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1.
Ann Fam Med ; 18(1): 80-82, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31937537

RESUMO

In a previous story ("On Blindness and Blind Spots")1 I sought to understand the psychological causes of a long-time patient's myriad of seemingly inexplicable symptoms. Since then, I learned more of her story, which helped me understand my patient with a new perspective.Dana shared with me, and now with the readers, short poetic pieces she has written to describe her traumatic experiences as a child-and the efforts she makes as a grown woman to heal, like the phoenix rises from its ashes. The value of belief in one's patient, alongside patience and the opportunity to build a trusting relationship over many years-as the truth has a pace of its own-are underscored.

2.
Harefuah ; 158(10): 664-668, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576714

RESUMO

INTRODUCTION: Professional burnout of physicians is common and culminates in the residency period. Burnout affects the doctor's health and quality of life, and it is associated with worse patient outcomes and an increase in the incidence of medical errors. The Israeli Ministry of Health recently conducted a survey on the burnout of health professionals in Israel and showed the extent of the phenomena, calling on health organizations to provide actions in order to reduce or prevent it. In the Department of Family Medicine at Ben-Gurion University of the Negev, there is a four-year course for family medicine residents in which we teach various clinical and psychosocial topics essential for the family medicine profession. As part of this course, we set up a program to prevent burnout. Four "mini-courses" were chosen and integrated into the course curriculum for family medicine residents: "Healers' art™", "meaning in medicine ", narrative medicine and reflective writing, mindfulness, meditation and relaxation techniques. In addition, the Balint groups continued to exist during the 3rd and 4th year of residence. Health institutions and organizations are committed, as part of the interventions to improve medical quality and patient safety, to detect and monitor the burnout of doctors and to offer changes in the work environment and interventions to prevent burnout. Although it is difficult to examine the long-term effects of these courses, the residents were very satisfied with the burnout prevention courses. There is a need to step up interventions and build a research and follow-up program to assess the short and long-term outcomes of these experiences on the physicians' well-being and patients' safety.


Assuntos
Esgotamento Profissional , Medicina de Família e Comunidade , Internato e Residência , Esgotamento Psicológico , Humanos , Israel , Qualidade de Vida
3.
Fam Syst Health ; 37(2): 176-178, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045386

RESUMO

This narrative traces the development of a relationship between a family physician and a challenging patient who undergoes a cerebro-vascular accident following severe eclampsia. The story describes the patient's complicated relations with her husband, her community, the medical system, and the newborn whom she unconsciously blames for her situation. The slow painful process of developing trust in the therapeutic relationship over nearly 2 decades enables the patient to eventually reflect on herself and consider forgiveness. All identifying information regarding the case was changed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Relações Familiares/psicologia , Síndrome HELLP/psicologia , Adulto , Feminino , Síndrome HELLP/reabilitação , Humanos , Relações Mãe-Filho , Relações Médico-Paciente , Gravidez , Atenção Primária à Saúde/métodos
5.
Ann Fam Med ; 16(4): 364-366, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29987089

RESUMO

This story is a reflection on the evolving relationship of a family physician with a patient suffering from a severe conversion disorder, expressed inter alia through "blindness." The narrative follows our journey as I attempt to unravel the meaning of the symptoms as a metaphoric expression of her agony. Eventually, I conclude that clinicians at times also may have a "blind spot" that prevents us from entirely grasping patients' complex inner struggles.


Assuntos
Cegueira/psicologia , Relações Médico-Paciente , Humanos
6.
Fam Syst Health ; 35(3): 382-384, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28945450

RESUMO

This personal narrative presents the imagined inner dialogue of my father, when caring for me as a young sickly child. It is a compassionate exercise in attempting to understand the remote inner emotional world of my father, a Holocaust survivor, as he contended with my ongoing medical challenges that perhaps triggered his traumatic memories from the war. I am the daughter who eventually grew up to be a physician herself. (PsycINFO Database Record


Assuntos
Cuidadores/psicologia , Doença Crônica/terapia , Pai/psicologia , Holocausto/psicologia , Humanos , Judaísmo/psicologia , Núcleo Familiar/psicologia
7.
Patient Educ Couns ; 100(8): 1619-1620, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28209471

RESUMO

This story is a reflection on the concept of friendship and forgiveness, on belief in change and the difficulty in letting go. It is presented through the story of two elderly patients, sisters-in-law, next-door neighbors and friends, treated by the same family physician. A trivial argument causes a rift between the two, severing a 60-year friendship. Five years later, as one lays dying in her home, the physician, accompanied by her nurse, attempts to reconcile between the two. The article includes the physician's reflections on this process, her role as a "multi-system" physician in these patient's lives and its impact on her work.


