The physician's tears:Experiences and attitudes of crying among physicians and medical interns

We examined several aspects of the crying experiences of physicians and medical interns, including the most common reasons to cry in the workplace, and their perceptions of and attitudes towards crying in the workplace and in the presence of a patient. A sample of Dutch physicians and medical interns (Nphysicians = 1068 and Nmedical interns = 302 and for the full version Nphysicians = 776 and Nmedical interns = 181) completed an especially designed anonymous online questionnaire about experiences with crying in the workplace, and perceptions of and attitudes towards crying in the workplace and in the presence of patients. Crying is a rather frequent behavior among physicians, in particular when they have to deal with the severe suffering of patients and their relatives. We found a considerable variety in the attitudes and perception of crying in the work setting, although there was also much agreement that crying in the presence of a patient is only appropriate if it is over the condition of the patient. Physicians reported a slightly more positive attitude and a stronger need for more attention to this topic in training and education than medical interns. Crying in the medical setting is a common, though understudied phenomenon. There is a strong need for further research on this topic in order to understand it better and how and when it might interfere with or facilitate with the therapeutic process. We strongly feel that currently the time is ripe for this topic because in particular the physicians expressed a greater need for more attention to this topic in training and the medical interns showed signs of, perhaps unhealthy, suppression of their emotions

Approach to diagnosis and pathological examination in bronchial Dieulafoy disease: a case series

<p>Abstract</p> <p>Background</p> <p>There are limited series concerning Dieulafoy disease of the bronchus. We describe the clinical presentation of a series of 7 patients diagnosed with Dieulafoy disease of the bronchus and provide information about the pathological diagnosis approach.</p> <p>Patients and methods</p> <p>A retrospective review of patients who underwent surgery for massive and unexplained recurrent hemoptysis in a referral center during a 11-year period.</p> <p>Results</p> <p>Seven heavy smoker (49 pack years) patients (5 males) mean aged 54 years experienced a massive hemoptysis (350–1000 ml) unrelated to a known lung disease and frequently recurrent. Bronchial contrast extravasation was observed in 3 patients, combining both CT scan and bronchial arteriography. Efficacy of bronchial artery embolization was achieved in 40% of cases before surgery. Pathological examination demonstrated a minute defect in 3 cases and a large and dysplasic superficial bronchial artery in the submucosa in all cases.</p> <p>Conclusion</p> <p>Dieulafoy disease should be suspected in patients with massive and unexplained episodes of recurrent hemoptysis, in order to avoid hazardous endoscopic biopsies and to alert the pathologist if surgery is performed.</p

Swimming against the tide: A case study of an integrated social studies department

A recent trend in developed countries&rsquo; school curricula has been the transition from disciplinary to generic forms of knowledge, resulting in an emphasis on interdisciplinary organisation and more active forms of learning. Subject specialists are increasingly expected to demonstrate how their subject interconnects and equips pupils with key life skills. Such a change requires a major cultural shift and has been controversial, particularly in Scotland where Curriculum for Excellence, the latest curriculum reform, has seen this debate re-emerge. A detailed empirical case study of one secondary school Social Studies department that has already negotiated these shifts is presented. The case study provides insights into how school and department structures and cultures conducive to a more integrated approach have been developed. Leadership, increased opportunities for teachers to exercise greater autonomy in their work, sources of impetus and support for innovation, and the co-construction of meaning through dialogue are important themes in this process. This case study connects with current policy and provides an insight into strategies that other schools might employ when seeking to embed integrative practices. The department is identified as a significant locus for innovation and one which appears to challenge the norm