How Attending Physician Preceptors Negotiate Their Complex Work Environment: A Collective Ethnography.

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Lemaire, Jane B; Wallace, Jean E; Sargious, Peter M; Bacchus, Maria; Zarnke, Kelly; Ward, David R; Ghali, William A

2017-12-01

To generate an empiric, detailed, and updated view of the attending physician preceptor role and its interface with the complex work environment. In 2013, the authors conducted a modified collective ethnography with observations of internal medicine medical teaching unit preceptors from two university hospitals in Canada. Eleven observers conducted 32 observations (99.5 hours) of 26 preceptors (30 observations [93.5 hours] of 24 preceptors were included in the analysis). An inductive thematic approach was used to analyze the data with further axial coding to identify connections between themes. Four individuals coded the main data set; differences were addressed through discussion to achieve consensus. Three elements or major themes of the preceptor role were identified: (1) competence or the execution of traditional physician competencies, (2) context or the extended medical teaching unit environment, and (3) conduct or the manner of acting or behaviors and attitudes in the role. Multiple connections between the elements emerged. The preceptor role appeared to depend on the execution of professional skills (competence) but also was vulnerable to contextual factors (context) independent of these skills, many of which were unpredictable. This vulnerability appeared to be tempered by preceptors' use of adaptive behaviors and attitudes (conduct), such as creativity, interpersonal skills, and wellness behaviors. Preceptors not only possess traditional competencies but also enlist additional behaviors and attitudes to deal with context-driven tensions and to negotiate their complex work environment. These skills could be incorporated into role training, orientation, and mentorship.

Information exchange using a prescribed form and involvement of occupational health nurses promotes occupational physicians to collaborate with attending physicians for supporting workers with illness in Japan.

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Muto, Go; Nakamura, Rina Ishii; Yokoyama, Kazuhito; Kitamura, Fumihiko; Omori, Yuki; Saito, Masahiko; Endo, Motoki

2017-12-19

The maintenance of a balance between work and disease treatment is an important issue in Japan. This study explored factors that affect collaboration between occupational physicians (OPs) and attending physicians (APs). A questionnaire was mailed to 1,102 OPs. The questionnaire assessed the demographic characteristics of OPs; their opinions and behaviors related to collaboration, including the exchange of medical information with APs; and the occupational health service system at their establishments. In total, 275 OPs completed the questionnaire (25.0% response rate). Over 80% of respondents believed OPs should collaborate with APs. After adjusting for company size, collaboration >10 times/year (with regard to both returning to work following sick leave and annual health check-ups for employees) was significantly associated with environmental factors, such as the presence of occupational health nurses (odds ratio (OR): 5.56 and 5.01, respectively, p0.05). The majority of OPs believed that collaboration with APs is important for supporting workers with illnesses. Support systems including prescribed forms of information exchange and occupational health nurses, play pivotal roles in promoting this collaboration.

Urinary incontinence and overactive bladder in patients attending the family practice physicians office: a pan-Slovenian cross-sectional, questionnaire-based survey

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Igor But

2013-04-01

Conclusions: Both, UI and OAB represent a significant problem among patients attending the family practice physician office. It seems that the knowledge of both dysfunctions is satisfactory among physicians. The majority of patients would tell their doctors about UI and OAB and would also receive appropriate instructions regarding the bladder training and PFMT, both methods being very important for the prevention and treatment of these dysfunctions.

Do physicians attend to base rates? Prevalence data and statistical discrimination in the diagnosis of coronary heart disease.

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Maserejian, Nancy N; Lutfey, Karen E; McKinlay, John B

2009-12-01

To examine whether physicians attend to gender prevalence data in diagnostic decision making for coronary heart disease (CHD) and to test the hypothesis that previously reported gender differences in CHD diagnostic certainty are due to discrimination arising from reliance on prevalence data ("statistical discrimination"). A vignette-based experiment of 256 randomly sampled primary care physicians conducted from 2006 to 2007. Factorial experiment. Physicians observed patient presentations of cardinal CHD symptoms, standardized across design factors (gender, race, age, socioeconomic status). Structured interview. Most physicians perceived the U.S. population CHD prevalence as higher in men (48.4 percent) or similar by gender (44.9 percent). For the observed patient, 52 percent did not change their CHD diagnostic certainty based on patient gender. Forty-eight percent of physicians were inconsistent in their population-level and individual-level CHD assessments. Physicians' assessments of CHD prevalence did not attenuate the observed gender effect in diagnostic certainty for the individual patient. Given an adequate presentation of CHD symptoms, physicians may deviate from their prevalence data during diagnostic decision making. Physicians' priors on CHD prevalence did not explain the gender effect in CHD certainty. Future research should examine personal stereotypes as an explanation for gender differences.

Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children.

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King, Marta A; Nkoy, Flory L; Maloney, Christopher G; Mihalopoulos, Nicole L

2015-10-01

To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education. Copyright © 2015 Elsevier Inc. All rights reserved.

Resident perceptions of the impact of duty hour restrictions on resident-attending interactions: an exploratory study.

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Gerjevic, Kristen A; Rosenbaum, Marcy E; Suneja, Manish

2017-07-18

The institution of duty hour reforms by the Accreditation Council for Graduate Medical Education in 2003 has created a learning environment where residents are consistently looking for input from attending physicians with regards to balancing duty hour regulations and providing quality patient care. There is a paucity of literature regarding resident perceptions of attending physician actions or attitudes towards work hour restrictions. The purpose of this study was to identify attending physician behaviors that residents perceived as supportive or unsupportive of their compliance with duty hour regulations. Focus group interviews were conducted with residents exploring their perceptions of how duty hour regulations impact their interactions with attending physicians. Qualitative analysis identified key themes in residents' experiences interacting with faculty in regard to duty hour regulations. Forty residents from five departments in two hospital systems participated. Discussion of these interactions highlighted that attending physicians demonstrate behaviors that explicitly or implicitly either lend their support and understanding of residents' need to comply with these regulations or imply a lack of support and understanding. Three major themes that contributed to the ease or difficulty in addressing duty hour regulations included attending physicians' explicit communication of expectations, implicit non-verbal and verbal cues and the program's organizational culture. Resident physicians' perception of attending physicians' explicit and implicit communication and residency programs organization culture has an impact on residents' experience with duty hour restrictions. Residency faculty and programs could benefit from explicitly addressing and supporting the challenges that residents perceive in complying with duty hour restrictions.

Attending Physician Remote Access of the Electronic Health Record and Implications for Resident Supervision: A Mixed Methods Study.

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Martin, Shannon K; Tulla, Kiara; Meltzer, David O; Arora, Vineet M; Farnan, Jeanne M

2017-12-01

Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.

Physician attitudes toward industry: a view across the specialties

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Korenstein, Deborah; Keyhani, Salomeh; Ross, Joseph S.

2010-01-01

Objectives Physician relationships with industry are receiving attention as government and professional organizations move toward restrictive policies and financial transparency. Our objective was to explore attitudes of physicians from all specialties toward gifts from and interactions with the pharmaceutical and device industries. Design Anonymous cross sectional survey. Setting Hospitals in the Mount Sinai School of Medicine consortium, in the New York City metro area Participants Faculty and trainee physicians from all clinical departments Main Outcome Measures Attitudes toward industry interactions and gifts and their appropriateness, measured on 4-point Likert scales. Results Five hundred ninety physicians and medical students completed the survey (response rate=67%); 59% were male, 39% were attendings, and 24% were from surgical specialties. Attitudes toward industry and gifts were generally positive. More than 65% found educational materials and sponsored lunches appropriate, whereas fewer than 25% considered vacations or large gifts appropriate. Surgeons, trainees, and those unfamiliar with institutional policies on industry interactions held more positive attitudes than others and were more likely to deem some gifts appropriate, including industry funding of residency programs and, among surgeons, receiving meals, travel expenses, and payments for attending lectures. Non-attendings held more positive attitudes toward meals in clinical settings, textbooks and samples. Conclusions Physicians continue to hold positive attitudes toward marketing-oriented activities of the pharmaceutical and device industries. Changes in medical culture and physician education focused on surgeons and trainees may align physician attitudes with current policy trends. PMID:20566978

Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study.

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Okuyama, Toru; Endo, Chiharu; Seto, Takashi; Kato, Masashi; Seki, Nobuhiko; Akechi, Tatsuo; Furukawa, Toshiaki A; Eguchi, Kenji; Hosaka, Takashi

2009-06-01

To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians. Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician ("no perceived need to disclose emotions," "fear of the negative impact of emotional disclosure," "negative attitude toward emotional disclosure," "hesitation to disturb the physician with emotional disclosure"). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0. The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 +/- 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer-related variables were associated with depression underrecognition by physicians. The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness.

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Frush, Benjamin W; Brauer, Simon G; Yoon, John D; Curlin, Farr A

2018-03-01

Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Among eligible physicians (n = 1878), 62% (n = 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was "not applicable" were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23-0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15-3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35-0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13-2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40-0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08-2.50). This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor

The knowledge and expectations of parents about the role of antibiotic treatment in upper respiratory tract infection – a survey among parents attending the primary physician with their sick child

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Ron Adi

2003-12-01

Full Text Available Abstract Background Upper respiratory tract infections (URTI are common. The etiologic factor is usually viral, but many physicians prescribe antibiotics. We aimed to evaluate parents' expectations of and knowledge about the role of antibiotics in childhood URTI. Methods The study was conducted in thirteen primary care pediatric clinics. Parents of children aged 3 months to 6 years who attended with URTI symptoms were included when it was the first attendance in the current illness. Questionnaire about the current illness, reasons for attending and expectations from the visit, knowledge about URTI was filled before the visit. Results In 122 visits the average age was 2.8 ± 1.9 years. The main reasons for the visit were to avoid complications (81% and to be examined (78%. Expected treatment was: cough suppressants (64%, anti-congestants (57%, paracetamol (56%, natural remedies (53% and antibiotics (25%. In 28% the child had received antibiotics in past URTI. Only 37% thought that antibiotics would not help in URTI and 27% knew that URTI is a self-limited disease. 61% knew that URTI is a viral disease. Younger parental age and higher education were associated with lower expectations to receive antibiotics (p = 0.01, p Conclusions A quarter of the parents attending the physician with URTI are expecting to get antibiotics. Predictors were lower education, older parental age, receiving antibiotics in the past and the belief that antibiotics help in URTI.

Evaluation of Physicians' Cognitive Styles.

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Djulbegovic, Benjamin; Beckstead, Jason W; Elqayam, Shira; Reljic, Tea; Hozo, Iztok; Kumar, Ambuj; Cannon-Bowers, Janis; Taylor, Stephanie; Tsalatsanis, Athanasios; Turner, Brandon; Paidas, Charles

2014-07-01

Patient outcomes critically depend on accuracy of physicians' judgment, yet little is known about individual differences in cognitive styles that underlie physicians' judgments. The objective of this study was to assess physicians' individual differences in cognitive styles relative to age, experience, and degree and type of training. Physicians at different levels of training and career completed a web-based survey of 6 scales measuring individual differences in cognitive styles (maximizing v. satisficing, analytical v. intuitive reasoning, need for cognition, intolerance toward ambiguity, objectivism, and cognitive reflection). We measured psychometric properties (Cronbach's α) of scales; relationship of age, experience, degree, and type of training; responses to scales; and accuracy on conditional inference task. The study included 165 trainees and 56 attending physicians (median age 31 years; range 25-69 years). All 6 constructs showed acceptable psychometric properties. Surprisingly, we found significant negative correlation between age and satisficing (r = -0.239; P = 0.017). Maximizing (willingness to engage in alternative search strategy) also decreased with age (r = -0.220; P = 0.047). Number of incorrect inferences negatively correlated with satisficing (r = -0.246; P = 0.014). Disposition to suppress intuitive responses was associated with correct responses on 3 of 4 inferential tasks. Trainees showed a tendency to engage in analytical thinking (r = 0.265; P = 0.025), while attendings displayed inclination toward intuitive-experiential thinking (r = 0.427; P = 0.046). However, trainees performed worse on conditional inference task. Physicians capable of suppressing an immediate intuitive response to questions and those scoring higher on rational thinking made fewer inferential mistakes. We found a negative correlation between age and maximizing: Physicians who were more advanced in their careers were less willing to spend time and effort in an

Effect of exposure to good vs poor medical trainee performance on attending physician ratings of subsequent performances.

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Yeates, Peter; O'Neill, Paul; Mann, Karen; Eva, Kevin W

2012-12-05

Competency-based models of education require assessments to be based on individuals' capacity to perform, yet the nature of human judgment may fundamentally limit the extent to which such assessment is accurately possible. To determine whether recent observations of the Mini Clinical Evaluation Exercise (Mini-CEX) performance of postgraduate year 1 physicians influence raters' scores of subsequent performances, consistent with either anchoring bias (scores biased similar to previous experience) or contrast bias (scores biased away from previous experience). Internet-based randomized, blinded experiment using videos of Mini-CEX assessments of postgraduate year 1 trainees interviewing new internal medicine patients. Participants were 41 attending physicians from England and Wales experienced with the Mini-CEX, with 20 watching and scoring 3 good trainee performances and 21 watching and scoring 3 poor performances. All then watched and scored the same 3 borderline video performances. The study was completed between July and November 2011. The primary outcome was scores assigned to the borderline videos, using a 6-point Likert scale (anchors included: 1, well below expectations; 3, borderline; 6, well above expectations). Associations were tested in a multivariable analysis that included participants' sex, years of practice, and the stringency index (within-group z score of initial 3 ratings). The mean rating scores assigned by physicians who viewed borderline video performances following exposure to good performances was 2.7 (95% CI, 2.4-3.0) vs 3.4 (95% CI, 3.1-3.7) following exposure to poor performances (difference of 0.67 [95% CI, 0.28-1.07]; P = .001). Borderline videos were categorized as consistent with failing scores in 33 of 60 assessments (55%) in those exposed to good performances and in 15 of 63 assessments (24%) in those exposed to poor performances (P performances compared with 25 of 63 assessments (39.5%) in those exposed to poor performances (P poor

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.

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Janssen, Patricia A; Saxell, Lee; Page, Lesley A; Klein, Michael C; Liston, Robert M; Lee, Shoo K

2009-09-15

Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes. The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00-1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00-1.43) among women attended by a midwife and 0.64 (95% CI 0.00-1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.36; assisted vaginal delivery, RR 0.41, 95% 0.33-0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28-0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49-0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14-0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24-0.59). The findings were similar in the comparison with

Physician-patient discussions of controversial cancer screening tests.

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Dunn, A S; Shridharani, K V; Lou, W; Bernstein, J; Horowitz, C R

2001-02-01

Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

Improving nurse-physician teamwork through interprofessional bedside rounding.

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Henkin, Stanislav; Chon, Tony Y; Christopherson, Marie L; Halvorsen, Andrew J; Worden, Lindsey M; Ratelle, John T

2016-01-01

Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician-nurse teamwork are often suboptimal. To improve nurse-physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients' bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds. To assess the effect of bedside rounding on nurse-physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician-nurse communication. Participation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 ("In this clinical area, it is not difficult to speak up if I perceive a problem with patient care", 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 ("Nurse input is well received in this area", 62% vs 82%, P=0.01). Increasing face-to-face communication through

Factors associated with non-attendance, opportunistic attendance and reminded attendance to cervical screening in an organized screening program: a cross-sectional study of 12,058 Norwegian women

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Eriksen Tormod

2011-04-01

likelihood of attendance in an organized screening program was higher among women who were aware of cervical screening, which suggests a potential for a higher attendance rate through improving the public knowledge of screening. Further, the lower awareness among opportunistic than reminded attendees suggests that physicians may inform their patients better when smears are taken at the physician's initiative.

Physicians' preferences for asthma guidelines implementation.

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Kang, Min-Koo; Kim, Byung-Keun; Kim, Tae-Wan; Kim, Sae-Hoon; Kang, Hye-Ryun; Park, Heung-Woo; Chang, Yoon-Seok; Kim, Sun-Sin; Min, Kyung-Up; Kim, You-Young; Cho, Sang-Heon

2010-10-01

Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. We obtained information through a questionnaire survey. The questionnaire was distributed to physicians attending continuing medical education courses and sent to other physicians by airmail, e-mail, and facsimile. A total of 183 physicians responded (male to female ratio, 2.3:1; mean age, 40.4±9.9 years); 89.9% of respondents were internists or pediatricians, and 51.7% were primary care physicians. Physicians preferred information that described asthma medications, classified the disease according to severity and level of control, and provided methods of evaluation/treatment/monitoring and management of acute exacerbation. The most effective strategies for encouraging the use of the guidelines were through continuing medical education and discussions with colleagues. Physicians required supporting evidence in the form of randomized controlled trials and expert consensus. They preferred that the guidelines be presented as algorithms or flow charts/flow diagrams on plastic sheets, pocket cards, or in electronic medical records. This study identified the items of the asthma guidelines preferred by physicians in Korea. Asthma guidelines with physicians' preferences would encourage their implementation in clinical practice.

Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

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DeMaria Lisa M

2012-04-01

Full Text Available Abstract Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM, obstetric nurses (ON and general physicians (GP. A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to

Migration analysis of physicians practicing in Hawai'i from 2009-2011.

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Stephens, Laura D; Withy, Kelley M; Racsa, C Philip

2012-04-01

Hawai'i suffers a 20% shortage of physicians. Examining physician migration patterns into and out of Hawai'i may better inform physician recruitment and retention techniques. 2009-2011 practice location data on all non-military, practicing physicians in Hawai'i were compiled in a database maintained by the University of Hawai'i John A Burns School of Medicine, Area Health Education Center (AHEC). Medical school attended was extracted from an AMA Masterfile list. Physicians were contacted or searched online to ascertain practice location as of September 2011. Currently 3,187 physicians actively practice in Hawai'i; 2,707 (84.9%) trained at a total of 136 US medical schools. Nearly half of all US-trained physicians attended medical school in Hawai'i, California, New York, Illinois, or Pennsylvania. International medical graduates represented 191 medical schools from 67 distinct countries, primarily in the Philippines (23.1%). From 2009-2011, 238 physicians retired from clinical activity, and 329 physicians left Hawai'i to practice in other locations. California received the largest portion of Hawai'i's former physicians (26.4%). Only 15.5% of physicians returned to the state where they attended medical school. Medical schools with some of the most alumni practicing in Hawai'i (eg, Creighton, UCLA, Georgetown) all have active Hawai'i student clubs, suggesting a target for recruitment efforts. Physician emigration cannot be fully explained by geography of a physician's medical school alma mater. Analysis of physician residency locations and exit surveys of physicians leaving Hawai'i are recommended for future study.

Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.

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Jacob, Rebecca; Wong, Mai Luen; Hayhurst, Catherine; Watson, Peter; Morrison, Cecily

2016-08-01

Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate. © 2016 Royal College of Physicians.

41 CFR 301-74.16 - What must be included in any advertisement or application form relating to conference attendance?

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2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What must be included in any advertisement or application form relating to conference attendance? 301-74.16 Section 301-74.16... included in any advertisement or application form relating to conference attendance? (a) Any advertisement...

Attitudes and relationship between physicians and the pharmaceutical industry in a public general hospital in Lima, Peru.

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Aldo De Ferrari

Full Text Available BACKGROUND: The interaction between physicians and the pharmaceutical industry influences physicians' attitudes and prescribing behavior. Although largely studied in the US, this topic has not been well studied in resource-poor settings, where a close relationship between physicians and industry still exists. OBJECTIVE: To describe physician interactions with and attitudes towards the pharmaceutical industry in a public general hospital in Lima, Peru. DESIGN: Descriptive, cross-sectional study through an anonymous, self-filled questionnaire distributed among faculty and trainee physicians of five different clinical departments working in a Peruvian public general hospital. A transcultural validation of an existing Spanish questionnaire was performed. Exposure to marketing activities, motivations to contact pharmaceutical representatives and attitudes towards industry were studied. Collected data was analyzed by degree of training, clinical department, gender and teaching status. Attitudes were measured on a four-point LIKERT scale. RESULTS: 155 physicians completed the survey, of which 148 were included in the study sample. 94.5% of attending physicians reported ongoing encounters with pharmaceutical representatives. The most common industry-related activities were receiving medical samples (91.2%, promotional material (87.8% and attending meetings in restaurants (81.8%. Respondents considered medical samples and continuing medical education the most ethically acceptable benefits. We found significant differences between attendings and residents, and teaching and non-teaching attendings. An association between the amount of encounters with pharmaceutical representatives, and attitudes towards industry and acceptance of medical samples was found. CONCLUSIONS: A close physician-industry relationship exists in the population under study. The contact is established mainly through pharmaceutical representatives. Medical samples are the most received

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

Directory of Open Access Journals (Sweden)

Victoria Weston

2017-04-01

Full Text Available Introduction: Emergency department (ED crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. Methods: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI. Secondary outcomes were defined as differences in median ED length of stay (LOS, median door-to-provider (DTP time, proportion of left without being seen (LWBS, and proportion of “very good” overall patient satisfaction scores. Results: Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs equated to a gain (ROI: 54% for resident TLPs and a loss (ROI: −31% for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317% and for attending TLPs (ROI: 86%. Median DTP time for resident TLPs was significantly lower (p<0.0001 than attending or historical control. Proportion of “very good” patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

Science.gov (United States)

Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

2017-06-01

Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (phistorical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

In the Eyes of Residents Good Supervisors Need to Be More than Engaged Physicians: The Relevance of Teacher Work Engagement in Residency Training

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Scheepers, Renée A.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.

2015-01-01

During their development into competent medical specialists, residents benefit from their attending physicians' excellence in teaching and role modelling. Work engagement increases overall job performance, but it is unknown whether this also applies to attending physicians' teaching performance and role modelling. Attending physicians in clinical…

Association between Breastfeeding Duration and Type of Birth Attendant

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Jordyn T. Wallenborn

2018-01-01

Full Text Available Introduction. Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods. Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics’ national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. Results. Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. Conclusions. Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population.

Communication Skills Training for Physicians Improves Patient Satisfaction.

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Boissy, Adrienne; Windover, Amy K; Bokar, Dan; Karafa, Matthew; Neuendorf, Katie; Frankel, Richard M; Merlino, James; Rothberg, Michael B

2016-07-01

Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted. We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience. This was an observational study. The study was conducted at a large, multispecialty academic medical center. Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014. An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction. Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

[Minors visits (ages 14-18) at primary clinics without an accompanying guardian: attitudes of primary care physicians of Clalit Health Services - South District].

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Hildesheimer, Efrat; Orkin, Jacob; Biderman, Aya

2010-04-01

According to Israeli law, for a minor to receive medical treatment, the physician is obligated to obtain informed consent from the minor's parents. In practice, minors under the age of 18 often attend the clinics on their own. In past years, only a few attempts have been made to revise the law, however, none were implemented. To evaluate the attitudes and knowledge of physicians in primary care clinics regarding the legal aspects of minors' visits at the clinics, relating to how widespread is the phenomena, the influencing factors, the physician's opinion and approach. A descriptive study based on self-administered questionnaires that were distributed by post during 2005, to primary care physicians belonging to Clalit Health Services, south district. The questionnaires included demographic details, attitudes and knowledge of minors' visits. Analysis of 103 questionnaires found that minors attending clinics without their parent is a common phenomenon. The reasons noted were: acquaintance with the parents, and that their children are "mature enough". The physician's knowledge about the Israeli law on the subject was found to be deficient: 56% answered incorrectly to questions on which the law is very clear, and in most of the other questions many claimed they did not know the correct answer. Many of the physicians think that minors should not visit the clinic by themselves; only 6% attended an educational program related to this matter. The subject of minors attending clinics without an accompanying parent warrants discussion, and clear and updated legislation. In addition, as stems from the study, there is a need to update physicians regarding this issue.

Evaluation of Documentation Patterns of Trainees and Supervising Physicians Using Data Mining.

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Madhavan, Ramesh; Tang, Chi; Bhattacharya, Pratik; Delly, Fadi; Basha, Maysaa M

2014-09-01

The electronic health record (EHR) includes a rich data set that may offer opportunities for data mining and natural language processing to answer questions about quality of care, key aspects of resident education, or attributes of the residents' learning environment. We used data obtained from the EHR to report on inpatient documentation practices of residents and attending physicians at a large academic medical center. We conducted a retrospective observational study of deidentified patient notes entered over 7 consecutive months by a multispecialty university physician group at an urban hospital. A novel automated data mining technology was used to extract patient note-related variables. A sample of 26 802 consecutive patient notes was analyzed using the data mining and modeling tool Healthcare Smartgrid. Residents entered most of the notes (33%, 8178 of 24 787) between noon and 4 pm and 31% (7718 of 24 787) of notes between 8 am and noon. Attending physicians placed notes about teaching attestations within 24 hours in only 73% (17 843 of 24 443) of the records. Surgical residents were more likely to place notes before noon (P Data related to patient note entry was successfully used to objectively measure current work flow of resident physicians and their supervising faculty, and the findings have implications for physician oversight of residents' clinical work. We were able to demonstrate the utility of a data mining model as an assessment tool in graduate medical education.

Dutch criteria of due care for physician-assisted dying in medical practice: a physician perspective

NARCIS (Netherlands)

Buiting, H. M.; Gevers, J. K. M.; Rietjens, J. A. C.; Onwuteaka-Philipsen, B. D.; van der Maas, P. J.; van der Heide, A.; van Delden, J. J. M.

2008-01-01

Introduction: The Dutch Euthanasia Act (2002) states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient's suffering should be unbearable

Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians

Directory of Open Access Journals (Sweden)

Dave W. Lu

2015-12-01

Full Text Available Introduction: Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices. Methods: In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed. Results: We included 77 out of 155 (49.7% responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012 and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036 than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744. Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011 and lower career satisfaction (77.3% vs 97.0%, p=0.02. EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care. Conclusion: A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.

Physician profiling. An analysis of inpatient practice patterns in Florida and Oregon.

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Welch, H G; Miller, M E; Welch, W P

1994-03-03

Physician profiling is a method of cost control that focuses on patterns of care instead of on specific clinical decisions. It is one cost-control method that takes into account physicians' desire to curb the intrusion of administrative mechanisms into the clinical encounter. To provide a concrete example of profiling, we analyzed the inpatient practice patterns of physicians in Florida and Oregon. Data for 1991 from Medicare's National Claims History File were used to profile 12,720 attending physicians in Florida and 2589 in Oregon. For each attending physician, we determined the total relative value of all physicians' services delivered during each patient's hospital stay. Relative value was measured in relative-value units (RVUs), according to the resource-based relative-value scale used by Medicare in determining payments to physicians. The mean number of RVUs per admission was then adjusted for the physician's case mix according to the patients' assigned diagnosis-related groups. The influence of the physician's specialty and of selected types of services (such as imaging and endoscopy) was also examined. Florida physicians used markedly more resources, on average, than their colleagues in Oregon (46 vs. 30 case-mix-adjusted RVUs per admission). The difference was apparent for all specialties and all types of service. To illustrate the profiling data potentially available to the medical staffs of individual hospitals, we examined specific data on individual attending physicians and for various types of service for three hospitals' staffs. Despite similar overall profiles that fell below the national mean, each staff had a different practice pattern and would require different efforts to improve efficiency. In an effort to encourage further debate, we have described one method of physician profiling. Profiling data help identify and characterize differences in practice style to which individual physicians or hospital staffs can respond. Because profiling is

Number needed to eat: pizza and resident conference attendance.

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Cosimini, Michael J; Mackintosh, Liza; Chang, Todd P

2016-12-01

The didactic conference is a common part of the resident education curriculum. Given the demands of clinical responsibilities and restrictions on duty hours, maximising education is a challenge faced by all residency programmes. To date, little research exists with respect to how the provision of complimentary food affects physician and resident conference attendance. The objective of this study was to determine whether complimentary food improves resident arrival times and attendance at educational conferences and, furthermore, to test whether this provision is a potentially cost-effective tool for improving education. A retrospective review of 36 resident educational Friday noon conferences, including 1043 resident arrivals, was performed. Data were analysed for total attendance, arrival times, number needed to eat (NNE) and the percentage of residents arriving on time, and compared between days on which food was and was not provided. Median attendance was 3.7% higher (p = 0.04) on days on which food was provided, at a cost of US$46 for each additional resident in attendance. Arrival times were also statistically significantly improved when food was provided, with a median improvement of 0.7 minutes (p = 0.02) and an 11.0% increase in on-time arrivals (p < 0.001). The NNE was 10.6. Complimentary food improves both attendance and arrival times by a small, but statistically significant, degree. The provision of complimentary food can be considered as an incentive for attendance and on-time arrival at didactic educational sessions, although more cost-effective modalities may exist. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

"Black cloud" vs. "white cloud" physicians - Myth or reality in apheresis medicine?

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Pham, Huy P; Raju, Dheeraj; Jiang, Ning; Williams, Lance A

2017-08-01

Many practitioners believe in the phenomenon of either being labeled a "black cloud" or "white cloud" while on-call. A "white-cloud" physician is one who usually gets fewer cases. A "black-cloud" is one who often has more cases. It is unclear if the designation is only superstitious or if there is some merit. Our aim is to objectively assess this phenomenon in apheresis medicine at our center. A one-year prospective study from 12/2014 to 11/2015 was designed to evaluate the number of times apheresis physicians and nurses were involved with emergent apheresis procedures between the hours from 10 PM and 7 AM. Other parameters collected include the names of the physician, apheresis nurse, type of emergent apheresis procedure, day of the week, and season of the year. During the study period, 32 emergent procedures (or "black-cloud" events) occurred. The median time between two consecutive events was 8 days (range: 1-34 days). We found no statistically significant association between the "black-cloud" events and attending physicians, nurses, day of the week, or season of the year by Chi-square and Fisher's analyses. However, exploratory analysis using association rule demonstrated that "black-cloud" events were more likely to happen on Thursday (2.19 times), with attending physician 2 (1.18 times), and during winter (1.15 times). The results of this pilot study may support the common perception that some physicians or nurses are either "black cloud" or "white cloud". A larger, multi-center study population is needed to validate the results of this pilot study. © 2016 Wiley Periodicals, Inc.

Grit, anxiety, and stress in emergency physicians.

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Wong, Matthew L; Anderson, Jared; Knorr, Thomas; Joseph, Joshua W; Sanchez, Leon D

2018-02-26

The personality traits of emergency physicians are infrequently studied, though interest in physician wellness is increasing. The objective of this study is to acquire pilot data about the amount of grit, anxiety, and stress in emergency physicians using established psychological survey instruments, and to examine their associations of each of these traits with each other. Thirty-six emergency medicine resident and attending physicians from an urban academic medical center consented for enrollment. Participants were administered the Duckworth 12-point Grit Scale, the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS), which measure grit, anxiousness, and perceived stress, respectively. These are the gold standard psychological instruments for each of their areas. We analyzed the results with descriptive statistics, Spearman correlations, and linear regression. Nineteen residents and 17 attending physicians completed the surveys during the first quarter of a new academic year. The mean grit score was 3.7 (95% CI 3.5-3.8, SD: 0.56), the mean trait-anxiety score was 32.61 (95% CI 30.15-35.07, SD: 7.26), and the mean PSS score was 12.28 (95% CI 10.58-13.97, SD: 4.99). Only trait-anxiety and perceived stress were significantly correlated (Spearman's rho: 0.70, panxious reported more stress. Levels of grit were not associated with trait-anxiety. These psychological concepts should be studied further as they relate to the function and health of emergency medicine providers. Copyright © 2018. Published by Elsevier Inc.

Are long physician working hours harmful to patient safety?

Science.gov (United States)

Ehara, Akira

2008-04-01

Pediatricians of Japanese hospitals including not only residents but also attending physicians work long hours, and 8% work for >79 h per week. Most of them work consecutively for >or=32 h when they are on call. The aim of the present study was to evaluate the effect of long work hours on patient safety. The electronic databases MEDLINE and EMBASE to searched identify the English- and Japanese-language literature for studies on work hours, medical errors, patient safety, and malpractice for years 1966-2005. Studies that analyzed the relationship between physician work hours and outcomes directly related to patient safety were selected. Seven studies met the criteria. Four studies suggest that reduction of work hours has a favorable effect on patient safety indicators. In the other three studies no significant changes of the indicators were observed, but no report found that shorter work hours were harmful to patient safety. Decrease of physician work hours is not harmful but favorable to patient safety.

Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

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Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

2011-01-01

educational value. The caseload can be so great that inadequate reflective time is left for learning based on clinical experiences. In addition, supervision is often vaguely defined and discontinuous. Medical malpractice data indicate that resident physicians are frequently named in lawsuits, most often for lack of supervision. The recommendations are: The ACGME should adjust resident physicians workload requirements to optimize educational value. Resident physicians as well as faculty should be involved in work redesign that eliminates nonessential and noneducational activity from resident physician dutiesMechanisms should be developed for identifying in real time when a resident physician's workload is excessive, and processes developed to activate additional providersTeamwork should be actively encouraged in delivery of patient care. Historically, much of medical training has focused on individual knowledge, skills, and responsibility. As health care delivery has become more complex, it will be essential to train resident and attending physicians in effective teamwork that emphasizes collective responsibility for patient care and recognizes the signs, both individual and systemic, of a schedule and working conditions that are too demanding to be safeHospitals should embrace the opportunities that resident physician training redesign offers. Hospitals should recognize and act on the potential benefits of work redesign, eg, increased efficiency, reduced costs, improved quality of care, and resident physician and attending job satisfactionAttending physicians should supervise all hospital admissions. Resident physicians should directly discuss all admissions with attending physicians. Attending physicians should be both cognizant of and have input into the care patients are to receive upon admission to the hospitalInhouse supervision should be required for all critical care services, including emergency rooms, intensive care units, and trauma services. Resident physicians

Evaluation of non-radiologist physicians' knowledge on aspects related to ionizing radiation in imaging

International Nuclear Information System (INIS)

Madrigano, Renata Rodrigues; Abrao, Karen Cristine; Regacini, Rodrigo; Puchnick, Andrea

2014-01-01

Objective: to assess the non-radiologist physicians' knowledge on the use of ionizing radiation in imaging. Materials and Methods: cross-sectional study utilizing an anonymous questionnaire responded by physicians in clinical and surgical specialties, divided into two parts as follows: one including questions about the physicians' characteristics, frequency of imaging studies requests and participation in professional updating events, and another part including multiple choice questions approaching general knowledge about radiation, optimization principles and radioprotection. Results: from a total of 309 questionnaires, 120 (38.8%) were responded, 50% by physicians in surgical specialties and 50% in clinical specialties; respectively 45% and 2.5% of physicians responded that magnetic resonance imaging and ultrasonography use ionizing radiation. Overall, the average grade was higher for surgical specialists with no significant difference, except for the question about exposure in pregnant women (p = 0.047). Physicians who are professionally updated, particularly those attending clinical meetings (p = 0.050) and participating in teaching activities (p = 0.047), showed statistically superior knowledge about ionizing radiation as compared with others. Conclusion: the non-radiologist physicians' is heterogeneous and in some points needs to be improved. Multidisciplinary clinical meetings and teaching activities are important ways to disseminate information on the subject. (author)

Self-Sampling for Human Papillomavirus Testing among Non-Attenders Increases Attendance to the Norwegian Cervical Cancer Screening Programme.

Directory of Open Access Journals (Sweden)

Espen Enerly

Full Text Available Increasing attendance to screening offers the best potential for improving the effectiveness of well-established cervical cancer screening programs. Self-sampling at home for human papillomavirus (HPV testing as an alternative to a clinical sampling can be a useful policy to increase attendance. To determine whether self-sampling improves screening attendance for women who do not regularly attend the Norwegian Cervical Cancer Screening Programme (NCCSP, 800 women aged 25-69 years in the Oslo area who were due to receive a 2nd reminder to attend regular screening were randomly selected and invited to be part of the intervention group. Women in this group received one of two self-sampling devices, Evalyn Brush or Delphi Screener. To attend screening, women in the intervention group had the option of using the self-sampling device (self-sampling subgroup or visiting their physician for a cervical smear. Self-sampled specimens were split and analyzed for the presence of high-risk (hr HPV by the CLART® HPV2 test and the digene® Hybrid Capture (HC2 test. The control group consisted of 2593 women who received a 2nd reminder letter according to the current guidelines of the NCCSP. The attendance rates were 33.4% in the intervention group and 23.2% in the control group, with similar attendance rates for both self-sampling devices. Women in the self-sampling subgroup responded favorably to both self-sampling devices and cited not remembering receiving a call for screening as the most dominant reason for previous non-attendance. Thirty-two of 34 (94.1% hrHPV-positive women in the self-sampling subgroup attended follow-up. In conclusion, self-sampling increased attendance rates and was feasible and well received. This study lends further support to the proposal that self-sampling may be a valuable alternative for increasing cervical cancer screening coverage in Norway.

Self-Sampling for Human Papillomavirus Testing among Non-Attenders Increases Attendance to the Norwegian Cervical Cancer Screening Programme.

Science.gov (United States)

Enerly, Espen; Bonde, Jesper; Schee, Kristina; Pedersen, Helle; Lönnberg, Stefan; Nygård, Mari

2016-01-01

Increasing attendance to screening offers the best potential for improving the effectiveness of well-established cervical cancer screening programs. Self-sampling at home for human papillomavirus (HPV) testing as an alternative to a clinical sampling can be a useful policy to increase attendance. To determine whether self-sampling improves screening attendance for women who do not regularly attend the Norwegian Cervical Cancer Screening Programme (NCCSP), 800 women aged 25-69 years in the Oslo area who were due to receive a 2nd reminder to attend regular screening were randomly selected and invited to be part of the intervention group. Women in this group received one of two self-sampling devices, Evalyn Brush or Delphi Screener. To attend screening, women in the intervention group had the option of using the self-sampling device (self-sampling subgroup) or visiting their physician for a cervical smear. Self-sampled specimens were split and analyzed for the presence of high-risk (hr) HPV by the CLART® HPV2 test and the digene® Hybrid Capture (HC)2 test. The control group consisted of 2593 women who received a 2nd reminder letter according to the current guidelines of the NCCSP. The attendance rates were 33.4% in the intervention group and 23.2% in the control group, with similar attendance rates for both self-sampling devices. Women in the self-sampling subgroup responded favorably to both self-sampling devices and cited not remembering receiving a call for screening as the most dominant reason for previous non-attendance. Thirty-two of 34 (94.1%) hrHPV-positive women in the self-sampling subgroup attended follow-up. In conclusion, self-sampling increased attendance rates and was feasible and well received. This study lends further support to the proposal that self-sampling may be a valuable alternative for increasing cervical cancer screening coverage in Norway.

Factors influencing non-attendance of clinic appointments in ...

African Journals Online (AJOL)

without an appointment, with an average of eight patients per day missing their appointment. The low rate of compliance with clinic appointments was of concern for the physicians at both the diabetes clinics. Prior to the current study, the reasons for non-attendance had not been examined. Materials and methods. A sample ...

The Impact of Communication Skills Training on Cardiology Fellows' and Attending Physicians' Perceived Comfort with Difficult Conversations.

