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Sample records for male family physician

  1. [Familial characteristics and self-perceived health among female and male primary care physicians in Andalusia (Spain)].

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    Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia

    2013-01-01

    To determine the relationships between a group of professional and family characteristics and the components of physical and mental health in female and male primary care physicians working in health centers in Andalusia (Spain). A descriptive, cross-sectional, multicenter study was performed. The population consisted of urban health centers in Andalusia and their physicians. The sample comprised 88 health centers and 500 physicians. Measurements consisted of sex, age, professional characteristics (postgraduate training in family medicine, position of health center manager, accreditation as a residents' tutor, and workload based on patient quota and the mean number of patients/day); family responsibilities, defined by two dimensions of the family-work relationship (support overload-family support deficit and family-work conflict); and perceived physical and mental health. The data source was a self-administered questionnaire sent by surface mail. Multiple regression analyses were performed for physical and mental health for the whole sample and by gender. Responses were obtained from 368 physicians (73.6%). Mental health was worse in female physicians than in male physicians; no differences were found between genders in physical health. The family-work conflict was associated with physical and mental health in physicians of both genders. Physical health deteriorated with increasing age in both genders, improved in the female tutors of residents, and decreased with increasing family-work conflict in male physicians. Mental health decreased with increasing housework on the weekends and with family-work conflict in both genders. In male physicians, mental health deteriorated with postgraduate training in family medicine and improved if they were health center managers. Workload and professional characteristics have little relationship with the health of primary care physicians. Family characteristics play a greater role. Copyright © 2012 SESPAS. Published by Elsevier

  2. Maternity care and maternal serum screening. Do male and female family physicians care for women differently?

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    Woodward, C A; Carroll, J C; Ryan, G; Reid, A J; Permaul-Woods, J A; Arbitman, S; Domb, S B; Fallis, B; Kilthei, J

    1997-06-01

    To examine whether male and female family physicians practise maternity care differently, particularly regarding the maternal serum screening (MSS) program. Mailed survey fielded between October 1994 and March 1995. Ontario family practices. Random sample of 2000 members of the College of Family Physicians of Canada who care for pregnant women. More than 90% of eligible physicians responded. Attitudes toward, knowledge about, and behaviour toward MSS. Women physicians were more likely than men to practise part time, in groups, and in larger communities. Men physicians were more likely to perform deliveries; women were more likely to do shared care. Despite a shorter work week, on average, female physicians cared for more pregnant women than male physicians did. Among those providing intrapartum care, women performed more deliveries, on average, than men. Women physicians were more likely than men to offer MSS to all pregnant patients. Although average time spent discussing MSS before the test was similar, women physicians had better knowledge of when best to do the test and its true-positive rate. All differences reported were statistically significant (P women, women physicians cared for more pregnant women than men did. Both spent similar time discussing MSS with their patients before offering screening, but more women physicians offered MSS to all their patients and were more knowledgeable about MSS than men physicians.

  3. [Family and career planning in young physicians].

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    Buddeberg-Fischer, Barbara; Stamm, Martina; Klaghofer, Richard

    2008-01-01

    The study investigates in what way physicians integrate their desire to have children into their career planning. Within the framework of a prospective cohort study of Swiss medical school graduates on career development of young physicians, beginning in 2001, 534 participants (285 women, 249 men) were assessed in January 2007, in terms of having children, planning to have children, the career aspired to and the work-family balance used or planned. Among the study participants, 19% (54) of the women and 24% (59) of the men have children. Of the others 88% plan to start a family in the future. Female physicians with children are less advanced in their careers than women without children; for male physicians no such difference can be observed. Of the female physicians with children or the desire for children 42% aspire to work in a practice, 28% to a clinical and only 4% to an academic career. Of the male physicians with children or the desire for children one third aspire to work in a practice, one third to a clinical and 14% to an academic career. The preferred model of work repartition of female physicians with children is father full time/mother part time or both parents part time; the preferred model of male physicians is father full time/mother part time or not working. Children are an important factor in the career and life planning of physicians, female physicians paying more attention to an even work-family balance than male physicians. Copyright 2008 S. Karger AG, Basel.

  4. 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.

  5. 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.

  6. Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians

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    Farhad Fakhrudin Vasanwala

    2017-07-01

    Full Text Available Male patients with lower urinary tract symptoms (LUTS and benign prostatic hyperplasia (BPH are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.

  7. Investigating performance of rural family physicians in Fars province working as part of Family Physician Program

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    Mansour Kashfi

    2016-09-01

    Full Text Available Background & Objective: Health family physician program is a complete system which eliminates the bewilderment of people and increases the satisfaction with health services as its most important results in medical care. The aim of this study was to evaluate the performance of family physicians and their strengths and weaknesses. Material & Methods: In this study, 52 family physicians were chosen via Random Stratified Sampling to participate in the study. A questionnaire titled “Performance of Family Physicians” with 5 domains of management, performance, contract guidelines, community involvement and results was used to collect data. Data were analyzed using SPSS-19 via t-test, ANOVA, Pearson correlation coefficient, and non-parametric tests. Results: Among the 52 studied family physicians, 56.9% were female and 43.1% were male. The lowest and the highest scores were obtained for the community involvement and results, respectively. Based on the results of this study, there were significant relationships among most of the domains. However, there was no significant correlation between the gender and different domains. Conclusion: In order to solve the problems of family physician program and improve the quality of services, more researches should be carried out soon to determine the types and causes of referring to the family physicians. Accordingly, appropriate interventions should be implemented to reduce the burden of visits and improve the quality of health services by guiding the society towards the prevention measures.

  8. [High prevalence of job dissatisfaction among female physicians: work-family conflict as a potential stressor].

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    Adám, Szilvia; Gyorffy, Zsuzsa; László, Krisztina

    2009-08-02

    Due to the family-centric nature of Hungarian society and to the high proportion of women in the medical profession, more female than male physicians may experience work-family conflict. The authors hypothesized that work-family conflict may reduce job satisfaction among female physicians. However, there is limited information about the prevalence of work-family conflict and job dissatisfaction as well as their associations among female physicians. To explore the prevalence of work-family conflict and its relations to job dissatisfaction among Hungarian physicians. Cross-sectional study with 219 female and 201 male physicians using self-report questionnaires. As hypothesized, female physicians reported significantly higher level of work-family conflict compared to male physicians (3.0 (SD 0.9) vs. 2.6 (SD 0.9); t (df): -3.8 (418); p conflict often or extremely often [56% vs. 41%, respectively; chi 2 (df) = 9.3 (1); p conflict predicts job dissatisfaction among female and all physicians (beta = -0.17, 95% CI -0.31 - -0.04 and beta = -0.14, 95% CI -0.22 - -0.04, respectively). These results show that the level and prevalence of work-family conflict experienced by female physicians in Hungary is significantly higher than that among male physicians. Furthermore, these findings suggest that work-family conflict as a stressor may contribute to the development of job dissatisfaction and hence may adversely impact the well-being of female and male physicians and consequently the quality of patient care.

  9. Male Spouses of Women Physicians: Communication, Compromise, and Carving Out Time.

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    Isaac, Carol; Petrashek, Kara; Steiner, Megan; Manwell, Linda Baier; Byars-Winston, Angela; Carnes, Molly

    2013-01-01

    As the numbers of female physicians continue to grow, fewer medical marriages are comprised of the traditional dyad of male physician and stay-at-home wife. The "two-career family" is an increasingly frequent state for both male and female physicians' families, and dual-doctor marriages are on the rise. This qualitative study explored the contemporary medical marriage from the perspective of male spouses of female physicians. In 2010, we conducted semi-structured, in-depth interviews with nine spouses of internal medicine resident and faculty physicians. Interviewers queried work-home balance, career choices, and support networks. We used an interpretive, inductive, iterative approach to thematically analyze interview transcripts and develop broad, consensus-derived themes. A conceptual framework based on three major themes emerged: "A time for us? Really?", "Supporting and protecting her, sometimes at my expense,'" and "Hers is a career, mine is a job." This framework described the inflexibility of physicians' time and its impact on spousal time, career development, and choices. Having a set time for synchronizing schedules, frequent verbal support, and shared decision-making were seen as important by the husbands of female, full-time physicians. This exploratory study examined the contemporary medical marriage from the male spouse's perspective and highlights specific strategies for success.

  10. Work week duration, work-family balance and difficulties encountered by female and male physicians: results from the French SESMAT study.

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    Estryn-Behar, M; Fry, C; Guetarni, K; Aune, I; Machet, G; Doppia, M A; Lassaunière, J M; Muster, D; Pelloux, P; Prudhomme, Ch

    2011-01-01

    France encounters difficulties attracting physicians to work in hospitals. Organisation at work and at home may be at the heart of the problem for female as well as for male physicians. A comprehensive questionnaire was filled out online by a representative sample of 1924 French hospital physicians. We conducted gender bivariate and multivariate analysis of the risk factors for burnout and intent to leave the profession(ITL). ITL was declared by 17.4% of physicians. According to 41.3% of female physicians (FP), their profession was an obstacle to having children (versus 19.3% for male physicians (MP)). Major factors linked with burnout were Effort/Reward imbalance (FP adjOR = 5.09, MP adjOR = 5.93), Work-family conflicts (FP adjOR = 2.97, MP adjOR = 3.04), and Low quality of teamwork (FP adjOR = 1.82, MP adjOR = 2.68). Major factors linked with ITL were Low quality of teamwork (FP adjOR = 4.49, MP adjOR = 3.03), Patient-related burnout (FP adjOR = 2.10, MP adjOR = 2.35) and General burnout (FP adjOR = 1.85, MP adjOR = 1.45). Excessive job demands are linked with burnout and with work-family conflicts, conducting to difficulties in organising one's life in order to have and raise children. Potential solutions include facilitating teamwork in order to reduce departure, which increase workload on those who stay increasing their work family conflict.

  11. 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

  12. Opinions of Primary Care Family Physicians About Family Medicine Speciality Training Program

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    Hamit Sirri Keten

    2014-04-01

    Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304

  13. Personal values of exemplary family physicians: implications for professional satisfaction in family medicine.

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    Eliason, B C; Schubot, D B

    1995-09-01

    Personal social values have been identified as important determinants of generalists' specialty choice. However, the personal values or "guiding principles" of generalist physicians have not been identified scientifically. To establish a benchmark, we measured the personal values of exemplary family physicians because they serve as role models for current and future physicians. We also explored the relationship between personal values and practice satisfaction. We obtained a list of 330 family physicians nominated for the American Academy of Family Physicians' (AAFP) Family Doctor of the Year award for the years 1988 through 1993. We asked them to complete the Schwartz Values Questionnaire, a 56-item instrument for measuring personal values. They also answered three questions concerning practice satisfaction. The return rate was 83%. The physicians' mean age was 63 years. They had been in practice an average of 34 years, 93% were male, and 52% practiced in rural areas. Honesty was rated as the most important of the 56 values, and social power as the least important. Of the 10 value types (groups of common values), the responding physicians rated "Benevolence" as most important and "Power" as least important. Practice satisfaction correlated positively with the Benevolence value type (r = .21, P = .001) and negatively with the Power value type (r = -.15, P = .023). Of the 10 value types, Benevolence was rated the most important and Power the least important by exemplary family physicians, and both value types also correlated, positively and negatively, respectively, with their practice satisfaction. These results have implications for the selection, training, and career satisfaction of generalist physicians.

  14. Salary discrepancies between practicing male and female physician assistants.

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    Coplan, Bettie; Essary, Alison C; Virden, Thomas B; Cawley, James; Stoehr, James D

    2012-01-01

    Salary discrepancies between male and female physicians are well documented; however, gender-based salary differences among clinically practicing physician assistants (PAs) have not been studied since 1992 (Willis, 1992). Therefore, the objectives of the current study are to evaluate the presence of salary discrepancies between clinically practicing male and female PAs and to analyze the effect of gender on income and practice characteristics. Using data from the 2009 American Academy of Physician Assistants' (AAPA) Annual Census Survey, we evaluated the salaries of PAs across multiple specialties. Differences between men and women were compared for practice characteristics (specialty, experience, etc) and salary (total pay, base pay, on-call pay, etc) in orthopedic surgery, emergency medicine, and family practice. Men reported working more years as a PA in their current specialty, working more hours per month on-call, providing more direct care to patients, and more funding available from their employers for professional development (p pay, overtime pay, administrative pay, on-call pay, and incentive pay based on productivity and performance (p pay (p = .001) in orthopedic surgery, higher total income (p = .011) and base pay (p = .005) in emergency medicine, and higher base pay in family practice (p discrepancies remain between employed male and female PAs regardless of specialty, experience, or other practice characteristics. Copyright © 2012. Published by Elsevier Inc.

  15. Human papillomavirus vaccination of males: attitudes and perceptions of physicians who vaccinate females.

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    Weiss, Thomas W; Zimet, Gregory D; Rosenthal, Susan L; Brenneman, Susan K; Klein, Jonathan D

    2010-07-01

    We assessed U.S. physicians' attitudes and perceptions regarding potential human papillomavirus (HPV) vaccination of males. We surveyed a random sample of 2,714 pediatricians and family practitioners identified in administrative claims of a U.S. health plan as HPV vaccinators of females; 595 pediatricians and 499 family practitioners participated. Most physicians would recommend HPV vaccination to males aged 11-12 (63.9%), 13-18 (93.4%), and 19-26 (92.7%) years. Physicians agreed that males should be vaccinated to prevent them from getting genital and anal warts (52.9% strongly and 36.0% somewhat) and to protect females from cervical cancer (75.3% strongly and 20.8% somewhat). Physicians agreed that an HPV vaccine recommendation for males would increase opportunities to discuss sexual health with adolescent male patients (58.7% strongly, 35.3% somewhat). Most did not strongly agree (15.4% strongly, 45.4% somewhat) that parents of adolescent male patients would be interested in HPV vaccination for males, that a gender-neutral HPV vaccine recommendation would increase acceptance by adolescent females and their parents (19.6% strongly, 42.0% somewhat), or that a gender-neutral recommendation would improve current female vaccination rates (10.4% strongly, 26.0% somewhat). Physicians who currently vaccinate females against HPV supported the concept of vaccinating males for its benefits for both sexes. They agreed that a gender-neutral HPV vaccination recommendation would be appropriate with regard to public health and believed that it would increase opportunities for sexual health discussions, but were less sure that such a recommendation would change patient or parental attitudes toward HPV vaccination or improve current HPV vaccination efforts. Copyright (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  16. Mentorship and job satisfaction among Navy family physicians.

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    Saperstein, Adam K; Viera, Anthony J; Firnhaber, Gina C

    2012-08-01

    Among civilian academic physicians, having a mentor is associated with greater job satisfaction. Whether this is true for military physicians is unknown. We sought to examine whether having a mentor is associated with positive job satisfaction among Navy family physicians. A web-based survey was sent to all Navy family physicians in the Specialty leader's database in May 2008. Our main outcome variable was "positive job satisfaction," and our main exposure variable was being in a mentor relationship. Chi-square was used to test for difference in frequencies in categorical variables and logistic regression was used to adjust for covariates. The response rate was 60.2% (186/309). Among respondents, 73.7% reported positive job satisfaction. Factors associated with positive job satisfaction included having a mentor, being >9 years postresidency, spending <50% of time in patient care, higher rank, male gender, and being active in research. After adjustment for these factors, having a mentor remained significantly associated with positive job satisfaction (odds ratio 2.86, 95% confidence interval 1.22-6.71). Having a mentor is associated with positive job satisfaction among Navy family physicians, even after adjusting for multiple other factors. An implication is that a mentorship program may be a strategy for improving job satisfaction.

  17. Patients' attitudes toward the attire of male physicians: a single-center study in Saudi Arabia.

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    Batais, Mohammad Ali

    2014-01-01

    The doctor-patient relationship has been influenced by the appearance of physicians, and there is an association between a physician's physical appearance and the patients' initial perceptions of physician competence. This study aims to explore patients' preferences toward the attire of a male physician, and to examine if a physician's choice of uniform influences the degree of trust, confidence, and follow-up care among respondents. A cross-sectional survey conducted among patients of the Alwazarat family medicine center in Riyadh, Saudi Arabia. A self-administered questionnaire was completed by 300 patients (50% were male and 83.6% had received a secondary education; the mean age was 33.4 [10.1] years) in the Alwazarat family medicine center in Riyadh. The questionnaire was also customized for the local setting with the inclusion of photos of a male doctor in Saudi Arabian national costume, and 3 other dress styles (Western dress with white coat, scrubs with white coat, and scrubs only). Overall, across all questions regarding physician dress style preferences, participants significantly preferred Western dress (39.9%, P patients (P=.002). Respondents were more likely to favor a physician wearing Western attire with a white coat. However, Saudi national dress, followed by Western dress, is the preferred attire when physicians are dealing with social, sexual, and psychological problems.

  18. 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.

  19. 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.

  20. [High prevalence of work-family conflict among female physicians: lack of social support as a potential antecedent].

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    Adám, Szilvia

    2009-12-13

    According to stress theory, social support from work and non-work-related sources may influence the level of perceived work-family conflict. Despite the high prevalence of work-family conflict as a source of distress among female physicians, no information is available on the associations between work-family conflict and social support in a traditional, family-centric cultural setting, where female role expectations are demanding. The author hypothesized that high prevalence of work-family conflict could be attributed to the lack of social support among female physicians. To investigate the prevalence and psychosocial characteristics of social support and its relations to work-family conflict among female physicians. Quantitative and qualitative study using questionnaires ( n = 420) and in-depth interviews ( n = 123) among female and male physicians. Female physicians reported significantly higher mean level and prevalence of work-family conflict compared to men. The predominant form of work-family was work-to-family conflict among physicians; however, significantly more female physicians experienced family-to-work conflict and strain-based work-family conflict compared to men (39% vs. 18% and 68% vs. 20%, respectively). Significantly more male physicians experienced time-based work-family conflict compared to women. Content analyses of interview data revealed that provision of support to physicians manifested itself in parental support in career selection, spousal support with household duties, peer support with enabling access to professional role models-mentors, peer support to ensure gender equity, and organizational support with family-centric policies. Female physicians reported significantly less parental, spousal, and peer support compared to men. Female physicians lacking parental, peer, or organizational support experienced significantly higher level of work-family conflict compared to appropriate control. In regression analyses, high job demands, job

  1. Chaperone use during intimate examinations in primary care: postal survey of family physicians

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    Upshur Ross EG

    2005-12-01

    Full Text Available Abstract Background Physicians have long been advised to have a third party present during certain parts of a physical examination; however, little is known about the frequency of chaperone use for those specific intimate examinations regularly performed in primary care. We aimed to determine the frequency of chaperone use among family physicians across a variety of intimate physical examinations for both male and female patients, and also to identify the factors associated with chaperone use. Methods Questionnaires were mailed to a randomly selected sample of 500 Ontario members of the College of Family Physicians of Canada. Participants were asked about their use of chaperones when performing a variety of intimate examinations, namely female pelvic, breast, and rectal exams and male genital and rectal exams. Results 276 of 500 were returned (56%, of which 257 were useable. Chaperones were more commonly used with female patients than with males (t = 9.09 [df = 249], p Conclusion Clinical practice concerning the use of chaperones during intimate exams continues to be discordant with the recommendations of medical associations and medico-legal societies. Chaperones are used by only a minority of Ontario family physicians. Chaperone use is higher for examinations of female patients than of male patients and is highest for female pelvic exams. The availability of a nurse in the clinic to act as a chaperone is associated with more frequent use of chaperones.

  2. [Family physicians attitude towards quality indicator program].

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    Shani, Michal; Nakar, Sasson; Azuri, Yossi

    2012-10-01

    Quality indicator programs for primary care are implanted throughout the world improving quality in health care. In this study, we have assessed family physicians attitudes towards the quality indicators program in Israel. Questionnaires were distributed to family physicians in various continuing educational programs. The questionnaire addressed demographics, whether the physician dealt with quality indicators, time devoted by the physician to quality indicators, pressure placed on the physician related to quality indicators, and the working environment. A total of 140 questionnaires were distributed and 91 (65%) were completed. The average physician age was 49 years (range 33-65 years]; the average working experience as a family physician was 17.8 years (range 0.5-42); 58 physicians were family medicine specialist (65.9%). Quality indicators were part of the routine work of 94% of the physicians; 72% of the physicians noted the importance of quality indicators; 84% of the physicians noted that quality indicators demand better team work; 76% of the physicians noted that quality indicators have reduced their professional independence. Pressure to deal with quality indicators was noted by 72% of the family physicians. Pressure to deal with quality indicators was related to reduced loyalty to their employer (P = 0.001), reducing their interest to practice family medicine (p programs, without creating a heavy burden on the work of family physicians.

  3. How female and male physicians' communication is perceived differently.

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    Mast, Marianne Schmid; Kadji, Keou Kambiwa

    2018-06-07

    This paper is based on a 2017 Baltimore International Conference on Communication in Healthcare (ICCH) plenary presentation by the first author and addresses how female and male physicians' communication is perceived and evaluated differently. Female physicians use patient-centered communication which is the interaction style clearly preferred by patients. Logically, patients should be much more satisfied with female than male physicians. However, research shows that this is not the case. This article provides an overview on how female and male physician communication is evaluated and perceived differently by patients and discusses whether and how gender stereotypes can explain these differences in perception and evaluation. Male physicians obtain good patient outcomes when verbally expressing patient-centeredness while female physicians have patients who report better outcomes when they adapt their nonverbal communication to the different needs of their patients. The analysis reveals that existing empirical findings cannot simply be explained by the adherence or not to gender stereotypes. Female physicians do not always get credit for showing gender role congruent behavior. All in all, female and male physicians do not obtain credit for the same behaviors. Physician communication training might put different accents for female and male physicians. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Preventive health services implemented by family physicians in Portugal—a cross-sectional study based on two clinical scenarios

    Science.gov (United States)

    Martins, Carlos; Azevedo, Luís Filipe; Santos, Cristina; Sá, Luísa; Santos, Paulo; Couto, Maria; Pereira, Altamiro; Hespanhol, Alberto

    2014-01-01

    Objectives To assess whether Portuguese family physicians perform preventive health services in accordance with scientific evidence, based on the recommendations of the United States Preventive Services Task Force (USPSTF). Design Cross-sectional study. Setting Primary healthcare, Portuguese National Health Service. Participants 255 Portuguese family physicians selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Outcomes Prevalence of compliance with USPSTF recommendations for screening, given a male and female clinical scenario and a set of proposed medical interventions, including frequency of the intervention and performance in their own daily practice. Results A response rate of 95.7% was obtained (n=244). 98–100% of family physicians answered according to the USPSTF recommendations in most interventions. In the male scenario, the lowest concordance was observed in the evaluation of prostate-specific antigen with 37% of family physicians answering according to the USPSTF recommendations. In the female scenario, the lowest concordance was for cholesterol testing with 2% of family physicians complying. Family physicians younger than 50 years had significantly better compliance scores than older ones (mean 77% vs 72%; p<0.001). Conclusions We found a high degree of agreement with USPSTF recommendations among Portuguese family physicians. However, we also found results suggesting excessive use of some medical interventions, raising concerns related to possible harm associated with overdiagnosis and overtreatment. PMID:24861550

  5. Family Physicians Managing Medical Requests From Family and Friends.

    Science.gov (United States)

    Giroldi, Esther; Freeth, Robin; Hanssen, Maurice; Muris, Jean W M; Kay, Margareth; Cals, Jochen W L

    2018-01-01

    Although guidelines generally state that physicians should not treat their family members or friends (nonpatients), physicians regularly receive medical requests from nonpatients. We aimed to explore junior and senior family physicians' experiences with and attitudes toward managing medical requests from nonpatients. We conducted a qualitative study with 7 focus groups with junior and senior physicians. We performed a thematic analysis during an iterative cycle of data collection and analysis. When confronted with a medical request from a nonpatient, physicians first oriented themselves to the situation: who is this person, what is he or she asking of me, and where are we? Physicians next considered the following interrelated factors: (1) nature/strength of the relationship with the nonpatient, (2) amount of trust in his/her own knowledge and skills, (3) expected consequences of making mistakes, (4) importance of work-life balance, and (5) risk of disturbing the physician-patient process. Senior physicians applied more nuanced considerations when deciding whether to respond, whereas junior physicians experienced more difficulties dealing with these requests, were less inclined to respond, and were more concerned about disturbing the existing relationship that a person had with his/her own physician. This study provides insight into the complexity that physicians face when managing medical questions and requests from nonpatients. Facilitated group discussions during which experiences are shared can help junior physicians become more confident in dealing with these complex issues as they formulate their own personal strategy regarding provision of medical advice or treatment to family and friends. © 2018 Annals of Family Medicine, Inc.

  6. Canadian family physician job satisfaction - is it changing in an evolving practice environment? An analysis of the 2013 National Physician Survey database.

    Science.gov (United States)

    Malhotra, Jana; Wong, Eric; Thind, Amardeep

    2018-06-23

    To explore the determinants of job satisfaction and work-life balance satisfaction of family physicians in Canada. This is a secondary analysis of the Canadian 2013 National Physician's Survey using descriptive statistics and binomial logistic regression. An estimated 34,753 family physicians practicing in Canada at the time of survey administration in 2013 were eligible for the survey. The main outcome measures were respondent satisfaction with professional life and satisfaction with work-life balance. The survey had a response rate of 17%. Seventy-two percent of respondents were satisfied with their professional lives, and 49% were satisfied with their work-life balance. Male family physicians had lower odds of satisfaction with their work-life balance than their female counterparts (OR = 0.86, 95% CI 0.82-0.92). Family physicians using an electronic medical record had higher odds of dissatisfaction with their professional lives (OR = 1.13, 95% CI 1.05-1.22) and work-life balance (OR = 1.22, 95% CI 1.15-1.30) than those not using an EMR. Family physicians not in a focused practice had greater odds of dissatisfaction (OR = 1.61, 95% CI 1.50-1.72) with both their professional lives and work-life balance (OR = 1.29, 95% CI 1.22-1.37) compared to their colleagues who have one or more areas of clinical focus. Canadian family physicians are more satisfied with their professional lives than with their work-life balance. Novel findings that family physicians with one or more clinical areas of focus are more satisfied with their work and work-life balance satisfaction, and that family physicians using electronic health records are less satisfied with their work and their work-life balance merit further inquiry.

  7. Possible reasons why female physicians publish fewer scientific articles than male physicians - a cross-sectional study.

    Science.gov (United States)

    Fridner, Ann; Norell, Alexandra; Åkesson, Gertrud; Gustafsson Sendén, Marie; Tevik Løvseth, Lise; Schenck-Gustafsson, Karin

    2015-04-02

    The proportion of women in medicine is approaching that of men, but female physicians are still in the minority as regards positions of power. Female physicians are struggling to reach the highest positions in academic medicine. One reason for the disparities between the genders in academic medicine is the fact that female physicians, in comparison to their male colleagues, have a lower rate of scientific publishing, which is an important factor affecting promotion in academic medicine. Clinical physicians work in a stressful environment, and the extent to which they can control their work conditions varies. The aim of this paper was to examine potential impeding and supportive work factors affecting the frequency with which clinical physicians publish scientific papers on academic medicine. Cross-sectional multivariate analysis was performed among 198 female and 305 male Swedish MD/PhD graduates. The main outcome variable was the number of published scientific articles. Male physicians published significantly more articles than female physicians p articles, as was collaborating with a former PhD advisor for both female physicians (OR = 2.97; 95% CI 1.22-7.20) and male physicians (OR = 2.10; 95% CI 1.08-4.10). Control at work was significantly associated with a higher number of published articles for male physicians only (OR = 1.50; 95% CI 1.08-2.09). Exhaustion had a significant negative impact on number of published articles among female physicians (OR = 0.29; 95% CI 0.12-0.70) whilst the publishing rate among male physicians was not affected by exhaustion. Women physicians represent an expanding sector of the physician work force; it is essential that they are represented in future fields of research, and in academic publications. This is necessary from a gender perspective, and to ensure that physicians are among the research staff in biomedical research in the future.

  8. Colorado family physicians' attitudes toward medical marijuana.

    Science.gov (United States)

    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.

  9. Family physicians' perspectives regarding palliative radiotherapy

    International Nuclear Information System (INIS)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

    2006-01-01

    Purpose: To assess family physicians' views on common indications for palliative radiotherapy and to determine whether this influences patient referral. Methods and materials: A 30-item questionnaire evaluating radiotherapy knowledge and training developed at the Ottawa Regional Cancer Centre (ORCC) was mailed to a random sample of 400 family physicians in eastern Ontario, Canada. The completed surveys were collected and analyzed, and form the basis of this study. Results: A total of 172 completed surveys were received for a net response rate of 50% among practicing family physicians. Almost all of the physicians (97%) had recently seen cancer patients in their offices, with 85% regularly caring for patient with advanced cancer. Fifty-four percent had referred patients in the past for radiotherapy and 53% had contacted a radiation oncologist for advice. Physicians who were more knowledgeable about the common indications for palliative radiotherapy were significantly more likely to refer patients for radiotherapy (P<0.01). Inability to contact a radiation oncologist was correlated with not having referred patients for radiotherapy (P<0.01). Only 10% of the physicians had received radiotherapy education during their formal medical training. Conclusions: Many of the family physicians surveyed were unaware of the effectiveness of radiotherapy in a variety of common palliative situations, and radiotherapy referral was correlated with knowledge about the indications for palliative radiotherapy. This was not surprising given the limited education they received in this area and the limited contact they have had with radiation oncologists. Strategies need to be developed to improve continuing medical education opportunities for family physicians and to facilitate more interaction between these physicians and radiation oncologists

  10. [Suicide in female and male physicians

    NARCIS (Netherlands)

    Lagro-Janssen, A.L.M.; Luijks, H.D.P.

    2008-01-01

    OBJECTIVE: To determine whether there are gender differences in the incidence of suicide in physicians, and whether there are differences in the methods used by male and female physicians to commit suicide. DESIGN: Systematic literature search. METHOD: A literature search was performed in the

  11. [Determinants in the careers of male and female physicians from the viewpoint of chief physicians].

    Science.gov (United States)

    Buddeberg-Fischer, B; Spindler, A; Peter, Y; Buddeberg, C

    2003-01-03

    Chief physicians play an important role for physicians' careers by providing advanced training and allocating time and research resources. This study examined which characteristics will help physicians to achieve a leadership position and how chief physicians conduct career promotion. All 532 chief physicians in Switzerland's German speaking cantons with medical schools were approached with a questionnaire covering professional motivation and personal attributes of career-oriented physicians career-promoting personal and institutional factors, and type of career promotion. 207 chief physicians (189 men, 18 women; participation rate 38.9 %;) participated. Respondents rated achievement motivation combined with professional interest and job enjoyment (intrinsic), and interest in advancement and social prestige (extrinsic motivation) as beneficial. Extraprofessional concerns such as family obligations and leisure interests were viewed as less important. Instrumental attributes were rated as advantageous. Expressive qualities were also seen as beneficial but less crucial. Ratings were independent of respondents' age, specialty, or type of workplace. The following personal factors were named: professional commitment, professional and social competence, goal orientation, endurance, and strength of character. The institutional factors referred to quality of training and teaching, a good work atmosphere, a transparent and flexible clinic structure. Career promotion was offered predominantly in the form of coaching, career planning, and support in job search. Career promotion should be more targeted and structured, e. g. be conducted in mentoring programmes, thus providing the prerequisites for a truly equal career promotion of female and male physicians.

