-2101, USA.
TI Physician satisfaction in a changing health care environment: the impact of
challenges to professional autonomy,
authority, and dominance.
SO Journal of Health & Social Behavior. 39(4):356-67, 1998 Dec.
LM Dana (incomplete) and some Web.Check catalog for holdings.
AB For some time, sociologists have debated whether physicians still retain
dominance in the health care world, public faith in their moral and
scientific authority, and the autonomy to set work
conditions and make clinical decisions. Using ideas derived from this debate,
we analyze the impact of changes in the health care environment on physician
satisfaction. Our data come from a mailed survey of 510 Arizona physicians.
Our results show that background physician attributes did not predict
satisfaction, nor did most organizational attributes. However, participation
in IPAs (Individual Practice Associations) predicted higher satisfaction,
while payment according to a third party payer's fee-for-service schedule
predicted lower satisfaction. In addition, physicians were more likely to be
satisfied if they wrote the orders that non-physicians had to follow, were
paid what they wanted, did not need to subordinate their clinical judgment to
that of non-physicians, and believed that their patients had confidence in
physicians. Our conclusions discuss both theoretical and policy implications
of our findings.
<3>
AN 98401643
AU Braverman AS.
IN Department of Medicine, SUNY, USA.
TI The public stake in physician authority.
SO Pharos of Alpha Omega Alpha Honor Medical Society. 61(3):32-5, 1998 Summer.
LM Dana. Incomplete holdings, check catalog.
<4>
AN 98332236
AU Liang BA.
IN Pepperdine University School of Law, Malibu, CA 90263-4655, USA.
TI The practical utility of gag clause legislation [see comments].
CM Comment in: J Gen Intern Med 1998 Jun;13(6):422-3
SO Journal of General Internal Medicine. 13(6):419-21, 1998 Jun.
LM Pre-1993 at Dana,1993-date at MFHSL.
<5>
AN 98173316
AU Morreim EH.
IN College of Medicine, University of Tennessee, Memphis 38163, USA.
TI Revenue streams and clinical discretion.
SO Journal of the American Geriatrics Society. 46(3):331-7, 1998 Mar.
LM Dana and MFHSL. Incomplete holdings, check catalog.
<6>
AN 98134733
AU Liner RS.
TI Physician deselection: the dynamics of a new threat to the
physician-patient relationship.
SO American Journal of Law & Medicine. 23(4):511-37, 1997.
LM Print holdings at DANA. For Web access, check catalog.
<7>
AN 97285956
AU Lazarus ES.
IN Department of Anthropology, Case Western Reserve University, Cleveland, OH
44120, USA.
TI Politicizing abortion: personal morality and professional
responsibility of residents training in the United States.
SO Social Science & Medicine. 44(9):1417-25, 1997 May.
LM Dana Biomedical Library (Dana).
AB Ever-increasing technological innovations surrounding birth are creating new
challenges in biomedical ethics in U.S. obstetrics. The politicization of
abortion has augmented these challenges and led to increased conflict between
physicians' personal morality and professional
responsibility. This paper focuses on some of the problems generated by
abortion policies and procedures in an obstetric/ gynecology residency
program. Examples of conflicts among residents are presented to demonstrate
the effect of pluralistic moral perspectives. A system is described where
some residents will do abortions and some will not. Patients seeking abortion
are often treated in an unprofessional manner when it
appears that a conflict exists between the values of patients and those of
residents. Unless the socialization of residents includes ethical training,
defined educational policy and institutional direction, ethical dilemmas will
lead to increased resident stress, an inadequate doctor-patient
relationship and a continued shortage of physicians willing
to perform abortions despite new policies called for in graduate medical
education.
<8>
AN 97192599
AU Katz S.
TI Aequanimitas, ... and then some.
SO American Journal of Gastroenterology. 92(2):199-203, 1997 Feb.
LM Pre-1993 at Dana,1993-date at MFHSL.
<9>
AN 97154310
AU Meaney ME.
IN Department of Philosophy St. Joseph's University Philadelphia, PA 19131,
USA.
TI Freedom and democracy in health care ethics: is the cart before the horse?.
[Review] [21 refs]
SO Theoretical Medicine. 17(4):399-414, 1996 Dec.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<10>
AN 97086268
AU Chavkin W. Breitbart V.
IN The Center for Population and Family Health, Columbia University School of
Public Health, New York, USA.
TI Reproductive health and blurred professional boundaries.
[Review] [46 refs]
SO Womens Health Issues. 6(2):89-96, 1996 Mar-Apr.
LM MFHSL. Incomplete holdings, check catalog.
AB We recognize that many of the issues raised are not simple. Our proposal
calls for the same thoughtful deliberation applied in other settings to be
brought to bear on reproductive health care. Some have already tried
alternative approaches. In Albuquerque, New Mexico, a university hospital
neonatologist and the district attorney have collaborated to create an
alternative to sentencing program for women who are arrested for drug-related
crimes and found to be both pregnant and drug addicted. Rather than proceed
with criminal sanctions, these women are offered entry into a drug treatment
program that is geared to families with young children and run by the
pediatrics department. Here, the physician and the district attorney
collaboratively responded in ways congruent with the
professional integrity of each. In another example in
Portland, Oregon, physicians, drug treatment providers, and child protective
social service representatives cooperatively defeated a legislative proposal
to mandatorily test and report pregnant women for illicit drug use and,
instead, formed a task force to jointly develop state policy regarding the
issue. Drug use, HIV infection, child abuse, and poverty are all cause for
alarm. Yet it is critical that our frustration about these difficult problems
not be translated into blaming individuals for "deviance," or into short-term
inadequate responses. In developing policy we should consider the impact on
the legal and ethical rights and obligations of both patient and physician.
