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It is unethical for residents to practice catheterization on patients who are receiving CPR. In a survey of 234 medical residents, 34% believed it was appropriate to practice catheterization on a patient receiving CPR. Sixteen percent had done this themselves. Some believed the patient was already dead or that future patients would benefit from their practice. However, the patient by definition did not consent to this procedure and would not benefit from it. This violates informed consent and the principle of giving patients treatments that will benefit them.

Federally Qualified Health Centers (FQHCs) provide primary care to older adults, yet most FQHC providers do not have formal training in geriatrics. A geriatric educational program for interprofessional health care providers was established at a community health center called Fair Haven Community Health Care (FHCHC). Providers' self-reported confidence in caring for older adults, and access to and satisfaction with professional development at the workplace were surveyed after 14 sessions. Thirty-two of 48 participants (67%) completed the survey. FHCHC health care providers had high baseline confidence in caring for older adults and demonstrated a trend towards increased confidence after 14 sessions. Participants' access to and satisfaction with professional development at the workplace increased significantly from 65% vs 96%, (P = 0.005) and 62% vs 96%, (P = 0.003), respectively. Establishment of an onsite geriatric education program improved FHCHC health care providers access to, and satisfaction with, professional development at the workplace. [ABSTRACT FROM AUTHOR]

The article presents the second part of a two-part series which discusses the diagnosis and management of major depression in primary care. It focuses on the initial treatment options for patients with depression and discusses the common side effects of medications, monitoring of response, complications of abruptly stopping medications, and signs of serotonin toxicity. The antidepressant options if a patient does not respond to an initial selective serotonin receptor inhibitor are tackled.

The article discusses the screening, diagnosis and management of major depression in primary care. There is a need to evaluate patients with multiple somatic complaints for medical conditions, substance abuse and certain stressors that could influence their symptoms. Beck Depression Inventory and Quick Diagnostic Interview Schedule are examples of tools for depression screening. Symptoms associated with depression are feeling sad, sleep disturbance, fatigue and change in appetite or weight.

The article offers a discussion on a survey concerning the necessity of reporting medical errors for the improvement of the patients' safety. It is noted that the although the data collection on medical errors is significant, the factors which affect the error reporting by physicians are poorly understood. In line with this an investigation on the reporting of actual errors was conducted through a survey of resident physicians and faculty has been conducted in the midwest, mid-Atlantic, as well as in the northeast region of the United States. The result shows that the participants are inclined to report the hypothetical causes of errors, but only few actually had reported an error.

BACKGROUND: Disclosing errors to patients is an important part of patient care, but the prevalence of disclosure, and factors affecting it. are poorly understood. OBJECTIVE: To survey physicians and trainees about their practices and attitudes regarding error disclosure to patients. DESIGN AND PARTICIPANTS: Survey of faculty physicians, resident physicians, and medical students in Midwest, Mid-Atlantic, and Northeast regions of the United States. MEASUREMENTS: Actual error disclosure; hypothetical error disclosure; attitudes toward disclosure; demographic factors. RESULTS: Responses were received from 538 participants (response rate=77%). Almost all faculty and residents responded that they would disclose a hypothetical error resulting in minor (97%) or major (93%) harm to a patient. However, only 41% of faculty and residents had disclosed an actual minor error (resulting in prolonged treatment or discomfort), and only 5% had disclosed an actual major error (resulting in disability or death). Moreover, 19% acknowledged not disclosing an actual minor error and 4% acknowledged not disclosing an actual major error. Experience with malpractice litigation was not associated with less actual or hypothetical error disclosure. Faculty were more likely than residents and students to disclose a hypothetical error and less concerned about possible negative consequences of disclosure. Several attitudes were associated with greater likelihood of hypothetical disclosure, including the belief that disclosure is right even if it comes at a significant personal cost. CONCLUSIONS: There appears to be a gap between physicians' attitudes and practices regarding error disclosure, Willingness to disclose errors was associated with higher training level and a variety of patient-centered attitudes, and it was not lessened by previous exposure to malpractice litigation. [ABSTRACT FROM AUTHOR]

The article discusses the medical interview that remains the cornerstone of patient care for obtaining history, building relationship and educating patients. It states that patient-centered approach improves physician satisfaction in enhancing the relationship with their patients. Re-focusing on patient-centered medical interview helps to begin with social history followed by family history, medication and allergies.

The history and physical examination skills are being replaced by the tools of technology in establishing the actual cause of illness. We present a patient where the history and physical examination were essential in establishing the diagnosis. A 28-year-old female presented to the Emergency Department (ED) with an acute episode of epigastric pain radiating to the back associated with vomiting. Laboratory examinations revealed pancreatitis, imaging showed gallstones and the patient was admitted with the diagnosis of gallstone pancreatitis. A more detailed history and physical examination, however, was notable for a family history of "Mediterranean blood" and abdominal examination demonstrated splenomegaly and laboratory examination showed a microcytic anemia. The recognition of the family history, splenomegaly and microcytic anemia led to the diagnosis of thalassemia as the cause of the gallstone pancreatitis. clearly, the history was essential in establishing the underlying cause of the problem. [ABSTRACT FROM AUTHOR]

Creutzfeldt-Jakob Disease (CJD) is a fatal neurologic disorder caused by an infectious agent called a human prion protein. CJD can be classified as sporadic CJD, familial CJD, variant CJD, and iatrogenic CJD. We report a 64-year-old man diagnosed with CJD three months after cataract surgery. Although sporadic CJD is the most common type, the patient's cataract surgery elicited the possibility of an iatrogenic transmission. It is important to consider whether visual symptoms are a manifestation of sporadic CJD, rather than cataract surgery resulting in iatrogenic CJD. Preceding cataract surgeries have been reported with CJD, but there is no proven causality. This case highlights consideration of sporadic versus iatrogenic cause when seen in association with cataract surgery.