When competent patients make irrational choices
Developments in medicine during recent years have led to an emphasis on 'shared decision-making' between physician and patient, resulting in the genesis of complex, problematic issues. A review and discussion of some of these are provided, with a focus on the particularly troubling case of irrational decisions made by patients who are otherwise competent. What is the physician's role in such a situation? Patients' well-being must always be foremost, but their right to make their own decisions must also be protected. Some forms of irrational decision making that patients can display are elaborated. Patients may be biassed toward the present or near future, rather than toward the longer term, or may express the view that 'it won't happen to me'. Fear of treatment, even when the patient acknowledges it to be in his best interests, can lead to refusing physicians' recommendations. Patients may desire treatments that do not make sense, such as 'coining' (a form of treatment in some cultures); in such cases, physicians may respect patients' rights to pursue the option, as long as adequate treatment is also ongoing. So-called 'framing effects' - how an option is framed, or presented - affect decisions, too: if hypertension (high blood pressure) is lowered, the patient can either be told he will live longer, or that he is less likely to die earlier. Other types of irrational decision making stem from the tendency of insured patients, and their doctors, to select all available options, regardless of cost. Overuse of health care in such situations stems not from an individual patient's poor decision making, but, rather, from irrationality in the health care financing system. Individually rational decisions, such as to not vaccinate a child because the (correctly) perceived threat of infection is low, could affect the community negatively if extended to the larger group. Patients do not have the right to endanger other people, even if their own decision making process is rational. It is important for physicians to distinguish between irrational and unusual decisions, and to keep in mind the complexity of this entire issue. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Privatization from the acquirer's perspective: a mergers and acquisitions based framework
Privatization, especially in developing countries, presents international firms with opportunities for market entry and growth, but acquirers have to consider the distinct characteristics of a state owned enterprise (SOE) and the influence of the government as seller and policy maker. This study introduces a model, based on mergers and acquisitions literature and microeconomic theory, that explains the critical relationships among characteristics of the SOE, the government, and the acquirer. Public administration research suggests that the critical characteristics of SOEs are their sources of funding and their mode of social control of the organization, and recent work in privatizing countries emphasizes the influence of the government. The theoretical framework for the model suggested here is derived from research within the field of strategic management on mergers and acquisitions. The paper develops propositions regarding the organizational fit between private firms and those heretofore owned by governments and discusses research and managerial implications. (Reprinted by permission of the publisher.)
Publication Name: Journal of Management Studies
Subject: Business, general
Transforming an organization through teamwork
Chrysler Corp. has changed its management philosophy from one that emphasized centralized control into one that uses the team concept to effect cost reduction and generate increased productivity. This transformation has generated positive results although the process is still incomplete. The team effort is reinforced by the concept of leadership as not simply a monitoring and directing job, as in the early days, but also a coaching and inspiring activity.
Publication Name: Mid-American Journal of Business
Subject: Business, regional
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