Clinician Resources and Training

Despite the multiple patient factors that hinder effective decision making, clinicians may still be the greatest obstacle to involving patients in their healthcare decisions. Although clinicians rarely withhold cancer diagnoses from patients anymore, they still often fail to give patients enough information to be fully involved in their healthcare decisions. Analyzing audiotapes of visits between clinicians and patients, researchers have found that physicians rarely give patients thorough and comprehensible information about their treatment alternatives.52 In addition, clinicians often do a poor job of giving patients an opportunity to express their concerns, interrupting them frequently throughout the visits, and not giving them a chance to ask questions.

Physicians' poor communication results partly from remnants of paternalism. Many physicians still believe that healthcare decisions are primarily theirs to make. Neverthe less, even those physicians who reject this view often have difficulty communicating to patients. Most physicians do not receive extensive training on how to communicate effectively with patients.53 Medical school curricula are still dominated by the basic sciences. Also, clinical teaching, although emphasizing the importance of conducting thorough histories and physical examinations, rarely uses the latest advances in the communication sciences. This is unfortunate, because communication skills can be taught, and medical schools that have integrated communication skills into their curricula have found that their medical students are better communicators.54

In addition, clinicians face time pressures and fiscal constraints that reduce their incentive to discuss issues at length with their patients. Perhaps more importantly, clinicians recognize that patients are not always emotionally or intellectually prepared to absorb a great deal of information about their healthcare alternatives. Consequently, clinicians may feel that it is a waste of time and money to embark on lengthy discussions of treatment alternatives with their patients.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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