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Workplace violence and aggression toward healthcare staff has a significant impact on the individual, causing self-blame, isolation and burnout. Timely and appropriate support can mitigate harm, but there is little research into how this should be delivered. We conducted multi-speciality peer groups for London doctors in postgraduate training (DPT), held over a 6-week period. Pre- and post-group burnout questionnaires and semi-structured interviews were used to evaluate peer support. Thematic analysis and descriptive statistical methods were used to describe the data.
Results
We found four themes: (a) the experience and impact of workplace violence and aggression on DPT, (b) the experience of support following incidents of workplace violence and aggression, (c) the impact and experience of the peer groups and (d) future improvements to support. DPTs showed a reduction in burnout scores.
Clinical implications
Peer groups are effective support for DPT following workplace violence and aggression. Embedding support within postgraduate training programmes would improve access and availability.
This Article provides an empirical analysis of all free movement of doctors cases decided by the CJEU. The aim of the Article is twofold: to provide a ‘characterisation’ of the type of doctors who rely on free movement law, and to make a link between their reliance on free movement law and the concept of medical professionalism. In what circumstances, and with what purpose, do doctors rely on free movement law? And does their reliance on free movement law pose a risk to medical professionalism? The analysis shows that most cases before the CJEU focussed on the expertise and qualifications of doctors. Many cases were brought by groups of doctors or medical professional associations. In most cases, the aim of the doctor's reliance on free movement law was to defend medical professionalism. Nevertheless, some recent cases show that doctors do rely on free movement law to restrict their accountability towards patients or national healthcare systems. Moreover, these cases show that arguments based on free movement law are relied on in a broader range of non-specialised courts or tribunals. This makes it important that national courts continue to engage in a dialogue with the CJEU.
This chapter explores the “medical revolution” of Tokugawa Japan. At the beginning of this period, medical care by physicians was largely an urban phenomenon, but over the course of some 200 years, medicine became an integral part of everyday life in towns and villages all around Japan. The political authorities had little involvement in the expansion of the medical profession, which instead was driven by commercial and social factors. The development of print culture made medical knowledge more widely available, both to physicians and the larger public, while the tensions of the status system made the medical profession desirable to many, from low-ranking members of the warrior status group to the ambitious sons of villager families. Medical academies established by prominent doctors in cities such as Kyoto, Edo, Osaka, and Nagasaki made it possible for would-be doctors to acquire training in a variety of new medical fields, from obstetrics to so-called Dutch medicine. However, by the early nineteenth century, the proliferation of doctors with varying degrees of training and skill and the increasingly intense competition among them led some localities to adopt new licensing measures designed to weed out “quacks” and ensure the livelihood of established doctors.
The tenth to thirteenth centuries were formative in the creation of what we now know as Chinese cuisine, including its rich regional diversity. The foods that people in the Song, Liao, and Jin ate were dependent on what the natural environment provided or what could be acquired through trade. But food and drink were also products of cultural preferences that evolved over time and came to identify economic, social, and ethnic difference. Song, Khitan, and Jurchen foodways differed significantly, rooted in the experiences of steppe and agrarian life as well as the diversity of cultures. People encountered unfamiliar food and drink in the cities andthrough diplomatic and commercial exchanges between Song and its neighbors. The food and drink people consumed were also deeply tied to the theory and practice of Chinese medicine, which reached new levels of standardization and sophistication during the Song and Jin. How were medical traditions transmitted through texts and teachers? How did the state promote and regulate medical knowledge and practice? The spread of printing and commercial publishing made information about food and medicine more widely available to the literate, and others could gain access to this knowledge through oral and visual transmission.
The years 1968-73 are a key period. The initial Irish response to the 1968 papal encyclical Humanae Vitae – reaffirming traditional Catholic teaching on contraception – was muted, compared with Europe or the United States, reflecting continuing Irish deference to clerical authority; clerical dissent was also limited. By 1972 however, two family planning clinics had opened in Dublin, and the ban on contraception was being challenged in the courts and the Oireachtas (parliament).This was happening against the backdrop of the Northern Ireland Troubles and a debate over minority rights. During the early 1970s there was a possibility that Ireland would come into line with other European countries, where laws against contraception had been liberalised in recent years. The Catholic Hierarchy argued that liberalising contraception would damage public morality, and that argument was repeated by the government. Given the political challenges of enacting legislation to enable even limited access to contraception, the government preferred to await the outcome of a Supreme Court judgment on the legality of the existing ban.
Central to the history of family planning in Ireland is the interaction between religious observance and expressions of Irishness, and how that changed in response to domestic political and socio-economic developments, and international forces. An Irish identity imagined around rural living, Catholicism, large families, traditional gender roles, and sexual puritanism, combined with a belief that Ireland could withstand the changes that were underway in twentieth-century western society in relation to sexual behaviour – drove the sustained hostility to legalising contraception. The 1980s was the decade when it became evident that the tide had turned. The number of married women in the workforce rose significantly, and fertility fell sharply. By the early 1990s Irish fertility was still the highest in Europe, but only by a small margin, and it was lower than in the United States. And yet the decline of this imagined Irishness was not unopposed; indeed, many lamented its passing. it is significant that the moral legislation enacted in the first decades after independence survived until the closing decades of the twentieth century, which might suggest that Ireland was exceptional.
