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In this capacity he Marius Smith-Petersen and the gifted all-rounder served from July 1917 to August 1919 order alesse 0.18 mg free shipping, latterly as Philip Wilson buy alesse 0.18mg with mastercard. The situation, seen from afar, consultant in charge of amputations to the whole seemed to many of us to point to the choice of of the American Expeditionary Force. On demo- Philip Wilson, but the selectors decided other- bilization, the Wilsons, with their son Paul, born wise. Philip was deeply disappointed by their in Paris, found themselves back in Columbus, action, but when given the autonomous control Ohio. But Philip was now one of the coming of the fracture service, he continued to serve as a young men, and later in 1919 he returned to loyal member of the department. He was invited to Goldthwait and to be appointed to the visiting become Surgeon-in-Chief at the Hospital for the staff of the Orthopedic Department of the Mass- Ruptured and Crippled in New York. He reorganized the 1941 for a further term, the hospital having staffing, changed the name of the hospital, estab- moved to the new Churchill Hospital at Oxford. For his contribution to the Street close to the New York Hospital and Cornell British wartime hospital services, Philip was Medical School. The year before, tus Surgeon-in-Chief, and still occupied by an France had made him a Chevalier of the Legion extensive private practice, Philip began to look of Honor. His powers founding fathers of the American Academy of of statesmanship had never been better displayed Orthopedic Surgery and was president of this than in the negotiations that led to the recognition body in 1934. He served a term on the Board of by the Cornell Medical School of the Hospital for Regents of the American College of Surgeons, Special Surgery as a teaching unit for undergrad- firm in his belief that orthopedic surgery should uates. For a short time Philip enjoyed the title of be represented within the unity of surgery. All this was the transformation of his tologie was held in New York in 1960, he was the dream into reality. For here was a special hospi- natural choice to be elected president for the 1963 tal giving the highest standards of the care of meeting in Vienna. Over the years he became patients, teaching both undergraduates and post- an honorary member of almost every existing graduates, and actively engaged in the promotion foreign orthopedic association and of many soci- of research. Before this came to pass, the hospi- eties representing surgery as a whole. Of the tal had already become a famous postgraduate many honors bestowed on him in his long pro- training center for residents. Many of Philip’s fessional life, none gave him and his devoted wife pupils are to be found among the present-day more joy than the degree of Docteur Honoris leaders of orthopedic surgery, not only in North Causa conferred on him at the Sorbonne in America, but in far distant countries. The fact that his oldest friend in united in deep affection for their master. Great Britain, the writer of this memoir, received The outbreak of World War II came as an inter- the same honor on that occasion, gave him added ruption 5 years after the Wilson family had moved pleasure. The fall of France and the evacua- made an honorary fellow of the Royal College of tion of the remains of the British Expeditionary Surgeons of Edinburgh, an appropriate distinction Force from Dunkerque were events of deep for one who in part at least came of Scottish concern to Germaine and Philip—both loyal ancestry. Throughout his life Philip was punctilious in And so in September 1940, Philip arrived in the his attendance at annual meetings of surgical United Kingdom with the vanguard of the Amer- bodies of which he was a member. One meeting ican Hospital in Britain, a hospital financed by that he was loath to miss was that of the funds raised in the United States by friends of American Surgical Society, where his enduring Great Britain and France. The story of this hospi- curiosity, and his zest for learning about new tal is recorded in documents now deposited in the ideas and procedures outside the bounds of his library of the Hospital for Special Surgery. The Philip stayed some months in England to see meeting of the American Surgical Society in the hospital installed at Park Prewett, Cincinnati in April 1969 was the last surgical Basingstoke, and shared with thousands the early gathering he was to attend. He returned in December York a little tired but inspired by the memory of 363 Who’s Who in Orthopedics a panel discussion on amputations in which he had been invited to speak on his unrivalled expe- riences in this field. This occasion carried him back to those days in France over half a century ago. In Great Britain we have long seen Philip Wilson not only as an outstanding surgical leader in the United States, the doyen of orthopedic surgery, but as a world figure. For us he repre- sented the outward symbol of that “special rela- tionship” between the orthopedic surgeons of our two countries, created in the days of war by Sir Robert Jones and nurtured by Robert Osgood.

I said generic alesse 0.18 mg without a prescription, “You’re going to have to get here somehow generic 0.18mg alesse with mastercard, or I’ll send someone to get you. What she really had was a bad case of fibromyalgia and a lot of psy- chiatric problems. Now she swims daily in the ocean; she sings; she’s out doing all sorts of things; she walks miles every day. Physicians want what they view as best for their patients—doctors are accustomed to being in control. In hospitals, their orders are typically Physicians Talking to Their Patients / 147 obeyed to the letter, by clinical colleagues and patients alike. Physicians can write prescriptions, for example, but patients must purchase medications and follow instructions. Most peo- ple understand the rationale for prescription drugs and generally trade off potential side effects for explicit, anticipated benefits. But when therapies ask people to alter daily routines—to exercise, lose weight, use a cane, re- arrange their home—physicians wield only the power of persuasion. Hawn’s story exemplifies this situation, with hints of confrontation, a bat- tle of wills, physicians forcing reluctant patients to pull themselves up by their bootstraps and march onward. Of course, this is often for the good: the woman from Southie is probably much happier now than before Dr. Many physicians recognize that, with progressive chronic conditions, patients make the important daily decisions about managing their health (Ellers 1993; Holman 1996). In these circumstances, an important role for physicians is defining expectations. Although doctors are critical guides, patients are generally in control. Cassell, elevating physicians to perhaps a higher height than many patients might accord. Nevertheless, “All these things that in acute disease seemed peripheral have now become central. If chronic disease is overwhelmingly personal, than [sic] the person is central. This means that the body of knowledge of medical science that has served medicine so well in acute dis- ease, is only part, albeit a crucial part, of the story in chronic disease” (1997, 25). Then there are others with even less disability who get decubi- tus ulcers. They don’t take care of themselves as well, don’t turn their bod- ies, and don’t initiate what they need to do. I have people of all economic circumstances without any obvious pattern. He’s lost both his legs because of decubitus ulcers that didn’t really need to de- velop. He gets all over town in his wheelchair, going down the street real fast. He has a personal-care assistant, and he’s got the whole system down pat. He’s 148 / Physicians Talking to Their Patients the world’s expert on how to get everything that you need to live success- fully. Or they suggest another possibility—“denial,” refusal to admit or acknowledge that anything is wrong. In doctors’ minds, denial hinders care on two levels: patients with- hold important data that could inform their care, then reject actions to “im- prove” their situations. Patrick O’Reilley practices in a poor neighbor- hood where many elderly people live alone. He worries that people hide their walking difficulties: Let’s be honest.

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Write the central idea purchase alesse 0.18 mg free shipping, theme or issue in the middle of a large sheet of pa­ per discount alesse 0.18mg line. Note down ideas, opinions, facts and figures associated with the cen­ tral idea using one- or two-word phrases. Use lines and arrows to show how points link together, and to indicate the hierarchy of the information. Once you have covered all the areas, you can start to sort your data into cohesive groupings. Asking yourself questions is a useful way of focusing your thinking, for example, ‘How do I know this child is showing a delay in gross motor skills? Drafting your report Once you have gathered your information and organised it into a basic framework, you can start to prepare a draft. Writing a report is not just about what you say but also how you say it. Remember that the majority of reports will now be read by the client and the client’s family or carers (NHS Plan 2001). Try to phrase your re­ port in a way that is more accessible for a lay person with limited clinical or technical knowledge. One idea to get around this problem is to provide a summary writ­ ten specifically for the client (NHS Training Division 1994). Remember that the way in which the message is expressed often inad­ vertently conveys underlying attitudes. Look at this example: ‘Mother ini­ tially denied any concerns about his hearing, but then confessed that she thought he did have problems…’ These words imply some sort of negative judgement on the part of the report writer about the client. Check that your report is objective and your interpretations have a clear evidence base. When preparing your final draft, consider how you will present the re­ port. Here are some general guidelines: ° Place the name or logo of the employing organisation at the top of the report. Indicate if there has been a delay between a report being dictated or drafted, and the date when it was actually typed. Type or print your full name, title and profession underneath your signature. Do not repeat any headings or addresses used on the first page, but you might want to include some client identification information. Editing your report Once you have written your draft, you can check the content, spelling, grammar and presentation. Check you have used: q A clear framework q A logical sequence q Headings. Check the content is: q Balanced (no one area is given too much emphasis) q Accurate q Current q Objective. Check that you have: q Reduced unnecessary repetition q Included all the key points q Summarised the main points in a conclusion q Clearly stated recommendations and actions. Check you have: q Reduced jargon q Reduced complexity 90 WRITING SKILLS IN PRACTICE q Made it easy for the reader to find information q Used non-judgemental language. Once you have finished your edit you are ready to complete your final draft. Remember to ensure that copies of your report go to other relevant professionals or agencies. Initial assessment report – key content ° Name, address and identification details (date of birth, hospital number and so on) of the subject of the report. Discharge report – key content ° Name, address and identification details (date of birth, hospital number and so on) of the subject of the report. Summary Points ° Letters and reports about the care and management of clients are an essential form of communication within the health service. Careful consideration needs to be given to the choice of vocabulary and the way the message is phrased. Providing written material is one way of help­ ing to meet this need and involving clients in decision making. However, both professionals and clients have expressed concern about the quality of some of this information. The following chapter looks at how the writing and presentation of written leaflets may be improved.

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Many for-profit hospitals and clinics have sites that advertise their facilities but also provide excellent information such as research results and treat- ment protocols order alesse 0.18 mg on-line. Look for sources on the Internet that list references to research studies or published books generic 0.18mg alesse with visa. Check the references periodically to make sure that they have not been made up by the author of the site. In our experience, most mystery malady patients have great suc- cess with “. Therefore, he directly went to a website for a certain uni- versity known for its excellent medical teaching facilities. When he clicked on the A-Z Health Encyclopedia and typed in fatigue he was led to the diagnosis of sleep apnea. He knew then he had to make an appointment at a sleep disorder clinic where this diagnosis was later confirmed and treated. Some sites volunteer to be inspected and monitored so they can receive a seal attesting to the accu- racy of the information they contain. Health on the Net (HON) is an organization that monitors health websites to ensure they are secure, confidential, and backed by legiti- mate sources. To validate the button’s authenticity, try clicking on it to see if it takes you to the HON website. A seal from the Utilization Review Accreditation Council (URAC) indicates the site has met URAC’s fourteen principles and fifty-three specific standards, including the use of credible sources, the ongoing updating of material, and security to ensure that no personal informa- tion can be revealed. To verify a site’s seal of approval, search URAC’s online directory at urac. The council does a full review of each accredited website once a year and conducts periodic reviews to verify that it remains compliant with the standards. We do not mean to imply that sites without seals of approval are necessarily inaccurate or dishonest. Commercial sites—those dot- coms and dot-nets—may seek seals to validate their legitimacy, whereas sites from respected nonprofit organizations, institutions, and govern- ment agencies may not feel the need for such validation. Abstracts of scientifically sound studies will include terms such as double-blind, ran- domized, case-controlled, or placebo-controlled. These terms indicate that the information is neither observational nor anecdotal. Anecdotal information and chat rooms can be helpful in pointing you in a spe- cific direction; they should not be relied on for factual data. Most health top- ics you might be searching for will have multiple rather than single studies. Be sure to read several studies on the same topic before taking the first one you find at face value. If several studies duplicate the same results, these results can probably be trusted. Medical Detective Work on the Internet 83 A single study could have turned out to be a dead end that no one continued to research, or it could be so new that the results haven’t yet been duplicated. So if it’s a single study, you can probably assume the results are not yet accepted by the scientific community. PubMed is a premier Internet site maintained by the National Library of Medicine and the National Center for Biotechnology Information. It allows public access to the NLM’s MEDLINE database, which houses articles from forty-five hundred journals from as far back as 1966. If you are unable to find a study mentioned there, the chances are better than not that the study was not published in a peer-reviewed journal. However, it is not essential for you to read the complete arti- cle or abstract. They (and you) need to read only the title and the conclusion section, which usu- ally contains short amounts of text. Possible Pitfalls in Internet Detective Work There are any number of problems in doing detective work on the Internet, which is why we always urge you to check the information you have found with your physician.

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