Articles: professional-practice.
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Comparative Study
Use of nurses from supplemental services: implications for hospitals.
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Medical education and the acquisition of professional credentials do not guarantee that medical knowledge (information that is taught, apart from the reality of practice, or gleaned from the literature) will be coupled rigorously to the decision-making process of everyday clinical practice. The limitations of the unaided human mind in a memory-based educational system must be forthrightly acknowledged by those who would be responsible for curriculum reform, so the need for new premises and new tools will be recognized and implemented. Because of their knowledge of the many variables that are unique to them, the patients themselves must be given a much more central role in the process of medical care and medical education. ⋯ New computer tools, as components of a problem-solving decision support system (knowledge couplers, knowledge networks, the coupler editor and documentation system, and the computerized patient record), are described. How these might be incorporated into a new type of medical education curriculum is presented. Finally, new goals, within the context of the new premises being implemented into a new system of education and medical care, are outlined.
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An attempt was made to determine the extent to which physicians trained and certified in family medicine are involved in emergency medicine. An 18-item, self-report questionnaire was mailed to 73 graduates of a family practice residency program to obtain information on their practices, their professional and emergency medicine experiences, and their attitudes toward the practice of emergency medicine by family practitioners. ⋯ Supplemental income was cited the most often as a reason for becoming involved in emergency medicine. Only variables related to the physicians' attitudes discriminated between those who were practicing emergency medicine and those who were not.
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The traditional exchange of medical expertise between physicians for patient benefit has been accomplished by referral. Physicians have traditionally decided when and to whom to refer patients. Health care "systems" now dominate medical practice, and their formats can alter spontaneous collegial interaction in referral. ⋯ Referral behavior can affect a physician's personal income in prepaid insurance programs where referrals are discouraged. The referring physician may bear legal liability for actions of the consultant. New practice arrangements and affiliations may place physicians in financial conflict-of-interest situations, challenge ethical commitments, and add new moral responsibility.