In another case order generic cytotec medications like xanax, a Master failed to administer penicillin to a burned seaman generic cytotec 200mcg mastercard treatment strep throat, although it was available order cytotec with amex symptoms genital herpes, and to render first aid treatment although the ship passed within a mile of a first aid station. On the other hand, a slight injury to a seaman’s finger did not require landing at some port before the ship reached its destination, since it could not be fairly inferred that neither the seaman or the engineer who extracted the steel from the injured finger anticipated that the slight wound would amount to anything serious. In this case, the finger eventually 12 required amputation due to complications secondary to infection. Once it is determined that medical care is needed and the Master determines that the seaman should see a doctor, the ship owner’s responsibility does not end. Since medical services are provided under both contract and statute, negligence of the doctor can be imputed to the ship owner-employee, even if the ship’s Master took due care in selecting a reputable physician to treat the 13 seaman. These cases involving physicians demonstrate two ways that the ship owner may be found negligent. One is improperly providing for seaman care, including the negligent selection of a doctor; the other is in the negligence of the doctor as a practitioner. In determining negligence, the jury or the judge must take into account such factors as whether the ship was at sea or in port; if in port, what medical facilities were available, were such facilities obviously limited or inadequate; and what means were reasonably obtainable to transfer the seaman to the nearest adequate facility. When a carrier does employ a doctor for the convenience of the passengers, the carrier has a duty to employ one who is qualified and competent. But, if the doctor is negligent in treating a passenger, that negligence will not be imputed to the 9 th Point Fermen, 70 F. The reason for this position is that the ship owner cannot interfere with the passenger-doctor relationship, and the ship owner cannot supervise the doctor, since the ship owner is not qualified to do so. This position 15 is extended to physicians providing medical advice offshore by radio. In one case, a physician was not called for a sick seaman until 15 hours after the arrival of the ship into port. In another case, a hospital discharged a seaman on the basis that a hospital in another port, seven sailing hours away, could better handle the case of a perforated ulcer. The ship’s departure was delayed for several hours, and the Master on arrival in the second port failed to call a doctor for another several hours. In yet another case, a seaman fell and broke his leg on board a ship while intoxicated. He was not shown to have suffered any ill effects from the delay in hospitalization 18 and was not entitled to recover. Similarly, a ship owner was held not liable under the Jones Act where the Master informed his first mate that he had been struck by a steering wheel. Since the first mate had repeatedly asked the Master whether he desired medical assistance and on each occasion the Master declined, the ship owner was found not to be liable. In another case where a seaman who was being treated in a hospital left before he was cured, no negligence was found when the seaman further injured himself. The above cases are mentioned only as examples of what is required of the crew in order to meet their obligation to provide adequate medical care at sea. Unlike the situation on land, where one voluntarily renders aid to a stranger, at sea there is legal duty to provide reasonable medical care under the relevant circumstances. The actions of the Master may, in certain situations, bind the vessel’s 14 th Barbetta v. The Master stands in loco parentis and has the duty of looking out for those aboard the vessel. This duty applies to situations that may be potentially hazardous, cases of actual injury or illness, discovery of a crew member missing at sea, and death of a crew member. Congress enacted specific statutes regarding provisions and accommodations for crew members, and these statutes provide for the personal liability of the vessel’s Master in the event the statutes’ dictates are not followed. Naval vessel, to Coast Guard officials, to American Consuls abroad, or to customs officials regarding inadequate or poor provisions aboard merchant vessels. Upon investigation, the authorities will notify the merchant vessel’s Master in writing if they find that the crew members’ charges are valid. If no action is taken by the Master to remedy this potential health problem, the Master is personally liable to a fine of $100. On the other hand, should investigations by the government officials prove that the provisions aboard the vessels are adequate, then the complaining crew members will be fined in the 19 amount of such investigation costs. When a seaman becomes injured or ill at sea, the Master