Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The mediated image of physicians has traditionally been a positive one. However, the changing face of medicine and the advent of the managed care revolution has negatively impacted this collective image. The place of physicians within the continually raging debate over the costs and consequences of health care is an uncertain one. This paper offers a rhetorical analysis of news reporting surrounding physicians and managed care to unpack the possible “lessons” or “equipment for living” provided about health care practitioners in public discourse. Particular attention is paid to the construction of physician ethos in these accounts. Two broad narrative strains emerged in this group of articles a) a patient-focused narrative emphasizing the absence of doctors as patients struggle against managed care companies, and b) a physician-focused narrative, which portrays physicians as frustrated agents in the health care debate. Implications of these representations and the ways in which they compromise physician credibility are discussed.

Publication Type: School Poster
Abstract: Study design:
During the sixth professional year, pharmacy students complete internal medicine clerkships. As a part of their clerkship requirement, they are expected to present a 15-20 minute physician in-service to the medical team they are assigned to. The topic of the presentation has to relate to the patient admitted to the medical service and his/her pharmacotherapeutic problem(s). The physicians are provided with the handouts and are asked to fill out oral in-service audience evaluation sheet. These sheets are then collected by the preceptor and comprise a part of students’ grade for the in-service. The study objective is to assess physician perceptions of the value of pharmacy student presentations during medical rounds.

Results:
Data were collected over the period of 3 years (2003—2005). 92 physician evaluations were available for inclusion into the study. The questionnaire contained 8 questions with 1 to 5 scale used for student evaluation, 1 being poor and 5 being excellent. The median score obtained by pharmacy students was 5/5, and the mean was 4.78/5. The item analysis demonstrated good performance on all endpoints, and also pinpointed the area where pharmacy students needed improvement. Physicians scored pharmacy student presentations above 95% in 7 out of 8 questions asked. The one category that needed improvement was the use of appropriate visual aids. Pharmacist preceptor grades were generally below physician grades, but correlated significantly with physicians grades (r=0.48, p<0.05). Overall, physicians were satisfied with the quality of the presentations and the relevance of these presentations to patient care.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Context: Interactions between physicians and drug representatives are common, and a voluminous literature documents the impact on physician behaviors. However, little is known about why physicians meet with detailers, how they evaluate these encounters, and whether they understand the inherent conflicts of interest.
Objective: To determine physicians’ attitudes about and motivations for interacting with drug representatives.
Design, Setting, and Participants: Six focus groups were conducted with 32 academic and community physicians in San Diego, Atlanta, and Chicago.
Main Outcome Measures: Qualitative analysis of focus group transcripts to determine physicians’ motivations for meeting with detailers; their beliefs about the quality of information conveyed and the impact on prescribing; and their understanding of the conflict between detailers’ desire to sell product and patient care.
Results: Physicians understood the concept of conflict of interest and applied it to relationships with detailers. However, they maintained favorable views of physician-detailer exchanges. Holding these mutually contradictory attitudes, physicians were in a position of cognitive dissonance. To resolve the dissonance, they used a variety of denials and rationalizations: They avoided thinking about the conflict of interest; they disagreed that industry relationships affected physician behavior; they denied responsibility for the problem; they enumerated techniques for remaining impartial; and they reasoned that meetings with detailers were educational and benefited patients.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: The legitimacy of functional syndromes is contested. These syndromes have no objective pathology and no known causes. Patient organizations pursue the scientific legitimization of functional syndromes. Patients and doctors often clash in their understanding of these syndromes and the medical profession is divided into different factions. The ongoing controversies surrounding functional syndromes are of sociological interest. They reveal ongoing changes in modern biomedicine, especially in regard to the conception of disease and the patient-physician relationship. They also touch on a number of phenomena and problems in medicine and contemporary societies. This paper examines physicians’ views regarding functional syndromes. Articles published in leading American medical journals between 1999 and 2005 were reviewed. The comments, editorials and letters reveal conflicting tendencies in modern biomedicine. Economic interests, patient autonomy, and professional authority are at odds. There are tendencies to conceptualize disease beyond the mind-body dualism, which are met with considerable resistance by patients. While idealists among doctors reject medicalization, pragmatists endorse it. The results of this exploratory study can be applied to other diseases, other medical areas, and other situations involving lay and expert interaction.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This article examines Puerto Rican physicians’ status and ambitions. Under Spanish colonialism, elite Puerto Rican physicians’ professional identity included a struggle for a broader political autonomy. After the Spanish-American War of 1898, under U.S. colonial rule, they based their claims for greater professional autonomy on ethnic difference. This paper argues that elite Puerto Rican physicians lost their relative autonomy from the state, were politically distanced from potential patients, and were immersed in unpopular public health interventions under U.S. colonial rule. As a result, elite Puerto Rican physicians’ turn to professionalization and “market closure” was linked to nationalist politics.