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 what symptoms might suggest a diagnosis of Hashimoto disease. How should patients be evaluated?
What other entities may cause painless thyroiditis? Use the information at DynaMed Plus: Hashimoto Thyroiditis, a benefit of your ACP membership, to help prepare for a teaching session.
What are potential complications of Hashimoto disease?
What was the rationale for thyroidectomy in this trial? Why was it hypothesized that it might be helpful? Was it? On the basis of this study's results, do your learners think they should consider thyroidectomy for patients similar to those enrolled in this study? Why or why not?
Ask your learners how they go about providing thyroid replacement therapy. How should it be monitored?
What do the “normal” ranges of thyroid function test results tell us? How should we approach patients who have persistent symptoms that are potentially attributable to abnormal thyroid function despite having values within the normal range?
Start a teaching session with a multiple-choice question. We've provided one below!
Ask your learners how common UI is. Are they surprised to hear that it affects about 17% of nonpregnant women?
How might UI affect a woman's physical and mental health?
Do your learners think that patients might not tell them about UI? Should your learners ask, and if so, how?
What are the differences among stress, urgency, and mixed UI? How is a diagnosis made? Does the approach to treatment differ according to the type of UI?
What nonpharmacologic and pharmacologic interventions are available? What does this review tell us about their effectiveness?
How does one arrange for behavioral treatments for UI at your institution?
Ask who is at elevated risk for GAD.
Ask what the diagnostic criteria are for GAD. What other diagnoses should be considered? Use Table 1 to help prepare for a teaching session. What physical examination findings might indicate possible GAD?
When should your learners consider consultation with a psychologist, psychiatrist, or other specialist?
Are there helpful nonpharmacologic interventions? How are they provided? What pharmacologic therapies are available, and when should they be used? How should they be monitored? Use the tables to help review.
Use the provided multiple-choice questions to help introduce topics during a teaching session. Be sure to log on and enter your answers to earn CME/MOC credit for yourself!
Watch the interview of Ms. F, a 71-year-old woman with metastatic neuroendocrine carcinoma.
Ask your learners whether they would refer Ms. F to palliative care. If so, what are the goals?
Ask whether palliative care can and/or should be provided by a patient's primary oncologist.
What is the difference between palliative care and hospice care? Are patients referred “too late” to palliative care? If so, why?
What are the potential benefits of palliative care? Where do the 2 consultants agree and disagree regarding how it should be provided? This is summarized succinctly at the end of the article.
Listen to an audio recording, read by Dr. Michael LaCombe.
Ask your learners whether they have provided telemedicine. How? Was it strange or uncomfortable? What are its limitations? Are there advantages?
What social and interpersonal issues had the potential to derail this medical encounter? Are they different in any way with telemedicine versus in person?
How did Dr. Taylor successfully navigate these issues? How did the order in which he chose to address the patient's issues affect the outcome of the visit? How might this have gone if he had done things in a different order? What potential mistakes were avoided? Are these lessons any different in a telemedicine visit versus in person?
Prof.Dr.Tanu Pramanik Principal, Dr. Evertz Solomon Associate Professor, Dr. Orette Williams Associate Professor, Dr. Anaya Pramanik lecturer,
Lincoln College, Hargreaves Hospital Complex, Mandeville, Manchester, Jamaica,WI.[www.lincolncollege.org]
April 8, 2019
Humanism and professionalism--A matter of major concern for medical educators
In recent years, clinical practice has been modernised to a great extent all over the world introducing several advanced equipment and automated computerised instrumentation in different speciality units of teaching hospital settings. Dr. Darren B. Taichman deserve our sincere applause for his attempt to emphasize the training of humanism and professionalism in medical programme Humanised clinical practice is fading away from medical training curriculum at a rapid space. Majority of our students will never understand, realize or practice humanised medicine. We are promoting commercialised clinical practice where behavioural science is disappearing and doctor-patient relationship is losing ground. In the name of professionalism, we underestimate training for compassionate communication skills which is important to reveal patient complains often left unsaid.Professionalism training is equally important in medical practice though. We need to balance between humanisation and professionalism in medical curriculum.Compassionate behavioural skills—using the right words expressed in the right way—can help minimise patient distress and offer reassurance to accompanying relatives Previously we reported that when we are sick, injured, or facing an existential life crisis, our greatest human need is loving kindness and compassion in response to our vulnerability and suffering. Most commonly young generation medical graduates find it difficult to initiate respectful and compassionate dialogues with their patients while working in a crowded out-patient department. Many of them fail to maintain professional conduct in a stressful working environment. Some of them often feel sick due to burn out state of their mind after long hours of emergency ward duties. It is most unfortunate that many of them did not get an opportunity to learn about behavioural science as a part of their curriculum during their medical school training program. They were never been exposed to the local community for a supervised health screening program with a mission to develop doctor-patient relationship and professional communication skills in real life scenario [ 3].Too often, what patients actually receive is rushed, clinical, and emotionally detached care. Physicians have many evidence based guidelines for disease management but little evidence based medicine for care of the whole person .1. Darren B. Taichman (2019) Annals for Educators (Humanism and Professionalism.https://annals.org/aim/fullarticle/2729967/annals-educators-2-april-20192. Tanu Pramanik: Teaching caring and compassionate communication: https://blogs.bmj.com/bmj/2017/05/30/tanu-pramanik-teaching-the-doctor-patient-relationship/3. Tanu Pramanik (2017) Impact of behavioral science curriculum in medical education Re: Humanizing Health care. https://www.bmj.com/content/355/bmj.i6262/rapid-responses.4. Humanising health care BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6262 (Published 13 December 2016)Cite this as: BMJ 2016;355:i6262
Taichman DB. Annals for Educators - 2 April 2019. Ann Intern Med. 2019;170:ED7. doi: https://doi.org/10.7326/AWED201904020
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Published: Ann Intern Med. 2019;170(7):ED7.
Endocrine and Metabolism, Nephrology, Thyroid Disorders, Urological Disorders.
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