A penetrating and personal look at a major problem in our nation's medical schools affecting how doctoring is taught and how medicine is practiced

Doctors are taught how to cure people. But they don’t always know how to care for them. Hardly anyone is happy with American healthcare these days. Patients are getting sicker and going bankrupt from medical bills. Doctors are burning out and making dangerous mistakes. Both parties blame our nation’s outdated and dysfunctional healthcare system. But that’s only part of the problem. In this important and timely book, Dr. Robert Pearl shines a light on the unseen and often toxic culture of medicine. Today’s physicians have a surprising disdain for technology, an unhealthy obsession with status, and an increasingly complicated relationship with their patients. All of this can be traced back to their earliest experiences in medical school, where doctors inherit a set of norms, beliefs, and expectations that shape almost every decision they make, with profound consequences for the rest of us. Uncaring draws an original and revealing portrait of what it’s actually like to be a doctor. It illuminates the complex and intimidating world of medicine for readers, and in the end offers a clear plan to save American healthcare.

In the 21st century, academic medical centers across the United States continue to make scientific breakthroughs, to make improvements in patient care, and to p- vide the most advanced information and guidance in matters affecting public health. The signs of growth are everywhere—in new research buildings, new pa- nerships with industry, new forms of molecular medicine, and new sensitivity to the role of the human spirit in healing. This growth is due in large part to the dedication and productivity of our faculty, who are providing more patient care, more research, more teaching, and more community service than ever before. Today, there are roughly 135,000 physicians, scientists, and other faculty wo- ing at approximately 125 academic medical centers around the country. Increasingly, they are asked to do more with less. Since the 1990s, academic medical centers in the United States have lost the financial margin they once enjoyed, thereby putting new pressures on research, education, and clinical care. Medical school faculty, previously given funded time for teaching and research, are increasingly drafted to bring in clinical revenues to cover their salaries. Dedicated to the missions of research, teaching, and care, our faculty have responded well to these challenges and perform at a very high level. However, we are beginning to see the results of ongoing stress.

The number of women practicing medicine in the United States has grown steadily since the late 1960s, with women now roughly at parity with men among entering medical students. Why did so many women enter American medicine? How are women faring, professionally and personally, once they become physicians? Are women transforming the way medicine is practiced? To answer these questions, The Changing Face of Medicine draws on a wide array of sources, including interviews with women physicians and surveys of medical students and practitioners. The analysis is set in the twin contexts of a rapidly evolving medical system and profound shifts in gender roles in American society. Throughout the book, Ann K. Boulis and Jerry A. Jacobs critically examine common assumptions about women in medicine. For example, they find that women's entry into medicine has less to do with the decline in status of the profession and more to do with changes in women's roles in contemporary society. Women physicians' families are becoming more and more like those of other working women. Still, disparities in terms of specialty, practice ownership, academic rank, and leadership roles endure, and barriers to opportunity persist. Along the way, Boulis and Jacobs address a host of issues, among them dual-physician marriages, specialty choice, time spent with patients, altruism versus materialism, and how physicians combine work and family. Women's presence in American medicine will continue to grow beyond the 50 percent mark, but the authors question whether this change by itself will make American medicine more caring and more patient centered. The future direction of the profession will depend on whether women doctors will lead the effort to chart a new course for health care delivery in the United States.

This text offers a new interpretation of the dramatic changes that occurred in women in medicine over the course of the last seventy years, starting from the 1950s when women physicians were a curiosity to the present day when their presence is accepted and their achievements are broadly acknowledged. In seven chapters arranged by decades, this book examines the seminal events that shaped what has been described as “the changing face of medicine.” Using the lived experiences of women physicians featured as vignettes throughout the narrative, the book traces the effects of the quota system for admissions, second wave feminism and Title IX legislation, the restrictions of the “glass ceiling,” and a cascade of “equity issues” in career advancement and salary to offer a new account of the roles women played in shaping the standards and the contributing to progress in the field of medicine. Women faced gender specific challenges to enter, train and practice medicine that did not abate as they strove to balance work and family. As the book shows, such challenges and the attendant institutional responses offered by medical schools and government rulings shaped how women “do” medicine differently. Women and the Practice of Medicine offers a unique interpretation of this history and accounts for the changes in social norms as well as in women’s perspectives that have made them an invaluable “new normal” in the contemporary world of medicine. This book fills a gap in the more recent history of women in medicine, much of which is written by academic historians or sociologists; this book contributes a clinician’s “on the ground” point of view. It includes a researched, structured historical narrative spanning the last 70 years, but it seeks to frame this narrative with the personal stories and accomplishments of women physicians who lived through the time in question. The book also provides an overview of how much has changed in the practice of medicine as well as a reminder of what has not changed and what needs to further evolve for women to be equitable partners in medicine as well as other professional disciplines. The book concludes with two appendices containing a questionnaire used in interviews of 40 women conducted at the start of the book project, and a summary of the qualitative findings from the semi-structured interviews.

