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Zeitschriftenartikel zum Thema "Ethnic groups – Medical care – Great Britain"
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Manchikanti, Laxmaiah. „Physician Payment 2008 for Interventionalists: Current State of Health Care Policy“. September 2007 5;10, Nr. 9;5 (14.09.2007): 607–26. http://dx.doi.org/10.36076/ppj.2007/10/607.
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Physicians in the United States have been affected by significant changes in the pattern(s) of medical practice evolving over the last several decades. These changes include new measures to 1) curb increasing costs, 2) increase access to patient care, 3) improve quality of healthcare, and 4) pay for prescription drugs. Escalating healthcare costs have focused concerns about the financial solvency of Medicare and this in turn has fostered a renewed interest in the economic basis of interventional pain management practices. The provision and systemization of healthcare in North America and several European countries are difficult enterprises to manage irrespective of whether these provisions and systems are privatized (as in the United States) or nationalized or semi-nationalized (as in Great Britain, Canada, Australia and France). Consequently, while many management options have been put forth, none seem to be optimally geared toward affording healthcare as a maximized individual and social good, and none have been completely enacted. The current physician fee schedule (released on July 12, 2007) includes a 9.9% cut in payment rate. Since the Medicare program was created in 1965, several methods have been used to determine physicians’ rate(s) for each covered service. The sustained growth rate (SGR) system, established in 1998, has evoked negative consequences on physician payment(s). Based on the current Medicare expenditure index, practice expenses are projected to increase by 34.5% from 2002 to 2016, whereas, if actual practice inflation is considered, this increase will be 90%. This is in contrast to projected physician payment cuts that are depicted to be 51%. No doubt, this scenario will be devastating to many practices and the US medical community at large. Resolutions to this problem have been offered by MedPAC, the Government Accountability Office, physician organizations, economists, and various other interested groups. In the past, temporary measures have been proposed (and sometimes implemented) to eliminate physician payment cuts. At present, the US Senate and House of Representatives are separately working on 2 different mechanisms to address and rectify these cost-payment discrepancies. The effects of both the problem and the potential solutions on interventional pain management may be somewhat greater than those on other specialties. Physician payments in interventional pain management may evidence cuts of 10% to 15%, whereas if procedures are performed in an office setting, such cuts may range from 29% to 39% over the period of the next 3 years if the proposed 9.9% cut is not reversed. Medicare cuts also impact other insurance payments, incurring a “ripple effect” such that many insurers will seek to pay at or around the Medicare rate. In this manuscript, we discuss universal healthcare systems, the CMS proposed ruling and its attendant ripple effect(s), historical aspects of the Medicare payment system, the Sustained Growth Rate system, and the potential consequences incurred by both proposed cuts and potential solutions to the discrepant cost-payment issue(s). As well, ethical issues of policy development upon the infrastructure and practice of interventional pain management are addressed. Key words: Health policy, physician payment policy, physician fee schedule, Medicare, sustained growth rate formula, interventional pain management, regulatory reform, ethics
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Swords, Chloe, Reshma Ghedia, Hannah Blanchford, James Arwyn–Jones, Elliot Heward, Kristijonas Milinis, John Hardman, Matthew E. Smith, Manohar Bance und Jameel Muzaffar. „Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults“. PLOS Medicine 21, Nr. 4 (04.04.2024): e1004296. http://dx.doi.org/10.1371/journal.pmed.1004296.
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Background Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. Methods and findings A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. Conclusions The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.
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CRAWFORD, M. J., U. NUR, K. McKENZIE und P. TYRER. „Suicidal ideation and suicide attempts among ethnic minority groups in England: results of a national household survey“. Psychological Medicine 35, Nr. 9 (September 2005): 1369–77. http://dx.doi.org/10.1017/s0033291705005556.
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Background. Socio-cultural factors impact on the extent of suicidal ideation and attempted suicide but the relative importance of these factors among people from different ethnic groups in Britain has not been explored. We examined the prevalence of suicidal ideation, the incidence of attempted suicide, and the extent of service utilization following attempted suicide among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England.Method. We conducted a secondary analysis of data from the EMPIRIC study, a cross-sectional survey of 4281 adults aged 16–74 years, living in private households in England.Results. Lifetime suicidal ideation was generally lower in ethnic minority groups but higher among those born in the UK than those who migrated to England as adults. Risk factors for suicidal ideation have much in common across different ethnic groups; current symptoms of mental distress being the most important. White British and Irish respondents were twice as likely to receive medical attention following attempted suicide than those from other ethnic groups.Conclusions. Services need to adapt in order to ensure that people from ethnic minorities receive appropriate psychological and medical care following attempted suicide.
