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On Becoming a Healer by , Summary
Each chapter ends with questions for reflection and discussion to help personalize the lessons for individual learners.
Each chapter ends with questions for reflection and discussion to help personalize the lessons for individual learners.
This thirteenth volume in the series addresses an increasingly salient worldwide research, design, and policy issue-women and physical environments. We live in an era of worldwide social change. Some nation-states are fracturing or disintegrating, migrations are resulting from political up heavals and economic opportunities, some ethnic and national animosi ties are resurfacing, and global and national economic systems are under stress. Furthermore, the variability of interpersonal and familial forms is increasing, and cultural subgroups-minorities, women, the physically challenged, gays, and lesbians-are vigorously demanding their rights in societies and are becoming significant economic and political forces. Although these social-system changes affect many people, their im pact on women is especially salient. Women are at the center of most forms of family life. Whether in traditional or contemporary cultures, women's roles in child rearing, home management, and community relations have and will continue to be central, regardless of emerging and changing family structures. And, because of necessity and oppor tunity, women are increasingly engaged in paid work in and outside the home (women in most cultures have historically always worked, but often not for pay). Their influence in cultures and societies is also mounting in the social, political, and economic spheres. In technological societies, women are playing higher-level roles, though still in small numbers, in economic and policy domains. This trend is likely to acceler ate in the twenty-first century.
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.
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Career changes are becoming common among professionals in recent years. Many physicians may want to change direction, but often do not know whether it is the right thing to do or if pursuing a career outside of clinical practice would achieve their professional goals. Doctors have the training and education to contribute to society in many beneficial ways in addition to traditional clinical practice. Yet, there is no formal mapped-out route for doctors who want to pursue alternative careers, which is where Careers Beyond Clinical Medicine comes in. Doctors at any stage, from early in training to mid-career, to nearing retirement, can use Careers Beyond Clinical Medicine to clearly evaluate the issues involved when considering a career change. This book shows physicians how they can serve society and patients in innovative ways, and make a notable impact on health care delivery, policy and quality when they use their medical background in a non-traditional career pursuit. The numerous unadvertised opportunities for physicians are explored and a step-by-step route with practical advice for finding the best career is described. Recent advances in healthcare technology, medical science, patient education require physicians to play new roles that have not traditionally been well-defined. Doctors can innovate and have a long-term productive impact on healthcare in the United States and throughout the world if they learn to seize the non-traditional career opportunities available to physicians, or even create a new way to fill a void in health care. Careers Beyond Clinical Medicine helps illuminate that path.
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles -- including limits on nurses' scope of practice -- should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
The ability to see deeply affects how human beings perceive and interpret the world around them. For most people, eyesight is part of everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility. Functioning eyes and vision system can reduce an adult's risk of chronic health conditions, death, falls and injuries, social isolation, depression, and other psychological problems. In children, properly maintained eye and vision health contributes to a child's social development, academic achievement, and better health across the lifespan. The public generally recognizes its reliance on sight and fears its loss, but emphasis on eye and vision health, in general, has not been integrated into daily life to the same extent as other health promotion activities, such as teeth brushing; hand washing; physical and mental exercise; and various injury prevention behaviors. A larger population health approach is needed to engage a wide range of stakeholders in coordinated efforts that can sustain the scope of behavior change. The shaping of socioeconomic environments can eventually lead to new social norms that promote eye and vision health. Making Eye Health a Population Health Imperative: Vision for Tomorrow proposes a new population-centered framework to guide action and coordination among various, and sometimes competing, stakeholders in pursuit of improved eye and vision health and health equity in the United States. Building on the momentum of previous public health efforts, this report also introduces a model for action that highlights different levels of prevention activities across a range of stakeholders and provides specific examples of how population health strategies can be translated into cohesive areas for action at federal, state, and local levels.
