The new health care civilization: integration of physician land and manageria

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.     

Freud's “Anna O.”: Social work's Bertha Pappenheim

The story of Anna O. has loomed large in psychoanalytic history, but few social workers know that the young woman, who was so influential in the development of Freud's thinking, became a pioneer social worker in Germany. The story of the transformation of the troubled young woman, who was actually Joseph Breuer's patient, is the focus of this paper. In addition, some of the facts of the case are discussed as social constructions. Anna O./ Bertha Pappenheim participated in the creation of the talking cure and eventually went on to be a leading feminist, developer of social programs for women, and social reformer.     

Political theater and student organizations in the 1989 Chinese movement: A multivariate analysis of Tiananmen

Social movement research has often been divided between organizational and cultural analyses of collective action. Organizationally oriented theorists have viewed indigenous organizational structure as the critical variable in the emergence of collective action. Political culture and cultural frame theorists have focused instead on the cultural frames that resonate with audiences, mobilizing them to action. But social movements cannot be the result of one or the other of these factors. An analysis of the 1989 Chinese movement illuminates the multivariate aspects of this social movement. This movement was a two-tiered movement with an organized student leadership tier and a mass audience. Enmeshed in university organizations and student networks, the student leaders relied on an organizational structure that had been emerging since the mid-1980s. This organized leadership tier employed cultural symbols and acts to mobilize mass audiences that were beyond the scope of the students' organizational linkages. The political theater of the organized student leaders was complemented by institutional changes that had been occurring over the decade of reform in China and a political opportunity that allowed wide coverage of the students' activities.     

Gambling and the Law®: Endless fields of dreams

This article examines the current trends of proliferation of commercial gaming, especially in the United States, in the context of the third wave of legalization of gambling that has been experienced since the founding of the nation. The author looks at the historic foundations of the spread of casino-style gambling, and notes the types of casino gaming that have led the way in the current expansion. He also points out why it is reasonable to expect that this wave too may come crashing down, as general acceptance of wide-spread casino gaming in America may indeed be short-lived.Gambling and the Law^® is a registered trademark of I. Nelson Rose.     

Psycho-social impacts of terrorism and organized crime: The counterfinality of the practico-inert

The phrase, the counterfinality of the practico-inert is from Sartre with reference to implications of modern technology as a shorthand for that enormous properly human and anti-natural power of dead human labor stored up in our machinery — an alienated power, which turns back on and against us in unrecognizable forms and can symbolize the massive dystopian horizon of organized crime as well as individual terrorist praxis (Jean-Paul Sartre (1948).Situations II. Paris: Gallimard).     

Women,conflict, and culture in former Yugoslavia

The civil war in the former Yugoslavia has taken a toll on the women's movement which has disintegrated across male-defined nationalist borders. The women's movement in this area got its start during the Second World War but was disbanded under communism until women's groups began to form in the 1970s. Today the women's movement has lost the power to oppose the war and has been unable to prevent widespread violence perpetuated against women. Some feminists who have refused to embrace nationalism and patriotism have been vilified and have had to seek refuge abroad. Recently, however, hundreds of nongovernmental organizations have been formed to provide support to women and children victimized by the war. Women have been raped and impregnated as a strategy of male warfare, and raped women who refused an abortion were ostracized. War-related rape has yet to be fully recognized as an international human rights violation, and the issue is being used as political propaganda in the former Yugoslavia while it is ignored elsewhere. Sensationalist reporting of these rapes has further victimized women and made them unable to give voice to their trauma. War also increases women's suffering by destroying economic and social welfare systems. Oxfam is helping women record their testimonies of war and reconstruct the fabric of their societies through programs which provide income-generation and training in micro-enterprises. In addition, Oxfam is strengthening electronic communication and networking among women's groups throughout the region.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

Effect of regulations and guidelines on gastroenterology programs

This paper reviews the standards of practice, regulations, and guidelines that govern gastrointestinal endoscopy and their effect on space and equipment, staff and physician quality of care, and educational programs. It also examines how all these considerations have affected the growth of an endoscopy center and describes the processes that have been instituted to ensure compliance with all relevant standards, regulations, and guidelines.     

Keeping the "care" in managed care: the importance of the therapeutic relationship and psychosocial factors in the managed care setting

There is much truth in the adage that "the more things change, the more they stay the same." Nowhere does this seem more apparent than in health care where, amidst monumental reconfiguration, basic foundations of physician-patient relationships and attention to the impact of psychosocial factors on health and health care delivery remain as critical influences. While the importance of the therapeutic relationship and the influence of psychosocial factors in medical care has been clear in traditional systems of delivery, these factors may be even more critical in managed care systems. These emphases must be incorporated by design, however, and not left to default.