is responsible for providing reasonable medical care aboard the vessel. This includes first aid, and such treatment in medicine as the competency of the Master or ship’s Doctor, if one is aboard, is able to provide. The Master must also decide whether or not to proceed to the next scheduled port of call or to deviate to some closer port in order to obtain medical attention. The availability of medical facilities should always be considered when determining the best course of action in treating a medical emergency. The reasonableness of the Master’s decision will likely be the conduct measured in the event that his or her deeds are later called into question. Considerations should be given to such means as: the accessibility of radio contact with a physician, the distance from medical evacuation by air, distance to the nearest port, the likelihood of securing competent medical care at the nearest port, the nature and severity of the injuries sustained by the crew member, and any advice offered by medical professionals during remote consultations. The many advances in electronic communications from scheduled Morse code to satellite conversations on demand have brought the patient at sea closer to 19 Jones Act, 46 U. Even with a physician on a satellite communications device, the decision of when to treat aboard and when to evacuate a medical casualty is a case by case decision. The historical root of an obligation to evacuate a medical casualty when 20 adequate care is not apparent aboard the ship is rooted in a 1900 case involving a seaman who fell from the yards of a vessel while rounding Cape Horn, sustaining injuries including a broken leg. The ship’s Master and the carpenter set the leg, and the vessel arrived in San Francisco months later. The mariner recovered from his other injuries but his leg did not heal and ultimately led to the amputation of the limb. The disabled crew member sued the Master for failing to put into port for proper medical attention. The Supreme Court concluded then that the circumstances dictate the necessary decision, and that in this case, the Master should have sought medical attention beyond that which was available aboard the vessel. The case affirmed the historical duty of the ship owner and Master to provide proper medical treatment and attendance for a mariner taken ill or sustaining an injury in the service of the owner’s ship. The court in that case stated: “We cannot say that in every instance where a serious accident occurs the Master is bound to disregard every other consideration and put into the nearest port, though if the accident happened within a reasonable distance of such port, his duty to do so would be manifested. Each case must depend upon its own circumstances, having reverenced to the seriousness of the injury, the care that can be given the sailor on ship board, the proximity of an intermediate port, the consequences of delay to the interests of the ship owner, the direction of the wind and the probability of its continuing in the same direction, and the fact whether a surgeon is likely to be found with competent skill. With reference to putting into port, all that can be demanded of the Master is the exercise of reasonable judgment, and the ordinary acquaintance of a seaman with the geography and resources of the country. He is not absolutely bound to put into such port if their cargo be such as would be seriously injured by the delay. Even the claims of humanity must be weighed in a balance with the loss that would probably occur to the owners of the ship and cargo. A seafaring life is a dangerous one, accidents of this kind are peculiarly liable to occur, and the general principle of law that a person entering a dangerous employment is regarded as assuming the ordinary risks of such employment is peculiarly applicable to the case of seamen. If an incorrect decision is made, the most likely result will be a civil suit against the vessel owner by the injured or ill crew member, a suit which will not involve the vessel’s Master. However, it should be remembered that any decision made regarding deviation or even treatment of a crew member may be scrutinized by the U.
Breast cancer survival statistics: Cancer Re- high-level evidence from research syntheses to identify diseases van Palenstein Helderman W buy cytotec 200 mcg with visa medicine 7 years nigeria, Holmgren C buy 200mcg cytotec mastercard symptoms 5 months pregnant, Monse B purchase discount cytotec on line medicine 6 year course, Benzian Marcenes W. Prevention and control of caries in low- and middle-income 2010: A systematic review and meta-regression. Hoboken: Wiley-Blackwell; Marcenes W, Kassebaum N, Bernabe E, Flaxman A, Naghavi M, funding. Collaborating Centre for Education, Training and Research in Otomo-Corgel J, Pucher J, Rethman M, Reynolds M. State of the Johnson N, Warnakulasuriya S, Gupta P, Dimba E, Chindia M, Chapple I, Genco R. Child, family, and community in- 24–25 Periodontal disease – Patient testimonies/What can Tonetti M, Van Dyke T. Periodontitis and atherosclerotic cardiovas- fuences on oral health outcomes of children. 