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Pierce, Elyse. „The Danger of Cultural Erasure in Inter-Ethnic, Inter-Religious, Trans-National Rescue During Genocide: A Comparison of the Shoah and the Bosnian Civil War“. Volume 4 4, Nr. 1 (01.08.2022): 16–28. http://dx.doi.org/10.33929/sherm.2022.vol4.no1.02.
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International genocide intervention strategies that involve the extended evacuation and/or displacement of refugees often save the physical lives of would-be victims at the expense of psychological and social trauma and cultural erasure. Through a comparison of the international rescue efforts of the Kindertransport program in Great Britain prior to and during the Second World War and the refugee caravans organized by La Benevolencija in Sarajevo during the Bosnian Civil War, the benefits and dangers of inter-ethnic, inter-religious rescue in times of mass violence are examined, along with how the social dynamics of racialized religious identification influenced the occurrence of these intervention strategies. The implications gleaned from this comparison offer guidance for current and future genocide intervention programs, where great care should be taken, whenever possible, to keep family groups intact and together, provide necessary psychological and social services for refugees, and allow for the continued practice of communal cultural and religious traditions without forced assimilation. The moment of physical rescue is only the initial component of a successful intervention into religio-ethnic violence; to truly prevent the genocidal destruction of a people and culture, those people’s ability to identify with their traditions and maintain their way of life is of equal and vital importance.
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Wheeler, V. W., und K. W. Radcliffe. „HIV Infection in the Caribbean“. International Journal of STD & AIDS 5, Nr. 2 (März 1994): 79–89. http://dx.doi.org/10.1177/095646249400500201.
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The Caribbean is a multi-ethnic region with many different cultural differences. The majority of the population is of African descent, but there are also other ethnic groups present such as Indians, Chinese, Syrians and Europeans. The Caribbean region is influenced by countries such as the USA, Great Britain, France and Holland. The countries of the Caribbean have a serious problem with HIV infection and AIDS. The epidemiology of HIV infection in this region, is different from most other parts of the world in that the mode of spread does not easily fit into any of the three WHO patterns. This review shows that the infection initially started in the homosexual/bisexual community, but since then, it has moved to the heterosexual population and this form of contact is now the main mode of transmission of the virus. The Governments of the Caribbean countries have realized the extent of the problem and have taken measures to try to control the epidemic.
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Bernis, Cristina, und Carlos Varea. „Pregnancy outcome and delivery in Spanish and migrant women: an ecological approach“. Anthropological Review 76, Nr. 2 (01.12.2013): 129–50. http://dx.doi.org/10.2478/anre-2013-0006.
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Abstract For most of our history as a species, maternal constraint was the main environmental factor affecting biological status at birth. However, the great increase in medical intervention in the20th Century coincided first with an extraordinary reduction in perinatal mortality and later with an increase in preterm and low birth-weight babies. Herein, we analyze these temporary trends in neonate biology in Spain, according to early viability (1980-2010) and ethnic variability (1996-2010). The aim of this study is to evaluate the interaction between maternal and medical environmental constraints affecting the biology of birth and to understand the observed ethnic differences and secular trends. All single births in Spain between 1980 and 2010 are included. Following descriptive analysis, logistic regression analysis was applied to evaluate the effect of secular trends, mode of delivery and mother’s origin on birth outcome after adjustment for other maternal bio-cultural factors. Results highlighted that mean birth weight decreased and prematurity increased in still births, live births and deaths before one day. In regard to ethnic differences, while there were no secular trends in weight by gestational age in the Spanish newborns, there was an increase among the newborns of foreign mothers. Spanish mothers experienced an increasing and higher frequency of low birth weight, while foreigners had an increasing and higher frequency of prematurity. Both groups, however, shared temporal reduction in gestational age, and although this was less marked in foreigners, it suggests a common trend related to medical care and increasing obstetric interventions
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Kotvitska, Alla, und Oleksii Prokopenko. „Determination of social and economic accessibility of drugs for treatment of Parkinson’s disease on the basis of modern approaches“. Pharmacia 67, Nr. 3 (15.09.2020): 173–79. http://dx.doi.org/10.3897/pharmacia.67.e46586.