  12. The new generation of family physicians--career motivation, life goals and work-life balance.

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Stamm, Martina; Buddeberg, Claus; Klaghofer, Richard

    2008-05-31

    The present study aimed to investigate the differences between future family physicians, and physicians aspiring to other medical specialities, in terms of sociodemographic factors and variables concerning personality factors, career motivation, career success, importance of life goals and work-life balance; further, the stability in career choice of family physicians from medical school through to residency was evaluated. Data reported are from four assessments of the Swiss physicians' longitudinal career development study, begun in 2001 (T1). At T4, in 2007, 543 residents (76% of the initial sample at T1) completed a questionnaire concerning their personal and professional goals. The difference between family physicians and specialists was studied by multivariate analyses of covariance adjusted for gender. Of the study sample, 84 (17%) decided on family medicine, 66% of them as early as medical school or at the beginning of residency. Compared to specialists, more family physicians are married and more have children. Their intrinsic and extrinsic career motivation is lower, their extraprofessional concerns are greater and they rate their objective and subjective career success lower. The favoured models of work-family and work-life balance respectively are part-time oriented. Future family physicians, both females and males, are less career-oriented. The results suggest that the waning reputation of family medicine and the uncertain development of this medical discipline in the Swiss healthcare system attract less career-oriented applicants. A well-balanced integration of professional and private life is an essential goal for the new generation of doctors; this applies even more to female doctors and family physicians. Considering this trend, the question arises whether the current number of medical school graduates is sufficient to ensure the population's healthcare provision in the future.

  13. Professional satisfaction of family physicians in Pakistan--results of a cross-sectional postal survey.

    Science.gov (United States)

    Ashraf, Hiba; Shah, Nasir; Anwer, Fahad; Akhtar, Hina; Abro, Mairaj Anwar; Khan, Asma

    2014-04-01

    To assess the level of professional satisfaction amongst family physicians of Pakistan and to identify the factors associated with professional dissatisfaction. The study was part of a larger national survey for "Status of PostgraduateTraining and Continuing Medical Education of Family Physicians in Pakistan" which was a cross-sectional, postal survey of family physicians conducted over 10 months between November 2009 and September 2010. The main outcome variables were professional satisfaction, as well as reasons for professional satisfaction and dissatisfaction. SPSS 17 was used for data analysis. Multivariable logistic regression was used to determine factors associated with professional dissatisfaction. Of the total 1200 survey forms distributed, 288 (24%) were received back. The mean age of the participants was 37 +/- 9 years with a range between 26 and 72 years. Of the total, 226 (78.5%) were males. Overall, 213 (74%) family physicians were satisfied with their profession. The factors significantly associated with professional dissatisfaction included the participants opinion that they were not respected by the public (OR: 11.6, C.I: 1.9-71.5); as well as regretting being a doctor (OR:62.9, C.I: 8.4-469.8). Most of the family physicians had professional satisfaction, but a minority had regrets about being a doctor and were dissatisfied over how their profession affected their family life. Further research may be needed to study work-life balance amongst family physicians of Pakistan.

  14. Professional activity. How is family physicians' work time changing?

    Science.gov (United States)

    Woodward, C A; Ferrier, B; Cohen, M; Brown, J

    2001-07-01

    To examine hours worked professionally, work preferences, and changes in both of these and their correlates. Repeated surveys done in 1993 and 1999. Ontario family practices. Cohort of physicians certified in family medicine between 1989 and 1991 after family medicine residency who were surveyed in 1993 when they resided in Ontario. Self-reported hours spent weekly on professional activities, desired hours of professional work, and balance between work and other activities. Fifty-three percent (293) of 553 physicians responded to the 1999 survey; 91% had remained family physicians; 85% of these had participated in the 1993 survey. The difference between the hours that family physicians preferred to work professionally and their actual hours of work had increased since 1993. Childless physicians, women physicians with preschool children, and women physicians married to other physicians worked fewer hours professionally than other physicians in 1999. Female physicians and physicians without children worked closer to their preferred hours than other physicians. Reporting a preference to work fewer hours professionally in 1993 was linked with a reduction in professional activities by 1999. Greater attention should be paid in physician resource planning to the family life cycle of female physicians. Lifestyle changes could lead to a reduction in professional activity among these physicians.

  15. Osteoporosis screening for men: are family physicians following the guidelines?

    Science.gov (United States)

    Cheng, Natalie; Green, Michael E

    2008-08-01

    To determine rates of screening for osteoporosis among men older than 65 years and to find out whether family physicians are following the recommendations of the Osteoporosis Society of Canada's 2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. Chart audit. The Family Medicine Centre at Hotel Dieu Hospital in Kingston, Ont. All male patients at the Family Medicine Centre older than 65 years for a total of 565 patients associated with 20 different physicians' practices. Rates of screening with bone mineral density (BMD) scans for osteoporosis, results of BMD testing, and associations between results of BMD testing and age. Of the 565 patients reviewed, 108 (19.1% of the study population) had received BMD testing. Rates of screening ranged from 0% to 38% in the 20 practices. Among 105 patients tested (reports for 3 patients were not retrievable), 15 (14.3%) were found to have osteoporosis, 43 (41.0%) to have osteopenia, and 47 (44.8%) to have normal BMD results. No significant association was found between BMD results and age. Screening rates were higher among men older than 75 years than among men aged 65 to 75 and peaked among those 85 to 89 years old. On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by BMD testing as recommended in the guidelines. Considering the relatively high rates of osteoporosis and osteopenia found in this study and the known morbidity and mortality associated with osteoporotic fractures in this population, higher rates of BMD screening and more widespread treatment of osteoporosis could prevent many fractures among these patients. Family physicians need to become more aware of the risk factors indicating screening, and barriers to screening and treatment of osteoporosis in men need to be identified and addressed.

  16. Family physician perspectives on primary immunodeficiency diseases

    Directory of Open Access Journals (Sweden)

    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.

  17. When Patients Divorce: The Family Physician's Legal Position

    OpenAIRE

    Mesbur, Ruth E.

    1983-01-01

    When divorce and family disintegration loom, the family physician is often the first outsider on the scene. The family physician may, indeed, have a critical role to play in handling the crisis; he may advise, refer to other professionals like therapists or lawyers, or appear in court as an expert witness. The physician must consider his legal position. Is reconciliation counselling confidential, privileged information? Can he recommend a lawyer for a patient? What is the physician's vulnerab...

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

    Science.gov (United States)

    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.

  19. Job Satisfaction Among Academic Family Physicians.

    Science.gov (United States)

    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.

  20. Factors affecting public dissatisfaction with urban family physician plan: A general population based study in Fars Province.

    Science.gov (United States)

    Imanieh, Mohammad Hadi; Mirahmadizadeh, Alireza; Imani, Bahareh

    2017-11-01

    Understanding the level of public satisfaction with a family physician plan as well as the relevant factors in this respect, can be employed as valuable tools in identifying quality of services. To determine the factors affecting public dissatisfaction with an urban family physician plan in Iran. This cross-sectional study was conducted from January 2014 through June 2015 on Fars Province residents in Iran, selected based on cluster sampling method. The data collection instrument was comprised of a two-part checklist including demographic information and items related to dissatisfaction with the family physician plan, specialists, para-clinic services, pharmacy, physicians on shift work, emergency services, and family physician assistants. Data were described by SPSS 20. In this study, 1,020 individuals (524 males, 496 females) were investigated. Based on the results, the most frequent factor affecting dissatisfaction with physicians was their single work shifts and unavailability (53%). In terms of dissatisfaction with family physicians' specialist colleagues and para-clinic services, the most common factors were related to difficulty in obtaining a referral form (41.5%) and making appointments (21.6%), respectively. Given the level of dissatisfaction with pharmacies, the significant factor was reported to be excessive delay in medication delivery (31.6%); and in terms of physicians on shift work and emergency services, the most important factor was lower work hours for family physicians (9.2%). It seems that, the most common causes of dissatisfaction with the urban family physician plan are due to the short duration of services, obtaining a referral form and making appointments, and providing prescribed medications.

  1. Female Physicians and the Work-Family Conflict.

    Science.gov (United States)

    Treister-Goltzman, Yulia; Peleg, Roni

    2016-05-01

    There has been a dramatic increase in the number of female physicians in all fields and specializations of medicine, but this increase has not resulted in a redistribution of domestic tasks and responsibilities. Reviewing the literature of the last two decades (April 1994 to April 2014) on how female physicians cope with the challenge of balancing their family and professional lives for the duration of their professional careers revealed that they suffer from the work-family conflict more than other professionals and that it has a more negative effect on women than on men. Women physicians consider work-family balance significantly when making career choices. These considerations affect their career success, their productivity as faculty members, their marital life, and parenthood. Having a supportive spouse at home and a facilitating mentor at work are important for a positive work-family balance among female physicians. Special career-supporting measures, such as flexible work schedules and expanded support for childcare over the course of work and when taking part in academic activities, are critical for female physicians.

  2. Early pregnancy failure management among family physicians.

    Science.gov (United States)

    Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

    2013-03-01

    Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

  3. Evaluation of correct diagnosis of referral patients to skin clinic by family physicians: A needs assessment for UME,CME

    Directory of Open Access Journals (Sweden)

    A Ramezanpour

    2009-08-01

    Full Text Available Background and purpose: It has been demonstrated that the level of welfare and improvement of nations is evaluated by the progress and achievement of their health service networks. The specialization of therapeutic approaches is one of the practical and effective ways to accomplish this goal. The health system savants believe that the family physician guideline is the redeemer of health system section. This study is aimed, to evaluate the accuracy of diagnosis of the dermatologic disease of referred patients by family physician in Zanjan Valiasr hospital in year 2008.Methods: This descriptive and cross-sectional study was done on 173 cases of referred patients from village family physician to dermatologic clinic. After correct diagnosis by dermatologist data including age, sex, family physician diagnosis and dermatologist diagnosis were recorded on data forms and then analyzed by Chi-square test.Results: From 173 referred patients, 76 cases (43.9% were male, 49 cases (28.3% were under 15 years old, 73 cases (42.2% were between 15-30 years old, and rest were more than 30 years old. 28 cases (16.1% have been referred with correct diagnosis.Conclusion: The level of accurate diagnosis by family physicians was law, which can be due to non-familiarity with common local skin disease and lack of enough instruction and education before starting the family physician project. We recommended that before starting this project, specialist workshop be prepared for family physicians.key words: Family Physician, Skin Diseases, Needs Assessment

  4. 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.

  5. Vaccines provided by family physicians.

    Science.gov (United States)

    Campos-Outcalt, Doug; Jeffcott-Pera, Michelle; Carter-Smith, Pamela; Schoof, Bellinda K; Young, Herbert F

    2010-01-01

    This study was conducted to document current immunization practices by family physicians. In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consisted of questions regarding the demographics of the practice, vaccines that are provided at the physicians' clinical site, whether the practice refers patients elsewhere for vaccines, and participation in the Vaccines for Children (VFC) program. The response rate was 38.5%, 31.8% after non-office-based respondents were deleted. A high proportion of respondents (80% or more) reported providing most routinely recommended child, adolescent, and adult vaccines at their practice sites. The exceptions were rotavirus vaccine for children and herpes zoster vaccine for adults., A significant proportion, however, reported referring elsewhere for some vaccines (44.1% for children and adolescent vaccines and 53.5% for adult vaccines), with the most frequent referral location being a public health department. A higher proportion of solo and 2-physician practices than larger practices reported referring patients. A lack of adequate payment was listed as the reason for referring patients elsewhere for vaccines by one-half of those who refer patients. One-half of responders do not participate in the VFC program. Provision of recommended vaccines by most family physicians remains an important service. Smaller practices have more difficulty offering a full array of vaccine products, and lack of adequate payment contributes to referring patients outside the medical home. The reasons behind the lack of participation in the VFC program deserve further study.

  6. Swiss family physicians' perceptions and attitudes towards knowledge translation practices.

    Science.gov (United States)

    Bengough, Theresa; Bovet, Emilie; Bécherraz, Camille; Schlegel, Susanne; Burnand, Bernard; Pidoux, Vincent

    2015-12-11

    Several studies have been performed to understand the way family physicians apply knowledge from medical research in practice. However, very little is known concerning family physicians in Switzerland. In an environment in which information constantly accumulates, it is crucial to identify the major sources of scientific information that are used by family physicians to keep their medical knowledge up to date and barriers to use these sources. Our main objective was to examine medical knowledge translation (KT) practices of Swiss family physicians. The population consisted of French- and German-speaking private practice physicians specialised in family medicine. We conducted four interviews and three focus groups (n = 25). The interview guides of the semi-structured interviews and focus groups focused on (a) ways and means used by physicians to keep updated with information relevant to clinical practice; (b) how they consider their role in translating knowledge into practice; (c) potential barriers to KT; (d) solutions proposed by physicians for effective KT. Family physicians find themselves rather ambivalent about the translation of knowledge based on scientific literature, but generally express much interest in KT. They often feel overwhelmed by "information floods" and perceive clinical practice guidelines and other supports to be of limited usefulness for their practice. They often combine various formal and informal information sources to keep their knowledge up to date. Swiss family physicians report considering themselves as artisans, caring for patients with complex needs. Improved performance of KT initiatives in family medicine should be tailored to actual needs and based on high quality evidence-based sources.

  7. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    Science.gov (United States)

    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.

  10. The African Family Physician

    African Journals Online (AJOL)

    North America and Europe, and these serve us well up to a point. When a colleague ... Maybe we need a different set of principles to work by in the Afri- ... base the balance. ... The African Family Physician is dedicated to life-long learning and.

  11. The economic impact of rural family physicians practicing obstetrics.

    Science.gov (United States)

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  12. Exodus of male physicians from primary care drives shift to specialty practice.

    Science.gov (United States)

    Tu, Ha T; O'Malley, Ann S

    2007-06-01

    An exodus of male physicians from primary care is driving a marked shift in the U.S. physician workforce toward medical-specialty practice, according to a national study by the Center for Studying Health System Change (HSC). Two factors have helped mask the severity of the shift--a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians. Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population. At the same time, primary care physicians' incomes have lost ground to both inflation and medical and surgical specialists' incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics. If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care--trends that could aggravate a predicted shortage of primary care physicians.

  13. Do family physicians electronic health records support meaningful use?

    Science.gov (United States)

    Peterson, Lars E; Blackburn, Brenna; Ivins, Douglas; Mitchell, Jason; Matson, Christine; Phillips, Robert L

    2015-03-01

    Spurred by government incentives, the use of electronic health records (EHRs) in the United States has increased; however, whether these EHRs have the functionality necessary to meet meaningful use (MU) criteria remains unknown. Our objective was to characterize family physician access to MU functionality when using a MU-certified EHR. Data were obtained from a convenience survey of family physicians accessing their American Board of Family Medicine online portfolio in 2011. A brief survey queried MU functionality. We used descriptive statistics to characterize the responses and bivariate statistics to test associations between MU and patient communication functions by presence of a MU-certified EHR. Out of 3855 respondents, 60% reported having an EHR that supports MU. Physicians with MU-certified EHRs were more likely than physicians without MU-certified EHRs to report patient registry activities (49.7% vs. 32.3%, p-valuevs. 56.4%, p-valuecommunication abilities were low regardless of EHR capabilities. Family physicians with MU-certified EHRs are more likely to report MU functionality; however, a sizeable minority does not report MU functions. Many family physicians with MU-certified EHRs may not successfully meet the successively stringent MU criteria and may face significant upgrade costs to do so. Cross sectional survey. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Social media beliefs and usage among family medicine residents and practicing family physicians.

    Science.gov (United States)

    Klee, David; Covey, Carlton; Zhong, Laura

    2015-03-01

    Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.

  15. Birth order, family size, and children's use of physician services.

    Science.gov (United States)

    Tessler, R

    1980-01-01

    The purpose of this study is to separate out the effects of number of siblings and birth order on children's use of physician services. Prior research has consistently revealed an inverse relationship between family size and physician visits, but the possible confounding influence of the child's ordinal position in the family has been ignored. Later born children may be taken to the doctor less often than first and other early borns because of their parents' increasing knowledgeability in regard to child care as well as their growing understanding of the uses and limitations of physician visits. On the assumption that part of the family size effect observed in prior research may have been due to the clustering of first and early borns in small families, an inverse relationship between birth order and physician utilization is hypothesized. Support for this hypothesis comes from an empirical study of 1,665 children from 587 families in which variation in family size is statistically controlled. PMID:7372499

  16. Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, egypt.

    Science.gov (United States)

    Eldein, Hebatallah Nour; Mansour, Nadia M; Mohamed, Samar F

    2013-04-01

    Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. The present study was conducted to assess family physicians' knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. SPSS version 18 was used for data entry and statistical analysis. The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.

  17. Patients' and physicians' satisfaction with a pharmacist managed anticoagulation program in a family medicine clinic.

    Science.gov (United States)

    Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John

    2015-06-09

    A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the

  18. Family Physician Readiness for Value-Based Payments: Does Ownership Status Matter?

    Science.gov (United States)

    Robertson-Cooper, Heidy; Neaderhiser, Bradley; Happe, Laura E; Beveridge, Roy A

    2017-10-01

    Value-based payments are rapidly replacing fee-for-service arrangements, necessitating advancements in physician practice capabilities and functions. The objective of this study was to examine potential differences among family physicians who are owners versus employed with respect to their readiness for value-based payment models. The authors surveyed more than 550 family physicians from the American Academy of Family Physician's membership; nearly 75% had made changes to participate in value-based payments. However, owners were significantly more likely to report that their practices had made no changes in value-based payment capabilities than employed physicians (owners 35.2% vs. employed 18.1%, P value-based practice capabilities were not as advanced as the employed physician group: (1) quality improvement strategies, (2) human capital investment, and (3) identification of high-risk patients. Specifically, the employed physician group reported more quality improvement strategies, including quality measures, Plan-Do-Study-Act, root cause analysis, and Lean Six Sigma (P value-based payments, consideration of different population health management needs according to ownership status has the potential to support the adoption of value-based care delivery for family physicians.

  19. 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.

  20. Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

    Science.gov (United States)

    Hustedde, Carol; Paladine, Heather; Wendling, Andrea; Prasad, Rupa; Sola, Orlando; Bjorkman, Sarah; Phillips, Julie

    2018-04-01

    The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

  1. The Relationship between the Family Physician and Psychosomatic Medicine

    Directory of Open Access Journals (Sweden)

    Farzad Goli

    2017-08-01

    Full Text Available Background: Organizing the health system around family medicine (FM has been a productive approach for developed countries. The aim of this study, which was concurrent with the Iran Health Transform Plan (HTP and the establishment of the family physician in Iran, was to discuss the sufficiency of a family physician training program for their roles and increase their competency.Methods: This descriptive study was conducted in the Psychosomatic Research Center affiliated to Isfahan University of Medical Science, Iran, with the assistance of the Iranian Institute of Higher Health (2015. An expert panel consisting of 6 individuals including specialists, trainers, and researchers in FM and psychosomatic medicine was held for this purpose. Using the World Organization of Family Doctors‎ (WONCA website for the definition of a family physician, the curriculum developed by the Ministry of Health and Medical Education was studied. Data were summarized in one table.Results: The current FM curriculum, with this content and method, does not seem to be capable of enabling physicians to perform their multidisciplinary roles. it still has a reductionist approach and disease orientation instead of a clinical reasoning method and systematic viewpoint. The psychosomatic approach is applicable at all prevention levels and in all diseases‎, since it is basically designed for this longitudinal (between all preventive levels and horizontal (bio-physical–social-spiritual intervention integration.Conclusion: Psychosomatic medicine, not as a biomedical specialty, but rather as a systems thinking model in health, had a rapid rise during previous decades. Now, its services have been integrated into all medical fields. This means that it should be adopted in the core of health care services (i.e., the family physician position before other sections. This would help the implementation of this approach in the health system, and the reduction of patients' pain and

  2. How Accurate Is Diagnosis of Congenital Anomalies Made by Family Physicians?

    Directory of Open Access Journals (Sweden)

    Hossein Mashhadi Abdolahi

    2014-12-01

    Full Text Available Background: Although family physicians have a key role in clinical management of many diseases and in community health, the accuracy of the diagnosis for congenital anomalies by family physicians still needs more investigations. The aim of this study was to assess the accuracy of family physicians in case detec-tion and diagnosis of congenital anomalies in rural areas, northwest of Iran. Methods: In a community-based study of 22500 children born between 2004 and 2012, all 172 cases of congenital anomalies diagnosed by family physicians were assessed by a qualified pediatrician in 47 health houses in rural areas of Tabriz District, northwest Iran. A group of 531 children was compared as con-trol subjects. Results: The overall sensitivity and specificity of family physicians‟ diagnosis for congenital anomalies were estimated 98% (95% Confidence Interval (CI: 95.9 to 100 and 100% (95% CI: 99.3 to 100, respectively. Sensitivity for diagnosis of congenital heart diseases was 97% (95% CI: 93 to 100, and for genitourinary tract, it was 86% (95% CI: 59 to 100. Specificity was estimated 100% for both groups of heart and genitourinary tract anomalies. Conclusion: The performance of family physicians was found accurate enough in the diagnosis of congenital anomalies. Health care system may consider family physician program as an effective approach to detect and clinical management of congenital anomalies.

  3. [Burnout syndrome among family physicians].

    Science.gov (United States)

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon

    2013-01-01

    burnout syndrome is a state of physical and emotional exhaustion that can occur among workers who interact directly with others. This could affect job performance. The objective was to determine the prevalence of this syndrome and its associated factors among family physicians. a cross-sectional survey applying the Maslach Burnout Inventory was conducted in a selected convenience non-probability sampling of family physicians. Central tendency and dispersion measures were used in determining the prevalence of burnout syndrome; the associated factors were analysed by χ(2) test. there were 59 cases of burnout syndrome, 36 had involvement in a single component, 15 in 2 and 8 were affected in 3 components; we observed that 35 % of positive cases reported doing an average of 10 extra shifts a month (p = 0.013). Having a second job was associated with positive cases of burnout syndrome. the results are consistent with similar studies. Working extra shifts or having a second job were the related factors most associated to this syndrome.

  4. Use of information sources by family physicians: a literature survey

    NARCIS (Netherlands)

    Verhoeven, A.A.H.; Boerma, E.J.; Meyboom-de Jong, B

    Analysis of the use of information sources by family physicians is important for both practical and theoretical reasons. First, analysis of the ways in which family physicians handle information may point to opportunities for improvement. Second, such efforts may lead to improvements in the

  5. Attitudes of physicians providing family planning services in Egypt about recommending intrauterine device for family planning clients.

    Science.gov (United States)

    Aziz, Mirette; Ahmed, Sabra; Ahmed, Boshra

    2017-12-01

    To assess the attitudes of physicians providing family planning services at the public sector in Egypt about recommending intrauterine device (IUD) for family planning clients, and to identify the factors that could affect their attitudes. A descriptive cross sectional study, in which all the physicians providing family planning services in Assiut Governorate were invited to complete self-administered questionnaires. The study participants were recruited at the family planning sector monthly meetings of the 13 health directorates of Assiut Governorate, Upper Egypt. 250 physicians accepted to participate in the study. Bivariate and Multivariate regression analyses were performed to identify the most important predictors of recommending IUD to family planning clients when appropriate. Less than 50% of physicians would recommend IUD for clients with proper eligibility criteria; women younger than 20 years old (49.2%), women with history of ectopic pregnancy (34%), history of pelvic inflammatory diseases (40%) or sexually transmitted diseases (18.4%) and nulliparous women (22.8%). Receiving family planning formal training within the year preceding data collection and working in urban areas were the significant predictors of recommending IUD insertion for appropriate clients. Physicians providing family planning services in Upper Egypt have negative attitudes about recommending IUD for family planning clients. Continuous education and in-service training about the updated medical eligibility criteria, especially for physicians working in rural areas may reduce the unfounded medical restrictions for IUD use. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Burnout and Scope of Practice in New Family Physicians.

    Science.gov (United States)

    Weidner, Amanda K H; Phillips, Robert L; Fang, Bo; Peterson, Lars E

    2018-05-01

    Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may provide. We examined the associations between family physician scope of practice and self-reported burnout. Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (N = 1,617). We used bivariate analyses and logistic regression to compare self-report of burnout and measures of scope of practice including: inpatient medicine, obstetrics, pediatric ambulatory care, number of procedures and/or clinical content areas, and providing care outside the principal practice site. Forty-two percent of respondents reported feeling burned out from their work once a week or more. In bivariate analysis, elements of scope of practice associated with higher burnout rates included providing more procedures/clinical content areas (mean procedures/clinical areas: 7.49 vs 7.02; P = .02) and working in more settings than the principal practice site (1+ additional settings: 57.6% vs 48.4%: P = .001); specifically in the hospital (31.4% vs 24.2%; P = .002) and patient homes (3.3% vs 1.5%; P = .02). In adjusted analysis, practice characteristics significantly associated with lower odds of burnout were practicing inpatient medicine (OR = 0.70; 95% CI, 0.56-0.87; P = .0017) and obstetrics (OR = 0.64; 95% CI, 0.47-0.88; P = .0058). Early career family physicians who provide a broader scope of practice, specifically, inpatient medicine, obstetrics, or home visits, reported significantly lower rates of burnout. Our findings suggest that comprehensiveness is associated with less burnout, which is critical in the context of improving access to good quality, affordable care while maintaining physician wellness. © 2018 Annals of Family Medicine, Inc.

  7. Global Cardiovascular Risk Assessment by Family Physicians in Suez Canal University-Family Medicine Centers-Egypt.

    Science.gov (United States)

    Nour-Eldein, Hebatallah; Abdelsalam, Shimaa A; Nasr, Gamila M; Abdelwahed, Hassan A

    2013-01-01

    The close sustained contact of family physician with their patients and local community makes preventive care an integral part of their routine work. Most cardiovascular diseases (CVD) can be prevented by addressing their risk factors. There are several guidelines that recommend different CV risk assessment tools to support CV prevention strategies. This study aimed to assess awareness and attitude of global CV risk assessment and use of their tools by family physicians; aiming to improve CV prevention service. The current study is a cross-sectional descriptive analytic. Sixty-five family physicians were asked to respond to, validated anonymous questionnaire to collect data about characteristics of family physicians, their awareness, attitude, current use, barriers, and recommendations of global CV risk assessment. Statistical Package for Social Sciences (SPSS) version 18 was used for data entry and analysis. Awareness of guidelines of global CV risk assessment was relatively higher regarding the American guidelines (30.8%) than that recommended by World Health Organization (WHO) for Egypt (20.2%). 50.8% of participants had favorable attitude. There was statistical significant relationship between attitude scores and physician characteristics; age (P = 0.003), qualification (P = 0.001) and number of patients seen per week (P = 0.009). Routine use of global CV risk assessment tools was reported only (23%) by family physicians. Relative higher attitude scores than use of global CV risk assessment tools in practice. The most frequent barriers were related to lack of resources and shortage in training/skills and the raised suggestions were towards training.

  8. Rural Women Family Physicians: Strategies for Successful Work-Life Balance.

    Science.gov (United States)

    Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather

    2016-05-01

    Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. © 2016 Annals of Family Medicine, Inc.

  9. Professional Success and Gender in Family Medicine: Design of Scales and Examination of Gender Differences in Subjective and Objective Success Among Family Physicians.

    Science.gov (United States)

    Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia; Luna del Castillo, Juan de Dios

    2016-03-01

    Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family-work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach's α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension. © The Author(s) 2014.

  10. Specialist physician knowledge of chronic kidney disease: A comparison of internists and family physicians in West Africa

    Directory of Open Access Journals (Sweden)

    Emmanuel I. Agaba

    2012-05-01

    Full Text Available Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD. We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists. Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians. Results: Only 19 (27.5% of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2% of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28. Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians. Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians.

  11. Unto the third generation: evidence for strong familial aggregation of physicians, psychologists, and psychotherapists among first-year medical and psychology students in a nationwide Austrian cohort census.

    Science.gov (United States)

    Tran, Ulrich S; Berger, Nina; Arendasy, Martin E; Greitemeyer, Tobias; Himmelbauer, Monika; Hutzler, Florian; Kraft, Hans-Georg; Oettl, Karl; Papousek, Ilona; Vitouch, Oliver; Voracek, Martin

    2017-05-03

    Medical students present higher numbers of physician relatives than expectable from the total population prevalence of physicians. Evidence for such a familial aggregation effect of physicians has emerged in investigations from the Anglo-American, Scandinavian, and German-speaking areas. In particular, past data from Austria suggest a familial aggregation of the medical, as well as of the psychological and psychotherapeutic, professions among medical and psychology undergraduates alike. Here, we extend prior related studies by examining (1) the extent to which familial aggregation effects apply to the whole nation-wide student census of all relevant (eight) public universities in Austria; (2) whether effects are comparable for medical and psychology students; (3) and whether these effects generalize to relatives of three interrelated health professions (medicine, psychology, and psychotherapy). We investigated the familial aggregation of physicians, psychologists, and psychotherapists, based on an entire cohort census of first-year medical and psychology students (n = 881 and 920) in Austria with generalized linear mixed models. For both disciplines, we found strong familial aggregation of physicians, psychologists, and psychotherapists. As compared with previous results, directionally opposite time trends within disciplines emerged: familial aggregation of physicians among medical students has decreased, whilst familial aggregation of psychologists among psychology students has increased. Further, there were sex-of-relative effects (i.e., more male than female physician relatives), but no substantial sex-of-student effects (i.e., male and female students overall reported similar numbers of relatives for all three professions of interest). In addition, there were age-benefit effects, i.e., students with a relative in the medical or the psychotherapeutic profession were younger than students without, thus suggesting earlier career decisions. The familial

  12. Work-Family Conflict and the Sex Difference in Depression Among Training Physicians.

    Science.gov (United States)

    Guille, Constance; Frank, Elena; Zhao, Zhuo; Kalmbach, David A; Nietert, Paul J; Mata, Douglas A; Sen, Srijan

    2017-12-01

    Depression is common among training physicians and may disproportionately affect women. The identification of modifiable risk factors is key to reducing this disease burden and its negative impact on patient care and physician career attrition. To determine the presence and magnitude of a sex difference in depressive symptoms and work-family conflict among training physicians; and if work-family conflict impacts the sex difference in depressive symptoms among training physicians. A prospective longitudinal cohort study of medical internship in the United States during the 2015 to 2016 academic year in which 3121 interns were recruited across all specialties from 44 medical institutions. Prior to and during their internship year, participants reported the degree to which work responsibilities interfered with family life using the Work Family Conflict Scale and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Mean (SD) participant age was 27.5 (2.7) years, and 1571 participants (49.7%) were women. Both men and women experienced a marked increase in depressive symptoms during their internship year, with the increase being statistically significantly greater for women (men: mean increase in PHQ-9, 2.50; 95% CI, 2.26-2.73 vs women: mean increase, 3.20; 95% CI, 2.97-3.43). When work-family conflict was accounted for, the sex disparity in the increase in depressive symptoms decreased by 36%. Our study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is

  13. Family physicians' perspectives on interprofessional teamwork: Findings from a qualitative study.

    Science.gov (United States)

    Szafran, Olga; Torti, Jacqueline M I; Kennett, Sandra L; Bell, Neil R

    2018-03-01

    The aim of this study was to describe family physicians' perspectives of their role in the primary care team and factors that facilitate and hinder teamwork. A qualitative study was conducted employing individual interviews with 19 academic/community-based family physicians who were part of interprofessional primary care teams in Edmonton, Alberta, Canada. Professional responsibilities and roles of physicians within the team and the facilitators and barriers to teamwork were investigated. Interviews were audiotaped, transcribed and analysed for emerging themes. The study findings revealed that family physicians consistently perceived themselves as having the leadership role on in the primary care team. Facilitators of teamwork included: communication; trust and respect; defined roles/responsibilities of team members; co-location; task shifting to other health professionals; and appropriate payment mechanisms. Barriers to teamwork included: undefined roles/responsibilities; lack of space; frequent staff turnover; network boundaries; and a culture of power and control. The findings suggest that moving family physicians toward more integrative and interdependent functioning within the primary care team will require overcoming the culture of traditional professional roles, addressing facilitators and barriers to teamwork, and providing training in teamwork.