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Asthenia is frequent with sometimes a negative impact on school and socio-professional life order generic cytotec on line medications in checked baggage. Hepatosplenomegaly sometimes causes painful abdominal distension which may obstruct breathing order discount cytotec on-line medicine quizlet. Onset is usually in the infant aged from 3 to 6 months (sometimes discount cytotec 100 mcg with visa symptoms quitting tobacco, in utero) with systemic toxicity, hepatosplenomegaly and an early and severe neurological syndrome. The first signs are oculomotor paralysis or bilateral fixed strabismus associated secondarily with bulbar signs and in particular, severe swallowing disorders, gradually worsening spasticity and choreoathetosic movements. Convulsions occur later and lead to myoclonic epilepsy resistant to antiepileptic treatments. Certain patients have moderate systemic involvement associated with ophthalmoplegia as the only neurological symptom. Variable neurological signs are seen in more severe forms: Supranuclear horizontal ophthalmoplegia, progressive myoclonic epilepsy, cerebellar ataxia, spasticity and dementia. It is detected at the foetal stage and is characterized by foetoplacental anasarca, hepatosplenomegaly, ichthyosis, arthrogryposis, and facial dysmorphia. It is implemented by: Lysosomal storage disease or metabolic disease reference centres and their corresponding network of contact(s); The specialists most often involved are: paediatrician, internist, haematologist, rheumatologist, neurologist, and gastroenterologist; The primary care physician ; Any other specialist whose opinion is required according to the clinical picture. The following signs should be sought during the interview and physical: Asthenia, which is frequently observed and may have a negative impact on school and socio-professional life; Growth retardation or delayed puberty; Splenomegaly, which is sometimes very severe and observed in 95% of patients; sometimes painful spleen infarct. It may result in: Crises of disabling hyperalgic pain caused by bone infarcts and aseptic osteonecrosis; Pathological fractures; Vertebral compression; Chronic pain; Deformities. Involvement of other organs with rarely: Pulmonary lesions (lung fibrosis, secondary restrictive syndrome with deformity of the spine, pulmonary hypertension); Cardiac lesions (interstitial infiltration of the myocardium or pericardium); Pigmentation of the skin and ocular, gastrointestinal or renal involvement is very rare. It associates: Systemic involvement with hepatosplenomegaly; An early and severe neurological syndrome; The first signs are oculomotor paralysis or bilateral fixed strabismus secondarily associated with bulbar signs, in particular severe swallowing disorders, progressive spasticity and dystonic movements; Convulsions occur later, with the onset of myoclonic epilepsy resistant to antiepileptic treatments. Neurological involvement occurs later and progression is more gradual than in type 2. Certain patients have moderate systemic involvement and associated ophthalmoplegia is the only neurological symptom. It is suspected in the event of foetal deaths in utero, unexplained foetal anasarca, foetal organomegaly and thrombocytopenia, immobility, skin abnormalities (collodion baby). It is crucial to establish the diagnosis of these forms for subsequent prenatal diagnosis: From autopsy data, after birth of a dead foetus or neonatal death; From the assay of glucocerebrosidase and/or genotyping using a skin biopsy culture or an amniotic fluid specimen; By genotyping the parents. This determination must be made by a specialized laboratory committed to quality control procedures. It is usually carried out on the patient’s blood or during prenatal diagnosis, on total white blood cells or better on mononuclear cells, using synthetic substrates. If there is a discrepancy between the clinical and biochemical findings, a skin biopsy must be made to obtain a fibroblast culture on which to check glucocerebrosidase enzyme activity. In patients with a history of splenectomy, the complete blood count may be modified and must be interpreted accordingly. If abnormal clinical or biochemical coagulation values are obtained, a coagulation specialist should be consulted. Vitamin B12, serum folates In the case of a suggestive abnormality of the complete blood count. The myelogram and certain other investigations are performed to investigate these cases and guide diagnosis by demonstrating the presence of Gaucher cells. However, the presence of Gaucher cells is insufficient and enzymatic confirmation is mandatory. The presence in a patient of the N370S (or 1226G) mutation in a homozygote or heterozygote state rules out the risk of neurological involvement (types 2 or 3), but is not predictive of the severity of the bone and visceral involvement. Certain homozygous N370S/N370S patients may remain asymptomatic for a