Appendix: Medical Epidemiology and Biostatistics

Introduction Medical epidemiology is the study of the factors affecting the occurrence and distribution of diseases in human populations. The basic measures in epidemiology are rates (e.g., incidence rates and prevalence rates) and measures of risk (e.g., relative risk, attributable risk, and odds risk ratio). Biostatistics summarizes and evaluates data obtained from epidemiologic and other […]

Chapter 27: Systems of Health Care Delivery

Introduction The United States has the most advanced medical technology and the most highly trained physicians in the world. However, when compared to people in many other developed countries, Americans have shorter life expectancies (Table 27-1) and a greater probability of dying in infancy (Fig. 27-1). The explanation for this counterintuitive concurrence lies to some […]

Chapter 26: Ethical and Legal Issues in Medicine

Introduction According to the Code of Medical Ethics of the American Medical Association (2008 to 2009), ethical conduct for physicians is a standard based on moral principles or practices and matters of social policy involving moral issues. In contrast, legal conduct is behavior that conforms to written law and to the regulations that interpret and […]

Chapter 25: Psychosomatic Medicine

Introduction Everyone knows or has heard of somebody who became medically ill after a stressful experience. The medical student who always seems to have a cold during exam week, or the elderly man who, 6 months after the death of his wife, is diagnosed with a rapidly metastasizing cancer, are familiar situations. Although these examples […]

Chapter 24: Doctor–Patient Communication

Introduction Professionals often must establish relationships with and elicit personal information from their clients. The latter may be uncomfortable for the client for at least two reasons. First, the professional is essentially a stranger to the client. Second, in some professions, such as accounting and law, clients must reveal sensitive information to the professional. Doctors […]

Chapter 23: Substance-Related Disorders

Introduction Substance-related disorders are an increasing public health concern in the United States. In 2009, of the population aged 12 or older, about 9% reported current use of illicit drugs and 52% reported current use of alcohol. Because these figures were obtained from self-reports, the actual number of American substance users is likely to be […]

Chapter 22: Violence, Impulse Control and Related Disorders, and Abuse

Introduction The attempted assassination of a U.S. Congresswoman in Arizona in 2011 in which six people including a 9-year-old child were killed, the murders of 32 people at Virginia Tech in 2007 by a mentally ill student, and the catastrophic events of September 11, 2001, have led to increased public understanding that all citizens are […]

Chapter 21: Human Sexuality

Introduction Sexual and relationship problems can hamper recovery from illness and impair quality of life. Although people who have sexual concerns are commonly counseled to consult their family doctors, many physicians are not particularly knowledgeable or at ease addressing these issues. In order to develop competence in dealing with the sexual issues of patients, doctors […]

Chapter 20: Culture and Illness

Introduction A Chinese-American patient who has chronic heart disease is more likely to die on the fourth than on any other day of the month. This puzzling observation, called “The Hound of the Baskervilles Effect” because of a similar occurrence in the classic Sir Arthur Conan Doyle novel, is attributed to the stress provoked by […]

Chapter 19: Biological Therapies

Introduction Until the late 1940s, patients with serious psychiatric illnesses had few treatment options. They might have received insulin shock therapy, electroconvulsive therapy (ECT) (without anesthesia), or barbiturate or narcotic sedation. They almost certainly were confined for the duration of their illness to a secure institution where they may have been kept in physical restraints. […]