Darren B. Taichman, MD, PhD
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From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University.
Ask your learners whether they think firearm-related injuries are a medical issue. Is it appropriate to approach the problem from an epidemiologic and public health perspective?
Do your learners think they should talk to patients who they believe are at risk for firearm-related harm about how they can reduce the risks? Use the accompanying editorial to help frame your discussion.
The author and editorialists encourage physicians to make a public commitment to talk to patients when they believe risks for firearm-related injuries are present. Do your learners think such declarations are useful or appropriate? Why or why not? Will your learners make such commitments?
Will your learners talk to patients they believe are at risk? If so, do they know how? Do they know what they will ask and advise them? Use a recent paper that addresses such issues to help frame your discussion.
Start a teaching session with a multiple-choice question. We've provided one below.
Ask your learners if a patient has ever said that she or he would like to die. How have they responded? What questions should they ask? Have they ever been asked by a patient for help ending his or her life? Do they feel qualified to talk to patients about such issues? If not, what do they need to learn?
Do your learners think there are situations where a patient's request for assistance in bringing about death should be honored? Why or why not?
What are the laws regarding physician-assisted suicide where you practice? If it is legal, do your learners think all physicians have an obligation to participate? If not, how do we balance the needs and beliefs of the patients and physicians involved?
Some health care professional societies oppose participation in physician-assisted suicide, whereas others provide support to physicians who do participate. What do your learners think is the best approach?
Do your learners think there is a difference between palliative sedation and/or analgesics that, as a side effect, hasten death versus the provision of sedatives and/or analgesics that are used to bring about death?
Ask your learners who is at risk for intimate partner violence. Do they ask patients whether they have been victims of intimate partner violence or are worried about this issue?
Review the U.S. Preventive Services Task Force recommendation statement that recommends screening all women of childbearing age for intimate partner violence.
Why have federal laws aimed at protecting women from intimate partner violence been less effective than they might have been?
Do your learners think they will be comfortable asking their patients about these issues? Why or why not? How can they overcome any hesitation so as to better protect their patients?
What else can physicians do to help reduce the risk for intimate partner violence? Use the accompanying editorial to help frame your discussion.
Ask your learners whether they have received feedback on how well they have made correct diagnoses in their patients.
How do we react when we learn that we have made an incorrect diagnosis or that it took longer than it should have to reach the right diagnosis?
How can we improve how we make use of such feedback?
Review the paper's table, and ask your learners if together you could adopt some of the suggested “tracking systems” the author proposes in your practices. How will you monitor yourself or each other to see whether this new approach is working? How will you judge success or failure?
What does the author mean by “calibration” and “an incessant watch” with regard to improving one's diagnostic skills?
Listen to an audio recording of the essay, read by Dr. Michael LaCombe.
How frequently do physicians at your center follow their outpatients when they are hospitalized? Do your learners go to see their outpatients when they are admitted? Why or why not?
What are the barriers to outpatient-based physicians following their patients in the hospital? What pressures have made such practice less common? In what ways has hospital care been improved by its being led by physicians focusing only on inpatient care? What are the tradeoffs?
The author wonders whether our profession will continue to develop systems where physicians work in the hospital or in outpatient settings, but not both. She believes that safer and more satisfying models will emerge but that they will be worked out by the next generation of physicians. What do your learners think is best? How should the system work?
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Taichman DB. Annals for Educators - 17 October 2017. Ann Intern Med. ;167:ED8. doi: 10.7326/AFED201710170
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Published: Ann Intern Med. 2017;167(8):ED8.
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