From the early 1970s government proposals for legislation permitting access to contraception reveal a consistent dilemma for politicians: how to make contraception available to married couples while restricting access by single people. Records of consultative meetings organised by the Department of Health, suggest that by the late 1970s there was consensus, sometimes grudging, among the main churches, medical groups, and the trade union congress that contraception should be available on a restricted basis, but it was also recognised that it would prove difficult to prevent access by single people. These consultations also reveal a determination on the part of doctors and pharmacists to protect their professional interests, and an incapacity to provide family planning through the public health system. The 1979 Family Planning Act legalised access to contraception, ‘for bona fide family planning purposes’ – terminology that was not defined, and it privileged ‘natural methods’, providing state support to promote them in order to placate the Catholic hierarchy. Its restrictive nature ensured that contraception remained a matter for political contention.
Hunger is an embodied experience which impacts the physical and mental state. This chapter explores the impact of starvation. The physical effects of starvation on the body are wasting, swelling (edema), susceptibility to disease, and eventually death. The mental effects of starvation include behavioral changes, food obsession, and irritability. All of these were observed by individuals in the ghetto who recorded this as diarists or in some cases physicians studying the impact of the lack of food on their patients. This also chapter explores food fantasy resulting from hunger and humor which arose in response to food deprivation.
Miranda de Ebro was created in 1937 to imprison Republicans and foreigners who fought with the International Brigades in Spanish Civil War. From 1940, the camp was used only to concentrate detained foreign refugees with no proper documents. More than 15 000 people, most of them from France and Poland, were kept there until the camp was closed in January 1947. Playing both sides of the international divide, fascist Spain at various points in time allowed passage and was a country of refuge both for those escaping Nazism and for Nazis and collaborators who, at the end of World War II (WWII), sought to escape justice. Treatment of each of these groups passing through Miranda was very different: real repression was meted out to the members of the International Brigades (IB), tolerance shown towards those escaping Nazism, and protection and active cooperation given to former Nazis and their collaborators. For the first time, data about foreign physicians imprisoned in Miranda de Ebro were consulted in the Guadalajara Military Archive (Spain). From 1937 to 1947, 151 doctors were imprisoned, most of them in 1942 and 1943, which represents around 1% of the prisoners. Fifty-two of the doctors were released thanks to diplomatic efforts, thirty-two by the Red Cross, and ten were sent to other prisons, directly released or managed to escape. All of them survived. After consulting private and public archives, it was possible to reconstruct some biographies and fill the previous existing gap in the history of migration and exile of doctors during the Second World War.
The purpose of this commentary article is to explain the causes and effects of the economic migration of health care workers from Poland to Western countries, and to analyse the impact of the migration of doctors and nurses on the functioning of the public health system. We use data from the National Central Statistical Office, our own preliminary research, social surveys and the Watch Health Care database. Domestic data are analysed and compared with trends in Western Europe as described in Eurostat and Organisation for Economic Co-operation and Development reports. The decreasing number of active physicians remaining in the health care system results in long waits for specialist appointments. The demand for doctors from Central and Eastern Europe will continue to grow. Consequently, there will be a further outflow of medical staff from Poland and other countries in the region and the current problems with access to health care will continue.
The ‘knowledge economy’ is said to depend increasingly on capacities for innovation, knowledge-generation and complex problem-solving – capacities attributed to university graduates with research degrees. To what extent, however, is the labour market absorbing and fully utilising these capabilities? Drawing on data from a recent cohort of PhD graduates, we examine the correlates and consequences of qualification and skills mismatch. We show that job characteristics such as economic sector and main work activity play a fundamental and direct role in explaining the phenomenon of mismatch, experienced as overeducation and overskilling. Academic attributes operate mostly indirectly in explaining this mismatch, since their effect loses importance once we control for job-related characteristics. We detected a significant earnings penalty for those who are both overeducated and overskilled. Being mismatched reduces satisfaction with the job as a whole and with non-monetary aspects of the job, especially for those whose skills are underutilised. Overall, the problem of mismatch among PhD graduates is closely related to the demand-side constraints of the labour market. Increasing the number of adequate jobs and broadening the job skills that PhD students acquire during training should be explored as possible responses.
This chapter explores the practice of dissection in the first and second centuries AD, based largely on the evidence of Galen but drawing a picture beyond his activities alone. Divided into sections according to the contexts of and motivations for dissection, it begins with private dissections for practice and research. It next turns to performative dissections, beginning with those for public display. These public dissections occurred at different scales, and this section considers their contents, their diverse practitioners, and the size and make-up of their various audiences, including a discussion of venues, such as auditoria, and their capacities. The chapter then turns to examples of dissection specifically for medical advertisement, including evidence for public surgery, and then to two instances of dissection in the context of formal competition, one attested textually, the other epigraphically. Finally, it zeroes in on the competitive motivations of Roman dissection and its use in the adjudication of medical and philosophical debates, as well as in the jockeying between rivals.
