Ethics and the Physician-Patient Relationship

Book Reviews in This Article:
Getting Rid of Patients: Contradictions in the Socialization of Physicians . By Terry Mizrahi
Physicians and Social Change . By John Colombotos and Corinne Kirchner
Changing Values in Medicine . Edited by Eric J. Cassell and Mark Siegler
Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum . By Harmon L. Smith and Larry R. Churchill
Physician—Patient Decision-Making: A Study in Medical Ethics . By Douglas N. Walton
With Dignity: The Search for Medicare and Medicaid . By Sheri I. David
The Dismissal of Students with Mental Disorders. Legal Issues, Policy Considerations, and Alternative Responses .
Courtroom Toxicology . By Marshall Houts, Randall C. Baselt, and Robert H. Cravey     

Dissecting intramural haematoma of the coronary artery with intimal tears.

A dissecting intramural haematoma of the coronary artery is an infrequent cause of sudden and unexpected death. Most cases are women and in a significant number of these women, the haematoma occurred at term to 80 days postpartum. Because the intimal rupture and communication with the lumen were not found in most of the cases, the site of rupture has been considered to be a vasa vasorum. The authors report on a case of one woman who was at a later postpartum period (106 days). The microscopic finding of the dissected coronary artery revealed two intimal tears in a section. The case showed that the dissecting intramural haematoma of the coronary artery is caused not only by the rupture of the vasa vasorum but also by the rupture of the intima.     

Threatening and otherwise inappropriate letters to members of the United States Congress

The authors examine the characteristics of threatening and otherwise inappropriate communications sent to members of the U.S. Congress by a sample of 86 subjects, 20 of whom threatened assassination. We quote excerpts from these letters and provide quantitative data on such variables as the volume, duration, form, and appearance of such communications; the enclosures; the subjects' perceived relationships to the recipients; the thematic content of the communications; and the messages and threats communicated. Comparisons between 43 subjects who pursued encounters with members of Congress and 43 who did not revealed 17 factors associated with such pursuit. In this population, threateners were significantly less likely to pursue an encounter than inappropriate letter writers who did not threaten, regardless of the type of threat or the harm threatened. Inappropriate letters to members of Congress are compared with those directed to Hollywood celebrities. Mentally disordered persons writing to public figures often mention and sometimes threaten public figures other than those to whom the letters are addressed, which raises important issues regarding notification of endangered third parties and the sharing of information among protective agencies.     

SPECIAL NEEDS CHILDREN IN FAMILY COURT CASES

This article presents a conceptual framework for describing cases involving children with special needs that are increasingly being seen in family court. Three categories that represent the most common of such cases include (1) acute, life-threatening medical conditions; (2) chronic developmental disorders; and (3) psychological and behavioral syndromes. After detailing the nature of the disabilities in each category, perspectives from the bench are offered with specific recommendations and general strategies for effective case management. This is followed by a proposal of an innovative conceptual model—the Individualized Parenting Plan (IPP)—that organizes and integrates nine domains essential for a comprehensive parenting plan for special needs children. The article concludes with a list of sixteen strategic guidelines for servicing the families of these special needs children, in their best interests.     

The psychodynamics of a work stoppage at the Tenth Pan American Games

A study of the various stressors faced by interns serving as security assistants at the Tenth Pan American Games and the coping mechanisms they utilized was undertaken during the months of July and August 1987. This study revealed that group development can be altered and maladaptive behavior can result among students experiencing high degrees of stress, frustration, and feelings of helplessness, who are subject to a leadership void. The data strongly support the need for planners of similar large-scale internship programs to consider group processes, organizational factors, and interpersonal relations if organizational goals are to be achieved, maladaptive coping mechanisms are to be avoided, and student stress is to be lessened.