  14. 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.

  15. Comparison of burnout pattern between hospital physicians and family physicians working in Suez Canal University Hospitals.

    Science.gov (United States)

    Kotb, Amany Ali; Mohamed, Khalid Abd-Elmoez; Kamel, Mohammed Hbany; Ismail, Mosleh Abdul Rahman; Abdulmajeed, Abdulmajeed Ahmed

    2014-01-01

    The burnout syndrome is characterized by emotional exhaustion, depersonalization, and low personal accomplishment. It is associated with impaired job performance. This descriptive study examined 171 physicians for the presence of burnout and its related risk factors. The evaluation of burnout was through Maslach Burnout Inventory (MBI). The participant was considered to meet the study criteria for burnout if he or she got a "high" score on at least 2 of the three dimensions of MBI. In the current study, the prevalence of burnout in hospital physicians (53.9%) was significantly higher than family physicians (41.94%) with (p=0.001). Participants who work in the internal medicine department scored the highest prevalence (69.64%) followed by Surgeons (56.50%) and Emergency doctors (39.39%). On the other hand, Pediatricians got the lowest prevalence (18.75%). Working in the teaching hospital and being married are strong predictors for occurrence of burnout. There is a significant difference of burnout between hospital physicians and family physicians among the study subjects. Working in the teaching hospital and being married are strong predictors for occurrence of burnout.

  16. Workplace Bullying Among Family Physicians: A Gender Focused Study.

    Science.gov (United States)

    Rouse, Linda P; Gallagher-Garza, Shalena; Gebhard, Roberta E; Harrison, Suzanne L; Wallace, Lorraine S

    2016-09-01

    Continuing gender disparities within the medical profession have raised concerns about the extent to which women physicians face an inhospitable work environment. The purpose of this study was to examine the types and frequency of workplace bullying reported by a national sample of family physicians employed in academic settings, as related to gender. Data for this study were gathered as part of the Council of Academic Family Medicine (CAMF) Educational Research Alliance (CERA) omnibus electronic survey. Respondents completed questions addressing sociodemographic and practice characteristics, general experience with bullying, types of bullying, actions in response to bullying, and outcomes. A total of 1065 academic family physicians (male = 56.8%; female = 43.2%), mostly non-Hispanic white (84.2%) or Asian (5.3%) and between the ages 30 and 60 (58.7%) completed the CERA survey. One in 10 respondents acknowledged bullying someone in the workplace; 30% had been personally bullied in the workplace. Compared to men, female physicians were more likely to report being bullied overall and, specifically, to experience having their opinions ignored, lack of recognition for good work, feeling pressured not to claim rightful benefits, and being given unmanageable workloads. Despite some gender differences in actions taken, outcomes for each kind of action were the same for men and women.

  17. Understanding patient and physician perceptions of male androgenetic alopecia treatments in Asia-Pacific and Latin America.

    Science.gov (United States)

    Lulic, Zrinka; Inui, Shigeki; Sim, Woo-Young; Kang, Hoon; Choi, Gwang Seong; Hong, Woosung; Hatanaka, Toshiki; Wilson, Timothy; Manyak, Michael

    2017-08-01

    This survey aimed to explore patient and physician attitudes towards male androgenetic alopecia (AGA), satisfaction with currently available male AGA treatments and investigate the factors affecting treatment choice. The survey was carried out in five countries (Japan, South Korea, Taiwan, Mexico and Brazil) between November and December 2015 using a standard market research methodology. Questionnaires were completed by patients with male AGA or hair loss/thinning and practicing physicians who were responsible for prescribing AGA treatment. In total, 835 patients and 338 physicians completed the questionnaire. Overall, 37.6% of patients reported satisfaction with the treatments they had used. The highest patient satisfaction was reported for 5-alpha-reductase inhibitors (53.9% of patients satisfied). In all countries, physicians were more likely than patients to think that male AGA has a major impact on patient confidence (89.3% vs 70.4%, respectively). There was agreement by physicians and patients that male AGA patients who are involved in their treatment decisions have better outcomes. Patients who were satisfied with AGA treatments were more likely to have the level of involvement they desired in treatment decisions (69.1% of satisfied patients) than dissatisfied patients (56.4% of dissatisfied patients). This survey provides valuable insights into the attitudes of patients and physicians in Asia and Latin America about male AGA and its treatments. The survey identified areas of disconnect between physicians and patients regarding the impact of male AGA, treatment consultations and the importance of treatment attributes. It also highlights the need for physicians to spend sufficient time with patients discussing AGA treatment approaches. © 2017 GlaxoSmithKline. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.

  18. Rural Family Physicians Are Twice as Likely to Use Telehealth as Urban Family Physicians.

    Science.gov (United States)

    Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew

    2018-04-01

    Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.

  19. The opinions and experiences of family physicians regarding direct-to-consumer advertising.

    Science.gov (United States)

    Lipsky, M S; Taylor, C A

    1997-12-01

    The use of direct-to-consumer advertising (DTCA) by pharmaceutical companies is increasing. Our study examines the opinions and experiences of family physicians concerning DTCA. A survey instrument designed to elicit the opinions, experiences, and perceptions of family physicians about DTCA was sent to a 2% (N = 880) systematic sampling of active physician members of the American Academy of Family Physicians. Descriptive statistics were used to analyze responses with t tests and chi 2 tests for independence used to examine subgroup response differences. Four hundred fifty-four (52%) physicians responded to the survey. Most physicians (95%) had encountered DTCA personally, and had been approached by an average of 7 patients over the previous 6 months with requests for specific prescription drugs. Prescription antihistamines and antihypertensive drugs were the most commonly requested. Overall, 80% of the physician respondents believed that print DTCA was not a good idea, while 84% expressed negative feelings about television and radio advertising. Both groups cited "misleading biased view" and "increased costs" as the most common disadvantages. Some reported benefits included "better informed patients" and "promoting physician-patient communication." Overall, the study group physicians had negative feelings about DTCA in both print and electronic media. Studies directly examining patient perspectives, as well as cost benefits, are necessary to test the validity of the physicians' perceptions about DTCA.

  20. Family medicine physicians' advice about use of nonconventional modalities for menopausal symptom management.

    Science.gov (United States)

    Grant, Kathryn; Burg, Mary Ann; Fraser, Kathryn; Gui, Serena; Kosch, Shae Graham; Nierenberg, Barry; Oyama, Oliver; Pomm, Heidi; Sibille, Kimberly; Spruill, Timothy; Swartz, Virginia

    2007-05-01

    This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management. Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief. Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed. These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.

  1. Disrespect, harassment, and abuse: all in a day's work for family physicians.

    Science.gov (United States)

    Miedema, Baukje; Easley, Julie; Fortin, Pierrette; Hamilton, Ryan; Tatemichi, Sue

    2009-03-01

    To examine harassment and abusive encounters between family physicians and their patients or colleagues in the workplace. Qualitative case study using semistructured interviews. Province of New Brunswick. Forty-eight family physicians from across the province. A collective case-study approach was developed, with 24 cases of 2 individuals per case. Cases were selected based on sex, location (urban or rural), language (French or English), and number of years since medical school graduation ( 20 years). Physicians were interviewed in either French or English. Participants were recruited using the College of Physicians and Surgeons of New Brunswick's physician directory. Based on the rates of response and participation, some cases were overrepresented, while others were not completed. All interviews were audiotaped, transcribed verbatim, and analyzed thematically using a categorical aggregation approach. A coding scheme for the thematic analysis was developed by the research team before the interviews were transcribed. Although the original intent of this study was to examine the work environment of family physicians in light of the increasing number of women entering the profession, harassment and abusive encounters in the workplace emerged as a main theme. These encounters ranged from minor to severe. Minor abusive encounters included disrespectful behaviour and verbal threats by patients, their families, and occasionally colleagues. More severe forms of harassment involved physical threats, physical encounters, and stalking. Demanding patients, such as heavy drug users, were often seen as threatening. Location of practice, years in practice, and sex of the physician seemed to affect abusive encounters--young, female, rural physicians appeared to experience such encounters most often. Abusive encounters in the workplace are concerning. It is essential to address these issues of workplace harassment and abuse in order to protect physician safety and avoid workplace

  2. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia.

    Science.gov (United States)

    Mumenah, Sahar H; Al-Raddadi, Rajaa M

    2015-01-01

    The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH) are with their counterparts who work at some selected non-MOH hospitals. An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC), and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians' level of satisfaction and how it was affected by the difficulties was assessed. Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011) and radiologists (P building maintenance (P < 0.001). Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032). MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  3. Chronic Pain, Patient-Physician Engagement, and Family Communication Associated With Drug-Using HIV Patients' Discussing Advanced Care Planning With Their Physicians.

    Science.gov (United States)

    Hansen, Eric D; Mitchell, Mary M; Smith, Tom; Hutton, Nancy; Keruly, Jeanne; Knowlton, Amy R

    2017-10-01

    In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known that this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown. To further characterize factors associated with successful ACP in PLWHA, we examined associations between patient-physician relationship, chronic pain, family communication and problem-solving skills, and rates of patients discussing ACP with their physicians. Data were from the Affirm Care study (N = 325), which examined social and environmental factors associated with health outcomes among PLWHA and their informal caregivers. In multivariate analysis, higher odds of patient reports of discussing ACP with their physicians were associated with their higher rating of their relationship with their physician (adjusted odds ratio [AOR] 1.73; P family arguments about end-of-life medical decisions (AOR 2.43; P family members about problems (AOR 1.33; P family communication and family problem-solving skills. The findings also suggest that PLWHA with chronic pain and prior family discord over end-of-life medical decisions may be primed for ACP. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Family and physician influence on asthma research participation decisions for adolescents: the effects of adolescent gender and research risk.

    Science.gov (United States)

    Brody, Janet L; Scherer, David G; Annett, Robert D; Turner, Charles; Dalen, Jeanne

    2006-08-01

    There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians' views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research

  5. [Old gender patterns still used when physicians are pictured in medical journals. Male physicians are portrayed as active leaders, women physicians as listening, compassionate].

    Science.gov (United States)

    Eriksson, Bodil; Johansson, Eva E

    As a part of a medical student' s research project on medical socialisation, the 2002 issue of two Swedish medicaljournals, Läkartidningen and Moderna Läkare, were scrutinized regarding how male and female physicians were represented on pictures. The outward façade was mostly male; 87% of portrays of editorials pictured a man, 81% of career announcements displayed men. Authors of articles and chroniclers more often presented a female face (55%). Photos in reports showed around 60% men and 40 % women, both regarding area and number of photos. These shares corresponded well to the actual share of male and female physicians in Sweden. The content analysis of pictures, however, demonstrated gender features: men were to a much higher degree focused in leading, demonstrating and speaker positions, while women to a higher degree were portrayed as taking part in consultations or caring activities.

  6. Family Physicians May Benefit From Cognitive Behavioral Therapy Skills in Primary Care Setting.

    Directory of Open Access Journals (Sweden)

    Omer Serkan Turan

    2017-08-01

    Full Text Available Dr Francis Peabody commented that the swing of the pendulum toward specialization had reached its apex, and that modern medicine had fragmented the health care delivery system too greatly. Thus the system was in need of a generalist physician to provide comprehensive personalized care. Family physician is the perfect candidate to fill the gap which Dr Peabody once speaks of and grants biopsychosocial model as its main philosophy. Biopsychosocial model proposes physician to consider multiple aspects of patient's life in order to manage disease. Behavioral pathogens such as poor diet, lack of physical activity, stress, substance abuse, unsafe sexual activity, inadequate emotional support, nonadherence to medical advice contribute to disease progress. Family physician can guide patient like a coach to obtain higher levels in Maslow’s hierarchy of needs as biopsychosocial model suggests and obtain the change in behavior towards a healthier life with using cognitive behavioral therapy skills. So family physician, biopsychosocial model and cognitive behavioral skills are three pillars of comprehensive personalized care and family physicians having these skill sets can be very helpful in making positive changes in the life of the patient. [JCBPR 2017; 6(2.000: 98-100

  7. E-Learning Readiness in Medicine: Turkish Family Medicine (FM) Physicians Case

    Science.gov (United States)

    Parlakkiliç, Alaattin

    2015-01-01

    This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…

  8. Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness.

    Science.gov (United States)

    Fries, Christopher J

    2008-11-01

    ABSTRACTOBJECTIVETo develop a classification of complementary and alternative medicine (CAM) practices widely available in Canada based on physicians' effectiveness ratings of the therapies.DESIGNA self-administered postal questionnaire asking family physicians to rate their "belief in the degree of therapeutic effectiveness" of 15 CAM therapies.SETTINGProvince of Alberta.PARTICIPANTSA total of 875 family physicians.MAIN OUTCOME MEASURESDescriptive statistics of physicians' awareness of and effectiveness ratings for each of the therapies; factor analysis was applied to the ratings of the 15 therapies in order to explore whether or not the data support the proposed classification of CAM practices into categories of accepted and rejected.RESULTSPhysicians believed that acupuncture, massage therapy, chiropractic care, relaxation therapy, biofeedback, and spiritual or religious healing were effective when used in conjunction with biomedicine to treat chronic or psychosomatic indications. Physicians attributed little effectiveness to homeopathy or naturopathy, Feldenkrais or Alexander technique, Rolfing, herbal medicine, traditional Chinese medicine, and reflexology. The factor analysis revealed an underlying dimensionality to physicians' effectiveness ratings of the CAM therapies that supports the classification of these practices as either accepted or rejected.CONCLUSIONThis study provides Canadian family physicians with information concerning which CAM therapies are generally accepted by their peers as effective and which are not.

  9. THE PREVALENCE OF STRESS AND BURNOUT SYNDROME IN HOSPITAL DOCTORS AND FAMILY PHYSICIANS.

    Science.gov (United States)

    Stanetic, Kosana D; Savic, Suzana M; Racic, Maja

    2016-11-01

    Introducti on. Burnout syndrome is the result of chronic emotional stress. It is characterized by high levels of emotional exhaustion and depersonalization, and reduced level of personal accomplishment. The aim of this study was to determine the level of stress and risk ror burnout syndrome in doctors employed in health centers and hospitals, and to investigate the impact of socio-derrdgraphic characteristics on the level of stress and the o ccurrence of burnout syndrome. A cross-sectional study was conducted in the period from October I to December 31, 2015 in three health centers and in the University Clinical Center of the Republic of Srpska. The survey was anonymous. A socio-demographic questionnaire and a questionnaire for self-assessment of the level of stress and Maslach Burnout Inventory were used as research instruments. Out of 151 doctors included in the study, 49% were family physicians, and 51% were hospital doctors. The analysis of responses to questionnaires for self-assessment of stress level revealed that 51.7% of participants had high levels of stress (52.7% of family physicians, 50.6% of doctors working in hospital). A high degree of emotional exhaustion was found in 27.2% of participants (29.7% of fam ily physicians, 24.6% of doctors working in hospital), high depersonalization was found in 23.8% of participants (25.7% of family physicians, 22. 1% of doctors working in hospital), a low level of personal accomplishment was found in 39.7% of participants (37.8% of family physicians. 41.6% of doctors working in hospital). No statistically significant difference regarding stress degree, emotional exhaustion and depersonalizaion and personal accomplishment was found between hospital doctors and family physicians. The physicians aged over 45 years had a significantly (p = 0.030) higher level of emotional exhaustion than their younger colleagues. This study found that there was a high risk of burnout syndrome in physicians in the Republic of Srpska

  10. Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

    Science.gov (United States)

    Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

    2017-08-01

    To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

  11. Advantages and disadvantages of educational email alerts for family physicians: viewpoint.

    Science.gov (United States)

    Badran, Hani; Pluye, Pierre; Grad, Roland

    2015-02-27

    Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians' knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants' suggestions to improve email alert services for CME. We conducted a qualitative descriptive study using the "Knowledge, Attitude, Behavior" model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

  12. A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation.

    Science.gov (United States)

    Twibell, Renee; Siela, Debra; Riwitis, Cheryl; Neal, Alexis; Waters, Nicole

    2018-01-01

    To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. Despite the growing acceptance of family presence during resuscitation worldwide, healthcare professionals continue to debate the risks and benefits of family presence. As many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations. Research has not clarified the factors that influence the decision-making processes of nurses and physicians related to inviting family presence. This is the first study to elicit written data from healthcare professionals to explicate factors in decision-making about family presence. Qualitative exploratory-descriptive. Convenience samples of registered nurses (n = 325) and acute care physicians (n = 193) from a Midwestern hospital in the United States of America handwrote responses to open-ended questions about family presence. Through thematic analysis, decision-making factors for physicians and nurses were identified and compared. Physicians and nurses evaluated three similar factors and four differing factors when deciding to invite family presence during resuscitation. Furthermore, nurses and physicians weighted the factors differently. Physicians weighted most heavily the family's potential to disrupt life-saving efforts and compromise patient care and then the family's knowledge about resuscitations. Nurses heavily weighted the potential for the family to be traumatised, the potential for the family to disrupt the resuscitation, and possible family benefit. Nurses and physicians considered both similar and different factors when deciding to invite family presence. Physicians focused on the patient primarily, while nurses focused on the patient, family and resuscitation team. Knowledge of factors that influence the decision-making of interprofessional colleagues

  13. Genetics Home Reference: familial male-limited precocious puberty

    Science.gov (United States)

    ... male-limited precocious puberty Familial male-limited precocious puberty Printable PDF Open All Close All Enable Javascript ... expand/collapse boxes. Description Familial male-limited precocious puberty is a condition that causes early sexual development ...

  14. Why don't men seek help? Family physicians' perspectives on help-seeking behavior in men.

    Science.gov (United States)

    Tudiver, F; Talbot, Y

    1999-01-01

    Men tend to underuse primary care health services despite their susceptibility to particular types of illness. The purpose of this study was to report the family physician's perspective on why men do not access the health care system for medical problems. We used focus group interviews to identify major themes. The participants were family physicians in active practice randomly selected from a list of 500 full- and part-time teachers. Four focus groups were formed from 18 participants (12 men, 6 women), in practice an average of 17 years. Eleven of the physicians were in community practice. Three key themes were identified: (1) Support: Men appear to get most of their support for health concerns from their female partners, little from their male friends. Their pattern of seeking support tends to be indirect rather than straightforward. (2) Help Seeking: Perceived vulnerability, fear, and denial are important influences on whether men seek help. They look for help for specific problems rather than for more general health concerns. (3) Barriers: Personal barriers involved factors related to a man's traditional social role characteristics: a sense of immunity and immortality; difficulty relinquishing control; a belief that seeking help is unacceptable; and believing men are not interested in prevention. Systematic barriers had to do with time and access; having to state the reason for a visit; and the lack of a male care provider. Many of these findings are supported by psychological theories. Future research should apply these theories in more transferable populations and settings. However, an in-depth understanding of the patterns of men's use of primary care services is needed before we can determine if a regular source of primary care would have a positive impact on their health.

  15. Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: a cross-sectional study

    Science.gov (United States)

    Klemenc-Ketis, Zalika; Bulc, Mateja; Kersnik, Janko

    2011-01-01

    Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age  [± standard deviation] 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention. PMID:21495204

  16. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    Science.gov (United States)

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  17. Portuguese Family Physicians' Awareness of Diagnostic and Laboratory Test Costs: A Cross-Sectional Study.

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    Luísa Sá

    Full Text Available Physicians' ability to make cost-effective decisions has been shown to be affected by their knowledge of health care costs. This study assessed whether Portuguese family physicians are aware of the costs of the most frequently prescribed diagnostic and laboratory tests.A cross-sectional study was conducted in a representative sample of Portuguese family physicians, using computer-assisted telephone interviews for data collection. A Likert scale was used to assess physician's level of agreement with four statements about health care costs. Family physicians were also asked to estimate the costs of diagnostic and laboratory tests. Each physician's cost estimate was compared with the true cost and the absolute error was calculated.One-quarter (24%; 95% confidence interval: 23%-25% of all cost estimates were accurate to within 25% of the true cost, with 55% (95% IC: 53-56 overestimating and 21% (95% IC: 20-22 underestimating the true actual cost. The majority (76% of family physicians thought they did not have or were uncertain as to whether they had adequate knowledge of diagnostic and laboratory test costs, and only 7% reported receiving adequate education. The majority of the family physicians (82% said that they had adequate access to information about the diagnostic and laboratory test costs. Thirty-three percent thought that costs did not influence their decision to order tests, while 27% were uncertain.Portuguese family physicians have limited awareness of diagnostic and laboratory test costs, and our results demonstrate a need for improved education in this area. Further research should focus on identifying whether interventions in cost knowledge actually change ordering behavior, in identifying optimal methods to disseminate cost information, and on improving the cost-effectiveness of care.

  18. Are Patients Ready for Lesbian, Gay and Bisexual Family Physicians - A Croatian Study.

    Science.gov (United States)

    Grabovac, Igor; Mustajbegović, Jadranka; Milošević, Milan

    2016-06-01

    Discrimination and harassment of lesbian, gay and bisexual (LGB) physicians from their colleagues and superiors are known. However there is little knowledge about the patients’ attitudes and discrimination toward physicians. A cross sectional Internet survey was conducted in urban Croatian regions. The participants were asked to answer questions regarding their socio-demographic status, the Attitudes Towards Lesbians and Gay Men Scale (ATLG), and whether they would refuse to see a LGB physician and, if so, why. Of the 1004 participants, 8.8% said they would refuse a male GB physician while 7.9% would refuse a female LB physician, and 7.3% would refuse both. The two most common reasons for discriminating were: “disaccord with political or religious beliefs” and “fear of being sexually harassed”. A logistical regression model showed that male sex, higher ATLG score and higher age were associated with more refusals of male GB physicians. Also higher age, higher ATLG score were associated with more refusals of female LB physicians, while personal contact with LGB people was associated with less refusals of both groups. The observed prevalence of discrimination is significant. The results suggest that discrimination is based on emotional reasons and stereotypical beliefs. Educational efforts should be directed towards changing misconceptions about LGB people.

  19. Career and Family - Are They Compatible?: Results of a Survey of Male and Female Gynaecologists in Germany.

    Science.gov (United States)

    Hancke, K; Toth, B; Igl, W; Ramsauer, B; Bühren, A; Wöckel, A; Jundt, K; Ditsch, N; Gingelmaier, A; Rhiem, K; Vetter, K; Friese, K; Kreienberg, R

    2012-05-01

    Purpose: Nowadays, most gynaecologists are female and the compatibility of job-related career and family life is an upcoming issue. The working group "Gender and Career" of the German Society for Gynaecology and Obstetrics (DGGG) designed a survey to reflect the present situation with a focus on the compatibility of career and family. Material and Methods: A web-based 74-item survey was filled out by members of the DGGG. In total, there were 1037 replies, 75 % female (n = 775) and 25 % male (n = 261) gynaecologists. Results: 62 % of the female and 80 % of the male respondents had already finished their doctoral theses and 2 % female and 13 % male had finished their PhD. Mean number of children was 1.06 (SD 1.08) in female and 1.68 (SD 1.34) in male gynaecologists. The majority of females desired day care for their children, but only 5 to 13 % of employers offer any day care. 88 % of the female and 72 % of the male physicians think that job-related career and family are not compatible. Conclusion: The majority of female gynaecologists wished to have professional child care, but most employers or other institutions do not offer this. This might be one of the reasons why career and family appear incompatible.

  20. A Questionnaire Study on the Attitudes and Previous Experience of Croatian Family Physicians toward their Preparedness for Disaster Management.

    Science.gov (United States)

    Pekez-Pavliško, Tanja; Račić, Maja; Jurišić, Dinka

    2018-04-01

    To explore family physicians' attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia. The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis. Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster ( p =0.012), to carry out accepted triage principles used in the disaster situation ( p =0.003) and recognize differences in health assessments indicating potential exposure to specific agents ( p =0,001) compared to their female colleagues. Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.

  1. Employed family physician satisfaction and commitment to their practice, work group, and health care organization.

    Science.gov (United States)

    Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L

    2010-04-01

    Test a model of family physician job satisfaction and commitment. Data were collected from 1,482 family physicians in a Midwest state during 2000-2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure.

  2. Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt.

    Science.gov (United States)

    Eldein, Hebatallah Nour

    2013-01-01

    The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

  3. Educational needs of family physicians in Yazd province

    Directory of Open Access Journals (Sweden)

    M Karimi

    2012-02-01

    Conclusion: The gap between theory and practical training in the GP training is high with the expectation from family physicians and this needs to revised the curriculum of GP training which approved by the ministry of health.

  4. Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

    Science.gov (United States)

    Eniola, Kehinde; Evarts, Lori

    2017-05-01

    Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

  5. Evidence-based medicine in primary care: qualitative study of family physicians

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme

    2003-05-01

    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  6. Evidence-based medicine in primary care: qualitative study of family physicians.

    Science.gov (United States)

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G

    2003-05-09

    The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  7. The attitudes of family physicians toward a child with delayed growth and development.

    Science.gov (United States)

    Aker, Servet; Şahin, Mustafa Kürşat; Kınalı, Ömer; Şimşek Karadağ, Elif; Korkmaz, Tuğba

    2017-09-01

    Aim The purpose of this study was to assess the attitude of family physicians toward a child with delayed growth and development. Primary healthcare professionals play a key role in monitoring growth and development, the best indicator of the child's health status. If delayed growth and development can be detected early, then it is usually possible to restore functioning. This descriptive study was performed in Samsun, Turkey, in May and June 2015. In total, 325 family physicians were included. The study consisted of two parts. In the first session of the research, the story of an 18-month-old child with delayed growth and development was presented using visual materials. An interview between the child's mother and a member of primary healthcare staff was then enacted by two of the authors using role-playing. Subsequently, participants were given the opportunity to ask the mother and member of primary healthcare staff questions about the case. During the sessions, two observers observed the participants, took notes and compared these after the presentation. In the second part of the study, the participants were asked to complete a questionnaire consisting of three open-ended questions. Findings When asking questions of the mother, family physicians generally used accusatory and judgmental language. One of the questions most commonly put to the mother was 'Do you think you are a good mother?' Family physicians were keen to provide instruction for the patient and relatives. Family physicians to a large extent thought that the problem of a child with delayed growth and development can be resolved through education. Family physicians' manner of establishing relations with the patient and relatives is inappropriate. We therefore think that they should receive on-going in-service training on the subject.

  8. Difficulties facing physician mothers in Japan.

    Science.gov (United States)

    Yamazaki, Yuka; Kozono, Yuki; Mori, Ryo; Marui, Eiji

    2011-11-01

    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce. © 2011 Tohoku University Medical Press

  9. Difficulties faced by family physicians in primary health care centers in Jeddah, Saudi Arabia

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    Sahar H Mumenah

    2015-01-01

    Full Text Available Aim: The aim was to determine the difficulties faced by family physicians, and compare how satisfied those working with the Ministry of Health (MOH are with their counterparts who work at some selected non-MOH hospitals. Methods: An analytical, cross-sectional study was conducted at King Abdulaziz University Hospital, King Faisal Specialist Hospital and Research Center (KFSH and RC, and 40 MOH primary health care centers across Jeddah. A structured multi-item questionnaire was used to collect demographic data and information on the difficulties family physicians face. The physicians′ level of satisfaction and how it was affected by the difficulties was assessed. Results: Women constituted 71.9% of the sample. Problems with transportation formed one of the main difficulties encountered by physicians. Compared to non-MOH physician, a significantly higher proportion of MOH physicians reported unavailability of radiology technicians (P = 0.011 and radiologists (P < 0.001, absence of the internet and computer access (P < 0.001, unavailability of laboratory services (P = 0.004, reagents (P = 0.001, X-ray equipment (P = 0.027, ultrasound equipment (P < 0.001, an electronic medical records system (P < 0.001, insufficient laboratory tests (P = 0.0001, and poor building maintenance (P < 0.001. Family physicians with the MOH were less satisfied with their jobs compared with non-MOH physicians (P = 0.032. Conclusion: MOH family physicians encountered difficulties relating to staff, services, and infrastructure, which consequently affected their level of satisfaction.

  10. Doing the Same and Earning Less: Male and Female Physicians in a New Medical Specialty

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    Timothy J. Hoff

    2004-09-01

    Full Text Available This study presents findings from a national survey of physicians working in the emerging career of hospital medicine. It finds that female hospitalists earn significantly less annually than male hospitalists, despite similar work schedules and commitments; that these similarities in work and differences in pay remain even for male and female hospitalists who are married and have children; and that female hospitalists maintain positive feelings toward their work careers despite assuming multiple work and nonwork roles simultaneously. The results present a unique picture of female physicians career experiences in toto. They have implications for how health care organizations and managers should think about the contemporary female physician (e.g., her career development needs and workplace challenges; for female physicians need to gain greater equity vis-à-vis men within the profession; and for the kinds of questions researchers should raise around physician gender in their work.

  11. Survey of family physicians' perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs.

    Science.gov (United States)

    Papic, Ognjen; Malak, Ziad; Rosenberg, Ellen

    2012-02-01

    Immigrants in Canada form a significant portion of the population and have unique and complex health needs. This study was undertaken to evaluate family physicians' perspectives on the care of this population. Questionnaires were distributed to family physicians in Montreal (n=598). The main outcomes of interest were attitudes of family physicians to care of immigrants including barriers perceived, resources and strategies used to accommodate immigrant patients, as well as physicians' training in immigrant care. Family physicians find communication difficulties to be the key barrier and would like to see the access to interpreters improved. Very few physicians make use of professional interpreters. Only a minority of physicians have received specific cross-cultural competence training but those who have seem to provide better quality of care. Knowledge of physician perspectives is an essential element on which to base interventions to improve the quality of care to this population. Physicians should be reminded of the importance of using professional interpretation services in multi-lingual encounters. Cross-cultural training should be further advanced in Canadian medical curricula. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. The new generation of family physicians - career motivation, life goals and work-life balance

    OpenAIRE

    Buddeberg-Fischer, B; Stamm, M; Buddeberg, C; Klaghofer, R

    2008-01-01

    QUESTIONS UNDER STUDY: The present study aimed to investigate the differences between future family physicians, and physicians aspiring to other medical specialities, in terms of sociodemographic factors and variables concerning personality factors, career motivation, career success, importance of life goals and work-life balance; further, the stability in career choice of family physicians from medical school through to residency was evaluated. METHODS: Data reported are from four assessment...

  13. How family physicians respond to unpleasant emotions of ethnic minority patients.

    Science.gov (United States)

    Aelbrecht, Karolien; De Maesschalck, Stéphanie; Willems, Sara; Deveugele, Myriam; Pype, Peter

    2017-10-01

    The diversity in our society makes patient-centered care more difficult. In this study, we aim to describe how family physicians respond to unpleasant emotions of ethnic minority patients. One hundred ninety one consultations of family physicians with ethnic minority patients were video-recorded and analyzed using the Verona Codes for Provider Responses (VR-CoDES-P) to describe physicians' responses to patients' expressed unpleasant emotions or cues (implicit) and concerns (explicit). 42.4% (n=81) of all the consultations contained no cues or concerns, and thus no physician responses. Of the consultations containing at least one cue or concern, a mean of 3.45 cues and a mean of 1.82 concerns per consultation were found. Physicians are significantly (p≤0.001) more frequently stimulating further disclosure of patients' cues and concerns (providing space: n=339/494 or 68.6% versus reducing space: n=155/494 or 31.4%). However, these explorations are more often about the factual, medical content of the cue than about the emotion itself (n=110/494 or 22.3% versus n=79/494 or 16%). The inter-physician variation in response to patients' cues is larger than the variation in response to the patient's concerns. Although family physicians are quite often providing room for patients' emotions, there is much room for improvement when it comes to explicitly talking about emotional issues with patients. Further research should focus on a more qualitative in-depth analysis of the complex interplay between culture and language of ethnic minority patients in primary care and, consequently, create awareness among these healthcare providers about the importance of ethnic minority patients' emotions and how to respond accordingly. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint

    Science.gov (United States)

    Badran, Hani; Grad, Roland

    2015-01-01

    Background Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. PMID:25803184

  15. Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity.

