The Journal of family practice
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Competent physicians occasionally make critical errors in patient care that can lead to long-lasting remorse and guilt. The perceived causes of self-admitted physician errors have not been previously explored. ⋯ Family physicians attribute their memorable errors to a wide variety of causes, but most commonly to hurry, distraction, lack of knowledge, premature closure of the diagnostic process, and inadequately aggressive patient management. Physicians who understand common causes of errors may be better prepared to prevent them.
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Epidural anesthesia, although effective, has been associated with changing the course of labor. Previous studies have been criticized for not pinpointing the factors determining the use of epidural anesthesia. The purpose of this study was to determine the effect of epidural anesthesia use on the course of labor. ⋯ The average length of the second stage of labor is significantly longer for women who receive epidural anesthesia. The rate of epidural anesthesia use in this study population was strongly influenced by a change in health-care financing.
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Norplant removal has been much more difficult for many physicians than might have been anticipated. Dr Untung Praptohardjo of Indonesia recently developed the "U" technique, speeding the time required to remove the six Norplant implants to an average of 7 minutes. In his technique, a unique oval-ring-tipped forceps with an internal diameter of 2.2 mm is used to reach through a 4-mm incision to firmly grasp each of the implants. ⋯ Using the Modified U technique, the time required to remove Norplant implants in 20 patients in the United States has ranged from 8 to 13 minutes. Improperly placed implants are readily removed with this technique. The Modified U technique requires a minimal incision and offers both the physician and the patient a speedy, positive removal.
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Comparative Study
A multivariate model for specialty preference by medical students.
Numerous studies have demonstrated differences among students regarding their preference of a medical specialty. The goal of the present research was to develop a model for the selection of a primary care specialty (ie, family practice, general internal medicine, medicine/pediatrics, and general pediatrics). ⋯ No single factor dominates a student's preference for primary care. Students preferring primary care were most strongly influenced by their perceptions of practice variations. Students preferring nonprimary care specialties were more interested in income, prestige, and hospital-based practice. Medical school faculty had no significant impact on the preferences of either group of students.