Science.gov (United States)

Berlacher, Kathryn; Arnold, Robert M; Reitschuler-Cross, Eva; Teuteberg, Jeffrey; Teuteberg, Winifred

2017-07-01

Cardiologists need to decide which treatments are appropriate for seriously ill patients and whether they align with patient goals. Reconciling medical options with patients' wishes requires skilled communication. Although there is evidence that communication is teachable, few cardiologists receive formal training. To demonstrate that providing communication skills training to cardiologists is feasible and improves their perceived preparedness (PP) for leading difficult conversations. CardioTalk is a workshop to improve communication through short didactic sessions followed by interactions with standardized patients. Competencies include giving bad news, defining goals of care, responding to emotion, supporting religious beliefs, and withdrawing therapies. Settings/Subjects: First year cardiology fellows, heart failure fellows, and cardiac intensive care unit attendings. Surveys evaluated the curriculum's efficacy and learners' PP before and after the workshop. Eight cardiology attendings and 20 cardiology fellows participated. Eighty-nine percent reported having any prior education in communication. Fellows reported more prior education than attendings (100% vs. 62.5%, p = 0.017). Level of PP improved in all competencies for all learners. Ninety-six percent of respondents would recommend the training to peers. All attendings felt that it should be required for cardiologists in the cardiac intensive care unit and reported improved preparedness to teach communication to learners. All learners improved in levels of PP in communication competencies. CardioTalk is the first described training program that prepares cardiologists for the challenges they face when having conversations with seriously ill patients.

Evaluation of non-radiologist physicians' knowledge on aspects related to ionizing radiation in imaging

Energy Technology Data Exchange (ETDEWEB)

Madrigano, Renata Rodrigues [Hospital Santa Helena, Santo Andre, SP (Brazil); Abrao, Karen Cristine; Regacini, Rodrigo, E-mail: regacini@gmail.com [Universidade Anhembi Morumbi, Sao Paulo, SP (Brazil). Escola de Medicina; Puchnick, Andrea [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina

2014-07-15

Objective: to assess the non-radiologist physicians' knowledge on the use of ionizing radiation in imaging. Materials and Methods: cross-sectional study utilizing an anonymous questionnaire responded by physicians in clinical and surgical specialties, divided into two parts as follows: one including questions about the physicians' characteristics, frequency of imaging studies requests and participation in professional updating events, and another part including multiple choice questions approaching general knowledge about radiation, optimization principles and radioprotection. Results: from a total of 309 questionnaires, 120 (38.8%) were responded, 50% by physicians in surgical specialties and 50% in clinical specialties; respectively 45% and 2.5% of physicians responded that magnetic resonance imaging and ultrasonography use ionizing radiation. Overall, the average grade was higher for surgical specialists with no significant difference, except for the question about exposure in pregnant women (p = 0.047). Physicians who are professionally updated, particularly those attending clinical meetings (p = 0.050) and participating in teaching activities (p = 0.047), showed statistically superior knowledge about ionizing radiation as compared with others. Conclusion: the non-radiologist physicians' is heterogeneous and in some points needs to be improved. Multidisciplinary clinical meetings and teaching activities are important ways to disseminate information on the subject. (author)

Physician Assistant | Center for Cancer Research

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The Surgical Oncology section of the Thoracic & Gastrointestinal Oncology Branch is recruiting a Physician Assistant (PA) to support general surgery clinical activities of the Branch. Responsibilities: Complete in-depth documentation through written progress notes, dictation summaries, and communication with referring physicians according to medical record documentation requirements. Participate in clinical rounds and conferences. Administer and adjust trial medication under the guidance of a physician. Explain discharge instructions and medication regimens to patients and follow up with consulting service recommendations.  Order, perform and interpret basic laboratory diagnostic/treatment tests and procedures. Perform comprehensive health care assessments by obtaining health and family medical histories. Complete physical examinations. Perform clinical data recording and medical chart entries. Obtain informed consent. Perform minor surgeries (incisional and excisional biopsies). Maintain and complete medical records. Place orders for medications and tests. Perform retrievals from electronic medical information system. Distinguish between normal and abnormal findings and determine which findings need further evaluation and/or collaboration assessment. Develop and implement a plan for care, including appropriate patient/family counseling and education based on in-depth knowledge of the specific patient populations and/or protocols. Evaluate, modify and revise care plan at appropriate intervals. Assess acute and non-acute clinical problems and toxicities. Assess needs and/or problem areas and plan appropriate therapeutic measures. Assist in developing, implementing and evaluating medical services policies and practices. Ensure compliance with applicable licensure/certification requirements, healthcare standards, governmental laws and regulations, and policies, procedures, and philosophy in nature. Attend scheduled patient care rounds and didactic lecture sessions of

In the eyes of residents good supervisors need to be more than engaged physicians: the relevance of teacher work engagement in residency training

NARCIS (Netherlands)

Scheepers, Renée A.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.

2015-01-01

During their development into competent medical specialists, residents benefit from their attending physicians' excellence in teaching and role modelling. Work engagement increases overall job performance, but it is unknown whether this also applies to attending physicians' teaching performance and

Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

Science.gov (United States)

Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

2011-01-01

tasks with little educational value. The caseload can be so great that inadequate reflective time is left for learning based on clinical experiences. In addition, supervision is often vaguely defined and discontinuous. Medical malpractice data indicate that resident physicians are frequently named in lawsuits, most often for lack of supervision. The recommendations are: The ACGME should adjust resident physicians workload requirements to optimize educational value. Resident physicians as well as faculty should be involved in work redesign that eliminates nonessential and noneducational activity from resident physician dutiesMechanisms should be developed for identifying in real time when a resident physician’s workload is excessive, and processes developed to activate additional providersTeamwork should be actively encouraged in delivery of patient care. Historically, much of medical training has focused on individual knowledge, skills, and responsibility. As health care delivery has become more complex, it will be essential to train resident and attending physicians in effective teamwork that emphasizes collective responsibility for patient care and recognizes the signs, both individual and systemic, of a schedule and working conditions that are too demanding to be safeHospitals should embrace the opportunities that resident physician training redesign offers. Hospitals should recognize and act on the potential benefits of work redesign, eg, increased efficiency, reduced costs, improved quality of care, and resident physician and attending job satisfactionAttending physicians should supervise all hospital admissions. Resident physicians should directly discuss all admissions with attending physicians. Attending physicians should be both cognizant of and have input into the care patients are to receive upon admission to the hospitalInhouse supervision should be required for all critical care services, including emergency rooms, intensive care units, and trauma

Workload of Attending Physicians at an Academic Center in Taiwan

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Hsueh-Fen Chen

2010-08-01

Conclusion: This study found that work hours among departments differed significantly and that physicians in surgical departments spend the longest hours in clinical work. Those in administrative positions are most involved in clinical work. However, work hours do not definitely represent work intensity, and to define the workload by working hours may be inappropriate for some departments. This possible difference between work hours and work intensity merits further consideration.

Medical school type and physician income.

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Weeks, William B; Wallace, Tanner A

2008-01-01

We wanted to determine whether the type of medical school attended--private US, public US, or foreign medical school--is associated with practice characteristics or incomes of physicians. Therefore, we used survey responses obtained during the 1990s from 10,436 actively practicing white male physicians who worked in one of 13 medical specialties and who graduated from a public US (5,702), private US (3,797), or international (937) medical school. We used linear regression modeling to determine the association between type of medical school attended and physicians' annual incomes after controlling for specialty, work hours, provider characteristics, and practice characteristics. We found that, for most specialties, international medical school graduates worked longer hours, were less likely to be board certified, had practiced medicine for fewer years, and were less likely to work in rural settings than US medical school graduates. After controlling for key variables, international medical school graduates' annual incomes were 2.6 percent higher (95% CI: 0.1%, 4.4%, p = .043) and public US medical school graduates' were 2.2 percent higher (95% CI: -0.9% -6.1%, p = 0.2) than private US medical school graduates' incomes. Because of their lower tuition expenses, international and public US medical school graduates may experience higher returns on educational investment than their counterparts who graduated from private US medical schools.

Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing.

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Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

2017-05-02

In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a

Physician communication behaviors from the perspective of adult HIV patients in Kenya.

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Wachira, Juddy; Middlestadt, Susan; Reece, Michael; Peng, Chao-Ying Joanne; Braitstein, Paula

2014-04-01

We describe perceived physician communication behaviors and its association with adherence to care, among HIV patients in Kenya. This cross-sectional study was conducted between July and August 2011. The study was conducted in three adult HIV clinics within the Academic Model Providing Healthcare program in western Kenya. HIV adult patients. Patient's predisposition to attend clinic, missed appointment and missed combined antiretroviral therapy (cART) medication. A total of 400 patients were enrolled and participated in the study; the median age was 38 years (IQR = 33-44) and 56.5% were female. Patients perceived physicians engaged in a high number of communication behaviors (mean = 3.80, range 1-5). A higher perceived general health status (P = 0.01), shorter distance to the health facility (P = 0.03) and lesser time spent at the health facility (P = 0.02) were associated with a higher number of perceived physician communication behaviors. Physician-patient relationship factors were not associated with physician communication behaviors. In addition, a higher number of perceived physician communication behaviors was associated with a very high likelihood of patients' attending the next HIV clinic [adjusted odds ratio (AOR): 1.89, 95% confidence interval (CI): 1.49-2.40], a lower likelihood of patients' missing an appointment (AOR: 0.75, 95% CI: 0.61-0.92) and missing cART medication (AOR: 0.68, 95% CI: 0.52-0.87). Patients' perception of physician communication behaviors was found to be associated with their adherence to HIV care.

Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors.

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Bruno, C J; Johnston, L; Lee, C; Bernstein, P S; Goffman, D

2018-04-01

Our goal was to garner opinions regarding neonatal resuscitation training for obstetric physicians. We sought to evaluate obstacles to neonatal resuscitation training for obstetric physicians and possible solutions for implementation challenges. We distributed a national survey via email to all neonatal-perinatal medicine fellowship directors and obstetrics & gynecology residency program directors in the United States. This survey was designed by a consensus method. Ninety-eight (53%) obstetric and fifty-seven (51%) neonatal program directors responded to our surveys. Eighty-eight percent of neonatologists surveyed believe that obstetricians should be neonatal resuscitation program (NRP) certified. The majority of surveyed obstetricians (>89%) believe that obstetricians should have some neonatal resuscitation training. Eighty-six percent of obstetric residents have completed training in NRP, but only 19% of obstetric attendings are NRP certified. Major barriers to NRP training that were identified include time, lack of national requirement, lack of belief it is helpful, and cost. Most obstetric attendings are not NRP certified, but the majority of respondents believe that obstetric providers should have some neonatal resuscitation training. Our study demonstrates that most respondents support a modified neonatal resuscitation course for obstetric physicians.

Impact of Procedural Specialty on Maternity Leave and Career Satisfaction Among Female Physicians.

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Scully, Rebecca E; Davids, Jennifer S; Melnitchouk, Nelya

2017-08-01

The aim of this study was to perform a large-scale, national survey of physician mothers to define the personal, professional, and financial impact of maternity leave and its relationship to career satisfaction for female physicians in procedural and nonprocedural fields. Little is known about the impact of maternity leave on early career female physicians or how childbearing affects career satisfaction. A nationwide sample of physician mothers completed a 45-question anonymous, secure, online questionnaire regarding the impact of pregnancy and childbearing. One thousand five hundred forty-one respondents were attending physicians during their most recent pregnancy and 393 (25.5%) practiced in a procedural field. Overall, 609 (52.9%) reported losing over $10,000 in income during leave with no significant difference between procedural and nonprocedural fields. Maternity leave was included in only 28.9% of female physicians' most recent contracts. Proceduralists were more likely to report negative impact on referrals by maternity leave [odds ratio (OR) 1.78, 95% confidence interval (95% CI) 1.28-2.47, P = 0.001], a requirement to complete missed shifts (OR 3.04, 95% CI 2.12-4.36, P maternity leave and report high rates of career dissatisfaction, particularly those in procedural specialties. Given these findings, improved family leave policies may help improve career satisfaction for female physicians.

When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care?

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Richards, Claire A; Starks, Helene; O'Connor, M Rebecca; Bourget, Erica; Lindhorst, Taryn; Hays, Ross; Doorenbos, Ardith Z

2018-06-01

Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.

Does delivery volume of family physicians predict maternal and newborn outcome?

International Nuclear Information System (INIS)

Klein, M.C.; Spence, A.; Kaczorowski, J.; Kelly, A.; Grzybowski, S.

2002-01-01

The number of births attended by individual family physicians who practice intrapartum care varies. We wanted to determine if the practice-volume relations that have been shown in other fields of medical practice also exist in maternity care practice by family doctors. For the period April 1997 to August 1998, we analyzed all singleton births at a major maternity teaching hospital for which the family physician was the responsible physician. Physicians were grouped into 3 categories on the basis of the number of births they attended each year: fewer than 12, 12 to 24, and 25 or more. Physicians with a low volume of deliveries (72 physicians, 549 births), those with a medium volume of deliveries (34 physicians, 871 births) and those with a high volume of deliveries (46 physicians, 3024 births) were compared in terms of maternal and newborn outcomes. The main outcome measures were maternal morbidity, 5-minute Apgar score and admission of the baby to the neonatal intensive care unit or special care unit. Secondary outcomes were obstetric procedures and consultation patterns. There was no difference among the 3 volume cohorts in terms of rates of maternal complications of delivery, 5-minute Apgar scores of less than 7 or admissions to the neonatal intensive care unit or the special care unit, either before or after adjustment for parity, pregnancy-induced hypertension, diabetes, ethnicity, lone parent status, maternal age, gestational age, newborn birth weight and newborn head circumference at birth. High-and medium-volume family physicians consulted with obstetricians less often than low-volume family physicians (adjusted odds ratio [OR] 0.586 [95% confidence interval, CI, 0.479-0.718] and 0.739 [95% Cl 0.583-0.935] respectively). High-and medium-volume family physicians transferred the delivery to an obstetrician less often than low-volume family physicians (adjusted OR 0.668 [95% CI 0.542-0.823] and 0.776 [95% Cl 0.607-0.992] respectively). Inductions were performed

Does delivery volume of family physicians predict maternal and newborn outcome?

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Klein, M.C. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Univ. of British Columbia, Dept. of Family Practice, Vancouver, British Columbia (Canada); Spence, A. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Kaczorowski, J. [McMaster Univ., Depts. of Family Medicine and of Clinical Epidemiology and Biostatistics, Hamilton, Ontario (Canada); Kelly, A. [Children' s and Women' s Health Centre, Dept. of Family Practice, Vancouver, British Columbia (Canada); Univ. of British Columbia, Dept. of Health Care and Epidemiology, Vancouver, British Columbia (Canada); Grzybowski, S. [Univ. of British Columbia, Dept. of Family Practice, Vancouver, British Columbia (Canada)

2002-05-01

The number of births attended by individual family physicians who practice intrapartum care varies. We wanted to determine if the practice-volume relations that have been shown in other fields of medical practice also exist in maternity care practice by family doctors. For the period April 1997 to August 1998, we analyzed all singleton births at a major maternity teaching hospital for which the family physician was the responsible physician. Physicians were grouped into 3 categories on the basis of the number of births they attended each year: fewer than 12, 12 to 24, and 25 or more. Physicians with a low volume of deliveries (72 physicians, 549 births), those with a medium volume of deliveries (34 physicians, 871 births) and those with a high volume of deliveries (46 physicians, 3024 births) were compared in terms of maternal and newborn outcomes. The main outcome measures were maternal morbidity, 5-minute Apgar score and admission of the baby to the neonatal intensive care unit or special care unit. Secondary outcomes were obstetric procedures and consultation patterns. There was no difference among the 3 volume cohorts in terms of rates of maternal complications of delivery, 5-minute Apgar scores of less than 7 or admissions to the neonatal intensive care unit or the special care unit, either before or after adjustment for parity, pregnancy-induced hypertension, diabetes, ethnicity, lone parent status, maternal age, gestational age, newborn birth weight and newborn head circumference at birth. High-and medium-volume family physicians consulted with obstetricians less often than low-volume family physicians (adjusted odds ratio [OR] 0.586 [95% confidence interval, CI, 0.479-0.718] and 0.739 [95% Cl 0.583-0.935] respectively). High-and medium-volume family physicians transferred the delivery to an obstetrician less often than low-volume family physicians (adjusted OR 0.668 [95% CI 0.542-0.823] and 0.776 [95% Cl 0.607-0.992] respectively). Inductions were performed

Nationwide survey to evaluate the decision-making process in euthanasia requests in Belgium: do specifically trained 2nd physicians improve quality of consultation?

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Cohen, Joachim; Van Wesemael, Yanna; Smets, Tinne; Bilsen, Johan; Onwuteaka-Philipsen, Bregje; Distelmans, Wim; Deliens, Luc

2014-07-16

Following the 2002 enactment of the Belgian law on euthanasia, which requires the consultation of an independent second physician before proceeding with euthanasia, the Life End Information Forum (LEIF) was founded which provides specifically trained physicians who can act as mandatory consultants in euthanasia requests. This study assesses quality of consultations in Flanders and Brussels and compares these between LEIF and non-LEIF consultants. A questionnaire was sent in 2009 to a random sample of 3,006 physicians in Belgium from specialties likely involved in the care of dying patients. Several questions about the last euthanasia request of one of their patients were asked. As LEIF serves the Flemish speaking community (i.e. region of Flanders and the bilingual Brussels Capital Region) and no similar counterpart is present in Wallonia, analyses were limited to Flemish speaking physicians in Flanders and Brussels. Response was 34%. Of the 244 physicians who indicated having received a euthanasia request seventy percent consulted a second physician in their last request; in 30% this was with a LEIF physician. Compared to non-LEIF physicians, LEIF physicians were more often not a colleague (69% vs 42%) and not a co-attending physician (89% vs 66%). They tended to more often discuss the request with the attending physician (100% vs 95%) and with the family (76% vs 69%), and also more frequently helped the attending physician with performing euthanasia (44% vs 24%). No significant differences were found in the extent to which they talked to the patient (96% vs 93%) and examined the patient file (94% vs 97%). In cases of explicit euthanasia requests in Belgium, the consultation procedure of another physician by the attending physician is not optimal and can be improved. Training and putting at disposal consultants through forums such as LEIF seems able to improve this situation. Adding stipulations in the law about the necessary competencies and tasks of consulting

Interaction of a physician and a specialist on physical rehabilitation at violations of activity of the musculoskeletal system

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Andrii Hertsyk

2016-08-01

Full Text Available Purpose: the improvement of cooperation and the interaction of an attending physician and a specialist on physical rehabilitation at violations of activity of musculoskeletal system. Material & Methods: physical rehabilitation is considered as a difficult system with the hierarchically-ordered structure. The analysis of references and the system analysis are applied. Results: the modern approaches to coordination of centers of decision-making and the management in hierarchical systems are analyzed. The ways of the interlevel coordination in organizational systems are revealed. The need of coordination of activity of an attending physician and a specialist on physical rehabilitation is proved. The content and the direction of coordination signals for the system of physical rehabilitation at violations of activity of the musculoskeletal system are determined. Conclusions: the coordination of activity of an attending physician and a specialist on physical rehabilitation at violations of activity of the musculoskeletal system has to occur in certain ways: on purposes, on restrictions, in time, on input and output parameters.

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

NARCIS (Netherlands)

Rijssen, H.J. van; Schellart, A.J.M.; Anema, J.R.; Boer, W.E.L. de; Beek, A.J. van der

2011-01-01

Background Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education,

Physician practice management companies: should physicians be scared?

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Scott-Rotter, A E; Brown, J A

1999-01-01

Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

[Differences in practice among physicians staffing an emergency department in relation to years of experience].

Science.gov (United States)

Busca, Pablo; Inchaurza, Estibaliz; Illarramendi, Aiora; Urbina, Ohiana; González, Laura; Miró, Òscar

2015-06-01

To determine differences in certain variables reflecting clinical practice in a group of emergency physicians with varying levels of experience and to explore whether differences are associated with experience. Retrospective observational study of differences in variables reflecting emergency physicians' practice between 2005 and 2012. We studied work variables (months worked, patients treated, caseload distribution according to triage levels), patient management variables (consultation with other specialists, admissions, ambulance requests), diagnostic procedures ordered (simple radiographs, laboratory tests, ultrasound or computed tomography imaging), and time patients discharged home spent in the department (arrival to discharge). We explored relationships between these variables and the emergency physician's experience using linear regression analysis, followed by the construction of multivariable models to adjust for physician characteristics. Data for 50 emergency medicine physicians, in 291 years of work, were analyzed. The specialists' experience ranged from 1 to 22 years (mean [SD], 9.5 [5.8] years). They attended between 47 and 158 patients monthly (mean, 86 [19] patients). The physicians' experience was inversely and independently related to the mean number of patients attended monthly and the percentage of patients assigned a triage level of 1 or 2. Experience was directly and independently related to discharged patients' time spent in the emergency department and number of simple radiographs ordered. All associations were small (R2<0.010), however. Those variables continued to show statistically significant associations after increasingly complex modeling to adjust for the following physician variables: physician, age, sex, specialty, residency training in the same hospital). The practice of emergency physicians with more accumulated experience shows slight but significant differences from the practice of less experienced physicians.

Aggression and violence directed toward general medicine physicians

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Petrov-Kiurski Miloranka

2016-01-01

Full Text Available Objective: To explore the extent of aggression (verbal abuse and violence (physical abuse directed toward General Medicine physicians by their patients, to identify causes and consequences of such behaviour on physicians' professional work and to establish prevention measures. Method: All general medicine physicians who attended an educational seminar from 28 to 29 February 2015 in Belgrade were given the questionnaire and asked to complete it. Results: 411 general medicine physicians have completed the questionnaire. Both genders were included: 86.37% of them were women. Majority of the participants were in the age group of 51-60 years (45.25%, mean age was 49.27±9.32. Mean number of years in practice was 21.10±9.87. Most of them specialized in General Medicine (62.30%. 85.40% of physicians have encountered some kind of abuse during their work and there was no significant difference regarding physicians' gender or qualifications. In the preceding year 62.3% of participants have encountered aggression or violence in their workplace. Aggression was reported by 82.97% and violence by 8.83% of participants. There were no statistically significant differences in terms of physicians' gender (p=0.859, type of workplace (p=0.097, number of years in practice (p=0.640 and specialty (p=0.537. In 83.2% of cases acts of aggression or violence have been committed by patients and in 40.2% by members of their families. In 44.2% of these cases nobody tried to assist the physicians and even less so if they were male doctors (p=0.05. The most common causes were: patients' dissatisfaction (60.4%, long waiting time for examination (37.0% and patient's alcohol or drug intoxication (35.0%. The most common consequence of this on physicians was decreased satisfaction with their job (53.6%. Prevention measures for this issue would be: decreasing of the number of consultations per day (56.0%, introduction of a new 'in line of duty' status for healthcare workers (55

Does Attendance Matter? An Examination of Student Attitudes, Participation, Performance and Attendance

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Massingham, Peter; Herrington, Tony

2006-01-01

Non attendance of lectures and tutorials appears to be a growing trend. The literature suggests many possible reasons including students' changing lifestyle, attitudes, teaching and technology. This paper looks at the reasons for non attendance of students in the Faculty of Commerce at the University of Wollongong and identifies relationships…

Physician self-referral and physician-owned specialty facilities.

Science.gov (United States)

Casalino, Lawrence P

2008-06-01

Physician self-referral ranges from suggesting a follow-up appointment, to sending a patient to a facility in which the doctor has an ownership interest or financial relationship. Physician referral to facilities in which the physicians have an ownership interest is becoming increasingly common and not always medically appropriate. This Synthesis reviews the evidence on physician self-referral arrangements, their effect on costs and utilization, and their effect on general hospitals. Key findings include: the rise in self-referral is sparked by financial, regulatory and clinical incentives, including patient convenience and doctors trying to preserve their income in the changing health care landscape. Strong evidence suggests self-referral leads to increased usage of health care services; but there is insufficient evidence to determine whether this increased usage reflects doctors meeting an unmet need or ordering clinically inappropriate care. The more significant a physician's financial interest in a facility, the more likely the doctor is to refer patients there. Arrangements through which doctors receive fees for patient referrals to third-party centers, such as "pay-per-click," time-share, and leasing arrangements, do not seem to offer benefits beyond increasing physician income. So far, the profit margins of general hospitals have not been harmed by the rise in doctor-owned facilities.

Physician-industry relations. Part 1: individual physicians.

Science.gov (United States)

Coyle, Susan L

2002-03-05

This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

The Palliative Treatment Plan as a Bone of Contention between Attending Physicians and Nurses

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Wolfgang Lederer

2015-10-01

Full Text Available Acute vital crisis in end-of-life situations may result in hospitalization and intensive care without recognizable benefit in many cases. Advance directives regarding indications for resuscitation, hospitalization, and symptomatic treatment help ensure that acute complications can be managed quickly and satisfactorily in the patient’s customary surroundings. A plan was designed and implemented in Austrian nursing homes to provide emergency physicians with rapidly obtainable information on the patient’s current situation, and whether resuscitation attempts and hospitalization are advised or not. This palliative treatment plan is arranged by a physician together with caregivers, close relatives, and the patient or his court-appointed health care guardian or holder of power of attorney. Four years after implementation of the plan, a user satisfaction survey was carried out. The majority of participating nurses, emergency physicians and family doctors judged application and design of the palliative treatment plan positively. However, the low response rate of family doctors indicates nonconformity. In particular, the delegation of symptomatic treatment to nurses proved to be controversial. There is still a need to provide up-to-date information and training for health professionals in order for them to understand advance directives as extended autonomy for patients who have lost their ability to make their own decisions.

Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis.

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King, Marissa; Essick, Connor; Bearman, Peter; Ross, Joseph S

2013-01-30

To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. Difference-in-differences approach. 14 US medical schools with an active gift restriction policy in place by 2004. Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications.

A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits.

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Calpin, Pádraig; Imran, Ather; Harmon, Dominic

2017-03-01

The patient-physician encounter forms the cornerstone of every health service. However, optimal medical outcomes are often confounded by inadequate patient-physician communication. Chronic pain is estimated to affect over 25% of the population. Its effects are multifaceted with patients at increased risk of experiencing emotional and functional disturbances. Therefore, it is crucial to address all components of the patient's pain experience, including beliefs and expectations. It is our understanding that no other study to date has evaluated the expectations of physicians and compared them to those of patients for pain clinic visits. We sought to describe and compare expectations of chronic pain patients and their physicians during a clinic consultation. We performed a retrospective review on patients attending the pain clinic for the first time who were enrolled and completed a questionnaire asking their expectations for their clinic visit as well as outcomes that would satisfy and disappoint them. Pain physicians were also included. We compared physicians' to patients' responses and evaluated relationships between patient responses and age, gender, pain location, Pain Self-Efficacy, Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. One hundred chronic pain patients and 10 pain physicians were surveyed. Patients' clinical expectations for visits focused primarily on some pain relief (34%), education on the cause of pain (24%), and a definitive diagnosis (18%). Physician's expectations included formulation and communication of a management plan (70%), patient assessment for cause of pain (50%), and the education of patients on the cause of pain (40%) as important aims. Pain relief would satisfy the majority of patients (74%) and physicians (70%). No improvement would cause greatest dissatisfaction for patients (52%), but causing more harm would be disappointing to physicians (50%). Gender, age, pain location, and sleep quality all

Knowledge, attitudes, and practices of Florida physicians regarding dengue before and after an educational intervention.

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Doblecki-Lewis, Susanne; Chang, Aileen; Jiddou-Yaldoo, Renee; Tomashek, Kay M; Stanek, Danielle; Anil, Leena; Lichtenberger, Paola

2016-04-26

Failure to recognize and appropriately manage dengue early in the clinical course may result in late initiation of supportive treatment for severe disease. In Florida, travel-related and autochthonous dengue occur and are likely under-recognized. The objective of this study was to evaluate physician knowledge of dengue and its management before and after an educational intervention in Florida. From 2012-13 we conducted 14 grand-rounds style lectures on dengue clinical management attended by 413 physicians, and analyzed data from the pre- and post-tests. Of those attending, 231 and 220 completed the pre-and post-tests, respectively. Overall, the mean pre-test score for knowledge-based questions was 74.3 and average post-test score was 94.2%, indicating a mean increase of 19.9% (P dengue recognition and management also increased. Non-US trained physicians and those who had treated more than ten dengue cases performed significantly better in the pre-test. Post-test scores did not differ by subgroup. The train-the-trainer approach with grand-rounds style presentations appear to be an effective intervention to improve knowledge of dengue among physicians.

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

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Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

Interactions between non-physician clinicians and industry: a systematic review.

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Quinn Grundy

2013-11-01

Full Text Available BACKGROUND: With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. METHODS AND FINDINGS: We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the

Interactions between non-physician clinicians and industry: a systematic review.

Science.gov (United States)

Grundy, Quinn; Bero, Lisa; Malone, Ruth

2013-11-01

With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis

Useful but Different: Resident Physician Perceptions of Interprofessional Feedback.

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Vesel, Travis P; O'Brien, Bridget C; Henry, Duncan M; van Schaik, Sandrijn M

2016-01-01

Phenomenon: Based on recently formulated interprofessional core competencies, physicians are expected to incorporate feedback from other healthcare professionals. Based on social identity theory, physicians likely differentiate between feedback from members of their own profession and others. The current study examined residents' experiences with, and perceptions of, interprofessional feedback. In 2013, Anesthesia, Obstetrics-Gynecology, Pediatrics, and Psychiatry residents completed a survey including questions about frequency of feedback from different professionals and its perceived value (5-point scale). The authors performed an analysis of variance to examine interactions between residency program and profession of feedback provider. They conducted follow-up interviews with a subset of residents to explore reasons for residents' survey ratings. Fifty-two percent (131/254) of residents completed the survey, and 15 participated in interviews. Eighty percent of residents reported receiving written feedback from physicians, 26% from nurses, and less than 10% from other professions. There was a significant interaction between residency program and feedback provider profession, F(21, 847) = 3.82, p feedback provider profession, F(7, 847) = 73.7, p feedback from attending physicians higher than feedback from others, and anesthesia residents rated feedback from other professionals significantly lower than other residents. Ten major themes arose from qualitative data analysis, which revealed an overall positive attitude toward interprofessional feedback and clarified reasons behind residents' perceptions and identified barriers. Insights: Residents in our study reported limited exposure to interprofessional feedback and valued such feedback less than intraprofessional feedback. However, our data suggest opportunities exist for effective utilization of interprofessional feedback.

Attendance and achievement in medicine: investigating the impact of attendance policies on academic performance of medical students.

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Subramaniam, Bs; Hande, S; Komattil, R

2013-04-01

The attendance mandate for the medical course in Melaka Manipal Medical College, Manipal, India was increased from 75% to 90% based on the assumption that the mandatory increase will improve the students' performance. To find out whether there is any correlation between class attendance and academic performance. This was an institution based retrospective analytical study. Students who have completed Phase I (first two and a half years) of the MBBS course were included in the study. Student marks and attendance, from the database were obtained from three random batches, each, from two clusters A and B respectively. Those who had a mandatory attendance requirement of 75% belonged to A (n = 243), and those who had a mandatory attendance percentage of 90% belonged to B (n = 360). Statistical analyses performed included, Pearson 2 tailed correlation to correlate class attendance with student performance; Cluster analysis to classify group average in a similarity matrix; t-test to determine significance of difference in percentage of students who attained 100% when the college changed mandatory attendance from 75% to 90%; Mann-Whitney test to find out if there was a better performance in university exam when attendance policy changed. There was a significant correlation between attendance and the students who passed in the University exam. The number of students in the pass category was maximum (>90%) compared to students in distinction and failed categories. Percentage of students with 100% attendance rose from 4% (n = 10) to 11% (n = 40) when the mandatory attendance was increased from 75% to 90%. Attendance policy correlated with better academic performance. Reducing absenteeism, probably contributed to the improved academic performance of the students. But the link between attendance and best and worst performances could not be predicted because of small numbers in every batch.

Costs of Planned Home vs. Hospital Birth in British Columbia Attended by Registered Midwives and Physicians.

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Patricia A Janssen

Full Text Available Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.Costs for all women planning home birth with a regulated midwife in British Columbia, Canada were compared with those of all women who met eligibility requirements for home birth and were planning to deliver in hospital with a registered midwife, and with a sample of women of similar low risk status planning birth in the hospital with a physician. We calculated costs of physician service billings, midwifery fees, hospital in-patient costs, pharmaceuticals, home birth supplies, and transport. We compared costs among study groups using the Kruskall Wallis test for independent groups.In the first 28 days postpartum, we report a $2,338 average savings per birth among women planning home birth compared to hospital birth with a midwife and $2,541 compared to hospital birth planned with a physician. In longer term outcomes, similar reductions were observed, with cost savings per birth at $1,683 compared to the planned hospital birth with a midwife, and $1,100 compared to the physician group during the first eight weeks postpartum. During the first year of life, costs for infants of mothers planning home birth were reduced overall. Cost savings compared to planned hospital births with a midwife were $810 and with a physician $1,146. Costs were similarly reduced when findings were stratified by parity.Planned home birth in British Columbia with a registered midwife compared to planned hospital birth is less expensive for our health care system up to 8 weeks postpartum and to one year of age for the infant.

Psychological distress as a predictor of frequent attendance in family practice: a cohort study

DEFF Research Database (Denmark)

Vedsted, Peter; Fink, Per; Olesen, Frede

2001-01-01

In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice.......16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness........ In 1990, 185 consecutive adults who consulted their primary care physician (PCP) about an illness were rated on two psychometric scales (Hopkins Symptom Check List [SCL-8] and Whiteley-7), and their annual number of face-to-face contacts with a family practice was followed until 1996. Frequent attenders...

Key Elements of Clinical Physician Leadership at an Academic Medical Center

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Dine, C. Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A

2011-01-01

Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training. PMID:22379520

Physician identification and patient satisfaction in the emergency department: are they related?

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Mercer, Mary P; Hernandez-Boussard, Tina; Mahadevan, Swaminatha V; Strehlow, Matthew C

2014-05-01

Patient satisfaction has become a quality indicator tracked closely by hospitals and emergency departments (EDs). Unfortunately, the primary factors driving patient satisfaction remain poorly studied. It has been suggested that correct physician identification impacts patient satisfaction in hospitalized patients, however, the limited studies that exist have demonstrated mixed results. In this study, we sought to identify factors associated with improved satisfaction among ED patients, and specifically, to test whether improving physician identification by patients would lead to increased satisfaction. We performed a pre- and postintervention, survey-based study of patients at the end of their ED visits. We compared patient satisfaction scores as well as patients' abilities to correctly identify their physicians over two separate 1-week periods: prior to and after introducing a multimedia presentation of the attending physicians into the waiting room. A total of 486 patients (25% of all ED visits) were enrolled in the study. In the combined study population, overall patient satisfaction was higher among patients who correctly identified their physicians than among those who could not identify their physicians (combined mean satisfaction score of 8.1 vs. 7.2; odds ratio [OR] 1.07). Overall satisfaction was also higher among parents or guardians of pediatric patients than among adult patients (satisfaction score of 8.4 vs. 7.4; OR 1.07), and among patients who experienced a shorter door-to-doctor time (satisfaction score of 8.2 for shorter waiting time vs. 5.6 for longer waiting time; OR 1.15). Ambulance patients showed decreased satisfaction over some satisfaction parameters, including physician courtesy and knowledge. No direct relationship was demonstrated between the study intervention (multimedia presentation) and improved patient satisfaction or physician identification. Improved patient satisfaction was found to be positively correlated with correct physician

Physician satisfaction with a critical care clinical information system using a multimethod evaluation of usability.

Science.gov (United States)

Hudson, Darren; Kushniruk, Andre; Borycki, Elizabeth; Zuege, Danny J

2018-04-01

Physician satisfaction with electronic medical records has often been poor. Usability has frequently been identified as a source for decreased satisfaction. While surveys can identify many issues, and are logistically easier to administer, they may miss issues identified using other methods This study sought to understand the level of physician satisfaction and usability issues associated with a critical care clinical information system (eCritical Alberta) implemented throughout the province of Alberta, Canada. All critical care attending physicians using the system were invited to participate in an online survey. Questions included components of the User Acceptance of Information Technology and Usability Questionnaire as well as free text feedback on system components. Physicians were also invited to participate in a think aloud test using simulated scenarios. The transcribed think aloud text and questionnaire were subjected to textual analysis. 82% of all eligible physicians completed the on-line survey (n = 61). Eight physicians were invited and seven completed the think aloud test. Overall satisfaction with the system was moderate. Usability was identified as a significant factor contributing to satisfaction. The major usability factors identified were system response time and layout. The think aloud component identified additional factors beyond those identified in the on-line survey. This study found a modestly high level of physician satisfaction with a province-wide clinical critical care information system. Usability continues to be a significant factor in physician satisfaction. Using multiple methods of evaluation can capture the benefits of a large sample size and deeper understanding of the issues. Copyright © 2018 Elsevier B.V. All rights reserved.

Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

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Chanin Johann C

2008-09-01

Full Text Available Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We conducted semi-structured interviews with 23 primary care physicians across the US regarding their experience treating patients with depression, barriers to care, and commonly promoted CCM-based interventions. Themes were identified from interview transcripts using a grounded theory approach. Results Six barriers emerged from the interviews: difficulty diagnosing depression, patient resistance, fragmented mental health system, insurance coverage, lack of expertise, and competing demands and other responsibilities as a primary care provider. A number of interventions were seen as helpful in addressing these barriers – including care managers, mental health integration, and education – while others received mixed reviews. Mental health consultation models received the least endorsement. Two systems-related barriers, the fragmented mental health system and insurance coverage limitations, appeared incompletely addressed by the interventions. Conclusion CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is

Physician-Pharmacist Collaborative Care for Dyslipidemia Patients: Knowledge and Skills of Community Pharmacists

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Villeneuve, Julie; Lamarre, Diane; Lussier, Marie-Therese; Vanier, Marie-Claude; Genest, Jacques; Blais, Lucie; Hudon, Eveline; Perreault, Sylvie; Berbiche, Djamal; Lalonde, Lyne

2009-01-01

Introduction: In a physician-pharmacist collaborative-care (PPCC) intervention, community pharmacists were responsible for initiating lipid-lowering pharmacotherapy and adjusting the medication dosage. They attended a 1-day interactive workshop supported by a treatment protocol and clinical and communication tools. Afterwards, changes in…

Physicians' perceptions of physician-nurse interactions and information needs in China.

