Critical Appraisal Essay Example for Free

Critical Appraisal Essay This exclusive practical session revolves around students attachment to family doctor or general practitioner. Beforehand, a sound understanding and distinguishable comparison between these two specialty is necessary to perform this task efficiently. Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and all parts of the body. It is based on knowledge of the patient in the context of the family and community, emphasizing disease prevention and health promotion. According to the World Organization of Family Doctors, the aim of family medicine is to provide personal, comprehensive and continuing care for the individual in the context of the family and community. On the other hand, general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education to patients. The good general practitioners will treat patients both as people and as a population. In some healthcare systems general practitioners work in primary care healthcare centers where they play a central role in the healthcare team. Nevertheless, in some models of care general practitioners work as single-handed practitioners. In conjunction with this block, I visited a local puskesmas to understand more about role of a general practitioner and family physician. Physical Access , Convenience and Facilities The clinic I was designated to is Puskesmas Danurejan I. The puskesmas is located in Bausasran, Danurejan in Yogyakarta. After being renovated and improvised since December 2011, Puskesmas Danurejan possesses new physical structure and more sophisticated facilities. Now, the puskesmas has a new building, whereas the ground floor serves as an infectious and non-infectious area. The puskesmas is almost 656 meter squared in size with general consultation rooms, dental consultation rooms, emergency room, pharmacy and laboratory fitted in the ground floor. On the other hand, the first floor serves as the supporting facility . This floor contains the office, hygiene and sanitation department and prayer room. This health center is located in the midst of housing estates, and therefore very accessible to those living within close proximity. The housing area is also densely populated, with numerous shops, public amenities which makes it a rather ideal and conducive stay. The puskesmas is open daily on weekdays and Saturdays from 7. 30am to 3. 00pm. The puskesmas also has a landline which makes it reachable for any prior information before the peoples visit. One distinct setback of the setting is that of, the signboard was unclear and hidden in tree branches. The direction guiding the visitors are vague and not specified. This may be inconvenient for anyone who is about to make their very first visit without prominently knowing the location. Furthermore, there were not enough parking lots near the puskesmas. The Waiting Room The waiting room is spacious, sufficient to fit about 20 patients at an instance with appropriate number of chairs provided. The cleanliness and tidiness of the waiting room is also well maintained . There were garbage bins provided. The ventilation of the room is also well considered as there are presence windows for good air movement. Huge healthcare pamphlets and banners are also seen in the waiting room, aimed educate and enlighten patients. A staff was bserved in the waiting area as she is assigned to take vital signs of the patients and direct them to the physician as their turn comes. As we were walking pass the waiting room, I noticed surreptitious gazes from the patients who were rather clueless of our enthusiastic presence with white coats. I managed to start a conversation with a few patients even before tending to the consultation room for observation. Patient Load and Examination Room The patients who visit this puskesmas are mostly from the community living within close proximity to the center. Apparently, the densely populated housing estate are attracted to the recently renovated health center. The health center receives a generous average of 40 patients daily, most probably due to the satisfactory health care received and affordable charges. The examination room is rather small but sufficient to carry out basic physical examination, equipped with racks, table for physician and an examination bed. During my observation period, the physician received 5 patients. in which 3 of them were regular patients under controlled medications (hypertension and diabetes mellitus patients), with the other 2 having ordinary fever and viral flu. According to the doctor, most of his patients are children with acute illnesses and elderly patients facing chronic diseases. However, any serious medical complication which cannot be diagnosed or treated by the doctor is referred to the possible hospital. Physician-Patient Communication Based on my observation, the physician seemed to have mastered all crucial skills in order to provide the best for the patient. Firstly, I would like to discuss about the primary care management of the physician towards the patient. The doctor successfully connects with the patient via good communication and interpersonal skills, and subsequently put the patient at ease to express his complaints and condition. Therefore, the physician is able do deal competently with the problems presented to her. Even though the physician I observed has just completed internship, she has an amazing person centered care towards each of her patient. She understands and relates her patients as individuals and developed the ability to work in partnership. The physician encountered various different cases involving different ranging from a myriad of genders, age group and illness. However, she applies specific problem-solving skills about the context-specific aspects of general practice and successfully dealt with undifferentiated illness and skills. The duration of consultancy was about 10 minutes per patient for chronic diseases like hypertension and diabetes mellitus and the interaction process took about 5 minutes. Shortly after my observation, I managed to have a word with the physician. She explained to me that the key to a good family physician is the comprehensive approach. It is about how one as a physician must be able to co-ordinate care of acute illness, chronic illness, health promotion and disease prevention in the general practice setting. Not to forget, to respect and honor the patients for an impeccable physician-patient communication. Besides