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Book The Physician as Patient

    Book Details:
  • Author : Michael F. Myers
  • Publisher : American Psychiatric Pub
  • Release : 2008
  • ISBN : 9781585623129
  • Pages : 0 pages

Download or read book The Physician as Patient written by Michael F. Myers and published by American Psychiatric Pub. This book was released on 2008 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Professionals treating physicians need to be attuned to a host of considerations not applicable to other patients--coverage found in The Physician as Patient. This practical handbook combines the perspectives of two seasoned psychiatrists who have been assessing and treating physicians for more than 30 years and who here discuss not only common illnesses and problems seen in doctors but also the many biopsychosocial treatments that are indicated. Myers and Gabbard consider such issues as the uniqueness of the physician's psychological makeup that facilitates or impedes diagnosis and treatment, describe the most common medical and psychiatric illnesses in physicians (including addictions), and address such topics as personality disorders and the increasingly important subject of boundary violations. In addition to key issues in therapy and prevention, the authors cover important topics such as considering sociocultural customs and values when treating minority physicians and addressing the clinical, humanistic, ethical, and legal dimensions of psychiatric evaluation. Brimming with case examples, the book's reader-friendly style facilitates quick grasp of concepts, while an extensive list of references and websites provides an entrée for additional support, making it an indispensable resource for all mental health professionals who take caregivers into their care.

Book When Doctors Become Patients

Download or read book When Doctors Become Patients written by Robert Klitzman and published by Oxford University Press. This book was released on 2008 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: For many doctors, their role as powerful healer precludes thoughts of ever getting sick themselves. When they do, it initiates a profound shift of awareness-- not only in their sense of their selves, which is invariably bound up with the "invincible doctor" role, but in the way that they view their patients and the doctor-patient relationship. While some books have been written from first-person perspectives on doctors who get sick-- by Oliver Sacks among them-- and TV shows like "House" touch on the topic, never has there been a "systematic, integrated look" at what the experience is like for doctors who get sick, and what it can teach us about our current health care system and more broadly, the experience of becoming ill.The psychiatrist Robert Klitzman here weaves together gripping first-person accounts of the experience of doctors who fall ill and see the other side of the coin, as a patient. The accounts reveal how dramatic this transformation can be-- a spiritual journey for some, a radical change of identity for others, and for some a new way of looking at the risks and benefits of treatment options. For most however it forever changes the way they treat their own patients. These questions are important not just on a human interest level, but for what they teach us about medicine in America today. While medical technology advances, the health care system itself has become more complex and frustrating, and physician-patient trust is at an all-time low. The experiences offered here are unique resource that point the way to a more humane future.

Book Patients at Risk

    Book Details:
  • Author : Niran Al-Agba
  • Publisher : Universal-Publishers
  • Release : 2020-11-01
  • ISBN : 1627343164
  • Pages : 254 pages

Download or read book Patients at Risk written by Niran Al-Agba and published by Universal-Publishers. This book was released on 2020-11-01 with total page 254 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare exposes a vast conspiracy of political maneuvering and corporate greed that has led to the replacement of qualified medical professionals by lesser trained practitioners. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for the guardians of our nation’s healthcare continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans. With the rate of nurse practitioner and physician assistant graduates exceeding that of physician graduates, if you are not already being treated by a non-physician, chances are, you soon will be. While advocates for these professions insist that research shows that they can provide the same care as physicians, patients do not know the whole truth: that there are no credible scientific studies to support the safety and efficacy of non-physicians practicing without physician supervision. Written by two physicians who have witnessed the decline of medical expertise over the last twenty years, this data-driven book interweaves heart-rending true patient stories with hard data, showing how patients have been sacrificed for profit by the substitution of non-physician practitioners. Adding a dimension neglected by modern healthcare critiques such as An American Sickness, this book provides a roadmap for patients to protect themselves from medical harm. WORDS OF PRAISE and REVIEWS Al-Agba and Bernard tell a frightening story that insiders know all too well. As mega corporations push for efficiency and tout consumer focused retail services, American healthcare is being dumbed down to the point of no return. It's a story that many media outlets are missing and one that puts you and your family's health at real risk. --John Irvine, Deductible Media Laced with actual patient cases, the book’s data and patterns of large corporations replacing physicians with non-physician practitioners, despite the vast difference in training is enlightening and astounding. The authors' extensively researched book methodically lays out the problems of our changing medical care landscape and solutions to ensure quality care. --Marilyn M. Singleton, MD, JD A masterful job of bringing to light a rapidly growing issue of what should be great concern to all of us: the proliferation of non-physician practitioners that work predominantly inside algorithms rather than applying years of training, clinical knowledge, and experience. Instead of a patient-first mentality, we are increasingly met with the sad statement of Profits Over Patients, echoed by hospitals and health insurance companies. --John M. Chamberlain, MHA, LFACHE, Board Chairman, Citizen Health A must read for patients attempting to navigate today’s healthcare marketplace. --Brian Wilhelmi MD, JD, FASA

