203

priate in a class comprised of students from various dlied health disciplines, and the systematic nature of the patient care audit topic lends itself easily in individ- ualized instruction.

8) Audio-visual recording in surgery: Do patients mind? CAMPBELL, I.K. Heachan Group Surg., Kings Lynn, Norfolk, PE3 1 7EA, United Kingdom J. R. Coll. Gen. Pratt. 32(242), 548-549, 1982 The introduction of sophisticated video recording sys- tems has made filming in surgery practic?l. Many train- ing and non-training practices have been filmed in surgery, and there is evidence that studying video recordings is an effective method of teaching consulta- tion techniques. However, fears have been expressed that patients are unhappy with filming and that it threatens the essential elements of privacy and confiden- tiality in consultations. Therefore the attitudes and feel- ings of patients who had been filmed were examined, in an attempt to estimate whether the technique is accept- able. The results of questionnaires completed by 145 patients following audio-visual recording of their con- sultations are analyzed. It is concluded that the tech- nique is well accepted and non-intrusive.

9) Health education via cable TV as a public service and subscriber survey PAEGLE, R.D., ANDERSON, T., BROOKS, H.L., et al. Dept. Pathol., Milwaukee, WI, U.S.A. Wise. Med. J. 81(12), 11-14, 1982

This article describes the evolution, including the mechanics of developing and producing a health- education series via cable television for a local commu- nity, and the results of a subsequent cable-TV sub- scriber survey about preferences for health-education topics. This information may be helpful to physicians in other communities who are considering various means to reach the lay public.

ETHICAL ISSUES

Every health-care provider eventually faces problems associated with the dying of individual patients. The special circumstances of terminally ill psychiatric pa- tients reveal how complex these problems can be. How to navigate the maze of ethical and humane issues in- volved while remaining both within the law and within one’s institutional guidelines is a serious challenge for providers in all health-care disciplines.

10) Terminal ihess in a psychiatric patht-issIIeS and ethics LEVIN, S.M., and FELDMAN, M.B. Dept. Psychiatry, Univ. Witwatersrand, Johannesburg, South Africa S. Afr. Med.. J. 63(13), 492-494, 1983 A woman with paranoid psychosis and terminal breast cancer refused palliative radiation, demanding pain killers and permission to leave the hospital to go into the mountains and die on her own. Was it ethical to allow her to do so, or should a court order have been sought to impose hospital treatment on her? Should she have been persuaded to accept hospital care? When do those in charge deem a terminally ill patient unable to understand the issues, and dictate treatment? The aim of this article is to highlight a number of ethical matters regarding patient care, as well as to determine the role a hospice should play towards the terminally ill patient with associated psychiatric disorder.

ROLES OF HEALTH PROFESSIONALS

It is becoming increasingly clear that each health disci- pline has its own unique set of roles to play in the education and counseling of patients and their families. How these roles are taught initially in professional train- ing subsequently becomes a key variable in how health professionals actually perform these roles. Equally im- portant, however, is the extent to which these roles are supported by peers in the field and by leadership groups in particular health-care institutions.

11) The effectiveness of a consultation. Compliance with initial recommendations SEARS, CL., and CHARLSON, M.E. Dept. Med., Cornell Univ. Coil., New York, NY, U.S.A. Am. J. Med. 74(5), 870-876, 1983

To identify the attributes of an effective consultation, 202 general medicine consultations were analyzed to assess the extent of compliance ‘with the consultant’s initial recommendations. The overall compliance rate was 77%. Compliance decreased as the number of rec- ommendations increased. The consultant made more recommendations among patients who had more com- plex and more severe illnesses. Although compliance did increase significantly in severely ill patients (P < O.Ol), for each severity level compliance was higher when five or fewer recommendations were made. In fact, compliance decreased from 96% in severely ill patients with small consultation lists to 79% in those with large lists. Compliance was greatest with recom- mendations involving medications and least with those requiring direct physician and nursing action. Mul-

VOLUME 5/NUMBER 4

204

tivariate analysis confirmed that clinical severity of the patient’s illnesses and the type and number of recom- mendations were all predictors of compliance. To pro- mote overall compliance, consultants should limit the total number of recommendations in their initial consul- tation to five or fewer, focusing on issues central to current patient care. This is especially true in severely ill patients. Since recommendations that must be im- plemented by physicians or nurses have a lower com- pliance rate, consultants must carefully follow up those requests.

