Physician-Citizens—Public Roles and Professional Obligations

Gruen, Russell L.; Pearson, Steven D.; Brennan, Troyen A.

doi:10.1001/jama.291.1.94

Cited by 295 publications

(166 citation statements)

References 20 publications

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“…115 Greater understanding of how to expand the appropriate role of clinicians in community public health, such as through advocating necessary environmental and political changes, would be helpful. 116,117 A major limitation for clinicians addressing overweight among children, most of whom are not morbidly overweight, is the uncertain criteria for determining clinically significant overweight. Although BMI is the best clinically available measure of overweight, uncertainty in its application to individual patients remains, because of limited knowledge of the current and future health effects of BMI and the possible limits in the applicability of current BMI cutoff points, particularly for minority race/ethnicity.…”

Section: E138mentioning

confidence: 99%

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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ABSTRACT. Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is >50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.Conclusions.

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Section: E138mentioning

confidence: 99%

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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“…[23] One that advocates speaks on behalf of another person as that individual perceives his or her interests. [24] While advocacy is commonly used in a legalistic sense, it takes on various definitions within the health professions.…”

Section: Advocacymentioning

confidence: 99%

Urban Parish nurses: A qualitative analysis of the organization of work in community-based practices

Young

2015

JNEP

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In the changing political economy of the health care environment, it is critical to understand the role of community providers serving vulnerable groups as central to their core service missions. Religion becomes salient in the work of health care providers in church communities. This study deconstructs and critically examines the factors that shape the work of nurses in urban congregations. The design utilized in-depth semi-structured interviews and a survey that included educational background, years in practice, congregation demographics and outreach activities. Nurses discussed how their faith-based work aligns along broader common dimensions of their practice. The organization of work is a useful sociological framework in which to explore this community-based nursing specialty.

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“…This model sees the physician as having extended obligations to ensure access to care and influence socioeconomic forces that have a direct influence on health [18]. According to this model, the oncologist's stewardship role at the community level could include participation in decisions regarding the appropriate use of cancer resources, working with health care teams in deciding reasonable options while maintaining a continuity role, participating in decisions about whether it is acceptable to set limits-and if so, in setting limits that are acceptable to patients and physicians-participating in quality improvement efforts, and helping to develop policy regarding appropriate care within one's catchment area.…”

Section: The Role Of Oncologists As a Professional Groupmentioning

confidence: 99%

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

Wenger¹,

Vespa

2010

The Oncologist

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Value in cancer care from a patient-centered perspective not only requires full oncologist-to-patient communication of information about potential treatments, but also imbues in the oncologist a responsibility to evaluate the value of cancer therapies and to offer to patients only those potential therapies that are appropriate for the patient. A case is presented in which the possibility of a low-probability treatment presented without adequate context or advice led to a prolonged, unsatisfying death for a young person with advanced cancer. The professional responsibility of the oncologist includes provision of care based on wise, cost-effective management aimed at meeting the needs of the individual patient. The oncologist has the clinical knowledge, is aware of a patient's clinical details, and has the relationship with the patient that permits understanding his or her values in order to guide cancer care decisions. The oncologist must identify the spectrum of treatments that are indicated for the patient, understand patient preferences and goals in order to inform the patient about options, and advise the patient concerning choice of cancer care. Oncologists as a professional group can ensure the use of standardized outcome measures, promote communication of prognosis and goals in order to guide optimal cancer care choices, and ensure appropriate patient selection and reasonableness in the cost per benefit increment of treatments. In this way, oncologists can ensure value in cancer care. The Oncologist 2010;15(suppl 1): [43][44][45][46][47][48]

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Physician-Citizens—Public Roles and Professional Obligations

Cited by 295 publications

References 20 publications

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

Urban Parish nurses: A qualitative analysis of the organization of work in community-based practices

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

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