    Science.gov (United States)

    Sarma, Sisira; Devlin, Rose Anne; Belhadji, Bachir; Thind, Amardeep

    2010-12-01

    To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care. Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously. To this end, we estimate a system of work activity equations and allow for correlated errors. Our results show that the mode of remuneration has little effect on the total hours worked after accounting for the endogeneity of remuneration schemes; however it does affect the allocation of time to different activities. We find that physicians working in non-fee-for-service remuneration schemes spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings, and more hours on indirect patient care. Canadian family physicians working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and devote more hours to indirect patient care. The allocation of time in non-fee-for-service practices may have some implications for quality improvement. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. Personal values of family physicians, practice satisfaction, and service to the underserved.

    Science.gov (United States)

    Eliason, B C; Guse, C; Gottlieb, M S

    2000-03-01

    Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians

  17. Youth Mental Health, Family Practice, and Knowledge Translation Video Games about Psychosis: Family Physicians' Perspectives.

    Science.gov (United States)

    Ferrari, Manuela; Suzanne, Archie

    2017-01-01

    Family practitioners face many challenges providing mental healthcare to youth. Digital technology may offer solutions, but the products often need to be adapted for primary care. This study reports on family physicians' perspectives on the relevance and feasibility of a digital knowledge translation (KT) tool, a set of video games, designed to raise awareness about psychosis, marijuana use, and facilitate access to mental health services among youth. As part of an integrated knowledge translation project, five family physicians from a family health team participated in a focus group. The focus group delved into their perspectives on treating youth with mental health concerns while exploring their views on implementing the digital KT tool in their practice. Qualitative data was analyzed using thematic analysis to identify patterns, concepts, and themes in the transcripts. Three themes were identified: (a) challenges in assessing youth with mental health concerns related to training, time constraints, and navigating the system; (b) feedback on the KT tool; and, (c) ideas on how to integrate it into a primary care practice. Family practitioners felt that the proposed video game KT tool could be used to address youth's mental health and addictions issues in primary care settings.

  18. Perspectives of family medicine physicians on the importance of adolescent preventive care: a multivariate analysis.

    Science.gov (United States)

    Taylor, Jaime L; Aalsma, Matthew C; Gilbert, Amy L; Hensel, Devon J; Rickert, Vaughn I

    2016-01-20

    The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. Pediatricians were significantly more likely (p family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.

  19. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences

    Directory of Open Access Journals (Sweden)

    Schwappach David

    2008-10-01

    Full Text Available Abstract Background Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict – namely work interfering with family conflict (WIF – which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Methods Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April–July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9% participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ, work interfering with family conflict scale (WIF, and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. Results German hospital physicians reported elevated levels of WIF (mean = 74 compared to the general German population (mean = 45, p p Conclusion In our study, work interfering with family conflict (WIF as part of Work-Family Conflict (WFC was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.

  20. Attitudes toward Management of Sickle Cell Disease and Its Complications: A National Survey of Academic Family Physicians

    Directory of Open Access Journals (Sweden)

    Arch G. Mainous

    2015-01-01

    Full Text Available Objective. Sickle cell disease (SCD is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician’s attitudes toward SCD management. Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD. Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS tools would be useful for treatment (69.4% and avoiding complications (72.6% in managing SCD patients. Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients.

  1. Family physicians' professional identity formation: a study protocol to explore impression management processes in institutional academic contexts.

    Science.gov (United States)

    Rodríguez, Charo; Pawlikowska, Teresa; Schweyer, Francois-Xavier; López-Roig, Sofia; Bélanger, Emmanuelle; Burns, Jane; Hugé, Sandrine; Pastor-Mira, Maria Ángeles; Tellier, Pierre-Paul; Spencer, Sarah; Fiquet, Laure; Pereiró-Berenguer, Inmaculada

    2014-09-06

    Despite significant differences in terms of medical training and health care context, the phenomenon of medical students' declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians' professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians' professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies.

  2. Work Values and Job Satisfaction of Family Physicians

    Science.gov (United States)

    Bouwkamp-Memmer, Jennifer C.; Whiston, Susan C.; Hartung, Paul J.

    2013-01-01

    Theory and prior research suggest linkages between work values and job satisfaction. The present study examined such linkages in a group of workers in a professional occupation. Family physicians (134 women, 206 men, 88% Caucasian) responded to context-specific measures of work values and job satisfaction. ANOVA results indicated a work values…

  3. Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

    Science.gov (United States)

    Mehter, Hashim M; McCannon, Jessica B; Clark, Jack A; Wiener, Renda Soylemez

    2018-02-01

    Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making. Semistructured interviews were conducted with 18 critical care physicians from four academically affiliated hospitals. Interview transcripts were analyzed using methods of grounded theory. Physicians described strategies for engaging families to resolve conflict about end-of-life decision-making and tending to families' emotional health. Physicians commonly began by gauging family receptiveness to recommendations from the healthcare team. When faced with resistance to recommendations for less aggressive care, approaches ranged from deference to family wishes to various persuasive strategies designed to change families' minds, and some of those strategies may be counterproductive or harmful. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family's "substituted judgment" and the ability to control patient pain and suffering. Physicians reported concern for the family's emotional needs and made efforts to alleviate the burden on families by assuming decision-making responsibility and expressing nonabandonment and commitment to the patient. Physicians were attentive to repairing damage to their relationship with the family in the aftermath of conflict. Finally, physicians described their own emotional responses to conflict, ranging from frustration and anxiety to satisfaction with successful resolution of conflict. Critical care physicians described a complex and multilayered approach to physician-family conflict. The reported strategies

  4. Physician Communication to Enhance Patient Acupuncture Engagement in Family Medicine.

    Science.gov (United States)

    Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul

    2018-04-09

    Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.

  5. [Compatibility of Work and Family Life: Survey of Physicians in the Munich Metropolitan Area].

    Science.gov (United States)

    Lauchart, Meike; Ascher, Philipp; Kesel, Karin; Weber, Sabine; Grabein, Beatrice; Schneeweiss, Bertram; Fischer-Truestedt, Cordula; Schoenberg, Michael; Rogler, Gudrun; Borelli, Claudia

    2017-05-15

    Aim Investigation of the compatibility of work and family life for physicians in the Munich metropolitan area. Methods Survey of a representative sample of 1,800 physicians using a questionnaire. Results Men were less satisfied (7% very satisfied vs. 21%) with compatibility between work and family life than women. The group least satisfied overall was hospital-based physicians (p=0.000, chi-square=122.75). Women rather than men cut back their career due to children, perceived their professional advancement as impaired, desisted from establishing private practice or quit hospital employment altogether. Respondents strove for flexible childcare and makeshift solution if the established service failed. Most did not have that at their disposal. Hospital-based physicians wished for predictable working hours, and would like to have a say in the structure of their schedule. For the majority this was not the case. While for 80% it would be important to participate in the definition of their working hours, this was only possible in 17%. 86% found the opportunity to work part-time important, but many doctors (more than 30%) did not have that option. The biggest help for office-based physicians would be an expedited procedure by the Bavarian Association of Statutory Health Insurance Physicians (KVB) when applying for a proxy. The second most important would be the ability to hand over on-call duties. 36% of respondents felt that compatibility of work and family life was best achieved outside of patient care, during residency 42% believed this to be the case. Only 6% of physicians felt the best compatibility to be achieved in a hospital. Among the physician owners of practices, 34% considered their model to be the best way to reconcile both aspects of life. Conclusion More flexible options for childcare and more influence on the definition of working hours are necessary in order to better reconcile work and family life. For office-based physicians it must be made easier to

  6. Walking and neighborhood environments for obese and overweight patients: perspectives from family physicians.

    Science.gov (United States)

    Hong, Yan; Ory, Marcia G; Lee, Chanam; Wang, Suojin; Pulczinksi, Jairus; Forjuoh, Samuel N

    2012-05-01

    Primary care practitioners can play a significant role in helping patients adopt healthy behaviors such as physical activity (PA). The aim of this qualitative study was to assess family physicians' understanding and perception of the personal and environmental factors influencing PA, especially walking, and factors affecting their counseling of obese patients about environmental motivators and barriers to PA. We conducted five focus groups with 35 family physicians and 14 family medicine residents in four clinics and a residency program affiliated with CenTexNet, a primary care practice-based research network in central Texas. Data were transcribed and analyzed using thematic content analysis. Physicians were aware of the PA guidelines, but not many actually brought up PA during their counseling of patients. Physicians agreed that neighborhood environments are important for walking and reported that their patients often brought up environmental barriers. Physicians recommended walking as an ideal type of PA for obese patients and sidewalks, parks, and trails/tracks with smooth and soft surfaces as ideal places to engage in walking. However, they rarely talked about these factors with their patients due to a perceived ineffectiveness in counseling, an inability to address environmental factors, and time constraints in the medical encounter. While physicians believe neighborhood environments often present many barriers to PA, they still believe that environmental factors are secondary to personal motivation in promoting PA among obese patients. Physicians, if better informed of the growing evidence on the environment-PA links, may be able to facilitate patients' behavior change more effectively.

  7. Family physicians' awareness and knowledge of the Genetic Information Non-Discrimination Act (GINA).

    Science.gov (United States)

    Laedtke, Amanda L; O'Neill, Suzanne M; Rubinstein, Wendy S; Vogel, Kristen J

    2012-04-01

    Historically, physicians have expressed concern about their patients' risk of genetic discrimination, which has acted as a barrier to uptake of genetic services. The Genetic Information Nondiscrimination Act of 2008 (GINA) is intended to protect patients against employer and health insurance discrimination. Physicians' awareness and knowledge of GINA has yet to be evaluated. In 2009, we mailed surveys to 1500 randomly selected members of the American Academy of Family Physicians. Questions measured physicians' current knowledge of GINA and their level of concern for genetic discrimination. In total, 401 physicians completed the survey (response rate 26.9%). Approximately half (54.5%) of physicians had no awareness of GINA. Of physicians who reported basic knowledge of GINA, the majority were aware of the protections offered for group health insurance (92.7%), private health insurance (82.9%), and employment (70.7%). Fewer physicians were aware of GINA's limitations regarding life insurance (53.7%) and long-term care insurance (58.8%). Physicians demonstrated highest levels of concern for health insurance, life insurance, and long-term care insurance discrimination, with less concern for employer and family/social discrimination. Level of concern for the risk of genetic discrimination did not correlate significantly with awareness of GINA. Approximately 17 months after GINA was signed into federal law, physicians' knowledge remained limited regarding the existence of this legislation and relevant details. Physicians who are aware of GINA continue to have significant concerns regarding the risk of genetic discrimination. This study reveals the need to further educate physicians about the existence of GINA and the protections offered.

  8. Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences.

    Science.gov (United States)

    Fuss, Isabelle; Nübling, Matthias; Hasselhorn, Hans-Martin; Schwappach, David; Rieger, Monika A

    2008-10-07

    Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict--namely work interfering with family conflict (WIF)--which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April-July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9%) participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. German hospital physicians reported elevated levels of WIF (mean = 74) compared to the general German population (mean = 45, p work, elevated number of days at work despite own illness, and consequences of short-notice changes in the duty roster. Good sense of community at work was a protective factor. Compared to the general German population, we observed a significant higher level of quantitative work demands among hospital physicians (mean = 73 vs. mean = 57, p work ability, and higher satisfaction with life in general. Compared to the German general population, physicians showed significantly higher levels of individual stress and quality of life as well as lower levels for well-being. This has to be judged as an alerting finding regarding the state of physicians' health. In our study, work

  9. Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.

    Science.gov (United States)

    Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba

    2014-01-01

    Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

  10. Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

    Directory of Open Access Journals (Sweden)

    Keri Hager

    2018-02-01

    Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the

  11. Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

    Science.gov (United States)

    Cabrera Pivaral, C E; Gutiérrez Roman, E A; Gonzalez Pérez, G; Gonzalez Reyes, F; Valadez Toscano, F; Gutiérrez Ruvalcaba, C; Rios Riebeling, C D

    2008-02-01

    There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

  12. Convergence or divergence of male and female physicians' hours of work and income.

    Science.gov (United States)

    Dedobbeleer, N; Contandriopoulos, A P; Desjardins, S

    1995-08-01

    This article verifies if the increase in the percentage of women in the medical profession led to the convergence of male and female physicians' hours of work as well as income. Active physicians in Quebec in 1978 were compared to the ones in 1988. Data were obtained from the computerized files of the Quebec Corporation of Physicians and the Régie d'assurance-maladie du Quebec. Despite the increasing representation of women in the medical profession, gender differences in hours worked and income remained. However, results also showed a tendency toward a convergence in total hours of work, more behavioral variation among women physicians and some behavioral change among men. The experience of the past should thus not be used as the basis for projections of future physician productivity or for medical manpower planning purposes without a careful analysis of trends in behavioral changes.

  13. Role of the family physician in reducing deaths due to obstetric ...

    African Journals Online (AJOL)

    Family Medicine became a registered specialty in 2007. A consensus was reached on the core competencies that were needed for a family physician (FP). These competencies were encapsulated in the 5 unit standards that are exit outcomes for FPs. The re-engineering of primary health care (PHC) and the introduction of ...

  14. Work family balance, stress, and salivary cortisol in men and women academic physicians.

    Science.gov (United States)

    Bergman, B; Ahmad, F; Stewart, D E

    2008-01-01

    The stress of medical practice has been recurrently studied, but work- and family-related determinants of health by gender remain under researched. To test the hypothesis that cortisol excretion would be affected by the perceived severity of total workload imbalance. By hierarchical regression analysis, the associations between work-family balance and diurnal salivary cortisol levels by sex in academic physicians (n = 40) were investigated. Men physicians reported more paid work hours per week than women physicians and women more time in childcare, but their total working hours were similar. Controlling for sex and age, the mean of the diurnal cortisol release was associated with a combined effect of sex and responsibility at home. When morning cortisol, sex, and children at home were held constant, cortisol levels in the evening were associated with responsibility at home without significant gender interaction. With increasing responsibility at home, women and men reacted differently with regard to cortisol responses over the day. However, in the evening, controlling for the morning cortisol, these gender differences were not as obvious. These findings highlight traditional gender patterns among both women and men physicians in the challenge of finding a balance between work and family.

  15. Behavioral science priorities in residency education: The perspective of practicing family physicians.

    Science.gov (United States)

    Brandt-Kreutz, Richard L; Ferguson, Kyle E; Sawyer, Devin

    2015-12-01

    The family medicine residency behavioral science curriculum is more effective if prioritized to match what is needed in practice after graduation. Two prior studies (Kendall, Marvel, & Cruickshank, 2003; Marvel & Major, 1999) identified physician priorities for behavioral science education. The present study extends this research to include topics from more recent curriculum guidelines and examines the extent to which size of community and perceived competence correlate with prioritization of Washington state family physicians. Practicing family physicians in Washington state (N = 2,270) were invited to complete the survey. Respondents provided demographic and practice information. Respondents then rated, on a scale from 1 to 4, 35 behavioral science topics on 2 different scales including (a) priority to be given in residency education and (b) perceived level of competence. A total of 486 responded and 430 completed both priority and competence scales for a response rate of 19%. The top half of 35 topics of the present study included the top 13 topics found in the 2 prior studies. Priority and competence scales were moderately correlated (r = .48, n = 430, p = .001). There was a small significant correlation with size of community and priority ratings (r = .13, n = 435, p = .006). Family physicians in Washington state prioritize behavioral science topics in residency education similar to Colorado and Mississippi. The results of this study support recent ACGME guidelines, in that training should focus on common psychiatric illnesses, including depression and anxiety, and interpersonal processes. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  16. Family physicians' attitude and practice of infertility management at ...

    African Journals Online (AJOL)

    Introduction: The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service ...

  17. Physicians' attitudes about interprofessional treatment of chronic pain: family physicians are considered the most important collaborators.

    Science.gov (United States)

    Klinar, Ivana; Ferhatovic, Lejla; Banozic, Adriana; Raguz, Marija; Kostic, Sandra; Sapunar, Damir; Puljak, Livia

    2013-06-01

    Interprofessional collaboration is the process in which different professional groups work together to positively impact health care. We aimed to explore physicians' attitudes toward interprofessional collaboration in the context of chronic pain management with the implication that if attitudes are not positive, appropriate interventions could be developed. A quantitative attitudes study. The ethical committee approved the study. A web-based survey about interprofessional treatment of chronic pain was administered to physicians. Outcome measures were as follows: physicians' demographic and workplace information, previous experience of working within an interprofessional team, and attitudes towards interprofessional collaboration in chronic pain management. There were 90 physicians who responded to the survey. Physicians had positive attitudes towards team work in the context of chronic pain, but they were undecided about sharing their role within an interprofessional team. The family physician was singled out as the most important as well as the most common collaborator in chronic pain treatment. Interprofessional educational seminars and workshops were suggested as methods for improving interprofessional collaboration. Interprofessional collaboration may be enhanced with continuing medical education that will bring together different healthcare professionals, enable them to exchange experiences and learn about their potential roles within a team. © 2012 Nordic College of Caring Science.

  18. An Examination of Family Physicians Plan Implementation in Rural ...

    African Journals Online (AJOL)

    Background: Family physician plan (FPP) and referral system (RS) is one of the major plans in Iran's health system with the aim of increasing the accountability in the health market, enhancing the public's access to the health services, lowering the unnecessary costs and equitable distribution of health across the society.

  19. Physicians' perceptions of and approaches to woman abuse. Does certification in family medicine make a difference?

    OpenAIRE

    Tudiver, F.; Permaul-Woods, J. A.

    1996-01-01

    OBJECTIVE: To discover whether family physicians who go through residency training and The College of Family Physicians of Canada's (CFPC) certification process are more responsive than other physicians to woman abuse, whether they perceive and approach such abuse more appropriately, and whether they seek out more education on the subject. DESIGN: A national survey using a pretested 43-item mailed questionnaire to examine perceptions of and approaches to detection and management of woman abus...

  20. Perceptions of the first family physicians to adopt advanced access in the province of Quebec, Canada.

    Science.gov (United States)

    Breton, Mylaine; Maillet, Lara; Paré, Isabelle; Abou Malham, Sabina; Touati, Nassera

    2017-10-01

    In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi-structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early-adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

    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.

  2. Inter-Provincial Migration Intentions of Family Physicians in Canada: The Roles of Income and Community Characteristics.

    Science.gov (United States)

    Mou, Haizhen; Olfert, M Rose

    2015-11-01

    The inter-provincial migration patterns of family physicians in canada show that some provinces like newfoundland and saskatchewan experience persistent net out-migration, while others, including ontario and british columbia, are destinations more often than origins of migrants. Governments in provinces exhibiting net out-migration have responded with a number of incentive and recruitment programs. In this study, we investigate the determinants of the stated interprovincial migration intentions of 3,995 rural and urban family physicians in the 2010 wave of the national physician survey. We consider a range of physician characteristics, community attributes and working conditions. We find that in the intention to move, higher compensation has a modest effect, while the community characteristics have a consistently important influence. Our results suggest that policy and program designers should acknowledge the critical role of community-level living and working conditions in their family physician recruitment and retention efforts. Copyright © 2015 Longwoods Publishing.

  3. [The Quality of the Family Physician-Patient Relationship. Patient-Related Predictors in a Sample Representative for the German Population].

    Science.gov (United States)

    Dinkel, Andreas; Schneider, Antonius; Schmutzer, Gabriele; Brähler, Elmar; Henningsen, Peter; Häuser, Winfried

    2016-03-01

    Patient-centeredness and a strong working alliance are core elements of family medicine. Surveys in Germany showed that most people are satisfied with the quality of the family physician-patient relationship. However, factors that are responsible for the quality of the family physician-patient relationship remain unclear. This study aimed at identifying patient-related predictors of the quality of this relationship. Participants of a cross-sectional survey representative for the general German population were assessed using standardized questionnaires. The perceived quality of the family physician-patient relationship was measured with the German version of the Patient-Doctor Relationship Questionnaire (PDRQ-9). Associations of demographic and clinical variables (comorbidity, somatic symptom burden, psychological distress) with the quality of the family physician-patient relationship were assessed by applying hierarchical linear regression. 2278 participants (91,9%) reported having a family physician. The mean total score of the PDRQ-9 was high (M=4,12, SD=0,70). The final regression model showed that higher age, being female, and most notably less somatic and less depressive symptoms predicted a higher quality of the family physician-patient relationship. Comorbidity lost significance when somatic symptom burden was added to the regression model. The final model explained 11% of the variance, indicating a small effect. Experiencing somatic and depressive symptoms emerged as most relevant patient-related predictors of the quality of the family physician-patient relationship. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Alberta family physicians? willingness to work during an influenza pandemic: a cross-sectional study

    OpenAIRE

    Dickinson, James A; Bani-Adam, Gisoo; Williamson, Tyler; Berzins, Sandy; Pearce, Craig; Ricketson, Leah; Medd, Emily

    2013-01-01

    Objective Effective pandemic responses rely on frontline healthcare workers continuing to work despite increased risk to themselves. Our objective was to investigate Alberta family physicians willingness to work during an influenza pandemic. Design: Cross-sectional survey. Setting: Alberta prior to the fall wave of the H1N1 epidemic. Participants: 192 participants from a random sample of 1000 Alberta family physicians stratified by region. Main Outcome Measures: Willingness to work through di...

  5. [Physician's professional retirement. Family dynamics].

    Science.gov (United States)

    Aguirre Gas, Héctor G

    2011-01-01

    Human beings have a natural resistance to think about their old age, both personally and professionally. Governments have targeted efforts to successfully prolong the life of the population, situation which already is a social and economic problem. “Old is a person with physical, intellectual and emotional limitations, who has a reduced autonomy and welfare, as a result of the years lived”. Not everyone ages at the same age; it will depend on health, habits, physical and intellectual activity, nutritional status, vices and attitude towards life. A physician may decide not to continue exercising medicine due to: health problems, because they do not want to, because they do not feel competent, because of the risk of having to deal with a complaint or a lawsuit, to have a new life project, or because they have no patients. The options available for a doctor at the time of retirement will depend on his/her age, health status, stage of the aging process: autonomy, dependency or old age; his/her physical and mental condition, professional development, economic situation and family environment. A doctor may remain independent, join another family or seek shelter in a retirement home.

  6. Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians.

    Science.gov (United States)

    Hunchak, Cheryl; Tannenbaum, David; Roberts, Michael; Shah, Thrushar; Tisma, Predrag; Ovens, Howard; Borgundvaag, Bjug

    2015-03-01

    Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information. Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys. Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ''often'' or ''always'' aware of patient ED visits, used the portal ''always'' or ''regularly'' to access patients' health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care. Introduction of a web-based ED visit communication tool improved ED-family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.

  7. Identifying frailty in primary care: a qualitative description of family physicians' gestalt impressions of their older adult patients.

    Science.gov (United States)

    Korenvain, Clara; Famiyeh, Ida-Maisie; Dunn, Sheila; Whitehead, Cynthia R; Rochon, Paula A; McCarthy, Lisa M

    2018-05-14

    Many tools exist to guide family physicians' impressions about frailty status of older adults, but no single tool, instrument, or set of criteria has emerged as most useful. The role of physicians' subjective impressions in frailty decisions has not been studied. This study explores how family physicians conceptualize frailty, and the factors that they consider when making subjective decisions about patients' frailty statuses. Descriptive qualitative study of family physicians who practice in a large urban academic family medicine center as they participated in one-on-one "think-aloud" interviews about the frailty status of their patients aged 80 years and over. Of 23 eligible family physicians, 18 shared their impressions about the frailty status of their older adult patients and the factors influencing their decisions. Interviews were audio-recorded, transcribed, and thematically analyzed. Four themes were identified, the first of which described how physicians conceptualized frailty as a spectrum and dynamic in nature, but also struggled to conceptualize it without a formal definition in place. The remaining three themes described factors considered before determining patients' frailty statuses: physical characteristics (age, weight, medical conditions), functional characteristics (physical, cognitive, social) and living conditions (level of independence, availability of supports, physical environment). Family physicians viewed frailty as multifactorial, dynamic, and inclusive of functional and environmental factors. This conceptualization can be useful to make comprehensive and flexible evaluations of frailty status in conjunction with more objective frailty tools.

  8. Are people in Tehran prepared for the family physician program?

    Directory of Open Access Journals (Sweden)

    Azam Majidi

    2014-01-01

    Full Text Available Background: Upon successful experiences of family physician program in the rural regions, Iranian Ministry of Health and Medical Education (MOHME made a decision to expand this program to urban areas. For this reason a pilot program were designated and some cities have been selected to determine dos and don′ts of performing family physician program in the cities. Various studies were published during this period demonstrating the advantages and disadvantages of family physicians′ care in these cities. After this process in 2012 and 2013 MOHME announced implementation of family physician program in Tehran. Our study investigated public attitudes, knowledge and practice about the newly introduced program. Methods: This cross-sectional study was performed in Tehran during November to December 2012. A telephone survey was carried out using the Random Digit Dialing (RDD method and data was gathered by a researcher designed questionnaire. A total of 386 residents aged 18 years and over participated in the study. To compare the differences between various groups′ knowledge scores data were analyzed performing Chi-square test, t-test, ANOVA, and logistic regression by SPSS software version 17, to find factors that affected individuals′ agreement with the program. Results: Among all samples 214(57.4% knew about the program and almost 120(85.1% of these aware people were planning to participate in the program. Television and Radio were the major information resources. After adjusting for Educational status, Access to Internet and Socio Economic Status(SES those people who didn′t have any kind of health coverage systems(Health insurance were most likely to accept the program and agree with that[OR= 2.38(1.05-5.38 ]. Conclusions: The fact that despite low levels of information, most of aware people intend to enroll in the new program reveals that expanding informative programs would bring more participation and involvement among community.

  9. Male Involvement in Family Planning Decision Making in Ile-Ife ...

    African Journals Online (AJOL)

    Erah

    ORIGINAL RESEARCH ARTICLE. Male Involvement ... However, fertility and family planning research and .... design, employing both quantitative and qualitative research .... Table 2: Types of family planning methods known to male residents ...

  10. [Family physician attitudes towards insulinization in type II diabetics].

    Science.gov (United States)

    Díaz-Rodríguez, M I; Sánchez-Morales, M C; Aceña-Gutiérrez, M T; Carrasco-Flores, J; Villarín-Castro, A

    2014-04-01

    To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  11. The Hispanic family and male-female relationships: an overview.

    Science.gov (United States)

    Galanti, Geri-Ann

    2003-07-01

    An overview of the traditional Hispanic family and male-female relationships is presented, with an emphasis on issues relevant to providing health care to Hispanic populations. Aspects of the family presented include visitation, decision making, self-care, and emotional problems. Male-female relationships stem from traditional gender roles. Machismo and patriarchal authority characterize the male role; the roles of a traditional woman are housewife and mother. Women are expected to defer to the authority of their husbands. The negative aspects of machismo can result in heavy drinking and the pursuit of high-risk activities, leading to domestic violence and HIV/AIDS. These health risks are exacerbated by such cultural factors as male dominance, female modesty, and the practice of keeping problems within the family. The importance of personalism in patient-provider encounters is emphasized.

  12. Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico.

    Science.gov (United States)

    Hojat, M; Nasca, T J; Cohen, M J; Fields, S K; Rattner, S L; Griffiths, M; Ibarra, D; de Gonzalez, A A; Torres-Ruiz, A; Ibarra, G; Garcia, A

    2001-01-01

    Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

  13. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators.

    Science.gov (United States)

    Von Pressentin, Klaus B; Mash, Bob J; Esterhuizen, Tonya M

    2017-04-28

    The supply of appropriate health workers is a key building block in the World Health Organization's model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011. This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators. All 52 South African health districts were included as units of analysis. An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015. Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district. The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician's circle of control may be better positioned to demonstrate a measurable impact in the short term.

  14. Dutch family physicians' awareness of cognitive impairment among the elderly

    NARCIS (Netherlands)

    van den Dungen, P.; van Charante, E.P.M.; van de Ven, P.M.; Foppes, G.; van Campen, J.P.C.M.; van Marwijk, H.W.J.; van der Horst, H.E.; van Hout, H.P.J.

    2015-01-01

    Background: Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians' (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs' awareness

  15. Rural physicians' perspectives on cervical and breast cancer screening: a gender-based analysis.

    Science.gov (United States)

    Ahmad, F; Stewart, D E; Cameron, J I; Hyman, I

    2001-03-01

    Several studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians' mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians' gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.

  16. Monitoring of international normalized ratios: comparison of community nurses with family physicians.

    Science.gov (United States)

    Levine, Max A; Shao, Wei; Klein, Douglas

    2012-08-01

    To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring. A retrospective cohort analysis of patients taking long-term warfarin therapy. The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta. Medical records of patients currently taking warfarin were examined. Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring. The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared. Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789). Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings.

  17. Dutch family physicians' awareness of cognitive impairment among the elderly

    NARCIS (Netherlands)

    van den Dungen, Pim; Moll van Charante, Eric P.; van de Ven, Peter M.; Foppes, Gerbrand; van Campen, Jos P. C. M.; van Marwijk, Harm W. J.; van der Horst, Henriëtte E.; van Hout, Hein P. J.

    2015-01-01

    Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians' (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs' awareness of cognitive

  18. The Filipino male as a target audience in family planning.

    Science.gov (United States)

    Vitug, W

    1986-01-01

    Since the official launching of the Philippine Population Program in 1970, family planning campaigns have substantially addressed themselves to women. The suggestion to devote equal, if not more, attention to men as family planning targets had been raised by Dr. Mercado as early as 1971. It was not until 1978, that the deliberate inclusion of males as a target audience in family planning became a matter of policy. The Population Center Foundation (PCF), from 1979 to 1982, carried out research projects to determine the most suitable approaches and strategies to reach Filipino men. The objectives of the PCF's Male Specific Program are: 1) to test alternative schemes in promoting male family planning methods through pilot-testing of family planning clinics for men, 2) to develop teaching materials geared toward specific segments of the male population, 3) to undertake skills training in male-specific motivational approaches for program professionals, and 4) to assess the extent of the husband's role in family planning. An important finding of 1 study was that most outreach workers were female stood in the way of the motivation process, thus hampering the campaign. While the consultative motivational skills training improved knowledge, attitudes, and skills of outreach workers with regard to vasectomy and the motivation process, there were certain predispositions that were hindering the fieldworkers' effectiveness in motivating target clients. Overall, in-depth, 1-to-1 motivation in dealing with men is needed to strengthen internalization of family planning values.

  19. Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

    Directory of Open Access Journals (Sweden)

    Jia Lee, PhD, RN

    2010-12-01

    Conclusions: There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

  20. Nine years of publications on strengths and weaknesses of Family Physician Program in rural area of Iran: A systematic review

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2016-12-01

    Full Text Available Introduction: One of the most important duties of a family physician is to provide primary health care. This is completely considered in the Family Physician Program for a target population. The aim of this study was to systematically review the Family Physician and Referral System strength and weakness in rural area of Iran. Methods: In this systematic review, Scientific Information Database (SID, Science Direct, and PubMed databases were searched and Google search engine was employed using key words such as family medicine, family physician, and referral system for the period of January 2005 to June 2013, both in English and Persian. For identifying duplicated references, Endnote Software was used and for summarizing results of fully assessed articles extraction table was employed. Results: Strengths and weaknesses of Family Physician Program and referral system in rural areas of Iran were extracted from 28 studies. In total, 115 weaknesses (3.96 per study and 103 strengths (3.55 per study were obtained. Content analysis was used and 218 items were summarized into 29 items. Strengths of Family Physician Program were: access of villagers to health services, filling health document for clients, improving services for pregnant mothers, and family planning; while its obvious weaknesses included repeated unnecessary referral of clients as well as lack of providing job stability. Conclusion: Results of studies conducted in Iran showed that Family Physician and Referral System in rural area of Iran could not be successful enough and has many shortcomings. Therefore, a growing body of effective changes must be made for a better performance and to obtain better outcomes.

