Mirror, mirror on the wall: reflections from failure to establish a truly uniform national health care policy

When the author gazed into the proverbial mirror and asked if the U.S. health care system was the fairest of them all, it shattered. In this article, Thompson tells why the system is broken and what failure to fix it means to physician executives. He suggests that we, as Americans, must reinvent ourselves by realigning our value systems and and stifling our obsession with profit before trying to reinvent health care.     

Analgesia produced in women by genital self-stimulation

This study investigated the relative effectiveness of specific genital regional self-stimulation in elevating pain thresholds. Anecdotal reports in humans suggest that sexual activity and orgasm decrease a wide variety of human responses to pain and touch, but the phenomenon has not been evaluated objectively. Two types of self-stimulation, pressure and pleasurable, were applied by 10 women to the anterior vaginal wall, the posterior vaginal wall, and the clitoris. Significant increases in pain thresholds but not tactile thresholds occurred when pressure stimulation was applied to the anterior wall of the vagina or when "pleasurable" self-stimulation was applied to any of the three areas. Tactile thresholds were not significantly affected by any genital stimulation condition. However, there was a significant increase in tactile threshold but not pain thresholds in the distraction control condition. On the basis of these findings, we conclude that (a) a sensation of pleasure evoked by genital stimulation can elevate pain thresholds, (b) these pleasurable stimuli were not general "distractants" because they elevated pain thresholds but not tactile thresholds differentially, and (c) genital pleasurable stimuli activate an analgesic process that is distinct from a distraction process.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Organizational effectiveness. Primary care and the congruence model

The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.     

Making the journey into the networked enterprise, Part 2

In the May issue of Physician Executive, the authors described the difficulties other industries have had with vertical integration and why so many corporations have abandoned it for other organizational structures. In this second part of the series, they explore the ways health care organizations can make the shift into integrated delivery systems, avoiding the trap of the hierarchical, vertically integrated monolithic structures that will become the dinosaurs of the future.     

The computerized patient record and confidentiality. The nabobs of negativism are wrong

The handwritten medical record has been the method of choice for documenting health care data since the last millennium. Given this successful tenure, it would be natural to greet any new information system that purports to be an advancement with skepticism. Moreover, physicians as a group are hardly progressive. Yet health care is taking a giant leap and is finally accepting computerization. The advantages and drawbacks of computerized information systems have long been thoroughly tested in such diverse industries as the military, banking, and the airlines. It is difficult to imagine any of these industries in their modern form without an advanced information system.     

The changing academic health center. The death of the traditional academic physician

Organizational change is required if academic health centers (AHCs) are to survive the decreased societal commitment to them. The changes will generate significant emotional responses in the physicians employed by such institutions. This article presents an analogy between the reactions of academic physicians to the changes they are experiencing, and the stages of grief that Dr. Kübler Ross described in terminally ill patients. By placing physician responses in this context, emotional responses to organizational changes can be more easily understood and managed, allowing academic physicians to devote more energy to facing the threats to AHCs in an innovative and constructive manner.     

Labour crunch,foreign workers and policy responses: the experience of Japan

"Japan has experienced labour shortages since the late 1960s....The present study is an attempt to analyse the Japanese government's response to circumvent labour shortages. It focuses on two aspects: perception of Japanese society towards the increasing presence of foreign workers in Japan and associated problems; and measures taken by the government to overcome labour crunch. These aspects are examined within the [framework of an] increasing flow of foreigners to Japan during the past decades." (SUMMARY IN FRE AND SPA)