A thoroughly revised and updated fourth edition of a text that has become an international standard for curriculum development in health professional education. Intended for faculty and other content experts who have an interest or responsibility as educators in their discipline, Curriculum Development for Medical Education has extended its vision to better serve a diverse professional and international audience. Building on the time-honored, practical, and user-friendly approach of the six-step model of curriculum development, this edition is richly detailed, with numerous examples of innovations that challenge traditional teaching models. In addition, the fourth edition presents • updates in our understanding of how humans learn; • a new chapter on curricula that address community needs and health equity; and • an increased emphasis throughout on health systems science, population health, equity, educational technology in health professions education, and interprofessional education. This new edition remains a cutting-edge tool and practical guidebook for faculty members and administrators responsible for the educational experiences of health professional students, residents, fellows, and practitioners. It includes chapters on each of the steps of curriculum development, with updated examples and questions to guide the application of the timeless principles. Subsequent chapters cover curriculum maintenance and enhancement, dissemination, and curriculum development for larger programs. Appendixes present examples of full curricula designed using the six-step approach, which is widely recognized as the current standard for publication and dissemination of new curricula and provides a basis for meaningful educational interventions, scholarship, and career advancement for the health professional educator. The book also provides curricular, faculty development, and funding resources. Contributors: Chadia N. Abras, Belinda Y. Chen, Heidi L. Gullett, Mark T. Hughes, David E. Kern, Brenessa M. Lindeman, Pamela A. Lipsett, Mary L. O'Connor Leppert, Amit K. Pahwa, Deanna Saylor, Mamta K. Singh, Sean A. Tackett, Patricia A. Thomas

This book engages topical and problematic issues regarding the impacts of cultural change on traditional healing beliefs and practices in both developing and developed nations. It describes issues ranging from the attrition of cultural heritage knowledge, or traditional knowledge (TK), to the implications of unconventional modern and traditional healing in various guises encountered during projects that entailed research fieldwork in communities of Australia, Africa and within institutions of mainstream healthcare in the United States. Furthermore, it explores philosophical aspects of contemporary complementary medicine practices. This book has pertinence for many practitioners and consumers of traditional non-medical forms of health practices, and relevance for the theoretical body of understanding related to these diverse fields. In particular, the individual chapters describe topics important to indigenous persons, people living in rural areas, those with mental illnesses, practitioners of Chinese medicine and massage therapy, practitioners and consumers of traditional Western herbal medicine, social theorists interested in unconventional health domains, and US veterans seeking adjunctive wellbeing care and advice alongside medical treatment, It also provides a chapter with information dedicated to their medical and complementary wellbeing providers. In the contemporary context, for Western countries such as US, UK and Australia, non-biomedical treatments are generally grouped together under the common term Complementary and Alternative Medicine (CAM), or more recently Complementary and Integrative Healthcare (CIH). In developing countries such as Africa, and in relation to indigenous healing (for instance, in many communities in remote Australia where there is a concentrated population of Aboriginal and Torres Strait Islander people), heritage healing practices and unconventional approaches to healthcare, including spiritually-focused and specific cultural approaches to managing diseases, may instead be termed traditional healing. Much health research today is geared towards securing quantitative outcomes that fortify the significant gains advanced by biomedicine in treating disease. However, the global spread of biomedical practices and ways of conceptualising health unfortunately follows in the footsteps of centuries of Western social and economic global colonisation, and thereby represents a current ongoing process of deep colonisation. The cultural shift brought about by this process has wrought deep and lasting changes in the body of heritage practices and beliefs that belong to culturally-situated healing traditions, and in the retention of TK associated with such healing. This book presents several chapters of anthropological and qualitative research, which contribute to literature describing this process of cultural change and its impacts. It offers suggestions and commentary regarding the value of CAM and traditional healing to: 1) Promote wellbeing; 2) preserve traditional knowledge and medicinal plant species; 3) address specific health problems and the needs of population groups; and 4) extend a willingness to accept and incorporate essential CAM healthcare services, holistic beliefs and new understandings of well-being, alongside Western biomedicine.