Men and women in dual-doctor families differed from other physicians in many aspects of their professional and family lives, but they achieved their career and family goals as frequently. These differences reflect personal choices that will increasingly affect the profession as more physicians marry physicians.

Using a national sample of 466 doctors, this work is the first to determine how sociodemographic characteristics, family lives, educational experiences and work environments combine over the life course to shape physician attitudes and behaviors toward serving the medically indigent. Survey data reveal that most physicians have positive experiences with indigent patients, and feel responsible for providing care for the needy. On average, one-quarter of doctors' patients are medically indigent, and physicians provide six hours of charity care per week. Multivariate regression and path analyses indicate that disparate social forces predict humanitarian attitudes and behaviors of physicians. Physician attitudes toward the indigent are shaped largely by socializing forces, including medical education and relationships with mentors. In contrast, care of indigent patients is driven by physician attitudes and by characteristics of medical practice such as specialty and practice setting. Implications for scholarship and for medical education, practice and health policy are discussed.

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This chapter focuses on nursing home care for the elderly. It begins with an overview of the goals, approaches, and types of interventions that characterize special programs in nursing home settings. It then reviews recent programs and practice innovations, focusing on initiatives aimed at improving overall quality of resident life. A conceptual framework for patient-responsive care in nursing homes is developed to guide future initiatives as well as identify neglected areas that require intervention.

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