Science.gov (United States)

Wen, Dong; Guan, Pengcheng; Zhang, Xingting; Lei, Jianbo

2018-01-01

Good communication between physicians and nurses is important for the understanding of disease status and treatment feedback; however, certain issues in Chinese hospitals could lead to suboptimal physician-nurse communication in clinical work. Convenience sampling was used to recruit participants. Questionnaires were sent to clinical physicians in three top tertiary Grade-A teaching hospitals in China and six hundred and seventeen physicians participated in the survey. (1) Common physician-nurse interactions were shift-change reports and provisional reports when needed, and interactions expected by physicians included face-to-face reports and communication via a phone or mobile device. (2) Most respondents believed that the need for information in physician-nurse interactions was high, information was moderately accurate and timely, and feedback regarding interaction time and satisfaction indicated that they were only average and required improvement. (3) Information needs in physician-nurse interactions differed significantly according to hospital category, role, workplace, and educational background (p < .05). There was a considerable need for information within physician-nurse interactions, and the level of satisfaction with the information obtained was average; requirements for the improvement of communication differed between physicians and nurses because of differences in their characteristics. Currently, the use of information technology in physician-nurse communication was less common but was highly expected by physicians.

Study of relation of continuing medical education to quality of family physicians' care.

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Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

1988-10-01

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction.

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Katz-Sidlow, Rachel J; Ludwig, Allison; Miller, Scott; Sidlow, Robert

2012-10-01

While there are numerous benefits of smartphone use for physicians, little is known about the negative effects of using these devices in the context of patient care. To assess resident and faculty smartphone use during inpatient attending rounds and its potential as a source of distraction during transfer of clinical information. Cross-sectional survey. University-affiliated public teaching hospital. All housestaff and inpatient faculty in the departments of Medicine and Pediatrics. Participants were asked about smartphone ownership, usage patterns during attending rounds, and whether team members had ever missed important data during rounds due to distraction from smartphones. Attendings were asked whether policies should be established for smartphone use during rounds. The overall response rate was 73%. Device ownership was prevalent (89% residents, 98% faculty), as was use of smartphones during inpatient rounds (57% residents, 28% attendings). According to self-reports, smartphones were used during rounds for patient care (85% residents, 48% faculty), reading/responding to personal texts/e-mails (37% residents, 12% faculty), and other non-patient care uses (15% residents, 0% faculty). Nineteen percent of residents and 12% of attendings believed they had missed important information because of distraction from smartphones. Residents and faculty agreed that smartphones "can be a serious distraction during attending rounds," and nearly 80% of faculty believed that smartphone policies should be established. Smartphone use during attending rounds is prevalent and can distract users during important information transfer. Attendings strongly favored the institution of formal policies governing appropriate smartphone use during inpatient rounds. Copyright © 2012 Society of Hospital Medicine.

Barriers of Chinese primary care attenders to seeking help for psychological distress in Hong Kong.

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Sun, Kai Sing; Lam, Tai Pong; Lam, Kwok Fai; Lo, Tak Lam; Chao, David Vai Kiong; Lam, Edmund Wing Wo

2016-05-15

Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong. Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics. Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems. The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture. Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help. Copyright © 2016 Elsevier B.V. All rights reserved.

Physician Communication in Pediatric End-of-Life Care: A Simulation Study.

Science.gov (United States)

Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L

2016-12-01

The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

Burnout among physicians

OpenAIRE

Romani, Maya; Ashkar, Khalil

2014-01-01

Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to ...

Effect on attendance by including focused information on spirometry in preventive health checks: study protocol for a randomized controlled trial.

Science.gov (United States)

Ørts, Lene Maria; Løkke, Anders; Bjerregaard, Anne-Louise; Maindal, Helle Terkildsen; Sandbæk, Annelli

2016-12-01

Early detection of lung diseases can help to reduce their severity. Lung diseases are among the most frequently occurring and serious diseases worldwide; nonetheless, many patients remain undiagnosed. Preventive health checks including spirometry can detect lung diseases at early stages; however, recruitment for health checks remains a challenge, and little is known about what motivates the attendance. The aim of the study is to examine whether focused information on spirometry in the invitation compared to general information will impact the attendance rate in preventive health checks. This randomized, controlled trial tests the effect of information on spirometry embedded in the Check your Health Preventive Program (CHPP). The CHPP is an open-label, household cluster-randomized, controlled trial offering a preventive health check to 30- to -49-year-olds in a Danish municipality from 2012 to 2017 (n = 26,216). During 2015-2016, 4356 citizens aged 30-49 years will be randomized into two groups. The intervention group receives an invitation which highlights the value and contents of spirometry as part of a health check and information about lung diseases. The comparison group receives a standard invitation containing practical information and specifies the contents of the general health check. Outcomes are (1) differences in attendance rates measured by the proportion of citizens attending each of the two study groups and (2) proportion of persons at risk defined by smoking status and self-reported lung symptoms in the study groups. The proportion of participants with abnormal spirometry assessed at the preventive health check will be compared between the two study groups. The results from the present study will inform future recruitment strategies to health checks. The developed material on content, value, and information about lung disease is feasible and transferable to other populations, making it easy to implement if effective. ClinicalTrials.gov: NCT

Clinical competence of biopsychosocially trained physicians and controls.

Science.gov (United States)

Adler, Rolf H; Minder, Christoph E

2012-07-25

To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training. A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness. The symptoms had begun before her final nursing- exam and exacerbated on her mother's 60th birthday two months later. The patient's mother is the sole caretaker for the patient's sister, who also attended the birthday party. The patient's sister is 19 and had been diagnosed with storage disease and is wheelchair-bound. The doctors were asked to record their observations and interpretations while reviewing the case report. Group A-physicians mentioned and interpreted the physician-patient relationship and the patient's body language as described in the case report more often (p = 0.002, Wilcoxon-Mann-Whitney rank sum test (RS)), mentioned physical symptoms more often (p = 0.0099, Fisher's exact test (FE)) and more often interpreted illness settings with respect to the patient's fear and guilt (Fisher's exact test, p = 0.007 and p = 0.015). A precise integrative diagnosis (life events leading to stress, the latter evoking fear and guilt, leading to symptoms of the fight-flight reaction) was suggested by 7 of group A and 4 of group C. Extensive laboratory work-up and requests for consultations were more frequently asked for by the C group (p = 0.048, RS). Residency training in biopsychosocial medicine in an Internal Medicine Department increased sensitivity to and interpretation of biological and psychosocial data many years after the training and decreased the extent of work-up and consultation costs. However it only tended to enhance psychosomatic conceptualisation with respect to anxiety

Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease

DEFF Research Database (Denmark)

Zachariae, R; Pedersen, C G; Jensen, A B

2003-01-01

-efficacy, and perceived control were completed prior to and after the consultation by 454 patients attending an oncology outpatient clinic. After the consultation, the patients also rated the physicians' communicative behaviours by completing a patient-physician relationship inventory (PPRI), and the physicians were......The aim of the study was to investigate the association of physician communication behaviours as perceived by the patient with patient reported satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease in cancer patients. Questionnaires measuring distress, self...

Skilled attendance at delivery; how skilled are institutional birth attendants? : An explorative study on birth attendants at Bansang Hospital, The Gambia

OpenAIRE

Kreyberg, Ina; Helsingen, Lise Mørkved

2010-01-01

Abstract Background: As reflected in the United Nations Millennium Development Goals (UN MDG 5), reducing maternal mortality represents an important area of concern. The common causes of maternal deaths may be preventable and treatable by having access to emergency obstetric care (EmOC), including skilled birth attendance (SBA), when needed. Measuring the presence of a birth attendant has been the main focus until now, not their skills and qualifications, and by this we cannot presuppose ...

VERTIGO AS AN ENT DISEASE : GENERAL PHYSICIAN AND THE COMMON MAN’S PERCEPTION

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Sumit

2015-08-01

Full Text Available BACKGROUND : To study consciousness amongst General Physicians and common people, on their perception of Vertigo related to ENT disease. METHODS : Study was conducted in two different places of Eastern India from 2006 to 2015 . The patients with complaints of vertigo attending Otorhinolaryngologists at the first instance or by GP referral were studied . General Physicians also underwent a survey through a questionnaire. RESULTS : From the last 9 years of data , we find a defin ite increment in the number of vertigo patients at our OPD along with an increase in consciousness amongst the general physicians, though majority of doctors still don't think Vertigo to be predominantly an ENT disease

Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction.

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Weng, Hui-Ching

2008-01-01

Much of the literature pertinent to management indicates that service providers with high emotional intelligence (EI) receive higher customer satisfaction scores. Previous studies offer limited evidence regarding the impact of physician's EI on patient-physician relationship. Using a multilevel and multisource data approach, the current study aimed to build a model that demonstrated the impact of a physician's EI on the patient's trust and the patient-physician relationship. The survey sample included 983 outpatients and 39 physicians representing 11 specialties. Results of path analyses demonstrated that the ratio of patient's follow-up visits (p impact of patient's trust on patient's satisfaction was mediated by the patient-physician relationship at a significant level (p relationship had a significantly positive effect on patient's satisfaction (p relationship; however, mutual trust and professional respect between nurses and physicians play a critical role in reinforcing the patient-physician relationship to effect improvements in the provision of patient-centered care.

Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives.

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Rothenfluh, Fabia; Schulz, Peter J

2017-05-01

Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes

Physicians' opinions of a health information exchange.

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Hincapie, Ana Lucia; Warholak, Terri L; Murcko, Anita C; Slack, Marion; Malone, Daniel C

2011-01-01

Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE). To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs. A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding. A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of "doctor shopping"; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system. Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.

Wife abuse: a hidden problem. A study among Saudi women attending PHC centres.

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Tashkandi, A; Rasheed, F P

2009-01-01

The aim of this cross-sectional study was to measure the prevalence, severity and type of wife abuse experienced by ever-married women attending primary health centres in Medina, Saudi Arabia. Women were interviewed in private at health centres using a questionnaire which included items from the Modified Conflict Tactic Scale, Kansas Marital Scale and the lie scale of the Minnesota Multiphase Personality Inventory. Of 689 eligible women, 25.7% reported physical abuse and 32.8% emotional abuse without physical violence. Of those physically abused, 36.7% suffered minor and 63.3% severe incidents. The lifetime prevalence of abuse among the women was 57.7%. Only 36.7% of 109 abused women had informed and discussed the issue with their primary care physician.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

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Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

Improving communication between physicians and patients who speak a foreign language.

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Bischoff, Alexander; Perneger, Thomas V; Bovier, Patrick A; Loutan, Louis; Stalder, Hans

2003-07-01

Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.

Complexities in euthanasia or physician-assisted suicide as perceived by Dutch physicians and patients' relatives.

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Snijdewind, Marianne C; van Tol, Donald G; Onwuteaka-Philipsen, Bregje D; Willems, Dick L

2014-12-01

The practice of euthanasia and physician-assisted suicide (EAS) is always complex, but some cases are more complex than others. The nature of these unusually complex cases is not known. To identify and categorize the characteristics of EAS requests that are more complex than others. We held in-depth interviews with 28 Dutch physicians about their perception of complex cases of EAS requests. We also interviewed 26 relatives of patients who had died by EAS. We used open coding and inductive analysis to identify various different aspects of the complexities described by the participants. Complexities can be categorized into relational difficulties-such as miscommunication, invisible suffering, and the absence of a process of growth toward EAS-and complexities that arise from unexpected situations, such as the capricious progress of a disease or the obligation to move the patient. The interviews showed that relatives of the patient influence the process toward EAS. First, the process toward EAS may be disrupted, causing a complex situation. Second, the course of the process toward EAS is influenced not only by the patient and his/her attending physician but also by the relatives who are involved. Communicating and clarifying expectations throughout the process may help to prevent the occurrence of unusually complex situations. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Do HCAHPS Doctor Communication Scores Reflect the Communication Skills of the Attending on Record? A Cautionary Tale from a Tertiary-Care Medical Service.

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Velez, Vicente J; Kaw, Roop; Hu, Bo; Frankel, Richard M; Windover, Amy K; Bokar, Dan; Rish, Julie M; Rothberg, Michael B

2017-06-01

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient satisfaction with hospital care. It is not known if these reflect the communication skills of the attending physician on record. The Four Habits Coding Scheme (4HCS) is a validated instrument that measures bedside physician communication skills according to 4 habits, namely: investing in the beginning, eliciting the patient's perspective, demonstrating empathy, and investing in the end. To investigate whether the 4HCS correlates with provider HCAHPS scores. Using a cross-sectional design, consenting hospitalist physicians (n = 28), were observed on inpatient rounds during 3 separate encounters. We compared hospitalists' 4HCS scores with their doctor communication HCAHPS scores to assess the degree to which these correlated with inpatient physician communication skills. We performed sensitivity analysis excluding scores returned by patients cared for by more than 1 hospitalist. A total of 1003 HCAHPS survey responses were available. Pearson correlation between 4HCS and doctor communication scores was not significant, at 0.098 (-0.285, 0.455; P = 0.619). Also, no significant correlations were found between each habit and HCAHPS. When including only scores attributable to 1 hospitalist, Pearson correlation between the empathy habit and the HCAHPS respect score was 0.515 (0.176, 0.745; P = 0.005). Between empathy and overall doctor communication, it was 0.442 (0.082, 0.7; P = 0.019). Attending-of-record HCAHPS scores do not correlate with 4HCS. After excluding patients cared for by more than 1 hospitalist, demonstrating empathy did correlate with the doctor communication and respect HCAHPS scores. Journal of Hospital Medicine 2017;12:421-427. © 2017 Society of Hospital Medicine

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit.

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Arnold, Jacob; Tango, Jennifer; Walker, Ian; Waranch, Chris; McKamie, Joshua; Poonja, Zafrina; Messman, Anne

2018-03-01

Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank - an online resident community - conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module "Self-Care Series" focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module "Clinical Care Series" focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

Directory of Open Access Journals (Sweden)

Jacob Arnold

2018-02-01

Full Text Available Introduction: Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout. Methods: A 30-person (27 residents, three attending physicians Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank – an online resident community – conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. Results: Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module “Self-Care Series” focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module “Clinical Care Series” focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. Conclusion: The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.

[Position paper from the Department of Ethics of the Chilean College of Physicians about conscientious objection].

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Salas, Sofía P; Besio, Mauricio; Bórquez Estefó, Gladys; Salinas, Rodrigo A; Valenzuela, Carlos Y; Micolich, Constanza; Novoa Sotta, Fernando; Bernier Villarroel, Lioniel; Montt M, Julio; Misseroni Raddatz, Adelio

2016-03-01

The Chilean bill that regulates abortion for three cases (Bulletin Nº 9895-11) includes the possibility that health professionals may manifest their conscientious objection (CO) to perform this procedure. Due to the broad impact that the issue of C O had, the Ethics Department of the Chilean College of Physicians considered important to review this concept and its ethical and legal basis, especially in the field of sexual and reproductive health. In the present document, we define the practical limit s of CO, both for the proper fulfillment of the medical profession obligations, and for the due respect and non-discrimination that the professional objector deserves. We analyze the denial of some health institutions to perform abortions if it is legalize d, and we end with recommendations adjusted to the Chilean reality. Specifically, we recognize the right to conscientious objection that all physicians who directly participate in a professional act have. But we a lso recognize that physicians have ineludib le obligations towards their patients, including the obligation to inform about the existence of this service, how to access to it and -as set out in our code of ethics- to ensure that another colleague will continue attending the patient.

Self-reported smoking cessation activities among Swiss primary care physicians

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Ruffieux Christiane

2009-03-01

Full Text Available Abstract Background Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. Methods The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as ≥ 2. Results The response rate was 55%. Respondents were predominately over the age of 40 years (88%, male (79%, and resided in urban areas (74%. Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%, bupropion (65%, or provided counselling (70%. A minority of physicians recommended acupuncture (26%, hypnosis (8%, relaxation (7%, or self-help material (24%. A good practice score was obtained by 85% of respondents. Having attended a smoking cessation-training program was the only significant predictor of a good practice score (odds ratio: 6.24, 95% CI 1.95–20.04. Conclusion The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients.

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Kitts, Robert Li

2010-01-01

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.

Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians

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Marcus Eh Ong

2009-11-01

Full Text Available Marcus Eh Ong1, Susan Yap1, Kim P Chan1, Papia Sultana2, Venkataraman Anantharaman11Department of Emergency Medicine, 2Department of Clinical Research, Singapore General Hospital, SingaporeObjective: To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR and defibrillation.Methods: We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions.Results: The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED, and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS (P < 0.001 and advanced cardiac life support (P = 0.005 or to have ever attended to a patient with cardiac arrest (P = 0.007. Female physicians tended to agree that all clinics should have AEDs (P = 0.005 and support legislation to make AEDs compulsory in clinics (P < 0.001. We also found that a large proportion of physicians who were trained in BCLS (P = 0.006 were willing to perform mouth-to-mouth ventilation.Conclusion: Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.Keywords: general practitioners, cardiac arrest, resuscitation, defibrillation, attitude, knowledge

Current level of training, experience and perceptions of emergency physicians as expert witnesses: a pilot study.

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Cunningham, Nicola Y; Weiland, Tracey J

2009-12-01

The objective of the present study was to determine emergency physicians' training, experience and perceptions as expert witnesses. Emergency physicians of an adult tertiary referral and teaching hospital participated in a pilot survey regarding their experiences in report writing and in court as expert witnesses. The 28-item survey also examined the amount of formalized forensic medical teaching that emergency physicians had received during their training. Of the participants, 41% (95% CI 21.6-64.1; 7/17) had never received any undergraduate or postgraduate training in forensic medicine, 11/17 (65%, 95% CI 41.2-82.8) had provided a written expert opinion for court, and 12/17 (71%, 95% CI 46.6-87.0) had attended court as an expert witness. All participants considered themselves 'skilled in attending an emergency resuscitation', whereas 3/13 (23%, 95% CI 7.5-50.9) considered themselves 'skilled in attending a courtroom trial'. Nearly 90% (95% CI 64.7-98.0; 15/17) thought that medical evidence training should be a requirement of emergency speciality training. The most commonly preferred forms of medical evidence training were mock court sessions (76%, 95% CI 52.2-91.0; 13/17) and forensic workshops (76%, 95% CI 52.2-91.0; 13/17). From 10 non-technical skills required of an EP, 'appearing in court as an expert witness' was perceived to be the second most difficult skill by most respondents. Emergency physicians in this pilot study have limited training for the role of expert witness and see it as one of the most difficult non-technical skills they have to perform. Further research is required regarding the current and future scope of forensic training.

Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

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Sayaka Saito

Full Text Available BACKGROUND: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. METHODS AND FINDINGS: From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%, received drug samples (85% and stationery (96%, and participated in industry-sponsored continuing medical education (CME events at the workplace (80% and outside the workplace (93%. Half accepted meals outside the workplace (49% and financial subsidies to attend CME events (49%. Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to

The account system for students school‘s attendance

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Birgėlienė, Raminta

2007-01-01

SUMMARY The account system for students school‘s attendance The purpose of the created students school‘s attendance account system is to assist teachers in registering, observing and making reports on students school‘s attendance. This work presents the of secondary school students���result attendance account transferred to the informatics system. The system includes the analysis, separable processes, adjustable structured analysis and projections‘methods, which allow dealing with a real prob...

Impact of Attendance Policies on Course Attendance among College Students

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Chenneville, Tiffany; Jordan, Cary

2008-01-01

The purpose of this study was twofold: (a) to investigate whether having a graded attendance policy would have an effect on course attendance among college students, and (b) to examine beliefs about education and attendance policies among college students. Results support the utility of graded attendance policies for increasing class attendance…

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

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Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

Sickness presenteeism: The prevalence of coming to work while ill among paediatric resident physicians in Canada.

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Mitchell, Kevin J; Vayalumkal, Joseph V

2017-05-01

Sickness presenteeism is defined as the act of attending one's job despite ill-health. Recently, physicians and other health care workers have become the focus of sickness presenteeism research, because presenteeism in this population can put patients at risk of infection. There are currently no data on this topic among physicians in Canada. The aim of this study was to investigate sickness presenteeism in paediatric resident physicians in Canada. We conducted an anonymous, online, cross-sectional survey study in which all paediatric residents in Canada were eligible. Outcomes of interest included prevalences of sickness presenteeism, sickness during the study period and voluntary self-appointed personal protective equipment use when engaging in sickness presenteeism. Response rate was 56.5% (N=323). During the previous 2 months, 61% (95% confidence interval [CI] 55.7 to 66.3) of respondents reported having experienced an illness and 59% (95% CI 53.7 to 64.5) of respondents had come to work sick. Of those who reported becoming ill during the study period, 97.0% (95% CI 94.6 to 99.4) reported coming to work while sick. There was no difference in prevalence when comparing across post-graduate year training levels. Extra personal protective equipment was used by 86% (95% CI 82.1 to 91.7) when engaging in sickness presenteeism. Sickness presenteeism is a common phenomenon among paediatric resident physicians. Our results should influence residents and supervising staff physicians to encourage appropriate self-care at home, rather than presenteeism.

The development of rhythmic attending in auditory sequences: attunement, referent period, focal attending.

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Drake, C; Jones, M R; Baruch, C

2000-12-15

This paper is divided into three sections. The first section is theoretical; it extends Dynamic Attending Theory (Jones, M. R. Psychological Review 83 (1976) 323; Jones, M. R. Perception and Psychophysics 41(6) (1987) 631; Jones, M. R. Psychomusicology 9(2) (1990) 193; Jones, M. R., & Boltz, M. Psychological Review 96(3) (1989) 459) to developmental questions concerning tempo and time hierarchies. Generally Dynamic Attending Theory proposes that, when listening to a complex auditory sequence, listeners spontaneously focus on events occurring at an intermediate rate (the referent level), and they then may shift attention to events occurring over longer or shorter time spans, that is at lower (faster) or higher (slower) hierarchical levels (focal attending). The second section of the paper is experimental. It examines maturational changes of three dynamic attending activities involving referent period and level, attunement, and focal attending. Tasks involve both motor tapping (including spontaneous motor tempo and synchronization with simple sequences and music) and tempo discrimination. We compare performances by 4-, 6-, 8-, and 10-year-old children and adults, with or without musical training. Results indicate three changes with increased age and musical training: (1) a slowing of the mean spontaneous tapping rate (a reflection of the referent period) and mean synchronization rate (a reflection of the referent level), (2) enhanced ability to synchronize tapping and discriminate tempo (improved attunement), and (3) an enlarged range of tapping rates towards slower rates and higher hierarchical levels (improved focal attending). A final section considers results in light of the theory proposed here. It is suggested that growth trends can be expressed in terms of listeners' engagement of slower attending oscillators with age and experience, accompanied by the passage from the initial use of a single oscillator towards the coupling of multiple oscillators.

Administrative skills for academic physicians.

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Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E

1989-01-01

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

Nurse-physician communication - An integrated review.

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Tan, Tit-Chai; Zhou, Huaqiong; Kelly, Michelle

2017-12-01

To present a comprehensive review of current evidence on the factors which impact on nurse-physician communication and interventions developed to improve nurse-physician communication. The challenges in nurse-physician communication persist since the term 'nurse-doctor game' was first used in 1967, leading to poor patient outcomes such as treatment delays and potential patient harm. Inconsistent evidence was found on the factors and interventions which foster or impair effective nurse-physician communication. An integrative review was conducted following a five-stage process: problem identification, literature search, data evaluation, data analysis and presentation. Five electronic databases were searched from 2005 to April 2016 using key search terms: "improve*," "nurse-physician," "nurse," "physician" and "communication" in five electronic databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Science Direct and Scopus. A total of 22 studies were included in the review. Four themes emerged from the data synthesis, namely communication styles; factors that facilitate nurse-physician communication; barriers to effective nurse-physician communication; and interventions to improve nurse-physician communication. This integrative review suggests that nurse-physician communication still remains ineffective. Current interventions only address information needs of nurses and physicians in limited situations and specific settings but cannot adequately address the interprofessional communication skills that are lacking in practice. The disparate views of nurses and physicians on communication due to differing training backgrounds confound the effectiveness of current interventions or strategies. Cross-training and interprofessional educational from undergraduate to postgraduate programmes will better align the training of nurses and physicians to communicate effectively. Further research is needed to determine the

First and foremost, physicians: the clinical versus leadership identities of physician leaders.

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Quinn, Joann Farrell; Perelli, Sheri

2016-06-20

Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

Associations Between Physician Empathy, Physician Characteristics, and Standardized Measures of Patient Experience.

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Chaitoff, Alexander; Sun, Bob; Windover, Amy; Bokar, Daniel; Featherall, Joseph; Rothberg, Michael B; Misra-Hebert, Anita D

2017-10-01

To identify correlates of physician empathy and determine whether physician empathy is related to standardized measures of patient experience. Demographic, professional, and empathy data were collected during 2013-2015 from Cleveland Clinic Health System physicians prior to participation in mandatory communication skills training. Empathy was assessed using the Jefferson Scale of Empathy. Data were also collected for seven measures (six provider communication items and overall provider rating) from the visit-specific and 12-month Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS) surveys. Associations between empathy and provider characteristics were assessed by linear regression, ANOVA, or a nonparametric equivalent. Significant predictors were included in a multivariable linear regression model. Correlations between empathy and CG-CAHPS scores were assessed using Spearman rank correlation coefficients. In bivariable analysis (n = 847 physicians), female sex (P empathy scores. In multivariable analysis, female sex (P empathy scores. Of the seven CG-CAHPS measures, scores on five for the 583 physicians with visit-specific data and on three for the 277 physicians with 12-month data were positively correlated with empathy. Specialty and sex were independently associated with physician empathy. Empathy was correlated with higher scores on multiple CG-CAHPS items, suggesting improving physician empathy might play a role in improving patient experience.

Physicians' perspectives of pharmacist-physician collaboration in the United Arab Emirates: Findings from an exploratory study.

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Hasan, S; Stewart, K; Chapman, C B; Kong, D C M

2018-03-28

Interprofessional collaborative care has been shown to improve patient outcomes. Physicians' views on collaboration with pharmacists give an insight into what contributes to a well-functioning team. Little is known about these views from low and ​middle-income countries and nothing from the United Arab Emirates (UAE). The purpose of this study is to investigate physicians' opinions on collaborative relationships with community pharmacists in the UAE. Semi-structured individual interviews and group discussions are conducted with a purposive sample of physicians. Thematic analysis based on the framework approach is used to generate themes. A total of 53 physicians participated. Three themes about collaboration emerged: perceived benefits of collaboration, facilitators of collaboration and perceived barriers to collaboration. Perceived benefits include reducing the burden on physicians, having the pharmacist as an extra safety check within the system, having the pharmacist assist patients to manage their medications: coping with side effects, reducing drug waste and costs, and attaining professional and health-system gains. Perceived facilitators included awareness and trust building, professional role definition, pharmacists' access to patient records and effective communication. Perceived barriers included patient and physician acceptance, logistic and financial issues and perceived pharmacist competence. This study has, for the first time, provided useful information to inform the future development of pharmacist-physician collaboration in the UAE and other countries with similar healthcare systems.

Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders

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ter Riet Gerben

2009-01-01

Full Text Available Abstract Background General Practitioners spend a disproportionate amount of time on frequent attenders. So far, trials on the effect of interventions on frequent attenders have shown negative results. However, these trials were conducted in short-term frequent attenders. It would be more reasonable to target intervention at persistent frequent attenders. Typical characteristics of persistent frequent attenders, as opposed to 1-year frequent attenders and non-frequent attenders, may generate hypotheses regarding modifiable factors on which new randomized trials may be designed. Methods We used the data of all 28,860 adult patients from 5 primary healthcare centers. Frequent attenders were patients whose attendance rate ranked in the (age and sex adjusted top 10 percent during 1 year (1-year frequent attenders or 3 years (persistent frequent attenders. All other patients on the register over the 3-year period were referred to as non-frequent attenders. The lists of medical problems coded by the GP using the International Classification of Primary Care (ICPC were used to assess morbidity. First, we determined which proportion of 1-year frequent attenders was still a frequent attender during the next two consecutive years and calculated the GPs' workload for these patients. Second, we compared morbidity and number of prescriptions for non-frequent attenders, 1-year frequent attenders and persistent frequent attenders. Results Of all 1-year frequent attenders, 15.4% became a persistent frequent attender equal to 1.6% of all patients. The 1-year frequent attenders (3,045; 10.6% were responsible for 39% of the face-to-face consultations; the 470 patients who would become persistent frequent attenders (1.6% were responsible for 8% of all consultations in 2003. Persistent frequent attenders presented more social problems, more psychiatric problems and medically unexplained physical symptoms, but also more chronic somatic diseases (especially diabetes

Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness.

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Truong, Amanda; Cobb, Nadia M; Hawkes, Jason E; Adjase, Emmanuel T; Goldgar, David E; Powell, Douglas L; Lewis, Bethany K H

2018-03-01

To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana. Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material. In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes. This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.

Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units.

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Henrich, Natalie; Ayas, Najib T; Stelfox, Henry T; Peets, Adam D

2016-09-01

Fatigue is common among physicians and adversely affects their performance. To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU). We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada. In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions. ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.

Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians' Perceptions and Attitudes.

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Daniel, Fady; Jabak, Suha; Sasso, Roula; Chamoun, Yara; Tamim, Hani

2018-04-06

The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. This was a cross-sectional observational study using an online survey that addressed physicians' perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. ©Fady Daniel, Suha Jabak, Roula Sasso, Yara Chamoun, Hani Tamim. Originally published in JMIR Medical Informatics (http

How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance.

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Byrne, Abbey; Morgan, Alison

2011-11-01

Forty years of safe motherhood programming has demonstrated that isolated interventions will not reduce maternal mortality sufficiently to achieve MDG 5. Although skilled birth attendants (SBAs) can intervene to save lives, traditional birth attendants (TBAs) are often preferred by communities. Considering the value of both TBAs and SBAs, it is important to review strategies for maximizing their respective strengths. To describe mechanisms to integrate TBAs with the health system to increase skilled birth attendance and examine the components of successful integration. A systematic review of interventions linking TBAs and formal health workers, measuring outcomes of skilled birth attendance, referrals, and facility deliveries. Thirty-three articles met the selection criteria. Mechanisms used for integration included training and supervision of TBAs, collaboration skills for health workers, inclusion of TBAs at health facilities, communication systems, and clear definition of roles. Impact on skilled birth attendance depended on selection of TBAs, community participation, and addressing barriers to access. Successful approaches were context-specific. The integration of TBAs with formal health systems increases skilled birth attendance. The greatest impact is seen when TBA integration is combined with complementary actions to overcome context-specific barriers to contact among SBAs, TBAs, and women. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.

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Juan E Corral

Full Text Available Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control.A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH prevention guidelines and the US Preventive Services Task Force (USPSTF recommendations. Analysis compared knowledge of recommendations within and between hospitals.In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings. With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level.Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.

Is that your pager or mine: a survey of women academic family physicians in dual physician families.

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Schrager, Sarina; Kolan, Anne; Dottl, Susan L

2007-08-01

This study explored the unique challenges and strategies of women in academic family medicine who are in dual physician families. An e-mail survey was sent to all female physician members of the Society of Teachers of Family Medicine (STFM) who were listed in the on-line database. The survey collected demographic information, details of job descriptions and family life, and included 3 open-ended questions about the experiences of dual physician families. Over 1200 surveys were sent to women physicians in academic family medicine. One hundred fifty-nine surveys were returned. Half of all women worked full time compared to 87% of their partners. Most women reported benefits of having a physician partner including support and having an understanding person at home, though scheduling conflicts and childcare responsibilities contributed to the need for job compromises. Women prioritized finding work-life balance and having supportive partners and mentors as most important to their success as academic family physicians. Dual physician relationships involve rewards and conflicts. More research should explore the competing demands of family life with success in academic medicine.

The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

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Parlier, Anna Beth; Galvin, Shelley L; Thach, Sarah; Kruidenier, David; Fagan, Ernest Blake

2018-01-01

To examine the literature documenting successes in recruiting and retaining rural primary care physicians. The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

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Lauridsen KG

2017-03-01

Full Text Available Kasper G Lauridsen,1–3 Anders S Schmidt,1–3 Philip Caap,3,4 Rasmus Aagaard,2,3,5 Bo Løfgren1,3,4 1Department of Internal Medicine, 2Clinical Research Unit, Regional Hospital of Randers, Randers, 3Research Center for Emergency Medicine, Aarhus University Hospital, 4Institute of Clinical Medicine, Aarhus University, Aarhus, 5Department of Anesthesiology, Randers Regional Hospital, Denmark Background: The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods: We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results: In total, 93 physicians (53% male from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39 years. Respondents were medical students working as locum physicians (5%, physicians in training (79% and consultants (16%, and the median postgraduate clinical experience was 48 (19–87 months. Most respondents (92% felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41% and focused cardiac ultrasound (39% during cardiac arrest. Median time since last CPR training was 4 (2–10 months, and 48% had attended a European Resuscitation Council (ERC Advanced Life Support course. The majority (84% felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion: Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have

Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study.

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Buiting, Hilde; van Delden, Johannes; Onwuteaka-Philpsen, Bregje; Rietjens, Judith; Rurup, Mette; van Tol, Donald; Gevers, Joseph; van der Maas, Paul; van der Heide, Agnes

2009-10-27

An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%). Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they

Ambivalent stereotypes of nurses and physicians: impact on students' attitude toward interprofessional education.

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Sollami, Alfonso; Caricati, Luca; Mancini, Tiziana

2015-03-13

Nurse-physician stereotypes have been proposed as a factor hindering interprofessional collaboration among practitioners and interprofessional learning among nursing and medical students. Using socio-psychological theories about ambivalent stereotypes, the present work aimed to analyse: a) the content of nurse and physician stereotypes held by nursing and medical students and b) the role of auto-stereotype on students' attitude toward interprofessional education (IPE).  Methods. A cross-sectional on-line survey was adopted and a questionnaire was emailed to 205 nursing students and 151 medical students attending an Italian university. Nursing and medical students shared the stereotypical belief that nurses are warmer but less competent than physicians. Nurses and physicians were basically depicted with ambivalent stereotypes: nurses were seen as communal, socially competent and caring but less competent, not agentic and less autonomous, while physicians were seen as agentic, competent and autonomous, but less communal, less collectivist and less socially competent. Moreover, a professional stereotypical image impacted the students' attitude toward IPE. More precisely, when nurses and physicians were seen with classic ambivalent stereotypes, both nursing and medical students were less favourable towards interprofessional education programmes. The content of professional stereotypes of healthcare students was still linked to classical views of nurses as caring and physicians as curing. This seemed to limit students' attitude and intention to be engaged in IPE.

Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

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Sommersguter-Reichmann, Margit; Stepan, Adolf

2017-12-01

Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system's purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician's possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system's primary purposes.

Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

NARCIS (Netherlands)

Boeft, M. den; Huisman, D.; Wouden, J.C. van der; Numans, M.E.; Horst, H.E. van der; Lucassen, P.L.B.J.; Olde Hartman, T.C.

2016-01-01

BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they

The last phase of life: who requests and who receives euthanasia or physician-assisted suicide?

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Onwuteaka-Philipsen, Bregje D; Rurup, Mette L; Pasman, H Roeline W; van der Heide, Agnes

2010-07-01

When suffering becomes unbearable for patients they might request for euthanasia. To study which patients request for euthanasia and which requests actually resulted in euthanasia in relation with diagnosis, care setting at the end of life, and patient demographics. A cross-sectional study covering all Dutch health care settings. In 2005, of death certificates of deceased persons, a stratified sample was derived from the Netherlands central death registry. The attending physician received a written questionnaire (n = 6860; response 78%). If deaths were reported to have been nonsudden, the attending physician filled in a 4-page questionnaire on end-of-life decision-making. Data regarding the deceased person's age, sex, marital status, and cause of death were derived from the death certificate. Of patients whose death was nonsudden, 7% explicitly requested for euthanasia. In about two thirds, the request did not lead to euthanasia or physician-assisted suicide being performed, in 39% because the patient died before the request could be granted and in 38% because the physician thought the criteria for due care were not met. Factors positively associated with a patient requesting for euthanasia are (young) age, diagnosis (cancer, nervous system), place of death (home), and involvement of palliative teams and psychiatrist in care. Diagnosis and place of death are also associated with requests resulting in euthanasia. Only a minority of patients request euthanasia at the end of life and of these requests a majority is not granted. Careful decision-making is necessary in all requests for euthanasia.

Second medical opinions: the views of oncology patients and their physicians.

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Philip, Jennifer; Gold, Michelle; Schwarz, Max; Komesaroff, Paul

2010-09-01

Second medical opinions (SMOs) are common in oncology practice, but the nature of these consultations has received relatively little attention. This study examines the views of patients with advanced cancer and their physicians of SMOs. Parallel, concurrent surveys were developed for patients and physicians. The first was distributed to outpatients with advanced cancer-attending specialist clinics in an Australian quaternary hospital. The second survey, developed on the basis of results of exploratory interviews with medical oncologists, was distributed to medical oncologists in Australia. Seventeen of fifty two (33%) patients had sought a SMO, most commonly prompted by concerns around communication with their first doctor, the extreme and desperate nature of their medical condition and the need for reassurance. Most (94%) patients found the SMO helpful, with satisfaction related to improved communication and reassurance. Patients were concerned that seeking a second medical opinion may affect their relationship with their primary doctor. Most physicians (82%) reported seeing between one and five SMO per month, with patients being motivated by the need for additional information and reassurance. Physicians regarded SMO patients as having greater information needs (84%), greater psychosocial needs (58%) and requiring more of the physician's time and energy (77%) than other patients. SMOs are common in cancer care with most patients motivated by the need for improved communication, additional information and reassurance. Physicians identify patients who seek SMOs as having additional psychosocial needs compared with other oncology patients.

The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study

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Keibun Liu

2018-02-01

Full Text Available Abstract Background There are numerous barriers to early mobilization (EM in a resource-limited intensive care unit (ICU without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. Methods This was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety. Results A total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2–3.8% and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66% sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62% got out of bed within 2 days (median 1.2 days; interquartile range 0.1–2.0. Conclusions EM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO

"Righteous minds" in health care: measurement and explanatory value of social intuitionism in accounting for the moral judgments in a sample of U.S. physicians.

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Tilburt, Jon C; James, Katherine M; Jenkins, Sarah M; Antiel, Ryan M; Curlin, Farr A; Rasinski, Kenneth A

2013-01-01

The broad diversity in physicians' judgments on controversial health care topics may reflect differences in religious characteristics, political ideologies, and moral intuitions. We tested an existing measure of moral intuitions in a new population (U.S. physicians) to assess its validity and to determine whether physicians' moral intuitions correlate with their views on controversial health care topics as well as other known predictors of these intuitions such as political affiliation and religiosity. In 2009, we mailed an 8-page questionnaire to a random sample of 2000 practicing U.S. physicians from all specialties. The survey included the Moral Foundations Questionnaire (MFQ30), along with questions on physicians' judgments about controversial health care topics including abortion and euthanasia (no moral objection, some moral objection, strong moral objection). A total of 1032 of 1895 (54%) physicians responded. Physicians' overall mean moral foundations scores were 3.5 for harm, 3.3 for fairness, 2.8 for loyalty, 3.2 for authority, and 2.7 for sanctity on a 0-5 scale. Increasing levels of religious service attendance, having a more conservative political ideology, and higher sanctity scores remained the greatest positive predictors of respondents objecting to abortion (β = 0.12, 0.23, 0.14, respectively, each p<0.001) as well as euthanasia (β = 0.08, 0.17, and 0.17, respectively, each p<0.001), even after adjusting for demographics. Higher authority scores were also significantly negatively associated with objection to abortion (β = -0.12, p<0.01), but not euthanasia. These data suggest that the relative importance physicians place on the different categories of moral intuitions may predict differences in physicians' judgments about morally controversial topics and may interrelate with ideology and religiosity. Further examination of the diversity in physicians' moral intuitions may prove illustrative in describing and addressing moral differences that

Forecasting the global shortage of physicians: an economic- and needs-based approach

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Liu, Jenny X; Kinfu, Yohannes; Dal Poz, Mario R

2008-01-01

Abstract Objective Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Methods Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country’s economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. Findings By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. Conclusion The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected. PMID:18670663

Chronological changes in Japanese physicians' attitude and behavior concerning relationships with pharmaceutical representatives: a qualitative study.

