The Mount Sinai journal of medicine, New York
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Sickle cell disease is an autosomal recessive disease that primarily affects persons of African ancestry. The hallmark of the disease is hemolytic anemia and vaso-occlusive crisis. Patients often have recurrent and severely painful episodes that necessitate the use of opioids. ⋯ The socio-cultural disparity between patients and providers may play a role. However, the lack of knowledge and understanding of the underlying pathophysiology of the disease and pain are the key issues. Education, research and hands-on experience, resulting in changes in attitudes and behaviors, will ultimately lead to a more empathic approach to the sickle cell patient.
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Historical Article
Minority distrust of medicine: a historical perspective.
Recent philosophical work has disclosed a host of problems in our apparently natural ways of classifying things. The contemporary classification of certain groups as "minorities" exemplifies some of these problems. ⋯ Such classifications can play a destructive role in determining the sort of health care which minorities receive. Embracing them, even with the intent of improving the lot of those who do not fare well in the present health care environment, is subversive of the egalitarian stance which has been central to medical ethics since Hippocrates.
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This essay explores the idea that it is possible for a patient to feel ill at ease with a health care professional, even though there is no active ill will on the part of the professional. Noting that the relationship between the patient and the health care professional, especially in the case of the physician, is an asymmetrical one, I suggest that it is incumbent upon professionals to take extra steps to insure that the patient feels at ease in the staff-patient encounter, notwithstanding the good will that health professionals may be assumed to have toward patients generally.
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The pregnant Jehovah's Witness patient's refusal of lifesaving transfusion creates a conflict for the physician. While legal steps may be initiated to address the problem, a medical approach stressing prophylaxis which anticipates and avoids the ethical dilemma of managing a hemorrhaging pregnant Jehovah's Witness is preferable.
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Asian patients receive, with significant frequency, suboptimal medical care. The sources of shortcomings in the treatment of the Asian American patient are examined in this paper. ⋯ Misunderstanding begets further "noncompliance," initiating a downward spiral. The way out of such spirals lies, I argue, in seeking a more adequate understanding of the patient's beliefs and their behavioral consequences.