Emeritus Faculty-Med Ctr Line, Medicine
Director, Center for Education in Family and Community Medicine, Stanford School of Medicine (2002 - 2009)
Honors & Awards
Physician Of The Year, California Academy of Family Medicine (April, 2006)
Humanism in Medicine National Award, American Association of Medical Colleges (2003)
Compassion in Medicine Award, Lance Armstrong Foundation and Stanford Medical Student Association (2003)
Kaiser Award for Excellence in Clinical Teaching, Stanford School of Medicine (2001)
M.D., University of Calgary, Medicine (1989)
Ph.D., Michigan State University, Clinical Psychology (1979)
Current Research and Scholarly Interests
Physician-patient communication; cross cultural dimensions of health care; strategies for health maintenance and promotion; integrative medicine.
Use of traditional medicine by immigrant chinese patients
57th Annual Meeting of the Congress-of-Neurological-Surgery
SOC TEACHERS FAMILY MEDICINE. 2007: 195–200
Chinese immigrants constitute the largest group of foreign-born Asians living in the United States. Knowledge of their use of traditional Chinese medicine (TCM) is limited. A survey was conducted to determine their TCM use and to evaluate physician awareness of these practices.Structured interviews were conducted with 198 Chinese immigrant patients, and a survey was administered to 17 physicians in two federally funded community health clinics.Nearly 100% of the patients had used TCM during the previous year, mostly for musculoskeletal or abdominal pain, fatigue, and health maintenance. Self-medication with herbal products was the most common (93% at least once, 43% weekly). A smaller number (23%) had used herbs prescribed by a TCM provider. Use of acupuncture was less common (14%), although higher than the national average. Most patients indicated a preference to consult Western physicians for acute infections. Only 5% reported that their physicians had ever asked about their use of TCM. By contrast, 77% of physicians reported that they "usually or sometimes" asked about TCM use.Results suggest that these patients used TCM, primarily self-prescribed over-the-counter herbal preparations, for many health problems. Information about use was not shared with their physicians, nor did patients perceive their doctors as soliciting sufficient information on TCM use. Physician education in this area may be warranted.
View details for Web of Science ID 000247796900012
View details for PubMedID 17323211
Family medicine in Iran: The birth of a new specialty
2005; 37 (7): 502-505
Since the revolution of 1978-1979, the government of Iran has worked toward development of a primary health care system to improve basic health for its citizens. Although infant mortality and other parameters have improved, increasing urbanization and poor lifestyle choices continue to present major challenges to improving overall health statistics in the country. Generalist physicians, with no training beyond medical school graduation, have not inspired confidence from patients or specialist colleagues. Therefore, many patients prefer to receive care for common health complaints from specialist physicians. Health care for many individuals tends to be episodic, driven by patient concerns for acute illness rather than by patient-centered, longitudinal care. The government of Iran has decided to develop family medicine as a specialty within the country to help respond to these problems. Based on an initial consultation with some leaders in the Ministry of Health and Medical Education, as well as students, nursing staff, subspecialists, administrators, and medical educators, a number of suggested steps were recommended to support the development of family medicine in Iran. These involved, among others, further development of the specialty and parity with other specialties, development of faculty and curricula, and a plan for financing rural health care.
View details for Web of Science ID 000230468400014
View details for PubMedID 15988644
Can the future of medicine be saved from the success of science
114th Annual Meeting of the Association-of-American-Medical-Colleges
LIPPINCOTT WILLIAMS & WILKINS. 2004: 661–65
The author considers how an emphasis on the achievements of biomedical science has contributed to a loss of human understanding and increased cynicism and dissatisfaction in the practice of medicine. A balanced approach to health care requires attention to both the biological and humanistic aspects of our patients' lives. Awareness and acceptance of our own individual weaknesses and strengths as physicians are also essential to understanding and appreciating the full range of needs in our patients, a process that ultimately leads to compassionate care.