  1. Preconception care by family physicians and general practitioners in Japan

    Directory of Open Access Journals (Sweden)

    Fetters Michael D

    2005-07-01

    Full Text Available Abstract Background Preconception care provided by family physicians/general practitioners (FP/GPs can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. Methods A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. Results Two hundred and sixty-eight of 347 (77% eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%, and the least was about folic acid supplementation (12%. Many participants reported providing smoking cessation in their practice (60%, though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10% or folic acid supplementation (4%. About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. Conclusion FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

  2. How do physicians and their partners coordinate their careers and private lives?

    Science.gov (United States)

    Stamm, Martina; Buddeberg-Fischer, Barbara

    2011-03-25

    Over the past few years, there has been increasing interest in the question of how couples coordinate their careers and private lives. The aim of this study was to investigate the career arrangements of physicians and their partners according to gender and parenthood status, and to compare dual-physician couples with other types of couples. Data pertaining to 414 physicians (214 females, 51.7%; 200 males, 48.3%) from a cohort of medical school graduates participating in the SwissMedCareer Study was analysed according to socio-demographic variables, employment status and career prioritisation of the physicians and their partners. Differences in terms of gender, parenthood status and type of couple were investigated with Chi-square tests. The most prevalent career arrangement for a male physician with young children was that of full-time employment for the physician himself with a partner not in employment or working less than 50%-time. By contrast, the most common arrangement for a female physician with young children was that of 50-69% part-time employment with a partner working full-time. For couples without children, the most common arrangement was full-time employment for both partners. Dual-physician couples differed significantly from other types of couples in terms of how they rated career priority, with male physicians with physician partners more likely than male physicians with partners holding another academic degree or with non-academic partners to regard both careers as equally important (p ≤0.001). Female physicians with physician partners were more likely to consider their partners' careers as of prime importance than those with academic or non-academic partners (p ≤0.001). The priority given by couples to the man's career reflects traditional gender-role attitudes in male and female physicians. Starting a family slows down the career progress of female physicians but not of male physicians. Providing more childcare facilities in hospitals and

  3. Which family physician should I choose? The analytic hierarchy process approach for ranking of criteria in the selection of a family physician.

    Science.gov (United States)

    Kuruoglu, Emel; Guldal, Dilek; Mevsim, Vildan; Gunvar, Tolga

    2015-08-05

    Choosing the most appropriate family physician (FP) for the individual, plays a fundamental role in primary care. The aim of this study is to determine the selection criteria for the patients in choosing their family doctors and priority ranking of these criteria by using the multi-criteria decision-making method of the Analytic Hierarchy Process (AHP) model. The study was planned and conducted in two phases. In the first phase, factors affecting the patients' decisions were revealed with a qualitative research. In the next phase, the priorities of FP selection criteria were determined by using AHP model. Criteria were compared in pairs. 96 patient were asked to fill the information forms which contains comparison scores in the Family Health Centres. According to the analysis of focus group discussions FP selection criteria were congregated in to five groups: Individual Characteristics, Patient-Doctor relationship, Professional characteristics, the Setting, and Ethical Characteristics. For each of the 96 participants, comparison matrixes were formed based on the scores of their information forms. Of these, models of only 5 (5.2 %) of the participants were consistent, in other words, they have been able to score consistent ranking. The consistency ratios (CR) were found to be smaller than 0.10. Therefore the comparison matrix of this new model, which was formed based on the medians of scores only given by these 5 participants, was consistent (CR = 0.06 < 0.10). According to comparison results; with a 0.467 value-weight, the most important criterion for choosing a family physician is his/her 'Professional characteristics'. Selection criteria for choosing a FP were put in a priority order by using AHP model. These criteria can be used as measures for selecting alternative FPs in further researches.

  4. Influencing Factors on Family Physician Retaining in Kohgilouye and Boyer Ahmad Province, Iran in 2009

    OpenAIRE

    SA Mosaviraja; AA Nasiripour; JM Malekzadeh

    2014-01-01

    Background & aim: Family Physician Plan in health and treatment services providing a relatively new plan beginning from 2005 by ministry of health in collaboration with general health insurance office to increase people's access to comprehensive health services. One of the main problems is the lack of retention of doctors in the workplace, particularly in deprived areas. The purpose of this study was to evaluate factors associated with survival in the workplace of family physicians in the Koh...

  5. Cross-cultural Adaptation of a Questionnaire on Self-perceived Level of Skills, Abilities and Competencies of Family Physicians in Albania.

    Science.gov (United States)

    Alla, Arben; Czabanowska, Katarzyna; Kijowska, Violetta; Roshi, Enver; Burazeri, Genc

    2012-01-01

    Our aim was to validate an international instrument measuring self-perceived competency level of family physicians in Albania. A representative sample of 57 family physicians operating in primary health care services was interviewed twice in March-April 2012 in Tirana (26 men and 31 women; median age: 46 years, inter-quartile range: 38-56 years). A structured questionnaire was administered [and subsequently re-administered after two weeks (test-retest)] to all family physicians aiming to self-assess physicians' level of abilities, skills and competencies regarding different domains of quality of health care. The questionnaire included 37 items organized into 6 subscales/domains. Answers for each item of the tool ranged from 1 ("novice" physicians) to 5 ("expert" physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for the test and retest procedures. Cronbach's alpha was used to assess the internal consistency for both the test and the retest procedures, whereas Spearman's rho was employed to assess the stability over time (test-retest reliability) of the instrument. Cronbach's alpha was 0.87 for the test and 0.86 for the retest procedure. Overall, Spearman's rho was 0.84 (Pcross-cultural adaptation of an international instrument taping self-perceived level of competencies of family physicians in Albania. The questionnaire displayed a satisfactory internal consistency for both test and retest procedures in this sample of family physicians in Albania. Furthermore, the high test-retest reliability (stability over time) of the instrument suggests a good potential for wide scale application to nationally representative samples of family physicians in Albanian populations.

  6. Seasonal variation in family member perceptions of physician competence in the intensive care unit: findings from one academic medical center.

    Science.gov (United States)

    Stevens, Jennifer P; Kachniarz, Bart; O'Reilly, Kristin; Howell, Michael D

    2015-04-01

    Researchers have found mixed results about the risk to patient safety in July, when newly minted physicians enter U.S. hospitals to begin their clinical training, the so-called "July effect." However, patient and family satisfaction and perception of physician competence during summer months remain unknown. The authors conducted a retrospective observational cohort study of 815 family members of adult intensive care unit (ICU) patients who completed the Family Satisfaction with Care in the Intensive Care Unit instrument from eight ICUs at Beth Israel Deaconess Medical Center, Boston, Massachusetts, between April 2008 and June 2011. The association of ICU care in the summer months (July-September) versus other seasons and family perception of physician competence was examined in univariable and multivariable analyses. A greater proportion of family members described physicians as competent in summer months as compared with winter months (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.2-3.0; P = .003). After adjustment for patient and proxy demographics, severity of illness, comorbidities, and features of the admission in a multivariable model, seasonal variation of family perception of physician competence persisted (summer versus winter, OR of judging physicians competent 2.4; 95% CI 1.3-4.4; P = .004). Seasonal variation exists in family perception of physician competence in the ICU, but opposite to the "July effect." The reasons for this variation are not well understood. Further research is necessary to explore the role of senior provider involvement, trainee factors, system factors such as handoffs, or other possible contributors.

  7. Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients.

    Science.gov (United States)

    Burelli, Gabrielle; Berthelier, Chloé; Vanacker, Hélène; Descaillot, Léonard; Philippon-Jouve, Bénédicte; Fabre, Xavier; Kaaki, Mahmoud; Chakarian, Jean-Charles; Domine, Alexandre; Beuret, Pascal

    2018-06-01

    This study aimed to evaluate the impact of a visual aid on the discordance about prognosis between physicians and family members. The study was performed in a general intensive care department with two 6-bed units. In the unit A, family members could consult a visual aid depicting day by day the evolution of global, hemodynamic, respiratory, renal and neurological conditions of the patient on a 10-point scale. In the unit B, they only received oral medical information. On day 7 of the ICU stay, the physician and family members estimated the prognosis of the patient among four proposals (life threatened; steady state but may worsen; steady state, should heal; will heal). Then we compared the rate of discordance about prognosis between physicians and family members in the two units. Seventy-nine consecutive patients admitted in the intensive care department and still present at day 7, their family members and physicians, were enrolled. Patients in the two units were comparable in age, sex ratio, reason for admission, SAPS II at admission and SOFA score at day 7. In the unit A, physician-family members discordance about prognosis occurred for 12 out of 39 patients (31%) vs. 22 out of 40 patients (55%) in the unit B (P=0.04). In our study, adding a visual aid depicting the evolution of the condition of critically ill patients day by day to classic oral information allowed the family to have an estimate of the prognosis less discordant with the estimate of the physician. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  8. Diagnosis and management of hypertension: the stated practices of family physicians.

    OpenAIRE

    Dunn, E.; Hilditch, J.; Chipman, M.; Hardacre, G.; Morrison, M.

    1984-01-01

    Hypertension is an important and common problem in family practice, but there is no general agreement on the systolic and diastolic pressures at which it should be diagnosed and treated. Responses from 273 family physicians surveyed by mail in Metropolitan Toronto showed a wide variation in the pressures used as cut-off points. The probability that in a given patient hypertension would be diagnosed or treated at different systolic and diastolic pressures varied considerably among the physicia...

  9. Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: a mixed methods study.

    Science.gov (United States)

    Puts, Martine T E; Sattar, Schroder; McWatters, Kara; Lee, Katherine; Kulik, Michael; MacDonald, Mary-Ellen; Jang, Raymond; Amir, Eitan; Krzyzanowska, Monika K; Leighl, Natasha; Fitch, Margaret; Joshua, Anthony M; Warde, Padraig; Tourangeau, Ann E; Alibhai, Shabbir M H

    2017-03-01

    Although comorbidities, frailty, and functional impairment are common in older adults (OA) with cancer, little is known about how these factors are considered during the treatment decision-making process by OAs, their families, and health care providers. Our aim was to better understand the treatment decision process from all these perspectives. A mixed methods multi-perspective longitudinal study using semi-structured interviews and surveys with 29 OAs aged ≥70 years with advanced prostate, breast, colorectal, or lung cancer, 24 of their family members,13 oncologists, and 15 family physicians was conducted. The sample was stratified on age (70-79 and 80+). All interviews were analyzed using thematic analysis. There was no difference in the treatment decision-making experience based on age. Most OAs felt that they should have the final say in the treatment decision, but strongly valued their oncologists' opinion. "Trust in my oncologist" and "chemotherapy as the last resort to prolong life" were the most important reasons to accept treatment. Families indicated a need to improve communication between them, the patient and the specialist, particularly around goals of treatment. Comorbidity and potential side-effects did not play a major role in the treatment decision-making for patients, families, or oncologists. Family physicians reported no involvement in decisions but desired to be more involved. This first study using multiple perspectives showed neither frailty nor comorbidity played a role in the treatment decision-making process. Efforts to improve communication were identified as an opportunity that may enhance quality of care. In a mixed methods study multiple perspective study with older adults with cancer, their family members, their oncologist and their family physician we explored the treatment decision making process and found that most older adults were satisfied with their decision. Comorbidity, functional status and frailty did not impact the

  10. Depression in the Family of Patients With Dementia in Korea.

    Science.gov (United States)

    Jang, Sung-In; Bae, Hong-Chul; Shin, Jaeyong; Jang, Suk-Yong; Hong, Seri; Han, Kyu-Tae; Park, Eun-Cheol

    2016-09-01

    Dementia is the leading cause of disability worldwide in the elderly individuals. Although prior studies have examined psychiatric symptoms in dementia caregivers, few studies have examined physician-diagnosed depression in the family caregiver of a patient with dementia. We used data from 457 864 respondents from the Korea Community Health Survey. We used logistic regression to examine the relationship between physician-diagnosed depression and cohabitation with a patient with dementia. Cohabitation with a patient with dementia (1.2% of the Korean population) was significantly associated with physician-diagnosed depression. The significance remained in females when the data were stratified by sex. A significant association also occurred among males with low family income. To reduce the burden of dementia, we need a management policy that includes the caregiver as well as the patient with dementia. In particular, political management for the vulnerable population, male caregiver in low-income family and female caregiver in high-income family, should be prepared. © The Author(s) 2016.

  11. Knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season: questionnaire study.

    Science.gov (United States)

    Rurik, Imre; Langmár, Zoltán; Márton, Hajnalka; Kovács, Eszter; Szigethy, Endre; Ilyés, István

    2011-04-15

    To evaluate the knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season. A questionnaire with 20 questions was developed and sent to 232 family physicians in 3 largest Hungarian cities: Budapest, Debrecen, and Miskolc. The study was conducted in December 2009 and January 2010. A hundred and ninety eight (85%) physicians answered the questionnaire adequately. Respondents believed that the influenza outbreak represented less of a threat to their practices than to Hungary or the world as a whole. They mostly agreed that vaccination was important and were frequently dissatisfied with the support from health authorities. The proportion of vaccinated patients ranged between 2% and 53%, without differences according to geographical region, age, sex, and duration of physicians' employment in family practice. Physicians who were satisfied with the payment for procedures and underwent vaccination themselves were more active in vaccination. Health authorities should provide clear and evidence-based professional support to family physicians and should encourage them to get vaccinated against pandemic influenza, while insurance funds have to establish appropriate reimbursement system.

  12. Familial patterning and prevalence of male androphilia among Istmo Zapotec men and muxes.

    Directory of Open Access Journals (Sweden)

    Francisco R Gómez

    Full Text Available Male androphilia (i.e., male sexual attraction to other adult males is known to cluster within families. Some studies demonstrate that male androphilia clusters in both the paternal and maternal familial lines, whereas other studies demonstrated that it clusters only in the latter. Most of these studies were conducted in Euro-American populations where fertility is low and the sexual orientation of male relatives can sometimes be difficult to ascertain. These two factors can potentially confound the results of such studies. To address these limitations, we examined the familial patterning of male androphilia among the Istmo Zapotec of Oaxaca, Mexico--a high fertility, non-Euro-American population where androphilic males are known locally as muxes, a third gender category. The Istmo Zapotec recognize two types of muxes--muxe gunaa and muxe nguiiu--who typify the transgender and cisgender forms of male androphilia, respectively. We compared the familial patterning of male androphilia between muxe gunaa and muxe nguiiu, as well as between gynephilic men and muxes (both cisgender and transgender forms combined. Istmo Zapotec muxe gunaa and muxe nguiiu exhibit similar familial patterning of male androphilia. Overall, muxes were characterized by significantly more muxe relatives than gynephilic men. This familial patterning was equivalent in both the paternal and maternal lines of muxes. The population prevalence rate of male androphilia was estimated to fall between 3.37-6.02% in the Istmo Zapotec. This is the first study that has compared cisgender and transgender androphilic males from the same high fertility population and demonstrated that the two do not differ with respect to the familial patterning of male androphilia.

  13. Familial patterning and prevalence of male androphilia among Istmo Zapotec men and muxes.

    Science.gov (United States)

    Gómez, Francisco R; Semenyna, Scott W; Court, Lucas; Vasey, Paul L

    2018-01-01

    Male androphilia (i.e., male sexual attraction to other adult males) is known to cluster within families. Some studies demonstrate that male androphilia clusters in both the paternal and maternal familial lines, whereas other studies demonstrated that it clusters only in the latter. Most of these studies were conducted in Euro-American populations where fertility is low and the sexual orientation of male relatives can sometimes be difficult to ascertain. These two factors can potentially confound the results of such studies. To address these limitations, we examined the familial patterning of male androphilia among the Istmo Zapotec of Oaxaca, Mexico--a high fertility, non-Euro-American population where androphilic males are known locally as muxes, a third gender category. The Istmo Zapotec recognize two types of muxes--muxe gunaa and muxe nguiiu--who typify the transgender and cisgender forms of male androphilia, respectively. We compared the familial patterning of male androphilia between muxe gunaa and muxe nguiiu, as well as between gynephilic men and muxes (both cisgender and transgender forms combined). Istmo Zapotec muxe gunaa and muxe nguiiu exhibit similar familial patterning of male androphilia. Overall, muxes were characterized by significantly more muxe relatives than gynephilic men. This familial patterning was equivalent in both the paternal and maternal lines of muxes. The population prevalence rate of male androphilia was estimated to fall between 3.37-6.02% in the Istmo Zapotec. This is the first study that has compared cisgender and transgender androphilic males from the same high fertility population and demonstrated that the two do not differ with respect to the familial patterning of male androphilia.

  14. Knowledge about cervical cancer screening among family physicians: cross-sectional survey.

    Science.gov (United States)

    Del Refugio Gonzalez-Losa, Maria; Gongora-Marfil, Glendy K; Puerto-Solis, Marylin

    2009-04-01

    Cervical cancer (CC) is an important public health problem worldwide. In Mexico, there has been a National Cervical Cancer Screening Program (NCCSP) since 1974. Mexican Social Security Institute attended Mexican workers and family physicians are responsible of the primary care of patients. To evaluate knowledge about the aetiology and prevention of CC among family physicians working in Yucatan, Mexico, at Mexican Social Security Institute. A questionnaire was applied to 187 family doctors. Self-administer questionnaire with 10 item previously used by ours and other researchers, was used for the evaluation. Each correctly answered item was given a point. The maximum grade was 10 and the minimum 0. The knowledge mean was 6.93 points. Fewer than 50% knew what to do with women who are human papillomavirus (HPV) positive without a precancerous cervical lesion and the appropriate age range for Pap smears. A total of 61.1% identified CC as an important health problem in Mexico; however, 95.1% identified CC as a preventive cause of deaths among Mexican women and recognized that HPV is the main CC aetiological agent, and 90.3% mentioned the Pap smear as the main method of diagnosis of CC. The family doctors need to have an adequate knowledge of the practical elements of the NCCSP to give an efficient attention to their patients.

  15. Gender awareness among physicians – the effect of specialty and gender. A study of teachers at a Swedish medical school

    Directory of Open Access Journals (Sweden)

    Hamberg Katarina

    2003-10-01

    Full Text Available Abstract Background An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. Method Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. Results The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. Conclusions There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the

  16. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

    Science.gov (United States)

    Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

    2014-01-01

    Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

  17. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  18. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring.

    Science.gov (United States)

    Jones, Barbara L; Contro, Nancy; Koch, Kendra D

    2014-02-01

    Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

  19. Smoking behaviour, knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Broers Teresa

    2004-06-01

    Full Text Available Abstract Background Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. Methods The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Results Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77% completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking

  20. Smoking behaviour, knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina.

    Science.gov (United States)

    Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall

    2004-06-11

    Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health

  1. In search of attachment: a qualitative study of chronically ill women transitioning between family physicians in rural Ontario, Canada.

    Science.gov (United States)

    Randall, Ellen; Crooks, Valorie A; Goldsmith, Laurie J

    2012-12-23

    Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition

  2. LEVEL OF COMPETENCIES OF FAMILY PHYSICIANS IN KOSOVO FROM DIFFERENT PERSPECTIVES.

    Science.gov (United States)

    Bojaj, Gazmend; Skeraj, Fitim; Czabanowska, Katarzyna; Burazeri, Genc

    2016-10-01

    The aim of this analysis was to compare the level of self-perceived competencies of primary health care physicians in Kosovo with patients' viewpoint, as well as the necessary (required) level of such competencies from decision-makers' standpoint. Three cross-sectional studies were carried out in Kosovo in 2013 including: i) a representative sample of 1340 primary health care users aged ≥18 years (49% men; overall mean age: 50.5±17.9 years; response rate: 89%); ii) a representative sample of 597 primary health care physicians (49% men; overall mean age: 46.0±9.4 years; response rate: 90%), and; iii) a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63% men; mean age: 47.7±5.7 years). A structured self-administered questionnaire (consisting of 37 items) was used in the three surveys in order to assess physicians' competencies regarding different domains of the quality of health care. There was a significant gap in the level of self-perceived physicians' competencies and patients' perspective in transitional Kosovo. Furthermore, there was a gap in the level of self-perceived physicians' competencies and the necessary (required) level of physicians' competencies from decision-makers perspective which was less evident in Prishtina, but considerable in the other regions of Kosovo. Our analysis provides valuable evidence about the level of competencies of primary health care physicians in Kosovo from different stakeholders' perspectives. There is an urgent need for continuous professional development of family physicians in post-war Kosovo.

  3. Family physicians and the surgical disease burden in west Africa: a ...

    African Journals Online (AJOL)

    Background: Surgical disease burden is quite high in sub Saharan Africa (SSA), and is complicated by low human resource for health. These factors tend to increase thesurgical Disability Adjusted Life Years (DALYs)in SSA. Increasing the training and deployment of surgically trained generalists like Family Physicians, is a ...

  4. Consanguinity and family clustering of male factor infertility in Lebanon.

    Science.gov (United States)

    Inhorn, Marcia C; Kobeissi, Loulou; Nassar, Zaher; Lakkis, Da'ad; Fakih, Michael H

    2009-04-01

    To investigate the influence of consanguineous marriage on male factor infertility in Lebanon, where rates of consanguineous marriage remain high (29.6% among Muslims, 16.5% among Christians). Clinic-based, case-control study, using reproductive history, risk factor interview, and laboratory-based semen analysis. Two IVF clinics in Beirut, Lebanon, during an 8-month period (January-August 2003). One hundred twenty infertile male patients and 100 fertile male controls, distinguished by semen analysis and reproductive history. None. Standard clinical semen analysis. The rates of consanguineous marriage were relatively high among the study sample. Patients (46%) were more likely than controls (37%) to report first-degree (parental) and second-degree (grandparental) consanguinity. The study demonstrated a clear pattern of family clustering of male factor infertility, with patients significantly more likely than controls to report infertility among close male relatives (odds ratio = 2.58). Men with azoospermia and severe oligospermia showed high rates of both consanguinity (50%) and family clustering (41%). Consanguineous marriage is a socially supported institution throughout the Muslim world, yet its relationship to infertility is poorly understood. This study demonstrated a significant association between consanguinity and family clustering of male factor infertility cases, suggesting a strong genetic component.

  5. Giving patients responsibility or fostering mutual response-ability: family physicians' constructions of effective chronic illness management.

    Science.gov (United States)

    Thille, Patricia H; Russell, Grant M

    2010-10-01

    Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.

  6. Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

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    Meyer Swanepoel

    2014-12-01

    Full Text Available Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS of the Western Cape. Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method. Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers. Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

  7. Help-seeking preferences in the area of mild cognitive impairment: comparing family physicians and the lay public.

    Science.gov (United States)

    Werner, Perla; Heinik, Jeremia; Giveon, Shmuel; Segel-Karpas, Dikla; Kitai, Eliezer

    2014-01-01

    Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer's disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management. To compare help-seeking preferences of family physicians and the lay public in the area of MCI. A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed. The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help. There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians' greater tendency to recommend professional sources of help-seeking. Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients.

  8. Contextualizing the Physician Charter on Professionalism in Qatar: From Patient Autonomy to Family Autonomy.

    Science.gov (United States)

    Ho, Ming-Jung; Alkhal, Abdullatif; Tekian, Ara; Shih, Julie; Shaw, Kevin; Wang, Chung-Hsiang; Alyafei, Khalid; Konopasek, Lyuba

    2016-12-01

    The Physician Charter on medical professionalism has been endorsed by professional organizations worldwide, yet it is unclear if this Western framework of professionalism is applicable in non-Western countries. This study examines how physicians practicing in a Middle Eastern context perceive the terms, principles, and commitments outlined in the charter. In May 2013, the authors conducted 6 focus groups with 43 clinician-educators practicing at Hamad Medical Corporation in Doha, Qatar, to discuss the applicability of the Physician Charter in a local context. The research team coded and analyzed transcripts to identify sociocultural influences on professionalism. Participants generally expressed agreement with the applicability of the charter's principles to physician professionalism in Qatar. However, 3 contextual factors (religious beliefs and practices, family-centered decision making, and multinationality) complicated the application of the core principles of patient autonomy and social justice. Islamic beliefs reinforced the importance of professional values such as altruism, but presented a barrier to the principle of self-determination for female patients. The family-centered culture in Qatar called for enlarging the scope of patient-centered decision making to include the patient's family. Qatar's multinational population prompted debate over equal treatment and how to conceptualize and implement the principle of social justice. Several sociocultural contexts influence the conceptualization of the principles of medical professionalism in Qatar. The findings suggest that contextual factors should be considered when developing or adopting a professionalism framework in an international setting and context.

  9. Characteristics of patients with erectile dysfunction in a family physician-led erectile dysfunction clinic: Retrospective case series

    OpenAIRE

    Lap Kin Chiang; Cheuk-Wai Kam; Kin-Chung Michael Yau; Lorna Ng

    2017-01-01

    Objectives: 1. To examine the characteristics of patients with erectile dysfunction in a family physician led erectile dysfunction clinic; 2. To review association of chronic disease spectrum and erectile dysfunction; 3. To review initial treatment pattern and outcome. Design: Retrospective case series review. Subjects: All consecutive patients seen in a regional hospital family physician led erectile dysfunction clinic from April 2014 to March 2015. Main outcome measures: 1. The severity of ...

  10. Asking the Stakeholders: Perspectives of Individuals With Aphasia, Their Family Members, and Physicians Regarding Communication in Medical Interactions.

    Science.gov (United States)

    Burns, Michael; Baylor, Carolyn; Dudgeon, Brian J; Starks, Helene; Yorkston, Kathryn

    2015-08-01

    The purpose of this study was to explore the experiences of patients with aphasia, their family members, and physicians related to communication during medical interactions. Face-to-face, semistructured interviews were conducted with 18 participants—6 patients with aphasia, 6 family members involved in patient care, and 6 practicing physicians. A qualitative description approach was used to collect and summarize narratives from participants' perspectives and experiences. Participants were asked about experiences with communication during medical interactions in which the family member accompanied the patient. Interviews were audio- and/or video-recorded, transcribed, and then coded to identify main themes. Patients and family members generally described their communication experiences as positive, yet all participants discussed challenges and frustrations. Three themes emerged: (a) patients and family members work as a team, (b) patients and family members want physicians to "just try" to communicate with the patient, and (c) physicians want to interact with patients but may not know how. Participants discussed the need for successful accommodation, or changing how one communicates, to help facilitate the patients' increased understanding and ability to express themselves. Over- and underaccommodation with communication were commonly reported as problems. Speech-language pathologists have a role to play in helping to improve communication during medical interactions. Implications for current speech-language pathologist practice and future directions of research are discussed.

  11. University of Venda's male students' attitudes towards contraception and family planning.

    Science.gov (United States)

    Raselekoane, Nanga R; Morwe, Keamogetse G; Tshitangano, Takalani

    2016-07-08

    Many young men continue to disregard the importance of contraception and family planning in South Africa. The fact that even university students also do not take contraception and family planning seriously poses a serious threat to their own health and well-being. This paper aims at investigating the attitudes of male students towards contraception and the promotion of female students' sexual health rights and well-being at the University of Venda. Quantitative research method is used to determine how attitudes of 60 male students towards contraception can jeopardise the health and well-being of both male and female students. This study reveals that the majority of 60 male students at the University of Venda have a negative attitude towards contraceptives. As a result, male students at the University of Venda are not keen on using contraceptives. Male students' negative attitude and lack of interest in contraceptives and family planning also limit progress in achieving the Millennium Development Goals on primary health care, especially with regard to sexual and reproductive health and well-being of female students at the University of Venda. The fact that more than half of the male students interviewed did not take contraception and family planning seriously poses a serious threat to health and well-being of students, including violation of female students' sexual and reproductive health rights in South Africa. This calls for radical health promotion and sexual and reproductive rights programmes which should specifically target male students at the University of Venda.

  12. Email communication in a developing country: different family physician and patient perspectives.

    Science.gov (United States)

    Makarem, Nisrine N; Antoun, Jumana

    2016-01-01

    Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians' and patients' use of email within the same health care setting of a developing country. A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans.

  13. Do family physicians retrieve synopses of clinical research previously read as email alerts?

    Science.gov (United States)

    Grad, Roland; Pluye, Pierre; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Bartlett, Gillian; Marlow, Bernard

    2011-11-30

    A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved

  14. The grief process for patient, family, and physician.

    Science.gov (United States)

    Bruce, Christine A

    2002-09-01

    In the grieving process, patient, family, and health professionals have the same needs-rest, relaxation, nourishment, a sense of security, trust, hope in the future, and humor among them. Grief, defined as a shared, universal, and natural neuropsychobiologic expression in response to loss, is distinct from mourning, a practice that varies in expression across diverse cultures. To aid in an understanding of grief and its effects, the author looks at the models for grief proposed by Kubler-Ross, Bowlby, Parkes, Worden, and Wolfelt. Addressing patients' concerns requires physicians be empathic, attentive, and respective and have willingness to take time, be present, and listen.

  15. Male attitudes to family planning education in Santiago, Chile.

    Science.gov (United States)

    Hall, M F

    1977-01-01

    Male attitudes toward family planning education were assessed through a study of 720 men in Santiago and 240 men in a nearby rural area of Chile. Interviews were conducted by male students at the University of Chile School of Public Health. A large majority of the men were using or planned to use contraception in the future. There was a near consensus that adults should be informed regarding family planning. More than a majority of the respondents favored provision of contraceptive information for unmarried women, but most did not approve of premarital sexual activity for females. Most respondents favored the teaching of sex education in schools "according to the age of the children." Younger and higher class males tended to hold the most liberal attitudes.

  16. Family physician's knowledge, beliefs, and self-reported practice patterns regarding hyperlipidemia: a National Research Network (NRN) survey.

    Science.gov (United States)

    Eaton, Charles B; Galliher, James M; McBride, Patrick E; Bonham, Aaron J; Kappus, Jennifer A; Hickner, John

    2006-01-01

    Family physicians have the potential to make a major impact on reducing the burden of cardiovascular disease through the optimal assessment and management of hyperlipidemia. We were interested in assessing the knowledge, beliefs, and self-reported practice patterns of a representative sample of family physicians regarding the assessment and management of hyperlipidemia 2 years after the release of the evidence-based National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. A 33-item survey was mailed to a random sample (N = 1200) of members of the American Academy of Family Physicians in April of 2004, with 2 follow-up mailings to nonresponders. Physicians were queried about sociodemographic characteristics, their knowledge, attitudes, and self-reported practice patterns regarding the assessment and management of hyperlipidemia. Four case scenarios also were presented. Response rate was 58%. Over 90% of surveyed family physicians screened adults for hyperlipidemia as part of a cardiovascular disease prevention strategy. Most (89%) did this screening by themselves without the support of office staff, and 36% reported routine use of a flow sheet. Most had heard of the ATP III guidelines (85%), but only 13% had read them carefully. Only 17% of respondents used a coronary heart disease (CHD) risk calculator usually or always. Over 90% of those responding reported using low-density lipoprotein (LDL) as the treatment goal but only 76% reported using non-high-density lipoprotein (HDL) cholesterol as a secondary goal of therapy. We found a large variability in knowledge, beliefs, and practice patterns among practicing family physicians. We found general agreement on universal screening of adults for hyperlipidemia as part of cardiovascular disease prevention strategy and use of LDL cholesterol as a treatment goal. Many other aspects of the NCEP ATP III guidelines, such as use of a systematic, multidisciplinary approach, using non

  17. The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

    NARCIS (Netherlands)

    Reyniers, T.; Houttekier, D.; Pasman, H.R.; Stichele, R.V.; Cohen, J.; Deliens, L.