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Sayaka Saito

Full Text Available BACKGROUND: Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. METHODS AND FINDINGS: A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position, role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. CONCLUSIONS: Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.

Physician buy-in for EMRs.

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Yackanicz, Lori; Kerr, Richard; Levick, Donald

2010-01-01

Implementing an EMR in an ambulatory practice requires intense workflow analysis, introduction of new technologies and significant cultural change for the physicians and physician champion. This paper will relate the experience at Lehigh Valley Health Network in the implementation of an ambulatory EMR and with the physician champions that were selected to assist the effort. The choice of a physician champion involves political considerations, variation in leadership and communication styles, and a cornucopia of personalities. Physician leadership has been shown to be a critical success factor for any successful technology implementation. An effective physician champion can help develop and promote a clear vision of an improved future, enlist the support of the physicians and staff, drive the process changes needs and manage the cultural change required. The experience with various types of physician champions will be discussed, including, the "reluctant leader", the "techie leader", the "whiny leader", and the "mature leader". Experiences with each type have resulted in a valuable, "lessons learned" summary. LVHN is a tertiary academic community medical center consisting of 950 beds and over 450 employed physicians. LVHN has been named to the Health and Hospital Network's 100 Top Wired and 25 Most Wireless Hospitals.

EMS-physicians' self reported airway management training and expertise; a descriptive study from the Central Region of Denmark

Directory of Open Access Journals (Sweden)

Rognås Leif K

2011-02-01

Full Text Available Abstract Background Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS. Methods The EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians. Results There are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s, 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management. Conclusions In this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed.

Family Violence and Family Physicians

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Herbert, Carol P.

1991-01-01

The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987

Developing a Physician׳s Professional Identity Through Medical Education.

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Olive, Kenneth E; Abercrombie, Caroline L

2017-02-01

Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The "hidden curriculum" within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Development of physician leadership competencies: perceptions of physician leaders, physician educators and medical students.

Science.gov (United States)

McKenna, Mindi K; Gartland, Myles P; Pugno, Perry A

2004-01-01

Research regarding the development of healthcare leadership competencies is widely available. However, minimal research has been published regarding the development of physician leadership competencies, despite growing recognition in recent years of the important need for effective physician leadership. Usingdata from an electronically distributed, self-administered survey, the authors examined the perceptions held by 110 physician leaders, physician educators, and medical students regarding the extent to which nine competencies are important for effective physician leadership, ten activities are indicative of physician leadership, and seven methods are effective for the development of physician leadership competencies. Results indicated that "interpersonal and communication skills" and "professional ethics and social responsibility" are perceived as the most important competencies for effective physician leadership. Furthermore, respondents believe "influencing peers to adopt new approaches in medicine" and "administrative responsibility in a healthcare organization" are the activities most indicative of effective physician leadership. Finally, respondents perceive"coaching or mentoring from an experienced leader" and "on-job experience (e.g., a management position)" as the most effective methods for developing physician leadership competencies. The implications of these findings for the education and development of physician leaders are discussed.

Physician wages across specialties: informing the physician reimbursement debate.

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Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Kravitz, Richard L

2010-10-25

Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate. In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables. In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (wage near median, $85.98): internal medicine and pediatrics combined (-$24.36), internal medicine (-$24.27), family medicine (-$23.70), and other pediatric subspecialties (-$23.44). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region. Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians.

Exposing physicians to reduced residency work hours did not adversely affect patient outcomes after residency.

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Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay

2014-10-01

In 2003, work hours for physicians-in-training (residents) were capped by regulation at eighty hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work-hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000-09 that were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and patients' length-of-stay varied according to the number of years a physician was exposed to the 2003 duty-hour regulations during his or her residency. We examined this database of practicing Florida physicians, using a difference-in-differences analysis that compared trends in outcomes of junior physicians (those with one-year post-residency experience) pre- and post-2003 to a control group of senior physicians (those with ten or more years of post-residency experience) who were not exposed to these reforms during their residency. We found that the duty-hour reforms did not adversely affect hospital mortality and length-of-stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, assessment of the impact of the duty-hour reforms on other clinical outcomes is needed. Project HOPE—The People-to-People Health Foundation, Inc.

Electronic Attendance Application Using Raspberry Pi

International Nuclear Information System (INIS)

Mohd Dzul Aiman Aslan; Saaidi Ismail; Mohamad Safuan Sulaiman

2016-01-01

Raspberry Pi is a cheap mini-computer that officially runs on a Linux distribution Operating System (OS) such as Raspbian. It has many input and output mechanisms simulating a computer which make it useful replacement for a computer system. SimpleCV, an open source python-based image processing software and Telegram, a popular social application provide API that allow communication trough a device such as Raspberry Pi. Combining these two, an electronic attendance has been developed using open source basis, and the electronic attendance also provide enhancement of current system that is to record the person face and sending information through Telegram application. The methodology include gathering requirements on remaining system and test it on Linux which will discuss further. This project is serve as a prototype for enhancement of current Commersial Of The Shelf (COTS) electronic attendance that only record ID of the attendees. In the future, the electronic attendance can be enhanced with many features and should be make in-a-box for commercialization. (author)

Primary birthing attendants and birth outcomes in remote Inuit communities—a natural “experiment” in Nunavik, Canada

Science.gov (United States)

Simonet, F; Wilkins, R; Labranche, E; Smylie, J; Heaman, M; Martens, P; Fraser, W D; Minich, K; Wu, Y; Carry, C; Luo, Z-C

2010-01-01

Background There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural “experiment”, birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. Methods A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989–2000: primary birth attendants were Inuit midwives in the Hudson Bay (1529 Inuit births) vs western physicians in Ungava Bay communities (1197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, post-neonatal death, preterm, small-for-gestational-age and low birthweight birth. Multilevel logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. Results The aORs (95% confidence interval) for perinatal death comparing the Hudson Bay vs Ungava Bay communities were 1.29 (0.63 to 2.64) for all Inuit births and 1.13 (0.48 to 2.47) for Inuit births at ≥28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. Conclusion Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care compared with the Ungava Bay communities with physician-led maternity care. These findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote indigenous communities. PMID:19286689

Treatment practices in pulmonary tuberculosis by private sector physicians of Meerut, Uttar Pradesh.

Science.gov (United States)

Yadav, A; Garg, S K; Chopra, H; Bajpai, S K; Bano, T; Jain, S; Kumar, A

2012-01-01

Majority of the qualified medical practitioners in the country are in the private sector and more than half of patients with tuberculosis (TB) seek treatment from them. The present study was conducted with the objective of assessing the treatment modalities in pulmonary tuberculosis by the private physicians in Meerut City, Uttar Pradesh, India. A cross-sectional study was carried out covering all the private physicians (graduates and postgraduates in Medicine and Chest Diseases) registered under the Indian Medical Association, Meerut Branch (n = 154). The physicians were interviewed by a pre-designed and pre-tested questionnaire about the treatment modalities practiced by them. Only 43.5% private physicians had attended any Revised National Tuberculosis Control Programme (RNTCP) training in the past five years. Only 33.1% of them were aware of the International Standards of Tuberculosis Care (ISTC). Fifty-three different regimens were used to treat the patients. Majority of physicians (76%) prescribed daily regimens while 24% administered both daily and intermittent treatment. None of the private physicians prescribed exclusive intermittent regimen. Eighty-seven different treatment regimens were used for the treatment of multidrug-resistant TB (MDR-TB) with none of them prescribing standard treatment under RNTCP. As majority of private practitioners do not follow RNTCP guidelines for treating TB, there is an urgent need for their continued education in this area.

The occupational health and safety of flight attendants.

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Griffiths, Robin F; Powell, David M C

2012-05-01

In order to perform safety-critical roles in emergency situations, flight attendants should meet minimum health standards and not be impaired by factors such as fatigue. In addition, the unique occupational and environmental characteristics of flight attendant employment may have consequential occupational health and safety implications, including radiation exposure, cancer, mental ill-health, musculoskeletal injury, reproductive disorders, and symptoms from cabin air contamination. The respective roles of governments and employers in managing these are controversial. A structured literature review was undertaken to identify key themes for promoting a future agenda for flight attendant health and safety. Recommendations include breast cancer health promotion, implementation of Fatigue Risk Management Systems, standardization of data collection on radiation exposure and health outcomes, and more coordinated approaches to occupational health and safety risk management. Research is ongoing into cabin air contamination incidents, cancer, and fatigue as health and safety concerns. Concerns are raised that statutory medical certification for flight attendants will not benefit either flight safety or occupational health.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

Directory of Open Access Journals (Sweden)

VLAUDIMIR DIAS MARQUES

Full Text Available ABSTRACT Objective: to evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room. Methods: we conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of Maringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians. Results: of the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (n=187, the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values was performed in greater numbers when compared with cases led by surgeons (n=501. There was a statistically significant relationship (p<0.01 between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28 in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments. Conclusion: in the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

Physician suicide.

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Preven, D W

1981-01-01

The topic of physician suicide has been viewed from several perspectives. The recent studies which suggest that the problem may be less dramatic statistically, do not lessen the emotional trauma that all experience when their lives are touched by the grim event. Keeping in mind that much remains to be learned about suicides in general, and physician suicide specifically, a few suggestions have been offered. As one approach to primary prevention, medical school curriculum should include programs that promote more self-awareness in doctors of their emotional needs. If the physician cannot heal himself, perhaps he can learn to recognize the need for assistance. Intervention (secondary prevention) requires that doctors have the capacity to believe that anyone, regardless of status, can be suicidal. Professional roles should not prevent colleague and friend from identifying prodromal clues. Finally, "postvention" (tertiary prevention) offers the survivors, be they family, colleagues or patients, the opportunity to deal with the searing loss in a therapeutic way.

Dying cancer patients talk about physician and patient roles in DNR decision making.

Science.gov (United States)

Eliott, Jaklin A; Olver, Ian

2011-06-01

Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.

Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.

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Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M

2008-12-01

To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the

Physician fees and managed care plans.

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Zwanziger, Jack

2002-01-01

One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

[Factors determining irregular attendance to follow-up visits among human immunodeficiency virus patients: results of the hospital survey of patients infected with human immunodeficiency virus].

Science.gov (United States)

Diaz, Asuncion; Ten, Alicia; Marcos, Henar; Gutiérrez, Gonzalo; González-García, Juan; Moreno, Santiago; Barrios, Ana María; Arponen, Sari; Portillo, Álvaro; Serrano, Regino; García, Maria Teresa; Pérez, José Luis; Toledo, Javier; Royo, Maria Carmen; González, Gustavo; Izquierdo, Ana; Viloria, Luis Javier; López, Irene; Elizalde, Lázaro; Martínez, Eva; Castrillejo, Daniel; Aranguren, Rosa; Redondo, Caridad; Diez, Mercedes

2015-05-01

To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Inappropriate Usage of Dietary Supplements in Patients by Miscommunication with Physicians in Japan

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Chiba, Tsuyoshi; Sato, Yoko; Nakanishi, Tomoko; Yokotani, Kaori; Suzuki, Sachina; Umegaki, Keizo

2014-01-01

Recently, people have used dietary supplements not only for nutritional supplementation, but also for treatment of their diseases. However, use of dietary supplements to treat diseases, especially with medications, may cause health problems in patients. In this study, we investigated use of dietary supplements in patients in Japan. This survey was conducted from January to December 2012, and was completed by 2732 people, including 599 admitted patients, 1154 ambulatory patients, and 979 healthy subjects who attended a seminar about dietary supplements. At the time of the questionnaire, 20.4% of admitted patients, 39.1% of ambulatory patients, and 30.7% of healthy subjects were using dietary supplements, which including vitamin/mineral supplements, herbal extracts, its ingredients, or food for specified health uses. The primary purpose for use in all groups was health maintenance, whereas 3.7% of healthy subjects, 10.0% of ambulatory patients, and 13.2% of admitted patients used dietary supplements to treat diseases. In addition, 17.7% of admitted patients and 36.8% of ambulatory patients were using dietary supplements concomitantly with their medications. However, among both admitted patients and ambulatory patients, almost 70% did not mention dietary supplement use to their physicians. Overall, 3.3% of all subjects realized adverse effects associated with dietary supplements. Communication between patients and physicians is important to avoid health problems associated with the use of dietary supplements. PMID:25431879

Attendance Policies, Student Attendance, and Instructor Verbal Aggressiveness

Science.gov (United States)

Snyder, Jason; Forbus, Robert; Cistulli, Mark

2012-01-01

The authors utilized an experimental design across six sections of a managerial communications course (N = 173) to test the impact of instructor verbal aggressiveness and class attendance policies on student class attendance. The experimental group received a policy based on the principle of social proof (R. B. Cialdini, 2001), which indicated…

Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study

Directory of Open Access Journals (Sweden)

Gevers Joseph

2009-10-01

Full Text Available Abstract Background An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless, the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. Methods We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Results Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65% and/or had repeated the request several times (23%. Unbearable suffering was often substantiated with physical symptoms (62%, function loss (33%, dependency (28% or deterioration (15%. In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%, a known colleague (21%, otherwise (25%, or not clearly specified in the report (24%. Review committees relatively often scrutinized the consultation (41% and the patient's (unbearable suffering (32%; they had few questions about possible alternatives (1%. Conclusion Dutch physicians substantiate their adherence to the criteria in a variable way with an

Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper.

Science.gov (United States)

Snyder Sulmasy, Lois; Mueller, Paul S

2017-10-17

Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling. On the basis of substantive ethics, clinical practice, policy, and other concerns articulated in this position paper, the ACP does not support legalization of physician-assisted suicide. It is problematic given the nature of the patient-physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession's role in society. Furthermore, the principles at stake in this debate also underlie medicine's responsibilities regarding other issues and the physician's duties to provide care based on clinical judgment, evidence, and ethics. Society's focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care. The ACP remains committed to improving care for patients throughout and at the end of life.

The Burnout Syndrome and its Intervention Strategies for Physicians ...

African Journals Online (AJOL)

Studies on physician burnout showed that physicians are vulnerable to burnout. The consequences of physician burnout include ineffective quality of care of patients and it can also lead to poor physical and mental health of affected physicians. The resultant poor physical and mental health of the burnout physician is likely ...

The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings.

Science.gov (United States)

McGrath, Robert J; Priestley, Jennifer Lewis; Zhou, Yiyun; Culligan, Patrick J

2018-04-09

Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as "America's Top Doctors" through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed "Top Doctor" versus those who were not. The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization. ©Robert J McGrath, Jennifer Lewis Priestley, Yiyun Zhou, Patrick J Culligan. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 09.04.2018.

Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

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Wilson, I B; Kaplan, S

2000-12-15

Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Cross-sectional survey of physicians and patients. Cohort study enrolling patients from throughout eastern Massachusetts. 264 patients with HIV disease and their their primary HIV physicians (n = 69). Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's alpha = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's alpha = 0.92). The mean age of patients was 39. 5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (pbetter communication. The interaction of patient gender and visit length was also significant (p =.02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p =.002) and gay/lesbian/bisexual sexual preference (p =.003) were significantly associated with better HIV

[Legal issues of physician-assisted euthanasia. Part II--Help in the dying process, direct and indirect active euthanasia].

Science.gov (United States)

Laux, Johannes; Röbel, Andreas; Parzeller, Markus

2013-01-01

In Germany, physician-assisted euthanasia involves numerous risks for the attending physician under criminal and professional law. In the absence of clear legal provisions, four different categories of euthanasia have been developed in legal practice and the relevant literature: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. The so-called "help during the dying process" by administering medically indicated analgesic drugs without a life-shortening effect is exempt from punishment if it corresponds to the will of the patient. If the physician omits to give such analgesic drugs although the patient demands them, this is deemed a punishable act of bodily injury. The same applies if the physician administers analgesics against the will of the patient. Medically indicated pain treatment which has a potential or certain life-shortening effect (indirect active euthanasia) is permitted under certain conditions: if there are no alternative and equally suitable treatment options without the risk of shortening the patient's life, if the patient has given his consent to the treatment and if the physician does not act with the intention to kill. The deliberate killing of a dying or terminally ill patient for the purpose of ending his suffering (direct active euthanasia) is prohibited. This includes both deliberately killing a patient against or without his will (by so-called "angels of death") and the killing of a patient who expressly and earnestly demands such an act from his physician (killing on request/on demand). Physician-assisted suicide is generally not liable to punishment in Germany. Nevertheless, the action may be subject to punishment if the physician omits to rescue the life of an unconscious suicide victim. "Palliative sedation" is regarded as a special case. It may become necessary if certain symptoms in the terminal stage of a fatal disease unbearable for the patient cannot be controlled by any other

Physician payment 2008 for interventionalists: current state of health care policy.

Science.gov (United States)

Manchikanti, Laxmaiah; Giordano, James

2007-09-01

Physicians in the United States have been affected by significant changes in the pattern(s) of medical practice evolving over the last several decades. These changes include new measures to 1) curb increasing costs, 2) increase access to patient care, 3) improve quality of healthcare, and 4) pay for prescription drugs. Escalating healthcare costs have focused concerns about the financial solvency of Medicare and this in turn has fostered a renewed interest in the economic basis of interventional pain management practices. The provision and systemization of healthcare in North America and several European countries are difficult enterprises to manage irrespective of whether these provisions and systems are privatized (as in the United States) or nationalized or seminationalized (as in Great Britain, Canada, Australia and France). Consequently, while many management options have been put forth, none seem to be optimally geared toward affording healthcare as a maximized individual and social good, and none have been completely enacted. The current physician fee schedule (released on July 12, 2007) includes a 9.9% cut in payment rate. Since the Medicare program was created in 1965, several methods have been used to determine physicians' rate(s) for each covered service. The sustained growth rate (SGR) system, established in 1998, has evoked negative consequences on physician payment(s). Based on the current Medicare expenditure index, practice expenses are projected to increase by 34.5% from 2002 to 2016, whereas, if actual practice inflation is considered, this increase will be 90%. This is in contrast to projected physician payment cuts that are depicted to be 51%. No doubt, this scenario will be devastating to many practices and the US medical community at large. Resolutions to this problem have been offered by MedPAC, the Government Accountability Office, physician organizations, economists, and various other interested groups. In the past, temporary measures have

Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto

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Constance E Shehu

2013-01-01

Full Text Available Background: One of the most sensitive and intimate decisions made by any individual or couple is that of fertility control . The knowledge of the factors which influence contraceptive choices may increase its acceptance and uptake. This study determines the choice and reason for contraception among new clients attending the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: In this prospective study a structured questionnaire was administered to 251 consecutive clients, who attended the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto between 1 July 2008 and 31 December 2008. Results: Most (58.2% of the clients were between 21 and 30 years of age. Many (42.6% were grand multipara. Majority (76.9% of the clients were married. The main source of knowledge of contraception and referral (45.8% was the physicians. Child spacing (87.7% was the most common reason given for contraceptive use. Majority (55.8% of the clients chose Implanon and the least preferred method of contraception was the condom (2.0%. Conclusion: Our data shows that the most commonly chosen contraceptive method in the study population was the Implanon. Child spacing was the main reason for seeking family planning while the source of contraceptive knowledge was the physicians.

Physician-patient communication in managed care.

OpenAIRE

Gordon, G H; Baker, L; Levinson, W

1995-01-01

The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

Thinking Styles and Regret in Physicians.

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Djulbegovic, Mia; Beckstead, Jason; Elqayam, Shira; Reljic, Tea; Kumar, Ambuj; Paidas, Charles; Djulbegovic, Benjamin

2015-01-01

Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni's adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni's correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; prational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks. Regret in physicians is strongly associated with their tendency to maximize; i.e. the

Peseshet--the first female physician?

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Harer, W B; el-Dawakhly, Z

1989-12-01

Excavation of the tomb of Akhet-Hetep at Giza revealed a monument dedicated to his mother Peseshet, who is identified by many important titles including "Overseer of Women Physicians." She is probably the world's earliest known woman physician. She practiced at the time of the building of the great pyramids in Egypt, about 2500 BC.

The effect of physician feedback and an action checklist on diabetes care measures.

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Schectman, Joel M; Schorling, John B; Nadkarni, Mohan M; Lyman, Jason A; Siadaty, Mir S; Voss, John D

2004-01-01

The objective was to evaluate whether physician feedback accompanied by an action checklist improved diabetes care process measures. Eighty-three physicians in an academic general medicine clinic were provided a single feedback report on the most recent date and result of diabetes care measures (glycosylated hemoglobin [A1c], urine microalbumin, serum creatinine, lipid levels, retinal examination) as well as recent diabetes medication refills with calculated dosing and adherence on 789 patients. An educational session regarding the feedback and adherence information was provided. The physicians were asked to complete a checklist accompanying the feedback on each of their patients, indicating requested actions with respect to follow-up, testing, and counseling. The physicians completed 82% of patient checklists, requesting actions consistent with patient needs on the basis of the feedback. Of the physicians, 93% felt the patient information and intervention format to be useful. The odds of urine microalbumin testing, serum creatinine, lipid profile, A1c, and retinal examination increased in the 6 months after the feedback. The increase was sustained at 1 year only for microalbumin and retinal exams. There was no significant change in refill adherence for the group overall after the feedback, although adherence did improve among patients of physicians attending the educational session. No significant change was noted in lipid or A1c levels during the study period. In conclusion, a simple physician feedback tool with action checklist can be both helpful and popular for improving rates of diabetes care guideline adherence. More complex interventions are likely required to improve diabetes outcomes.

Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians.

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Butkus, Renee; Serchen, Joshua; Moyer, Darilyn V; Bornstein, Sue S; Hingle, Susan Thompson

2018-05-15

Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work-life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized.

Obstetric complications: does training traditional birth attendants make a difference?

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Patricia E. Bailey

2002-01-01

Full Text Available Objective. To assess the effect that a training intervention for traditional birth attendants (TBAs in Guatemala had on the detection of obstetric complications, the referral of patients with complications to the formal health care system, and, ultimately, those patients' utilization of essential obstetric care services. Methods. Using a quasi-experimental design, a surveillance system of births was implemented to collect population-based information from 3 518 women between 1990 and 1993. All women were interviewed postpartum by physicians. There were three key independent variables in our study: 1 geographical area (intervention community and non-intervention community, 2 time in relation to the training intervention (before or after, and 3 presence or absence of a TBA at the time of the complication. The key dependent variables for women interviewed were 1 development of an obstetric complication, 2 detection of the problem by the TBA, 3 referral to a health facility, 4 compliance with referral, and 5 use of services. Results. The incidence of postpartum complications decreased after the intervention, controlling for intervention community. On the other hand, after the intervention TBAs were less likely to recognize most maternal complications, and referral rates did not increase significantly. The likelihood of using health care services increased six-fold among women who were not attended by TBAs, and no increase was observed among those who were attended by TBAs. Conclusion. Training TBAs may have had a positive effect on the rate, detection, and referral of postpartum complications. However, the evidence is less convincing for overall increases in the detection of complications, in referral to the formal health care system, and in the utilization of essential obstetric services among women attended by TBAs.

Do young people attending addiction services differ from those attending youth mental health services?

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Christie, Grant; Merry, Sally; Robinson, Elizabeth

2010-07-01

We aimed to describe and compare the self-reported substance use, psychopathology and psychosocial morbidity in adolescents attending two adolescent outpatient services, a triage-based mental health service and an engagement-focused addiction service in Auckland, New Zealand. A naturalistic cross-section of 131 (addiction service = 67, mental health service = 64) 14-18-year-old boys and girls attending each service completed a standardised screening and assessment instrument, the Drug Use Screening Inventory-Revised. The Drug Use Screening Inventory-Revised measures self-reported problems across 10 domains of functioning, including substance use, behaviour, psychiatric symptoms and school and family functioning. Descriptive statistics were used to provide an overview of the self-reported morbidity in each group and t-tests were used to determine differences between the two groups. Adolescents attending the addiction service reported significantly more problems with substance use, school performance and peer relationships than those attending the mental health service. There was no significant difference in reported psychiatric symptoms, behavioural problems, social competency, health problems, family problems, difficulties in work functioning or leisure time between the two groups. Young people presenting to engagement-focused substance use services report similar difficulties to those at mental health services across most areas of psychosocial functioning. Addiction services may require equivalent staffing expertise and workforce development to that in mental health to effectively meet young people's needs.

Assertion Practices and Beliefs Among Nurses and Physicians on an Inpatient Pediatric Medical Unit.

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Reese, Jennifer; Simmons, Ryan; Barnard, Juliana

2016-05-01

Teamwork and communication are critical elements of safe and effective patient care. Standardized communication tools have been implemented in many health care organizations, but little is known about attitudes and perceptions of assertion, the willingness to "speak up," by nurses and physicians at an academic pediatric institution. We conducted 6 focus groups with nurses, residents, and attending physicians using a standardized semistructured focus group guide to promote discussion. Focus groups were recorded and transcribed, and results were analyzed by 2 independent reviewers to identify thematic content. Three themes emerged: (1) interpersonal factors, (2) organizational factors, and (3) complexity of care environment. Subthemes were the roles of hierarchy, relationships, and communication and personality style; the value of using standardized communication tools such as SBAR (Situation, Background, Assessment, Recommendation), direct face-to-face communication, and geographic and technology factors; and the need for coordinated communication and agreement across care team members about the care plans. Nurses reported reliance on peers for decision-making, on when and how to assert on behalf of patient care. Nurses and residents experienced barriers to assertion from concerns of relationships and their position within professional hierarchies. Attending physicians were supportive of being asserted to by any care team provider. Interpersonal relationships, power dynamics, and organizational factors impact care team providers' willingness to assert in the inpatient setting. Standardized communication tools are effective. Further development and implementation of communication models that support experience, peer reliance, and direct face-to-face communication are warranted to improve assertion communication in the inpatient setting

Physician recruitment and retention in New Brunswick: a medical student perspective

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Mariah Giberson

2016-10-01

Full Text Available Background: Physician recruitment and retention is a priority for many Canadian provinces. Each province is unique in terms of recruitment strategies and packages offered; however, little is known about how medical students evaluate these programs. The purpose of the current study was to determine which factors matter most to New Brunswick (NB medical students when considering their location of future practice. Method: A survey of NB medical students was conducted. Descriptive statistics were produced and a linear regression model was developed to study factors predictive of a student’s expressed willingness to practice in NB. Results:  158 medical students completed the online survey, which is a response rate of 55%. Job availability and spouse’s ability to work in the province were ranked as the top factors in deciding where to practice. In the final regression model, factors predictive of an expressed desire to practice in NB include being female, living in NB prior to medical school, attending medical school at Université de Sherbrooke, participation in the NB Preceptorship program, and a desire to practice family medicine. Conclusions: This study provides insight into what medical students consider when deciding where to practice. This research may be used to inform physician recruitment efforts and guide future research into medical education and policy.

Inequalities in Dental Attendance throughout the Life-course

Science.gov (United States)

2012-01-01

The purpose of this study was to identify socio-economic inequalities in regular dental attendance throughout the life-course. The analyses relied on data from SHARE (waves 1 to 3 of the Survey of Health, Ageing, and Retirement in Europe), which includes retrospective information on life-course dental attendance of 26,525 persons currently aged 50 years or greater from 13 European countries (Austria, Poland, Spain, Italy, the Netherlands, Belgium, Greece, the Czech Republic, France, Denmark, Switzerland, Germany, and Sweden). Inequalities in dental attendance were assessed by means of Concentration Indices. Socio-economic disparities in regular dental attendance were identified as early as childhood. Moreover, higher educational attainment resulted in increased probabilities of regular dental attendance throughout subsequent life-years in all nations. In most countries, inequality levels remained relatively inelastic throughout the life-course. These findings suggest that a considerable proportion of inequalities in dental care use is already established at childhood and persists throughout the life-course. PMID:22699676

Attendance as control

OpenAIRE

Beckton, Julian

2013-01-01

Student attendance in higher education, particularly at lectures, is a topic that researchers have largely neglected, other than in relatively small scale studies. This paper reviews university attendance policies based on documentary research in university web sites. While there are acknowledged methodological limitations to this approach, some universities are beginning to implement automated recording of student attendance in UK higher education and others are debating the merits of doing ...

Who Is the Preferred Tutor in Clinical Skills Training: Physicians, Nurses, or Peers?

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Abay, Ece Şükriye; Turan, Sevgi; Odabaşı, Orhan; Elçin, Melih

2017-01-01

Phenomenon: Clinical skills centers allow structured training of undergraduate medical students for the acquisition of clinical skills in a simulated environment. Physician, nurse, or peer tutors are employed for training in those centers. All tutors should have appropriate training about the methodology used in the clinical skills training. Many of the studies revealed the effectiveness of various types of tutors. The aim of our study was to evaluate medical students' satisfaction with clinical skills training, and their opinions about the differences in coaching skills among the physician, nurse, and peer tutors. This study was conducted with third-year students (467 students) in 2013-2014 academic year at Hacettepe University Faculty of Medicine. Participation rate was 85 % (397 students). The students attended the suturing skill training in groups of 40 students. First, a faculty member from the Department of Medical Education delivered a video demonstration and conducted discussion. After the demonstration, the students were divided into groups of 5-6 students. A physician, nurse, or a peer tutor facilitated each group. The students were asked to complete the Coaching Skills Evaluation Form after the practicum session. It contained 13 criteria for assessing the coaching skills. Additionally, the form included a question for rating the student's satisfaction with the tutor. The performance of the tutors at each step was rated on a three-point scale. Kruskal Wallis analysis was used to compare students' scores for their tutors. The students' satisfaction with tutors was high for all of the tutors. However, there was no difference between students' scores in suturing skill, and between physician, nurse, and peer tutors' coaching skills. Insights: In this study, we revealed that physician, nurse, and peer tutors were equally effective on the students' performances. They were also regarded as effective in their teaching role by students. But the most important

Agreement between physicians and parents in rating functional ability of children with juvenile idiopathic arthritis

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Buoncompagni Antonella

2007-12-01

Full Text Available Abstract Objective To investigate concordance between physicians and parents in rating the degree of functional ability of children with juvenile idiopathic arthritis (JIA. Methods The attending physician and a parent were asked to rate independently the level of physical functioning of 155 patients with disease duration ≥ 5 years on a 6-point scale ranging from 1 = no disability (i.e. the child can do without difficulty all activities that children of his/her age can do to 6 = severe disability (i.e. all activities are difficult for the child. At study visit, measures of JIA activity and damage were assessed. Agreement was evaluated with weighted kappa (0.80 excellent agreement. Physician/parent evaluations were divided in 3 groups: 1 concordance; 2 parent over-rating = parent assessment over-rated relative to physician assessment; 3 physician over-rating = physician assessment over-rated relative to parent assessment. Factors affecting concordance/discordance were evaluated by means of Kruskal-Wallis or Chi-square/Fisher exact test. Results Concordance, parent over-rating and physician over-rating were observed in 107 (69%, 29 (18.7% and 19 (12.3% evaluations, respectively. Kappa value was 0.69. Parent over-rating was associated with greater intensity of pain (p = 0.01 and higher Childhood Health Assessment Questionnaire (C-HAQ score (p = 0.004, whereas physician over-rating was associated with more severe joint disease (p = 0.04 to Conclusion Physicians and parents revealed fair concordance in rating functional ability of children with JIA. Parent over-rating was associated with greater child's pain and worse C-HAQ score, whereas physician over-rating was associated with greater severity of joint inflammation and damage.

Administrative skills for academy physicians.

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Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

Father Attendance in Nurse Home Visitation

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Holmberg, John R.; Olds, David L.

2015-01-01

Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts. PMID:25521707

The Influence of Physician Communication Style on Overweight Patients’ Perceptions of Length of Encounter and Physician Being Rushed

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Gulbrandsen, Pål; Østbye, Truls; Lyna, Pauline; Dolor, Rowena J.; Tulsky, James A.; Alexander, Stewart C.; Pollak, Kathryn I.

2012-01-01

BACKGROUND AND OBJECTIVES Little is known about how patients and physicians perceive time and the extent to which they perceive the physician being rushed during encounters. One aim of this paper is to examine whether patient and physician characteristics and physician communication influence patient perception of the duration of the encounter and their perception of physicians being rushed. Another aim is to examine the relationship between patient and physician perceptions of physicians feeling rushed. METHODS We audiorecorded 461 encounters of overweight or obese patients with 40 primary care physicians and included 320 encounters in which weight was discussed. We calculated time spent with physician and coded all communication about weight using the Motivational Interview Treatment Integrity scale (MITI). Patients completed post-visit questionnaires in which they reported the estimated duration of the encounter and how rushed they thought the physician was during the encounter. Physicians reported how rushed they felt. RESULTS Patients estimated encounters to be longer than they actually were by an average of 2.6 minutes (SD=11.0). When physicians used reflective statements when discussing weight, patients estimated the encounter to be shorter than when physicians did not use reflective statements (1.17 versus 4.56 minutes more than actual duration). Whites perceived the encounter as shorter than African Americans (1.45 versus 4.28 minutes more than actual duration). Physicians felt rushed in 66% of visits; however, most patients did not perceive this. Internists were perceived to be more rushed than family physicians. CONCLUSIONS There is wide variation in patients’ ability to estimate the length of time they spend with their physician. Some physician and patient characteristics were related to patient perceptions of the length of the encounter. Reflective statements might lead patients to perceive encounters as shorter. Physicians, especially family

Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants

International Nuclear Information System (INIS)

Kelvin, Joanne Frankel; Moore-Higgs, Giselle J.; Maher, Karen E.; Dubey, Ajay K.; Austin-Seymour, Mary M.; Daly, Nancy Riese; Mendenhall, Nancy Price; Kuehn, Eric F.

1999-01-01

Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high quality patient care in radiation oncology. One mechanism is the implementation of non-physician practitioner roles, such as the advanced practice nurse (APN) and physician assistant (PA). This paper provides information for radiation oncologists and nurses making decisions about: (1) whether or not APNs or PAs are appropriate for their practice, (2) which type of provider would be most effective, and (3) how best to implement this role. Methods: Review of the literature and personal perspective. Conclusions: Specific issues addressed regarding APN and PA roles in radiation oncology include: definition of roles, regulation, prescriptive authority, reimbursement, considerations in implementation of the role, educational needs, and impact on resident training. A point of emphasis is that the non-physician practitioner is not a replacement or substitute for either a resident or a radiation oncologist. Instead, this role is a complementary one. The non-physician practitioner can assist in the diagnostic work-up of patients, manage symptoms, provide education to patients and families, and assist them in coping. This support facilitates the physician's ability to focus on the technical aspects of prescribing radiotherapy

The relationship between physician humility, physician-patient communication, and patient health.

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Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

2016-07-01

Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

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McLaughlin, Megan M; Simonson, Louis; Zou, Xia; Ling, Li; Tucker, Joseph D

2015-01-01

Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust. We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians. These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

African migrant patients' trust in Chinese physicians: a social ecological approach to understanding patient-physician trust.

Directory of Open Access Journals (Sweden)

Megan M McLaughlin

Full Text Available Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants' trust in Chinese physicians and to identify potential mechanisms for promoting trust.We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants' trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients' social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients' trust of their physicians.These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions.

Developing physician-leaders: a call to action.

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Stoller, James K

2009-07-01

The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' training can handicap their developing leadership skills. In this context, an emerging trend is for health-care institutions to offer physician-leadership programs. This paper reviews the rationale for developing physician-leaders. Factors that underscore this need include: (1) physicians may lack inclinations to collaborate and to follow, (2) health-care organizations pose challenging environments in which to lead (e.g., because of silo-based structures, etc.), (3) traditional criteria for advancement in medicine regard clinical and/or academic skills rather than leadership competencies, and (4) little attention is currently given to training physicians regarding leadership competencies. Definition of these competencies of ideal physician-leaders will inform the curricula and format of emerging physician leadership development programs.

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study☆

Science.gov (United States)

van Ryn, Michelle; Hardeman, Rachel R.; Phelan, Sean M.; Burke, Sara E.; Przedworski, Julia; Allen, Michele L.; Burgess, Diana J.; Ridgeway, Jennifer; White, Richard O.; Dovidio, John F.

2014-01-01

Objective Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students’ attitudes toward the value of physician empathy in clinical encounters. Methods First year students (n = 4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Results Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students’ attitudes toward the benefit of physician empathy in clinical encounters. Conclusion Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Practice implications Curricula in medical school promoting empathic care may be more universally effective if students’ preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. PMID:25065328

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study.

Science.gov (United States)

van Ryn, Michelle; Hardeman, Rachel R; Phelan, Sean M; Burke, Sara E; Przedworski, Julia; Allen, Michele L; Burgess, Diana J; Ridgeway, Jennifer; White, Richard O; Dovidio, John F

2014-09-01

Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students' attitudes toward the value of physician empathy in clinical encounters. First year students (n=4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students' attitudes toward the benefit of physician empathy in clinical encounters. Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Curricula in medical school promoting empathic care may be more universally effective if students' preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students. Copyright © 2014. Published by Elsevier Ireland Ltd.

Resident trainees do not affect patient satisfaction in an outpatient gastroenterology clinic: a prospective study conducted in a Canadian gastroenterology clinic.

Science.gov (United States)

Brahmania, Mayur; Young, Madison; Muthiah, Chetty; Ilnyckyj, Alexandra; Duerksen, Donald; Moffatt, Dana C

2015-10-01

There is little literature regarding how a gastroenterology trainee affects a patient's interpretation of care during outpatient clinic visits. Improving patient satisfaction is desirable and benefits may include enhanced patient compliance as well as providing trainees with areas for improvement. To evaluate patient satisfaction in an outpatient gastroenterology clinic when seen by a trainee and attending physician versus an attending physician alone. The secondary objective was to evaluate physician characteristics that play a role in creating a positive clinical experience. A randomized prospective survey study was conducted over an 11-month period (July 2012 to June 2013) at St Boniface Hospital (Winnipeg, Manitoba). Two gastroenterology fellows (postgraduate year 4 and 5) and nine internal medicine residents (postgraduate year 1 to 3) comprised the 'trainee' role, while three academic clinicians comprised the 'attending' role. Patients included individuals seen for an initial consultation and were >18 years of age. A total of 211 patients comprised the final study group, with 118 in the attending group and 93 in the trainee group. In univariate analysis, patients more often had a very good experience when seen by an attending physician alone versus a trainee and attending physician (73% versus 56%; P=0.016); however, on multivariate analysis, there was no significant difference in patient satisfaction (OR 0.89; P=0.931). Physician factors found to be associated with high patient satisfaction on multivariate analysis included: addressing all patient concerns (OR 27.56; P=0.021); giving the patient a preliminary diagnosis (OR 78.02; P=0.006); and feeling the physician was thorough (OR 72.53; P=0.029). The present study did not reveal a difference in patient satisfaction if a patient sees an attending physician alone or with a trainee. Moreover, to improve patient satisfaction in a gastroenterology clinic, physicians should address all patient concerns, provide a

Comparison of Complications and Surgical Outcomes of Adolescent Idiopathic Scoliosis Between Junior Attending Surgeons and Senior Attending Surgeons.