View details for PubMedID 15234916
- Teaching clinical students to teach FAMILY MEDICINE 2004; 36 (2): 87-88
Attitudes toward cervical cancer screening among Muslim women: A pilot study
WOMEN & HEALTH
2004; 39 (3): 63-77
Immigrant Muslim women have low rates of health care utilization, especially preventive care such as breast exams, mammograms, and cervical cancer screening. Religious and cultural beliefs, such as the value placed on modesty and premarital virginity, contribute to reluctance to seek health care. In addition, it has been unclear whether discussions of health care behavior that involve sexuality and reproductive health would be welcomed among immigrant Muslim women.(1) To examine the impact of religious and cultural values on health care behavior of Muslim women from immigrant backgrounds in the San Francisco Bay Area, particularly with regard to cervical cancer screening; (2) To determine whether these women would welcome discussing values and beliefs regarding sexuality and reproductive health.Our key informants were five Muslim women who identified pelvic and Pap smear screening exams as major sources of anxiety for their community, and therefore major barriers to health care. Three focus groups were then convened, including 15 women ages 18-25, to discuss these issues in more detail.Many Muslim women from immigrant backgrounds face challenges in obtaining adequate health care due to some common barriers of language, transportation, insurance, and family pressures. Additionally, many Muslim women resist screening practices that are the standard in the US but which threaten their cultural and religious values. Equally important, many health care professionals contribute to the women's challenges by making inappropriate recommendations regarding physical exams and reproductive health. The women were enthusiastic and candid in discussing these highly sensitive and taboo topics.
View details for DOI 10.1300/j013v39n03_05
View details for Web of Science ID 000223990000005
View details for PubMedID 15256356
Knowledge and beliefs regarding Type 2 diabetes mellitus in rural Mexico
ETHNICITY & HEALTH
2003; 8 (4): 353-360
To investigate adults with Type 2 diabetes mellitus (DM) in a rural area of Mexico in order to explore their knowledge and beliefs regarding diabetes.A pilot study was conducted in a rural town in Morelos, Mexico. Adults over the age of 40 were invited to participate in a screening program for DM, and those who had been previously diagnosed with Type 2 DM were invited for an interview to learn about their knowledge and beliefs regarding diabetes.The glucose screening project enrolled 521 participants, including 56 previously diagnosed with Type 2 DM. Interviews were conducted with 37 of those with previously diagnosed DM. Almost all individuals in the interview sample held causal explanations based on non-scientific beliefs. Home remedies were used by a majority, and most informants used one or more methods. Blood glucose monitoring was virtually non-existent. The most frequently reported source of social support was family members. Physicians appeared to be a less important source of support.Most respondents would like to improve management of their DM, and they try to do so with whatever resources they can afford; however, a lack of information and restricted economic resources appear to limit the availability of modern medical resources. Without the availability of glucose monitoring/screening programs and affordable medication, it appears unlikely that improved treatment of Type 2 DM will occur. Dietary changes and other management approaches may be best modified through family and community influence, instead of the individual lifestyle modification strategies described in the US Type 2 DM management model.
View details for DOI 10.1080/1355785032000163920
View details for Web of Science ID 000187491800005
View details for PubMedID 14660126
Teaching family medicine medical students about sleep disorders
2003; 35 (8): 547-549
A 3.5-hour workshop was developed to teach family medicine medical students about sleep disorders.This family medicine clerkship requirement engages students in role-plays and provides them with didactic information about common sleep problems.Fifty-one students completed questionnaires assessing their knowledge prior to the workshop, 2 weeks and 6 months after the workshop, and their clinical behavior after the workshop.A role-play-based workshop is an effective, fun way to improve students' sleep knowledge and skills. Students retain that information over a 6-month period and are able to apply it during their clinical clerkships.