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In the context of the economic crisis, the availability of medicines for the population is one of the key issues facing pharmaceutical sector of healthcare system. Due to the fact of that, the purpose of the work was to study the social and economic accessibility of medicines, since such studies in the future may provide an opportunity for effective input of medicines costs reimbursement system, which will increase their availability, especially for socially vulnerable groups of population. The data analysis of the clinical protocols of Great Britain, Kazakhstan and Ukraine was conducted, and the indicators of social and economic availability within 2014–2018 were calculated. The obtained results indicate an adequate level of availability of medicines for the able-bodied population and, unfortunately, a low level of accessibility of medicines for people of retirement age with a tendency to further descension. These results point the necessity of the further research and development of government control systems and provision of pharmaceutical care for the population.
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Andreev, D. A., und A. A. Zavyalov. „Organizing the national prostate cancer audit in the UK (review of foreign literature)“. Cancer Urology 17, Nr. 3 (11.11.2021): 154–64. http://dx.doi.org/10.17650/1726-9776-2021-17-3-154-164.
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Background. The growing number of patients with prostate cancer (PCa) imposes additional requirements on the quality control system in healthcare, including ensuring the widespread availability of innovative algorithms for early diagnosis and treatment. One illustrative example of quality management initiatives is national PCa audit in the UK. Objective. Highlighting the approaches to quality assessments within audit of PCa care in the UK.Materials and methods. The relevant scientific data have been retrieved from Google and PubMed. The search horizon covered the last 10 years. The queries included such wording as: "prostate cancer" AND "audit" OR/AND "Great Britain" AND "quality assurance", etc.Results. At least four basic parameters were used as signal indicators to check the consistency and overall quality of the collected data on PCa patients in England and Wales. The fundamental arrangement of clinical quality indicators for PCa care comprised not less than fourteen measures. The outliers for some indicators were allocated into two groups using such criteria as: 1) more than three standard deviations from the national average (definition of an alarm); 2) more than two but below three standard deviations from the national average (definition of an alert). The outlier policy is usually applied for three treatment outcome performance indicators.Conclusion. The multidisciplinary teams must actively collaborate to provide the best standards of cancer care to the community. The introduction of multicriterial assessments to monitor the performance of highly specialized professional groups would bring a great benefit for cancer patients, particularly, through increasing the affordability of state-of-the-art medical algorithms across the counties.
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Joseph, Pradeep. „Eliminating disparities and implicit bias in health care delivery by utilizing a hub-and-spoke model“. Research Ideas and Outcomes 4 (03.05.2018): e26370. http://dx.doi.org/10.3897/rio.4.e26370.
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The state of health disparities in the United States has remained relatively stable over a number of years. Although overall outcomes for all patients have improved, a difference persists in how different racial, ethnic, and gender groups have fared in our health care system. Many programs that have sought to combat this problem have been predicated on the belief that only a small number of providers in the medical community are aware of their own biases. Accordingly, it was believed that bias awareness is the direct conduit for this particular change in the health system. However, the results of such programs have been unsatisfactory. The reason for such ineffectiveness is that many programs have not taken into account the presence of implicit bias within the patient-provider relationship. This complex form of bias operates in specific ways, and must be dealt with appropriately. The use of digital checklists to aid in clinical decision making has proved to be both a way that patients can receive equitable care, and a way to improve overall patient outcomes. Secondly, in order to reach the most at-risk populations, health care must expand beyond the hospital walls, and out into the community. Nurse navigator programs have been shown to accomplish this with great success. Together, checklists and nurse navigators are the necessary next-step in the battle against health care disparities. What’s more, this two-pronged approach is relatively simple to implement. By making use of current electronic medical records, digital checklists can be quickly installed. Likewise, nurse navigator programs, a comparatively inexpensive option, can be rolled out quickly because of their simple design. A focus on the patient-provider relationship and community outreach is critical for progress in eliminating health care disparities.
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Douglas, Nerone K. O., Elizabeth A. Moroni, Carolyn De La Cruz und Francesco M. Egro. „Are We Speaking the Same “Language” Regarding Underrepresented Groups in Plastic Surgery and Increasing Diversity Within Our Field?“ Annals of Plastic Surgery 92, Nr. 4S (April 2024): S218—S222. http://dx.doi.org/10.1097/sap.0000000000003876.
