Sigall K Bell

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PURPOSE To probe medical students' narrative essays as a rich source of data on the hidden curriculum, a powerful influence shaping the values, roles, and identity of medical trainees. METHOD In 2008, the authors used grounded theory to conduct a thematic analysis of third-year Harvard Medical School students' reflection papers on the hidden curriculum.(More)
BACKGROUND Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. OBJECTIVE To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. DESIGN Quasi-experimental trial of PCPs and patient(More)
A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that(More)
Best practice for the clinical management of acute human immunodeficiency virus (HIV) infection remains unknown. Although some data suggest possible immunologic, virologic, or clinical benefit of early treatment, other studies show no difference in these outcomes over time, after early treatment is discontinued. The literature on acute HIV infection is(More)
OBJECTIVES The disclosure of harmful errors to patients is recommended, but appears to be uncommon. Understanding how trainees disclose errors and how their practices evolve during training could help educators design programmes to address this gap. This study was conducted to determine how trainees would disclose medical errors. METHODS We surveyed 758(More)
n engl j med 357;17 www.nejm.org october 25, 2007 1682 S 1999, health care professionals have been focusing on To Err Is Human, the Institute of Medicine report that sounded alarms about medical error. As we have strived to reduce the rate of errors, systems-based practices such as electronic order entry and procedure checklists have proliferated.(More)
Fifty-two ambulatory surgery (obstetrical/gynecological) patients were randomly assigned into three groups. Oral metoclopramide and intravenous metocloprarnide and droperidol were compared to placebo. The variables of age, weight, predisposition by history, type of surgery and length of recovery time were examined. Data analysis failed to reveal any(More)
Historically, radiologists' official written reports have functionally been proprietary communications between radiologists and referring providers. Although never secret, these reports have traditionally been archived in the medical record, with tightly controlled access. Patients rarely viewed reports directly. As patient-centered care, transparent(More)
You are a young neurologist practicing in a small hospital. You admit a 55-year-old woman with hypertension and type 2 diabetes mellitus who had an embolic stroke at home. On reviewing the patient’s medical record, you notice that she appears to have been in atrial fibrillation during two electrocardiographic (ECG) tests during visits to the office of her(More)
A longitudinal clerkship was designed at Harvard Medical School (HMS) in 2004-2005 to emphasize continuity, empathy, learner-centeredness, and patient-centered care. In 2005-2006, the curriculum was piloted with eight students who voluntarily enrolled in the third-year curriculum, which focused on longitudinal mentorship and feedback, interdisciplinary(More)