RESUMEN
Extracurricular employment ("moonlighting") by resident physicians has been a subject of considerable controversy for many years. A review of the medical literature for the past two decades reveals substantial debate regarding the legitimacy of the practice, the establishment of some organizational policies, and the intrusion of some new legal concerns. I have summarized the findings of previous studies of the subject, including both general reviews and data-based studies. The latter suggest that escalating financial pressures, changing call schedules, and perceived shifts in career opportunities all contribute to continuation of the practice. In addition, some extracurricular jobs seem to offer valuable clinical opportunities. These factors, which have led to several fundamental dilemmas for academic medical programs, have been explicitly defined. There is still a need for a coherent, ethical, economically sensitive, and legally defensible policy on moonlighting. Using the tangible data about moonlighting and the ongoing controversies, I have synthesized some model guidelines that could be used by residency programs to place moonlighting activities on a fair and reasonable footing.
Asunto(s)
Empleo , Hospitales de Enseñanza , Internado y Residencia , Actitud del Personal de Salud , Curriculum , Educación de Postgrado en Medicina/economía , Educación de Postgrado en Medicina/organización & administración , Empleo/economía , Femenino , Hospitales de Enseñanza/organización & administración , Humanos , Internado y Residencia/economía , Masculino , Formulación de Políticas , Salarios y Beneficios , Tolerancia al Trabajo ProgramadoRESUMEN
Erotomania is a relatively rare delusional syndrome, typically seen in heterosexual women of middle-age or beyond. This is the first reported occurrence in an adolescent, and one of very few involving homosexual orientation. A detailed case report is discussed in the context of adolescent developmental phenomena, including "crushes", identity formation, and the resolution of sexual orientation. The presentation of erotomania as alleged sexual abuse, and a possible etiologic role for childhood sexual trauma, are considered.
Asunto(s)
Deluciones , Trastornos Mentales/psicología , Conducta Sexual , Estudiantes/psicología , Intento de Suicidio/psicología , Adolescente , Conducta del Adolescente , Clorpromazina/administración & dosificación , Clorpromazina/uso terapéutico , Femenino , Homosexualidad , Humanos , Relaciones Interpersonales , Litio/administración & dosificación , Litio/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Salud Mental , EnseñanzaRESUMEN
Traumatic brain injury, a prevalent health problem in contemporary society, poses complex adaptational challenges for victims' families. The sequelae most disruptive to family functioning appear to be residual psychiatric symptoms. With a peak incidence among young adults, brain trauma also befalls many parents of dependent children; these children are vulnerable to subsequent emotional and behavioral difficulties. An approach to these problems must recognize the broad spectrum of clinical outcomes from brain injury. Valuable insights may also be gained from earlier work on children's responses to more familiar parental psychiatric disorders. Three case reports of children with head-injured parents are presented, followed by a discussion of treatment considerations for this emerging "at-risk" population.
Asunto(s)
Daño Encefálico Crónico/psicología , Lesiones Encefálicas/psicología , Hijo de Padres Discapacitados/psicología , Rol del Enfermo , Trastornos por Estrés Postraumático/psicología , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Desarrollo de la PersonalidadRESUMEN
Stress, emotional dysfunction, and work impairment are seen as accelerating phenomena in residency training, and have received increased attention in the medical literature. The authors review relevant literature in this area, and note continued deficiencies in programs for prevention and intervention. The present study focuses on the perceptions of key members of the academic hierarchy regarding housestaff stress and impairment. Chairmen, program directors, and chief residents in all specialties were asked to estimate the prevalence of several impairment syndromes, to describe any existing policies or programs to assist residents, and to express their opinions about developing such intervention strategies. The results are compared by respondent group, by resident postgraduate year, and by groupings of surgical and non-surgical programs. Suggestions for further research in this area are then offered.