1/11. Death in the home: the doctor's responsibility.The role physicians assume when patients die at home is nebulous and ill defined. Beyond the traditional function of providing comfort and condolence to family members, the physician's duties are directed toward how our society deals with the bureaucratic and legal aspects of death. statistics are maintained regarding the numbers of deaths in municipalities and states and the causes of death, and those numbers are used by individuals and organizations for a multitude of legal, medical, and political purposes. The state also has an obvious interest in uncovering and prosecuting crime. The physician has a vital part to play in providing essential medical information for those record-keeping, statistical, and legal purposes. physicians need to be mindful of the important functions being served when they are asked to complete death certificates and to report cases and provide information to the medical examiner. As with many other physician activities, the information we provide about our patients' deaths serves a singular societal need; thus, we should view that function not as a burden but as a vital aspect of the enriching and enobling work that is uniquely ours.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. adolescent grief: "It never really hit me...until it actually happened".In the united states, more than 2 million children and adolescents (3.4%) younger than 18 years have experienced the death of a parent. When death can be anticipated, as with a terminal illness, and even when the death is sudden, as in the September 11, 2001, attacks on the World Trade Center and Pentagon, physicians and other health care professionals have an opportunity to ameliorate the impact of the loss. Developmental factors shape adolescents' reactions and responses to the death of a parent. Recent research in childhood and adolescent bereavement shows how health professionals can support the adolescent's coping strategies and prepare the family to facilitate an adolescent's mastery of adaptive tasks posed by the terminal phase of the parent's illness, the death, and its aftermath. Robert, a bereaved 14-year-old, illustrates some of these adaptive challenges.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/11. Caring for an adolescent with a chronic illness.Although early, mid, and late adolescence are transient psychological periods, the teenager must master these three phases to complete the psychological stages and tasks of adolescence. Because chronic disease delays or alters these phases, it becomes imperative for the primary care physician to reassess psychological development periodically for appropriate and intensive counseling. With the advantage of continuous contact with the family and the understanding of the family's structure and interpersonal relationships, the primary care physician may be able to: alleviate struggles for control that may seriously impede care, encourage the teenager to accomplish the psychological tasks of adolescence, both during hospitalization and in follow-up outpatient care visits, promote the adolescent's participation in his or her own health care, and ultimately enhance both the family's and the teenager's adaptation to a chronic illness. Finally, during the terminal phase of an illness, the primary care physician will be able to help the adolescent find meaning in his or her short life, provide the support to help the teenager to disengage from life with dignity, and provide a supportive relationship to the parents and siblings.- - - - - - - - - - ranking = 0.75keywords = physician (Clic here for more details about this article) |
4/11. The psychological treatment of cancer: the patient's confusion of the time for living with the time for dying.It has been shown that it is possible to influence cancer growth by a form of intensive meditation, although it is not yet established whether it can be influenced to the point of cure. In working with these patients it has been observed that the course of the illness has often been influenced by the patient's confusion of the biologically appropriate time for living and the time for dying. Without recourse to any formal psychotherapy, the family physician aware of this reaction may be able to enhance the immune defences and increase the quality of life of such patients.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/11. Functional use of secondary cancer symptomatology.This article presents several case studies which illustrate the way in which a terminal patient's attention may be diverted from the primary disease process, cancer, to secondary somatic symptomatology such as pain and nausea. This phenomenon has important consequences for the patient, family, physician, and the patient's medical treatment. These consequences are discussed in terms of primary gain, tertiary gain, and the "medicalization of existential problems."- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
6/11. Unresolved grief in the family.Unresolved grief after a death in the family may have serious consequences not merely for individuals but for entire families, from grandparents to grandchildren. When the grieving process is abnormal or incomplete, the problem may manifest itself in the physician's office. observation of a family system can reveal the extent of pathology and the nature of the blocks that keep grief alive. Treatment of unresolved grief ranges from a simple statement of the problem to extended therapy. The physician must be aware of this problem in order to manage it; the cases in this article illustrate presentations of unresolved grief in a variety of family members.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/11. When a child dies.The family physician can be of great help to the parents after a child dies. Practical points to keep in mind are: in acute mourning, denial of death is a common response; parental emotional "detachment" from the dead child takes six to 12 months; parents may be motivated to "replace" the child too quickly; parental relationships with the surviving children can be impaired by overprotectiveness, and the physician should be aware of his limitations in this situation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/11. The treatment of unresolved grief following loss of an infant.This article includes a discussion of several factors in the development of unresolved grief and the emergence of a different state of mind, a self-image that is less able to cope with the stress of loss. Emphasis is placed on the issue of previous sensitization to loss stemming from childhood experiences. A case example is presented to illustrate the treatment of unresolved grief and the need to recognize the importance of developmental experiences in the patient's current mode of dealing with the stress of loss. Some suggestions are presented to assist the busy physician in dealing with patients who have experienced infant loss and in deciding when to refer such patients to psychiatrists.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
9/11. When there is no cure: palliative care for the dying patient.Acknowledging that death is a normal and inevitable process is often difficult for both physicians and patients. This article highlights by case example the type of care typically received by the terminally ill in acute care hospitals in the united states. The lack of familiarity with the core concepts of palliative care demonstrated by the medical team in this case reflects the pressing need for death education for health care professionals. We discuss the major principles of palliative care, including breaking bad news, developing a palliative care plan, planning for death, and withdrawal of artificial nutrition and hydration.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
10/11. family-centered care and the anticipated death of a newborn.Providing support for a family whose infant is expected to die requires planning and coordinated intervention by members of the health care team. From diagnosis until the death of the infant, the family's choices and needs must be integrated into an acceptable plan of care. The role of the health care team in this process includes four principal phases: planning for the baby's birth, preparing the siblings, caring for the baby, and supporting the family both at the time of the death and afterward. Specific strategies used by physicians, nurses, and child life specialists can encourage the family's full participation in the birth and death of the infant. A description of one family's experiences highlights implications for family-centered practice.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
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