View details for Web of Science ID 000185309100009
View details for PubMedID 12947515
- The multiple mini-SOAP format for student presentations of complex patients FAMILY MEDICINE 2003; 35 (1): 13-14
Barriers to cervical cancer screening in rural Mexico
INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
2002; 12 (5): 475-479
Cervical cancer is a major health problem in Mexico. The national mortality rate due to cervical cancer was estimated at 21.8 per 100,000 among women over 15 years of age in 1994. Reasons for this high prevalence have not been defined, although it may be influenced by lack of access to health care, lack of knowledge about the Pap procedure, or cultural beliefs. While some studies have examined barriers to Pap screening, most have focused on urban samples. We conducted a pilot study using direct interviews to learn about factors that may influence cervical cancer screening among rural Mexican women. We interviewed 97 rural women between the ages of 16 and 66 and found that 52% had not received a Pap smear within the last 2 years (of that group, 62% had never received a Pap smear). In our sample, the most frequent reason for not obtaining a Pap smear was anxiety regarding physical privacy (50%). Less frequent reasons were lack of knowledge (18%) and difficulty accessing health care (14%). Women who had delivered children were significantly more likely to have received a Pap smear (71%) than women who had no children (10%), P < 0.05. The responses of many women suggest that compliance with cervical cancer screening would be enhanced by addressing cultural beliefs, encouraging conversations about women's health issues, and increasing the number of female health care providers.
View details for Web of Science ID 000178476100012
View details for PubMedID 12366665
- A seriously playful man: Ernest "Jack" Hilgard's exploration of the unusual INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS 2002; 50 (2): 104-113
Use of traditional medicine in Mongolia: a survey
COMPLEMENTARY THERAPIES IN MEDICINE
2002; 10 (1): 42-45
To conduct a pilot investigation of the frequency with which individuals visit practitioners of Western and traditional Mongolian medicine and their motivations for making these visits.Survey based interviews were conducted in a sample of 90 adults.Darkhan, Mongolia.Measures included the annual frequency of visits to practitioners of traditional and Western medicine as well as ratings of the importance of seven factors in choosing what type of practitioner to use.During the past year, 51% of subjects interviewed had used Western services exclusively, 8% had used traditional services exclusively, and 38% had used both types of services. Users and non-users of traditional medicine did not vary in terms of age, gender, occupation or rural vs urban residence. Traditional medicine users rated the knowledge base of traditional practitioners higher than did nonusers (5.3/7 vs 4.5/7, P < 0.01). A patient's specific illness appears to be important in deciding what type of treatment he will seek.Traditional medicine appears to be a more significant component of Mongolian health care than is reported in the international literature and consequently may deserve additional attention in future studies of the country's medical system.
View details for DOI 10.1054/ctim.2002.0508
View details for Web of Science ID 000177550400008
View details for PubMedID 12442822
The hypnotic dreams of healthy children and children with cancer: A quantitative and qualitative analysis
INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL HYPNOSIS
2001; 49 (4): 305-319
In this study, the Stanford Hypnotic Clinical Scale for Children was administered to 52 healthy children and 47 children and adolescents with cancer. Responses to the dream item of this scale were analyzed for the type and detail of imagery. The hypnotizability scores of both groups were similar. However, children with cancer reported more pleasant than unpleasant fantasy in their hypnotic dreams, and their dream reports tended to contain less fantasy and detail overall. Rescoring the dream item based on extent of fantasy and detail resulted in a lower pass rate for that item, especially for children with cancer. Regardless of health status, older children experienced more self-involvement in their hypnotic dreams compared to younger children.
View details for Web of Science ID 000171252900003
View details for PubMedID 11596826
- Including the patient in student presentations FAMILY MEDICINE 2000; 32 (2): 87-88
- Evaluation as a dynamic process FAMILY MEDICINE 2000; 32 (1): 13-14
- A WORKSHOP ON TAKING A SEXUAL HISTORY AND COUNSELING ON CONTRACEPTION ACADEMIC MEDICINE 1995; 70 (5): 443-444
- STRUCTURED STUDENT INTERVIEWS OF ELDERS AT HOME DURING A FAMILY-PRACTICE CLERKSHIP ACADEMIC MEDICINE 1995; 70 (5): 446-447