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Qiao, Jun; Xiao, Lingyan; Xu, Leilei; Shi, Benlong; Qian, Bangping; Zhu, Zezhang; Qiu, Yong

2018-04-24

To our knowledge, few studies have compared complications and surgical outcomes of adolescent idiopathic scoliosis (AIS) between junior attending surgeons and senior attending surgeons. To compare surgical strategies, complications, and outcomes of posterior corrective surgery for AIS between junior attending surgeons and senior attending surgeons. According to experience level of operation surgeons, the patients were assigned to 2 groups. Group A was the "junior surgeon" group. Group B was the "senior surgeon" group. The following parameters were compared between the 2 groups: age, sex, diagnosis, hospital of record, surgeon experience level, type of instrumentation, type of screws, estimated blood loss, duration of surgery, length of fusion, correction techniques, main curve correction, and thoracic kyphosis correction. A total of 132 patients with AIS were included in group A, whereas 207 were in group B. The translational technique was used more often in group A (P Senior surgeons used more monoaxial screws than junior surgeons (P senior group (P senior group had significant better correction rates of severe main curve (>70°) and thoracic kyphosis than the junior group (P Senior attending surgeons outperformed junior surgeons in blood loss control, thoracic kyphosis correction, and correction of severe curves. Copyright © 2018 Elsevier Inc. All rights reserved.

Emergency Physicians' Knowledge of Cannabinoid Designer Drugs

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Patrick M Lank

2013-09-01

Full Text Available Introduction: The use of synthetic drugs of abuse in the United States has grown in the last few years, with little information available on how much physicians know about these drugs and how they are treating patients using them. The objective of this study was to assess emergency physician (EP knowledge of synthetic cannabinoids (SC.Methods: A self-administered internet-based survey of resident and attending EPs at a large urban emergency department (ED was administered to assess familiarity with the terms Spice or K2 and basic knowledge of SC, and to describe some practice patterns when managing SC intoxication in the ED.Results: Of the 83 physicians invited to participate, 73 (88% completed surveys. The terms “Spice” and “K2” for SC were known to 25/73 (34% and 36/73 (49% of respondents. Knowledge of SC came most commonly (72% from non-medical sources, with lay publications and the internet providing most respondents with information. Among those with previous knowledge of synthetic cannabinoids, 25% were not aware that SC are synthetic drugs, and 17% did not know they are chemically most similar to marijuana. Among all participants, 80% felt unprepared caring for a patient in the ED who had used synthetic cannabinoids.Conclusion: Clinically active EPs are unfamiliar with synthetic cannabinoids. Even those who stated they had heard of synthetic cannabinoids answered poorly on basic knowledge questions. More education is needed among EPs of all ages and levels of training on synthetic cannabinoids. [West J Emerg Med. 2013;14(5:467–470.

Family physicians' attitude and interest toward participation in urban family physician program and related factors

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Masoumeh Sadeghi

2016-01-01

Full Text Available Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP. Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1 to assess the attitude of rural/rural-urban family physicians about FPP and (2 to investigate their interest toward participation in urban FPP and (3 to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran. A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants' attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively were significantly associated with physicians' willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP.

Tailoring hospital marketing efforts to physicians' needs.

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Mackay, J M; Lamb, C W

1988-12-01

Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.

Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study.

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Emmert, Martin; Meier, Florian; Pisch, Frank; Sander, Uwe

2013-08-28

Over the past decade, physician-rating websites have been gaining attention in scientific literature and in the media. However, little knowledge is available about the awareness and the impact of using such sites on health care professionals. It also remains unclear what key predictors are associated with the knowledge and the use of physician-rating websites. To estimate the current level of awareness and use of physician-rating websites in Germany and to determine their impact on physician choice making and the key predictors which are associated with the knowledge and the use of physician-rating websites. This study was designed as a cross-sectional survey. An online panel was consulted in January 2013. A questionnaire was developed containing 28 questions; a pretest was carried out to assess the comprehension of the questionnaire. Several sociodemographic (eg, age, gender, health insurance status, Internet use) and 2 health-related independent variables (ie, health status and health care utilization) were included. Data were analyzed using descriptive statistics, chi-square tests, and t tests. Binary multivariate logistic regression models were performed for elaborating the characteristics of physician-rating website users. Results from the logistic regression are presented for both the observed and weighted sample. In total, 1505 respondents (mean age 43.73 years, SD 14.39; 857/1505, 57.25% female) completed our survey. Of all respondents, 32.09% (483/1505) heard of physician-rating websites and 25.32% (381/1505) already had used a website when searching for a physician. Furthermore, 11.03% (166/1505) had already posted a rating on a physician-rating website. Approximately 65.35% (249/381) consulted a particular physician based on the ratings shown on the websites; in contrast, 52.23% (199/381) had not consulted a particular physician because of the publicly reported ratings. Significantly higher likelihoods for being aware of the websites could be

Professional development through attending conferences: reflections of a health librarian.

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Jenkins, Ruth

2015-06-01

In this article, guest writer Ruth Jenkins from Berkshire Heathcare Foundation Trust reflects on two conferences she attended in 2014, LILAC and SLA. Through the process of reflection, she considers the benefits that attending conferences can have to library and information professionals in the health sector. In particular, she discusses the opportunities and areas for learning and professional development that conferences can offer including evidence-based practice and current awareness, gaining new knowledge and objectivity, and networking and the unexpected benefits of conferences. Ruth also offers some practical hints and tips on ways to facilitate your attendance at conferences, including through awards and funding. H.S. © 2015 Health Libraries Group.

Physician education: expansion of the radiation protection practice

International Nuclear Information System (INIS)

Classic, Kelly; Carlson, Stephanie; Vetter, Richard J.; Roessler, Genevieve

2008-01-01

Over the past several years, physician knowledge of radiation risk and risk associated with medical exams involving radiation has been studied and found deficient. In some cases, radiation risk was overestimated leading to patient anxiety. In other cases, the risk was underestimated leading to cavalier ordering of medical radiation exams. Even physicians practicing in radiology were unable to accurately assess the risk for their patients. Many of the studies concluded that more effort is needed to educate the physician community on radiation risk. Objectives of the Health Physics Society, a not-for-profit society of radiation safety professionals, include dissemination of radiation safety information and public education. In 1996, the Society launched a Web site as one method to achieve its objectives (www.hps.org). On the Web site, the initial focus was to provide radiation information resources for the public, but more recently that was expanded to include specific resources for teachers, students, legislators and regulators, and first responders. In addition to these, the Society is adding educational resources for physicians. Published studies we reviewed suggest that physician education should include information about radiation risk, radiation effects, the amount of radiation dose from medical exams, and potential doses to the concepts when a mother undergoes medical exams involving radiation. The information we provide includes these topics as well as radiation basics (radiation units, radiation terms, radiation in the environment) separated into brief educational programs (slide shows). To complement these, topical information sheets are available. Also available is a tool allowing physicians to ask individual questions of our experts about radiation, radiation exposure, and radiation risk. This approach of providing information and resources to physicians not only provides a benefit to the physician personally, but especially to his or her patients

Does outcome feedback make you a better emergency physician? A systematic review and research framework proposal.

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Lavoie, Curtis F; Schachter, Howard; Stewart, Aviva T; McGowan, Jessie

2009-11-01

The organization of emergency medical care limits the ability of emergency physicians to know the outcomes of most of their patients after the patients leave the emergency department. This lack of outcome feedback may hinder the practice of emergency medicine (EM) by preventing "calibration" of the decision tools of practitioners. We sought to determine what is currently known about outcome feedback in EM, including its incidence, impact and modifiers. We searched the following databases: PreMEDLINE, MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, DARE, Health Technology Assessment Database and AMED. We performed manual searches on abstract databases, reference lists, various health information and research websites, and nonindexed journals. Selection entailed a 2-step screening pro cess to exclude articles not pertaining to outcome feedback in EM. Our search yielded 1128 bibliographic records, from which screening identified 7 relevant reports: 5 surveys, 1 system level evaluation and 1 intervention trial. All studies were found to have "inadequate" or "unable to assess" reporting and study quality. Systems for outcome feedback to EM residents have been increasingly available since 1984, though they are perceived to be inadequate. Commonly used mechanisms for outcome feedback include automatic routing of discharge summaries, case conferences for admitted patients and telephone calls to patients or families for discharged patients. With respect to attending emergency physicians, no conclusions or clinical recommendations can be made given the level of available evidence. The potential importance of outcome feedback remains, at this time, underevaluated. We propose a research framework, and hypothesize that increasing outcome feedback would increase emergency physician diagnostic accuracy, therapeutic outcomes, clinical efficiency and job satisfaction. Future research in this area should include surveys and focus groups, as well as simulated or real-world intervention

Assessment of Turkish junior male physicians' exposure to mobbing behavior.

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Sahin, Bayram; Cetin, Mehmet; Cimen, Mesut; Yildiran, Nuri

2012-08-01

To determine the extent of Turkish junior male physicians' exposure to mobbing behavior and its correlation with physicians' characteristics. The study included physicians recruited for compulsory military service in April 2009. No sampling method was used, questionnaires were delivered to all physicians, and 278 of 292 (95%) questionnaires were returned. We used Leymann Inventory of Psychological Terror including 45 items for data collection and structural equation model for data analysis. A total of 87.7% of physicians experienced mobbing behavior. Physicians who worked more than 40 hours a week, single physicians, physicians working in university hospitals and private hospitals, and physicians who did not have occupational commitment were more exposed to mobbing (PMobbing was not associated with specialty status, service period, age, and personality variables (P>0.05). All goodness-of- fit indices of the model were acceptable (χ(2)=1.449, normed fit index=0.955, Tucker Lewis index=0.980, comparative fit index=0.985, and root mean square error of approximation=0.040). Workplace mobbing is a critical problem for junior male physicians in Turkey. We suggest an introduction of a reporting system and education activities for physicians in high-risk groups.

Exploring the school attendance of children with epilepsy

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Karina Piccin Zanni

2009-12-01

Full Text Available The childhood epilepsy is a chronic disease that can have an impact in various spheres of life of the child, including academic performance and school attendance. This study aimed to describe and compare the school attendance of children with epilepsy who attend mainstream and special schools. Participants were 56 children aged between 7 and 14 years who attended regular or special schools located in two Brazilian cities of medium size. To collect the information we used two instruments: Data sheet of identification and characterization of the child and Data sheet to record the attendance school. The results showed that children in special schools had higher rates of absenteeism compared to students in regular schools. Additionally, we observed that these children use more drugs and have implications on health more severe than children in regular schools. Thus, it is the childhood epilepsy as a disease complex that brings substantial effects on various areas of children’s lives by reinforcing the need for studies that might expand the knowledge to and the experiences associated with the education of these children.

Are physicians and patients in agreement? Exploring dyadic concordance.

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Coran, Justin J; Koropeckyj-Cox, Tanya; Arnold, Christa L

2013-10-01

Dyadic concordance in physician-patient interactions can be defined as the extent of agreement between physicians and patients in their perceptions of the clinical encounter. The current research specifically examined two types of concordance: informational concordance-the extent of agreement in physician and patient responses regarding patient information (education, self-rated health, pain); and interactional concordance-the extent of physician-patient agreement regarding the patient's level of confidence and trust in the physician and the perceived quality of explanations concerning diagnosis and treatment. Using a convenience sample of physicians and patients (N = 50 dyads), a paired survey method was tested, which measured and compared physician and patient reports to identify informational and interactional concordances. Factors potentially related to dyadic concordance were also measured, including demographic characteristics (patient race, gender, age, and education) and clinical factors (whether this was a first visit and physician specialty in family medicine or oncology). The paired survey showed informational discordances, as physicians tended to underestimate patients' pain and overestimate patient education. Interactional discordances included overestimating patients' understanding of diagnosis and treatment explanations and patients' level of confidence and trust. Discordances were linked to patient dissatisfaction with physician listening, having unanswered questions, and feeling the physician had not spent enough time. The paired survey method effectively identified physician-patient discordances that may interfere with effective medical practice; this method may be used in various settings to identify potential areas of improvement in health communication and education.

Recruiting physicians without inviting trouble.

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Hoch, L J

1989-05-01

Many hospitals use physician recruitment strategies--generally assistance or employment strategies--to ensure medical staff loyalty. Although these strategies appeal to both hospitals and physicians, they are becoming increasingly problematic. Over the past three years, the government has issued pronouncements that question their legality. Thus any hospital considering physician recruitment strategies would be wise to evaluate them in light of various legal issues. such as reimbursement, nonprofit taxation, corporate practice of medicine, and certificate-of-need statutes. The consequences of failing to consider these issues can be ominous. The penalties for violating the proscribed remuneration provision of the Medicare act can include a fine, imprisonment, suspension from the Medicare and Medicaid programs, or loss of license. Payment issues can result in reduced reimbursement levels. Nonprofit taxation issues can trigger the loss of tax exemption. As a result of the corporate practice of medicine, a physician recruitment strategy may not be reimbursable by third-party payers or may even constitute the unauthorized practice of medicine. Finally, in some states, physician recruitment may trigger certificate-of-need review.

Practice arrangement and medicare physician payment in otolaryngology.

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Cracchiolo, Jennifer; Ridge, John A; Egleston, Brian; Lango, Miriam

2015-06-01

Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Patients' satisfaction with male versus female physicians: a meta-analysis.

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Hall, Judith A; Blanch-Hartigan, Danielle; Roter, Debra L

2011-07-01

Female physicians have a more patient-centered practice style than male physicians, and patient satisfaction is predicted by a more patient-centered practice style. To assess whether there is a difference in patients' satisfaction with male versus female physicians and to examine moderators of this effect. MEDLINE and PsycINFO databases and citation search through 2009, using keywords pertaining to patient satisfaction and physician sex. English-language articles that compared patients' satisfaction in relation to their physicians' sex. Only studies of actual patients and physicians, including postgraduate trainees, were included. Forty-five studies reporting 28 effect sizes met inclusion criteria. Two coders independently extracted effect sizes (point-biserial correlations) and coded study attributes, then resolved disagreements through discussion. The satisfaction difference between male and female physicians was extremely small (r style and patients' values. Reasons for this disparity are discussed.

Developing a competency framework for academic physicians.

Science.gov (United States)

Daouk-Öyry, Lina; Zaatari, Ghazi; Sahakian, Tina; Rahal Alameh, Boushra; Mansour, Nabil

2017-03-01

There is a mismatch between the requirements of the multifaceted role of academic physicians and their education. Medical institutions use faculty development initiatives to support their junior academic physicians, however, these rarely revolve around academic physician competencies. The aim of this study was to identify these academic physician competencies and develop a competency framework customized to an organizational context. The authors conducted semi-structured interviews and Critical Incident Technique with 25 academic physicians at a teaching medical center in the Middle East region inquiring about the behaviors of academic physicians in teaching, clinical, research, and administrative roles. Using content analysis, the authors identified 16 competencies: five "Supporting Competencies", common to all four roles of academic physicians, and 11 "Function-Specific Competencies", specific to the role being fulfilled. The developed framework shared similarities with frameworks reported in the literature but also had some distinctions. The framework developed represents a step towards closing the gap between the skills medical students are taught and the skills required of academic physicians. The model was customized to the context of the current organization and included a future orientation and addressed the literature calling for increasing focus on the administrative skills of academic physicians.

Impact of a Physician-in-Triage Process on Resident Education

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Bret A. Nicks

2014-11-01

Full Text Available Introduction: Emergency department (ED crowding negatively impacts patient care quality and efficiency. To reduce crowding many EDs use a physician-in-triage (PIT process. However, few studies have evaluated the effect of a PIT processes on resident education. Our objective was to determine the impact of a PIT process implementation on resident education within the ED of an academic medical center. Methods: We performed a prospective cross-sectional study for a 10-week period from March to June 2011, during operationally historic trended peak patient volume and arrival periods. Emergency medicine residents (three-year program and faculty, blinded to the research objectives, were asked to evaluate the educational quality of each shift using a 5-point Likert scale. Residents and faculty also completed a questionnaire at the end of the study period assessing the perceived impact of the PIT process on resident education, patient care, satisfaction, and throughput. We compared resident and attending data using Mann-Whitney U tests. Results: During the study period, 54 residents and attendings worked clinically during the PIT process with 78% completing questionnaires related to the study. Attendings and residents indicated “no impact” of the PIT process on resident education [median Likert score of 3.0, inter-quartile range (IQR: 2-4]. There was no difference in attending and resident perceptions (p-value =0.18. Both groups perceived patient satisfaction to be “positively impacted” [4.0, IQR:2-4 for attendings vs 4.0,IQR:1-5 for residents, p-value =0.75]. Residents perceived more improvement in patient throughput to than attendings [3.5, IQR:3-4 for attendings vs 4.0, IQR:3-5 for residents, p-value =0.006]. Perceived impact on differential diagnosis generation was negative in both groups [2.0, IQR:1-3 vs 2.5, IQR:1-5, p-value = 0.42]. The impact of PIT on selection of diagnostic studies and medical decision making was negative for attendings

Clinic Attendance of Youth With Sickle Cell Disease on Hydroxyurea Treatment.

Science.gov (United States)

Ingerski, Lisa M; Arnold, Trisha L; Banks, Gabrielle; Porter, Jerlym S; Wang, Winfred C

2017-07-01

The objective of this study is to describe rates of clinic attendance of youth with sickle cell disease prescribed hydroxyurea and examine potential demographic and medical factors related to consistent clinic attendance. Participants included 148 youth diagnosed with sickle cell disease and prescribed hydroxyurea during a single calendar year. Clinic attendance and potential demographic and medical factors related to attendance were extracted via systematic retrospective medical chart review. Youth attended 90.3% of scheduled appointments and 85.1% of youth attended at least 80% of scheduled clinic appointments during the study window. Adjusting for other factors, multivariate analysis revealed families with fewer children in the household, families with private insurance, youth experiencing fever, and youth not experiencing pain during the calendar year were more likely to consistently attend clinic visits. Adherence to clinic appointments is critical to optimizing health outcomes for youth with sickle cell disease and integral for adequate monitoring of youth prescribed hydroxyurea, in particular. Findings may aid providers in appropriately identifying possible barriers to clinic attendance to develop attendance promotion interventions.

Factors driving physician-hospital alignment in orthopaedic surgery.

Science.gov (United States)

Page, Alexandra E; Butler, Craig A; Bozic, Kevin J

2013-06-01

The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging. Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals. We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite. Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services. Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.

Self-care as a professional imperative: physician burnout, depression, and suicide.

Science.gov (United States)

Kuhn, Catherine M; Flanagan, Ellen M

2017-02-01

Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic. The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems. Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care. The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.

Breast cancer patients' trust in physicians: the impact of patients' perception of physicians' communication behaviors and hospital organizational climate.

Science.gov (United States)

Kowalski, Christoph; Nitzsche, Anika; Scheibler, Fueloep; Steffen, Petra; Albert, Ute-Susann; Pfaff, Holger

2009-12-01

To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; porganizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.

Using Attendance Worksheets to Improve Student Attendance, Participation, and Learning

Science.gov (United States)

Rhoads, Edward

2013-06-01

As science instructors we are faced with two main barriers with respect to student learning. The first is motivating our students to attend class and the second is to make them active participants in the learning process once we have gotten them to class. As we head further into the internet age this problem only gets exacerbated as students have replaced newspapers with cell phones which can surf the web, check their emails, and play games. Quizzes can motivated the students to attend class but do not necessarily motivate them to pay attention. Active learning techniques work but we as instructors have been bombarded by the active learning message to the point that we either do it already or refuse to. I present another option which in my classroom has doubled the rate at which students learn my material. By using attendance worksheets instead of end of class quizzes I hold students accountable for not just their attendance but for when they show up and when they leave the class. In addition it makes the students an active participant in the class even without using active learning techniques as they are writing notes and answering the questions you have posed while the class is in progress. Therefore using attendance worksheets is an effective tool to use in order to guide student learning.

Physician burnout: contributors, consequences and solutions.

Science.gov (United States)

West, C P; Dyrbye, L N; Shanafelt, T D

2018-06-01

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients and healthcare organizations and systems. Drivers of this epidemic are largely rooted within healthcare organizations and systems and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually focused solutions such as mindfulness-based stress reduction and small-group programmes to promote community, connectedness and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both healthcare systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfil its mission for patients and for public health, all stakeholders

Physician Contacts and Their Influence on the Appropriateness of Pain Medication in Nursing Home Residents: A Cross-Sectional Study.

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Flaig, Tanja Maria; Budnick, Andrea; Kuhnert, Ronny; Kreutz, Reinhold; Dräger, Dagmar

2016-09-01

This study assessed the frequency of physician contacts for individual nursing home residents (NHRs) and investigated whether the frequency of contacts influences the appropriateness of pain medication in NHRs. Observational cross-sectional study conducted between March 2009 and April 2010. Forty nursing homes in Berlin and Brandenburg, Germany. A total of 560 NHRs. The number and type of NHR physician contacts were obtained by face-to-face interviews. To assess the appropriateness of pain medication, the German version of the Pain Medication Appropriateness Scale (PMASD) was used. The influence of physician contacts on the appropriateness of pain medication was calculated with a linear mixed-effect model. The proportions of NHRs with at least 1 contact with their attending physicians were 61.8% (primary care physicians), 55.2% (general practitioners), 9.6% (neurologists), 9.4% (other), 5.4% (internists), 2.2% (orthopedic surgeons), and 0.7% (psychiatrists). The number of all physician contacts correlated weakly with the appropriateness of pain medication (r = 0.166, P = .039). With every physician contact, the PMASD score rose by about 2 points (P = .056). Physician care in German nursing homes is mainly provided by primary care physicians. A higher number of physician contacts had a modest impact on more appropriate pain medication use. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.

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Dalal, Anuj K; Roy, Christopher L; Poon, Eric G; Williams, Deborah H; Nolido, Nyryan; Yoon, Cathy; Budris, Jonas; Gandhi, Tejal; Bates, David W; Schnipper, Jeffrey L

2014-01-01

Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results. We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction. We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), pemail notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern. ClinicalTrials.gov (NCT01153451).

Should Attendance Be Required in Lecture Classrooms in Dental Education? Two Viewpoints: Viewpoint 1: Attendance in the Lecture Classroom Should Be Required and Viewpoint 2: Attendance Should Not Be Required in the Lecture Classroom.

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Cutler, Christopher W; Parise, Mary; Seminario, Ana Lucia; Mendez, Maria Jose Cervantes; Piskorowski, Wilhelm; Silva, Renato

2016-12-01

This Point/Counterpoint discusses the long-argued debate over whether lecture attendance in dental school at the predoctoral level should be required. Current educational practice relies heavily on the delivery of content in a traditional lecture style. Viewpoint 1 asserts that attendance should be required for many reasons, including the positive impact that direct contact of students with faculty members and with each other has on learning outcomes. In lectures, students can more easily focus on subject matter that is often difficult to understand. A counter viewpoint argues that required attendance is not necessary and that student engagement is more important than physical classroom attendance. This viewpoint notes that recent technologies support active learning strategies that better engage student participation, fostering independent learning that is not supported in the traditional large lecture classroom and argues that dental education requires assimilation of complex concepts and applying them to patient care, which passing a test does not ensure. The two positions agree that attendance does not guarantee learning and that, with the surge of information technologies, it is more important than ever to teach students how to learn. At this time, research does not show conclusively if attendance in any type of setting equals improved learning or ability to apply knowledge.

Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.

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Forte, Daniel Neves; Vincent, Jean Louis; Velasco, Irineu Tadeu; Park, Marcelo

2012-03-01

This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

Effect of exposure to good vs poor medical trainee performance on attending physician ratings of subsequent performances

OpenAIRE

Yeates, Peter; O'Neill, Paul; Mann, Karen; Eva, Kevin W.

2012-01-01

Context: Competency-based models of education require assessments to be based on individuals' capacity to perform, yet the nature of human judgment may fundamentally limit the extent to which such assessment is accurately possible. Objective: To determine whether recent observations of the Mini Clinical Evaluation Exercise (Mini-CEX) performance of postgraduate year 1 physicians influence raters' scores of subsequent performances, consistent with either anchoring bias (scores biased similar t...

Knowledge and Awareness of First Aid of Avulsed Tooth among Physicians and Nurses of Hospital Emergency Department.

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Iyer, Sudeep Sreepad; Panigrahi, Antarmayee; Sharma, Shalini

2017-01-01

Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% ( n = 100) nurses and 74.7% ( n = 112) considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis.

Physician assessments of drug seeking behavior: A mixed methods study.

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Michael A Fischer

Full Text Available Pain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as "drug-seeking," or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions.Mixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of "drug-seeking" as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested. A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001. In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11-31.15;p = 0.002; other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse.When patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for

Physician recruitment and retention in Manitoba: results from a survey of physicians' preferences for rural jobs.

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Witt, Julia

2017-01-01

Rural recruitment and retention continues to present challenges to health workforce planners. This paper reports and analyzes the results of a survey sent to physicians in Manitoba, eliciting their opinions regarding rural jobs. A survey was sent to all physicians in Manitoba. Part 1 of the survey included questions about background and demographic information; part 2 was a set of job satisfaction questions regarding respondents' current job; and part 3 included 2 sets of stated-choice questions eliciting preferences for a set of attributes relevant to rural recruitment and retention. Of the 2487 physicians who received surveys, 561 (22.6%) responded. Respondents indicated that income, hours worked and on-call frequency are very important: overall job satisfaction increased with income and decreased with hours worked. Income, hours and on-call frequency were ranked "very important" by the largest proportions of physicians. The estimated compensation for on-call more frequent than 1-in-4 was very high (82% of average income), and additional hours worked were worth $183 per hour. Other attributes that were important included professional interaction, housing availability and community incentives during the first year, which were valued at 11%-31% of annual income. Work-life balance is a key consideration for rural jobs, and there are incentives that can compensate for less desirable attributes.

Family physicians understanding about Mantoux test: A survey from a high endemic TB country

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Ali Niloufer

2010-05-01

Full Text Available Abstract Background Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis. Aims This study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month. Methods A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups. Results Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (≥ 80% correct responses. This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69 and (Seen Conclusion Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

Electronic medical file exchange between on-duty care providers and the attending paediatrician: a Belgian paediatric pilot project.

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Deneyer, M; Hachimi-Idrissi, S; Michel, L; Nyssen, M; De Moor, G; Vandenplas, Y

2012-01-01

The authors propose the introduction of a pilot project: "paediatric core file exchange in emergencies" (PCF-EXEM) which enables the exchange of medical data between the attending paediatrician (AP), holder of the medical record, and on-duty medical units (i.e. general practitioners, paediatricians, surgeons, emergency physicians,...). This project is based on two pillars: a protected server (PCF-server) containing paediatric core files (PCF), with important clinical data that should be available for the physician in order to quickly get a clear insight into the relevant clinical medical history of the child, and secondly, the possibility to provide feedback to the attending physician about the findings recorded during the on-call duty. The permanent availability of health data on the PCF-server and the possibility to provide feedback represent together the PCF-EXEM-project. This project meets the demand of the care providers to have relevant medical information permanently available in order to guarantee high quality care in emergency situations. The frail balance between the right to informative privacy and professional confidentiality on the one hand and the right to quality health care on the other hand has been taken into account. The technical and practical feasibility of this project is described. The objectives and vision of the PCF-EXEM project are conform to Belgian legislation concerning the processing of medical data and are in line with the still under consideration European projects which are focusing on interoperability and the development of a common access control to databanks containing health data for care providers. PCF-EXEM could therefore be a model for other EU countries as well.

How Measurement and Modeling of Attendance Matter to Assessing Dimensions of Inequality

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Dougherty, Shaun M.

2018-01-01

Each iteration of high stakes accountability has included requirements to include measures of attendance in their accountability programs, thereby increasing the salience of this measure. Researchers too have turned to attendance and chronic absence as important outcomes in evaluations and policy studies. Often, too little attention is paid to the…

Colorado family physicians' attitudes toward medical marijuana.

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Kondrad, Elin; Reid, Alfred

2013-01-01

Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice. We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv. Items included individual and practice characteristics as well as experience with and attitudes toward medical marijuana. Five hundred twenty family physicians responded (30% response rate). Of these, 46% did not support physicians recommending medical marijuana; only 19% thought that physicians should recommend it. A minority thought that marijuana conferred significant benefits to physical (27%) and mental (15%) health. Most agreed that marijuana poses serious mental (64%) and physical (61%) health risks. Eighty-one percent agreed that physicians should have formal training before recommending medical marijuana, and 92% agreed that continuing medical education about medical marijuana should be available to family physicians. Despite a high prevalence of use in Colorado, most family physicians are not convinced of marijuana's health benefits and believe its use carries risks. Nearly all agreed on the need for further medical education about medical marijuana.

Burnout syndrome among physicians working in primary health care ...

African Journals Online (AJOL)

Objective: The aim of the study was to reveal extent of burnout problem among primary care physicians and the socio-demographic factors affecting its occurrence. Methods: The target population included all physicians working in these two health regions in Kuwait. Two hundred physicians working in the primary health ...

Comparing resident cataract surgery outcomes under novice versus experienced attending supervision

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Puri S

2015-09-01

Full Text Available Sidharth Puri,1 Amanda E Kiely,2 Jiangxia Wang,3 Alonzo S Woodfield,4 Saras Ramanathan,5 Shameema Sikder21Johns Hopkins School of Medicine, Baltimore, MD, 2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 4Kaiser Permanente South Sacramento Medical Center, Sacramento, 5San Francisco School of Medicine, University of California, San Francisco, CA, USAPurpose: To determine whether supervision by an attending new to surgical teaching or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents.Setting: Single tertiary hospital.Design: Retrospective cohort study. Methods: Resident-performed phacoemulsification cases supervised by one novice attending (N=189 and experienced attending (N=172 over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy, intraoperative risk factors (Trypan blue, iris hooks, and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet’s tear. Experienced attending data were compared against those of the novice attending.Results: Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005, Flomax (P<0.001, or glaucoma risk (P=0.001. For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001. Regarding complications, novice attending cases were associated with vitreous loss (P=0.002 and anterior capsule tears (P<0.001. When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice

Leadership development programs for physicians: a systematic review.

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Frich, Jan C; Brewster, Amanda L; Cherlin, Emily J; Bradley, Elizabeth H

2015-05-01

Physician leadership development programs typically aim to strengthen physicians' leadership competencies and improve organizational performance. We conducted a systematic review of medical literature on physician leadership development programs in order to characterize the setting, educational content, teaching methods, and learning outcomes achieved. Articles were identified through a search in Ovid MEDLINE from 1950 through November 2013. We included articles that described programs designed to expose physicians to leadership concepts, outlined teaching methods, and reported evaluation outcomes. A thematic analysis was conducted using a structured data entry form with categories for setting/target group, educational content, format, type of evaluation and outcomes. We identified 45 studies that met eligibility criteria, of which 35 reported on programs exclusively targeting physicians. The majority of programs focused on skills training and technical and conceptual knowledge, while fewer programs focused on personal growth and awareness. Half of the studies used pre/post intervention designs, and four studies used a comparison group. Positive outcomes were reported in all studies, although the majority of studies relied on learner satisfaction scores and self-assessed knowledge or behavioral change. Only six studies documented favorable organizational outcomes, such as improvement in quality indicators for disease management. The leadership programs examined in these studies were characterized by the use of multiple learning methods, including lectures, seminars, group work, and action learning projects in multidisciplinary teams. Physician leadership development programs are associated with increased self-assessed knowledge and expertise; however, few studies have examined outcomes at a system level. Our synthesis of the literature suggests important gaps, including a lack of programs that integrate non-physician and physician professionals, limited use of more

Parental awareness and use of online physician rating sites.

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Hanauer, David A; Zheng, Kai; Singer, Dianne C; Gebremariam, Achamyeleh; Davis, Matthew M

2014-10-01

The US public is increasingly using online rating sites to make decisions about a variety of consumer goods and services, including physicians. We sought to understand, within the context of other types of rating sites, parents' awareness, perceptions, and use of physician-rating sites for choosing primary care physicians for their children. This cross-sectional, nationally representative survey of 3563 adults was conducted in September 2012. Participants were asked about rating Web sites in the context of finding a primary care physician for their children and about their previous experiences with such sites. Overall, 2137 (60%) of participants completed the survey. Among these respondents, 1619 were parents who were included in the present analysis. About three-quarters (74%) of parents were aware of physician-rating sites, and about one-quarter (28%) had used them to select a primary care physician for their children. Based on 3 vignettes for which respondents were asked if they would follow a neighbor's recommendation about a primary care physician and using multivariate analyses, respondents exposed to a neighbor's recommendation and positive online physician ratings were significantly more likely to choose the recommended physician (adjusted odds ratio: 3.0 [95% confidence interval: 2.1-4.4]) than respondents exposed to the neighbor's recommendation alone. Conversely, respondents exposed to the neighbor's recommendation and negative online ratings were significantly less likely to choose the neighbor children's physician (adjusted odds ratio: 0.09 [95% confidence interval: 0.03-0.3]). Parents are beginning to use online physician ratings, and these ratings have the potential to influence choices of their children's primary care physician. Copyright © 2014 by the American Academy of Pediatrics.

[Addicted colleagues: a blind spot amongst physicians?].

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Rode, Hans; de Rond, Marlies; Dam, Ingrid

2013-01-01

Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.

Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

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Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".

Science.gov (United States)

Sidat, Mohsin M

2016-07-02

Health workforce shortages in Sub-Saharan Africa are widely recognized, particularly of physicians, leading the training and deployment of Non-physician clinicians (NPCs). The paper by Eyal et al provides interesting and legitimate viewpoints on evolving role of physicians in context of decisive increase of NPCss in Sub-Saharan Africa. Certainly, in short or mid-term, NPCs will continue to be a proxy solution and a valuable alternative to overcome physicians' shortages in sub-Saharan Africa. Indeed, NPCs have an important role at primary healthcare (PHC) level. Physicians at PHC level can certainly have all different roles that were suggested by Eyal et al, including those not directly related to healthcare provision. However, at secondary and higher levels of healthcare, physicians would assume other roles that are mainly related to patient clinical care. Thus, attempting to generalize the role of physicians without taking into account the context where they will work would be not entirely appropriate. It is true that often physicians start the professional carriers at PHC level and progress to other levels of healthcare particularly after clinical post-graduation training. Nevertheless, the training programs offered by medical institutions in sub-Saharan Africa need to be periodically reviewed and take into account professional and occupational roles physicians would take in context of evolving health systems in sub-Saharan Africa. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Radiology 24/7 In-House Attending Coverage: Do Benefits Outweigh Cost?

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Coleman, Stephanie; Holalkere, Nagaraj Setty; O׳Malley, Julie; Doherty, Gemma; Norbash, Alexander; Kadom, Nadja

2016-01-01

Many radiology practices, including academic centers, are moving to in-house 24/7 attending coverage. This could be costly and may not be easily accepted by radiology trainees and attending radiologists. In this article, we evaluated the effects of 24/7 in-house attending coverage on patient care, costs, and qualitative aspects such as trainee education. We retrospectively collected report turnaround times (TAT) and work relative value units (wRVU). We compared these parameters between the years before and after the implementation of 24/7 in-house attending coverage. The cost to provide additional attending coverage was estimated from departmental financial reports. A qualitative survey of radiology residents and faculty was performed to study perceived effects on trainee education. There were decreases in report TAT following 24/7 attending implementation: 69% reduction in computed tomography, 43% reduction in diagnostic radiography, 7% reduction in magnetic resonance imaging, and 43% reduction in ultrasound. There was an average daytime wRVU decrease of 9%, although this was compounded by a decrease in total RVUs of the 2013 calendar year. The financial investment by the institution was estimated at $850,000. Qualitative data demonstrated overall positive feedback from trainees and faculty in radiology, although loss of independence was reported as a negative effect. TAT and wRVU metrics changed with implementation of 24/7 attending coverage, although these metrics do not directly relate to patient outcomes. Additional clinical benefits may include fewer discrepancies between preliminary and final reports that may improve emergency and inpatient department workflows and liability exposure. Radiologists reported the impression that clinicians appreciated 24/7 in-house attending coverage, particularly surgical specialists. Loss of trainee independence on call was a perceived disadvantage of 24/7 attending coverage and raised a concern that residency education

Skills of primary healthcare physicians in paediatric cardiac auscultation.

Science.gov (United States)

Germanakis, Ioannis; Petridou, Eleni T H; Varlamis, George; Matsoukis, Ioannis L; Papadopoulou-Legbelou, Kiriaki; Kalmanti, Maria

2013-02-01

To evaluate the performance of primary healthcare physicians in paediatric cardiac auscultation and the impact of a multimedia-based teaching intervention. A total of 106 primary healthcare physicians (77 paediatricians, 14 general practitioners and 15 medical graduates) attended four paediatric cardiac auscultation teaching courses based on virtual patients' presentation (digital phonocardiography). Their auscultatory performance was documented at the beginning of each course and at the end of two of the courses. Participants initially detected 73% of abnormal murmurs and 17% of additional sounds, while 22% of innocent murmurs were interpreted as abnormal. Overall cardiac auscultation performance, assessed by a combined auscultation score, was low and independent of training level (graduates: 39.5/trainees: 42.8/board certified: 42.6, p = 0.89) or specialty (paediatricians: 42.7/general practitioners: 43.1, p = 0.89). Multimedia-based teaching was associated with a significant improvement in abnormal murmur (92.5%) and additional sound (40%) detection (p auscultation, independent of training level or specialty, still leave potential for improvement. Multimedia-based teaching interventions represent an effective means of improving paediatric cardiac auscultatory skills. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

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Tunde-Ayinmode Mosunmola

2012-07-01

Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score  In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p  Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of

Paid Sick Leave as a Means to Reduce Sickness Presenteeism Among Physicians

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Ingrid Steen Rostad

2017-06-01

Full Text Available Recurrent international data show that physicians often attend work while ill, termed sickness presenteeism. The current study investigated if sickness presenteeism scores among European physicians varied according to national paid sick leave legislation. We hypothesized that prevalence of presenteeism was higher in countries with lower levels of paid sick leave. We used repeated cross-sectional survey data, phase I (2004/2005, N = 1326 and phase II (2012/2013, N = 1403, among senior consultants at university hospitals in Sweden, Norway, and Italy. Analyses of variances assessed cross-country differences in presenteeism. To assess the impact of country on presenteeism, we used multiple regression analyses controlled for sex, age, family status, work hours, and work content. The results from phase I supported the initial hypothesis. At phase II, presenteeism scores had decreased among the Italian and Swedish sample. The results are discussed with regard to changes in legislation on workhours and medical liability in Italy and Sweden between phase I and II.