12) Teaching occupational health to medical students REST, K.M., CORDES, D.H., and HAKE, J.C. Arizona Cent. Occup. Saf. Health, Tucson, AZ, U.S.A. J. Family Pratt. 16(5), 979-983, 1983

Occupational and environmental diseases and injury are both widespread and preventable, yet their study has been traditionally neglected in undergraduate medical education. Because family physicians will encounter many working patients who are subject to varying de- grees of risk as a result of their job, home, or commu- nity environment, family-practice faculty must play an important role in teaching occupational and environmen- tal health to medical students. Goals for the longitudinal integration of occupational and environmental health over the four-year curriculum include sensitizing stu- dents to the relationship between work and health, introducing and reinforcing the importance of the occu- pational and environmental history in patient care, integrating occupational and environmental health prin- ciples and examples with existing course work, and providing appropriate clinical, research, and didactic ac- tivities for interested students. Goal achievement will vary with the availability of curricular time and teaching faculty. Strategies for implementing occupational and environmental health curriculum in the face of these two variables are discussed.

13) A pediatric approach to visual handicap JAFFE, M., and SCHNITZER, M.R. Div. Pediatr., Hanna Khoushy Cent. Dev. Pediatr., Rothschild Univ. Hosp., Techn. Fat. Med., Haifa, Israel Clin. Pediatr. (Philadelphia) 22(4), 255-258, 1983

When dealing with a visually handicapped child, the pediatrician’s responsibility is considerable. He or she plays a key role in establishing the pathologic diagnosis and in coordinating the subsequent medical therapy and genetic counseling if required. These responsibilities also include providing emotional support to the family,

and advice regarding the various medical, devel- opmental, and educational decisions that the family will face in the future. Basic knowledge regarding the ef- fects of visual deprivation on the development of the child, and the use of appropriate compensatory stimuli utilizing the other sensory modalities, will be of greater value as the pediatrician accompanies the patient through the trials that await him or her and the family.

14) Provision of health education through internships at student health service RIENZO, B.A., KNIGHT, S.M., and TUCKER, M.D. Dept. Health Educ., Univ. Florida, Gainesville, FL, U.S.A. J. Am. Coil. Health Assoc. 30(6), 296-297, 1982

The University of Florida Student Health Service and the Department of Health Education have entered into a cooperative arrangement for the provision of health education services. Senior-level undergraduate majors in health education earn academic credit through a course entitled Health Counseling and Public Health Field Experience. Students in this course develop pro- fessional health-education skills by volunteering time in local health agencies and attending the class in which basic helping skills are taught. The agencies are chosen by the students from an approved list provided by the instructor. The University of Florida Student Health Service has become one such agency choice, particu- larly for those majors with a patient-education emphasis area.

15) Four major benefits result from operating a joint practice (Editorial) Hospitals 56(15), 42, 1982

Better patient care, increased patient satisfaction, im- proved nurse/physician relationships, and easier opera- tional decisions are four major benefits of collaborative practice. As a result of the collaborative arrangement, physicians and nurses both know more about the condi- tion and progress of patients. Both professionals use this knowledge to achieve better communication and coordi- nation of health-care plans and to enhance their re- sponse to the medical and psychological needs of pa- tients. A final benefit of the collaborative practice is improved management decisions. Goodwin notes that one of the most difficult tasks for administrators is to choose between dissimilar requests from nurses and physicians for supplies, equipment, scheduling, and so forth. Where collaborative practice exists, nurses and physicians discuss such operational issues and present a unified proposal to administration.

PATIENT EDUCATION AND COUNSELING