Book The Patient Will See You Now

Download or read book The Patient Will See You Now written by Eric Topol and published by Basic Books. This book was released on 2016-10-25 with total page 400 pages. Available in PDF, EPUB and Kindle. Book excerpt: The essential guide by one of America's leading doctors to how digital technology enables all of us to take charge of our health A trip to the doctor is almost a guarantee of misery. You'll make an appointment months in advance. You'll probably wait for several hours until you hear "the doctor will see you now"-but only for fifteen minutes! Then you'll wait even longer for lab tests, the results of which you'll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical. In The Patient Will See You Now, Eric Topol, one of the nation's top physicians, shows why medicine does not have to be that way. Instead, you could use your smartphone to get rapid test results from one drop of blood, monitor your vital signs both day and night, and use an artificially intelligent algorithm to receive a diagnosis without having to see a doctor, all at a small fraction of the cost imposed by our modern healthcare system. The change is powered by what Topol calls medicine's "Gutenberg moment." Much as the printing press took learning out of the hands of a priestly class, the mobile internet is doing the same for medicine, giving us unprecedented control over our healthcare. With smartphones in hand, we are no longer beholden to an impersonal and paternalistic system in which "doctor knows best." Medicine has been digitized, Topol argues; now it will be democratized. Computers will replace physicians for many diagnostic tasks, citizen science will give rise to citizen medicine, and enormous data sets will give us new means to attack conditions that have long been incurable. Massive, open, online medicine, where diagnostics are done by Facebook-like comparisons of medical profiles, will enable real-time, real-world research on massive populations. There's no doubt the path forward will be complicated: the medical establishment will resist these changes, and digitized medicine inevitably raises serious issues surrounding privacy. Nevertheless, the result-better, cheaper, and more human health care-will be worth it. Provocative and engrossing, The Patient Will See You Now is essential reading for anyone who thinks they deserve better health care. That is, for all of us.

Book How to Improve Doctor Patient Connection

Download or read book How to Improve Doctor Patient Connection written by Christine J. Ko and published by Routledge. This book was released on 2021-10-28 with total page 125 pages. Available in PDF, EPUB and Kindle. Book excerpt: How to Improve Doctor-Patient Connection offers actionable steps for improving communication between health professionals and patients based on visual, auditory, and emotional understanding from the principles of cognitive psychology. Drawing on the author’s personal experience as both a healthcare professional and a mother of two children, How to Improve Doctor-Patient Connection explores communication between doctors and patients as well as bias in healthcare. This how-to text includes several practical applications that can be applied to healthcare encounters, enabling readers to form habits based on visual analysis of body language, auditory information from language and tone of voice, and logical emotion perception that will allow for improved doctor-patient connection. By integrating the perspectives of both doctors and patients and applying a psychological lens, this text is invaluable to healthcare practitioners, students of medicine, healthcare, biology, and related fields, and anyone looking to improve their own or other’s quality of doctor-patient interactions and overall healthcare experience.

Book Conflict of Interest in Medical Research  Education  and Practice

Download or read book Conflict of Interest in Medical Research Education and Practice written by Institute of Medicine and published by National Academies Press. This book was released on 2009-09-16 with total page 436 pages. Available in PDF, EPUB and Kindle. Book excerpt: Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.