Chapter 2 traces the Act’s early, formative years. We explain how its meaning was negotiated as women arrived in doctors’ surgeries seeking services that they now believed to be lawful and how doctors worked to understand and apply the new law. We explore how, over time, different interpretations of the Act coexisted, fell out of use or became entrenched in professional codes, internal policy and procedure documents, official guidance and medical curricula. The chapter ends in 1974 with the publication of two important texts discussing the workings of the Abortion Act in these early years: the sensationalist media expose Babies for Burning and the highly influential and authoritative Lane Report.
Death investigation was a central aspect of forensic medicine. However, doctors struggled with uncertainty in defining and evaluating signs of death, at the same time as popular fears of premature burial abounded. Moreover, they faced considerable difficulties in distinguishing between homicides, suicides, and natural or accidental deaths and in determining the cause of death. Anxiety about insufficiently trained and incompetent practitioners who performed medicolegal duties that exceeded the limits of their knowledge and skills fueled demands for medicolegal reform. As medicolegal expertise played a more and more decisive role in criminal investigations and prosecutions, flawed forensic expertise became an increasingly salient problem that sparked ongoing debates about possible structural solutions.
Like in the general population, in the medical community the most common mental disorders reported are depression and anxiety. Suicide risk was increased, especially in medical-related professions.
Objectives
To evaluate male and female psysician suicide risk.
Methods
Review all studies involving suicides, suicide attempts or suicidal ideation in health-care workers published in the last five years.
Results
Suicide decreased over time, especially in Europe. Some specialties might be at higher risk such as psychiatrists, general surgeons and anesthesiologists.
Conclusions
Psysicians are an at-risk profession of suicide, with women particularly at risk.
Malingering, the practice of feigning medical conditions for specific purposes, became a pressing concern for many practitioners of legal medicine following the introduction of conscription during the Revolutionary and Napoleonic Wars. A burgeoning medicolegal literature on malingering revealed that some doctors went to great lengths to detect and expose malingerers by using deceit, coercion, painful procedures, and altered states of consciousness as diagnostic tools. Doctors justified the far-reaching tactics used in adversarial contests with suspected malingerers in the name of the public good. Acting on behalf of the state to expose them, doctors engaged in adversarial relationships with suspected malingerers. These encounters also provided an impetus for debates about medical ethics; however, ethical concerns about doctors’ methods of detecting malingering were rarely raised and debated until the end of the nineteenth century.
The Science of Proof traces the rise of forensic medicine in late eighteenth- and nineteenth-century France and examines its implications for our understanding of expert authority. Tying real life cases to broader debates, the book analyzes how new forms of medical and scientific knowledge, many of which were pioneered in France, were contested, but ultimately accepted, and applied to legal problems and the administration of justice. The growing authority of medical experts in the French legal arena was nonetheless subject to sharp criticism and scepticism. The professional development of medicolegal expertise and its influence in criminal courts sparked debates about the extent to which it could reveal truth, furnish legal proof, and serve justice. Drawing on a wide base of archival and printed sources, Claire Cage reveals tensions between uncertainty about the reliability of forensic evidence and a new confidence in the power of scientific inquiry to establish guilt, innocence, and legal responsibility.
The aim of the study was to investigate mental health and conspiracy theory beliefs concerning COVID-19 among health care professionals (HCPs).
Material and methods:
During lockdown, an online questionnaire gathered data from 507 HCPs (432 females aged 33.86 ± 8.63 and 75 males aged 39.09 ± 9.54).
Statistical analysis:
A post-stratification method to transform the study sample was used; descriptive statistics were calculated.
Results:
Anxiety and probable depression were increased 1.5–2-fold and were higher in females and nurses. Previous history of depression was the main risk factor. The rates of believing in conspiracy theories concerning the COVID-19 were alarming with the majority of individuals (especially females) following some theory to at least some extend.
Conclusions:
The current paper reports high rates of depression, distress and suicidal thoughts in the HCPs during the lockdown, with a high prevalence of beliefs in conspiracy theories. Female gender and previous history of depression acted as risk factors, while the belief in conspiracy theories might act as a protective factor. The results should be considered with caution due to the nature of the data (online survey on a self-selected but stratified sample).
This chapter completes the description of the delivery system, focusing on three fundamental categories of providers: hospitals, doctors and nurses. For each of these three categories, recent data regarding the density of these providers with respect to the resident population are reported. These data are provided for the twenty-seven OECD countries analyzed in this book. A particular focus is reserved for the mechanism through which hospital facilities and physicians are remunerated.
This short note attempts to shed light on some of the surgical procedures referred to in Martial's epigram 10.56 by consulting pertinent Graeco-Roman medical texts. A fuller understanding of one such intervention (treatment of infected/inflamed uvula) supports Martial's text as transmitted.