Le politiquement incorrect en psychiatrie : l’expérience d’une vie professionnelle

The author criticizes theorists show, phenomenon of “administrative ecstasy”, and dominance of political correctness against truth and scientifically established facts. He tells three professional experiences where he refuses the official position, preferring the politically incorrect: mental report, AIDS in prisons, care reform in his own prison psychiatric department.     

Évaluation de la qualité de vie en oncologie: I—Définitions et objectifs

Résumé: En oncologie où lobjectif des traitements porte à la fois sur la quantité et sur la qualité de vie, lévaluation de la qualité de vie savère particulièrement pertinente. Le concept de qualité de vie se définit comme une perception subjective et globale. Son évaluation est multidimensionnelle et déterminée en fonction de définitions opérationnelles. Lévaluation de la qualité de vie permet délargir létude de limpact des traitements aux paramètres autres que biomédicaux, en particulier dans les situations au pronostic réservé ou face à des traitements defficacité équivalente. Les informations issues détudes de qualité de vie vont participer aux prises de décision thérapeutique. Elles se révèlent également utiles à lamélioration de la prise en charge globale du patient atteint de cancer, notamment par lidentification des besoins en soins de support. Cet article situe la problématique de lévaluation du concept de qualité de vie et en présente ses objectifs dans le domaine de loncologie.Dossier: «Évaluation de la qualité de vie»     

La réunion de concertation pluridisciplinaire : quelle place dans la décision médicale en cancérologie ?

Multidisciplinary meeting (MDM) in oncology has been institutionalised in France by the Cancer Plan. This study aims to determine the place of MDM in the decision process. From November 2004 to July 2005, we observed 29 meetings at the Tours Hospital and 324 case presentations, 80 in orthopaedics, 151 in gastroenterology and 93 in chest medicine. Forty physicians attending the meetings answered a questionnaire exploring their opinions on MDM and the collegial decision. We found that MDM is mostly the place for technical discussions and that patients’ wishes are rarely addressed. The different medical specialities are well represented but we observed that only physicians attend MDM. Decisions for straightforward cases are rapidly validated. For more complex clinical situations (25 to 40% of case presentations), the multidisciplinary approach allows to adapt guidelines or to choose alternative treatments. All the physicians interviewed express that MDM legitimates the medical decision. It occurs that they disagree with the RCP decision. We discuss how MDM impacts on the medical decision as well as the shift from the individual decision to the collective one, particularly in term of responsibility.     

Medical education and quality of decision-making: Is there an evidence-based relationship?

A medical decision when facing a clinical problem is the result of a complex process involving clinical reasoning and decision-making components. Several biases and external factors may influence this process. Educational interventions may be helpful to modify some of those factors and enhance the quality of decision-making, such as the training of clinical reasoning, making physicians aware of potential biases, or training them to use some tools brought by the evidence-based medicine movement. However, the impact of such interventions remains difficult to quantify because high-quality data are lacking and few studies really assess patient outcomes. This article reviews the available evidence of interventions aiming at improving the quality of decision-making and stresses the importance of involving clinician teachers in medical education research.