Volume 103, Issue 10

Depression in nursing home residents is a common phenomenon, though there is a wide range in the severity of this disorder as experienced by elderly adults in the United States. Treating older patients for depression is costly in both human and financial terms. The authors review guidelines and recommendations for the diagnosis of depression and medical treatment of depressed elderly adults from the 1993 Clinical Practice Guidelines for Depression in Primary Care by the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), making note also of similar guidelines provided by the American Medical Directors Association in 1996 and those provided by the American Psychiatric Association in 2000. In November 1999, the authors used a Delphi survey to gather data from prescreened panelists (N = 10) to have the panel review and clarify the importance and feasibility of each "A" rated item in the US Agency for Health Care Policy and Research guidelines. This research allows health care providers to evaluate the importance and feasibility of items related to the delivery of mental health services for the elderly in nursing homes.

Two computer-assisted clinical case SOAP (subjective, objective, assessment, plan) note exercises were used for second-year osteopathic medical students, and a standardized patient was used during third year to measure recording behaviors regarding structural examinations and osteopathic manipulative treatment (OMT). Students were questioned before leaving campus for clinical rotations and at pregraduation to determine their attitudes toward use of these skills. Ninety-one percent of the students recorded structural examination findings in both computer-assisted clinical case SOAP notes, and 61% suggested OMT be given on their basic science SOAP (pneumonia). All of the students in the osteopathic theory and methods exercise suggested OMT. On a standardized patient with chronic obstructive pulmonary disease, 11% of the students performed a structural examination, and 0.7% suggested OMT. Preclinically, 73% of the students believed they were prepared to conduct structural examinations, and 71% believed they were prepared to use OMT. Between 64% and 73% of pregraduation students, however, reported they had few opportunities to use these skills during clinical rotations. Most of the students believed they would use palpatory diagnosis and OMT for fewer than 25% of their future patients and primarily for patients with musculoskeletal problems.

The authors undertook a case control study to determine whether hospitalized patients with pneumonia had reflex points in the anterior chest wall as described by Frank Chapman, DO, specifically those classified as relating to the lung. Sixty-nine hospitalized patients were enrolled in the study. Patients with an admitting diagnosis of pneumonia were compared to those without pneumonia as their admitting diagnosis. All patients were examined to determine if Chapman reflex points for the lungs were present. The study controlled for potential confounding diagnoses by excluding patients with lung pathology other than pneumonia. Results demonstrated a statistically significant relationship between the presence of Chapman reflex points and pneumonia in hospitalized patients.

STUDY OBJECTIVE: Time-honored terminology is being replaced in the managed care era. Patients are now clients, customers, and health care consumers. Physicians and doctors are now health care providers and vendors. The authors set out to determine whether patients prefer traditional terms or managed care-era terms. METHODS: A questionnaire of four unambiguous questions was made available to all obstetrics and gynecology patients and all family practice patients for 2 weeks at a medium-sized US Army community hospital. Responses were calculated; statistical significance was determined using logistics regression analysis. Statistical significance was defined as P < .05. RESULTS: Two hundred eleven patients completed questionnaires. Patient age ranged from teenage to older than 60 years; 83% of responders were women. Eighty-four percent of the responders (N = 178; P < .001) preferred to be called patient. Seventy-eight percent of the responders (N = 164; P < .001) believed their physicians should be called doctor, rather than by managed care-era terms. The age and gender of responders did not significantly influence preferences. CONCLUSIONS: Results of this small prospective, observational study indicate that patients, regardless of age or gender, prefer traditional, time-honored terms like patient and doctor to the managed care-oriented terminology currently being used.