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Background Plastic Surgery is one of the fields that lags behind the rest when it comes to surgeons from backgrounds underrepresented in medicine (URiM). Extensive research has shown that diversity in health care not only fosters inclusivity but also saves lives. The study aim is to quantify how many integrated plastic surgery residency programs have outlined criteria defining diversity goals and/or groups of people they consider to be URiM. Methods All American Council for Graduate Medical Education-accredited integrated plastic surgery program Web sites were reviewed for diversity missions/statements and explicit mentions of the racial and ethnic groups. Web sites were deemed “up-to-date” if they were last updated within 6 months before the initial data collection period. The data collection period was from November 20 to 29, 2022. Results A total of 86 program were reviewed. Only 8 programs (9%) had clear URiM criteria listed on their Web sites, whereas 26 (30%) relied on institution/department-wide criteria, 1 (1%) listed that they were adhering to American Association of Medical Colleges definition of URiM, and 51 programs (60%) had no form of definition for what is considered URiM. When looking at the programs that have some form of criteria for URiM (n = 35 [40%]), all programs (100%) considered African American/Black, Native American/Alaskan Native, Hispanic/Latinx, and Pacific Islander/Native Hawaiian as groups URiM. Assessing the same subset of programs that have a form of criteria listed (n = 35 [40%]), 19 (58%) had listed other groups outside of race/ethnicity considered to be URiM for their program, and 14 (42%) programs did not. Fourteen programs (74%) considered LGBTQIA+ as a URiM group. Conclusion and Significance There still is a great deal of heterogeneity among residency programs when it comes to identifying which medical students are URiM. Numerous plastic surgery organizations have placed diversity and inclusive excellence at the forefront of their agendas; however, it is critical that residency programs also actively align their efforts in an equitable and intentional way. This study serves to encourage residency programs to evaluate their mission toward diversity, equity, and inclusion and to spark discussion toward creating a clearer URiM definition to be consistent among all programs.
Dissertationen zum Thema "Ethnic groups – Medical care – Great Britain"
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Liu, Lixun. „Exploring ethnic inequalities in cardiovascular disease using Hospital Episode Statistics“. Thesis, St Andrews, 2009. http://hdl.handle.net/10023/819.
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Murphy, Richard. „Health professionals and ethnic Pakistanis in Britain : risk, thalassaemia and audit culture“. Thesis, University of St Andrews, 2005. http://hdl.handle.net/10023/2802.
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The central theme or 'red-thread' that I consider in this thesis is the concept of risk as it is perceived by and affects the two sides of the medical encounter -in this instance ethnic Pakistanis and Health Professionals- in Britain. Each side very often perceives risk quite distinctively, relating to the balance between the spiritual and temporal realms. This is particularly germane in matters to do with possible congenital defects within the prenatal realm for the ethnic Pakistani, and predominantly Muslim, side of this encounter. Thus one of the factors considered in this thesis is how senses of Islam impact upon the two sides. By ethnic Pakistanis Islam is seen as central to all life decisions, whilst Health Professionals view Islam with some considerable trepidation, little understanding it or its centrality to the former's decision-making processes. This is particularly significant with regard to attitudes to health and health care. In the initial stages of the project I had thought first cousin marriage (FCM), seen by ethnic Pakistanis as desirable and by Health Professionals as putting ethnic Pakistanis at-risk to be central to the argument, but concluded that concerns around FCM were a 'red herring', merely a trope for the tensions between the two sides -at once both British and at-risk from audit culture. Although no longer central, FCM remains a viable touchstone in consideration of the two sides' perceptions of genetic risk. In this thesis the medical encounter between ethnic Pakistanis and Health Professionals is performed within the realm of the so called New Genetics. Here the respective understandings of the New Genetics are informed by the enculturation processes that shape the two sides' world view. Furthermore, I will agree with Lord Robert Winston's and others' concern that any attempt to eradicate an adaptive genetic mutation, in this instance, thalassaemia, from the gene pool is not only undesirable in the short term, but also that such eradications may have an adverse, and far reaching, effect on whole population groups in the future. The main thrust of my argument is that audit culture not only compounds risk for both sides, but also perpetuates institutional racism within the National Health Service (NHS), by promulgating what I have called the language myth. That is to say that much institutional racism is the unwanted by-product of the NHS's attempts to become more patient centred and its continuing efforts to develop systems of best practice. This professionalisation process within the NHS can be seen to impact most strongly in relation to communication -particularly the claimed language barrier between the two sides. This 'barrier' has worrying policy implications for any meaningful communication between the two sides, notably relating to obtaining informed consent from ethnic Pakistani patients -with a resultant increase in risk for the two sides and clear economic consequences for the NHS.