Book What I Say

    Book Details:
  • Author : Robert Osher
  • Publisher : CRC Press
  • Release : 2024-06-01
  • ISBN : 1040138179
  • Pages : 165 pages

Download or read book What I Say written by Robert Osher and published by CRC Press. This book was released on 2024-06-01 with total page 165 pages. Available in PDF, EPUB and Kindle. Book excerpt: Physicians of all disciplines know (or quickly learn the hard way) that effective and compassionate communication is arguably the single most important determinant of patient satisfaction. For cataract surgeons, the words said before, after, and even during the operation are often more important to the patient’s happiness than the objective quality of the surgical result. What I Say: Conversations that Improve the Physician-Patient Relationship is designed to help cataract surgeons to hone their verbal interactions to be as sharp as their surgical skills. Muddled, clumsy, or impromptu explanations diminish the doctor-patient relationship and could prevent patients from receiving the surgery they need or appreciating the results they get. Knowing in advance which words to use in difficult situations is analogous to knowing how to manage a complication before it occurs. The results are inevitably better when a physician has considered every possible outcome instead of attempting to come up with exactly the right solution on the spot. Rather than figure out the right words by trial and error, however, What I Say has recommendations on exactly what to say to build strong and trusting patient relationships. Drs. Robert Osher and Jack Parker have compiled conversational scripts from Dr. Osher’s 40-year career in ophthalmology, as well as contributions from over a dozen international mavens of bedside manner into a strategy guide through even the most difficult patient conversations that inevitably surround cataract surgery. Topics include: Lowering Expectations for Spectacle-Free Vision The Torn Posterior Capsule Postoperative Refractive Surprise The Dropped Nucleus The Unhappy Patient Despite a Good Result Containing examples of conversations with cataract surgery patients where informing and reassuring take top priority, What I Say: Conversations that Improve the Physician-Patient Relationship was created to aid cataract surgeons in their pre-operative, intra-operative, and post-operative interactions with patients. With the advice contained inside, surgeons will be able to motivate patients, calibrate expectations, and diffuse frustrations in every possible scenario.

Book Unequal Treatment

    Book Details:
  • Author : Institute of Medicine
  • Publisher : National Academies Press
  • Release : 2009-02-06
  • ISBN : 030908265X
  • Pages : 781 pages

Download or read book Unequal Treatment written by Institute of Medicine and published by National Academies Press. This book was released on 2009-02-06 with total page 781 pages. Available in PDF, EPUB and Kindle. Book excerpt: Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Book Physician Communication

    Book Details:
  • Author : Terry L. Schraeder
  • Publisher : Oxford University Press, USA
  • Release : 2019
  • ISBN : 0190882441
  • Pages : 241 pages

Download or read book Physician Communication written by Terry L. Schraeder and published by Oxford University Press, USA. This book was released on 2019 with total page 241 pages. Available in PDF, EPUB and Kindle. Book excerpt: Communication skills determine how the world perceives us - and how we perceive the world. Communication is at the heart of who we are and all that we do. As a clinician, your communication impacts how you take care of patients, work with colleagues, teach trainees, and engage audiences and the public. Communication encompasses all aspects of human skills, from listening and clearly articulating thoughts to an awareness of physical gestures, specific word choice, tone, and volume. Whether engaging with patients, peers, care teams, family members, residents, researchers, insurance agencies, management, or journalists, successful communication requires focusing on the importance of the relationship and the mission of each interaction. Today, due to the rise of digital technologies including electronic medical records, online forums, and video conferences, the content of information, the platform, and the audience are continuously changing and expanding for physicians. There is a great need in the physician community to learn how to facilitate the exchange of information, provide psychosocial support, partake in shared-decision making, translate complex information, and resolve controversies with sound science in a variety of settings. Addressing physicians at every level of training and practice, Physician Communication: Connecting with Patients, Peers, and the Public will enable providers to examine, analyse, and improve their skills in the art and science of communication. Divided into four sections: Face-to-face Communications; Digital Communications;Public Speaking; and Traditional Media, this book will help physicians navigate various situations using different methods and modes of communication.