In 1996, the Institute of Medicine (IOM) released its report Telemedicine: A Guide to Assessing Telecommunications for Health Care. In that report, the IOM Committee on Evaluating Clinical Applications of Telemedicine found telemedicine is similar in most respects to other technologies for which better evidence of effectiveness is also being demanded. Telemedicine, however, has some special characteristics-shared with information technologies generally-that warrant particular notice from evaluators and decision makers. Since that time, attention to telehealth has continued to grow in both the public and private sectors. Peer-reviewed journals and professional societies are devoted to telehealth, the federal government provides grant funding to promote the use of telehealth, and the private technology industry continues to develop new applications for telehealth. However, barriers remain to the use of telehealth modalities, including issues related to reimbursement, licensure, workforce, and costs. Also, some areas of telehealth have developed a stronger evidence base than others. The Health Resources and Service Administration (HRSA) sponsored the IOM in holding a workshop in Washington, DC, on August 8-9 2012, to examine how the use of telehealth technology can fit into the U.S. health care system. HRSA asked the IOM to focus on the potential for telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also emphasizing the quality and value in the delivery of health care services. This workshop summary discusses the evolution of telehealth since 1996, including the increasing role of the private sector, policies that have promoted or delayed the use of telehealth, and consumer acceptance of telehealth. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary discusses the current evidence base for telehealth, including available data and gaps in data; discuss how technological developments, including mobile telehealth, electronic intensive care units, remote monitoring, social networking, and wearable devices, in conjunction with the push for electronic health records, is changing the delivery of health care in rural and urban environments. This report also summarizes actions that the U.S. Department of Health and Human Services (HHS) can undertake to further the use of telehealth to improve health care outcomes while controlling costs in the current health care environment.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nationâ€™s public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Publicâ€™s Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nationâ€™s health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the publicâ€™s health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
This report presents the results of a series of surveys and semistructured interviews intended to identify and characterize determinants of physician professional satisfaction.
The New York Times bestselling author of Better and Complications reveals the surprising power of the ordinary checklist We live in a world of great and increasing complexity, where even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologies—neither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist. First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third. In riveting stories, Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements. And he follows the checklist revolution into fields well beyond medicine, from disaster response to investment banking, skyscraper construction, and businesses of all kinds. An intellectual adventure in which lives are lost and saved and one simple idea makes a tremendous difference, The Checklist Manifesto is essential reading for anyone working to get things right.
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base--as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systems--important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
This report describes the current situation with regard to universal health coverage and global quality of care, and outlines the steps governments, health services and their workers, together with citizens and patients need to urgently take.
Edited by past presidents of the American Medical Society for Sports Medicine, Netter’s Sports Medicine, 2nd Edition, is a superbly illustrated, go-to sports medicine resource for the outpatient office, the training room, on the sideline, and for certification preparation. Designed for quick reference, this interdisciplinary reference by Drs. Christopher Madden, Margot Putukian, Eric McCarty, and Craig Young, is organized by both topic and sport, so you can find what you need quickly. Whether you are a primary care physician managing a common or unique musculoskeletal injury in an ambulatory setting ... an orthopaedic surgeon gaining insight about a medical or psychological problem foreign to the cast or operating room ... an athletic trainer figuring out a diagnosis in the training room ... or a physical therapist pursuing further in-depth sports medicine knowledge, this reference gives you the guidance you need to keep athletes and other active patients at the top of their game. More than 1,000 superb Netter graphics, tables, figures, pictures, diagnostic images, and other medical artwork highlight the easy-to-read, bulleted text. Ideal for the sports clinician, team physician, and any health care professionals who provide care to athletes and active individuals. New chapters on travel considerations for the athlete, EKG interpretation, cardiac disease, diagnostic imaging and ultrasound, injury prevention protocols, equestrian sports and rodeo medicine, mixed martial arts, and many more. Up-to-date coverage of nutritional supplements, eating disorders, sports and pharmacology for chronic conditions and behavioral medicine, and extreme and adventure sports.