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Martin, U., M. S. Haque, S. Wood, S. M. Greenfield, P. S. Gill, J. Mant, Mohammed A. Mohammed et al. „Ethnicity and differences between clinic and ambulatory blood pressure measurements“. 2015. http://hdl.handle.net/10454/9264.
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YesThis study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.
Bücher zum Thema "Ethnic groups – Medical care – Great Britain"
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We don't buy sickness, it just comes: Health, illness, and health care in the lives of Black people in London. Aldershot, Hants, England: Gower, 1986.
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Karseras, Patience. British Asians: Health in the community. Chichester: Wiley, 1987.
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Ahmad, W. I. U. 1957- und Race Relations Research Unit, Hrsg. The politics of 'race' and health. Bradford, West Yorkshire: Race Relations Research Unit, University of Bradford and Bradford and Ilkley Comminity College, 1992.
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Ghada, Karmi, Hrsg. The ethnic health handbook: A factfile for health care professionals. Cambridge, Mass., USA: Blackwell Science, 1996.
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Larkin, Mary. Vulnerable Groups in Health and Social Care. London: Sage Publications, 2009.
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McNaught, Allan. Health action and ethnic minorities. London: Published for The Resource by Bedford SquarePress, 1987.
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Great Britain. National Health Service. National Institute for Clinical Excellence. A guide for patient/carer groups: Contributing to a technology appraisal. London: National Institute for Clinical Excellence, 2004.
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Ahmad, W. I. U. 1957-, Hrsg. "Race" and health in contemporary Britain. Buckingham: Open University Press, 1993.
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Suman, Fernando, und Keating Frank, Hrsg. Mental health in a multi-ethnic society: A multidisciplinary handbook. 2. Aufl. Hove: Routledge, 2008.
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Suman, Fernando, und Keating Frank, Hrsg. Mental health in a multi-ethnic society: A multidisciplinary handbook. 2. Aufl. Hove: Routledge, 2008.
Den vollen Inhalt der Quelle findenBuchteile zum Thema "Ethnic groups – Medical care – Great Britain"
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Bonner, Thomas Neville. „Toward New Goals for Medical Education, 1830-1850“. In Becoming a Physician. Oxford University Press, 1996. http://dx.doi.org/10.1093/oso/9780195062984.003.0011.
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The years around 1830, as just described, were a turning point in the movement to create a more systematic and uniform approach to the training of doctors. For the next quarter-century, a battle royal raged in the transatlantic countries between those seeking to create a common standard of medical training for all practitioners and those who defended the many-tiered systems of preparing healers that prevailed in most of them. At stake were such important issues as the care of the rural populations, largely unserved by university-trained physicians, the ever larger role claimed for science and academic study in educating doctors, the place of organized medical groups in decision making about professional training, and the role to be played by government in setting standards of medical education. In Great Britain, the conflict over change centered on the efforts of reformers, mainly liberal Whigs, apothecary-surgeons, and Scottish teachers and practitioners, to gain a larger measure of recognition for the rights of general practitioners to ply their trade freely throughout the nation. Ranged against them were the royal colleges, the traditional universities, and other defenders of the status quo. Particularly sensitive in Britain was the entrenched power of the royal colleges of medicine and surgery— “the most conservative bodies in the medical world,” S. W. F. Holloway called them—which continued to defend the importance of a liberal, gentlemanly education for medicine, as well as their right to approve the qualifications for practice of all other practitioners except apothecaries. Members of the Royal College of Physicians of London, the most elite of all the British medical bodies, were divided by class into a small number of fellows, almost all graduates of Oxford and Cambridge, and a larger number of licentiates, who, though permitted to practice, took no part in serious policy discussions and could not even use such college facilities as the library or the museum. “The Fellows,” claimed a petition signed by forty-nine London physicians in 1833, “have usurped all the corporate power, offices, privileges, and emoluments attached to the College.”