very long time. Patients homozygous for the L444P (or 1448C) mutation have a very high risk of developing neurological disease. Patients homozygous for the D409H mutation have a characteristic heart valve disorder. Determination of bone age (reference values are established using: anteroposterior view of left wrist and hand or anteroposterior and lateral view of elbow depending on age) The radiographs show in order of decreasing frequency: Deformities (remodelling disorder of the lower extremity of the femur: Erlenmeyer flask deformity in 80% of the cases); Sequelae of bone infarction (osteosclerosis) Aseptic osteonecrosis which may involve the femoral and humeral heads, femoral condyles, tibial plateaus and rarely the feet (astragalus, calcaneum), jaw; Lytic lesions; Cortical thinning; Vertebral compression, fractures; Osteomyelitis (very rare); Osteoarthritis complicating osteonecrosis; Prostheses or their complications (unsealing, wear, infection). Thechnetium-99m bone scan This is non-specific, but it may in certain cases pinpoint and evaluate the extension of atypical lesions requiring complementary imaging. Whatever the method used, the radiologist must be able to quantify the degree of bone infiltration. To inform couples at risk about the probability of transmitting the disease in homozygote form and the potential clinical consequences of such transmission. The family index case and the 2 parents must be studied before carrying out prenatal diagnosis. This is performed by: Determining the genotype of foetal cells by trophoblast biopsy (10-12 weeks of amenorrhoea), or amniocentesis (from 15 - 16 weeks of amenorrhoea) if mutations of the index case index have previously been identified. Assay of glucocerebrosidase activity in trophoblast cells or amniotic cells if no mutation could be identified in the genetic study of the index case. Self management education must ensure that both the patient and his close relatives have a good understanding of the information provided. Home infusion procedures should be explained: contact with nursing staff, infusion equipment, need for the presence of a third person during infusions, conduct in the event of adverse effects, handling of home generated medical waste (syringes, needles), patient healthcare record filled in by the medical and ancillary medical staff; When treatment is administered at home, the patient must obtain the treatment from the hospital nearest his/her home. These associations help improve patients’ overall management by encouraging cooperation between patients, patient associations and care providers. If for a specific reason this is not the case, and more generally, whenever a drug is prescribed in circumstances other than those given in the Marketing Authorisation, this is the responsibility of the prescribing physiscian; who must specifically inform the patient of this. The efficacy of this treatment, which is administered orally, has been demonstrated later in the disease and seems to be lower than that of enzyme replacement therapy. Its long-term efficacy and the incidence of adverse effects are currently under evaluation. Specific treatment is not indicated if all the criteria below are combined (pauci-symptomatic form): Platelets > 80,000/mm3 on 3 determinations (haemoglobin > 10. A decision on individual treatment for any patient not entering into the above 2 categories, must be taken after multidisciplinary discussion by experts at a designated reference centre. Miglustat may only be used for second-line therapy and its use is restricted to patients in whom enzyme therapy is impossible because of: Refusal of enzyme replacement treatment by the patient (refusal of infusions); Severe intolerance of imiglucerase making its safe reinstitution impossible. A reduction in splenomegaly and hepatomegaly is noted after 1 to 2 years of treatment and continues to be stabilized for 3 or 4 years. A radiological response on bone abnormalities seems to occur after 3 to 4 years of treatment. Interruption of treatment generally leads to a recrudescence of clinical signs and this is often preceded by a worsening of laboratory parameters. Substrate-reduction therapy (miglustat) reduces the volume of the liver and spleen. However it has a lower efficacy on haematological parameters and the improvement occurs later.