How we produce and consume food has a bigger impact on Americans' well-being than any other human activity. The food industry is the largest sector of our economy; food touches everything from our health to the environment, climate change, economic inequality, and the federal budget. From the earliest developments of agriculture, a major goal has been to attain sufficient foods that provide the energy and the nutrients needed for a healthy, active life. Over time, food production, processing, marketing, and consumption have evolved and become highly complex. The challenges of improving the food system in the 21st century will require systemic approaches that take full account of social, economic, ecological, and evolutionary factors. Policy or business interventions involving a segment of the food system often have consequences beyond the original issue the intervention was meant to address. A Framework for Assessing Effects of the Food System develops an analytical framework for assessing effects associated with the ways in which food is grown, processed, distributed, marketed, retailed, and consumed in the United States. The framework will allow users to recognize effects across the full food system, consider all domains and dimensions of effects, account for systems dynamics and complexities, and choose appropriate methods for analysis. This report provides example applications of the framework based on complex questions that are currently under debate: consumption of a healthy and safe diet, food security, animal welfare, and preserving the environment and its resources. A Framework for Assessing Effects of the Food System describes the U.S. food system and provides a brief history of its evolution into the current system. This report identifies some of the real and potential implications of the current system in terms of its health, environmental, and socioeconomic effects along with a sense for the complexities of the system, potential metrics, and some of the data needs that are required to assess the effects. The overview of the food system and the framework described in this report will be an essential resource for decision makers, researchers, and others to examine the possible impacts of alternative policies or agricultural or food processing practices.
NEW YORK TIMES BESTSELLER NATIONAL BESTSELLER In this urgent, singularly authoritative book, Bill Gates sets out a wide-ranging, practical--and accessible--plan for how the world can get to zero greenhouse gas emissions in time to avoid an irreversible climate catastrophe. Bill Gates has spent a decade investigating the causes and effects of climate change. With the help and guidance of experts in the fields of physics, chemistry, biology, engineering, political science and finance, he has focused on exactly what must be done in order to stop the planet's slide toward certain environmental disaster. In this book, he not only gathers together all the information we need to fully grasp how important it is that we work toward net-zero emissions of greenhouse gases but also details exactly what we need to do to achieve this profoundly important goal. He gives us a clear-eyed description of the challenges we face. He describes the areas in which technology is already helping to reduce emissions; where and how the current technology can be made to function more effectively; where breakthrough technologies are needed, and who is working on these essential innovations. Finally, he lays out a concrete plan for achieving the goal of zero emissions--suggesting not only policies that governments should adopt, but what we as individuals can do to keep our government, our employers and ourselves accountable in this crucial enterprise. As Bill Gates makes clear, achieving zero emissions will not be simple or easy to do, but by following the guidelines he sets out here, it is a goal firmly within our reach.
From registered nurse and public health advocate Sana Goldberg, RN, a timely, accessible, and comprehensive handbook to navigating common medical situations. From the routine to the unexpected, How to Be a Patient is your ultimate guide to better healthcare. Did you know that patients have statistically better outcomes when their surgeon is female? That you can mark-up an informed consent sheet before you sign it, or get second opinions on CTs and MRIs? That there’s a blue book for healthcare procedures, or an algorithm to decide between ER, Urgent Care, and waiting-until-Monday? In How to Be a Patient, nurse and public health advocate Sana Goldberg walks readers through the complicated and uncertain medical landscape, illuminating a path to better care. Warm and disarmingly honest, Goldberg’s advice is as expert as it is accessible. In the face of an epidemic of brusque, impersonal care she empowers readers with the information and tools to come to good decisions with their providers and sidestep the challenging realities of modern medicine. With sections like When All is Well, When It’s An Emergency, When It’s Your Person, and When You Have to Stand Up to the Industry, along with appendices to help track family history, avoid pointless medical tests, and choose when and where to undergo a procedure, How to Be a Patient is an invaluable and essential guide for a new generation of patients.