RESUMEN
In the United States, a disproportionately high number of incarcerated individuals suffer from serious mental illnesses, substance use disorders, chronic medical conditions, infectious diseases, and traumatic brain injuries. Correctional facilities are often ill-equipped to address the incarcerated community's physical and mental health needs. Current laws and policies remain outdated and do not adequately address the complex health issues faced by incarcerated individuals, particularly the aging and terminally ill patients in correctional settings. We present a case of a male with schizophrenia whose ongoing psychiatric symptoms impaired his decisional capacity, leading to him to refuse medical treatment for an initially treatable medical condition, ultimately resulting in his death due to the lack of a surrogate decision-maker. This case underscores the urgent need for policy revisions to assign medical decision-making authority for individuals in custody and highlights potential interventions to bridge existing gaps in care for this population.
RESUMEN
All clinicians have the right to work in environments free of discrimination. Trends such as shared decision making and tying reimbursement to patient satisfaction metrics prompt us to ask how we should respond to patient preferences that express unjust bias or prejudice. This article presents one orthopedic surgery resident physician's experience of bias incidents, suggests strategies for addressing patient discrimination, and offers patient care recommendations.
Asunto(s)
Internado y Residencia/ética , Atención al Paciente/ética , Prioridad del Paciente , Prejuicio , Profesionalismo/ética , Racismo , Femenino , Humanos , Masculino , Estados Unidos , Lugar de Trabajo/normasRESUMEN
Correctional staff suffer high rates of posttraumatic stress disorder compared to military veterans, and the suicide rate among correctional officers is twice as high as that of both police officers and the general population and higher than that of all other professions combined. Correctional facilities' physician employees are at risk of not only burnout but also other adverse mental health effects related to working in a correctional facility. Prison reform efforts should address the needs of both inmates and clinical staff.
Asunto(s)
Estrés Laboral/psicología , Atención al Paciente/ética , Prisiones , Racismo/psicología , Lugar de Trabajo , Femenino , HumanosRESUMEN
Studies have shown that the health status of lesbian, gay, bisexual and transgender (LGBT) people generally is worse than that of the population as a whole. This is in part because these individuals have not been well-served by the health care establishment. This article describes ways physicians can begin to better care for this population and provides tips for making practices more welcoming to LGBT patients.
Asunto(s)
Bisexualidad , Accesibilidad a los Servicios de Salud , Homosexualidad Femenina , Homosexualidad Masculina , Mejoramiento de la Calidad , Personas Transgénero , Educación Médica Continua , Femenino , Humanos , Masculino , Minnesota , Administración de la Práctica MédicaRESUMEN
Research has demonstrated that appropriate use of interpreters in clinical encounters improves outcomes and decreases adverse events. This article reviews both the medical reasons for working with trained medical interpreters and the related laws, and offers practical tips for working effectively with interpreters.
Asunto(s)
Diversidad Cultural , Emigrantes e Inmigrantes/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Lenguaje , Traducción , Conducta Cooperativa , Humanos , Comunicación Interdisciplinaria , Minnesota , Relaciones Médico-PacienteRESUMEN
Psychiatrists are occasionally called upon to assist in the management of patients with severe psychopathologic syndromes resulting from acute neurologic illness. In the absence of other options for treating the underlying neurological disorder or with persistence of the psychopathology after resolution of the neurologic illness, electroconvulsive therapy (ECT) may be considered. The authors treated four such patients, two of whom experienced no benefit and two of whom experienced dramatic benefit. The authors provide recommendations for the approach to acutely ill neurologic patients with regard to the use of ECT.
Asunto(s)
Encefalopatías/complicaciones , Catatonia/terapia , Terapia Electroconvulsiva , Trastornos Psicóticos/terapia , Adolescente , Adulto , Anciano , Encefalopatías/etiología , Encefalopatías/psicología , Catatonia/diagnóstico , Catatonia/psicología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Resultado del TratamientoRESUMEN
Linezolid, a novel antimicrobial with activity against gram-positive bacteria including pathogens resistant to traditional antimicrobials, also inhibits monoamine oxidase. This latter property can cause potentially lethal adverse interactions with antidepressant medications. Long known to psychiatrists, monoamine oxidase inhibitors (MAOIs) and complications of their use may be unfamiliar to medical and surgical practitioners who may thus unwittingly precipitate a hypertensive crisis or serotonin syndrome. We review the pharmacology of MAOis and describe 3 clinical situations In which linezolid-selective serotonin inhibitor (SSRI) interactions, actual or potential, figured prominently.