she emphasized the importance to keep patients informed about their condition, listen and respect their views about their health and respond to their question. Documentation and Medical Records The medical records are stored very systematically in the center. There is an allocated room with limited accessibility to keep all of the documents safely in order to avoid breach of confidentiality of the documents. Only the administration personnel are permitted to enter. As we were informed, the documents of the medical record has been computerized using a programme called MedCis System. However, the manual means are still practiced in the physicians desk. The information is then transferred by the administration personnel. The medical record on the hysicians desk is a piece of white-colored paper with patient identity particulars such as name, age, gender, registration number, and consultation date at the top. The remainder of the page is filled up by writing by the doctor himself, which are anamnesis, medical history, drug allergies, vital sign results, physical examination results, diagnosis, treatment and prescription. By the implementation of the computerized system, loss of data due to natural disaster is prevented. Besides, the patients privacy and confidentially is recognised as the system is well secured, in the sense no changes of previous medical history is made possible. The system can only be viewed by physicians for follow-ups and patient himself upon request. Clinical Care Processes The overall process of treatment is very structured indeed. It begins with registration and recording of vital signs. Later, the patients are directed accordingly to the appropriate departments namely psychology, nutrition, general consultation and dental consultation. After receiving their treatment, they were to settle payments before collecting their prescription from the pharmacy. As per clinical care specifically, the physician has performed necessary procedures to diagnose and treat the patient. The physician accomplishes her role as a family physician very successfully. Her anamnesis was very detailed and intricate. She thoroughly skims the past medical history, medication history, and latest prescription before she proceeds further. Concerning chronic diseases of the elderly like hypertension, she initiated by asking the patient how did they feel lately and if there were any relieve or aggravation from their condition. As the temperature, height, weight, blood pressure, respiratory rate and pulse rate has been obtained earlier from the registration personnel, she proceeds with treatment and prescription. The physician prescribes simple generic medicine for the patient which was available in the pharmacy. As for the child, she performed basic physical examination as he complained of body ache. I also observed that treating an elderly person and a child requires different approach altogether. Obviously, they had to be nurtured with care and respect. The physician was seen to have given importance to personal safety by the usage of gloves, masks, and hand sanitizer. This is an undisputedly important step to prevent nosocomial infections in the health center. One setback that I observed was in terms of educating the patients. The physician only provided the patients with very minimal input and education. Payment There are several paying methods made feasible by the puskesmas to facilitate the patients, namely insurance coverage and direct payment. For instance, Jaminan Kesihatan Masyarakat, Jaminan Kesihatan Daerah, Jaminan Kesihatan Social, Jaminan Kesihatan Persendirian and Jaminana Kesihatan AKS. Patients who owns insurance coverage as mentioned need not make any payment, whereas those without pays an amount as low as RP5000. 00. However, the medications has to be purchased by the patients at their own expense. For the most part of my observation, the patients receives prescription of their medication to be purchased themselves in the pharmacies, unless generic medicines which are provided in the puskesmas. I could deduce that the charges are very affordable compared to that of private practices. Therefore, quality medical care is made accessible to everyone regardless of their economic background. This is indeed extremely favorable in reaching out to the needs of the people in an actively developing region. Discussion In the context of satisfactory health care, patients gratification is substantial. This explains why health care providers should make extraordinary efforts in providing the best achievable standards of health care. In the context of Indonesia, family medicine is developing slowly, however a clear structure and guideline for patients has not been constructed. On the other hand, due to limited number of specialist available, most specialists carry out private general practice outside their work hours. This may reduce the efficiency of the physicians due to stress and overwork. Moreover, the general practitioners training programme is not welcomed and well supported by the specialist because they are held in direct competitions with the general practitioners. Pertaining the clinical attachment, the physician tried their level best to provide appropriate health care to her patients despite the limited resources. However, there is also abundant room for improvement in terms of educating the patient about prevention of diseases and the effects of medication prescribed. Besides, the physician should have given more enlightenment when concerning lifestyle related iseases, because at all times, prevention is better than care. On the whole, the entire health care team should work on the regulations concerning controlled medication to avoid abuse and overuse. Another most crucial point in family medicine is the community orientation. Community orientation is about the physical environment of your practice population, the need to understand the interrelationship between health and social care, and the tensions that may exist between individual wants and needs and the needs of the wider community. As a conclusion, holistic approach is about your ability to understand and respect your patients’ values, culture, family beliefs and structure, and understand the ways in which these will affect the experience and management of illness and health. I am very contented to be granted an opportunity for this clinical attachment. This would, in time, help me in my future endeavors as a doctor.

Beating Severe Combined Immunodeficiency Syndrome (SCID) Essay

Imagine living your entire life contained within a plastic bubble. Contact from the outside world, including your parents, is lethal. Rather than feeling the warm touch of a human hand, the clammy cold of laboratory gloves comforts you to sleep. Is this living or this surviving? You make the call. SCIDs is an acronym for Severe Combined Immunodeficiency Syndrome. Persons born with SCIDs lack the ability to fight off infections. SCIDs creates a situation in which the common cold is just as deadly as pneumonia. This family of diseases is obviously debilitating and life-threatening. That is why finding a cure is imperative. This disease is not contagious, it is genetic and is thus acquired through the simple role of the genetic dice. There is absolutely nothing we can do about this sad syndrome, or is there... We can look to gene therapy: an exciting and revolutionary new field of research and medicine which may reveal the key to unlocking a myriad of genetic diseases. This paper will explore the problems posed by SCIDs and the answer offered by Marina Cavazzana-Calvo and Salima Hacein-Bey. Their work in gene therapy has great potential towards bursting the bubble on SCIDs. Immune System Introduction So, you ask, what does it mean to have SCID? Well, in order to answer this question, we have to go through a quick tour of the immune system. The immune system of the human body is comprised of a vast array of cells that fight off diseases (antigens) that are harmful to the well-being of the body. In an individual with a properly functioning immune system, the body has multiple genes that encode specific instructions for the proper design and function of the cells of the immune system. T... ...g gene. Thus, the non-functional gamma-c chain of these patients was corrected to function like a normal gamma-c chain. The researchers then took the corrected cells and returned them to the patients. Did it work? Yes. The results show a dramatic increase in a variety of major immune system cells. Where are they now? Both patients left protective isolation after approximately three months of treatment. After an 11 month analysis, both patients appear to be growing well. No side effects (of any kind) have been reported. Basically, both patients have achieved a nearly perfect recovery in less than a year! On a third patient, similar positive results have been achieved after 4 months of treatment. Drs. Cavazzana-Calvo et. al. have BURSTED THE BUBBLE ON SCIDs!!! Of course, long-term analysis must be completed in order to see the duration of this treatment.

How Media Affects Society Essay

How The Media Affects Society The media is undoubtedly a significant and influential aspect in modern day society. As a means of communication in a world very much advanced in technology, the media touches all types of people through various forms such as the radio, newspapers, televisions etc. The question remains: what information is left unbiased and untarnished? The people within society must sort through the many bits of information fed to them and unfortunately, in most cases, all bits of media is taken as the whole truth. The ways in which media impacts society to a great extent are through the facts it chooses to reveal, as recently seen in the case of the Tamil war in Sri Lanka. The tone in which it is presented such as the recently reported cases of Tamil protest on the streets of downtown Toronto and finally in the manner it chooses to target certain audiences, such as the case of Victoria George-Pazzano in Mexico. The media affects society through the facts it chooses to reveal. The media can choose to mention certain things and not to mention certain things. As seen in the recent Tamil war in Sri Lanka all mainstream media outlets were banned from broadcasting out of the country. The media then proceeded not to broadcast any of it, leaving people unaware of it on a global scale, until the Tamils outside of Sri Lanka began to protest and make other countries aware of the situation. The media chose not to reveal this information and if it was not for the protest and marches held around the world it is possible, that society could have never known that genocide was being used against the Tamil Tigers. Society needs the media to be informed on the events happening around the world, but sometimes the media may not choose to show us what is exactly going on. This can result in society not knowing how to react to what is happening in other parts of the world. Just as important as the facts the media chooses to reveal, the tone and manner in which the media presents these facts plays a large role on society’s take on events. The tone in which the media presents the facts in can be hostile, neutral or in favour. The tone can affect society’s view on the situation, resulting in either a positive or negative reaction. As seen on May 10th when thousands of Tamils met on Toronto’s Gardiner Expressway, for almost 4 hours shutting down a key artery in the city’s road network. If the media had said, â€Å"The Tamil protesters are keeping Torontonians hostage in their own city† vs â€Å"The Tamil protesters are bravely doing what needs to be done to save their families†. This could have resulted in Toronto turning against the Tamil community and possibly resulting in hate crimes, but instead the tone of the media was in favour of the protesters. Which has resulted in a positive reaction from Toronto and the Canadian government. The tone in which the facts are presented by the media, can easily change the point of view of the consumer, and can have either a positive or negative reaction regardless of the truth behind the facts. Lastly, the media uses its voice to target certain audiences for certain reactions. Who can the media target? In the case of Victoria George-Pazzano, a 29 year old woman who suffered a severe asthma attack while on vacation in Mexico became critically ill. Victoria’s family pleaded to the Canadian government and Ontario hospitals to bring her home,but were continuously told that there were no beds and doctors available to treat in all of Ontario. The family of Victoria then pleaded there case to the media, who in return targeted the government officials and found out that either the hospitals or the officials were lying to Victoria’s family because there were more than 20 beds available at the time. Because the media targeted the government with the right tone and direction of attention, the heat was put on the government for action because all of the attention was affecting there reputation. Without the media Attention, Victoria George-Pazzano would have died in a hospital bed in Cancun Mexico because the government of Canada pushed her aside. With these three weapons at the media’s disposal, namely the facts it chooses to reveal, the perspective it chooses to take and the people it wishes to target. The media holds a great deal of power and influence over society. Of course, it may be for a positive effect or a negative one. Would one rather live in fear of all the rapes, assaults, robberies and murders that are reported or live happy, not knowing about every crime that takes place? That is another debate altogether. But, one thing is for certain: the people should not live blindly at the word and mercy of the media or another. There should always be room for doubt, speculation and of course one’s own opinions. Although the media may carry a great influence over society, each person is entitled to think for oneself.

Essay on Anne Fausto-Sterlings The Five Sexes - 1151 Words

Exploring the Social Standards of Sex and Gender There are several sources that tell a person how to be a man or woman. Science tells us by recognizing the X or Y chromosomes. The media shows us through the physically ideal celebrities that grace the covers of magazines and flaunt their bodies in commercials. Sports, wrestling, cars, and blue for the boys. Dresses, make-up, painted nails, and pink for the girls. All of these sources, as well as others, have evolved into an expectation that has become institutionalized within society. This expectation, is placement and belonging into the binary system of person: the man or the woman. In Anne Fausot-Sterlings acrticles â€Å"The Five Sexes† and the â€Å"The Five Sexes, Revisited†, the†¦show more content†¦Besides the genders male and female, there is also intersexed. Within that group of intersexed, there are subgroups. Fausto-Sterling explains this in her â€Å"The Five Sexes: Why Male and Female are Not Enough†: Firstly, the term intersex is used in medical literature to describe the so-called true hermaphrodite (possesses one testis and one ovary), the male pseudohermaphrodite (possess testes and some aspects of the female genitalia, but no ovaries), and female pseudohermaphadites (possess ovaries and some aspects of the male genitalia but lack testes). I had no idea that there were subgroups to the intersexed. Due to social conformity, along with the advancement of technology and surgical procedure intersexed persons are aimed to be fixed at birth. Although otherwise healthy, there is a need to perform surgery on the baby in order to remove certain sexual organs that dont fit with the perfect idea of what a girl or boy should look like. This often leaves scars, and the psychological and emotional confusion along with it. â€Å"The Five Sexes Revisited† focused on the importance of therapy over surgery. Medical ethicist Laurence B. McCullough of the Center for Medical Ethics and Health Policy at Baylor Collefe of Medicine in Houston, Texas â€Å"contend[ed] that in the process of assigning gender, physicians should minimize what he calls irreversible assignments: taking steps such as the surgical removalShow MoreRelatedThe Five Sexes: Why Male and Female Are Not Enough by Anne Fausto-Sterling1781 Words   |  7 PagesIn the article â€Å"The Five Sexes: Why Male and Female Are Not Enough†, Anne Fausto-Sterling makes some very compelling points. One of her main points is that the western worlds binary system of sex is to constraining and proposes that instead our system should be increase to five, or possible more, sexes. This paper will explain the premises of her argument and important terms. This will be followed by a counterargument as to why three sexes are the max needed and that Fausto-Sterling view could leadRead MoreThe traditional biological understandings of sex and gender create a binary concept mainly in the800 Words   |  4 PagesThe traditional biological understandings of sex and gender create a binary concept mainly in the Western culture by having two strictly fixed options of male or female. This binary notion of gender and sex was put to the test by both Anne Fausto-Sterling and Oyeronke Oyewumi. Sterling argues that rather than just two separate ends, biological gender occurs across a continuum of possibilities. This spectr um of anatomical deviation by itself should be enough to disregard the simplistic notion ofRead MoreSex : Strict Dimorphism Or Sexual Haploid1620 Words   |  7 Pagessociety has been recognized largely as a western cultural viewpoint. While not everyone agrees with this viewpoint, one biologist that plays a role in this discussion is Anne Fausto-Sterling. She is an expert in gender development and wrote extensively on the subject of gene and gender. In this paper I will discuss Fausto-Sterling’s view on sex and gender, and how she undermines the idea of strict universal dimorphism. Being that sexual dimorphism is the favored view of most in the scientific communityRead MoreGender Inequality Between Men And Women908 Words   |  4 Pagesand sex binaries through examples found in cultures throughout the world. In Anne Fausto-Sterling’s article, The Five Sexes, she discusses why the sex binary of male and female is not enough. She contends that â€Å"biologically speaking, there are many gradations running from female to male; and depending on how one calls the shots, one can argue that along that spectrum lie at least five sexes—and perhaps even more† (Fausto-Sterling; 21). The three subgroups within the sex spectrum have a mixture of