A Systematic Review of Physician Leadership and Emotional Intelligence

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Mintz, Laura Janine; Stoller, James K.

2014-01-01

Objective This review evaluates the current understanding of emotional intelligence (EI) and physician leadership, exploring key themes and areas for future research. Literature Search We searched the literature using PubMed, Google Scholar, and Business Source Complete for articles published between 1990 and 2012. Search terms included physician and leadership, emotional intelligence, organizational behavior, and organizational development. All abstracts were reviewed. Full articles were evaluated if they addressed the connection between EI and physician leadership. Articles were included if they focused on physicians or physicians-in-training and discussed interventions or recommendations. Appraisal and Synthesis We assessed articles for conceptual rigor, study design, and measurement quality. A thematic analysis categorized the main themes and findings of the articles. Results The search produced 3713 abstracts, of which 437 full articles were read and 144 were included in this review. Three themes were identified: (1) EI is broadly endorsed as a leadership development strategy across providers and settings; (2) models of EI and leadership development practices vary widely; and (3) EI is considered relevant throughout medical education and practice. Limitations of the literature were that most reports were expert opinion or observational and studies used several different tools for measuring EI. Conclusions EI is widely endorsed as a component of curricula for developing physician leaders. Research comparing practice models and measurement tools will critically advance understanding about how to develop and nurture EI to enhance leadership skills in physicians throughout their careers. PMID:24701306

Physician perspectives on collaborative working relationships with team-based hospital pharmacists in the inpatient medicine setting.

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Makowsky, Mark J; Madill, Helen M; Schindel, Theresa J; Tsuyuki, Ross T

2013-04-01

Collaborative care between physicians and pharmacists has the potential to improve the process of care and patient outcomes. Our objective was to determine whether team-based pharmacist care was associated with higher physician-rated collaborative working relationship scores than usual ward-based pharmacist care at the end of the COLLABORATE study, a 1 year, multicentre, controlled clinical trial, which associated pharmacist intervention with improved medication use and reduced hospital readmission rates. We conducted a cross-sectional survey of all team-based and usual care physicians (attending physicians and medical residents) who worked on the participating clinical teaching unit or primary healthcare teams during the study period. They were invited to complete an online version of the validated Physician-Pharmacist Collaboration Index (PPCI) survey at the end of the study. The main endpoint of interest was the mean total PPCI score. Only three (response rate 2%) of the usual care physicians responded and this prevented us from conducting pre-specified comparisons. A total of 23 team-based physicians completed the survey (36%) and reported a mean total PPCI score of 81.6 ± 8.6 out of a total of 92. Mean domain scores were highest for relationship initiation (14.0 ± 1.4 out of 15), and trustworthiness (38.9 ± 3.7 out of 42), followed by role specification (28.7 ± 4.3 out of 35). Pharmacists who are pursuing collaborative practice in inpatient settings may find the PPCI to be a meaningful tool to gauge the extent of collaborative working relationships with physician team members. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Social media: physicians-to-physicians education and communication.

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Fehring, Keith A; De Martino, Ivan; McLawhorn, Alexander S; Sculco, Peter K

2017-06-01

Physician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians. Social media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms. Orthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients' confidentiality.

Cystic fibrosis physicians' perspectives on the timing of referral for lung transplant evaluation: a survey of physicians in the United States.

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Ramos, Kathleen J; Somayaji, Ranjani; Lease, Erika D; Goss, Christopher H; Aitken, Moira L

2017-01-19

Prior studies reveal that a significant proportion of patients with cystic fibrosis (CF) and advanced lung disease are not referred for lung transplant (LTx) evaluation. We sought to assess expert CF physician perspectives on the timing of LTx referral and investigate their LTx knowledge. We developed an online anonymous survey that was distributed by the Cystic Fibrosis Foundation (CFF) to the medical directors of all CFF-accredited care centers in the United States in 2015. The survey addressed only adult patients (≥18 years old) and was sent to 119 adult CF physicians, 86 CFF-affiliated CF physicians (who see adults and children, but have smaller program sizes than adult or pediatric centers), and 127 pediatric CF physicians (who see some adults, but mostly children). The focus of the questions was on CFF-care center characteristics, physician experience and indications/contraindications to referral for LTx evaluation. There were 114/332 (34%) total responses to the survey. The response rates were: 57/119 (48%) adult physicians, 12/86 (14%) affiliate physicians and 43/127 (34%) pediatric physicians; 2 physicians did not include their CFF center type. Despite the poor ability of FEV 1  < 30% to predict death within 2 years, 94% of responding CF physicians said they would refer an adult patient for LTx evaluation if the patient's lung function fell to FEV 1  < 30% predicted. Only 54% of respondents report that pulmonary hypertension would trigger referral. Pulmonary hypertension is an internationally recommended indication to list a patient for LTx (not just for referral for evaluation). Very few physicians (N = 17, 15%) employed components of the lung allocation score (LAS) to determine the timing of referral for LTx evaluation. Interestingly, patient preference not to undergo LTx was "often" or "always" the primary patient-related reason to defer referral for LTx evaluation for 41% (47/114) of respondents. Some potential barriers to timely LTx

Perceptions of 24/7 In-house Attending Coverage on Fellow Education and Autonomy in a Pediatric Cardiothoracic Intensive Care Unit.

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Owens, Sonal T; Owens, Gabe E; Rajput, Shaili H; Charpie, John R; Kidwell, Kelley M; Mullan, Patricia B

2015-01-01

The 24/7 in-house attending coverage is emerging as the standard of care in intensive care units. Implementation costs, workforce feasibility, and patient outcomes resulting from changes in physician staffing are widely debated topics. Understanding the impact of staffing models on the learning environment for medical trainees and faculty is equally warranted, particularly with respect to trainee education and autonomy. This study aims to elicit the perceptions of pediatric cardiology fellows and attendings toward 24/7 in-house attending coverage and its effect on fellow education and autonomy. We surveyed pediatric cardiology fellows and attendings practicing in the pediatric cardiothoracic intensive care unit (PCTU) of a large, university-affiliated medical center, using structured Likert response items and open-ended questions, prior to and following the transition to 24/7 in-house attending coverage. All (100%) trainees and faculty completed all surveys. Both prior to and following transition to 24/7 in-house attending coverage, all fellows, and the majority of attendings agreed that the overnight call experience benefited fellow education. At baseline, trainees identified limited circumstances in which on-site attending coverage would be critical. Preimplementation concerns that 24/7 in-house attending coverage would negatively affect the education of fellows were not reflected following actual implementation of the new staffing policy. However, based upon open-ended questions, fellow autonomy was affected by the new paradigm, with fellows and attendings reporting decreased "appropriateness" of autonomy after implementation. Our prospective study, showing initial concerns about limiting the learning environment in transitioning to 24/7 in-house attending coverage did not result in diminished perceptions of the educational experience for our fellows but revealed an expected decrease in fellow autonomy. The study indirectly facilitated open discussions about

45 CFR 702.16 - Attendance of news media at public sessions.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Attendance of news media at public sessions. 702... Attendance of news media at public sessions. Reasonable access for coverage of public sessions shall be provided to the various communications media, including newspapers, magazines, radio, newsreels, and...

Mobile physician reporting of clinically significant events-a novel way to improve handoff communication and supervision of resident on call activities.

Science.gov (United States)

Nabors, Christopher; Peterson, Stephen J; Aronow, Wilbert S; Sule, Sachin; Mumtaz, Arif; Shah, Tushar; Eskridge, Etta; Wold, Eric; Stallings, Gary W; Burak, Kathleen Kelly; Goldberg, Randy; Guo, Gary; Sekhri, Arunabh; Mathew, George; Khera, Sahil; Montoya, Jessica; Sharma, Mala; Paudel, Rajiv; Frishman, William H

2014-12-01

Reporting of clinically significant events represents an important mechanism by which patient safety problems may be identified and corrected. However, time pressure and cumbersome report entry procedures have discouraged the full participation of physicians. To improve the process, our internal medicine training program developed an easy-to-use mobile platform that combines the reporting process with patient sign-out. Between August 25, 2011, and January 25, 2012, our trainees entered clinically significant events into i-touch/i-phone/i-pad based devices functioning in wireless-synchrony with our desktop application. Events were collected into daily reports that were sent from the handoff system to program leaders and attending physicians to plan for rounds and to correct safety problems. Using the mobile module, residents entered 31 reportable events per month versus the 12 events per month that were reported via desktop during a previous 6-month study period. Advances in information technology now permit clinically significant events that take place during "off hours" to be identified and reported (via handoff) to next providers and to supervisors via collated reports. This information permits hospital leaders to correct safety issues quickly and effectively, while attending physicians are able to use information gleaned from the reports to optimize rounding plans and to provide additional oversight of trainee on call patient management decisions.

Thinking Styles and Regret in Physicians.

Directory of Open Access Journals (Sweden)

Mia Djulbegovic

Full Text Available Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper.A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection were administered through a web-based survey to physicians of the University of South Florida. Bonferroni's adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni's correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret.165 trainees and 56 attending physicians (age range 25 to 69 participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001 and alternate search strategy (r=0.239; p=0.002. When Bonferroni's correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021. In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001, need for cognition (r=-0.340; p<0.001, and objectivism (r=-0.309; p=0.003 and positively correlated with ambiguity intolerance (r=0.285; p=0.012. However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001, while it was negatively associated with

In their own words: describing Canadian physician leadership.

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Snell, Anita J; Dickson, Graham; Wirtzfeld, Debrah; Van Aerde, John

2016-07-04

Purpose This is the first study to compile statistical data to describe the functions and responsibilities of physicians in formal and informal leadership roles in the Canadian health system. This mixed-methods research study offers baseline data relative to this purpose, and also describes physician leaders' views on fundamental aspects of their leadership responsibility. Design/methodology/approach A survey with both quantitative and qualitative fields yielded 689 valid responses from physician leaders. Data from the survey were utilized in the development of a semi-structured interview guide; 15 physician leaders were interviewed. Findings A profile of Canadian physician leadership has been compiled, including demographics; an outline of roles, responsibilities, time commitments and related compensation; and personal factors that support, engage and deter physicians when considering taking on leadership roles. The role of health-care organizations in encouraging and supporting physician leadership is explicated. Practical implications The baseline data on Canadian physician leaders create the opportunity to determine potential steps for improving the state of physician leadership in Canada; and health-care organizations are provided with a wealth of information on how to encourage and support physician leaders. Using the data as a benchmark, comparisons can also be made with physician leadership as practiced in other nations. Originality/value There are no other research studies available that provide the depth and breadth of detail on Canadian physician leadership, and the embedded recommendations to health-care organizations are informed by this in-depth knowledge.

Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

Directory of Open Access Journals (Sweden)

Geoffrey K Spurling

2010-10-01

Full Text Available BACKGROUND: Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing. METHODS AND FINDINGS: We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise. Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008, International Pharmaceutical Abstracts (1970 to February 2008, Embase (1997 to February 2008, Current Contents (2001 to 2008, and Central (The Cochrane Library Issue 3, 2007 using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies and other sources (138 studies. Articles were then excluded because they did not fulfil inclusion criteria (179 or quality appraisal criteria (18, leaving 58 included studies with 87 distinct

[Burnout in physicians].

Science.gov (United States)

Kurzthaler, Ilsemarie; Kemmler, Georg; Fleischhacker, W Wolfgang

2017-06-01

Burnout is a syndrome characterized by emotional exhaustion, depersonalization and low personal accomplishment. The primary objective of this study was to investigate both the prevalence and severity of burnout symptoms in a sample of clinical physicians from different speciality disciplines. A total of 69 clinical physicians ≤55 years who are working at the Medical University/regional Hospital Innsbruck were included into a cross-sectional study. Next to the assessment of sociodemographic and work-related variables the Maslach Burnout Inventory (MBI) was used to investigate burnout symtoms. Overall, 8.8% of the study population showed high emotional exhaustion with high or moderate depersonalization and low personal accomplishment and therefore had a high risk to develop a burnout syndrom. 11.8% showed a moderade burnout risk. Neither sociodemographic variables nor the degree of educational qualification or speciality discipline had an influence on burnout symptoms. However, there was a positive correlation between scientific activity and personal accomplihment. Our results suggest that the dimension of burnout symtoms among clinical physicians in Austria has be taken seriously. Further research is needed to develop specific programs in terms of burnout prevention and burnout therapy.

Do family physicians, emergency department physicians, and pediatricians give consistent sport-related concussion management advice?

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Stoller, Jacqueline; Carson, James D; Garel, Alisha; Libfeld, Paula; Snow, Catherine L; Law, Marcus; Frémont, Pierre

2014-06-01

To identify differences and gaps in recommendations to patients for the management of sport-related concussion among FPs, emergency department physicians (EDPs), and pediatricians. A self-administered, multiple-choice survey was e-mailed to FPs, EDPs, and pediatricians. The survey had been assessed for content validity. Two community teaching hospitals in the greater Toronto area in Ontario. Two hundred seventy physicians, including FPs, EDPs, and pediatricians, were invited to participate. Identification of sources of concussion management information, usefulness of concussion diagnosis strategies, and whether physicians use common terminology when explaining cognitive rest strategies to patients after sport-related concussions. The response rate was 43.7%. Surveys were completed by 70 FPs, 23 EDPs, and 11 pediatricians. In total, 49% of FP, 52% of EDP, and 27% of pediatrician respondents reported no knowledge of any consensus statements on concussion in sport, and 54% of FPs, 86% of EDPs, and 78% of pediatricians never used the Sport Concussion Assessment Tool, version 2. Only 49% of FPs, 57% of EDPs, and 36% of pediatricians always advised cognitive rest. This study identified large gaps in the knowledge of concussion guidelines and implementation of recommendations for treating patients with sport-related concussions. Although some physicians recommended physical and cognitive rest, a large proportion failed to consistently advise this strategy. Better knowledge transfer efforts should target all 3 groups of physicians. Copyright© the College of Family Physicians of Canada.

Guns, schools, and mental illness: potential concerns for physicians and mental health professionals.

Science.gov (United States)

Hall, Ryan Chaloner Winton; Friedman, Susan Hatters

2013-11-01

Since the recent shootings in Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut, there has been an ever-increasing state and national debate regarding gun control. All 3 shootings involved an alleged shooter who attended college, and in hindsight, evidence of a mental illness was potentially present in these individuals while in school. What appears to be different about the current round of debate is that both pro-gun control and anti-gun control advocates are focusing on mentally ill individuals, early detection of mental illness during school years, and the interactions of such individuals with physicians and the mental health system as a way to solve gun violence. This raises multiple questions for our profession about the apparent increase in these types of events, dangerousness in mentally ill individuals, when to intervene (voluntary vs involuntary), and what role physicians should play in the debate and ongoing prevention. As is evident from the historic Tarasoff court case, physicians and mental health professionals often have new regulations/duties, changes in the physician-patient relationship, and increased liability resulting from high-profile events such as these. Given that in many ways the prediction of who will actually commit a violent act is difficult to determine with accuracy, physicians need to be cautious with how the current gun debate evolves not only for ourselves (eg, increased liability, becoming de facto agents of the state) but for our patients as well (eg, increased stigma, erosion of civil liberties, and changes in the physician-patient relationship). We provide examples of potential troublesome legislation and suggestions on what can be done to improve safety for our patients and for the public. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar.

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Kim, Yoona A; Trinh, Sam; Thura, Si; Kyi, Khin Pyone; Lee, Thomas; Sze, Stan; Richards, Adam; Aronsohn, Andrew; Wong, Grace L H; Tanaka, Yasuhito; Dusheiko, Geoffrey; Nguyen, Mindie H

2017-01-01

In Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment. During a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement. One hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%). Physician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve liver disease management and future medical education efforts in Myanmar.

Factors enhancing career satisfaction among female emergency physicians.

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Clem, Kathleen J; Promes, Susan B; Glickman, Seth W; Shah, Anand; Finkel, Michelle A; Pietrobon, Ricardo; Cairns, Charles B

2008-06-01

Attrition rates in emergency medicine have been reported as high as 25% in 10 years. The number of women entering emergency medicine has been increasing, as has the number of female medical school graduates. No studies have identified factors that increase female emergency physician career satisfaction. We assess career satisfaction in women emergency physicians in the American College of Emergency Physicians (ACEP) and identify factors associated with career satisfaction. The survey questionnaire was developed by querying 3 groups: (1) ACEP women in the American Association of Women Emergency Physicians, the (2) Society for Academic Emergency Medicine Mentoring Women Interest Group, and (3) nonaffiliated female emergency physicians. Their responses were categorized into 6 main areas: schedule, relationships with colleagues, administrative support and mentoring, patient/work-related issues, career advancement opportunities, and financial. The study cohort for the survey included all female members of ACEP with a known e-mail address. All contact with survey recipients was exclusively through the e-mail that contained a uniform resource locator link to the survey itself. Two thousand five hundred two ACEP female members were sent the uniform resource locator link. The Web survey was accessed a total of 1,851 times, with a total of 1,380 surveys completed, an overall response rate of 56%. Most women were satisfied with their career as an emergency physician, 492 (35.5%) very satisfied, 610 (44.0%) satisfied, 154 (11.1%) neutral, 99 (7.1%) not satisfied, and 31 (2.3%) very unsatisfied. Significant factors for career satisfaction included amount of recognition at work, career advancement, schedule flexibility, and the fairness of financial compensation. Workplace factors associated with high satisfaction included academic practice setting and sex-equal opportunity for advancement and sex-equal financial compensation. Most of the ACEP female physicians surveyed were

Knowledge and awareness of first aid of avulsed tooth among physicians and nurses of hospital emergency department

Directory of Open Access Journals (Sweden)

Sudeep Sreepad Iyer

2017-01-01

Full Text Available Introduction: Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. Materials and Methods: A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. Results: With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% (n = 100 nurses and 74.7% (n = 112 considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. Conclusion: The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis.

Five-year Retrospective Review of Physician and Non-physician Performed Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service.

Science.gov (United States)

O'Dochartaigh, Domhnall; Douma, Matthew; MacKenzie, Mark

2017-01-01

To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18-34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34-56) p = reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care.

Malawian impressions of expatriate physicians: A qualitative study ...

African Journals Online (AJOL)

Background: In many low-income countries, including Malawi, expatriate physicians serve diverse roles in clinical care, education, mentorship, and research. A significant proportion of physicians from high-income countries have global health experience. Despite the well-known benefits of global health experiences for ...

Burnout among physicians | Romani | Libyan Journal of Medicine

African Journals Online (AJOL)

Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it ...

In-center hemodialysis attendance: patient perceptions of risks, barriers, and recommendations.

Science.gov (United States)

Chenitz, Kara B; Fernando, Michael; Shea, Judy A

2014-04-01

Missed hemodialysis treatments lead to increased morbidity and mortality in the end-stage renal disease population. Little is known about why patients have difficulty attending their scheduled in-center dialysis treatments. Semistructured interviews with 15 adherent and 15 nonadherent hemodialysis patients were conducted to determine patients' attitudes about dialysis, health beliefs and risk perception regarding missed treatments, barriers and facilitators to hemodialysis attendance, and recommendations to improve the system to facilitate dialysis attendance. Average time on dialysis was 2.5 years for the nonadherent group and 7.3 years in the adherent group. In both groups, patients felt that dialysis is life-saving and a necessity. A substantial number of patients in both groups understood that missing hemodialysis treatments is dangerous and several patients could clearly communicate the risk of skipping. The most common barriers to hemodialysis were inadequate or unreliable transportation (mentioned in both groups) and a lack of motivation to get to dialysis or that dialysis is not a priority (typically mentioned by the nonadherent group). Facilitators to hemodialysis attendance included explanations from the health care team regarding the risk of skipping and relationships with other dialysis patients. Patient recommendations to improve dialysis attendance included continued education about the risk of poor attendance and more accessible transportation. Patients did not feel that home dialysis would improve adherence. Hemodialysis patients must adhere to a complex and burdensome regimen. Through the elucidation of barriers and facilitators to hemodialysis attendance and through specific patient recommendations, at least three interventions may be further investigated to improve hemodialysis attendance: Improvement of the transportation system, education and supportive encouragement from the health care team, and peer support mentorship. © 2014 International

Health care workplace discrimination and physician turnover.

Science.gov (United States)

Nunez-Smith, Marcella; Pilgrim, Nanlesta; Wynia, Matthew; Desai, Mayur M; Bright, Cedric; Krumholz, Harlan M; Bradley, Elizabeth H

2009-12-01

To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value workplace discrimination, p value Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

Directory of Open Access Journals (Sweden)

Dolan Kate A

2005-06-01

Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

Factors affecting cardiac rehabilitation referral by physician specialty.

Science.gov (United States)

Grace, Sherry L; Grewal, Keerat; Stewart, Donna E

2008-01-01

Cardiac rehabilitation (CR) is widely underutilized because of multiple factors including physician referral practices. Previous research has shown CR referral varies by type of provider, with cardiologists more likely to refer than primary care physicians. The objective of this study was to compare factors affecting CR referral in primary care physicians versus cardiac specialists. A cross-sectional survey of a stratified random sample of 510 primary care physicians and cardiac specialists (cardiologists or cardiovascular surgeons) in Ontario identified through the Canadian Medical Directory Online was administered. One hundred four primary care physicians and 81 cardiac specialists responded to the 26-item investigator-generated survey examining medical, demographic, attitudinal, and health system factors affecting CR referral. Primary care physicians were more likely to endorse lack of familiarity with CR site locations (P negatively impacting CR referral practices than cardiac specialists. Cardiac specialists were significantly more likely to perceive that their colleagues and department would regularly refer patients to CR than primary care physicians (P Marketing CR site locations, provision of standardized referral forms, and ensuring discharge summaries are communicated to primary care physicians may improve their willingness to refer to CR.

Effect of a reorganized after-hours family practice service on frequent attenders

DEFF Research Database (Denmark)

Vedsted, Peter; Olesen, Frede

1999-01-01

of this reorganization on the use of services by frequent attenders (FAs). METHODS: From 1990 to 1994, methods of contact and annual costs per attender were analyzed in an ecological time-trend study based on aggregated administrative data collected from the database of the Public Health Insurance, Aarhus County......, Denmark (600,000 inhabitants). The study only included attenders ages 18 and over. FAs were defined as the group that, within each calendar year (12 months), had 4 or more contacts with the after-hours family practice service. RESULTS: FAs made up 9.5% of the attenders and accounted for more than 40...

Improving marital relationships: strategies for the family physician.

Science.gov (United States)

Starling, B P; Martin, A C

1992-01-01

Marital conflict and divorce are prevalent in our society, and patients frequently ask family physicians to assist them with marital difficulties. These difficulties are often associated with a decline in health, resulting in additional stress to the marital unit. A MEDLINE search was undertaken using the key words "family medicine," "marital therapy," "marital counseling," "brief psychotherapy," and "short-term psychotherapy." The bibliographies of generated articles were searched for additional references. The authors used the resources of their individual behavioral science libraries, as well as their clinical experiences. With adequate training, many family physicians can include marital counseling skills in their clinical repertoires. Family life cycle theory provides a framework for understanding the common stresses of marital life and also guides the family physician in recommending strategies to improve marital satisfaction. The physician's role is twofold: (1) to identify couples in crisis, and (2) to provide preventive strategies geared to assist couples in achieving pre-crisis equilibrium or higher levels of functioning. For physicians whose practices do not include marital counseling, an understanding of the basic techniques can be beneficial in effectively referring appropriate couples for marital therapy.

A new instrument to assess physician skill at thoracic ultrasound, including pleural effusion markup.

Science.gov (United States)

Salamonsen, Matthew; McGrath, David; Steiler, Geoff; Ware, Robert; Colt, Henri; Fielding, David

2013-09-01

To reduce complications and increase success, thoracic ultrasound is recommended to guide all chest drainage procedures. Despite this, no tools currently exist to assess proceduralist training or competence. This study aims to validate an instrument to assess physician skill at performing thoracic ultrasound, including effusion markup, and examine its validity. We developed an 11-domain, 100-point assessment sheet in line with British Thoracic Society guidelines: the Ultrasound-Guided Thoracentesis Skills and Tasks Assessment Test (UGSTAT). The test was used to assess 22 participants (eight novices, seven intermediates, seven advanced) on two occasions while performing thoracic ultrasound on a pleural effusion phantom. Each test was scored by two blinded expert examiners. Validity was examined by assessing the ability of the test to stratify participants according to expected skill level (analysis of variance) and demonstrating test-retest and intertester reproducibility by comparison of repeated scores (mean difference [95% CI] and paired t test) and the intraclass correlation coefficient. Mean scores for the novice, intermediate, and advanced groups were 49.3, 73.0, and 91.5 respectively, which were all significantly different (P < .0001). There were no significant differences between repeated scores. Procedural training on mannequins prior to unsupervised performance on patients is rapidly becoming the standard in medical education. This study has validated the UGSTAT, which can now be used to determine the adequacy of thoracic ultrasound training prior to clinical practice. It is likely that its role could be extended to live patients, providing a way to document ongoing procedural competence.

Which Physicians' Behaviors on Death Pronouncement Affect Family-Perceived Physician Compassion? A Randomized, Scripted, Video-Vignette Study.

Science.gov (United States)

Mori, Masanori; Fujimori, Maiko; Hamano, Jun; Naito, Akemi S; Morita, Tatsuya

2018-02-01

Although the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements. The objective of this study was to evaluate the effect of a compassionate death pronouncement on participant-perceived physician compassion, trust in physicians, and emotions. In this randomized, video-vignette study, 92 people (≥50 years) in Tokyo metropolitan area viewed two videos of death pronouncements by an on-call physician with or without compassion-enhanced behaviors, including five components: waiting until the families calm themselves down, explaining that the physician has received a sign-out about information of the patient's condition, performing examination respectfully, ascertaining the time of death with a wristwatch (vs. smartphone), and reassuring the families that the patient did not experience pain. Main outcomes were physician compassion score, trust in physician, and emotions. After viewing the video with compassion-enhanced behaviors compared with the video without them, participants assigned significantly lower compassion scores (reflecting higher physician compassion) (mean 26.2 vs. 36.4, F = 33.1, P vs. 3.00, F = 39.7, P vs. 3.78, F = 18.0, P sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P vs. 3.71, F = 19.4, P < 0.001). To convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Differential campsite pricing and campground attendance

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Wilbur F. LaPage; Paula L. Cormier; George T. Hamilton; Alan D. Cormier

1975-01-01

Several changes in the characteristics of campers' visits were discovered by comparing camping permit data before and after the start of differential campsite pricing at a New Hampshire state park campground in 1973. Differentials included a premium charge for waterfront sites and a preferential rate for New Hampshire residents. Attendance by state residents...

Physician Orders for Life Sustaining Treatment in US Nursing Homes: A Case Study of CRNP Engagement in the Care Planning Process

Directory of Open Access Journals (Sweden)

Gerald A. Hartle

2014-01-01

Full Text Available This case study describes changes in Physician Orders for Life Saving Treatment (POLST status among long-stay residents of a US nursing home who had a certified registered nurse practitioner (CRNP adopt the practice of participating in nursing home staff care plan meetings. The CRNP attended a nonrandomized sample of 60 care plan meetings, each featuring a review of POLST preferences with residents and/or family members. Days since original POLST completion, Charlson Comorbidity Index score, number of hospitalizations since index admission, and other sociodemographic characteristics including religion and payer source were among the data elements extracted via chart review for the sample as well as for a nonequivalent control group of 115 residents also under the care of the medical provider group practice at the nursing home. Twenty-three percent (n=14 of the 60 care conferences attended by the CRNP resulted in a change in POLST status after consultations with the resident and/or family. In all cases, POLST changes involved restated preferences from a higher level of intervention to a lower level of intervention. Fifty-nine percent of the CRNP-attended conferences resulted in the issuance of new medical provider orders. CRNP participation in care conferences may represent a best practice opportunity to revisit goals of care with individuals and their family members in the context of broader interprofessional treatment planning.

How do physicians discuss e-health with patients? the relationship of physicians' e-health beliefs to physician mediation styles.

Science.gov (United States)

Fujioka, Yuki; Stewart, Erin

2013-01-01

A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician-patient interaction, incorporating the theory of parental mediation of media into a medical context.

Prepaid entitlements. A new challenge for physician-patient relationships.

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Schroeder, J L; Clarke, J T; Webster, J R

1985-12-06

The transition from a fee-for-service model to a prepaid health care system creates new challenges for both physicians and patients. Occasionally both can feel trapped in the new setting and must rely on new or different strategies to reach sometimes divergent objectives. This may alter the physician-patient relationship in ways that neither likes. Based on our experience in a large multispecialty academic group practice, we have developed management strategies to mitigate such stresses on both parties. These include review of marketing efforts; education of new patients to foster realistic expectations; a physician-generated, prospective internal policy for dealing with dissatisfied patients and physicians; a strong central administrative physician to serve as a "lightning rod" and counselor; and continuing physician orientation and education to improve judgment and attitudes. These strategies promote the physician's role as expert consultant-educator with the best interests of the patient as the first priority.

[Electronic medical records: Evolution of physician-patient relationship in the Primary Care clinic].

Science.gov (United States)

Pérez-Santonja, T; Gómez-Paredes, L; Álvarez-Montero, S; Cabello-Ballesteros, L; Mombiela-Muruzabal, M T

2017-04-01

The introduction of electronic medical records and computer media in clinics, has influenced the physician-patient relationship. These modifications have many advantages, but there is concern that the computer has become too important, going from a working tool to the centre of our attention during the clinical interview, decreasing doctor interaction with the patient. The objective of the study was to estimate the percentage of time that family physicians spend on computer media compared to interpersonal communication with the patient, and whether this time is modified depending on different variables such as, doctor's age or reason for the consultation. An observational and descriptive study was conducted for 10 weeks, with 2 healthcare centres involved. The researchers attended all doctor- patient interviews, recording the patient time in and out of the consultation. Each time the doctor fixed his gaze on computer media the time was clocked. A total of 436 consultations were collected. The doctors looked at the computer support a median 38.33% of the total duration of an interview. Doctors of 45 years and older spent more time fixing their eyes on computer media (P<.05). Family physicians used almost 40% of the consultation time looking at computer media, and depends on age of physician, number of queries, and number of medical appointments. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

Science.gov (United States)

2010-10-01

... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians. (a...

Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar

Science.gov (United States)

Kim, Yoona A.; Trinh, Sam; Thura, Si; Kyi, Khin Pyone; Lee, Thomas; Sze, Stan; Richards, Adam; Aronsohn, Andrew; Wong, Grace L. H.; Tanaka, Yasuhito; Dusheiko, Geoffrey

2017-01-01

Background In Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment. Methods During a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement. Results One hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw <10 liver disease patients per week (74.3%). The majority of physicians were not comfortable with treating or managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%). Conclusions Physician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve

A Model for Physician Leadership Development and Succession Planning.

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Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

2015-01-01

Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

The physician-scientists: rare species in Africa.

Science.gov (United States)

Adefuye, Anthonio Oladele; Adeola, Henry Ademola; Bezuidenhout, Johan

2018-01-01

There is paucity of physician-scientists in Africa, resulting in overt dependence of clinical practice on research findings from advanced "first world" countries. Physician-scientists include individuals with a medical degree alone or combined with other advanced degrees (e.g. MD/MBChB and PhD) with a career path in biomedical/ translational and patient-oriented/evaluative science research. The paucity of clinically trained research scientists in Africa could result in dire consequences as exemplified in the recent Ebola virus epidemic in West Africa, where shortage of skilled clinical scientists, played a major role in disease progression and mortality. Here we contextualise the role of physician-scientist in health care management, highlight factors limiting the training of physician-scientist in Africa and proffer implementable recommendations to address these factors.

The Role of Attendance in Lecture Classes: You Can Lead a Horse to Water...

Science.gov (United States)

Golding, Jonathan M.

2011-01-01

A review of prior research on the role of attendance policies in large lecture classes (including psychology) is presented. This research showed that although students often did not attend class, various policies were effective in getting students to the classroom. Moreover, some research showed that an attendance policy did not lower instructor…

Effect of weather on football attendances

Energy Technology Data Exchange (ETDEWEB)

Cairns, J A

1984-01-01

On the premise that weather should have an effect on spectator attendance at sports events in outdoor settings (a topic which has received surprisingly little formalized study), the author examined the record of home attendances for three football teams in Scotland. In general, it was found that the greater the rainfall on the day of the match the lower the attendance. Dividing spectators into different groups, it was further found that an additional hour of sunshine was associated 162 more adults attending Aberdeen matches, while high temperatures appeared to increase juvenile attendance (by 57 for ever 1 deg. C. rise in temperature). Weather disruption of football games is attended by a number of costs, both direct and indirect. Quantifying the impact of weather can shed substantial light on the problem of scheduling for the season. For example, since certain periods are, on average, wetter than others, rescheduling to drier periods might encourage greater attendance.

Contraceptive use by female physicians in the United States.

Science.gov (United States)

Frank, E

1999-11-01

Little is known about female physicians' personal contraceptive use, and such usage could influence their prescribing patterns. We used data from the Women Physicians' Health Study, a large (n = 4501) national study, administered in 1993-1994, on characteristics of female physicians in the United States. These female physicians (ages 30-44 years) were more likely to use contraception than women in the general population (ages 15-44 years); this was true even when the physicians were compared with only other women of high socioeconomic status and when stratified by ethnicity, age, and number of children. Physicians were also more likely to use intrauterine devices, diaphragms, or condoms, and less likely to use female or male sterilization than were other women. Younger female physicians were especially unlikely to use permanent methods, particularly when compared with their age-matched counterparts in the general population. One fifth of contracepting physicians used more than one type of contraceptive; the most frequently used combination was spermicide with a barrier method. Female physicians contracept differently than do women in the general population, in ways consistent with delaying and reducing total fertility. Physicians' personal characteristics have been shown to influence their patient counseling practices, including their contraception-related attitudes and practices. Although female physicians' clinical advice might differ from their personal practices, as women physicians become more prevalent, their contraceptive choices could influence those of their patients.

A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance.

Science.gov (United States)

Hung, Susanna Lok Lam; Fu, Sau Nga; Lau, Po Shan; Wong, Samuel Yeung Shan

2015-01-31

This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education

The role of physicians in a community-wide program for prevention of cardiovascular disease: the Minnesota Heart Health Program.

Science.gov (United States)

Mittelmark, M B; Leupker, R V; Grimm, R; Kottke, T E; Blackburn, H

1988-01-01

The Minnesota Heart Health Program (MHHP) aims to reduce cardiovascular disease (CVD) morbidity and mortality by reducing risk factors among the mass of residents in three midwestern communities. A major aspect of the program is the involvement of community physicians because they have high credibility as citizen leaders, especially on health issues. In the MHHP, physicians contributed in a number of ways. The initial contacts with physicians resulted in their providing support and introductions to other community leaders, whose active support was also gained. Physicians sit as members of the central Community Advisory Borads of MHHP and serve on the executive committees of these boards. All MHHP issues related to medical practice are brought before Physicians' Advisory Groups in each community for resolution. Primary care physicians attend MHHP continuing education programs. In a survey of 109 physicians in one of the MHHP communities, 95 percent of respondents believed cigarette smoking to be an important risk factor for CVD, but only 15 percent judged themselves to be effective in dealing with patients who smoked. Forty-one percent of respondents said that elevated blood cholesterol is an important risk factor, but only 20 percent felt effective in treating the condition. Only 18 percent of the physicians in the sample believed that a poor eating pattern plays a substantial role in CVD, and 9 percent felt effective in counseling patients about eating habits. This pattern of results indicates the need not only for continuing education about risk factors for CVD, but also for training to improve patient counseling skills. PMID:3136495

Prevalence of intimate partner violence and its associated risk factors among Saudi female patients attending the primary healthcare centers in Western Saudi Arabia

Directory of Open Access Journals (Sweden)

Turki A. Alzahrani

2016-01-01

Full Text Available Objectives: To estimate the prevalence of intimate partner violence (IPV among female patients, age 18-60 years, attending primary health care centers (PHCCs and to measure its determinants, and reporting behavior. Methods: A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage. Results: The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56% talked regarding their IPV to their families, their husbands’ families (15.2%, or their friends (11.8%; while only a minority (3.3% complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency. Conclusion: One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victim and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.

Prevalence of intimate partner violence and its associated risk factors among Saudi female patients attending the primary healthcare centers in Western Saudi Arabia.

Science.gov (United States)

Alzahrani, Turki A; Abaalkhail, Bahaa A; Ramadan, Iman K

2016-01-01

To estimate the prevalence of intimate partner violence (IPV) among female patients, age 18-60 years, attending primary health care centers (PHCCs) and to measure its determinants, and reporting behavior. A cross-sectional study design using validated, translated, and self-administered questionnaire among 497 Saudi female patients attending PHCCs in Taif, Kingdom of Saudi Arabia (KSA) from January to February 2015 was employed. A 2-stage probability sampling was adopted for selection of PHCCs in the first stage, and then participants in the second stage. The estimated prevalence of IPV during the last year was 11.9%. Predictors of IPV related to abused women included divorced status and divorced parents; while those related to abusers (husbands) included widowed parents, exposure to violence in childhood, and alcohol or drugs addiction. Most of the abused wives (56%) talked regarding their IPV to their families, their husbands' families (15.2%), or their friends (11.8%); while only a minority (3.3%) complained to the police or to a judge, and no one reported this to a family physician, or to women protection agency. One out of 10 women is a victim of IPV in Taif, KSA. Intimate partner violence is significantly associated with a number of victims and abuser-related psychosocial factors, the detection of which might help screening for individuals at risk.

Designing a physician leadership development program based on effective models of physician education.

Science.gov (United States)

Hopkins, Joseph; Fassiotto, Magali; Ku, Manwai Candy; Mammo, Dagem; Valantine, Hannah

2017-02-02

Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management. The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance. The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011). Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members. All participants completed a team project during the program, adding value to the institution. Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system. Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care

Insights on skilled attendance at birth in Malawi - the findings of a ...

African Journals Online (AJOL)

Increasing the number of women who access skilled attendance at birth is the goal of many developing countries including Malawi. The Skilled Attendance for Everyone (SAFE) international research programme coordinated by the Dugald Baird Centre for research on Women\\'s Health at the University of Aberdeen, ...

Physician Compare

Data.gov (United States)

U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

Social capital and frequent attenders in general practice

DEFF Research Database (Denmark)

Pasgaard, Alexander A.; Mæhlisen, Maiken H.; Overgaard, Charlotte

2018-01-01

weeks. RESULTS: Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79-0.94)] and social network [OR 0.88 (0.79-0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity...... at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148...... and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99-1.11) and OR 1.01 (0.92-1.11) respectively]. None of the associations were statistically significant for men. CONCLUSION: This study suggests that for women, some aspects of social capital are associated...

