Physicians patients’ response

It is the physician s responsibility to inform the patient of the risk of immunization and to use vaccines and antisera in an appropriate manner. This may require skin testing to assess the risk of an untoward reaction. Some of the risks previously described are, however, currently unavoidable on the balance, the patient and society are clearly better off accepting the risks for routinely administered immunogens (eg, influenza and tetanus vaccines). 

Ultimately, the physician is responsible for the care of the patient and at anytime can discontinue the patient s involvement in the program. 

The effect of this reversal of the trend toward individualization is likely to increase burdens on the clinical trial process and on the submissions of NDAs and ANDAs. If customization is not practical through physician-patient trial and error experimentation, the submission of clinical data that defines effects and side effects specific to interactive medical conditions, ethnicity, gender, age, and genetic characteristics becomes all the more important. Unless a developer is willing to settle for a high-restricted label, significantly expanded and targeted clinical trials are the most likely response to the need for customized medication. 

Alternative medicine includes (but is not limited to) the following herbal medicine, homeopathy, aromatherapy, chiropractic, osteopathy, acupuncture, acupressure, yoga, tai chi, meditation, music or art therapy, shamanism, and faith healing. In this chapter our focus is on herbal medicine. The increased use of herbal medicine outside of the traditional physician-patient paradigm represents a search for other sources of health as well as an expression of assuming greater responsibility for our own health maintenance. In one sense, it is a return to an earlier period. The shift from traditional medicine to modern medicine can be traced to the Flexner Report of 1910. 

There are very real differences between the medical cultures of mental health and primary care. As mentioned in the previous chapter, physicians are nnder severe time constraints, which should be respected. For example, telephone conversations with physicians rarely last longer than 5 minntes withont interfering with the physician s responsibilities for patient care. A physician may appreciate a two- or three-sentence note or e-mail, providing a brief update on a patient, rather than having to find time to retnrn a phone call. 

As mentioned previously, some infectious diseases pharmacists have established effective clinical practices in the outpatient setting. The most common example of this is the presence of a pharmacist in an HIV clinic. The myriad of antimicrobial drug interactions and adverse effects associated with antiretroviral therapy, the need to periodically assess antiretroviral efficacy, and the considerable potential for noncompliance literally necessitate the need for a pharmacist in any established HIV clinic. Infectious diseases pharmacists work with infectious diseases and/or immunology physicians. Pharmacists conduct medication histories and answer drug information questions. In some settings, they may act under protocol to assess patient response to antiretroviral therapy based on virologic and immunologic measures, and to make appropriate modifications in therapy. 

The physicians most responsible for classifying witches as mental patients were the celebrated French psychiatrists Pinel, Esquirol, and Charcot. They were the founders not only of the French school of psychiatry but of all of modern psychiatry as a positivisdc-medical discipline. Their views dominated nineteenth-century medicine. 

In Germany and Italy, about 15% of RlCUs are located inside rehabilitation centers (12,16,17). Specialist physicians are responsible for medical care, with a physician/patient ratio of about 1 8 (9,13,14). 

If the nurse is responsible for administering the medication by nebulization, it is important to place the patient in a location where he can sit comfortably for 10 to 15 minutes. The compressor is plugged in and the medication mixed as directed, or the prepared unit dose vial is emptied into the nebulizer. Different types of medication are not mixed without checking with the physician or the pharmacist. The mask or mouthpiece is assembled and the tubing connected to the compressor. The patient is placed in a comfortable, upright position with the mask over the nose and mouth. The mask must fit properly so that the mist does not flow up into the eyes. If using a mouthpiece instead of a mask, have the patient place the mouthpiece into the mouth. The compressor is turned on and the patient instructed to take slow, deep breaths. If possible, the patient should hold his breath for 10 seconds before slowly exhaling. The treatment is continued until the medication chamber is empty. After treatment, the mask is washed with hot, soapy water, rinsed well, and allowed to air dry. 

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