Assuntos
Atitude Frente a Morte , Amigos , Cuidados Paliativos , Relações Médico-Paciente , Médicos/psicologia , Assistência Terminal , Idoso , Feminino , Humanos
8.
Ann Fam Med ; 14(5): 475-7, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27621166

RESUMO

A young woman in my care had 4 siblings diagnosed with mental illness. The story describes how, along normative family-cycle situations, she struggles to define and keep her sanity. I reflect on the shared anxiety of both the doctor and the patient of her losing her mind. As a family physician practicing in a small rural community, I believe that psychiatric, social, and family issues are also family medicine concerns.


Assuntos
Atitude do Pessoal de Saúde , Médicos de Família , Apoio Social , Ansiedade , Saúde da Família , Feminino , Humanos , Transtornos Mentais/psicologia , Relações Médico-Paciente , População Rural , Irmãos/psicologia
9.
Ann Fam Med ; 13(6): 587-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26553899

RESUMO

My fellow physician and friend died from a rare type of cancer. She was a model for me in many respects. She showed me how to cope with a chronic disease together with a demanding professional life, yet she left me without any comfort or guidelines on how to contend with a terminal disease. This story is a reflection on my frustration and disappointment with my friend's final choices that prevented us from processing our feelings and sharing our deepest thoughts. The story includes reflections and insights about our ability to understand and accept the preferences of patients and others close to us.


Assuntos
Atitude Frente a Morte , Doença Crônica/psicologia , Humanos
10.
Ann Fam Med ; 12(5): 475-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25201743

RESUMO

It finally happened to me: I was sued for malpractice by the family of a patient who had died suddenly. My inner turmoil in the aftermath of this traumatic event affected me deeply. While I was an experienced family doctor dedicated to patient-centered medicine, the event challenged my customary approach to my patients. I share three vignettes from my practice that describe my inner dialogue both "preprosecution" and "postprosecution" and explain how I acted in each case.


Assuntos
Morte Súbita , Medicina de Família e Comunidade/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Adulto , Anedotas como Assunto , Atitude do Pessoal de Saúde , Medicina de Família e Comunidade/ética , Humanos , Israel , Responsabilidade Legal , Masculino , Relações Médico-Paciente/ética
11.
Ann Fam Med ; 11(5): 477-80, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24019281

RESUMO

Recently, at the health maintenance organization (HMO) where I work, they introduced an employee time clock. As in many other workplaces, doctors across the country are now obligated to punch the clock at the beginning and end of their workday. This is the final act in an ongoing attempt to enhance management of doctors' schedules: limit nonurgent appointments to 10 minutes, define planned or urgent home visits, and control a physician's time, as well as managerial and clinical decisions. In this story I describe a day in the life of a family doctor, a salaried employee at a large HMO where there is now a time clock. I provide details on how the introduction of the clock influences small everyday clinical decisions that potentially affect the quality and depth of treatment while sharing the internal dialogue that accompanies me as I reaffirm my professional integrity again and again with each hastened visit. I also bring the internal dialogue of 2 of my patients, to illustrate the emotional world on the other side of these 10-minute interventions.


Assuntos
Agendamento de Consultas , Medicina de Família e Comunidade/organização & administração , Sistemas Pré-Pagos de Saúde/organização & administração , Adulto , Idoso , Feminino , Humanos , Masculino , Admissão e Escalonamento de Pessoal , Relações Médico-Paciente , Fatores de Tempo
12.
Patient Educ Couns ; 89(2): 219-20, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22878026

RESUMO

The essay describes an elderly Holocaust survivor, who re-experiences the horrors of the Holocaust through his senile hallucinations. Although he is demented, telling and re-telling the story to a therapist helps him regain a sense of control and feel less frightened. He is finally able to revise the nightmarish story into a narrative that enables him to find strength and meaning.


Assuntos
Holocausto/psicologia , Sobreviventes/psicologia , Demência/psicologia , Demência/terapia , Humanos , Narração , Terapia Narrativa , Relações Médico-Paciente
13.
Patient Educ Couns ; 87(2): 133-4, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21943791

RESUMO

This is my memoir as a sick child, hospitalized in the Pediatric ward of a large hospital, many years ago. The story tells about my friendship with another young patient, Jum'ah, a Bedouin child who suffered from Congenital Cyanotic Heart Disease, to whom the pediatric ward was Home. My Childish understanding of Jum'ah's loneliness, anxiety and struggle to be loved and belonged are described in this narrative. I describe how this experience still has an influence on my adult professional and personal concepts.


