Martin L. Pernoll – Benson and Pernolls Handbook of Obstetrics and Gynecology

Автор: Martin L. Pernoll
Название книги: Benson and Pernolls Handbook of Obstetrics and Gynecology
Формат: PDF
Жанр: Медицина
Страницы: 924
Качество: Изначально компьютерное, E-book

During the course of this text’s ten editions, societal evolutions have
materially transformed the provider-patient exchange. Each patient
and each provider’s perception of these alterations may vary and
there are certainly differences from country to country and within
different cultures; however, cumulatively these evolutions amount
to a changing paradigm of provider-patient interaction. In the US
the majority of these transformations are positive.
For example, as an ethical ideal, replacing patient autonomy
(interdependency) for physician paternalism (dependency) places
the care relationship on a much more mature and functional basis.
Provider-patient interdependence is furthered by patients having
nearly unlimited access to medical information (and in some
cases disinformation) via the Internet. No longer is the provider
the patient’s only source of information. Additionally, patients today
have greater freedom of choice to match their expectations
and personalities to that of a provider. This has been brought about
by the much welcome enhancement of sexual and racial “minorities’’
to what was once a very nearly homogenous provider base.
Even the increasing discourse (both pro and con) concerning public
health issues, such as immunizations, should result in better
understanding, broader public education, and more acceptable
public policies.
Other societal alterations have had more debatable impacts on
the interchange necessary for care. In this category are the efforts
cumulatively titled “managed care.’’ While accomplishing their objective
of cost containment, many of the methodologies are intrusive
(to both providers and patients) on health care and questions
of quality in such a system are rife. Another example in this category
is increasingly litigious behavior. While proponents indicate
this as a necessary function to protect individual rights, there is no
question (in the US) that the legal process increases both direct and
indirect costs of health care. Perhaps the cumulative intellect of patients,
attorneys, insurers, legislators, and providers could, through
a broader dialog, improve the impact of these aspects on health care.
Finally, scientific advancement has a marked impact on the
provider-patient interface. While this is pervasive in all aspects of
caring for women, nowhere are there greater advances than in genetics.
These advances when applied to humans raise major ethical
issues, for example the human genome project, the ability to detect
genetic predispositions for certain conditions, and cloning. Additionally,
patient, familial, and societal opinions are rapidly evolving
concerning both natural and technological aspects of reproductive
function. Two areas currently triggering debate are post mortem
sperm acquisition for in vitro fertilization and the sale of donor eggs.
The provider-patient interface must allow the freedom for discussion
of all such issues without threatening the individual beliefs,
ethics, or morality of any party involved in the dialogue. True openness
of discussion (listening as well as hearing) is imperative to
guard against the hazard of ambiguous expectations and relationship
difficulties. Moreover, the scientific, provider, legal, legislative,
and patient communities must endeavor to match the free,
open, nonjudgmental, and nonadversarial nature of most providerpatient
exchanges.
This edition continues in the spirit of true communication started
and maintained by Dr. Ralph Benson through preceding editions.
We encourage the reader to provide us with their thoughts and sincerely
desire that you find this edition useful.
Martin L. Pernoll, M.D.