    2014-01-01

    CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician’s role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or

  18. Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.

    Science.gov (United States)

    Dinkel, Andreas; Schneider, Antonius; Schmutzer, Gabriele; Brähler, Elmar; Häuser, Winfried

    2016-07-01

    To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. The quality of the family physician-patient relationship is not independently associated with frequent attendance. Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Defining the eHealth Information Niche in the Family Physician/Patient Examination and Knowledge Transfer Process

    Science.gov (United States)

    Ellington, Virginia Beth Elder

    2012-01-01

    This research study was undertaken to gain a richer understanding of the use of patient-introduced online health information during the physician/patient examination and knowledge transfer process. Utilizing qualitative data obtained from ten family physician interviews and workflow modeling using activity diagrams and task structure charts, this…

  20. Specialist physician knowledge of chronic kidney disease: A comparison of internists and family physicians in West Africa

    Directory of Open Access Journals (Sweden)

    Antonios H. Tzamaloukas

    2012-05-01

    Full Text Available Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD. We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists.Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians.Results: Only 19 (27.5% of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2% of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28. Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians.Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians.Connaissances des spécialistes des maladies rénales chroniques : Une comparaison des internistes et des médecins de famille en Afrique de l’OuestContexte: La formation de troisi

  1. Familial cutaneous amyloidosis with systemic manifestations in males.

    Science.gov (United States)

    Partington, M W; Marriott, P J; Prentice, R S; Cavaglia, A; Simpson, N E

    1981-01-01

    We describe a family in which two males and seven females have brown pigmentation of the skin. In the females, the type and distribution of the pigmentation mimicked incontinentia pigmenti; in the males, the pattern was reticulate. The histological appearance was the same in both sexes with amyloid deposits in the papillary dermis, melanin in the basal layer, and slight hyperkeratosis. The females were otherwise normal. Both males had thrived poorly as infants but had survived. One had severe gastroenteritis with blood in the stools starting at the age of three weeks followed by seizures, hemiplegia, and developmental delay; the other had recurrent pneumonia throughout life, a urethral stricture, inguinal herniae, and near-blindness from amyloid deposition in the cornea. Five other males in the family had had severe illnesses. Two died of pneumonia by three months. One died at three months from colitis. Both remaining boys had colitis as infants, failed to thrive, and developed recurrent pneumonia from which one died at three years. We think all of these relatives had the same disease carried by a single gene with pleiotropic effects. The most likely form of inheritance is X-linked.

  2. Investigation of administrative obstacles to family physician program in urban areas of Iran

    Directory of Open Access Journals (Sweden)

    Javad Javan noughabi

    2017-06-01

    Full Text Available Health is regarded as one of the basic rights of each person in society; so governments are obligated to provide it equally for everyone. The best way to achieve this goal is the establishment of health insurance with the orientation of family physician and the strategic referral system. Yet, such programs will not be successful without encouraging people to participate and changing social behaviors. The aim of the present study was to investigate the administrative obstacles and problems to family physician program in urban areas of Iran. This study was a qualitative research conducted. A purposive sampling method was employed and the data were gathered via semi-structured interview with open-ended questions and document examination. All the interviews were recorded digitally and immediately transcribed verbatim. They were finally analyzed based on framework analysis. The participants' detailed descriptions showed that systemic, environmental, and human related factors were the main obstacles to the implementation of family physician plan. Since the success and performance of each program effectively cannot be obtained without people’s acceptance and collaboration, the necessity of training and giving information rapidly and timely to the residents in urban areas is felt more than ever. Also, making authorities aware of the obstacles expressed by people can be helpful in harmonizing the program with people’s requests; and can result in overcoming the challenges and obstacles facing the program.

  3. 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.

    Science.gov (United States)

    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.

  4. A case of nonarteritic anterior ischemic optic neuropathy of a male with family history of the disease after receiving sildenafil

    Directory of Open Access Journals (Sweden)

    Felekis T

    2011-10-01

    Full Text Available T Felekis1, I Asproudis1, K Katsanos2, EV Tsianos21University Eye Clinic of Ioannina, Ioannina, Greece; 2First Department of Internal Medicine, University Hospital of Ioannina, Ioannina, GreeceAbstract: A 51-year-old male was referred to the University Eye Clinic of Ioannina with nonarteritic anterior ischemic optic neuropathy (NAION 12 hours after receiving sildenafil citrate (Viagra®. Examination for possible risk factors revealed mild hypercholesterolemia. Family history showed that his father had suffered from bilateral NAION. Although a cause-and-effect relationship is difficult to prove, there are reports indicating an association between the use of erectile dysfunction agents and the development of NAION. Physicians might need to investigate the presence of family history of NAION among systemic or vascular predisposing risk factors before prescribing erectile dysfunction drugs.Keywords: sildenafil, nonarteritic anterior ischemic optic neuropathy, erectile dysfunction drugs, family history

  5. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

    Science.gov (United States)

    Wood, M E; Flynn, B S; Stockdale, A

    2013-01-01

    Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

  6. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care.

    Science.gov (United States)

    Swedlund, Matthew P; Schumacher, Jayna B; Young, Henry N; Cox, Elizabeth D

    2012-01-01

    Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9-16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p relationships (p communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

  7. Physicians' perceptions of breaking bad news to cancer patients and family

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    Sami Ayed Alshammary

    2017-01-01

    Conclusion: Physicians face a dilemma when families do not wish the patient to know about the cancer diagnosis, and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into consideration, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

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

    Science.gov (United States)

    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.

  9. 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.

  10. The quality assessment of family physician service in rural regions, Northeast of Iran in 2012.

    Science.gov (United States)

    Vafaee-Najar, Ali; Nejatzadegan, Zohreh; Pourtaleb, Arefeh; Kaffashi, Shahnaz; Vejdani, Marjan; Molavi-Taleghani, Yasamin; Ebrahimipour, Hosein

    2014-04-01

    Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients' expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients' expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.

  11. Cost-effectiveness of a nurse practitioner-family physician model of care in a nursing home: controlled before and after study.

    Science.gov (United States)

    Lacny, Sarah; Zarrabi, Mahmood; Martin-Misener, Ruth; Donald, Faith; Sketris, Ingrid; Murphy, Andrea L; DiCenso, Alba; Marshall, Deborah A

    2016-09-01

    To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n = 45) to internal (n = 65), external (n = 70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study. © 2016 John Wiley & Sons Ltd.

  12. Measurement and correlates of empathy among female Japanese physicians

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    Kataoka Hitomi U

    2012-06-01

    Full Text Available Abstract Background The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. Methods The Jefferson Scale of Empathy (JSE was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. Results The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach’s coefficient alpha was .81. Female physicians who were practicing in “people-oriented” specialties obtained a significantly higher mean empathy score than their counterparts in “procedure-” or “technology-oriented” specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. Conclusions Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians’ empathy may help physicians to avoid career burnout.

  13. How family physicians address diagnosis and management of depression in palliative care patients.

    NARCIS (Netherlands)

    Warmenhoven, F.C.; Rijswijk, H.C.A.M. van; Hoogstraten, E. van; Spaendonck, K.P.M. van; Lucassen, P.L.B.J.; Prins, J.B.; Vissers, K.; Weel, C. van

    2012-01-01

    PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in

  14. The birth of a collaborative model: obstetricians, midwives, and family physicians.

    Science.gov (United States)

    Pecci, Christine Chang; Mottl-Santiago, Julie; Culpepper, Larry; Heffner, Linda; McMahan, Therese; Lee-Parritz, Aviva

    2012-09-01

    In the United States, the challenges of maternity care include provider workforce, cost containment, and equal access to quality care. This article describes a collaborative model of care involving midwives, family physicians, and obstetricians at the Boston Medical Center, which serves a low-income multicultural population. Leadership investment in a collaborative model of care from the Department of Obstetrics and Gynecology, Section of Midwifery, and the Department of Family Medicine created a culture of safety and commitment to patient-centered care. Essential elements of the authors' successful model include a commitment to excellence in patient care, communication, and interdisciplinary education. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

    Science.gov (United States)

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-04-01

    When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

  16. Training in male sexual and reproductive health for a primary care physician.

    Science.gov (United States)

    Shaiful, Bi

    2008-01-01

    In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU) for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs) will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.

  17. TRAINING IN MALE SEXUAL AND REPRODUCTIVE HEALTH FOR A PRIMARY CARE PHYSICIAN

    Directory of Open Access Journals (Sweden)

    SHAIFUL BI

    2008-01-01

    Full Text Available In 2006, I was awarded a scholarship from Universiti Sains Malaysia for Fellowship training at Monash University (MU for one year. The objective of the training programme was to develop knowledge and skills in several areas, including androgen deficiency, male infertility, prostate disease, testicular tumours, sexual dysfunction and sexually transmitted diseases. The training programme consisted of attachments with clinical specialists, completion of a course work module and a research project. After completion of the training programme, I believe that Primary Care Physicians (PCPs will benefit from undertaking the training programme that I had completed. It will enable PCPs to assume leadership roles in this multidisciplinary area. The ability of PCPs in handling sexual and reproductive health issues in men will definitely be a more cost effective form of care for patients, particularly as the number of specialists is limited, and even more importantly, it will be satisfying for the patient and the physician.

  18. Fostering excellence: roles, responsibilities, and expectations of new family physician clinician investigators.

    Science.gov (United States)

    Hogg, William; Kendall, Claire; Muggah, Elizabeth; Mayo-Bruinsma, Liesha; Ziebell, Laura

    2014-02-01

    A key priority in primary health care research is determining how to ensure the advancement of new family physician clinician investigators (FP-CIs). However, there is little consensus on what expectations should be implemented for new investigators to ensure the successful and timely acquisition of independent salary support. Support new FP-CIs to maximize early career research success. This program description aims to summarize the administrative and financial support provided by the C.T. Lamont Primary Health Care Research Centre in Ottawa, Ont, to early career FP-CIs; delineate career expectations; and describe the results in terms of research productivity on the part of new FP-CIs. Family physician CI's achieved a high level of research productivity during their first 5 years, but most did not secure external salary support. It might be unrealistic to expect new FP-CIs to be self-financing by the end of 5 years. This is a career-development program, and supporting new career FP-CIs requires a long-term investment. This understanding is critical to fostering and strengthening sustainable primary care research programs.

  19. University of Venda’s male students’ attitudes towards contraception and family planning

    Science.gov (United States)

    Morwe, Keamogetse G.; Tshitangano, Takalani

    2016-01-01

    Background Many young men continue to disregard the importance of contraception and family planning in South Africa. The fact that even university students also do not take contraception and family planning seriously poses a serious threat to their own health and well-being. Aim This paper aims at investigating the attitudes of male students towards contraception and the promotion of female students’ sexual health rights and well-being at the University of Venda. Methods Quantitative research method is used to determine how attitudes of 60 male students towards contraception can jeopardise the health and well-being of both male and female students. Results This study reveals that the majority of 60 male students at the University of Venda have a negative attitude towards contraceptives. As a result, male students at the University of Venda are not keen on using contraceptives. Male students’ negative attitude and lack of interest in contraceptives and family planning also limit progress in achieving the Millennium Development Goals on primary health care, especially with regard to sexual and reproductive health and well-being of female students at the University of Venda. Conclusion The fact that more than half of the male students interviewed did not take contraception and family planning seriously poses a serious threat to health and well-being of students, including violation of female students’ sexual and reproductive health rights in South Africa. This calls for radical health promotion and sexual and reproductive rights programmes which should specifically target male students at the University of Venda. PMID:27542288

  20. A Review of Contraception and Abortion Content in Family Medicine Textbooks.

    Science.gov (United States)

    Schubert, Finn D; Akse, Sarp; Bennett, Ariana H; Glassman, Nancy R; Gold, Marji

    2015-01-01

    Family physicians are critical providers of reproductive health care in the United States, and family physicians and trainees refer to textbooks as a source of clinical information. This study evaluates the coverage of reproductive health topics in current family medicine textbooks. We identified 12 common family medicine textbooks through a computerized literature search and through the recommendations of a local family medicine clerkship and evaluated 24 areas of reproductive health content (comprising contraceptive care, management of early pregnancy loss, and provision of induced abortion) for accuracy and thoroughness using criteria that we created based on the latest guidelines. All contraceptive methods evaluated were addressed in more than half of the textbooks, though discrepancies existed by method, with intrauterine devices (IUDs), external (male) condoms, and diaphragms addressed most frequently (10/12 texts) and male and female sterilization addressed least frequently (8/12 texts). While most contraceptive methods, when addressed, were usually addressed accurately, IUDs were often addressed inaccurately. Coverage of early pregnancy loss management was limited to 7/12 texts, and coverage of early abortion methods was even more limited, with only 4/12 texts addressing the topic. Family medicine textbooks do not uniformly provide correct and thorough information on reproductive health topics relevant to family medicine, and attention is needed to ensure that family physicians are receiving appropriate information and training to meet the reproductive health needs of US women.

  1. Physicians' age and sex influence breaking bad news to elderly cancer patients. Beliefs and practices of 50 Italian oncologists: the G.I.O.Ger study.

    Science.gov (United States)

    Locatelli, C; Piselli, P; Cicerchia, M; Repetto, L

    2013-05-01

    We attempt to shed light on the truth-telling attitudes and practices of oncologists working with a geriatric population in Italy. Physicians caring for cancer patients were asked to complete a specific survey centred on their beliefs, attitudes and practices towards truth telling to elderly cancer patients. Of 50 physicians surveyed, 68% were men. Physicians practising in the south of Italy were significantly older and more likely to be of male gender in comparison with physicians practising from the north and central areas. Eighty-four per cent of physicians consider the family to be an obstacle to a direct communication with the elderly. Forty-four per cent of male physicians who are faced with a family's request of nondisclosure talk with the patient, whereas 37.5% of female physicians talk with the family. For 60% of interviewed physicians, the reason underpinning the caregiver's choice of nondisclosure is to delay the emotional confrontation. We observed that variability of disclosure is related not only to the patient's age but also to the physicians' age and sex and to the geographic area where physicians work. The results also show that both caregivers and physicians are concerned by the emotional aspects related to clinical information. Italian oncologists have to learn and implement 'comprehensive' communication skills and have to promote an integration of the information needs of patient and caregivers, according to their socio-cultural affiliation, within the communication techniques. Copyright © 2012 John Wiley & Sons, Ltd.

  2. Evaluation of the implementation of centralized waiting lists for patients without a family physician and their effects across the province of Quebec

    NARCIS (Netherlands)

    Breton, M.; Brousselle, A.; Boivin, A.; Loignon, C.; Touati, N.; Dubois, C.A.; Nour, K.; Berbiche, D.; Roberge, D.

    2014-01-01

    BACKGROUND: Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues

  3. Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol

    Directory of Open Access Journals (Sweden)

    Clouston Kathleen

    2012-05-01

    Full Text Available Abstract Background Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening and are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (disincentives to patient FOBT uptake and internet use among 50 to 74 year old males and females for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. Methods/design A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website. The primary endpoint is patient fecal occult blood test completion rate after four months (intention to treat model. Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome

  4. Practice and payment preferences of newly practising family physicians in British Columbia

    Science.gov (United States)

    Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

    2012-01-01

    Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

  5. [Information needs of physicians, professional carers and family carers for an evidence-based dementia website].

    Science.gov (United States)

    Komarahadi, Fely L; Ruf, Daniela; Hüll, Michael; Härter, Martin

    2012-01-01

    Despite the demographically driven rapid growth of the number of persons with dementia, in Germany a website is lacking that provides evidence based information about the disease, its burden and therapeutic options to family and professional carers as well as physicians. A website was developed with the objective to give free access to evidence based information concerning the disease and care for patients with dementia. In order to meet the expectations of the user groups an analysis of information needs was performed with 80 physicians, 163 professional carers and 104 family carers. All user groups rated information on symptoms, course and treatment of dementia and support for family carers as important topics. Group differences were found for the need to be informed on financial support, daily care and interaction with patients. The contents of the website will be accommodated to the specific needs of the user groups. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Exploring perceptions and preferences of patients, families, physicians, and nurses regarding cancer disclosure: a descriptive qualitative study.

    Science.gov (United States)

    Abazari, Parvaneh; Taleghani, Fariba; Hematti, Simin; Ehsani, Maryam

    2016-11-01

    The aim of this study was to explore perceptions and preferences of cancer patients, their families, physicians, and nurses in disclosing cancer diagnosis. We selected 35 participants (15 patients, 6 family members, 9 physicians, and 5 nurses) by purposive sampling. We collected data by in-depth interviews and used qualitative content analysis for analysis. Data analysis resulted in three categories: (1) establishing a basis for breaking bad news; (2) adjusting to the tragedy of bad news; and (3) helping the patient cope with the shattering news. The first category comprised the following subcategories: provision of proper background; adhering to a patient-centered approach; and being unhurried. The second category comprised the following subcategories: cancer as a cultural taboo; death as a frightening vision of unattainable dreams and punishment; hope as an opening in the utter darkness of disease; and empathy as liniment for the injuries of disease. The third category comprised the following subcategories: the family as the most powerful healing source for the patient; the force of spirituality in achieving peace; and a multiprofessional, harmonious physician-centered team. The findings of this study can help healthcare teams break the bad news of cancer diagnosis in a more effective, satisfactory, and culture-based manner for patients and their families.

  7. iPad use in Iowa Research Network family physician offices.

    Science.gov (United States)

    Daly, Jeanette M; Xu, Yinghui; Levy, Barcey T

    2015-04-01

    Through a cancer research infrastructure building grant, iPads were given to health care providers in family physician offices. The purpose of this study was to determine the use and application of iPads in the Iowa Research Network. A Qualtrics survey was sent to 81 iPad recipients after institutional review board approval. Fifty-nine percent responded and 85% reported they have used the iPad. The main reason for use of the iPad was browsing the World Wide Web for health care information. Open-ended comments supported use of the iPad for photographic documentation of wound and other skin lesions for insertion into the medical record and it helped improve clinic flow by making it easier to put orders in the system through the iPad. Tablet uses are variable in physician offices with provider's gathering health care information from the Internet and securing education material for patients as the frequent usages. © The Author(s) 2014.

  8. More than half the families of mobile intensive care unit patients experience inadequate communication with physicians.

    Science.gov (United States)

    Debaty, Guillaume; Ageron, François-Xavier; Minguet, Laetitia; Courtiol, Guillaume; Escallier, Christophe; Henniche, Adeline; Maignan, Maxime; Briot, Raphaël; Carpentier, Françoise; Savary, Dominique; Labarere, José; Danel, Vincent

    2015-07-01

    This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. We conducted a cross-sectional study in four mobile intensive care units (ICUs, medicalized ambulances) in France from June to October 2012. Nurses collected data on patients, patient's relatives, and mobile ICU physicians. For each patient, one relative and one physician independently rated the patient's severity using a simplified version of the Clinical Classification of Out-of-Hospital Emergency Patients scale (CCMS). Relatives were also asked to assess their interview with the physician. The primary outcome was agreement between the relative's and physician's ratings of the patient's severity. Data were available for 184 patients, their relatives, and mobile ICU physicians. Full and partial agreement between relatives and physicians regarding the patient's severity was found for 79 (43%) and 121 (66%) cases, respectively [weighted kappa = 0.32 (95% confidence interval, CI, 0.23-0.42)]. Relatives overestimated the patient's severity assessed by the physician [6 (5-8) vs. 4 (3-7), p communicated by mobile ICU physicians.

  9. HPV vaccine awareness and the association of trust in cancer information from physicians among males.

    Science.gov (United States)

    Cooper, Dexter L; Hernandez, Natalie D; Rollins, Latrice; Akintobi, Tabia Henry; McAllister, Calvin

    2017-05-09

    Black and Hispanic men are diagnosed with more HPV-related cancers and at later stages compared to other racial/ethnic groups. Physician communication with men about HPV vaccination may be beneficial to increasing HPV vaccinations and decreasing HPV transmission. The purpose of this study was to examine HPV and HPV vaccine awareness among men by race, and the association between trust in cancer information from physicians and ever hearing about HPV and the HPV vaccine. U.S. adult males (age 18+) were identified from the 2014 Health Information National Trends Survey (HINTS) (n=1203). Binomial logistic regression models assessed the influences of race/ethnicity and trust of cancer information from physicians on men having heard of HPV and the HPV vaccination. Approximately 50% of the sample had never heard of HPV and 53% had never heard of the vaccine. Black men were less likely to know that HPV is sexually transmitted compared to White and Hispanic men (pcancer information compared to White and Black men (pawareness about HPV among men. Furthermore, statistically significant racial/ethnic differences were found in HPV vaccine knowledge and trust in receiving cancer information from physicians. Future interventions should include community-based approaches and improved physicians' HPV-related communication to increase knowledge and uptake of the HPV vaccine. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Relaxin family peptides in the male reproductive system--a critical appraisal.

    Science.gov (United States)

    Ivell, Richard; Kotula-Balak, Malgorzata; Glynn, Danielle; Heng, Kee; Anand-Ivell, Ravinder

    2011-02-01

    The human genome project has identified, besides ovarian relaxin (RLN), six other relaxin-like molecules (RLN3, H1-RLN, INSL3-6), most of which appear to be expressed in the testis and/or male reproductive system, together with four different G-protein-coupled receptors responsive to one or other of these peptides. Earlier work on relaxin in the male assumed the simplistic hypothesis of only a single relaxin-like entity. This review systematically examines the expression and physiology of relaxin-like molecules in the male reproductive system in order to reappraise the importance of this hormone system for male reproductive function. Although there are important species differences, only INSL3 and INSL6 appear to be generally expressed at a moderately high level within the testis, whereas ovarian RLN is consistently a major secretory product of the prostate epithelium. However, all members of this relaxin-like family appear to be expressed also at a low level in different organs of the male reproductive system, suggesting possible autocrine/paracrine effects. The four receptors (RXFP1-4) for these peptides are also expressed to differing levels in both somatic and seminiferous compartments of the testis and in the prostate, supporting relevant functions for most members of this interesting peptide family. Recent studies of relaxin family peptides in prostate pathology highlight their functional importance in the clinical context as potential causative, diagnostic and therapeutic agents and warrant more specific and detailed studies of their roles also in regard to male fertility and other aspects of male reproductive function.

  11. [Cranial-cerebral trauma after a traffic accident: perceptions of patients, family, physicians and professionals].

    Science.gov (United States)

    Lefebvre, Hélène; Pelchat, Diane; Swaine, Bonnie; Gélinas, Isabelle; Levert, Marie Josée

    2004-09-01

    This is a study of medical care when road accident incidents result in traumatic brain injury (TBI). We investigated the personal perceptions of those involved in acute care episodes and subsequent rehabilitation. We conducted simultaneous semi-structured interviews with individuals who had sustained a TBI (8) and their families (8). We then conducted semi-structured individual interviews with the professionals (22) and physicians (9) who attended them. Results reveal the difficulties encountered by the different people involved, from the standpoint of the rehabilitation of both the person who with the TBI and their families, the relationships among the various actors, and the continuity of care. The results disclose the importance of including the family and the TBI casualty in the care process by endorsing their participation and by setting up suitable structures that prioritize a meaningful partnership among the individuals, families, physicians, professionals and health care organizations and in which each person can play a role as an agent in the care of the person with the TBI. An important element, which came out again in our results, is that the shortage of information provided to the families can jeopardize establishing a relationship of trust among the actors. Furthermore, many of the family members were upset that the health intervention was entirely focussed on the TBI casualty: none of the professionals were concerned with what the families were going through, either during the acute care or rehabilitation. Another major problem is lack of communication, not just amongst the professionals, but also between institutions which seem to function in isolation. Lack of resources, the limited availability of those that are offered, and social policies are also detrimental to the reintegration of the TBI individual into the community. Finally, many of the professionals reported that they had not been trained to assist families in this situation.

  12. Correlates of CVD and discussing sexual issues with physicians among male military veterans.

    Science.gov (United States)

    Smith, Matthew Lee; Goltz, Heather Honoré; Motlagh, Audry S; Ahn, SangNam; Bergeron, Caroline D; Ory, Marcia G

    2016-10-01

    This study aims to identify socio-demographic and health behavior factors associated with cardiovascular disease (CVD) diagnosis and patient-physician communication concerning sexual issues among older Veterans. Cross-sectional data were collected from 635 male Veterans over age 55 years as part of the 2010 National Social Life, Health and Aging Project, a nationally-representative, population-based study of community-dwelling older Americans. Two independent logistic regression analyses were performed. Over 33% of Veterans were aged 75 years or older. Over one-half of participants reported having a CVD diagnosis (58%) and sexual intercourse within the previous year (58%); over one-third (37%) reported having one or more sexual dysfunctions and discussing sexual issues with their physician (42%). Veterans diagnosed with CVD were significantly more likely to self-identify as racial/ethnic minorities (OR=1.89, P=0.021), have more chronic disease comorbidities (OR=1.23, P=0.041), and have more sexual dysfunctions (OR=1.19, P=0.028). Veterans diagnosed with CVD were significantly less likely to report having sex within the previous year (OR=0.53, P=0.005). Veterans who reported discussing sexual issues with a physician were significantly more likely to be ≥75 years (OR=1.79, P=0.010), and report more than a high school education (OR=1.62, P=0.016), CVD diagnosis (OR=1.59, P=0.015), sex within the previous year (OR=1.69, P=0.033), and trouble achieving/maintaining an erection (OR=3.39, Paging and sexual health/counseling services. These services should promote increased patient-physician communication as well as referrals between physicians and sex health/counseling specialists. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review.

    Science.gov (United States)

    Visser, Mieke; Deliens, Luc; Houttekier, Dirk

    2014-11-18

    Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup. Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians' knowledge, physicians' attitudes or physicians' practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported. Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians' attitudes, 24 to physicians' knowledge and 20 to physicians' practice. Stronger evidence was found for physicians' lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient's true condition. We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance

  14. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Frémont Pierre

    2011-01-01

    Full Text Available Abstract Background To explore ways to reduce the overuse of antibiotics for acute respiratory infections (ARIs, we conducted a pilot clustered randomized controlled trial (RCT to evaluate DECISION+, a training program in shared decision making (SDM for family physicians (FPs. This pilot project demonstrated the feasibility of conducting a large clustered RCT and showed that DECISION+ reduced the proportion of patients who decided to use antibiotics immediately after consulting their physician. Consequently, the objective of this study is to evaluate, in patients consulting for ARIs, if exposure of physicians to a modified version of DECISION+, DECISION+2, would reduce the proportion of patients who decide to use antibiotics immediately after consulting their physician. Methods/design The study is a multi-center, two-arm, parallel clustered RCT. The 12 family practice teaching units (FPTUs in the network of the Department of Family Medicine and Emergency Medicine of Université Laval will be randomized to a DECISION+2 intervention group (experimental group or to a no-intervention control group. These FPTUs will recruit patients consulting family physicians and residents in family medicine enrolled in the study. There will be two data collection periods: pre-intervention (baseline including 175 patients with ARIs in each study arm, and post-intervention including 175 patients with ARIs in each study arm (total n = 700. The primary outcome will be the proportion of patients reporting a decision to use antibiotics immediately after consulting their physician. Secondary outcome measures include: 1 physicians and patients' decisional conflict; 2 the agreement between the parties' decisional conflict scores; and 3 perception of patients and physicians that SDM occurred. Also in patients, at 2 weeks follow-up, adherence to the decision, consultation for the same reason, decisional regret, and quality of life will be assessed. Finally, in both patients

  15. Mental health concerns among Canadian physicians: results from the 2007-2008 Canadian Physician Health Study.

    Science.gov (United States)

    Compton, Michael T; Frank, Erica

    2011-01-01

    In light of prior reports on the prevalence of stress, depression, and other mental health problems among physicians in training and practice, we examined the mental health concerns of Canadian physicians using data from the 2007-2008 Canadian Physician Health Study. Among 3213 respondents, 5 variables (depressive symptoms during the past year, anhedonia in the past year, mental health concerns making it difficult to handle one's workload in the past month, problems with work-life balance, and poor awareness of resources for mental health problems) were examined in relation to sex, specialty, practice type (solo practice vs group or other practice settings), and practice setting (inner city, urban/suburban, or rural/small town/remote). Nearly one quarter of physicians reported a 2-week period of depressed mood, and depression was more common among female physicians and general practitioners/family physicians. Anhedonia was reported by one fifth; anesthesiologists were most likely to report anhedonia, followed by general practitioners/family physicians. More than one quarter reported mental health concerns making it difficult to handle their workload, which was more common among female physicians and general practitioners/family physicians and psychiatrists. Nearly one quarter reported poor work-life balance. Lack of familiarity with mental health resources was problematic, which was more prominent among female physicians and specialists outside of general practice/family medicine or psychiatry. Mental health concerns are relatively common among Canadian physicians. Training programs and programmatic/policy enhancements should redouble efforts to address depression and other mental health concerns among physicians for the benefit of the workforce and patients served by Canadian physicians. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Should physicians have facial piercings?

    Science.gov (United States)

    Newman, Alison W; Wright, Seth W; Wrenn, Keith D; Bernard, Aline

    2005-03-01

    The objective of this study was to assess attitudes of patrons and medical school faculty about physicians with nontraditional facial piercings. We also examined whether a piercing affected the perceived competency and trustworthiness of physicians. Survey. Teaching hospital in the southeastern United States. Emergency department patrons and medical school faculty physicians. First, patrons were shown photographs of models with a nontraditional piercing and asked about the appropriateness for a physician or medical student. In the second phase, patrons blinded to the purpose of the study were shown identical photographs of physician models with or without piercings and asked about competency and trustworthiness. The third phase was an assessment of attitudes of faculty regarding piercings. Nose and lip piercings were felt to be appropriate for a physician by 24% and 22% of patrons, respectively. Perceived competency and trustworthiness of models with these types of piercings were also negatively affected. An earring in a male was felt to be appropriate by 35% of patrons, but an earring on male models did not negatively affect perceived competency or trustworthiness. Nose and eyebrow piercings were felt to be appropriate by only 7% and 5% of faculty physicians and working with a physician or student with a nose or eyebrow piercing would bother 58% and 59% of faculty, respectively. An ear piercing in a male was felt to be appropriate by 20% of faculty, and 25% stated it would bother them to work with a male physician or student with an ear piercing. Many patrons and physicians feel that some types of nontraditional piercings are inappropriate attire for physicians, and some piercings negatively affect perceived competency and trustworthiness. Health care providers should understand that attire may affect a patient's opinion about their abilities and possibly erode confidence in them as a clinician.

  17. Interactive genetic counseling role-play: a novel educational strategy for family physicians.

    Science.gov (United States)

    Blaine, Sean M; Carroll, June C; Rideout, Andrea L; Glendon, Gord; Meschino, Wendy; Shuman, Cheryl; Telner, Deanna; Van Iderstine, Natasha; Permaul, Joanne

    2008-04-01

    Family physicians (FPs) are increasingly involved in delivering genetic services. Familiarization with aspects of genetic counseling may enable FPs to help patients make informed choices. Exploration of interactive role-play as a means to raise FPs' awareness of the process and content of genetic counseling. FPs attending two large Canadian family medicine conferences in 2005 were eligible -- 93 participated. FPs discussed a case during a one-on-one session with a genetic counselor. Evaluation involved pre and post intervention questionnaires FPs' baseline genetic knowledge was self-rated as uniformly poor. Baseline confidence was highest in eliciting family history and providing psychosocial support and lowest in discussing risks/benefits of genetic testing and counseling process. Post-intervention, 80% of FPs had better appreciation of family history and 97% indicated this was an effective learning experience. Role-play with FPs is effective in raising awareness of the process and content of genetic counseling and may be applied to other health disciplines.

