The Treatment of Male Sexual Offenders

No abstract available for this article.     

Barriers to Optimal Care between Physicians and Lesbian,Gay, Bisexual,Transgender, and Questioning Adolescent Patients

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.     

Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

Socioeconomic Factors in Menopausal Women's Use of Hormone Replacement Therapy

This study examines if education, income, and medical insurance coverage are primary factors in determining whether menopausal women use hormone replacement therapy (HRT). To accomplish this purpose, the author conducted a survey of 62 women between 30 and 60 years of age. These women completed a self-administered questionnaire that provided both quantitative and qualitative information. The results suggest that these socioeconomic factors increase the likelihood that menopausal women will receive treatment with HRT. Implications for clinical practice are discussed.     

浅论两汉、魏晋儒医的隐迹现象

两汉、魏晋时期,正是中国传统医学形成的重要时期,而在这个时期有所开拓、有所创新的一些著名医家,却没有张扬自己,而是走隐迹的道路,淡化自己、隐匿自己。对于当时“君子不耻”的“巫、医、乐师、百工之人”的医家来说,他们的隐迹却有着自己的特色。“不为良相,当为良医”符合儒家思想的退隐选择,是一种实践“仁”道的方式;“重道避世”是隐迹的名医选择的另一种活法。     

元代医学教师职能特点

世祖中统三年（1262年）,元代医学正式创立。由于元朝特殊的医学管理体制,负责教授学生课业的医学教师有了不同于传统的＂授课＂与＂治病＂职能,最终形成了一职多责的特点。     

Called to Medicine: Physicians’ Experiences of Career Calling

Using consensual qualitative research methodology, the authors explored physicians’ (N = 17) career calling experiences through semistructured interviews. Eight domains emerged: definition of calling, development of calling, calling's fit with career, maintenance of calling, emotional well‐being, relationships, recreation, and future. Within these domains, 17 general and 40 typical categories emerged. Results suggest physicians’ callings were influenced by others, met with both support and barriers, and chosen because of fit with interests, prosocial motivation, or religious/spiritual influences. Calling positively and negatively influenced emotional well‐being, relationships, and recreation and was expected to continue after retirement. Counselors are encouraged to use a narrative lens to conceptualize clients’ calling development, use job crafting techniques to support calling maintenance, and prepare clients for postretirement career calling development. Future research might examine when and why a medical calling's strength may change over time.     

Doctors offline,activists online: an analysis of Chinese celebrity physicians’ politically oriented social media activities

This study explores the social media activities of politically oriented Chinese celebrity physicians. The results of the semi-structured in-depth interviews indicated that the celebrity physicians were dissatisfied because the government treated them as the scapegoats of the failed health care reform. They thus turned to social media to challenge the dominant narratives about the public health system and repair their professional reputations. To achieve these goals, the celebrity physicians produced media content that challenged the dominant governmental discourse about the public health system, and they collaborated to correct conventional media narratives about the medical profession when crises occurred. The findings of this study indicate the formation of a new type of online civil activism that was initiated by a group of professionals and intellectuals.     

Diagnosing and treating testosterone deficiency in different parts of the world. Results from global market research

Aim. This study analysed variations between different regions of the world in diagnosing and treating testosterone (T) deficiency.

Methods. Physicians were interviewed in Germany, Spain and the United Kingdom, in Brazil, in Saudi Arabia and South Korea. Items in the survey: 1) reasons/motivation to use or not to use T; 2) what category of patients would not receive T on the basis of these concerns; 3) concerns about prostate pathology in the decision not to provide T treatment; 4) phosphodiesterase type 5 (PDE-5) inhibitors are efficacious, but T treatment makes a comeback.

Results. Between 5% and 10% of consulting patients suffered from T deficiency. The fear to induce prostate cancer appeared very powerful. About 68% of physicians associate the use of T more with risks than benefits, more so in Europe than elsewhere. As a result about 35% of hypogonadal men do not receive treatment. The PDE-5 inhibitors are very prominent in the treatment of erectile dysfunction. Of patients suffering from erectile dysfunction, 18% to 29% have T deficiency which is not always diagnosed and treated.

Conclusion. World-wide physicians require more education on diagnosing T deficiency, on the role of T in erectile dysfunction and the relative safety of testosterone treatment.     

“It’s my body,my future”: Older women’s views of their interactions with physicians

ABSTRACT

Based on data obtained from in-depth, qualitative interviews conducted with 30 older Canadian women, this article examines older women’s experiences with, and views of, physicians. The research participants report a very high level of satisfaction with the patient–physician relationship; however, they also report physician shortcomings. Findings indicate that participants’ satisfaction with the patient–physician relationship was influenced by “stories about other doctors,” rationalizations and justifications, and a high level of patient assertiveness.