Book What Doctors Feel

    Book Details:
  • Author : Danielle Ofri
  • Publisher : Beacon Press
  • Release : 2013-06-04
  • ISBN : 0807073334
  • Pages : 232 pages

Download or read book What Doctors Feel written by Danielle Ofri and published by Beacon Press. This book was released on 2013-06-04 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: A look at the emotional side of medicine—the shame, fear, anger, anxiety, empathy, and even love that affect patient care Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And while much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients. How do the stresses of medical life—from paperwork to grueling hours to lawsuits to facing death—affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Danielle Ofri offers up an unflinching look at the impact of emotions on health care. With her renowned eye for dramatic detail, Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients and her forever fear of making another. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. But doctors don’t only feel fear, grief, and frustration. Ofri also reveals that doctors tell bad jokes about “toxic sock syndrome,” cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness. The stories here reveal the undeniable truth that emotions have a distinct effect on how doctors care for their patients. For both clinicians and patients, understanding what doctors feel can make all the difference in giving and getting the best medical care.

Book Responsibility in Health Care

Download or read book Responsibility in Health Care written by G.J. Agich and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicine is a complex social institution which includes biomedical research, clinical practice, and the administration and organization of health care delivery. As such, it is amenable to analysis from a number of disciplines and directions. The present volume is composed of revised papers on the theme of "Responsibility in Health Care" presented at the Eleventh Trans Disciplinary Symposium on Philosophy and Medicine, which was held in Springfield, illinois on March 16-18, 1981. The collective focus of these essays is the clinical practice of medicine and the themes and issues related to questions of responsibility in that setting. Responsibility has three related dimensions which make it a suitable theme for an inquiry into clinical medicine: (a) an external dimension in legal and political analysis in which the State imposes penalties on individuals and groups and in which officials and governments are held accountable for policies; (b) an internal dimension in moral and ethical analysis in which individuals take into account the consequences of their actions and the criteria which bear upon their choices; and (c) a comprehensive dimension in social and cultural analysis in which values are ordered in the structure of a civilization ([8], p. 5). The title "Responsibility in Health Care" thus signifies a broad inquiry not only into the ethics of individual character and actions, but the moral foundations of the cultural, legal, political, and social context of health care generally.

Book How Not to be My Patient

Download or read book How Not to be My Patient written by Edward T. Creagan and published by Write On, Inc.. This book was released on 2003 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Dr. Creagan's prescription for prevention and survival teaches readers how to take control of their health care, their medical records and their decision making and shows patients how to wisely select and build partnerships with their doctors.

Book Changing How We Think about Difficult Patients

Download or read book Changing How We Think about Difficult Patients written by Joan Naidorf and published by . This book was released on 2022-02-07 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: Physicians enter their professions with the highest of hopes and ideals for compassionate and efficient patient care. Along the way, however, recurring problems arise in their interactions with some patients that lead physicians to label them as "difficult." Some studies indicate that physicians identify 15% or more of their patients as "difficult." The negative feelings that physicians have toward these patients may lead to frustration, cynicism. and burnout. Changing How We Think about Difficult Patients uses a multi-tiered approach to bring awareness to the difficult patient conundrum, then introduces simple, actionable tools that every physician, nurse, and caregiver can use to change their mindset about the patients who challenge them. Positive thoughts lead to more positive feelings and more effective treatments and results for patients. They also lead to more satisfaction and decreased feelings of burnout in healthcare professionals. How does this book give you an advantage? Caring for difficult patients poses a tremendous challenge for physicians, nurses, and clinical practitioners. It may contribute significantly to feelings of burnout, including feelings of exhaustion, cynicism, and lost sense of purpose. In response, Dr. Naidorf offers a pragmatic approach to accepting patients the way they are, then provides strategies for providers to find more happiness and satisfaction in their interactions with even the most challenging patients and families. Here are just some of the topics the author discusses in detail: What Makes a "Good" Patient? The Four Core Ethical Principals of the Clinician-Patient Relationship The Four Models of the Physician-Patient Relationship What Challenges Anybody with Illness or Injury? How "Good" Patients Handle the Challenges of Illness and Injury Six Common Reactions to Illness and Hospitalization On "Taking Care of the Hateful Patient" Standards for Education in Medical Ethics De-escalation Strategies Cultural, Structural, and Language Issues Types of Patients Who Tend to Challenge Us The Think, Feel, Act Cycle Recognizing Our Preconceived Thoughts Three Common Thought Distortions About Patients Asking Useful Questions Getting Out of the Victim Mentality Guiding our Thoughts Through a Common Scenario Show Compassion, Feel Compassion If you're a healthcare provider or caregiver, Changing How We Think about Difficult Patients will give you the benefit of understanding your most challenging patients, and a roadmap to positively changing your mindset and actions to better deliver care and compassion for all.