Physician acceptance of new medical information systems: the field of dreams.

Science.gov (United States)

Treister, N W

1998-01-01

Physicians often fail to embrace a complex information system, may not see its relevance to their practices, and are characteristically reluctant to invest the time and energy to be trained in its use. Why is widespread physician buy-in so difficult to achieve? From physicians overwhelmed with change to failing to begin with an adequate physician base of support, this article explores some of the reasons that physicians demonstrate little buy-in to this process and offers suggestions to help create a more successful implementation. Ways to build acceptance include acknowledging the importance of physicians as customers and training them early and often.

Concordance analysis of methylation biomarkers detection in self-collected and physician-collected samples in cervical neoplasm

International Nuclear Information System (INIS)

Chang, Cheng-Chang; Huang, Rui-Lan; Liao, Yu-Ping; Su, Po-Hsuan; Hsu, Yaw-Wen; Wang, Hui-Chen; Tien, Chau-Yang; Yu, Mu-Hsien; Lin, Ya-Wen; Lai, Hung-Cheng

2015-01-01

Non-attendance at gynecological clinics is a major limitation of cervical cancer screening and self-collection of samples may improve this situation. Although HPV testing of self-collected vaginal samples is acceptable, the specificity is inadequate. The current focus is increasing self-collection of vaginal samples to minimize clinic visits. In this study, we analyzed the concordance and clinical performance of DNA methylation biomarker (PAX1, SOX1, and ZNF582) detection in self-collected vaginal samples and physician-collected cervical samples for the identification of cervical neoplasm. We enrolled 136 cases with paired methylation data identified from abnormal Pap smears (n = 126) and normal controls (n = 10) regardless of HPV status at gynecological clinics. The study group comprised 37 cervical intraepithelial neoplasm I (CIN1), 23 cervical intraepithelial neoplasm II (CIN2), 16 cervical intraepithelial neoplasm III (CIN3), 30 carcinoma in situ (CIS), 13 squamous cell carcinomas (SCCs) and seven adenocarcinomas (ACs)/adenosquamous carcinomas (ASCs). PAX1, SOX1 and ZNF582 methylation in study samples was assessed by real-time quantitative methylation-specific polymerase chain reaction analysis. We generated methylation index cutoff values for the detection of CIN3+ in physician-collected cervical samples for analysis of the self-collected group. Concordance between the physician-collected and self-collected groups was evaluated by Cohen’s Kappa. Sensitivity, specificity and area under curve (AUC) were calculated for detection of CIN3+ lesions. Finally, we produced an optimal cutoff value with the best sensitivity from the self-collected groups. We generated a methylation index cutoff value from physician-collected samples for detection of CIN3+. There were no significant differences in sensitivity, specificity of PAX1, SOX1 and ZNF582 between the self-collected and physician-collected groups. The methylation status of all three genes in the normal control

Exercise-induced bronchospasm: coding and billing for physician services.

Science.gov (United States)

Pohlig, Carol

2009-01-01

Physician reporting of the service to insurance companies for reimbursement is multifaceted and perplexing to those who do not understand the factors to consider. Test selection should be individualized based on the patient's history and/or needs. Federal regulations concerning physician supervision of diagnostic tests mandate different levels of physician supervision based on the type and complexity of the test. Many factors play a key role in physician claim submission. These include testing location, component services, coding edits, and additional visits. Medical necessity of the service(s) must also be demonstrated for payer consideration and reimbursement. The following article reviews various tests for exercise-induced bronchospasm and focuses on issues to assist the physician in reporting the services accurately and appropriately.

Knowledge of severe acute respiratory syndrome among community physicians, nurses, and emergency medical responders.

Science.gov (United States)

Tice, Alan Douglas; Kishimoto, Mitsumasa; Dinh, Chuong Hoang; Lam, Geoffrey Tak-Kin; Marineau, Michelle

2006-01-01

The preparedness levels of front-line clinicians including physicians, nurses, emergency medical responders (EMRs), and other medical staff working in clinics, offices and ambulatory care centers must be assessed, so these personnel are able to deal with communicable and potentially lethal diseases, such as severe acute respiratory syndrome (SARS). In order to determine the knowledge of these clinicians, a survey of their understanding of SARS and their use of educational resources was administered. A questionnaire was distributed to physicians, nurses, and EMRs attending conferences on SARS in the summer of 2003. Questions related to information sources, knowledge of SARS, and plans implemented in their workplace to deal with it. Statistical analysis was performed using the Statistical Package for the Social Sciences (10.1 Program, SPSS Inc., Chicago, Illinois). A total of 201 community healthcare providers (HCPs) participated in the study. A total of 51% of the participants correctly identified the incubation period of SARS; 48% correctly identified the symptoms of SARS; and 60% knew the recommended infection control precautions to take for families. There was little difference in knowledge among the physicians, nurses, and EMRs evaluated. Media outlets such as newspapers, journals, television, and radio were reported as the main sources of information on SARS. However, there appears to be a growing use of the Internet, which correlated best with the correct answers on symptoms of SARS. Fewer than one-third of respondents were aware of a protocol for SARS in their workplace. A total of 60% reported that N-95 masks were available in their workplace. These findings suggest the need for more effective means of education and training for front-line clinicians, as well as the institution of policies and procedures in medical offices, clinics, and emergency services in the community.

U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide.

Science.gov (United States)

Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William

2002-01-01

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

Attending and non-attending patients in a real-life setting of an early arthritis clinic: why do people leave clinics and where do they go?

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Nell-Duxneuner, Valerie; Rezende, Lucila Stange; Stamm, Tanja A; Duer, Mona; Smolen, Josef S; Machold, Klaus P

2012-01-01

Rheumatologist assessment as early as possible is considered essential for patients with inflammatory joint disease. In our Very Early Arthritis Clinic (VEAC), a substantial proportion of initially included and followed patients later stop attendance in the clinic. We questioned attending (AP) and non-attending patients (NAP) regarding current health status and satisfaction with care as well as reasons for discontinuation and current care received by NAP. VEAC patients first seen between 1996 and 2003 were included. Assessment included the RADAI, HAQ, and visual analogue scales for pain, disease activity, fatigue, satisfaction with current health care. Current (DMARD) treatment was recorded. Among AP, 87% had rheumatoid arthritis (RA) and 13% non-RA. Of NAP, 37% had RA, 23% non-RA and 40% no more rheumatic disease. Satisfaction with health care concerning rheumatic disease was better in AP than NAP. Likewise, most outcome parameters were better in AP. Substantially more RA patients in the AP than NAP group received DMARDs. Apart from the disappearance of arthritis, logistic reasons were given most frequently for discontinuation of attendance. Less than 10% of NAP indicated dissatisfaction with medical care. We found advantages in both disease activity measures and satisfaction with health care for patients receiving continuous care in a highly specialised Rheumatology clinic. Furthermore, different DMARD usage in RA in AP and NAP may indicate significant deficits in treatment quality outside specialist care. Logistic issues associated with access to continuous Rheumatology care for early arthritis patients need improvement.

Job Satisfaction Among Academic Family Physicians.

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Agana, Denny Fe; Porter, Maribeth; Hatch, Robert; Rubin, Daniel; Carek, Peter

2017-09-01

Family physicians report some of the highest rates of burnout among their physician peers. Over the past few years, this rate has increased and work-life balance has decreased. In academic medicine, many report lack of career satisfaction and have considered leaving academia. Our aim was to explore the factors that contribute to job satisfaction and burnout in faculty members in a family medicine department. Six academic family medicine clinics were invited to participate in this qualitative study. Focus groups were conducted to allow for free-flowing, rich dialogue between the moderator and the physician participants. Transcripts were analyzed in a systematic manner by independent investigators trained in grounded theory. The constant comparison method was used to code and synthesize the qualitative data. Six main themes emerged: time (62%), benefits (9%), resources (8%), undervalue (8%), physician well-being (7%), and practice demand (6%). Within the main theme of time, four subthemes emerged: administrative tasks/emails (61%), teaching (17%), electronic medical records (EMR) requirements (13%), and patient care (9%). Academic family physicians believe that a main contributor to job satisfaction is time. They desire more resources, like staff, to assist with increasing work demands. Overall, they enjoy the academic primary care environment. Future directions would include identifying the specific time restraints that prevent them from completing tasks, the type of staff that would assist with the work demands, and the life stressors the physicians are experiencing.

Physician heal thyself

African Journals Online (AJOL)

Compared to overweight or obese physicians, normal‑weight physicians were significantly more likely to discuss weight loss with their obese patients, according to a study among. 500 primary care physicians, undertaken by researchers at the Johns Hopkins Bloomberg School of Public Health.[4]. A recent, highly accessed ...

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

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Esmaeilpour-Bandboni, Mohammad; Vaismoradi, Mojtaba; Salsali, Mahvash; Snelgrove, Sherrill; Sheldon, Lisa Kennedy

2017-08-01

Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

The association between child and adolescent emotional disorder and poor attendance at school: a systematic review protocol.

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Finning, Katie; Moore, Darren; Ukoumunne, Obioha C; Danielsson-Waters, Emilia; Ford, Tamsin

2017-06-28

Anxiety and depression are common in young people and are associated with a range of adverse outcomes. Research has suggested a relationship between emotional disorder and poor school attendance, and thus poor attendance may serve as a red flag for children at risk of emotional disorder. This systematic review aims to investigate the association between child and adolescent emotional disorder and poor attendance at school. We will search electronic databases from a variety of disciplines including medicine, psychology, education and social sciences, as well as sources of grey literature, to identify any quantitative studies that investigate the relationship between emotional disorder and school attendance. Emotional disorder may refer to diagnoses of mood or anxiety disorders using standardised diagnostic measures, or measures of depression, anxiety or "internalising symptoms" using a continuous scale. Definitions for school non-attendance vary, and we aim to include any relevant terminology, including attendance, non-attendance, school refusal, school phobia, absenteeism and truancy. Two independent reviewers will screen identified papers and extract data from included studies. We will assess the risk of bias of included studies using the Newcastle-Ottawa Scale. Random effects meta-analysis will be used to pool quantitative findings when studies use the same measure of association, otherwise a narrative synthesis approach will be used. This systematic review will provide a detailed synthesis of evidence regarding the relationship between childhood emotional disorder and poor attendance at school. Understanding this relationship has the potential to assist in the development of strategies to improve the identification of and intervention for this vulnerable group. PROSPERO CRD42016052961.

Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia

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Mortier Freddy

2008-02-01

Full Text Available Abstract Background In this study we investigated (a to what extent physicians have experience with performing a range of end-of-life decisions (ELDs, (b if they have no experience with performing an ELD, would they be willing to do so under certain conditions and (c which background characteristics are associated with having experience with/or being willing to make such ELDs. Methods An anonymous questionnaire was sent to 16,486 physicians from specialities in which death is common: Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland. Results The response rate differed between countries (39–68%. The experience of foregoing life-sustaining treatment ranged between 37% and 86%: intensifying the alleviation of pain or other symptoms while taking into account possible hastening of death between 57% and 95%, and experience with deep sedation until death between 12% and 46%. Receiving a request for hastening death differed between 34% and 71%, and intentionally hastening death on the explicit request of a patient between 1% and 56%. Conclusion There are differences between countries in experiences with ELDs, in willingness to perform ELDs and in receiving requests for euthanasia or physician-assisted suicide. Foregoing treatment and intensifying alleviation of pain and symptoms are practiced and accepted by most physicians in all countries. Physicians with training in palliative care are more inclined to perform ELDs, as are those who attend to higher numbers of terminal patients. Thus, this seems not to be only a matter of opportunity, but also a matter of attitude.

Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.

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McQueen, Carl; Crombie, Nicholas; Hulme, Jonathan; Cormack, Stef; Hussain, Nageena; Ludwig, Frank; Wheaton, Steve

2015-01-01

In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands. Retrospective review of the MERIT clinical database for the 12 months following the launch of the scheme. Data was collected relating to the number of RSIs performed; indication for RSI; number of intubation attempts; grade of view on laryngoscopy and the base speciality/grade of the operator performing intubation. MERIT teams were activated 1619 times, attending scene in 1029 cases. RSI was performed 142 times (13.80% of scene attendances). There was one recorded case of failure to intubate requiring insertion of a supraglottic airway device (0.70%). In over a third of RSI cases, CCPs performed laryngoscopy and intubation (n=53, 37.32%). Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%). Intubation was successful at the first attempt in over 90% of cases. This study demonstrates that operation within a system that provides high levels of exposure, underpinned by comprehensive and robust training and governance frameworks, promotes levels of performance in successful prehospital RSI regardless of base speciality or profession. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country.

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Kersnik, J

2001-08-01

Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.

Family physician perspectives on primary immunodeficiency diseases

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Jordan eOrange

2016-03-01

Full Text Available Primary immunodeficiency diseases (PID include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed family practice physicians, of whom 44% reported following ≥1 patient with a PID. Selective immunoglobulin A (IgA, deficiency (21%, and chronic granulomatous disease (11% were most common and were followed by significantly more subspecialist immunologists (P<.0001. Use of intravenously administered Ig, and live viral vaccinations across PID was significantly different (P<.0001. Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4% vs. 79% of subspecialist immunologists, P<.0001. Family practice physicians will likely encounter patients with a PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.

An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

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Thom, D H; Bloch, D A; Segal, E S

1999-02-01

To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

Mobile phone messaging reminders for attendance at healthcare appointments.

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Car, Josip; Gurol-Urganci, Ipek; de Jongh, Thyra; Vodopivec-Jamsek, Vlasta; Atun, Rifat

2012-07-11

Missed appointments are a major cause of inefficiency in healthcare delivery, with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments, and reminders may help alleviate this problem. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications such as Short Message Service (SMS) and Multimedia Message Service (MMS) could provide an important, inexpensive delivery medium for reminders for healthcare appointments. To assess the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of patients' and healthcare providers' evaluation of the intervention; costs; and possible risks and harms associated with the intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009). We also reviewed grey literature (including trial registers) and reference lists of articles. We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies with at least three time points before and after the intervention. We included studies assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions.   Two review authors independently assessed all

A new, but old business model for family physicians: cash.

Science.gov (United States)

Weber, J Michael

2013-01-01

The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

Physician Appraisals: Key Challenges

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Klich Jacek

2017-06-01

Full Text Available The main purpose of the article is to identify key criteria being used for physician appraisals and to find how communication skills of physicians are valued in those appraisals. ScienceDirect and EBSCOhost databases were used for this search. The results show that a physician appraisal is underestimated both theoretically and empirically. The particular gap exists with respect to the communication skills of physicians, which are rarely present in medical training syllabi and physician assessments. The article contributes to the theoretical discourse on physician appraisals and points out at the inconsistency between the high status of physicians as a key hospital resource on the one hand and, on the other hand, at inadequate and poorly researched assessment of their performance with a special emphasis on communication skills. The article may inspire health managers to develop and implement up-to-date assessment forms for physicians and good managerial practices in this respect in hospitals and other health care units.

Interference with the patient-physician relationship

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Robbins RA

2012-11-01

Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….

29 CFR 785.28 - Involuntary attendance.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Involuntary attendance. 785.28 Section 785.28 Labor... POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS HOURS WORKED Application of Principles Lectures, Meetings and Training Programs § 785.28 Involuntary attendance. Attendance is not voluntary, of...

Appealing to an important customer. Physicians should be the target of marketing.

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Weiss, R

1989-05-01

Although many healthcare professionals are turning to the general public to increase market share and referrals, they should be directing their attention to physicians instead. One of the major challenges facing hospitals is determining physician needs. A survey may be necessary to identify physicians' perceptions, attitudes, values, expectations, market, and hospital loyalty. Another important research document is the physician profile, which includes each doctor by age, specialty, office location, admitting and outpatient referral activity, financial contribution, and referral and other affiliations. Surveying should not end with the physician. One of the best means of evaluating patient and physician satisfaction is by questioning physicians' office staff. To centralize physician services, a number of hospitals have established physician liaison programs, which bridge the gap between the hospital and the physician's office, heighten physician satisfaction, and increase referrals. Physician orientation is a key element of most outreach programs, providing an opportunity to develop relationships with new physicians. Other means of directly aiding physicians are physician referral services and practice enhancement and assistance.

Physicians and euthanasia: a Canadian print-media discourse analysis of physician perspectives.

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Wright, David Kenneth; Fishman, Jennifer R; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen

2015-01-01

Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. We conducted a discourse analysis of print media on physicians' perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician's perspective. We identified 3 predominant discourses about physicians' public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies.

Electronic Health Record Use a Bitter Pill for Many Physicians.

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Meigs, Stephen L; Solomon, Michael

2016-01-01

Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum.

Physician and medical student perceptions and expectations of the pediatric clerkship: a Qatar experience

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Hendaus MA

2016-05-01

Full Text Available Mohamed A Hendaus,1,2 Shabina Khan,1 Samar Osman,1 Yasser Alsamman,2 Tushar Khanna,2 Ahmed H Alhammadi1,2 1Department of Pediatrics, General Academic Pediatrics Division, Hamad Medical Corporation, Doha, 2Weill Cornell Medical College-Qatar, Al Rayyan, Qatar Background: The average number of clerkship weeks required for the pediatric core rotation by the US medical schools is significantly lower than those required for internal medicine or general surgery. Objective: The objective behind conducting this survey study was to explore the perceptions and expectations of medical students and pediatric physicians about the third-year pediatric clerkship. Methods: An anonymous survey questionnaire was distributed to all general pediatric physicians at Hamad Medical Corporation and to students from Weill Cornell Medical College-Qatar. Results: Feedback was obtained from seven attending pediatricians (100% response rate, eight academic pediatric fellow physicians (100% response rate, 36 pediatric resident physicians (60% response rate, and 36 medical students (60% response rate. Qualitative and quantitative data values were expressed as frequencies along with percentages and mean ± standard deviation and median and range. A P-value <0.05 from a 2-tailed t-test was considered to be statistically significant. Participants from both sides agreed that medical students receive <4 hours per week of teaching, clinical rounds is the best environment for teaching, adequate bedside is provided, and that there is no adequate time for both groups to get acquainted to each other. On the other hand, respondents disagreed on the following topics: almost two-thirds of medical students perceive postgraduate year 1 and 2 pediatric residents as the best teachers, compared to 29.4% of physicians; 3 weeks of inpatient pediatric clerkship is enough for learning; the inpatient pediatric environment is safe and friendly; adequate feedback is provided by physicians to

Family physician perceptions of working with LGBTQ patients: physician training needs.

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Beagan, Brenda; Fredericks, Erin; Bryson, Mary

2015-01-01

Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

Family physician perceptions of working with LGBTQ patients: physician training needs

Directory of Open Access Journals (Sweden)

Brenda Beagan

2015-04-01

Full Text Available Background: Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ. Understanding physician perceptions of this area of practice may aid in developing improved education. Method: In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results: Three major themes emerged: 1 Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2 Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3 Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions: Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women.

Use of critical incidents to develop a rating form for resident evaluation of faculty teaching.

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Silber, Cynthia; Novielli, Karen; Paskin, David; Brigham, Timothy; Kairys, John; Kane, Gregory; Veloski, Jon

2006-12-01

Monitoring the teaching effectiveness of attending physicians is important to enhancing the quality of graduate medical education. We used a critical incident technique with 35 residents representing a cross-section of programmes in a teaching hospital to develop a 23-item rating form. We obtained ratings of 11 attending physicians in internal medicine and general surgery from 54 residents. We performed linear and logistic regression analysis to relate the items on the form to the residents' overall ratings of the attending physicians and the programme directors' ratings of the attending physicians. The residents rated the attending physicians highly in most areas, but lower in provision of feedback, clarity of written communication and cost-effectiveness in making clinical decisions. When we used the residents' overall ratings as the criterion, the most important aspects of attending physicians' teaching were clarity of written communication, cost-effectiveness, commitment of time and energy and whether the resident would refer a family member or friend to the physician. When we used the programme directors' ratings as the criterion, the additional important aspects of performance were concern for the residents' professional well-being, knowledge of the literature and the delivery of clear verbal and written communication. The critical incident technique can be used to develop an instrument that demonstrates content and construct validity. We found that residents consider commitment of time to teaching and clinical effectiveness to be the most important dimensions of faculty teaching. Other important dimensions include written and verbal communication, cost-effectiveness and concern for residents' professional development.

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians.

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Eyal, Nir; Cancedda, Corrado; Kyamanywa, Patrick; Hurst, Samia A

2015-12-30

Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary - for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system. © 2016 by Kerman University of Medical Sciences.

Physician's practices and perspectives regarding tobacco cessation in a teaching hospital in Mysore City, Karnataka.

Science.gov (United States)

Saud, Mohammed; Madhu, B; Srinath, K M; Ashok, N C; Renuka, M

2014-01-01

Tobacco is a leading cause of disease and premature death. Most of the smokers visit a doctor for various health related ailments and thus such clinic visits provide many opportunities for interventions and professional tobacco cessation advice. The primary aim of the following study is to assess the physician practices, perspectives, resources, barriers and education relating to tobacco cessation and their perceived need for training for the same. The secondary aim is to compare the physician's cessation practices from patient's perspective. A descriptive study was conducted in a hospital attached to Medical College in Mysore city, Karnataka. Information about doctor's practices, perspectives and their perceived need for training in tobacco cessation were collected using pre-structured self-administered Questionnaire, which were distributed in person. Patient's practices and perspectives were assessed using a pre-structured Oral Questionnaire. Almost 95% of physicians said that they ask patients about their smoking status and 94% advise them to quit smoking, but only 50% assist the patient to quit smoking and only 28% arrange follow-up visits. Thus, they do not regularly provide assistance to help patients quit, even though 98% of the physicians believed that helping patients to quit was a part of their role. Only 18% and 35% of the physicians said that Undergraduate Medical Education and Post Graduate Medical Education respectively prepared them very well to participate in smoking cessation activities. Tobacco cessation requires repeated and regular assistance. Such assistance is not being provided to patients by attending doctors. Our medical education system is failing to impart the necessary skills to doctors, needed to help patients quit smoking. Reforms in education are needed so as to prepare the physician to effectively address this problem.

The communication between patient relatives and physicians in intensive care units.

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Cicekci, Faruk; Duran, Numan; Ayhan, Bunyamin; Arican, Sule; Ilban, Omur; Kara, Iskender; Turkoglu, Melda; Yildirim, Fatma; Hasirci, Ismail; Karaibrahimoglu, Adnan; Kara, Inci

2017-07-17

Patients in intensive care units (ICUs) are often physically unable to communicate with their physicians. Thus, the sharing of information about the on-going treatment of the patients in ICUs is directly related to the communication attitudes governing a patient's relatives and the physician. This study aims to analyze the attitudes displayed by the relatives of patients and the physician with the purpose of determining the communication between the two parties. For data collection, two similar survey forms were created in context of the study; one for the relatives of the patients and one for the ICU physicians. The questionnaire included three sub-dimensions: informing, empathy and trust. The study included 181 patient relatives and 103 ICU physicians from three different cities and six hospitals. Based on the results of the questionnaire, identification of the mutual expectations and substance of the messages involved in the communication process between the ICU patients' relatives and physicians was made. The gender and various disciplines of the physicians and the time of the conversation with the patients' relatives were found to affect the communication attitude towards the patient. Moreover, the age of the patient's relatives, the level of education, the physician's perception, and the contact frequency with the patient when he/she was healthy were also proven to have an impact on the communication attitude of the physician. This study demonstrates the mutual expectations and substance of messages in the informing, empathy and trust sub-dimensions of the communication process between patient relatives and physicians in the ICU. The communication between patient relatives and physicians can be strengthened through a variety of training programs to improve communication skills.

Burnout, job satisfaction, and medical malpractice among physicians.

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Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

2013-01-01

Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Physicians in Taiwan face both burnout and a high risk in medical malpractice. There is high

The Prevalence and Special Educational Requirements of Dyscompetent Physicians

Science.gov (United States)

Williams, Betsy W.

2006-01-01

Underperformance among physicians is not well studied or defined; yet, the identification and remediation of physicians who are not performing up to acceptable standards is central to quality care and patient safety. Methods for estimating the prevalence of dyscompetence include evaluating available data on medical errors, malpractice claims,…

Self-Sampling for Human Papillomavirus Testing among Non-Attenders Increases Attendance to the Norwegian Cervical Cancer Screening Programme

DEFF Research Database (Denmark)

Enerly, Espen; Bonde, Jesper; Schee, Kristina

2016-01-01

Increasing attendance to screening offers the best potential for improving the effectiveness of well-established cervical cancer screening programs. Self-sampling at home for human papillomavirus (HPV) testing as an alternative to a clinical sampling can be a useful policy to increase attendance....... To determine whether self-sampling improves screening attendance for women who do not regularly attend the Norwegian Cervical Cancer Screening Programme (NCCSP), 800 women aged 25-69 years in the Oslo area who were due to receive a 2nd reminder to attend regular screening were randomly selected and invited...... alternative for increasing cervical cancer screening coverage in Norway....

Predicting intention to attend and actual attendance at a universal parent-training programme: a comparison of social cognition models.

Science.gov (United States)

Thornton, Sarah; Calam, Rachel

2011-07-01

The predictive validity of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) were examined in relation to 'intention to attend' and 'actual attendance' at a universal parent-training intervention for parents of children with behavioural difficulties. A validation and reliability study was conducted to develop two questionnaires (N = 108 parents of children aged 4-7).These questionnaires were then used to investigate the predictive validity of the two models in relation to 'intention to attend' and 'actual attendance' at a parent-training intervention ( N = 53 parents of children aged 4-7). Both models significantly predicted 'intention to attend a parent-training group'; however, the TPB accounted for more variance in the outcome variable compared to the HBM. Preliminary investigations highlighted that attendees were more likely to intend to attend the groups, have positive attitudes towards the groups, perceive important others as having positive attitudes towards the groups, and report elevated child problem behaviour scores. These findings provide useful information regarding the belief-based factors that affect attendance at universal parent-training groups. Possible interventions aimed at increasing 'intention to attend' and 'actual attendance' at parent-training groups are discussed.

The impact of a lean rounding process in a pediatric intensive care unit.

Science.gov (United States)

Vats, Atul; Goin, Kristin H; Villarreal, Monica C; Yilmaz, Tuba; Fortenberry, James D; Keskinocak, Pinar

2012-02-01

Poor workflow associated with physician rounding can produce inefficiencies that decrease time for essential activities, delay clinical decisions, and reduce staff and patient satisfaction. Workflow and provider resources were not optimized when a pediatric intensive care unit increased by 22,000 square feet (to 33,000) and by nine beds (to 30). Lean methods (focusing on essential processes) and scenario analysis were used to develop and implement a patient-centric standardized rounding process, which we hypothesize would lead to improved rounding efficiency, decrease required physician resources, improve satisfaction, and enhance throughput. Human factors techniques and statistical tools were used to collect and analyze observational data for 11 rounding events before and 12 rounding events after process redesign. Actions included: 1) recording rounding events, times, and patient interactions and classifying them as essential, nonessential, or nonvalue added; 2) comparing rounding duration and time per patient to determine the impact on efficiency; 3) analyzing discharge orders for timeliness; 4) conducting staff surveys to assess improvements in communication and care coordination; and 5) analyzing customer satisfaction data to evaluate impact on patient experience. Thirty-bed pediatric intensive care unit in a children's hospital with academic affiliation. Eight attending pediatric intensivists and their physician rounding teams. Eight attending physician-led teams were observed for 11 rounding events before and 12 rounding events after implementation of a standardized lean rounding process focusing on essential processes. Total rounding time decreased significantly (157 ± 35 mins before vs. 121 ± 20 mins after), through a reduction in time spent on nonessential (53 ± 30 vs. 9 ± 6 mins) activities. The previous process required three attending physicians for an average of 157 mins (7.55 attending physician man-hours), while the new process required two

Physician-Assisted Suicide and Midwest Social Workers: Where Do They Stand?

Science.gov (United States)

Gaston, N Rose; Randall, Jill M; Kiesel, Lisa R

2018-01-01

Physician-assisted suicide (PAS) is explicitly legal in five states and by court decision in one. Legislative bills have been introduced in other states including Minnesota, Iowa, and Wisconsin. This quantitative study was designed to understand Midwest, hospice and palliative care at end-of-life social workers' attitudes toward PAS, preferred terminology, perception of preparedness for the implementation, and awareness of PAS legislation in their state. Sixty-two social workers from Minnesota, Iowa, and Wisconsin completed an anonymous online survey. The results indicated that over one-half of the participants supported PAS legislation and is consistent with previous research on social workers across the country. While there was a range of perceived preparedness for implementation, a majority felt moderately to very prepared. Professional and personal values as well as professional experience influenced their perceived preparedness. Few social workers had accurate awareness of PAS legislation in their state or had attended workshops/events for further education or as a policy advocate. To practice competently and advocate at all levels of practice, hospice and palliative care at end-of-life social workers' need to understand their own attitudes and values toward PAS and pursue additional education around this ethical issue.

Stabilization and treatment of dental avulsions and fractures by emergency physicians using just-in-time training.

Science.gov (United States)

McIntosh, Mark S; Konzelmann, Jason; Smith, Jeffrey; Kalynych, Colleen J; Wears, Robert L; Schneider, Howard; Wylie, Todd; Kaminski, Anne; Matar-Joseph, Madeline

2009-10-01

The objective of this investigation is to use a dental simulation model to compare splinting and bandaging methods for managing tooth avulsions and fractures, as measured by dentist evaluators for quality and time to complete each stabilization procedure. This was a randomized crossover study comparing 3 splinting techniques for managing a traumatically avulsed tooth (periodontal pack, wire, and bondable reinforcement ribbon) and 2 bandage techniques for managing a fractured tooth (calcium hydroxide paste and light-cured composite). After viewing a Just-in-Time training video, a convenience sample of emergency physicians performed the 5 stabilization techniques on dental models containing extracted teeth embedded in clay to simulate a segment of the human dentition. Data collected included time to complete each procedure, the evaluation of dentists about whether the procedure was performed satisfactorily or unsatisfactorily, and the ranking of dentists' and participants' preferred technique. Twenty-five emergency physicians participated in the study: 17 residents, 2 pediatric emergency medicine fellows, and 6 attending physicians. Reported median time, as well as minimum and maximum times to complete each splinting technique for an avulsed tooth, was as follows: periodontal pack 4.4 minutes (2.5 to 6.5 minutes), wire 8.6 minutes (5.8 to 12.9 minutes), and bondable reinforcement ribbon 8.9 minutes (5.6 to 15 minutes). Median time (and minimum and maximum times) to complete each protective bandaging technique for a fractured tooth was calcium hydroxide paste 4.6 minutes (3 to 9.6 minutes) and light-cured composite 7.1 minutes (5.5 to 14.1 minutes). When asked to choose a preferred splinting and bandaging technique according to the performance of the physicians, the dentists chose the bondable reinforcement ribbon 96% (24/25) and the light-cured composite 100% (25/25) of the time. Study participants had no measurable or agreeable preference for a particular splinting

Attended and Unattended Automated Office Blood Pressure Measurements Have Better Agreement With Ambulatory Monitoring Than Conventional Office Readings.

Science.gov (United States)

Andreadis, Emmanuel A; Geladari, Charalampia V; Angelopoulos, Epameinondas T; Savva, Florentia S; Georgantoni, Anna I; Papademetriou, Vasilios

2018-04-07

Automated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the "white coat effect" and shows a strong association with ambulatory blood pressure. We conducted a cross-sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland-Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (-5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, -6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and -2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician). Our findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Deafness among physicians and trainees: a national survey.

Science.gov (United States)

Moreland, Christopher J; Latimore, Darin; Sen, Ananda; Arato, Nora; Zazove, Philip

2013-02-01

To describe the characteristics of and accommodations used by the deaf and hard-of-hearing (DHoH) physician and trainee population and examine whether these individuals are more likely to care for DHoH patients. Multipronged snowball sampling identified 86 potential DHoH physician and trainee participants. In July to September 2010, a Web-based survey investigated accommodations used by survey respondents. The authors analyzed participants' demographics, accommodation and career satisfaction, sense of institutional support, likelihood of recommending medicine as a career, and current/anticipated DHoH patient population size. The response rate was 65% (56 respondents; 31 trainees and 25 practicing physicians). Modified stethoscopes were the most frequently used accommodation (n = 50; 89%); other accommodations included auditory equipment, note-taking, computer-assisted real-time captioning, signed interpretation, and oral interpretation. Most respondents reported that their accommodations met their needs well, although 2 spent up to 10 hours weekly arranging accommodations. Of 25 physicians, 17 reported primary care specialties; 7 of 31 trainees planned to enter primary care specialties. Over 20% of trainees anticipated working with DHoH patients, whereas physicians on average spent 10% of their time with DHoH patients. Physicians' accommodation satisfaction was positively associated with career satisfaction and recommending medicine as a career. DHoH physicians and trainees seemed satisfied with frequent, multimodal accommodations from employers and educators. These results may assist organizations in planning accommodation provisions. Because DHoH physicians and trainees seem interested in primary care and serving DHoH patients, recruiting and training DHoH physicians has implications for the care of this underserved population.

Women physicians as healthcare leaders: a qualitative study.

Science.gov (United States)

Roth, Virginia R; Theriault, Anne; Clement, Chris; Worthington, Jim

2016-06-20

Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent.

A Comparison of Sexual Minority Youth Who Attend Religiously Affiliated Schools and Their Nonreligious-School-Attending Counterparts

Science.gov (United States)

Stewart, Brandon T.; Heck, Nicholas C.; Cochran, Bryan N.

2015-01-01

Sexual minority youth are an at-risk group for negative health outcomes. The present study compares descriptive characteristics and outness of sexual minority youth who attend religious schools to sexual minorities who do not attend religious schools, and also investigates if attending religiously affiliated schools is associated with levels of…

Types and Distribution of Payments From Industry to Physicians in 2015.

Science.gov (United States)

Tringale, Kathryn R; Marshall, Deborah; Mackey, Tim K; Connor, Michael; Murphy, James D; Hattangadi-Gluth, Jona A

2017-05-02

Given scrutiny over financial conflicts of interest in health care, it is important to understand the types and distribution of industry-related payments to physicians. To determine the types and distribution of industry-related payments to physicians in 2015 and the association of physician specialty and sex with receipt of payments from industry. Observational, retrospective, population-based study of licensed US physicians (per National Plan & Provider Enumeration System) linked to 2015 Open Payments reports of industry payments. A total of 933 295 allopathic and osteopathic physicians. Outcomes were compared across specialties (surgery, primary care, specialists, interventionalists) and between 620 166 male (66.4%) and 313 129 female (33.6%) physicians using regression models adjusting for geographic Medicare-spending region and sole proprietorship. Physician specialty and sex. Reported physician payment from industry (including nature, number, and value), categorized as general payments (including consulting fees and food and beverage), ownership interests (including stock options, partnership shares), royalty or license payments, and research payments. Associations between physician characteristics and reported receipt of payment. In 2015, 449 864 of 933 295 physicians (133 842 [29.8%] women), representing approximately 48% of all US physicians were reported to have received $2.4 billion in industry payments, including approximately $1.8 billion for general payments, $544 million for ownership interests, and $75 million for research payments. Compared with 47.7% of primary care physicians (205 830 of 431 819), 61.0% of surgeons (110 604 of 181 372) were reported as receiving general payments (absolute difference, 13.3%; 95% CI, 13.1-13.6; odds ratio [OR], 1.72; P sole proprietorship, men within each specialty had a higher odds of receiving general payments than did women: surgery, 62.5% vs 56.5% (OR, 1.28; 95% CI, 1.26-1.31); primary

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice.

Science.gov (United States)

van Rijssen, H Jolanda; Schellart, Antonius J M; Anema, Johannes R; de Boer, Wout E L; van der Beek, Allard J

2011-06-03

Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course. A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation. A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial. The feasibility and practical relevance of the communication

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

Science.gov (United States)

2011-01-01

Background Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course. Methods A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation. Results A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial. Conclusions The feasibility and

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

Directory of Open Access Journals (Sweden)

Anema Johannes R

2011-06-01

Full Text Available Abstract Background Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1 to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2 to plan an evaluation of the training course. Methods A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation. Results A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial

Re-attenders to the emergency department of a major urban hospital serving a population of 290,000.

LENUS (Irish Health Repository)

Ramasubbu, B

2015-01-01

The national Emergency Medicine Programme (EMP) in Ireland, defines a re-attender as any patient re-presenting to the Emergency Department (ED) within 28 days with the same chief complaint. A retrospective, electronic patient record audit was carried out on all re-attenders to Connolly ED during November 2012. There were 2919 attendances made up from 2530 patients; 230 patients re-attended a total of 389 times. The re-attendance rate was 13% (389\\/2919). 63 (27%) were frequent presenters. There was a significantly higher admission rate at second attendance than first (89 (39%) vs 39 (17%), p < 0.001). 25% (57\\/230) of patients \\'left before completion of treatment\\' (LBCT) at first attendance (significantly higher than the number at second attendance (p < 0.01)). 14\\/57 (25%) of those who LBCT at first attendance required admission at second attendance. 28\\/89 (31%) of second attendance admissions were failed discharges from first attendance. Reasons for re-attendance are multi-factorial and include both patient and departmental factors.

Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Helen Barratt

Full Text Available The characteristics of Emergency Department (ED attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics.Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions.18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously.Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians.

Science.gov (United States)

Pelayo, Marta; Cebrián, Diego; Areosa, Almudena; Agra, Yolanda; Izquierdo, Juan Vicente; Buendía, Félix

2011-05-23

The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process.The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group.The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI 95%: 2.8 to 6.5 (p = 0.0001), scale range 0-33), confidence

Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

Directory of Open Access Journals (Sweden)

Agra Yolanda

2011-05-01

Full Text Available Abstract Background The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process. The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group. The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Methods Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. Results 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI

Reasons for choosing the profession and profile of newly qualified physicians in Brazil

Directory of Open Access Journals (Sweden)

MÁRIO CÉSAR SCHEFFER

Full Text Available SUMMARY Objective To evaluate the socio-demographic profile, path to medical school admission and factors affecting the choice of becoming a physician in Brazil. Method Application of a structured questionnaire to 4,601 participants among the 16,323 physicians who graduated between 2014 and 2015 that subsequently registered with one of the 27 Regional Boards of Medicine (CRMs. Results The average age of participants is 27 years, 77.2% are white, 57% come from families with a monthly income greater than ten times the minimum wage, 65% have fathers who have completed higher education, 79.1% attended a private high school, and 63.5% selected the “will to make a difference in people’s lives or do good” as their main reason for choosing medicine, with some differences between the sexes and matriculation at a public or private medical school. Conclusion The recent politics for educational diversity and the opening of additional medical schools has not yet had an impact on the socio-demographic profile of graduates, who are mainly white, wealthy individuals.

Student attendance and academic performance in undergraduate obstetrics/gynecology clinical rotations.

