Why should the medical student study growth and development?There are 69.9 million people under the age of eighteen in the United States at present, and the U.S. government estimates that there will be 77.6 million by the year 2020. Health care for the majority of these youth is provided by primary care physicians who will need to understand the concepts of growth and development. Additionally, USMLE and COMLEX consistently include questions on normal growth and development. This reflects the national consensus that all physicians should be aware of these issues. Finally, human growth and development has have a profound...

The exciting new abilities that emerge during the period from 6 to 10 years of age and the implications for home and school development will be reviewed in this chapter. Current understanding of development from the neurosciences will be correlated with developmental landmarks. Common developmental problems that the physician will encounter will be highlighted, as well as more serious problems that require referral to a specialist. The physician’s approach to the child of this age will be highlighted.

During the adolescent’s rapid period of development, multiple new issues arise that the physician needs to understand. The public health aspects of...

The transition from childhood and adolescence to young adulthood is not clearly defined in Western industrialized nations. Landmark events such as the ability to obtain a driver’s license, vote, drink alcoholic beverages, and serve in the armed forces mark the transition. Other common milestones are the completion of one’s higher education, the requirement to pay taxes, moving out of the parents’ home, and the transition to independent living. Young adults are brought to adult courts, not the juvenile justice system, when they break the law.

This transition may occur at different times and in different ways for different youth. For...

Health, as described by Hahn and Payne (1998), is the blend of physical, emotional, social, intellectual, spiritual, and occupational resources that help one master the developmental tasks necessary for a satisfying and productive life. Each phase of life presents unique challenges that evolve over time. Even though people are living longer, perceptions of aging may evolve more slowly. Life expectancy continues to expand as a result of advances in medical technology; this has redefined the stage of life known as midlife. At the beginning of the twenty-first century, people forty to sixty years old are considered to be in midlife....

Sex is one of the most powerful basic drives affecting human behavior and one of the most pleasurable ways humans express love, intimacy, and closeness. Like those of hunger and survival, sexual impulses have a biologic diathesis but are modulated by cultural, psychosocial, and spiritual factors. Sexuality can also express aggression and interpersonal power issues, as in rape.

The fascination and, at times, obsession with sexuality is graphically depicted in ancient art. In many ways, little has changed regarding human sexuality over the last five thousand years. Society and culture play a vital role in defining normal sexual behavior.

Physicians...

Stress is a popular concept within the general public and is believed to be related to the development of disease. Neither patients nor physicians escape the daily stressors of life, and all must cope effectively with them or run the risk of adverse consequences. For the physician, it is important to understand the impact of stress on health, along with the origins of and treatment strategies for stress.

Emotionally stressed patientsvisit the doctor and are hospitalized more frequentlythan nondistressed patients.

People with emotional stresscommonly report physical symptoms and complaints(dizziness, headaches, fatigue, pain, etc.) and never report...

Sarah Smith is admitted to the hospital with severe abdominal pain. Andrew Jones, a third-year medical student, finds out that Sarah has a long history of alcohol dependence and has pancreatic cancer. Sarah grew up in poverty with an alcoholic father who physically abused her and her mother. Sarah is divorced. She is currently being treated for depression. During her hospital stay it was discovered that her cancer had spread, and her pain was increasing. During her stay in the hospital, Andrew got to know the patient and her family very well. In spite of heroic treatment, the prognosis for...

Substance use has been traced to the very beginning of human life. Opium poppies have been discovered in the caves of Neanderthal man. Throughout history man has sought new substances to alter mood, and, as we have evolved, so, too, have substance-related disorders. This chapter aims to introduce the reader to basic information regarding substances of abuse and the disorders that emerge from their use.

Joe, a forty-eight-year-old male manager of a grocery store, five feet six inches tall, weighing 215 pounds, comes to see Dr. Garbely, his family doctor. His wife is threatening to leave him if he doesn’t...

Violence in the United States is a national health issue. Millions of people are terrorized daily by the threats and actions of perpetrators of interpersonal violence. The occurrence of interpersonal abuse not only causes physical pain but also leads to intense emotional distress and lifestyle disruption and at times death. Violence against all people, especially women, children, and the elderly, is often unrecognized as a cause of illness and injury. All physicians and medical students should routinely screen for domestic violence. Action needs to be taken to identify and address physical and mental abuse issues, from treating injuries and providing...

Suicide is a leading cause of death in the United States and one that is potentially preventable. Physicians, medical students, and other health professionals must be aware of this important public health problem and be familiar with risk factors, evaluation strategies, and effective interventions. Patients who attempt or complete suicide have often seen a physician shortly before the act. Therefore, at least in some cases, there is opportunity to intervene.

1. How many individuals die by suicide each year in the United States?

a. 30 million

b. 15 million

c. More than 1 million but less than 15 million

d. Less...

The goal of this chapter is to provide the student with a historical framework in which to better understand the societal responsibilities demanded of physicians, the stressors that may exist, and the challenges physicians may face. The intention is not to alarm future physicians, but rather to proactively prepare them for the exciting professional journey they have chosen to take.

In virtually every culture throughout history, physicians have enjoyed being members of a highly regarded profession. This position of status has helped maintain a high level of competition to enter the field, regardless of financial reward. Requirements to gain admission...

At one time or another each of us has been a patient. We have had pain or an illness and needed medical care. Being sick is scary. Going to the doctor is scary. Clinicians often forget that the person in front of them is more than a chief complaint on another medical chart. That patient has feelings, wishes, and expectations—a whole personal history that is not apparent during the encounter, yet it is there. What the doctor says and does has an amazing impact on the patient. If the patient trusts the physician and feels cared for and respected...

Mental illness was described by the first civilizations as a manifestation of magical and evil forces. It was not until the ancient civilizations of Greece and Rome—through the writings of Hippocrates, Plato, and his student Aristotle—that rational explanations for mental illness existed. The Hippocratic authors were the first to describe mania, delirium, phobias, hysteria, and paranoia in a cogent and clinical manner. The Arabs were the first to build hospitals with psychiatric divisions (in Baghdad, a.d. 750) and asylums for the insane (in Damascus, a.d. 800). Over the centuries mental health care shifted from segregation to clinical treatment...

There have been dramatic advances in health in this century. Maternal mortality has gone from 73 to 8.8 per 100,000 live births. Life expectancy has gone from 47 to 78 years. Infant mortality has gone from 58 per 1000 to 7 per 1000. However, in the United States and around the world, social and economic factors influence access to and quality of health care. Those variations lead to dramatically different health outcomes. For example, over 1 million newborns die in sub-Saharan Africa on a yearly basis. For the most part, these infants could be saved with simple health care interventions...

Providing for the health needs of a nation’s population remains a complicated and controversial process, and different countries have adopted various strategies for managing the health care needs of their people. Nations such as Great Britain and Canada have historically adopted national health care systems that, in theory, provide everyone access to general medical care funded by the national government. Other countries, such as the United States, have developed a mixed system of public and private health insurance. Whether primarily public, private, or mixed, however, many systems are currently being reexamined as populations increase, funding and access to care are...