  18. The relationship between job satisfaction, work stress, work–family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study

    Science.gov (United States)

    Lu, Yong; Hu, Xiao-Min; Huang, Xiao-Liang; Zhuang, Xiao-Dong; Guo, Pi; Feng, Li-Fen; Hu, Wei; Chen, Long; Zou, Huachun; Hao, Yuan-Tao

    2017-01-01

    Objective To investigate the relationship between job satisfaction, work stress, work–family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. Methods From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work–family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. Results A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work–family conflict. Conclusion Job satisfaction, work stress, work–family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention. PMID:28501813

  19. Equipping family physician trainees as teachers: a qualitative evaluation of a twelve-week module on teaching and learning.

    Science.gov (United States)

    de Villiers, Marietjie R; Cilliers, Francois J; Coetzee, Francois; Herman, Nicoline; van Heusden, Martie; von Pressentin, Klaus B

    2014-10-22

    There is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and learning capacity-building module was introduced into a new master's programme in family medicine at Stellenbosch University, South Africa. We report on the influence of this module on graduates after the first six years. A qualitative study was undertaken, interviewing thirteen graduates of the programme. Thematic analysis of data was done by a team comprising tutors and graduates of the programme and an independent researcher. Ethical clearance was obtained. The module influenced knowledge, skills and attitudes of respondents. Perceptions and evidence of changes in behaviour, changes in practice beyond the individual respondent and benefits to students and patients were apparent. Factors underlying these changes included the role of context and the role of personal factors. Contextual factors included clinical workload and opportunity pressure i.e., the pressure and responsibility to undertake teaching. Personal factors comprised self-confidence, modified attitudes and perceptions towards the roles of a family physician and towards learning and teaching, in addition to the acquisition of knowledge and skills in teaching and learning. The interaction between opportunity pressure and self-confidence influenced the application of what was learned about teaching. A module on teaching and learning influenced graduates' perceptions of, and self-reported behaviour relating to, teaching as practicing family physicians. This has important implications for educating family physicians in and for

  20. Mining reflective continuing medical education data for family physician learning needs.

    Science.gov (United States)

    Lewis, Denice Colleen; Pluye, Pierre; Rodriguez, Charo; Grad, Roland

    2016-04-06

    A mixed methods research (sequential explanatory design) studied the potential of mining the data from the consumers of continuing medical education (CME) programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

  1. Effects of male literacy on family size: A cross sectional study conducted in Chakwal city.

    Science.gov (United States)

    Mahmood, Humaira; Khan, Ziaullah; Masood, Sumaira

    2016-04-01

    To determine the effects of male education on family size, the desired family size, knowledge and use of contraception and opinion about female education. The cross-sectional study was carried out in Chakwal city, Punjab, Pakistan, from June to October 2009. A pre-tested questionnaire was used for data collection. The respondents were males and data on their demographics, age at marriage, actual and desired family size, knowledge about methods of contraception, and opinion about female education was collected. SPSS 15 was used for statistical analysis. Out of the 178 respondents, 52(29.2%) were illiterate and 126(70.8%) were educated. Among the educated, 97(77%) were in favour of small families compared to only 10(19.2%) of the uneducated males (pfamilies, while 67(37.6%) had other reasons, like trying to conceive. Among the uneducated males, 17(32.7%) didn't discuss any family planning issue with their wives compared to 14(11.3%) of educated males (pfamily size, contraceptive use and views in favour of female education.

  2. FEE-SCHEDULE INCREASES IN CANADA: IMPLICATION FOR SERVICE VOLUMES AMONG FAMILY AND SPECIALIST PHYSICIANS.

    Science.gov (United States)

    Ariste, Ruolz

    2015-01-01

    Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.

  3. Nature and nurture in the family physician's choice of practice location.

    Science.gov (United States)

    Orzanco, Maria Gabriela; Lovato, Chris; Bates, Joanna; Slade, Steve; Grand'Maison, Paul; Vanasse, Alain

    2011-01-01

    An understanding of the contextual, professional, and personal factors that affect choice of practice location for physicians is needed to support successful strategies in addressing geographic maldistribution of physicians. This study compared two categories of predictors of family practice location in non-metropolitan areas among undergraduate medical students: individual characteristics (nature), and the rural program component of their training program (nurture). The study aimed to identify factors that predict the location of practice 2 years post-residency training and determine the predictive value of combining nature and nurture variables using administrative data from two undergraduate medical education programs. Databases were developed from available administrative sources for a retrospective analysis of two undergraduate medical education programs in Canada: Université de Sherbrooke (UdeS) and University of British Columbia (UBC). Both schools have a strong mandate to evaluate the impact of their programs on physician distribution. The dependent variable was location of practice 2 years after completing postgraduate training in family medicine. Independent variables included individual and program characteristics. Separate analyses were conducted for each program using multiple logistic regression. The nature and nurture variables considered in the models explained only 21% to 27% of the variance in the eventual location of practice of family physician graduates. For UdeS, having an address in a rural/small-town environment at application to medical school (OR=2.61, 95% CI: 1.24-6.06) and for UBC, location of high school in a rural/small town (OR=4.03, 95% CI: 1.05-15.41), both increased the chances of practicing in a non-metropolitan area. For UdeS the nurture variable (ie length of clerkship in a non-metropolitan area) was the most significant predictor (OR=1.14, 95% CI: 1.067-1.22). For both medical schools, adding a single nurture variable to the

  4. Patients’ satisfaction regarding family physician's consultation in primary healthcare centers of Ministry of Health, Jeddah

    Science.gov (United States)

    Bawakid, Khalid; Rashid, Ola Abdul; Mandoura, Najlaa; Usman Shah, Hassan Bin; Ahmed, Waqar Asrar; Ibrahim, Adel

    2017-01-01

    Introduction: The current study aims to assess the level of patients’ satisfaction and the factors contributing to patients’ satisfaction toward family physicians (FPs) consultation, visiting primary healthcare centers (PHCCs) working under Ministry of Health, Jeddah. Materials and Methods: In this cross-sectional study conducted in Jeddah from November 1, 2016 to March 1, 2017, we used consultation satisfaction questionnaire and its four subscales with standard cutoffs. These subscales include general satisfaction, professional care, depth of relationship, and length of consultation. Mean scores along with standard deviation of these subscales were measured. Independent sample t-test, ANOVA, and multivariate regression analysis were performed to test the association between satisfaction level and predictors. Results: Overall, patients’ satisfaction was 60%. Around 74% of patients were satisfied with the professional care and 58% with the depth of the relationship. Around 60% of patients need more consultation time with the physicians. Knowledge about the presence of FP in the nearest PHCCs was around 70%. Multivariate regression analysis for the overall high satisfaction showed that the most important predictors of this high satisfaction level are regular visits to a particular FP (P < 0.001), distance from the PHCC (P = 0.044) and gender of the patient (P = 0.027). Conclusion: This study concluded that satisfaction with the FP's consultation is acceptable but needs improvement. Lower satisfaction was reported among males, patients living at a distance from PHCC and who had less knowledge about the presence of FP in their nearest PHCC. Such study data are vital for any corrective measures to boost satisfaction in patients attending PHCCs. PMID:29564270

  5. Acceptability of the Urban Family Medicine Project among Physicians: A Cross-Sectional Study of Medical Offices, Iran.

    Science.gov (United States)

    Kor, Elham Movahed; Rashidian, Arash; Hosseini, Mostafa; Azar, Farbod Ebadi Fard; Arab, Mohammad

    2016-10-01

    It is essential to organize private physicians in urban areas by developing urban family medicine in Iran. Acceptance of this project is currently low among physicians. The present research determined the factors affecting acceptability of the Urban Family Medicine Project among physicians working in the private sector of Mazandaran and Fars provinces in Iran. This descriptive-analytical and cross-sectional study was conducted in Mazandaran and Fars provinces. The target population was all physicians working in private offices in these regions. The sample size was calculated to be 860. The instrument contained 70 items that were modified in accordance with feedback from eight healthcare managers and a pilot sample of 50 physicians. Data was analyzed using the LISREL 8.80. The response rate was 82.21% and acceptability was almost 50% for all domains. The fit indices of the structural model were the chi-square to degree-of-freedom (2.79), normalized fit index (0.98), non-normalized fit index (0.99), comparative fit index (0.99), and root mean square error of approximation (0.05). Training facilities had no significant direct effect on acceptability; however, workload had a direct negative effect on acceptability. Other factors had direct positive effects on acceptability. Specification of the factors relating to acceptance of the project among private physicians is required to develop the project in urban areas. It is essential to upgrade the payment system, remedy cultural barriers, decrease the workload, improve the scope of practice and working conditions, and improve collaboration between healthcare professionals.

  6. Family support and acceptance, gay male identity formation, and psychological adjustment: a path model.

    Science.gov (United States)

    Elizur, Y; Ziv, M

    2001-01-01

    While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

  7. Filling the Educator Pipeline: Recruiting Male Family and Consumer Sciences Teachers

    Science.gov (United States)

    Godfrey, Roxie V.; Manis, Kerry T.

    2017-01-01

    To encourage males to enter the teaching field, specifically in family and consumer sciences (FCS), FCS professionals should participate in recruitment initiatives aimed at males. Administrators, teacher educators, career counselors, and FCS teachers can play a significant role in this comprehensive and systematic effort. This paper adopts the…

  8. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: an occupation and region specific approach.

    Science.gov (United States)

    Malinauskiene, Vilija; Einarsen, Staale

    2014-12-01

    The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R), other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence), behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis. A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR) of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI): 3.80-17.04). In the fully adjusted model it increased to 13.88 (95% CI: 4.68-41.13) indicating cumulative effects of all the investigated stressors. Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

  9. Educational Development and Detachment Processes of Male Adolescents from Immigrant Families

    Directory of Open Access Journals (Sweden)

    Vera KING

    2010-11-01

    Full Text Available Social class, gender, and migration status notably influence social inequalities in the German educational system. Empirical studies reveal that especially male students from Turkish immigrant families belong to the most disadvantaged group with regard to educational opportunities. In order to identify causes for this we reconstruct and contrast biographies of successful and less successful educational careers of male adolescents from Turkish immigrant families. Our theoretical framework is based on the assumption that educational careers depend decisively on the way youths master the twofold challenge connected with adolescence and migration. Adolescent detachment processes are conceived as intergenerational occurrences (cf. King 2002, in which the quality of intergenerational family relationships as well as the biographical treatment of a particular migration project on the part of the parents play a significant role.

  10. The relationship between job satisfaction, work stress, work?family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study

    OpenAIRE

    Lu, Yong; Hu, Xiao-Min; Huang, Xiao-Liang; Zhuang, Xiao-Dong; Guo, Pi; Feng, Li-Fen; Hu, Wei; Chen, Long; Zou, Huachun; Hao, Yuan-Tao

    2017-01-01

    Objective To investigate the relationship between job satisfaction, work stress, work?family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. Methods From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work?family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data a...

  11. The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, Pim; van Marwijk, Harm W. M.; van der Horst, Henriëtte E.; Moll van Charante, Eric P.; Macneil Vroomen, Janet; van de Ven, Peter M.; van Hout, Hein P. J.

    2012-01-01

    Objective: Optimising care for dementia patients and their informal carers is imperative in light of the impending dementia epidemic. An important aspect of care is accurate recognition and diagnosis of dementia. The aim of this review was to estimate family physicians' diagnostic accuracy at the

  12. The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, P.; van Marwijk, H.W.J.; van der Horst, H.E.; van Charante, E.P.M.; Vroomen, J.M.; van de Ven, P.M.; van Hout, H.P.J.

    2012-01-01

    Objective Optimising care for dementia patients and their informal carers is imperative in light of the impending dementia epidemic. An important aspect of care is accurate recognition and diagnosis of dementia. The aim of this review was to estimate family physicians' diagnostic accuracy at the

  13. Gender influences on career opportunities, practice choices, and job satisfaction in a cohort of physicians with certification in sports medicine.

    Science.gov (United States)

    Pana, A L; McShane, J

    2001-04-01

    To examine the gender differences in practice patterns, experiences, and career opportunities for family physicians who practice sports medicine. Descriptive, self-administered questionnaire. Family physicians with Certificate of Added Qualification (CAQ) in sports medicine were surveyed. The survey was sent to all women with a CAQ in Sports Medicine and a random sample of 20% of the men with CAQs in sports medicine. Survey consisted of multiple choice, Likert scale, and opened-ended questions. The data was analyzed with contingency tables, with gender as the dependent variable. Response rate to the survey was 75%, which included 42 females and 102 males. Demographics of our population demonstrated some gender differences. Males were of higher average age (41.1 vs. 38.1), and more likely to be married and have children. Practice types, location, and time spent in sports medicine did not differ with the exception of training room and event coverage. Males were more likely to cover all levels of training room except at the Division I level, where the percent of males and females covering training rooms were equal. Males were also more likely to cover all types of sporting events. Job satisfaction and reasons for choosing current jobs did not show significant gender differences. However, factors affecting career opportunities did vary. Professional relationships with athletic trainers and coaches were perceived to be different by males and females surveyed. Our survey of sports medicine physicians showed some gender differences in practice patterns relative to training room and sporting event coverage. Surprisingly, there were not many differences in the factors that affected job choice and factors affecting job opportunities with the exception of gender itself. However, our study does not conclude how or when gender begins to affect the female sports medicine physician's career opportunities.

  14. Male Involvement in Family Planning Decision Making in Ile-Ife ...

    African Journals Online (AJOL)

    Erah

    spousal communication, and investigated the correlates of men's opinion in family planning decision making in ... questionnaire to collect information from 402 male study participants. ..... who attained post-secondary education were more.

  15. "Do your homework…and then hope for the best": the challenges that medical tourism poses to Canadian family physicians' support of patients' informed decision-making.

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik

    2013-09-22

    Medical tourism-the practice where patients travel internationally to privately access medical care-may limit patients' regular physicians' abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors' typical involvement in patients' informed decision-making is challenged when their patients engage in medical tourism. Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants' perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians' abilities to support medical tourists' informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician's role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician's reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians' concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Medical tourism is creating new challenges for

  16. Differences in Physician Income by Gender in a Multiregion Survey.

    Science.gov (United States)

    Apaydin, Eric A; Chen, Peggy G C; Friedberg, Mark W

    2018-05-11

    Previous studies have documented income differences between male and female physicians. However, the implications of these differences are unclear, since previous studies have lacked detailed data on the quantity and composition of work hours. We sought to identify the sources of these income differences using data from a novel survey of physician work and income. To compare differences in income between male and female physicians. We estimated unadjusted income differences between male and female physicians. We then adjusted these differences for total hours worked, composition of work hours, percent of patient care time spent providing procedures, specialty, compensation type, age, years in practice, race, ethnicity, and state and practice random effects. We surveyed 656 physicians in 30 practices in six states and received 439 responses (67% response rate): 263 from males and 176 from females. Self-reported annual income. Male physicians had significantly higher annual incomes than female physicians (mean $297,641 vs. $206,751; difference $90,890, 95% CI $27,769 to $154,011) and worked significantly more total hours (mean 2470 vs. 2074; difference 396, 95% CI 250 to 542) and more patient care hours (mean 2203 vs. 1845; difference 358, 95% CI 212 to 505) per year. Male physicians were less likely than female physicians to specialize in primary care (49.1 vs. 70.5%), but more likely to perform procedures with (33.1 vs. 15.5%) or without general anesthesia (84.3 vs. 73.1%). After adjustment, male physicians' incomes were $27,404 (95% CI $3120 to $51,688) greater than female physicians' incomes. Adjustment for multiple possible confounders, including the number and composition of work hours, can explain approximately 70% of unadjusted income differences between male and female physicians; 30% remains unexplained. Additional study and dedicated efforts might be necessary to identify and address the causes of these unexplained differences.

  17. Dealing with symptoms and issues of hospitalized patients with cancer in indonesia: the role of families, nurses, and physicians

    NARCIS (Netherlands)

    Effendy, C.; Vissers, K.; Tejawinata, S.; Vernooij-Dassen, M.J.F.J.; Engels, Y.M.

    2015-01-01

    OBJECTIVE: Patients with cancer often face physical, psychological, social, spiritual, and emotional symptoms. Our aim was to study symptoms and issues of hospitalized patients with cancer in Indonesia, a country with strong family ties, and how family members, nurses, and physicians deal with them.

  18. The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study.

    Science.gov (United States)

    Lu, Yong; Hu, Xiao-Min; Huang, Xiao-Liang; Zhuang, Xiao-Dong; Guo, Pi; Feng, Li-Fen; Hu, Wei; Chen, Long; Zou, Huachun; Hao, Yuan-Tao

    2017-05-12

    To investigate the relationship between job satisfaction, work stress, work-family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work-family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work-family conflict. Job satisfaction, work stress, work-family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: An occupation and region specific approach

    Directory of Open Access Journals (Sweden)

    Vilija Malinauskiene

    2014-12-01

    Full Text Available Objectives: The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. Material and Methods: With a response rate of 89.2%, a total of 323 family physicians filled in an anonymous questionnaire on workplace bullying, post-traumatic symptomatology (IES-R, other psychosocial stressors at work and in everyday life, personal health resources (sense of coherence, behavioral characteristics and demographic variables. The statistical software SPSS 14.0, Windows was used in the analysis. Associations were tested using a multivariate logistic regression analysis. Results: A high prevalence of bullying was found among family physicians in Lithuania, with 13% of them experiencing severe workplace bullying and 17.3% experiencing more occasional incidents of bullying. The prevalence of post-traumatic stress symptoms was also high with 15.8% scoring above the standardized cut-off thresholds for post-traumatic stress disorder. The odds ratio (OR of severe bullying for post-traumatic stress after adjustment for age and gender was 8.05 (95% confidence intervals (CI: 3.80–17.04. In the fully adjusted model it increased to 13.88 (95% CI: 4.68–41.13 indicating cumulative effects of all the investigated stressors. Conclusions: Workplace bullying is particularly prevalent among Lithuanian family physicians, as are the symptoms of post-traumatic distress. Strong associations between post-traumatic stress and exposure to severe bullying indicate that bullying is a significant source of mental health.

  20. Family physicians' perceptions of academic detailing: a quantitative and qualitative study

    Directory of Open Access Journals (Sweden)

    O'Connor Nicolette

    2007-10-01

    Full Text Available Abstract Background The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs perceptions of academic detailing and the factors that affect their use of it. Methods We used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it. Results Overall response rate to the questionnaire was 33% (289/869. Response rate of non-users of academic detailing was 15% (60/393, of users was 48% (229/476. The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists. Conclusion Users of academic detailing highly value its educational

  1. Africa takes a more male-friendly approach to family planning.

    Science.gov (United States)

    Omuodo, D O

    1996-12-01

    It has been demonstrated that men are more likely to support family planning (FP) and to use a method themselves if services and educational programs are targeted to them. Because men fear that contraception reduces their control over their wives' sexuality, male-friendly approaches can enhance gender equality in reproductive health decisions. In Togo, the media is being used to encourage positive attitudes towards FP in specific male groups. In Ghana, FP services targeted to men have resulted in increased male involvement. In Swaziland, male audiences are targeted with FP education. In Sierra Leone, men have met in groups to learn about how to prevent sexually transmitted diseases and about the benefits of FP, and in Kenya, three male-only clinics exist to provide FP services to men.

  2. Maternity and family leave policies in rural family practices.

    Science.gov (United States)

    Mainguy, S; Crouse, B J

    1998-09-01

    To help recruit and retain physicians, especially women, rural family practice groups need to establish policies regarding maternity and other family leaves. Also important are policies regarding paternity leave, adoptive leave, and leave to care for elderly parents. We surveyed members of the American Academy of Family Physicians in rural practice in 1995 to assess the prevalence of leave policies, the degree to which physicians are taking family leave, and the characteristics of ideal policies. Currently, both men and women physicians are taking family leaves of absence, which indicates a need for leave policies. Furthermore, a lack of family leave policies may deter women from entering rural practice.

  3. Longitudinal qualitative study describing family physicians' experiences with attempting to integrate physical activity prescriptions in their practice: 'It's not easy to change habits'.

    Science.gov (United States)

    Bélanger, Mathieu; Phillips, Emily Wolfe; O'Rielly, Connor; Mallet, Bertin; Aubé, Shane; Doucet, Marylène; Couturier, Jonathan; Mallet, Maxime; Martin, Jessica; Gaudet, Christine; Murphy, Nathalie; Brunet, Jennifer

    2017-07-13

    Physical activity (PA) prescriptions provided by family physicians can promote PA participation among patients, but few physicians regularly write PA prescriptions. The objective of this study was to describe family physicians' experiences of trying to implement written PA prescriptions into their practice. Longitudinal qualitative study where participants were interviewed four times during a 12-month period. After the first interview, they were provided with PA prescription pads. Data were analysed using thematic analysis. Family medicine clinics in New Brunswick, Canada. Family physicians (n=11) with no prior experience writing PA prescriptions, but who expressed interest in changing their practice to implement written PA prescriptions. Initially, participants exhibited confidence in their ability to write PA prescriptions in the future and intended to write prescriptions. However, data from the follow-up interviews indicated that the rate of implementation was lower than anticipated by participants and prescriptions were not part of their regular practice. Two themes emerged as factors explaining the gap between their intentions and behaviours: (1) uncertainty about the effectiveness of written PA prescription, and (2) practical concerns (eg, changing well-established habits, time constraints, systemic institutional barriers). It may be effective to increase awareness among family physicians about the effectiveness of writing PA prescriptions and address barriers related to how their practice is organised in order to promote written PA prescription rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. A quantitative day in the life of a Saskatchewan rural physician.

    Science.gov (United States)

    Harrison, Emmett; Dhillon, Paul B A

    2018-01-01

    Rural family physicians are often required to meet a wide variety of medical service demands that are otherwise the responsibility of specialty physicians in urban centres. However, many rural physicians enjoy the practice variety and ability to meet patients' medical needs through this wider spectrum of care. We aimed to quantify and summarize the workload and clinical disorders seen by rural family physicians in Saskatchewan relative to urban family physicians. We used Saskatchewan Ministry of Health billing data for 2015/16 to compare rural and urban care provision. The data were summarized in a graphic 1-month format to portray a typical month in the life of a rural physician in the province. In the office setting, rural family physicians saw 16.8% more cardiac presentations in adults over 65 years of age than did urban family physicians; otherwise, there were no significant differences in the top office diagnosis categories seen by the 2 groups. Differences were apparent, however, in the hospital setting: urban family physicians saw more patients presenting with pain and, reflective of centralization of obstetric delivery services, performed more deliveries than did rural physicians. There are differences in the clinical presentations seen by rural and urban family physicians, and these need to be considered by new physicians considering rural practice. Our simple visual depiction of average workload, vacation and activity levels of rural physicians can further inform medical residents on the realities of working in rural Saskatchewan as a family physician. A more complete understanding of clinical workload expectations may promote recruitment of resident physicians.

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

    Science.gov (United States)

    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

  6. Patients' satisfaction regarding family physician's consultation in primary healthcare centers of Ministry of Health, Jeddah

    Directory of Open Access Journals (Sweden)

    Khalid Bawakid

    2017-01-01

    Full Text Available Introduction: The current study aims to assess the level of patients' satisfaction and the factors contributing to patients' satisfaction toward family physicians (FPs consultation, visiting primary healthcare centers (PHCCs working under Ministry of Health, Jeddah. Materials and Methods: In this cross-sectional study conducted in Jeddah from November 1, 2016 to March 1, 2017, we used consultation satisfaction questionnaire and its four subscales with standard cutoffs. These subscales include general satisfaction, professional care, depth of relationship, and length of consultation. Mean scores along with standard deviation of these subscales were measured. Independent sample t-test, ANOVA, and multivariate regression analysis were performed to test the association between satisfaction level and predictors. Results: Overall, patients' satisfaction was 60%. Around 74% of patients were satisfied with the professional care and 58% with the depth of the relationship. Around 60% of patients need more consultation time with the physicians. Knowledge about the presence of FP in the nearest PHCCs was around 70%. Multivariate regression analysis for the overall high satisfaction showed that the most important predictors of this high satisfaction level are regular visits to a particular FP (P < 0.001, distance from the PHCC (P = 0.044 and gender of the patient (P = 0.027. Conclusion: This study concluded that satisfaction with the FP's consultation is acceptable but needs improvement. Lower satisfaction was reported among males, patients living at a distance from PHCC and who had less knowledge about the presence of FP in their nearest PHCC. Such study data are vital for any corrective measures to boost satisfaction in patients attending PHCCs.

  7. Interventions to Increase Male Attendance and Testing for Sexually Transmitted Infections at Publicly-Funded Family Planning Clinics.

    Science.gov (United States)

    Fine, David; Warner, Lee; Salomon, Sarah; Johnson, David M

    2017-07-01

    We assessed the impact of staff, clinic, and community interventions on male and female family planning client visit volume and sexually transmitted infection testing at a multisite community-based health care agency. Staff training, clinic environmental changes, in-reach/outreach, and efficiency assessments were implemented in two Family Health Center (San Diego, CA) family planning clinics during 2010-2012; five Family Health Center family planning programs were identified as comparison clinics. Client visit records were compared between preintervention (2007-2009) and postintervention (2010-2012) for both sets of clinics. Of 7,826 male client visits during the time before intervention, most were for clients who were aged male visits (4,004 to 8,385; Δ = +109%); for comparison clinics, male visits increased modestly (3,822 to 4,500; Δ = +18%). The proportion of male clinic visits where chlamydia testing was performed increased in intervention clinics (35% to 42%; p males yielded similar findings for male client volume and chlamydia testing. The number of female visits declined nearly 40% in both comparison (21,800 to 13,202; -39%) and intervention clinics (30,830 to 19,971; -35%) between preintervention and postintervention periods. Multilevel interventions designed to increase male client volume and sexually transmitted infection testing services in family planning clinics succeeded without affecting female client volume or services. Copyright © 2017 Society for Adolescent Health and Medicine. All rights reserved.

  8. Family physicians' suggestions to improve the documentation, coding, and billing system: a study from the residency research network of Texas.

    Science.gov (United States)

    Young, Richard A; Bayles, Bryan; Hill, Jason H; Kumar, Kaparabonya A; Burge, Sandra

    2014-06-01

    The study's aim was to ascertain family physicians' suggestions on how to improve the commonly used US evaluation and management (E/M) rules for primary care. A companion paper published in Family Medicine's May 2014 journal describes our study methods (Fam Med 2014;46(5):378-84). Study subjects supported preserving the overall SOAP note structure. They especially suggested eliminating bullet counting in the E/M rules. For payment reform, respondents stated that brief or simple work should be paid less than long or complex work, and that family physicians should be paid for important tasks they currently are not, such as spending extra time with patients, phone and email clinical encounters, and extra paperwork. Subjects wanted shared savings when their decisions and actions created system efficiencies and savings. Some supported recent payment reforms such as monthly retainer fees and pay-for-performance bonuses. Others expressed skepticism about the negative consequences of each. Aligned incentives among all stakeholders was another common theme. Family physicians wanted less burdensome documentation requirements. They wanted to be paid more for complex work and work that does not include traditional face-to-face clinic visits, and they wanted the incentives of other stakeholders in the health care systems to be aligned with their priorities.

  9. The Effect of the Family Physician Program Implementation on the Monitoring of the Performance of Health and Treatment Centers and the Producing and Distribution of Healthy Water, Food and Cosmetics

    Directory of Open Access Journals (Sweden)

    Hossein Jabari Beyrami

    2015-07-01

    Full Text Available Background and Objectives : Family physician as the leader of health team is responsible for monitoring water quality, food and cosmetic preparation settings.  This study was carried out to determine the effect of family physician program on the performance of health centers in the mentioned processes in urban areas of East Azerbaijan, Iran. Materials and Methods : In this cross-sectional descriptive study, three health centers of the East Azerbaijan province were selected as samples and data were extracted from environmental health records files for water and sampling was used for food and cosmetic distributors for two periods of time: before and after implementing family physician plan. Data were analyzed using SPSS 16 software. Results : The results showed that monitoring of chlorine in drinking water was doubled and microbial sampling of water was increased one and a half time. Furthermore, the monitoring processes of health regulations in food and cosmetic preparation settings after implementing family physician program were improved. Conclusion : In spite of improvements in drinking water monitoring process after family physician program implementation, it is necessary to revise the family physician responsibilities and performance evaluation checklists in this section.

  10. Dealing with symptoms and issues of hospitalized patients with cancer in indonesia: the role of families, nurses, and physicians.

    Science.gov (United States)

    Effendy, Christantie; Vissers, Kris; Tejawinata, Sunaryadi; Vernooij-Dassen, Myrra; Engels, Yvonne

    2015-06-01

    Patients with cancer often face physical, psychological, social, spiritual, and emotional symptoms. Our aim was to study symptoms and issues of hospitalized patients with cancer in Indonesia, a country with strong family ties, and how family members, nurses, and physicians deal with them. In 2011, 150 hospitalized cancer patients in 3 general hospitals in Indonesia were invited to fill in a questionnaire, which was based on the validated Problems and Needs of Palliative Care (short version) questionnaire. Descriptive statistics were performed. Of 119 patients (79%) who completed the questionnaire, 85% stated that their symptoms and issues were addressed. According to these patients, financial (56%), autonomy (36%), and psychosocial (34%) issues were most often addressed by the family alone. Physical symptoms (52%) and spiritual issues (33%) were addressed mainly by a combination of family, nurses, and physicians. Hospitalized patients with cancer in Indonesia felt that most of their symptoms and issues had been addressed, and the family was highly involved. The strong family ties in Indonesian culture may have contributed to this family role. More research is needed to clarify how this influences patient outcome, quality of care, and quality of life of both the patients and their families, along with the degree of partnership between families and professionals. This information might help answer the question what advantages and disadvantages the family role in caring for a hospitalized patient with cancer generates for the patient, the family, and professional caregivers. © 2014 World Institute of Pain.

  11. Family Planning for Inner-City Adolescent Males: Pilot Study.

    Science.gov (United States)

    Reis, Janet; And Others

    1987-01-01

    Describes a pilot family planning program in an inner-city pediatric practice. Male adolescents were more likely to accept contraceptives if the provider first raised the topic of birth control to them. Identified a desire for anonymity/confidentiality and embarrassment or discomfort as the key reasons for not seeking contraceptives. Emphasizes…

  12. Family physicians and HIV infection.

    Science.gov (United States)

    Hall, N; Crochette, N; Blanchi, S; Lavoix, A; Billaud, E; Baron, C; Abgueguen, P; Perré, P; Rabier, V

    2015-01-01

    We aimed to describe the current and desired involvement of family physicians (FPs) in the treatment of HIV patients (screening practices, potential training and patient follow-up) to reduce the duration and frequency of their hospital treatment. We conducted a descriptive cross-sectional survey between 2011 and 2012 with the support of COREVIH (Regional Coordinating Committee on HIV). We sent a self-assessment questionnaire to all FPs of the Pays de la Loire region to enquire about their HIV screening practices and expectations for the management of HIV patients. A total of 871 FPs completed the questionnaire (response rate: 30.4%). A total of 54.2% said to provide care to HIV patients; the mean number of HIV patients per FP was estimated at 1.4. With regard to HIV screening, 12.2% systematically suggest an HIV serology to their patients and 72.7% always suggest it to pregnant women. About 45.4% of responding FPs said to be willing to manage HIV patients (clinical and biological monitoring, compliance checks and prescription renewal). FPs mainly reported the lack of training and the low number of HIV patients as a barrier to their further involvement in the management of HIV patients. The responding FPs provide care to very few HIV patients. They are, however, willing to be more involved in the routine care of these patients. Medical training provided by COREVIH would help improve HIV screening. The management of HIV patients could thus be handed over to willing FPs. Copyright © 2015. Published by Elsevier SAS.