Eric Lederman cytotec 200mcg 5 medications related to the lymphatic system, a physician 200mcg cytotec with mastercard symptoms 14 dpo, psychiatrist buy 100mcg cytotec overnight delivery administering medications 6th edition, homeopath, and naturopath who introduced me to the subject of nutrition when I was probably too young to appreciate it fully. I remember very clearly his advice that to understand dietary treatment, one had to experi- ment on oneself. Self-observation and self-knowledge derived from trial-and-error experimentation with oneself are absolutely essential to get the feel of the far-reaching effects of dietary change, supplementation, and all the other aspects of lifestyle manipulation. Through such observation, one is easily convinced that the essential aspect of self-regulation is the body’s ability to register what it needs. For example, we know that the body can be quite subtle in its appreciation of nutritional deficiencies. Some women get marked cravings for meat in the face of a falling iron level, and pregnancy seems to be a time when cravings and aversions reflect organismic needs to nurture and protect the fetus. Surprisingly, we pay little attention to this abil- ity, which is often overridden or obscured by habits and expectations. The epidemic of weight problems (overweight and underweight) in our culture Chapter 2 / The Art of Nutritional Medicine: Patient-Centered Care 39 is eloquent testimony to the fact that even the simpler aspects of dietary self- regulation are a challenge to many. It is easy for the physician to take over the body’s authority and impose his or her ideas of what is right for the person. This may be acceptable as a temporary expedient, but it keeps the patient powerless and dependent. The healer’s role is in fact to help patients reestablish their organismic sensitivity and to learn what they in their uniqueness require and when they require it. Actually, people often know what they require, but they may not have the words to express what is needed or believe that they do not have permission to speak. Often psychologic methods, such as Gendlin’s32 focus- ing or guided imagery, can help increase sensitivity to the body’s signals and the interpretation of these signals. The practitioner provides feedback to the client at many levels, and the client receives feed- back at many levels from the process of enlightened experimentation. The keys are client willingness, active participation, and intelligent appreciation of the process. The practitioner must complement these qualities in an equal partnership with the patient and always be willing to admit ignorance. This produces a special sort of relationship in which mutual feedback is food for the treatment process. Self-regulation also ensures that the body is very “for- giving” of treatment mistakes and excesses. Thus the body detoxifies thera- peutic poisons, rids itself of excesses, and may not immediately protest when we are on some new yet unproductive treatment path. Tintera J: The hypoadrenorortical state and its management, New York State Journal of Medicine 35(13), 1955. Svoboda R: Prakruti: your ayurvedic constitution, Twin Lakes, Wis, 1989, Lotus Press. Arraj J: Tracking the elusive human: an advanced guide to the typological worlds of C. Lee R: Protomorphology: the principle of cell autoregulation, 1947, Lee Foundation. Doolittle J: The evolution of vertebrate blood coagulation, Thromb Haemost 70:24-8, 1993. Health is the result of balanced interchange between mutually interacting physiologic processes: a change in one system affects the function of the entire organism. Homeostatic mechanisms interact to maintain bodily functions within viable limits. Negative feedback systems tend to minimize fluctuations and restore the status quo. The nervous system trans- mits messages as electrical impulses along neural pathways, and the endocrine system conveys chemical information in the blood and interstitial fluid. Three prerequisites to a homeostatic system are a receptor, a control center, and an effector. The control center determines the set point at which a process is to be maintained. The effector provides an afferent pathway that feeds information back to influence the stimulus. Consistent with the infomedical model, the flow of information in a homeostatic feedback sys- tem is circular, rather than linear. Multiple triggers, interacting at the level of diverse organ systems, converge and diverge at various interfaces to deter- mine health or disease, wellness or dysfunction. Nutrition is one factor that contributes to the cybernetic circularity of mutual causality. This chapter explores how diet, herbs, and supplements can modify phys- iologic and pathologic mechanisms. It demonstrates how biologic plausibil- ity provides a sound basis for guiding investigation into nutritional 41 42 Part One / Principles of Nutritional Medicine management and shows how the complex interactions involved in home- ostasis make it difficult to accurately predict clinical outcome despite sound pathophysiologic principles. They continually adjust the system to maintain function within an acceptable range. A negative feed- back system is one in which the afferent pathway depresses the control mechanism and seeks to neutralize the input. Examples include control of blood glucose levels, blood pressure, heart rate, and respiratory rate. A negative feedback system dampens biologic responses, keeping them within an acceptable physiologic range. Glucose is the major source of fuel for all cells; it is immediately available from the blood, and the levels are replenished as required. The gastrointestinal tract extracts simple sugars from foods and absorbs monosaccharides into the bloodstream, elevating the blood sugar level. As organs extract glucose from the bloodstream to meet their particular metabolic requirements, blood glucose levels start to fall. Glycogen, the storage form of carbohydrate in animals, is then con- verted to glucose. Glycogen, the human equivalent of starch in plants, is pro- duced and stored in the liver and skeletal muscle. The liver stores about 100 g of glycogen and provides an immediately available reserve of glucose (see Figure 3-1). Under aerobic conditions, pyruvate enters the tricarboxylic acid cycle and generates reduced nicotinamide adenine dinucleotide and the reduced form of flavin adenine dinucleotide, which produce cellular energy via the electron transport chain. Hepatic glycogen can maintain blood glu- cose levels for about 4 hours after absorption.
The following section provides a description of the literature search strategy used generic cytotec 100 mcg with mastercard treatment ulcer, followed by an overview of thyroid disease cytotec 100 mcg for sale symptoms 5 days before missed period. The conceptual framework for the study is described cytotec 100 mcg low cost symptoms vaginal yeast infection, and a review of the literature related to the chosen methodology is given. A thorough review of the literature on the doctor-patient relationship, the culture of the medical profession, diagnostic bias, and gender differences in communication is given. The initial search included the use of the terms women and thyroid disease and was expanded to include the terms diagnosis, treatment, gender, and doctor-patient relationship. Upon collection of relevant articles, the following search terms were added in June 2009: diagnostic bias, culture and medical profession, doctor education, gender differences and communication, attitudes, perceptions, power, empathy, patient autonomy, patient competence, and patient credibility. Between September 2009 and October 2010, a review of the reference lists in each article resulted in the collection of additional journal articles and books. Between November 2010 and February 2012, the aforementioned databases were searched for articles related to conducting research on the Internet. The following search terms were used: online research, Internet research, online interviews, synchronous, asynchronous, chat, and ethical considerations. In September 2012, an additional search of the aforementioned databases was conducted to gather articles regarding economic issues associated with chronic illness. The following search terms were used: chronic illness and economic issues, misdiagnosis and delayed diagnosis, and healthcare costs. In December 2012 and January 2013, the aforementioned databases were searched in order to gather literature about the steps that various research, educational, and medical institutions have taken to enhance awareness of gender issues in medicine. The following search terms were used: women and medical 24 profession, women and inclusion and research, doctor-patient relationship and gender, and doctor-patient relationship and women. After conducting the study and writing Chapter 4, I searched the aforementioned databases one more time in order to ensure that Chapter 5 would be written with consideration of the most recent literature available. From March 2015 through June 2015, the following search terms were used, and the resulting literature was incorporated into Chapters 1, 2, and 5: women and thyroid disease, diagnosis and treatment, natural thyroid medication, doctor-patient relationship, gender, shared decision making, patient self-advocacy behaviors, switching doctors, self-medicating, health information-seeking, and patient education level. Thus, searching of the literature took place from March 2009 through January 2013 and then again from March 2015 through June 2015. Thyroid disease is more prevalent in women than men, regardless of culture, and occurs in approximately 1 out of every 7 women (Canaris et al. Women’s risk for developing thyroid disease increases with age (about 20% in women over age 60; Godfrey, 2007). Hyperthyroidism and hypothyroidism are the two predominant conditions that result from thyroid disease, with Grave’s disease and Hashimoto’s disease, respectively, as the most common causes (Zeitlin et al. Other symptoms associated with hyperthyroidism include heat intolerance, hot flashes, absent menses, insomnia, decreased libido (Godfrey, 2007), rapid heartbeat, sweating, and tremors (Aslan et al. Grave’s disease, an autoimmune form of thyroid disease, is the most common cause of hyperthyroidism in the United States (Bunevicius & Prange, 2006; Goolsby & Blackwell, 2004). Other symptoms that tend to occur with hypothyroidism include fatigue (Bono et al. In extreme cases, the individual may experience slowing of thought processes, progressive cognitive impairment, hallucinations, and delusions (Bono et al. Hashimoto’s disease, an autoimmune form of thyroid disease, is the most common cause of hypothyroidism in the United States (Erdal et al. It is important to note that the most common causes of thyroid disease are autoimmune in nature, as autoimmune diseases tend to co-occur. In fact, approximately 26 25% of women who have an autoimmune disorder will develop thyroid disease (Godfrey, 2007). A definitive diagnosis of thyroid disease requires a physical examination and thorough history of the patient (Goolsby & Blackwell, 2004). Diagnosis Making a definitive diagnosis of thyroid disease has shown to be challenging due to a number of factors. In addition, although approximately 13 million Americans with thyroid disease remain undiagnosed (Goolsby & Blackwell, 2004), the U. Preventive Services Task Force indicated a lack of evidence for recommending for or against routine screening for thyroid disease in adults, thus leaving the use of this potentially beneficial diagnostic measure to the discretion of individual practitioners (Helfand, 2004). Even further, thyroid disease is often mistaken for other conditions due to the similarity in its symptoms to other disorders such as major depression, bipolar depression (Aslan et al. Thus, a thorough assessment, including a physical examination and complete history of the patient, is vital for ensuring proper diagnosis and treatment of an individual with thyroid disease (Goolsby & Blackwell, 2004). However, remission rates are variable and relapses are frequent when antithyroid drugs are used alone (Goolsby & Blackwell, 2004). Some experts recommend the addition of T3 (liothyronine; name brand Cytomel) for its antidepressant effects (Dayan, 2001; Joffe, 2006). Effective treatment of thyroid disease depends upon an accurate diagnosis of hyperthyroidism or hypothyroidism (Cappola & Cooper, 2015; Goolsby & Blackwell, 2004; Heinrich & Grahm, 2003; McDermott & Ridgway, 2001). Regular monitoring of the thyroid patient’s symptoms and interpreting blood work are necessary for determining treatment effectiveness. Thus, in cases in which physicians do not use all three main thyroid function tests, thyroid patients often experience chronic or worsening symptoms (Bunevicius & Prange, 2006; Heinrich & Grahm, 2003; McDermott & Ridgway, 2001). Diagnostic and treatment challenges related to thyroid disease underscore the importance of an effective doctor-patient relationship (Copeland et al. Female thyroid patients’ experiences of treatment and the doctor- patient relationship might be best understood through the lens of social constructivism and feminism, as both worldviews emphasize individuals’ experiences in social contexts (Hearn, 2009; Docherty & McColl, 2003). Conceptual Framework In this study, data interpretation was guided by social constructionism and feminist theory. Themes related to the culture of the medical profession, diagnostic bias, and gender differences in communication—all of which are discussed later in this 29 chapter—were identified. Social Constructionism Lupton (2003) and Martin and Peterson (2009) described the trajectory in medical thought by which social constructionism arose as a response to the biomedical model (p. This model located disease in specific parts of the body and reduced medical concerns to mechanistic processes. In the 1950s, as a response to the biomedical model, Talcott Parsons developed the functionalist perspective, in which the role of a sick individual is seen as a social response to the deviant place in society occupied by persons with poor health (Martin & Peterson, 2009). In the functionalist perspective, patients desire to be accepted by society and therefore seek verification from doctors that they are not malingering (Lupton, 2003). Although Parson’s work is acclaimed for identifying the role of society in understanding illness, the functionalist perspective has been criticized for characterizing patients as passive and grateful, while doctors were portrayed as universally competent and altruistic. In addition, according to Lupton (2003), the functionalist viewpoint did not take into consideration the potential for conflict within the doctor-patient relationship. The social constructionist model emerged in the 1980s in response to these criticisms. In this perspective, all medical issues, including health, chronic illnesses, and medical care, are socially constructed facts that are subject to varying degrees of consensus and interpretation due to cultural factors and social norms (Docherty & McColl, 2003; Fernandes et al. In other words, in the management of illness, both the patient and the doctor are influenced by their individual beliefs and experiences and the society in which they live. Thus, the social constructionist perspective is appropriate to the qualitative study of health and disease, which takes as its data the personal experiences, perceptions, observations, and narratives of individuals (Creswell, 2007; Hearn, 2009). The logical positivist perspective, commonly used in quantitative research, involves an assumption that there are stable, social facts with a single reality, separated from the feelings and beliefs of individuals (Creswell, 2007).