Book Toward Precision Medicine

    Book Details:
  • Author : National Research Council
  • Publisher : National Academies Press
  • Release : 2012-01-16
  • ISBN : 0309222222
  • Pages : 142 pages

Download or read book Toward Precision Medicine written by National Research Council and published by National Academies Press. This book was released on 2012-01-16 with total page 142 pages. Available in PDF, EPUB and Kindle. Book excerpt: Motivated by the explosion of molecular data on humans-particularly data associated with individual patients-and the sense that there are large, as-yet-untapped opportunities to use this data to improve health outcomes, Toward Precision Medicine explores the feasibility and need for "a new taxonomy of human disease based on molecular biology" and develops a potential framework for creating one. The book says that a new data network that integrates emerging research on the molecular makeup of diseases with clinical data on individual patients could drive the development of a more accurate classification of diseases and ultimately enhance diagnosis and treatment. The "new taxonomy" that emerges would define diseases by their underlying molecular causes and other factors in addition to their traditional physical signs and symptoms. The book adds that the new data network could also improve biomedical research by enabling scientists to access patients' information during treatment while still protecting their rights. This would allow the marriage of molecular research and clinical data at the point of care, as opposed to research information continuing to reside primarily in academia. Toward Precision Medicine notes that moving toward individualized medicine requires that researchers and health care providers have access to very large sets of health- and disease-related data linked to individual patients. These data are also critical for developing the information commons, the knowledge network of disease, and ultimately the new taxonomy.

Book The Patient Physician Relation

Download or read book The Patient Physician Relation written by Robert M. Veatch and published by Indiana University Press. This book was released on 1991-01-22 with total page 332 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Throughout the past two decades, when medical ethics has had a renaissance, Robert Veatch has been a leading contributor to its dialogue and advance. This collection of his work shows the breadth and the cogency of his thinking.... it is a book worth having."Â -- Journal of the American Medical Association "... a fascinating dissection of almost every aspect of the doctor-patient relationship.... strongly recommended reading for all health care workers interested in this rapidly evolving field."Â -- Queen's Quarterly "This outstanding discussion of important current medical issues is a valuable addition to academic and professional libraries." -- Choice "... an important contribution to bioethics... certain to provoke controversy in the field."Â -- Medical Humanities Review "Lucid and well-argued... " -- Religious Studies Review This book heralds the imminent demise of "doctor knows best." In it, Robert M. Veatch proposes a postmodern medicine in which decisions about patient care will routinely involve both doctor and patient -- not only in ethically complex cases such as the termination of life-sustaining treatment, but in everyday care as well.

Book Patient physician Relationship

Download or read book Patient physician Relationship written by Ratna Dutta Sharma and published by . This book was released on 2007 with total page 280 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Book Contains Papers Presented At A Workshop On Patient-Physician Relationship, Organised By Jadavpur University, By Thinkers From Various Disciplines Like Religion, Philosophy And Law Discussing Medical Ethics, Consent And Confidentiality, Gender-Related Differences, Etc.

Book The Medical Interview

    Book Details:
  • Author : Mack Jr. Lipkin
  • Publisher : Springer Science & Business Media
  • Release : 2012-12-06
  • ISBN : 1461224888
  • Pages : 643 pages

Download or read book The Medical Interview written by Mack Jr. Lipkin and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 643 pages. Available in PDF, EPUB and Kindle. Book excerpt: Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi tive and caring personal relationship, care by a single healthcare pro vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly.