“Evidence based medicine” is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. Since, when clinical practice guidelines are created, costs affect the content of EBM, (...) EBM inevitably becomes a form of rationing and adopts a public health point of view. This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism. (shrink)
Background: Ethical dilemmas are an integral part of medicine. Whether physicians actually feel that they have made ethically problematic treatment decisions or choices in their work is largely unknown. Identifying physicians with ethical problems, and the types of problems and underlying factors, might benefit organisational and educational efforts to help physicians solve ethical dilemmas in a constructive way. We investigated how the frequency and types of ethically difficult treatment decisions vary by specialty.Method: A mail survey of all non-retired Finnish physicians (...) was conducted in 2004. Of those who had made any ethically problematic treatment decisions, the types of decisions and reasons given for these decisions were asked for. Factor analysis was used to investigate clustering of ethically problematic treatment decisions, and logistic regression to investigate the effect of specialty, adjusted for age and gender.Results: Psychiatrists experienced ethically problematic treatment decisions most frequently, followed by pulmonologists, internists and neurologists. Problems were reported least often by pathologists, laboratory physicians and ophthalmologists. Overtreatment was more common than undertreatment in most specialties, with the exception of psychiatrists who emphasised undertreatment and patient rights issues.Conclusion: Physicians of different specialties differ significantly regarding frequency and types of ethically problematic treatment decisions they have made. Psychiatrists differ from all other specialists in reporting more undertreatment and patient rights issues. Experiencing ethically problematic decisions might affect the quality of care and physician well-being in many ways. The findings could be useful for both under- and postgraduate ethics education. (shrink)
General semantics and the cold war mentality, by S. I. Hayakawa.--The talking tribes, by W. Johnson.--On a certain sort of disagreement, by I. J. Lee.--Serial communication of information in organizations, by W. V. Haney.--The cultural roots of bragmatics, by C. M. Babcock.--Images of the consumer's mind on and off Madison Avenue, by M. Rokeach.--Semantics and sexuality, by S. I. Hayakawa.--The magic word in Nazi persuasion, by H. A. Bosmajian.--Freedom and commitment, by C. R. Rogers.--Bibliography (p. 63).
Aktualnejshaya problema segodnyashnego dnya - vyhod iz sistemy globalnyh krizisov, s kotorymi stolknulos naselenie Zemli, i perehod k "obschestvu razumnogo potrebleniya," obschestvu znaniya. Ogromnuyu rol v etom protsesse igraet obrazovanie - sotsialnyj institut, odnoj iz zadach kotorogo yavlyaetsya sohranenie i translyatsiya znaniya v sotsialnyh sistemah. A chto takoe informatsiya? Iznachalno ee teoriya voznikla dlya nuzhd tehniki. Iz-za etogo mnogie ee aspekty ostalis ne razvitymi, potomu chto oni prosto ne byli vazhnymi dlya tehnicheskih sistem. Primenenie teorii informatsii k biologicheskim sistemam uzhe (...) zastavilo zanyatsya voprosom vozniknoveniya novoj informatsii. A rabota s sotsialnymi sistemami vydvinula takie ponyatiya, kak tsennost, effektivnost, slozhnost informatsii i t. d. Bolee polnyj podhod k teorii informatsii, v svoyu ochered, pozvolyaet najti resheniya ryada problem v teorii sotsialnyh sistem, v chastnosti v obrazovanii, i pokazat puti optimizatsii etih protsessov. (shrink)
The concepts of rationality that are used by social scientists in the formation of hypotheses, models and explanations are explored in this collection of original papers by a number of distinguished philosophers and social scientists. The aim of the book is to display the variety of the concepts used, to show the different roles they play in theories of very different kinds over a wide range of disciplines, including economics, sociology, psychology, political science and anthropology, and to assess the explanatory (...) and predictive power that a theory can draw from such concepts. (shrink)
A new constructivist approach to modeling in economics and theory of consciousness is proposed. The state of elementary object is defined as a set of its measurable consumer properties. A proprietor's refusal or consent for the offered transaction is considered as a result of elementary economic measurement. Elementary (indivisible) technology, in which the object's consumer values are variable, in this case can be formalized as a generalized economic measurement. The algebra of such measurements has been constructed. It has been shown (...) that in the general case the quantummechanical formalism of the theory of selective measurements is required for description of such conditions. The economic analogs of the elementary slit experiments in physics have been created. The proposed approach can be also used for consciousness modeling. (shrink)