Medical training has traditionally focused on diagnosis and treatment of disease, with the notion that if these two factors are satisfactorily managed, the desired outcome will inevitably follow. When it does not, failure is often blamed on patient noncompliance. Failure of patients to return for follow-up visits or comply with medication regimens has been shown to be a major barrier to the delivery of effective medical care. However, effective clinical decision making requires that physicians skillfully address not only the biomedical aspects of diseases and their management, but also the sociobehavorial characteristics of patients. The authors maintain that patient participation is necessary for compliance and that a naturally occurring therapeutic alliance between physician and patient incorporates factors such as lifestyle, family, and living circumstances and an awareness of the culturally unique needs of minority patients. Integration of these factors into professional decision making and practical management plans will enhance patient compliance.

This article reports findings from a study in which the functional exchange of services, emotional (expressive) and tangible (instrumental) between grandparents and adult grandchildren were examined. The reciprocal (equivalent) and nonreciprocal (excessive giving or receiving) exchange of services was measured by the frequency of exchange and perception of potential support between the dyad. Noninstitutionalized Jewish grandparents (118, 65+ years of age) with at least one adult grandchild (18+ years of age) were randomly selected from an apartment house in Miami Beach. The results showed that the majority of grandparent-adult grandchild relationships are not reciprocal in either expressive or instrumental support. Grandparents' perception of reciprocity is that they receive more than they give. Social-work knowledge of functional exchange between this dyad may strengthen the social-support network of the elderly.

Enhanced knowledge and healthy attitudes toward aging sexuality can help promote the perception that full sexual expression is part of the entire extent of adulthood. We sought to determine gynecologists' knowledge and attitude regarding sexuality in older women. A total of 141 gynecologists in five hospitals responded to the survey: Aging Sexual Attitude and Knowledge Scale (ASKAS). No correlation was found between respondents' knowledge and attitude (r = .06, p = .54); no correlation found between respondents' age and knowledge (r = .20, p = .02), but 20% of the variance in attitude could be explained by age (beta 0.20, p = .02). Neither gender, ethnicity, level of training, nor hospital location demonstrated a significant correlation to either knowledge or attitude scores.

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