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"An eye-opening and compelling ethnography about how doctors make decisions The oath that doctors take to "do no harm" suggests that patient welfare is at the center of what it means to be a successful medical professional. It is also understood, however, that hospitals are not only vessels for medical care--they are businesses, educational institutions, and complex bureaucracies with intricate codes of etiquette that dictate how each staff member should approach situations with patients. In Conflicted Care, Hyeyoung Oh Nelson provides an in-depth look at the decision-making processes of physicians at a large, prestigious academic medical center--that she calls Pacific Medical Center--and finds that more often than not patient well-being is only one of several factors governing day-to-day decisions. The steps physicians take reveal a kind of hidden curriculum of the medical world, one that is guided by status and hierarchy, bureaucracy, norms for consulting with third-parties, regulations for interactions with patients, and medical uncertainty. While at an institutional and individual level patient care continues to be integral to everything the physicians do, they are forced to reconcile that vow with these other, often-conflicting internal logics. Harm, Nelson argues, is thus built into the practice of medicine in the United States. This harm can take the form of unnecessary treatments and consultations or inadequate treatment for pain to motivate specialist intervention that would otherwise be resisted. These and other practices have the overall consequence of significantly driving up inpatient care costs, which then results in patients forgoing needed, ongoing treatment once they receive their medical bills. Drawing on a deep ethnography of physicians in the Internal Medicine Service unit, Nelson offers a sharp assessment of current policies aimed at alleviating medical costs and explains why they are ineffective. She concludes by offering novel policy and practice recommendations for health care practitioners, policy makers, and healthcare institutions"--
Medical care --- Clinical medicine --- Physicians --- Academic medical centers --- Decision making --- Psychology --- commodification of care. --- ethnography. --- hidden curriculum. --- legal risk. --- organizations. --- patient-doctor interactions. --- physicians. --- professionalization. --- socialization. --- status hierarchies.
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Cultural competence has been acknowledged as an important set of skills and mindset for working effectively with diverse patients and for reducing social disparities in healthcare. In this Special Issue cultural competence was approached as an umbrella term and submissions relating to the whole spectrum of the concept were invited. Nine papers are published, 7 of which are research articles, 1 is a concept paper and 1 is a review, from authors from Spain, the UK, Germany, Denmark, Cyprus, France, Portugal, and Brazil. These 9 articles discuss a variety of concepts and aspects of cultural competence, such as cultural communication, cultural humility, diversity competence, and structural competence, and highlight the importance of cultural competence in healthcare and healthcare education, while opening new directions in research and policy making.
Public health & preventive medicine --- interpreters --- medical education --- educational and health outcomes --- cultural competence --- leadership --- healthcare leadership --- leadership development --- healthcare education --- curriculum --- equality --- diversity and inclusion --- NHS --- Delphi study --- diversity competence --- training objectives --- competence prioritisation --- health professionals --- migrant health --- minority health --- further education --- cultural asymmetries --- patient’s mother tongue --- health professionals’ perceptions --- dominant language --- minoritized --- structural competency --- access to healthcare --- migration --- medical training --- diversity --- health equity --- primary health care --- qualitative research --- sociology --- anthropology --- psychology --- curriculum development --- health inequalities --- critical incident --- hidden curriculum --- disciplinary knowledge --- global health --- neglected diseases --- black populations --- participatory research --- decolonization --- advocacy --- social production --- health policy --- public health --- human rights --- communication --- hospitals --- voluntary termination of pregnancy --- n/a --- patient's mother tongue --- health professionals' perceptions
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Land use affects many aspects of regional sustainable development, so insight into its influence is of great importance for the optimization of national space. The book mainly focuses on functional classification, spatial conflict detection, and spatial development pattern optimization based on productivity, sustainability, and livability perspectives, presenting a relevant opportunity for all scholars to share their knowledge from the multidisciplinary community across the world that includes landscape ecologists, social scientists, and geographers. The book is systematically organized into the optimization theory, methods, and practices for PLES (production–living–ecological space) around territorial spatial planning, with the overall planning of PLES as the goal and the promotion of ecological civilization construction as the starting point. Through this, the competition and synergistic interactions and positive feedback mechanisms between population, resources, ecology, environment, and economic and social development in the PLES system were revealed, and the nonlinear dynamic effects among subsystems and elements in the system identified. In addition, a series of optimization approaches for PLES is proposed.
PLES --- multiscale integration --- coupling coordination --- conflict diagnosis --- Ningbo --- coupling degree of compatibility --- ecological barrier area in the upper reaches of the Yangtze River --- Jiangjin District --- land-use transition --- production-living-ecological space --- spatial mismatch --- balance threshold --- ES management strategies --- land use conflict --- conflict identification --- suitability evaluation --- multi-objective evaluation --- multifunction --- agricultural space --- ecological space --- ecological fragile area --- land-use change --- carbon flow --- CA–Markov --- low-carbon optimization --- brownfields --- military fortification brownfields --- casemates with enhanced fortification --- historical and fabricated stories --- semi-natural ecosystem --- hidden curriculum --- butterflies and moths (Lepidoptera) --- land snails (Gastropoda) --- hidden singularity --- Production–Living–Ecological space --- overall optimization --- beautiful China --- ecological civilization --- PLE space --- trade-offs and conflicts --- sustainable development --- system dynamic model --- FLUS --- identification --- island exploitation --- perspective of geomorphology --- Yellow River Basin --- production–living–ecological space --- spatio-temporal pattern
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Land use affects many aspects of regional sustainable development, so insight into its influence is of great importance for the optimization of national space. The book mainly focuses on functional classification, spatial conflict detection, and spatial development pattern optimization based on productivity, sustainability, and livability perspectives, presenting a relevant opportunity for all scholars to share their knowledge from the multidisciplinary community across the world that includes landscape ecologists, social scientists, and geographers. The book is systematically organized into the optimization theory, methods, and practices for PLES (production–living–ecological space) around territorial spatial planning, with the overall planning of PLES as the goal and the promotion of ecological civilization construction as the starting point. Through this, the competition and synergistic interactions and positive feedback mechanisms between population, resources, ecology, environment, and economic and social development in the PLES system were revealed, and the nonlinear dynamic effects among subsystems and elements in the system identified. In addition, a series of optimization approaches for PLES is proposed.
Research & information: general --- Environmental economics --- PLES --- multiscale integration --- coupling coordination --- conflict diagnosis --- Ningbo --- coupling degree of compatibility --- ecological barrier area in the upper reaches of the Yangtze River --- Jiangjin District --- land-use transition --- production-living-ecological space --- spatial mismatch --- balance threshold --- ES management strategies --- land use conflict --- conflict identification --- suitability evaluation --- multi-objective evaluation --- multifunction --- agricultural space --- ecological space --- ecological fragile area --- land-use change --- carbon flow --- CA–Markov --- low-carbon optimization --- brownfields --- military fortification brownfields --- casemates with enhanced fortification --- historical and fabricated stories --- semi-natural ecosystem --- hidden curriculum --- butterflies and moths (Lepidoptera) --- land snails (Gastropoda) --- hidden singularity --- Production–Living–Ecological space --- overall optimization --- beautiful China --- ecological civilization --- PLE space --- trade-offs and conflicts --- sustainable development --- system dynamic model --- FLUS --- identification --- island exploitation --- perspective of geomorphology --- Yellow River Basin --- production–living–ecological space --- spatio-temporal pattern
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