Science.gov (United States)

Deane, Richard P; Murphy, Deirdre J

2013-12-04

Student attendance is thought to be an important factor in the academic performance of medical students, in addition to having important regulatory, policy, and financial implications for medical educators. However, this relationship has not been well evaluated within clinical learning environments. To evaluate the relationship between student attendance and academic performance in a medical student obstetrics/gynecology clinical rotation. A prospective cohort study of student attendance at clinical and tutorial-based activities during a full academic year (September 2011 to June 2012) within a publicly funded university teaching hospital in Dublin, Ireland. Students were expected to attend 64 activities (26 clinical activities and 38 tutorial-based activities) but attendance was not mandatory. All 147 fourth-year medical students who completed an 8-week obstetrics/gynecology rotation were included. Student attendance at clinical and tutorial-based activities, recorded using a paper-based logbook. The overall examination score (out of a possible 200 points) was obtained using an 11-station objective structured clinical examination (40 points), an end-of-year written examination comprising 50 multiple-choice questions (40 points) and 6 short-answer questions (40 points), and an end-of-year long-case clinical/oral examination (80 points). Students were required to have an overall score of 100 points (50%) and a minimum of 40 points in the long-case clinical/oral examination (50%) to pass. The mean attendance rate was 89% (range, 39%-100% [SD, 11%], n = 57/64 activities). Male students (84% attendance, P = .001) and students who failed an end-of-year examination previously (84% attendance, P = .04) had significantly lower rates. There was a positive correlation between attendance and overall examination score (r = 0.59 [95% CI, 0.44-0.70]; P year examination, and the timing of the rotation during the academic year. Distinction grades (overall score

Influences on physicians' choices of intravenous colloids.

Science.gov (United States)

Miletin, Michael S; Stewart, Thomas E; Norton, Peter G

2002-07-01

Controversy over the optimal intravenous fluid for volume resuscitation continues unabated. Our objectives were to characterize the demographics of physicians who prescribe intravenous colloids and determine factors that enter into their decision to choose a colloid. Questionnaire with 61 items. Ten percent ( n = 364) of frequent intravenous fluid prescribers in the province of Ontario, Canada. The response rate was 74%. Colloid use in the past year was reported by 79% of the responding physicians. Important reasons for choosing a colloid included blood loss and manipulation of oncotic pressure. Physicians tended to prefer either albumin or pentastarch, but no important reasons were found for choosing between the two. Albumin with or without crystalloid was preferred in 5/13 scenarios by more than 50% of the respondents, whereas pentastarch was not favored by more than 50% of respondents in any scenario. Physicians practising in critical care areas and teaching hospitals generally preferred pentastarch to albumin. Physicians reporting pentastarch as representing greater than 90% of total colloid use were more likely to have been visited by a drug detailer for pentastarch than those who used less synthetic colloid (54 vs 22%, p distribution. Although albumin appeared to be preferred in more clinical niches, most physicians did not state reasons for choosing between products. Marketing, specialty, location of practice and clinical scenario appear to play significant roles in the utilization of colloid products.

Studying physician-adolescent patient communication in community-based practices: recruitment challenges and solutions.

Science.gov (United States)

Bodner, Michael E; Bilheimer, Alicia; Gao, Xiaomei; Lyna, Pauline; Alexander, Stewart C; Dolor, Rowena J; Østbye, Truls; Bravender, Terrill; Tulsky, James A; Graves, Sidney; Irons, Alexis; Pollak, Kathryn I

2015-11-13

Practice-based studies are needed to assess how physicians communicate health messages about weight to overweight/obese adolescent patients, but successful recruitment to such studies is challenging. This paper describes challenges, solutions, and lessons learned to recruit physicians and adolescents to the Teen Communicating Health Analyzing Talk (CHAT) study, a randomized controlled trial of a communication skills intervention for primary care physicians to enhance communication about weight with overweight/obese adolescents. A "peer-to-peer" approach was used to recruit physicians, including the use of "clinic champions" who liaised between study leaders and physicians. Consistent rapport and cooperative working relationships with physicians and clinic staff were developed and maintained. Adolescent clinic files were reviewed (HIPAA waiver) to assess eligibility. Parents could elect to opt-out for their children. To encourage enrollment, confidentiality of audio recordings was emphasized, and financial incentives were offered to all participants. We recruited 49 physicians and audio-recorded 391 of their overweight/obese adolescents' visits. Recruitment challenges included 1) physician reticence to participate; 2) variability in clinic operating procedures; 3) variability in adolescent accrual rates; 4) clinic open access scheduling; and 5) establishing communication with parents and adolescents. Key solutions included the use of a "clinic champion" to help recruit physicians, pro-active, consistent communication with clinic staff, and adapting calling times to reach parents and adolescents. Recruiting physicians and adolescents to audio-recorded, practice-based health communication studies can be successful. Anticipated challenges to recruiting can be met with advanced planning; however, optimal solutions to challenges evolve as recruitment progresses.

Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians.

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Bell, Darrel J; Bringman, Jay; Bush, Andrew; Phillips, Owen P

2006-11-01

Physician job satisfaction has been the subject of much research. However, no studies have been conducted comparing academic and private practice physician satisfaction in obstetrics and gynecology. This study was undertaken to measure satisfaction levels for academic and private practice obstetrician-gynecologists and compare different aspects of their practice that contributed to their satisfaction. A survey was mailed to randomly selected obstetrician-gynecologists in Memphis, TN; Birmingham, AL; Little Rock, AR; and Jackson, MS. Physicians were asked to respond to questions concerning demographics and career satisfaction. They were also asked to assess the contribution of 13 different aspects of their practice in contributing to their job selection and satisfaction using a Likert scale. A score of 1 meant the physician completely disagreed with a statement regarding a factor's contribution or was completely dissatisfied; a score of 5 meant the physician completely agreed with a factor's contribution or was completely satisfied. Simple descriptive statistics, as well as the 2-sample t test, were used. Likert scale values were assumed to be interval measurements. Of the 297 questionnaires mailed, 129 (43%) physicians responded. Ninety-five (74%) respondents rated their overall satisfaction as 4 or 5. No significant difference was found between academic and private physicians when comparing overall job satisfaction (P = .25). When compared to private practice physicians, the aspects most likely contributing to overall job satisfaction for academic physicians were the ability to teach, conduct research, and practice variety (P = .0001, P = .0001, and P = .007, respectively). When compared with academic physicians, the aspects most likely contributing to job satisfaction for private practice physicians were autonomy, physician-patient relationship, and insurance reimbursement (P = .0058, P = .0001, and P = .0098, respectively). When choosing a practice setting

Mobile phone messaging reminders for attendance at healthcare appointments.

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Gurol-Urganci, Ipek; de Jongh, Thyra; Vodopivec-Jamsek, Vlasta; Atun, Rifat; Car, Josip

2013-12-05

This review is an update of the original Cochrane review published in July 2012. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs for the health system, leading to delays in diagnosis and appropriate treatment. Patients' forgetfulness is one of the main reasons for missed appointments. Patient reminders may help reduce missed appointments. Modes of communicating reminders for appointments to patients include face-to-face communication, postal messages, calls to landlines or mobile phones, and mobile phone messaging. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could provide an important, inexpensive delivery medium for reminders for healthcare appointments. To update our review assessing the effects of mobile phone messaging reminders for attendance at healthcare appointments. Secondary objectives include assessment of costs; health outcomes; patients' and healthcare providers' evaluation of the intervention and perceptions of safety; and possible harms and adverse effects associated with the intervention. Original searches were run in June 2009. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 8), MEDLINE (OvidSP) (January 1993 to August 2012), EMBASE (OvidSP) (January 1993 to August 2012), PsycINFO (OvidSP) (January 1993 to August 2012) and CINAHL (EbscoHOST) (January 1993 to August 2012). We also reviewed grey literature (including trial registers) and reference lists of articles. Randomised controlled trials (RCTs) assessing mobile phone messaging as reminders for healthcare appointments. We only included studies in which it was possible to assess effects of mobile phone messaging independent of other technologies or interventions.   Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third

Influences on physicians' adoption of electronic detailing (e-detailing).

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Alkhateeb, Fadi M; Doucette, William R

2009-01-01

E-detailing means using digital technology: internet, video conferencing and interactive voice response. There are two types of e-detailing: interactive (virtual) and video. Currently, little is known about what factors influence physicians' adoption of e-detailing. The objectives of this study were to test a model of physicians' adoption of e-detailing and to describe physicians using e-detailing. A mail survey was sent to a random sample of 2000 physicians practicing in Iowa. Binomial logistic regression was used to test the model of influences on physician adoption of e-detailing. On the basis of Rogers' model of adoption, the independent variables included relative advantage, compatibility, complexity, peer influence, attitudes, years in practice, presence of restrictive access to traditional detailing, type of specialty, academic affiliation, type of practice setting and control variables. A total of 671 responses were received giving a response rate of 34.7%. A total of 141 physicians (21.0%) reported using of e-detailing. The overall adoption model for using either type of e-detailing was found to be significant. Relative advantage, peer influence, attitudes, type of specialty, presence of restrictive access and years of practice had significant influences on physician adoption of e-detailing. The model of adoption of innovation is useful to explain physicians' adoption of e-detailing.

Impact of Students’ Class Attendance on Recalling Previously Acquired Information

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Camellia Hemyari

2018-03-01

Full Text Available Background: In recent years, availability of class material including typed lectures, the professor’s Power Point slides, sound recordings, and even videos made a group of students feel that it is unnecessary to attend the classes. These students usually read and memorize typed lectures within two or three days prior to the exams and usually pass the tests even with low attendance rate. Thus, the question is how effective is this learning system and how long the one-night memorized lessons may last.Methods: A group of medical students (62 out of 106 students, with their class attendance and educational achievements in the Medical Mycology and Parasitology course being recorded since two years ago, was selected and their knowledge about this course was tested by multiple choice questions (MCQ designed based on the previous lectures.Results: Although the mean re-exam score of the students at the end of the externship was lower than the corresponding final score, a significant association was found between the scores of the students in these two exams (r=0.48, P=0.01. Moreover, a significant negative association was predicted between the number of absences and re-exam scores (r=-0.26, P=0.037.Conclusion: As our findings show, the phenomenon of recalling the acquired lessons is preserved for a long period of time and it is associated with the students’ attendance. Many factors including generation effect (by taking notes and cued-recall (via slide picture might play a significant role in the better recalling of the learned information in students with good class attendance.Keywords: STUDENT, MEMORY, LONG-TERM, RECALL, ABSENTEEISM, LEARNING

Changing physician behavior: what works?

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Mostofian, Fargoi; Ruban, Cynthiya; Simunovic, Nicole; Bhandari, Mohit

2015-01-01

There are various interventions for guideline implementation in clinical practice, but the effects of these interventions are generally unclear. We conducted a systematic review to identify effective methods of implementing clinical research findings and clinical guidelines to change physician practice patterns, in surgical and general practice. Systematic review of reviews. We searched electronic databases (MEDLINE, EMBASE, and PubMed) for systematic reviews published in English that evaluated the effectiveness of different implementation methods. Two reviewers independently assessed eligibility for inclusion and methodological quality, and extracted relevant data. Fourteen reviews covering a wide range of interventions were identified. The intervention methods used include: audit and feedback, computerized decision support systems, continuing medical education, financial incentives, local opinion leaders, marketing, passive dissemination of information, patient-mediated interventions, reminders, and multifaceted interventions. Active approaches, such as academic detailing, led to greater effects than traditional passive approaches. According to the findings of 3 reviews, 71% of studies included in these reviews showed positive change in physician behavior when exposed to active educational methods and multifaceted interventions. Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice. Additionally, active approaches to changing physician performance were shown to improve practice to a greater extent than traditional passive methods. Further primary research is necessary to evaluate the effectiveness of these methods in a surgical setting.

[Job stress in locomotive attendants in a locomotive depot and related influencing factors].

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Kang, L; Jia, X C; Lu, F; Zhou, W H; Chen, R

2017-10-20

Objective: To investigate the current status of job stress in locomotive attendants in a locomotive depot and related influencing factors. Methods: From 2012 to 2013, cluster sampling was used to select 1500 locomotive attendants in a locomotive depot in Zhengzhou Railway Bureau as respondents.The contents of the investigation included general data and occupational information.A job satisfaction questionnaire was used to investigate the degree of satisfaction, a depression scale was used to investigate the frequency of symptoms, and a daily stress scale was used to investigate the frequency of fatigue and stress. Results: There was a significant difference in depression score between locomotive attendants with different ages, working years, degrees of education, working situations of spouse, total monthly family incomes, numbers of times of attendanceat night, monthly numbers of times of attendance,ormonthly attendance times( P job satisfaction score between locomotive attendants with different ages,working years, degrees of education, working situations of spouse, total monthly family incomes, numbers of times of attendance at night, monthly attendance times,or ways to work( P job satisfaction( β =1.546)and monthly number of times of attendance,working years,attendance time at night,and degree of education were negatively correlated with job satisfaction( β =-0.185,-0.097,-0.020,and -1.106); monthly number of times of attendance andcommute time were positively correlated with depression( β =0.243 and 0.029); attendance time at night,working situation of spouse,commute time,monthly number of times of attendance,degree of education,and working years were positively correlated with daily stress( β =0.006,0.473,0.010,0.043,0.585, and 0.028). Conclusion: Number of times of attendance, attendance time,working years,and spouse are influencing factors for job stress in locomotive attendants. Improvement in work process and care for their personal life help to reduce

Clinical Criteria for Physician Aid in Dying.

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Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A

2016-03-01

More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period.

Are physicians aware of their role in tobacco control? A conference-based survey in Portugal.

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Ravara, Sofia B; Castelo-Branco, Miguel; Aguiar, Pedro; Calheiros, Jose M

2014-09-20

The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs. Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed. Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p health, awareness of SFP benefits and TC law was limited, p outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p outdoors and private settings. The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities.

Defenses to malpractice: what every emergency physician should know.

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Hudson, Michael Jason; Moore, Gregory P

2011-12-01

Emergency medicine is a high-risk specialty that carries a constant risk of malpractice litigation. Fear of malpractice litigation can lead to less-than-optimal patient care as well as impairments in physician quality of life. Although malpractice fear can be ubiquitous among emergency physicians, most receive little to no education on malpractice. Medical malpractice requires that 1) The physician had a duty, 2) The physician breached the duty, 3) There was harm to the patient, and 4) The harm was caused by the physician's breach of duty. Even if all four medical malpractice conditions are met, there are still special legal defenses that have been and can be used in court to exonerate the physician. These defenses include assumption of the risk, Good Samaritan, contributory negligence, comparative fault, sudden emergency, respectable minority, two schools of thought, and clinical innovation. These legal defenses are illustrated and explained using defining precedent cases as well as hypothetical examples that are directly applicable to emergency medical practice. Knowledge of these special legal defenses can help emergency physicians minimize their risk of litigation when caring for patients. Published by Elsevier Inc.

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

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Nir Eyal

2016-03-01

Full Text Available Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician clinicians (NPCs, resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.

Physician participation in clinical research and trials: issues and approaches

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Sami F Shaban

2011-03-01

research culture’. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives, adequate training, research questions that are in line with physician interests and have clear potential to improve patient care, and regular feedback. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among medical students is now a high priority in order to develop more and better clinician-researchers.Keywords: physician, clinical research, clinical trial, medical education

Factors Affecting Non-Attendance in Irish Primary Schools and Reasons for Differences between Urban and Rural levels of Non-attendance

OpenAIRE

Gurhy, Anne Marie; Perry, Glen; Farrell, Mark

2018-01-01

This study will investigative the factors that influence school non-attendance, in designated disadvantaged Irish primary schools (DEIS1). Currently, no comprehensive data exists on the factors contributing to the levels and types of non-attendance within the Irish context. Since 2003/2004, the National Educational Welfare Board (NEWB, Appendix A) the agency with responsibility for school attendance, has collected specific data on attendance levels and the frequency of non-attendance across a...

Lifetime earnings for physicians across specialties.

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Leigh, J Paul; Tancredi, Daniel; Jerant, Anthony; Romano, Patrick S; Kravitz, Richard L

2012-12-01

Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking Study. Data regarding years of residency were collected from AMA FREIDA. Present value models were constructed assuming 3% discount rates. Estimates were adjusted for demographic and market covariates. Sensitivity analyses included 4 alternative models involving work hours, retirement, exogenous variables, and 1% discount rate. Estimates were generated for 4 broad specialty categories (Primary Care, Surgery, Internal Medicine and Pediatric Subspecialties, and Other), and for 41 specific specialties. The estimates of lifetime earnings for the broad categories of Surgery, Internal Medicine and Pediatric Subspecialties, and Other specialties were $1,587,722, $1,099,655, and $761,402 more than for Primary Care. For the 41 specific specialties, the top 3 (with family medicine as reference) were neurological surgery ($2,880,601), medical oncology ($2,772,665), and radiation oncology ($2,659,657). The estimates from models with varying rates of retirement and including only exogenous variables were similar to those in the preferred model. The 1% discount model generated estimates that were roughly 150% larger than the 3% model. There was considerable variation in the lifetime earnings across physician specialties. After accounting for varying residency years and discounting future earnings, primary care specialties earned roughly $1-3 million less than other specialties. Earnings' differences across specialties may undermine health reform efforts to control costs and ensure adequate numbers of primary care physicians.

Depression-Burnout Overlap in Physicians.

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Walter Wurm

Full Text Available Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI, the Hamburg Burnout Inventory (HBI, as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8% participated. The data of 5897 participants were suitable for analysis.Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06 for physicians with mild, 10.14 (95% CI 7.58-13.59 for physicians with moderate, 46.84 (95% CI 35.25-62.24 for physicians with severe burnout and 92.78 (95% CI 62.96-136.74 for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components. The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92 explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85 of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.This study demonstrates the

Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

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Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D

2001-03-01

Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

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Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

2016-01-01

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

Assessment of trust in physician: a systematic review of measures.

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Evamaria Müller

Full Text Available Over the last decades, trust in physician has gained in importance. Studies have shown that trust in physician is associated with positive health behaviors in patients. However, the validity of empirical findings fundamentally depends on the quality of the measures in use. Our aim was to provide an overview of trust in physician measures and to evaluate the methodological quality of the psychometric studies and the quality of psychometric properties of identified measures. We conducted an electronic search in three databases (Medline, EMBASE and PsycInfo. The secondary search strategy included reference and citation tracking of included full texts and consultation of experts in the field. Retrieved records were screened independently by two reviewers. Full texts that reported on testing of psychometric properties of trust in physician measures were included in the review. Study characteristics and psychometric properties were extracted. We evaluated the quality of design, methods and reporting of studies with the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN checklist. The quality of psychometric properties was assessed with Terwee's 2007 quality criteria. After screening 3284 records and assessing 169 full texts for eligibility, fourteen studies on seven trust in physician measures were included. Most of the studies were conducted in the USA and used English measures. All but one measure were generic. Sample sizes range from 25 to 1199 participants, recruited in very heterogeneous settings. Quality assessments revealed several flaws in the methodological quality of studies. COSMIN scores were mainly fair or poor. The overall quality of measures' psychometric properties was intermediate. Several trust in physician measures have been developed over the last years, but further psychometric evaluation of these measures is strongly recommended. The methodological quality of psychometric property studies

Prevalence of dyslipidemia in the population aged 45 to 64 years assisted by attending physician of the Institución de Asistencia Médica Colectiva

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Marcelo Morales

2011-09-01

Full Text Available Introduction: Ischemic heart disease and cerebrovascular disease are two of the major health problems at present, dyslipidemia is one of the major vascular risk factors modifiable. Since 2009 the Ministry of Health of Uruguay to care promoted the participation of "Medical Reference", especially in the 45 to 64 years. This care is a goal to achieve by the IAMC in Uruguay, which results in a payment to the institutions achieve compliance. It is in our interest to know the prevalence of dyslipidemia in this age group and association with other vascular risk factors. A study in 2009 found a prevalence CUDAM of dyslipidemia reported 25% in this age range. Objectives: 1 Determine the prevalence of dyslipidemia among users 45 to 64 of CUDAM assisted by their referring physician. 2 To determine the percentage of patients who know their dyslipidemia and the degree of compliance with medical therapy. 3 To evaluate the association with other vascular risk factors defined. Methods: 454 patients between 45 and 64 years attended between 01/07 and 31/12/10 by the referring doctor with lipid profile. We conducted a telephone survey to find the presence of dyslipidaemia, treatment, compliance and associated vascular risk factors. Results: 454 patients with lipid profiles, mean cholesterol levels of 211 mg / dl. 25% and 18.9% of patients have LDL levels of cholesterol and triglycerides respectively the reference value. 56% reported having dyslipidemia for interrogation, of which 26% had normal levels of LDL and triglycerides. Discussion: In these patients, the prevalence of dyslipidemia and vascular risk factors consistent with the literature further analyzed. The need to be controlled by your referring doctor raised the level of detection and dyslipidemic patients' knowledge of CUDAM.

The impact of provider consolidation on physician prices.

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Carlin, Caroline S; Feldman, Roger; Dowd, Bryan

2017-12-01

When a clinic system is acquired by an integrated delivery system (IDS), the ownership change includes both vertical integration with the hospital(s), and horizontal integration with the IDS's previously owned or "legacy" clinics, causing increased market concentration in physician services. Although there is a robust literature on the impact of hospital market concentration, the literature on physician market concentration is sparse. The objective of this study is to determine the impact on physician prices when two IDSs acquired three multispecialty clinic systems in Minneapolis-St Paul, Minnesota at the end of 2007, using commercial claims data from a large health plan (2006-2011). Using a difference-in-differences model and nonacquired clinics as controls, we found that four years after the acquisitions (2011), average physician price indices in the acquired clinic systems were 32-47% higher than expected in absence of the acquisitions. Average physician prices in the IDS legacy clinics were 14-20% higher in 2011 than expected. Procedure-specific prices for common office visit and inpatient procedures also increased following the acquisitions. Copyright © 2017 John Wiley & Sons, Ltd.

Disclosing medical mistakes: a communication management plan for physicians.

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Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

Mobile health apps in Sweden: what do physicians recommend?

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Zhang, Yiping; Koch, Sabine

2015-01-01

Currently over 50,000 mobile health apps are available worldwide. In general, they are considered as innovations potentially delivering benefits to patients. Physicians are considered as potential channels to disseminate these innovations to patients. However, physicians' behavior in this regard has not been studied. To capture physicians' attitudes towards recommending health apps to patients and to describe factors influencing physicians' behavior, taking the specifics of an early adopter country, Sweden, into account. Diffusion of Innovation theory, the Health App Maturity Model and the Six Hurdles Model were used to construct a web-based survey that was answered by 44 Swedish physicians. Survey results were followed up with 2 individual interviews. Descriptive statistics were used for quantitative data analysis and recursive abstraction for qualitative data analysis. Only a small group of physicians currently recommend mobile health apps to their patients. However, most physicians have a positive attitude and perceive improvement of patients' self-management ability as main benefit of health apps. Main perceived weaknesses include the lack of evidence-based content and lack of multi-language support. Regulation of health apps under the Medical Device Directive is asked for to assure quality and patient safety. Innovators and early adopters play an important role in the diffusion of mobile health apps. Interpersonal communication is seen as the most effective way for physicians gaining information and also motivates them to recommend mobile health apps to their patients. Physicians' knowledge about certified websites to ensure quality is however low.

Attendance Control System based on RFID technology

OpenAIRE

Nurbek Saparkhojayev; Selim Guvercin

2012-01-01

In Kazakhstan, checking students' attendance is one of the important issues for universities, because many universities evaluate students attendance and while giving the final grade, professors consider their total number of appearances on classes during the whole semester. This brings to the idea of having some tool to control students attendance. Some universities prefer to use paper sheet for controlling attendance, whereas some universities prefer to use paper sheet for checking students'...

SU-E-T-488: An Iso-Dose Curve Based Interactive IMRT Optimization System for Physician-Driven Plan Tuning

International Nuclear Information System (INIS)

Shi, F; Tian, Z; Jia, X; Jiang, S; Zarepisheh, M; Cervino, L

2014-01-01

Purpose: In treatment plan optimization for Intensity Modulated Radiation Therapy (IMRT), after a plan is initially developed by a dosimetrist, the attending physician evaluates its quality and often would like to improve it. As opposed to having the dosimetrist implement the improvements, it is desirable to have the physician directly and efficiently modify the plan for a more streamlined and effective workflow. In this project, we developed an interactive optimization system for physicians to conveniently and efficiently fine-tune iso-dose curves. Methods: An interactive interface is developed under C++/Qt. The physician first examines iso-dose lines. S/he then picks an iso-dose curve to be improved and drags it to a more desired configuration using a computer mouse or touchpad. Once the mouse is released, a voxel-based optimization engine is launched. The weighting factors corresponding to voxels between the iso-dose lines before and after the dragging are modified. The underlying algorithm then takes these factors as input to re-optimize the plan in near real-time on a GPU platform, yielding a new plan best matching the physician's desire. The re-optimized DVHs and iso-dose curves are then updated for the next iteration of modifications. This process is repeated until a physician satisfactory plan is achieved. Results: We have tested this system for a series of IMRT plans. Results indicate that our system provides the physicians an intuitive and efficient tool to edit the iso-dose curves according to their preference. The input information is used to guide plan re-optimization, which is achieved in near real-time using our GPU-based optimization engine. Typically, a satisfactory plan can be developed by a physician in a few minutes using this tool. Conclusion: With our system, physicians are able to manipulate iso-dose curves according to their preferences. Preliminary results demonstrate the feasibility and effectiveness of this tool

Two Polarities of Attention in Social Contexts: From Attending-to-Others to Attending-to-Self.

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Kuang, Shenbing

2016-01-01

Social attention is one special form of attention that involves the allocation of limited processing resources in a social context. Previous studies on social attention often regard how attention is directed toward socially relevant stimuli such as faces and gaze directions of other individuals. In contrast to attending-to-others, a different line of researches has shown that self-related information such as own face and name automatically captures attention and is preferentially processed comparing to other-related information. These contrasting behavioral effects between attending-to-others and attending-to-self prompt me to consider a synthetic viewpoint for understanding social attention. I propose that social attention operates at two polarizing states: In one extreme, individual tends to attend to the self and prioritize self-related information over others', and, in the other extreme, attention is allocated to other individuals to infer their intentions and desires. Attending-to-self and attending-to-others mark the two ends of an otherwise continuum spectrum of social attention. For a given behavioral context, the mechanisms underlying these two polarities will interact and compete with each other in order to determine a saliency map of social attention that guides our behaviors. An imbalanced competition between these two behavioral and cognitive processes will cause cognitive disorders and neurological symptoms such as autism spectrum disorders and Williams syndrome. I have reviewed both behavioral and neural evidence that support the notion of polarized social attention, and have suggested several testable predictions to corroborate this integrative theory for understanding social attention.

Relationships of multitasking, physicians' strain, and performance: an observational study in ward physicians.

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Weigl, Matthias; Müller, Andreas; Sevdalis, Nick; Angerer, Peter

2013-03-01

Simultaneous task performance ("multitasking") is common in hospital physicians' work and is implicated as a major determinant for enhanced strain and detrimental performance. The aim was to determine the impact of multitasking by hospital physicians on their self reported strain and performance. A prospective observational time-and-motion study in a Community Hospital was conducted. Twenty-seven hospital physicians (surgical and internal specialties) were observed in 40 full-shift observations. Observed physicians reported twice on their self-monitored strain and performance during the observation time. Associations of observed multitasking events and subsequent strain and performance appraisals were calculated. About 21% of the working time physicians were engaged in simultaneous activities. The average time spent in multitasking activities correlated significantly with subsequently reported strain (r = 0.27, P = 0.018). The number of instances of multitasking activities correlated with self-monitored performance to a marginally significant level (r = 0.19, P = 0.098). Physicians who engage in multitasking activities tend to self-report better performance but at the cost of enhanced psychophysical strain. Hence, physicians do not perceive their own multitasking activities as a source for deficient performance, for example, medical errors. Readjustment of workload, improved organization of work for hospital physicians, and training programs to improve physicians' skills in dealing with multiple clinical demands, prioritization, and efficient task allocation may be useful avenues to explore to reduce the potentially negative impact of simultaneous task performance in clinical settings.

Impact of physician-less pediatric critical care transport: Making a decision on team composition.

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Kawaguchi, Atsushi; Nielsen, Charlene C; Saunders, L Duncan; Yasui, Yutaka; de Caen, Allan

2018-06-01

To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions. Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects. In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team. No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

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Mehter, Hashim M; McCannon, Jessica B; Clark, Jack A; Wiener, Renda Soylemez

2018-02-01

offer insight into pragmatic approaches to achieving resolution of conflict while attending to both family and physician emotional impact, and they also highlight some potentially unhelpful or harmful behaviors that should be avoided. Further research is needed to evaluate how these strategies are perceived by families and other ICU clinicians and how they affect patient, family, and clinician outcomes.

Mothers' and fathers' attendance in a community-based universally offered parenting program in Sweden.

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Wells, Michael B; Sarkadi, Anna; Salari, Raziye

2016-05-01

Using a public health perspective, this study examined the characteristics of mothers and fathers who attended, compared to those who did not attend, a community-based practitioner-led universally offered parenting program. Mothers (141) and fathers (96) of 4- to 5-year-olds completed a set of questionnaires, including their demographic characteristics, their child's behavioral and emotional problems, and their own parenting behavior. They were all then given the opportunity to attend level 2 of the Triple P--Positive Parenting Program. During the first six months of the study, 33 mothers and 11 fathers opted to attend the program. The relation between program attendance and parental characteristics was similar for mothers and fathers. In general, fathers, non-native and lower educated parents were less likely to attend the program. Mothers, but not fathers, were more likely to attend if they reported more child behavior problems, while fathers, but not mothers, were observed at a trend level to attend if they perceived their child as having more emotional problems. In addition, parents in general were more likely to attend if they used more harsh parenting strategies. Although the universal offer did not reach parents universally, generally those parents who needed it were more likely to attend. Furthermore, this study shows that different factors may impact mothers' and fathers' attendance; therefore, parental data should be analyzed separately and different recruitment strategies should be used for mothers and fathers. © 2015 the Nordic Societies of Public Health.

[Inclusion of traditional birth attendants in the public health care system in Brazil: reflecting on challenges].

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Gusman, Christine Ranier; Viana, Ana Paula de Andrade Lima; Miranda, Margarida Araújo Barbosa; Pedrosa, Mayane Vilela; Villela, Wilza Vieira

2015-05-01

The present article describes an experience with traditional birth attendants carried out in the state of Tocantins, Brazil, between 2010 and 2014. The experience was part of a diagnostic project to survey home deliveries in the state of Tocantins and set up a registry of traditional birth attendants for the Health Ministry's Working with Traditional Birth Attendants Program (PTPT). The project aimed to articulate the home deliveries performed by traditional birth attendants to the local health care systems (SUS). Sixty-seven active traditional birth attendants were identified in the state of Tocantins, and 41 (39 indigenous) participated in workshops. During these workshops, they discussed their realities, difficulties, and solutions in the context of daily adversities. Birth attendants were also trained in the use of biomedical tools and neonatal resuscitation. Based on these experiences, the question came up regarding the true effectiveness of the strategy to include traditional birth attendants in the SUS. The present article discusses this theme with support from the relevant literature. The dearth of systematic studies focusing on the impact of PTPT actions on the routine of traditional birth attendants, including perinatal outcomes and remodeling of health practices in rural, riverfront, former slave, forest, and indigenous communities, translates into a major gap in terms of the knowledge regarding the effectiveness of such initiatives.

Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

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Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

2006-01-01

Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

Physicians' degree of motivation regarding their perception of hypertension, and blood pressure control.

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Consoli, Silla M; Lemogne, Cédric; Levy, Alain; Pouchain, Denis; Laurent, Stephane

2010-06-01

Despite clear international guidelines, the achievement of blood pressure (BP) control is still disappointing. To determine whether physicians' perception of hypertension, in general, is related to their patients' BP measures. DUO-HTA is a French cross-sectional survey, which included a representative sample of 346 general practitioners, 209 cardiologists and 2014 hypertensive patients. Data were collected using two self-administered questionnaires filled out by the hypertensive patients and their physicians. A cluster analysis was performed on the responses given by the physicians, prior to the inclusion of their patients into the study, to 13 questions concerning their perception of hypertension. Physicians were divided into five groups, ranging from 'poorly motivated' to 'highly motivated' physicians, with regard to their perception of hypertension. More motivated physicians had a more confident and optimistic approach of hypertension, looked more empathetic and supportive towards patients and were characterized by higher rates of patients with controlled BP included into the study (range 32-42%, P=0.01 for trend). After adjusting for sociodemographic, clinical and psychological patient-related variables, separate analyses for the patients included into the survey by general practitioners or cardiologists found a significant decreasing gradient for SBP according to physicians' level of motivation (respectively, P=0.029 and P=0.021). Close results were observed in multivariate logistic regression analyses of uncontrolled hypertension. These results underline the importance of physicians' perception of hypertension, in addition or concurrently to their compliance with international guidelines, for a successful management of hypertensive patients

Louisiana physician population trends: will increase in supply meet demand?

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Neumann, Julie A; Sessions, Blane A; Ali, Juzar; Rigby, Perry C

2012-01-01

Physician shortages in the United States are now recognized broadly and widespread by specialty and geography. While supply is increasing, demand inexorably rises. This situation will probably be further stressed post implementation of healthcare reform. The variations by region and by state are many and significant; this complexity is not fully understood nor yet characterized. Trends similar to the averages of the US have been identified in Louisiana, including the aging of physicians. Lack of physicians, both specialists and generalists, has been reported to compromise quality and effectiveness of healthcare. Thus, the importance of matching up supply and demand is evident. The supply of physicians is increasing in absolute number and in the physicians-to-population ratio. Variations in population, aging, geography, and specialties indicate, in some areas, that this may not be enough to deal with the increasing demand. This paper aims to assess historically how physician shortages may affect the balance of supply and demand in future healthcare delivery, particularly in Louisiana.

Variation in Primary Cesarean Delivery Rates by Individual Physician within a Single Hospital Laborist Model

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METZ, Torri D.; ALLSHOUSE, Amanda A.; GILBERT, Sara A Babcock; DOYLE, Reina; TONG, Angie; CAREY, J. Christopher

2016-01-01

Background Laborist practice models are associated with lower cesarean delivery rates than individual private practice models in several studies; however, this effect is not uniform. Further exploration of laborist models may help us better understand the observed reduction in cesarean delivery rates in some hospitals with implementation of a laborist model. Objective Our objective was to evaluate the degree of variation in primary cesarean delivery rates by individual laborists within a single institution employing a laborist model. In addition, we sought to evaluate whether differences in cesarean delivery rates resulted in different maternal or short-term neonatal outcomes. Study Design At this teaching institution, one laborist (either a generalist or maternal-fetal medicine attending physician) is directly responsible for labor and delivery management during each shift. No patients are followed in a private practice model nor are physicians incentivized to perform deliveries. We retrospectively identified all laborists who delivered nulliparous, term women with cephalic singletons at this institution from 2007-14. Overall and individual primary cesarean delivery rates were reported as percentages with exact Pearson 95% CI. Laborists were grouped by tertile as having low, medium or high cesarean delivery rates. Characteristics of the women delivered, indications for cesarean delivery, and short-term neonatal outcomes were compared between these groups. A binomial regression model of cesarean delivery was estimated, where the relative rates of each laborist compared to the lowest-unadjusted laborist rate were calculated; a second model was estimated to adjust for patient-level maternal characteristics. Results Twenty laborists delivered 2,224 nulliparous, term women with cephalic singletons. The overall cesarean delivery rate was 24.1% (95% CI 21.4-26.8). In an unadjusted binomial model, the overall effect of individual laborist was significant (pcesarean

The Business Case for Investing in Physician Well-being.

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Shanafelt, Tait; Goh, Joel; Sinsky, Christine

2017-12-01

Widespread burnout among physicians has been recognized for more than 2 decades. Extensive evidence indicates that physician burnout has important personal and professional consequences. A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (eg, return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization's long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all US health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization's journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level. Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return

Evaluation of smoking habits among Turkish family physicians.

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Baltaci, Davut; Bahcebasi, Talat; Aydin, Leyla Yilmaz; Ozturk, Serkan; Set, Turan; Eroz, Recep; Celer, Ahmet; Kara, Ismail Hamdi

2014-02-01

Smoking is still a major public health problem in Turkey. It was aimed to investigate smoking prevalence and habits among Turkish family physicians. Cross-sectional study among physicians working in primary care settings was established. A self-administered study survey was applied. The surveys of 1233 family physicians were analyzed. The study included 704 (57.1%) male and 529 (42.9%) female physicians. Mean age (SD) was 38.94 (7.01) years. The proportions of the current, the former and never smokers among family physicians were 34.1%, 14.7% and 51.3%, respectively. Mean age (SD) of smoking initiation was 21.73 (5.04) years. Mean duration (SD) of smoking use was 14.61 (7.29) years. Proportion of current smoker in male physicians was quite higher than in female counterparts (36.9% vs. 30.4%; p smoking initiation in female was 21.42 (4.59) years, but in male was 22.33 (4.98) years (p = 0.36). In female physicians, mean age (SD) for quitting cigarette smoking was found higher than in male (35.85 (6.35) years vs. 33.09 (6.45) years; p = 0.004). No significant difference between nicotine dependence (mean score (SD) of 3.76 (2.48) vs. 3.65 (2.82); p > 0.05) and mean (SD) unit of cigarette a day (18.34(6.03) vs. 17.17 ± 6.79; p > 0.05) between genders was observed. The number of male physicians who started smoking before faculty was higher than female counterparts (15.5% vs. 8.6%; p = 0.023). In conclusion, the smoking prevalence among Turkish family physicians is considerably high.

Al-Anon newcomers: benefits of continuing attendance for six months.

Science.gov (United States)

Timko, Christine; Laudet, Alexandre; Moos, Rudolf H

2016-07-01

Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another person's drinking, is the most widely used form of help by Concerned Others. This longitudinal study examined newcomers' outcomes of attending Al-Anon. Aims were to better understand early gains from Al-Anon to inform efforts in the professional community to facilitate concerned others' attendance of and engagement in Al-Anon. We compared two groups of Al-Anon newcomers who completed surveys at baseline and 6 months later: those who discontinued attendance by the 6-month follow-up (N = 133), and those who were still attending Al-Anon meetings (N = 97); baseline characteristics were controlled in these comparisons. Newcomers who sustained participation in Al-Anon over the first 6 months of attendance were more likely than those who discontinued participation during the same period to report gains in a variety of domains, such as learning how to handle problems due to the drinker, and increased well-being and functioning, including reduced verbal or physical abuse victimization. Newcomers to Al-Anon reported more personal gains than drinker-related gains. The most frequent drinker gain was a better relationship with the Concerned Other; attendees were more likely to report this, as well as daily, in-person contact with the drinker. Al-Anon participation may facilitate ongoing interaction between Concerned Others and drinkers, and help Concerned Others function and feel better. Thus, short-term participation may be beneficial. Health-care professionals should consider providing referrals to Al-Anon and monitoring early attendance.

Pharmaceutical industry gifts to physicians: patient beliefs and trust in physicians and the health care system.