  13. Lung cancer risk comparison among male smokers between the "six-prefecture cohort" in Japan and the British physicians' cohort.

    Science.gov (United States)

    Mizuno, S; Akiba, S; Hirayama, T

    1989-12-01

    We estimated the effective duration of cigarette smoking using the data of lung cancer mortality among male smokers of a large-scale cohort study in Japan and evaluated its role in the lung cancer risk difference between male smokers of the Japanese cohort and the British physicians' cohort. By selecting male cohort members who answered that they had started smoking at ages 18-22 (average = 20.3), the subjects of our analysis, which numbered 49,013, were made relatively homogeneous in terms of age at which smoking was started. Assuming lung cancer mortality to be proportional to the 4.5th power of the effective duration of cigarette smoking, i.e., (age-theta)4.5, as was proposed on the basis of the British cohort study by Doll and Peto, the parameter theta was estimated to be 29.4 for male smokers aged 40-64 in 1966; therefore, the estimated duration of cigarette smoking was, on average, 9.1 years (95% confidence interval = 5.8-11.6) shorter than that calculated from the reported age at which smoking was started. Our findings suggested that the low lung cancer mortality relative to daily cigarette consumption in Japan resulted from the shorter duration of cigarette smoking in the Japanese cohort, possibly due to the severe shortage of cigarettes during and shortly after World War II. Once the effective duration of cigarette smoking was adjusted, lung cancer mortality in the range of 5-34 cigarettes per day was fairly comparable to that observed among the cohort of male British physicians.

  14. Verbal Aggressiveness Among Physicians and Trainees.

    Science.gov (United States)

    Lazarus, Jenny Lynn; Hosseini, Motahar; Kamangar, Farin; Levien, David H; Rowland, Pamela A; Kowdley, Gopal C; Cunningham, Steven C

    2016-01-01

    To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences. The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type. The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed. Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a

  15. City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada.

    Science.gov (United States)

    Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam

    2016-05-06

    To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Prenatal genetic counseling in cross-cultural medicine: A framework for family physicians.

    Science.gov (United States)

    Bhogal, Ashvinder K; Brunger, Fern

    2010-10-01

    To help family physicians practise effective genetic counseling and offer practical strategies for cross-cultural communication in the context of prenatal genetic counseling. PubMed and the Cochrane Database of Systematic Reviews were searched. Most evidence was level II and some was level III. The values and beliefs of practitioners, no less than those of patients, are shaped by culture. In promoting a patient's best interest, the assumptions of both the patient and the provider must be held up for examination and discussed in the attempt to arrive at a consensus. Through the explicit discussion and formation of trust, the health professionals, patients, and family members who are involved can develop a shared understanding of appropriate therapeutic goals and methods. Reflecting on the cultural nature of biomedicine's ideas about risk, disability, and normality helps us to realize that there are many valid interpretations of what is in a patient's best interest. Self-reflection helps to ensure that respectful communication with the specific family and patient is the basis for health care decisions. Overall, this helps to improve the quality of care.

  17. Attitudes Toward Gender, Work, and Family among Female and Male Scientists in Germany and the United States

    Science.gov (United States)

    Hanson, Sandra L.; Fuchs, Stefan; Aisenbrey, Silke; Kravets, Natalyia

    This research used a comparative approach and an elite framework to look at attitudes toward gender, work, and family among male and female scientists. The data came from the 1994 International Social Survey Program module measuring family and changing gender roles in (the former) East Germany, West Germany, and the United States. Research questions focused on the variation between the three samples in male scientists' attitudes regarding gender, work, and family; women's representation in science occupations; and the relation between the two. Another major concern was the extent to which female scientists express attitudes regarding gender, work, and family that resemble those of male scientists and the implications of these processes for increasing women's access to science. As predicted, male scientists in East Germany tended to have the most progressive attitudes (especially those regarding gender and work), East German women had the greatest access to science occupations, and there were virtually no sex differences in attitudes of East German scientists. West German male scientists were the most traditional on attitudes regarding gender and work, and U. S. male scientists tended to be the most traditional on attitudes regarding family. The attitudes of female scientists in West Germany and the United States reflected this larger trend, but there were sex differences within countries, with female scientists being more progressive than male scientists. Thus, the findings suggest that women s representation in science is related to the attitudes of male scientists regarding gender, work, and family. And although female scientists often hold quite similar attitudes as male scientists, there is considerable cross-country variation in how progressive the attitudes are and how similar men's and women's attitudes are. Implications for women's access to elite science occupations are discussed.

  18. Assessment of physicians' awareness and knowledge of familial hypercholesterolemia in Saudi Arabia: Is there a gap?

    Science.gov (United States)

    Batais, Mohammed Ali; Almigbal, Turky H; Bin Abdulhak, Aref A; Altaradi, Hani B; AlHabib, Khalid F

    2017-01-01

    The scarcity of familial hypercholesterolemia (FH) cases reported in Saudi Arabia might be indicative of a lack of awareness of this common genetic disease among physicians. To assess physicians' awareness, practice, and knowledge of FH in Saudi Arabia. This is a cross-sectional study conducted among physicians at four tertiary hospitals in Riyadh, Saudi Arabia between March 2016 and May 2016 using a self-administered questionnaire. A total of 294 physicians completed the survey (response rate 90.1%). Overall, 92.9% of the participants have poor knowledge of FH while only 7.1% have acceptable knowledge. The majority (68.7%) of physicians rated their familiarity with FH as average or above average, and these had higher mean knowledge scores than participants with self-reported below average familiarity (mean 3.4 versus 2.6) (P knowledge scores compared to those without FH patients in their care (3.5 versus 2.9) (P = 0.006). In addition, there were statistically significant differences between physicians' mean knowledge scores and their ages, levels of training, and years in practice. Moreover, a substantial deficit was identified in the awareness of various clinical algorithms to diagnose patients with FH, cascade screening, specialist lipid services, and the existence of statin alternatives, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. A substantial deficit was found in the awareness, knowledge, practice, and detection of FH among physicians in Saudi Arabia. Extensive educational programs are required to raise physician awareness and implement best practices; only then can the impact of these interventions on FH management and patient outcome be assessed.

  19. Practical training in family medicine in the Dalmatian hinterland: first-hand experience of four physicians

    Directory of Open Access Journals (Sweden)

    Minka Jerčić

    2012-05-01

    Full Text Available Four physicians working in private family medicine offices in Dalmatian Hinterland described their first hand experience of teaching sixthyear medical students. They supervised students during the 2010/2011 academic year, in an area that is economically undeveloped, rural, and where a number of people live in extended families. Although hesitant at first, the patients came to like the interaction with students, and later even yearned to provide students with as much information as possible. They also liked the letters that students had to write to them about their illness, because they could take them home and look for information without needing to see the doctor. The students showed diverse attitudes to different types of work in family medicine offices, mostly depending on their plans for future career. In general, they either complained or hesitated to perform duties that they did not fully master during earlier education, especially working with children. They needed several days to adapt to direct contact with the patients, and were more relaxed and cooperative when working in pairs than alone. The physicians themselves felt that they profited both from the novelty in the everyday routine and from the exchange of their experiences with the students. They liked their young colleagues and admitted they could not objectively review their own work, knowledge and skills.

  20. Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease.

    Science.gov (United States)

    Rocker, Graeme; Young, Joanne; Donahue, Margaret; Farquhar, Morag; Simpson, Catherine

    2012-06-12

    A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context. Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology. Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more "normally," observed improvements in patients' symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure. Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment.

  1. A Social Network Family-Focused Intervention to Promote Smoking Cessation in Chinese and Vietnamese American Male Smokers: A Feasibility Study.

    Science.gov (United States)

    Tsoh, Janice Y; Burke, Nancy J; Gildengorin, Ginny; Wong, Ching; Le, Khanh; Nguyen, Anthony; Chan, Joanne L; Sun, Angela; McPhee, Stephen J; Nguyen, Tung T

    2015-08-01

    Smoking prevalence is high among limited English-proficient Chinese and Vietnamese American men, who are frequently unmotivated to quit and who underutilize smoking cessation resources. This study applied lay health worker outreach to leverage peer and family networks to promote smoking cessation among these men. We integrated qualitative formative research findings and Social Network Theory to develop a social-network family-focused intervention. In a pilot single-group trial, 15 lay health workers recruited 96 dyads (N = 192, 75% Vietnamese) of Chinese or Vietnamese male daily smokers and their family members and delivered the intervention consisting of two small group education sessions and two individual telephone calls over 2 months. At baseline, 42% of smokers were at precontemplation. At 3 months following the initiation of the intervention, 7-day and 30-day point prevalence smoking abstinence rates as reported by smokers and independently corroborated by family members were 30% and 24%, respectively. Utilization of smoking cessation resources (medication, quitline, physician's advice) increased from 2% to 60% (P Vietnamese smokers appears to be acceptable, feasible, and potentially efficacious. Findings warrant evaluation of long-term efficacy of the intervention in a larger scale randomized controlled trial. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Importance of telemedicine in diabetes care: Relationshipsbetween family physicians and ophthalmologists

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Diabetic retinopathy (DR) is the worldwide leadingcause of legal blindness. In 2010, 1.9% of diabetesmellitus (DM) patients were legally blind and 10.2%had visual impairment. The control of DM parameters(glycemia, arterial tension and lipids) is the goldstandard for preventing DR complications, although,unfortunately, DR still appeared in a 25% to 35% ofpatients. The stages of severe vision threading DR,include proliferative DR (6.96%) and diabetic macularedema (6.81%). This review aims to update ourknowledge on DR screening using telemedicine, thedifferent techniques, the problems, and the inclusion ofdifferent professionals such as family physicians in careprograms.

  3. Survey of nutrition knowledge of physicians in Kuwait.

    Science.gov (United States)

    Allafi, Ahmad R; Alajmi, Fahhad; Al-Haifi, Ahmad

    2013-07-01

    The objective of the present study was to determine whether nutrition knowledge differs between male and female physicians working in Kuwait City, Kuwait. The study employed a cross-sectional analysis of physician’s nutrition knowledge by using a sixteen-item multiple-choice questionnaire. Governmental hospitals in Kuwait City, Kuwait. One hundred Kuwaiti physicians (fifty males; fifty females) working in Kuwait City, Kuwait. A response rate of 73% was achieved (forty males; thirty-three females). The mean percentage of correctly answered questions was 60 %. The male and female physicians averaged 56% and 65% of correct responses, respectively (P50?042). However, only for two questions did male and female physicians’ scores differ significantly (P,0?05). The two age groups (,40 years; $40 years) had equal mean total correct scores (60 %, P50?935). Physicians’ knowledge was greatest for topics that have received a great deal of media coverage in Kuwait. Most (70 %) of the physicians described their nutrition knowledge as ‘moderate’. Physicians in Kuwait gave inaccurate information regarding common problems in Kuwaitis such as obesity, hypertension and osteoporosis. In view of the public’s perception of the role of the physician in providing nutrition advice, it is imperative that nutrition and diet training be part of continuing medical education to bridge these deficiencies in physicians’ knowledge.

  4. Perceptions of patients, families, physicians and nurses regarding challenges in cancer disclosure: A descriptive qualitative study.

    Science.gov (United States)

    Ehsani, Maryam; Taleghani, Fariba; Hematti, Simin; Abazari, Parvaneh

    2016-12-01

    The findings of numerous studies have illustrated that there is still a high proportion of cancer patients in Eastern and Middle-East countries including Iran, who are not properly informed of their disease due to the concealment atmosphere which still prevails. This descriptive qualitative study is aimed at exploring perceptions of patients, patients' family members, physicians and nurses regarding cancer disclosure challenges. Thirty-five participants (15 patients, 6 family members, 9 physicians, and 5 nurses) were selected through purposive sampling. The data were collected through in-depth interviews; after which they were analyzed using a qualitative content analysis with an inductive approach. Data analysis revealed the following three categories: first, challenges related to healthcare system which deals with the deficiencies, strains and concerns in medical setting and healthcare team training; second, challenges related to family insistence on concealment which includes their fear of cancer disclosure and its negative impact on the patients; and third, challenges related to policy making which consists of deficiencies in legislative and supportive institutions for advocacy of truth telling. Successful move from concealment to effective disclosure attitude in cancer patients in Iran requires a national determination for resolving challenges in medical education as well as other different social, cultural and policy making dimensions. Copyright © 2016. Published by Elsevier Ltd.

  5. Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say.

    Science.gov (United States)

    Hebert, Lauren M; Watson, Anne C; Madrigal, Vanessa; October, Tessie W

    2017-12-01

    When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented. We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative. Single-center PICU of a tertiary medical center. Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014. We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits. When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical

  6. 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

  7. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families.

    Science.gov (United States)

    Kimsma, G K

    2010-11-01

    In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998).

  8. Male Cross-Dressers in Therapy: A Solution-Focused Perspective for Marriage and Family Therapists.

    Science.gov (United States)

    Dzelme, Kristina; Jones, Rene A.

    2001-01-01

    Offers techniques on how to work with male cross-dressers using solution focused therapy. Solution focused therapy is discussed as a way to work with male cross dressers and their partners. A case study of a male cross dresser and his wife is presented and possible directions are suggested for marriage and family therapists. (BF)

  9. Parental Monitoring and Family Relations: Associations with Drinking Patterns among Male and Female Mexican Students

    Science.gov (United States)

    Strunin, Lee; Díaz-Martínez, L. Rosa; Díaz-Martínez, Alejandro; Heeren, Timothy; Winter, Michael; Kuranz, Seth; Hernández-Ávila, Carlos A.; Fernández-Varela, Héctor; Solís-Torres, Cuauhtémoc

    2015-01-01

    Introduction Parental monitoring and family relations are recognized as protective factors for youth alcohol use. The purpose of this study was to investigate perceived parental monitoring and family relations among subgroups of Mexican youths with different patterns of drinking behaviors and consequences. Methods A Latent Profile Analysis (LPA) identified profiles of drinking behavior in a cross-sectional survey of entering first year university students. Multinomial regression examined associations between parental monitoring, family relations and drinking profiles among 22,224 students. Results Both lower perceived parental monitoring and weaker perceived family relations were associated with heavier drinking profiles among males and females, but more strongly associated with female than male heavier drinking profiles. Being older, having parents with lower education, and not living with parents were also associated with lower parental monitoring and weaker family relations. There was a general trend of lower parental monitoring and weaker family relations as the profiles increased from Non/Infrequent-No Consequences to Excessive-Many Consequences drinkers. Lower perceived parental monitoring and weaker perceived family relations were more strongly associated with drinking profiles among females than among males. Both the parental monitoring and family relations scales had similar associations with drinking profiles. Conclusions Findings suggest drinking norms and values may contribute to any protective influences of parental monitoring and family relations on Mexican youths’ drinking. Research about changes in drinking norms, contextual factors, and youth-parent trust would inform the utility of parental monitoring or family relations as protective strategies against alcohol misuse among Mexican and Mexican American youths and also youths from other backgrounds. PMID:26256470

  10. Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests

    Science.gov (United States)

    Vouking, Marius Zambou; Evina, Christine Danielle; Tadenfok, Carine Nouboudem

    2014-01-01

    The World Health Organization (WHO) estimated in 2012 that 287,000 maternal deaths occurred in 2010; sub-Saharan Africa (56%) and Southern Asia (29%) accounted for the global burden of maternal deaths. Men are also recognized to be responsible for the large proportion of ill reproductive health suffered by their female partners. Male involvement helps not only in accepting a contraceptive but also in its effective use and continuation. The objectives were to assess men's knowledge, attitude, and practice of modern contraceptive methods; determine the level of spousal communication about family planning decision making; and investigate the correlates of men's opinion about their roles in family planning decision making. We searched the following electronic databases from January 1995 to December 2013: Medline, Embase, CINAHL, LILAS, International Bibliography of Social Sciences, Social Services Abstracts, and Sociological Abstracts. Along with MeSH terms and relevant keywords, we used the Cochrane Highly Sensitive Search Strategy for identifying reports of articles in PubMed. There were no restrictions to language or publication status. Of 137 hits, 7 papers met the inclusion criteria. The concept of family planning was well known to men. In the Nigerian study, almost (99%) men were aware of the existence of modern contraceptives, and most of them were aware of at least two modern methods. Awareness of the condom was highest (98%). In the Malawi study, all of the participants reported that they were not using contraception before the intervention. In Ethiopia, above 90% of male respondents have supported and approved using and choosing family planning methods, but none of them practiced terminal methods. Generally, more male respondents disagreed than agreed that men should make decisions about selected family planning issues in the family. Decision-making dynamics around method choice followed a slightly different pattern. According to female participants

  11. Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism.

    Science.gov (United States)

    Kahan, Ernesto; Fogelman, Yacov; Kitai, Eliezer; Vinker, Shlomo

    2003-08-01

    The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

  12. Impact of the rural pipeline in medical education: practice locations of recently graduated family physicians in Ontario.

    Science.gov (United States)

    Wenghofer, Elizabeth F; Hogenbirk, John C; Timony, Patrick E

    2017-02-20

    The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools? We used data from the College of Physicians and Surgeons of Ontario. We compared practice locations of certified Ontario family physicians who had graduated from NOSM vs. other Canadian medical schools in 2009 or later. We categorized the physicians according to where they completed their undergraduate (UG) and postgraduate (PG) training, either at NOSM or elsewhere. We used logistic regression models to determine if the location of UG and PG training was associated with rural or northern Ontario practice location. Of the 535 physicians examined, 67 had completed UG and/or PG medical education at NOSM. Over two thirds of physicians with any NOSM education were practicing in northern areas and 25.4% were practicing in rural areas of Ontario compared with those having no NOSM education, with 4.3 and 10.3% in northern and rural areas, respectively. Physicians who graduated from NOSM-UG were more likely to have practices located in rural Ontario (OR = 2.57; p = 0.014) whereas NOSM-PG physicians were more likely to have practices in northern Ontario (OR = 57.88; p education was associated with an increased likelihood of practicing in rural (NOSM-UG) and northern (NOSM-PG) Ontario.

  13. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families.

    NARCIS (Netherlands)

    Kimsma, G.K.

    2010-01-01

    In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a

  14. Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

    Science.gov (United States)

    Tan, Amy; Manca, Donna

    2013-01-22

    Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing

  15. Promoting deceased organ and tissue donation registration in family physician waiting rooms (RegisterNow-1 trial): study protocol for a pragmatic, stepped-wedge, cluster randomized controlled registry.

    Science.gov (United States)

    Li, Alvin H; Garg, Amit X; Prakash, Versha; Grimshaw, Jeremy M; Taljaard, Monica; Mitchell, Joanna; Matti, Danny; Linklater, Stefanie; Naylor, Kyla L; Dixon, Stephanie; Faulds, Cathy; Bevan, Rachel; Getchell, Leah; Knoll, Greg; Kim, S Joseph; Sontrop, Jessica; Bjerre, Lise M; Tong, Allison; Presseau, Justin

    2017-12-21

    There is a worldwide shortage of organs available for transplant, leading to preventable mortality associated with end-stage organ disease. While most citizens in many countries with an intent-to-donate "opt-in" system support organ donation, registration rates remain low. In Canada, most Canadians support organ donation but less than 25% in most provinces have registered their desire to donate their organs when they die. The family physician office is a promising yet underused setting in which to promote organ donor registration and address known barriers and enablers to registering for deceased organ and tissue donation. We developed a protocol to evaluate an intervention to promote registration for organ and tissue donation in family physician waiting rooms. This protocol describes a planned, stepped-wedge, cluster randomized registry trial in six family physician offices in Ontario, Canada to evaluate the effectiveness of reception staff providing patients with a pamphlet that addresses barriers and enablers to registration including a description of how to register for organ donation. An Internet-enabled tablet will also be provided in waiting rooms so that interested patients can register while waiting for their appointments. Family physicians and reception staff will be provided with training and/or materials to support any conversations about organ donation with their patients. Following a 2-week control period, the six offices will cross sequentially into the intervention arm in randomized sequence at 2-week intervals until all offices deliver the intervention. The primary outcome will be the proportion of patients visiting the office who are registered organ donors 7 days following their office visit. We will evaluate this outcome using routinely collected registry data from provincial administrative databases. A post-trial qualitative evaluation process will assess the experiences of reception staff and family physicians with the intervention and the

  16. Family Planning Behaviour of Male Civil Servants in Ibadan, South ...

    African Journals Online (AJOL)

    Men play critical roles in women's ability to seek health care and Reproductive Health programmes are likely to be more effective when men are involved in some way. The study was designed to assess the family planning (FP) behaviour of male civil servants in Ibadan, and determine their roles in their spouses' FP ...

  17. A survey of workplace violence against physicians in the hospitals, Myanmar.

    Science.gov (United States)

    Kasai, Yuichi; Mizuno, Tetsutaro; Sakakibara, Toshihiko; Thu, Si; Kyaw, Thein Aung; Htun, Kyaw Aung

    2018-02-15

    Workplace violence in hospitals is recently becoming a major global concern in many countries. However, in Myanmar, we have felt that patients and their families have rarely made unreasonable complaints in hospitals, and then, the purpose of this study is to report the current state of workplace violence in hospitals in Myanmar. Participants are 196 physicians (108 males and 88 females) in hospitals in Myanmar. A descriptive survey was conducted in regard to verbal abuse and physical violence from patients or the people concerned. At the results of this study, the percentages of physicians who have encountered verbal abuse and those who have encountered physical violence are markedly low (8.7 and 1.0%, respectively). The present study is the first to report the frequencies of verbal abuse and physical violence against physicians in a least developed country, and the results of the present study are important in terms of discussing workplace violence in hospitals.

  18. “Maternal Health and Family Planning Distance Education” experience among physicians: a three-phase study to determine the educational needs, develop education program, and evaluate efficacy of the education administered

    Science.gov (United States)

    Ciftci, Bestami; Uzel, Nesibe; Ozel, M Onur; Zergeroglu, Sema; Deger, Cetin; Turasan, S Sare; Karakoc, Ayse Gul; Ozbalci, Semra

    2016-01-01

    Aim This study aims to assess the educational needs of family practitioners and evaluate the efficacy of the ongoing “Maternal Health and Family Planning Distance Education” program conducted by the General Directorate of Health Research (SAGEM) of the Turkish Ministry of Health. Methods This study consisted of three phases. In the first phase, an online survey on maternal health and family planning educational needs was sent to 20,611 physicians via e-mail. Of the 20,611 physicians, 4,729 completed the survey. In the second phase, of the 1,061 physicians registered to the education program, 632 physicians with active participation were included. In the third phase, the preeducation expectations of 287 physicians and posteducation satisfaction of 54 physicians were analyzed with a questionnaire. Results The majority of the physicians were employed in a family health center (97.4%) and practicing for 16–20 years (23.2%) without any prior in-service training (60.9%). High-to-very high educational need was expressed by 56.4% of physicians for pregnancy, delivery, and puerperality. Topics that the physicians, including both those with ≥16 years in practice and without prior in-service training, expressed need for more detailed content were pregnancy, delivery, and puerperality (37.5%); emergency obstetric approach in the primary care setting (33.1%); and gynecological infectious diseases and treatment approach (32.4%). Following the education program, the participants’ expectations were fulfilled in terms of refreshing their knowledge, particularly in the field of Maternal Health and Family Planning (87.1% and 75.9%) and the percentage of participants who expressed that they had sufficient high level knowledge increased from 55% to 68.5%. Conclusion The education on Maternal Health and Family Planning refreshed the knowledge of participants and highly met the preeducation expectations. Determining the educational needs and expectations of the target

  19. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  20. Who needs a gatekeeper? Patients' views of the role of the primary care physician.

    Science.gov (United States)

    Gross, R; Tabenkin, H; Brammli-Greenberg, S

    2000-06-01

    The primary care physician serving as a 'gatekeeper' can make judicious decisions about the appropriate use of medical services, and thereby contribute to containing costs while improving the quality of care. However, in Israel, sick funds competing for members have not adopted this model for fear of endangering their competitive stance. The purpose of this study was to examine, for the first time, the stated preferences and actual behaviour of a national sample of members of the four Israeli sick funds regarding self-referral to specialists, and to identify the characteristics of patients who prefer the gatekeeper model. Data were derived from a national telephone survey carried out in 1997. A random representative sample of 1084 of all adult sick fund members were interviewed, with a response rate of 81%. Bivariate analysis was conducted using over all chi-square tests, and multivariate analysis was performed using logistic regression models. A third of all respondents prefer self-referral to a specialist, 40% prefer their family physician to act as gatekeeper and 19% prefer the physician to co-ordinate care but to refer themselves to a specialist. Independent variables predicting preference for the gatekeeper model are: living in the periphery, sick fund membership, low level of education, being male, fair or poor health status, having a permanent family physician and being satisfied with the professional level of the family physician. A significant correlation was found between practising self-referral and preference for self-referral. CONCLUSIONS.: The findings indicate the importance of surveying patients' attitudes as an input in policy formulation. The study identified specific population groups which prefer the gatekeeper model, and explored the advantages of a flexible model of gatekeeping.

  1. [Physicians' knowledge in Israel on the biology and control of head lice].

    Science.gov (United States)

    Mumcuoglu, Kosta Y; Mumcuoglu, Michael; Danilevich, Maria; Gilead, Leon

    2008-10-01

    Health providers such as physicians, nurses and pharmacists should be knowledgeable about the biology of head lice and the ways to control them effectively, in order to reduce the proportion of children infested with head lice. To evaluate the knowledge of physicians in Israel on the biology and epidemiology of lice, as well as their experience with infested individuals and their preferences for diagnosis, prophylaxis and control. An anonymous questionnaire with 37 questions was used. The first 20 questions addressed the general knowledge of physicians on lice biology and control, while the remaining 17 questions were related to their personal experience with lice and louse treatment. Out of 273 physicians interviewed 66.8% had good knowledge of lice, while the remaining 33.2% had some knowledge on lice. The difference between the groups of physicians with medium and good knowledge on lice was borderline significant (P=0.0722), with the dermatologists borderline significantly less knowledgeable than the rest (P=0.0765). Significant differences were found between those physicians with 4-6 or 11-20 years of professional experience and the remaining groups (twice Pbiology and control was higher than male physicians (39.4% and 29.4%, respectively), the differences were borderline significant (P=0.09). Pediatricians and dermatologists examined significantly more children than family physicians and general practitioners (P control of head louse infestations.

  2. Family support, self-esteem, and perceived racial discrimination among Asian American male college students.

    Science.gov (United States)

    Wei, Meifen; Yeh, Christine Jean; Chao, Ruth Chu-Lien; Carrera, Stephanie; Su, Jenny C

    2013-07-01

    This study was conducted to examine under what situation (i.e., when individuals used more or less family support) and for whom (i.e., those with high or low self-esteem) perceived racial discrimination would or would not have a significant positive association with psychological distress. A total of 95 Asian American male college students completed an online survey. A hierarchical regression analysis indicated a significant 3-way interaction of family support, self-esteem, and perceived racial discrimination in predicting psychological distress after controlling for perceived general stress. A simple effect analysis was used to explore the nature of the interaction. When Asian American male college students used more family support to cope with racial discrimination, the association between perceived racial discrimination and psychological distress was not significant for those with high or low self-esteem. The result from the simple interaction indicated that, when more family support was used, the 2 slopes for high and low self-esteem were not significantly different from each other. Conversely, when they used less family support, the association between perceived racial discrimination and psychological distress was not significant for those with high self-esteem, but was significantly positive for those with low self-esteem. The result from the simple interaction indicated that, when less family support was used, the slopes for high and low self-esteem were significantly different. The result suggested that low use of family support may put these male students with low self-esteem at risk for psychological distress. Limitations, future research directions, and clinical implications were discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Differential Effects of Family Structure on Religion and Spirituality of Emerging Adult Males and Females.

    Science.gov (United States)

    Handal, Paul J; Lace, John W

    2017-08-01

    This study examined measures of religion and spirituality in a sample of male and female emerging adult college students whose parents were either divorced or intact using the Personal Religious Inventory, the Duke University Religion Index, the Daily Spiritual Experiences Scale, the Spiritual Transcendence Scale, and the Spiritual Involvement and Beliefs Scale. Data were collected online, and 66% of participants received extra credit for participating. A main effect of sex was found, as females reported significantly higher scores than men on all but one measure of religion and spirituality, and the dataset was separated by sex. No differences were found between males from divorced and intact families. However, females from intact families scored significantly higher on all religion and spirituality measures than females from divorced families. This study suggests that females may respond differently than males to their parents' divorce in the context of religion and spirituality, and discusses possible reasons.

  5. Hostile sexist male patients and female doctors: a challenging encounter.

    Science.gov (United States)

    Klöckner Cronauer, Christina; Schmid Mast, Marianne

    2014-01-01

    Patient characteristics and attitudes can affect how patients react to the physician's communication style, and this reaction can then influence consultation outcomes. The goal of the present study was to investigate whether the attitude of a sexist male patient affects how he perceives a female physician's nonverbal communication and whether this then results in expecting less positive consultation outcomes. Participants were analog patients who viewed four videotaped male and four videotaped female physicians in a consultation with one of their patients. Physician videos were preselected to represent a range of high and low patient-centered physician nonverbal behavior. Participants filled in questionnaires to assess how patient-centered they perceived the female and male physicians' nonverbal communication to be, and participants indicated how positive they expected the consultation outcomes to be. Moreover, we assessed the participants' sexist attitudes with a questionnaire measuring hostile and benevolent sexism. Students (N = 60) from a French-speaking university in Switzerland were recruited on campus. The main outcome measures were the extent to which analog patients expect the consultation outcomes to be positive (high satisfaction, increased trust in the physician, intention to adhere to treatment recommendations, and perceived physician competence) and the extent to which analog patients perceive physicians as patient-centered (judged from the physicians' nonverbal cues). Male analog patients' hostile sexism was negatively related to perceiving the physicians as patient-centered, and male analog patients' hostile sexism was also negatively related to expected positive consultation outcomes. For male patients viewing female physicians, mediation analysis revealed that perceived physician patient-centeredness mediated the negative relationship between hostile sexism and expected positive consultation outcomes. Male hostile sexist patients perceive a female

  6. Supervisor continuity or co-location: Which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada

    DEFF Research Database (Denmark)

    Wearne, Susan M.; Wearne, Susan M.; Wearne, Susan M.

    2015-01-01

    but less overt components of residency education. Method Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning......, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Results Thirteen Australian family physicians from five states and one territory, and three Canadians from one...

  7. Skewed sex ratios in India: "physician, heal thyself".

    Science.gov (United States)

    Patel, Archana B; Badhoniya, Neetu; Mamtani, Manju; Kulkarni, Hemant

    2013-06-01

    Sex selection, a gender discrimination of the worst kind, is highly prevalent across all strata of Indian society. Physicians have a crucial role in this practice and implementation of the Indian Government's Pre-Natal Diagnostic Techniques Act in 1996 to prevent the misuse of ultrasound techniques for the purpose of prenatal sex determination. Little is known about family preferences, let alone preferences among families of physicians. We investigated the sex ratios in 946 nuclear families with 1,624 children, for which either one or both parents were physicians. The overall child sex ratio was more skewed than the national average of 914. The conditional sex ratios decreased with increasing number of previous female births, and a previous birth of a daughter in the family was associated with a 38 % reduced likelihood of a subsequent female birth. The heavily skewed sex ratios in the families of physicians are indicative of a deeply rooted social malady that could pose a critical challenge in correcting the sex ratios in India.

  8. "You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship.

    Science.gov (United States)

    Crooks, Valorie A; Li, Neville; Snyder, Jeremy; Dharamsi, Shafik; