Country differences in the diagnosis and management of coronary heart disease : a comparison between the US, the UK and Germany

Background The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany. Methods Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions. Results Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice. Conclusion Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process

Real Metamorphosis or More of the Same: Navigating the Practice of Law in the Wake of Ethics 20/20 - Globalization, New Technologies, and What it Means to Be a Lawyer in These Uncertain Times

On April 4 and 5, 2013, The University of Akron School of Law’s Miller-Becker Center for Professional Responsibility (“MBC”) hosted the symposium, Navigating the Practice of Law in the Wake of Ethics 20/20 – Globalization, New Technologies, and What It Means to Be a Lawyer in These Uncertain Times (Ethics 20/20 – Uncertain Times). The symposium examined the myriad of changes and problems confronting the bar, legal education, and the courts. Although law schools, courts, and the organized bar have provided a steady supply of programs addressing the recent changes confronting the profession and legal education, Ethics 20/20 – Uncertain Times was the first to examine some of these changes after the American Bar Association (ABA) Ethics 20/20 Commission (Ethics 20/20 Commission) concluded its work. The Ethics 20/20 Commission conducted an almost three-year review of the profession’s ethics rules and practice standards in light of new technologies and the increased globalization of the delivery of legal services. Ethics 20/20 – Uncertain Times sought, in part, to better understand the challenges confronting lawyers – or “what it means to be a lawyer in these uncertain times” – and whether the Ethics 20/20 Commission’s recommendations really helped the profession regarding the challenges of globalization, new technologies, and related concerns (e.g., multi-disciplinary practice (“MDP”))

Torture and the Professions

This paper examines the roles played by the learned professions in torture and cruel, inhuman, or degrading treatment carried out by the United States in the war on terrorism. It takes lawyers, physicians, psychologists, and anthropologists as its case studies. It originated as the keynote speech at the Association of Practical and Professional Ethics annual meeting in 2007

The unbearable trauma of being : death, hope, and (in)humanity in the work of Cormac McCarthy

For as long as the self-christened homo sapiens has roamed the Earth, various mythologies and their respective afterlives have followed without fail. Through the work of Cormac McCarthy, this paper seeks to explore the connections (if any) between mortality, hope, and the intrinsically human need for narratives of the afterlife. The term “after(-)life” is understood to denote not simply the realm that supposedly awaits us after physical death; throughout this paper, the after-life is also investigated as that mode of being which occurs follow a point of trauma, be it physical, mental, spiritual, or epistemological in nature. Three of McCarthy’s most pivotal novels (The Road, Child of God, and Blood Meridian) will be discussed in relation to the question of trauma, hope, and inhumanity, and what it means to be after the human experiences a distinct collapse in meaning. Finally, this paper endeavours to discuss such questions as “why this human need for hope?”, “how does hope persist in the face of inhumanity?”, and “is it this resilience that makes us human?”peer-reviewe