Assuntos
Ansiedade de Separação , Cardiopatias Congênitas , Solidão , Ansiedade de Separação/psicologia , Criança , Cianose , Feminino , Cardiopatias Congênitas/terapia , Humanos , Amor , Masculino , Narração , Relações Pais-Filho , Síndrome
15.
Patient Educ Couns ; 78(2): 141-2, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19616400

RESUMO

Tsunami is a fictionalized, based on the true story of a mother and baby patients who attended my rural clinic for 12 months and disappeared. (All personal identifiers have been removed.) It is a story of a family physician trying to establish trust relationship with a young mother, that her past history and living conditions make it almost impossible for her to raise a baby. The narrative describes the struggle of the clinic staff to help the mother to keep a safe and healthy environment for her baby, and their failure to maintain open communication and support for the young mother, until the inevitable end.


Assuntos
Comunicação , Relações Médico-Paciente , Período Pós-Parto , Medicina de Família e Comunidade , Feminino , Humanos , Lactente , Gravidez , Confiança
16.
Patient Educ Couns ; 80(2): 260-1, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19948389

RESUMO

This is the narratives of a family physician and a teacher of Medical Ethics, who herself suffers from Gaucher's disease. She was asked by a colleague to give an advice to a couple trying to decide whether to terminate a pregnancy of a fetus "like her". The ethical, emotional and communicational challenges of the conversation are described in this essay.


Assuntos
Doença de Gaucher/diagnóstico , Aconselhamento Genético , Diagnóstico Pré-Natal , Aborto Induzido/ética , Aborto Induzido/psicologia , Comunicação , Tomada de Decisões/ética , Feminino , Doença de Gaucher/genética , Humanos , Mães , Relações Médico-Paciente , Gravidez
17.
Fam Syst Health ; 27(1): 105-12, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19630450

RESUMO

Munchausen's Syndrome by Proxy is hard to diagnose and treat. The patient harms a defenseless person who is in his care, usually a baby or a child, in order to receive the attention the parent requires. Such a parent makes his child ill, introduces his body to various dangers, and with much concern and sacrifice brings him in for medical treatment, accompanying it all patiently, lovingly and anxiously. All the while, the caregiver is making sure to sabotage the healing and cause further harm. This syndrome is a challenge to family physicians, internists and pediatricians, since only the continuity of care of these families may reveal the dangerous syndrome and prevent its harmful outcomes. In this case report, Sarah, the loving mother of Joy, continuously damages her daughter's health and exposes her to the dangers of sophisticated medical interventions. Only careful inspection by the medical teams, dialogue and co-operation can bring to an end the harmful behavior of Joy's mother.


Assuntos
Síndrome de Munchausen Causada por Terceiro/diagnóstico , Síndrome de Munchausen Causada por Terceiro/psicologia , Criança , Maus-Tratos Infantis , Feminino , Humanos , Mães
20.
Isr Med Assoc J ; 8(5): 347-50, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16805236

RESUMO

The Ashkenazi-Jewish population is at increased risk for several recessively inherited disorders. While some of the disorders have severe or fatal symptom manifestations, others, such as non-neuronopathic Gaucher disease, do not usually pose a serious, life-threatening illness. Many healthcare centers in Israel offer prenatal panel screening. Controversy exists over the inclusion of Gaucher disease in the panel screening, especially since Gaucher disease screening lacks prognostic reliability. Most screening participants do not discriminate between the specific tests in the panel and are unable to discern between severe, life-threatening diseases and those that are less severe and even treatable. By including screening for Gaucher in the panel screening program, there is risk of a "panel effect," leading to termination of a pregnancy positive for Gaucher disease, without sufficient knowledge and understanding of the disease. Increasing medical and public awareness and knowledge of the disease, its prognosis and treatment options may reduce the rate of under-informed abortions associated with prenatal screening for Gaucher disease.


Assuntos
Doença de Gaucher/genética , Testes Genéticos/ética , Judeus/genética , Diagnóstico Pré-Natal/ética , Aborto Eugênico/ética , Feminino , Doença de Gaucher/etnologia , Humanos , Gravidez , Índice de Gravidade de Doença
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