For every course, we should evaluate both immediate and long-term efficacy,
the consequences for the doctor-patient relationship, and
the consequences for medical integrity. In the midst of the present
regulatory and fiscal turmoil affecting health care, we urge physicians to be
careful and deliberate in the policies they embrace and the actions they
take. [References: 46]
<11>
AN 96106290
AU Friedman E.
TI The power of physicians: autonomy and balance in a changing
system.
SO American Journal of Medicine. 99(6):579-86, 1995 Dec.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
<12>
AN 95048730
AU Wennberg JE.
IN Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover,
NH 03755-3863.
TI Health care reform and professionalism.
SO Inquiry. 31(3):296-302, 1994 Fall.
LM Pre-1993 Dana; 1993-date MFHSL (Incomplete, check catalog)
AB With its emphasis on consumer choice of health plans, the current health
care debate neglects a more fundamental crisis: changes in the traditional
physician-patient relationship. This paper
discusses how this relationship is being redefined and what
it means for professionals in the future, particularly in
the context of managed competition. The paper asserts that the final health
reform plan must address flaws in the scientific and ethical basis of
clinical practice. It calls for a flexible workforce policy that promotes
shared decision making, lifetime learning, professional
commitment to improved quality of care, a national evaluation program, and
organizations to coordinate these efforts.
<13>
AN 95003132
AU Holleman WL. Edwards DC. Matson CC.
IN Department of Family Medicine, Baylor College of Medicine, Houston, TX.
TI Obligations of physicians to patients and third-party payers.
SO Journal of Clinical Ethics. 5(2):113-20, 1994 Summer.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<14>
AN 94255328
AU Ehrmann PR.
TI Get off the fence and do something [interview by Corrinne Charais].
SO Postgraduate Medicine. 95(7):91-4, 1994 May 15.
LM Pre-1993 at Dana,1993-date at MFHSL.
<15>
AN 94088363
AU Pollard BJ.
TI Autonomy and paternalism in medicine [see comments].
CM Comment in: Med J Aust 1994 Mar 7;160(5):305-6
SO Medical Journal of Australia. 159(11-12):797-802, 1993 Dec 6-20.
LM Dana Biomedical Library (Dana).
AB The role of ethics in medical practice is now receiving close scrutiny, so
it is timely that ethical concepts, such as autonomy and
paternalism, be re-examined in their applied contexts. As neither
autonomy nor paternalism has a current universally accepted
meaning, their significance varies in both ethical and clinical discussion.
Of the two, autonomy has moved further from its original
moral context, to the extent that it often now signifies no more than a
person's expressed intention. Paternalism, characterised as the antithesis of
autonomy, is widely thought not to have any role in
medicine. The transforming effects of illness, which may radically alter a
person's decision making capacity, are commonly ignored.
<16>
AN 94086964
AU Choudhuri PK.
TI Medical profession and Consumer Protection Act [editorial].
SO Journal of the Indian Medical Association. 91(7):168-9, 1993 Jul.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<17>
AN 92355184
AU Coburn D.
IN Department of Behavioural Science, University of Toronto, Ontario, Canada.
TI Freidson then and now: an "internalist" critique of Freidson's past and
present views of the medical profession.
SO International Journal of Health Services. 22(3):497-512, 1992.
LM Dana. Incomplete holdings, check catalog.
AB Freidson is a foremost analyst of the medical profession. Most recently
Freidson attacks those who claim that medicine is declining in power. He
insists that medicine has not lost the core elements that make it a powerful,
indeed, the dominant, health profession. The author compares Freidson's early
writings on medicine with his most recent ones, and shows that there are
critical confusions in Freidson's central concepts of
professional autonomy and dominance. This
difficulty is illuminated by viewing dominance, autonomy,
and subordination as on a continuum of control. Using this continuum, the
author argues that Freidson implicitly admits what he set out to deny (that
medicine has not declined in power) by shifting his focus from medical
dominance to that of autonomy. Freidson also now rejects
valid parts of his earlier work (that which emphasizes social structural
determinants of behavior over socialization). In equating medicine in the
United States with teaching in that country, Freidson's contention of "little
change in medical power" meets its own refutation. Finally, despite his
derogation of others, Freidson's lack of an adequate framework to explain the
dynamics and not simply the structure of health care produces purely
normative, utopian (and unhelpful) policy recommendations.
<18>
AN 92327160
AU McDonnell K.
IN St Mary's College, Notre Dame, Indiana 46556.
TI Am I ethical? How do I know?.
SO Pediatric Annals. 21(5):282-6, 1992 May.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<19>
AN 92327161
AU Pakula LC.
TI The ethical practice of pediatrics in a world of potential conflicts: an
interview [interview by John M. Freeman].
SO Pediatric Annals. 21(5):287-91, 1992 May.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
<20>
AN 92327162
AU Seidel HM.
IN Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
TI On paternalism.
SO Pediatric Annals. 21(5):295-9, 1992 May.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.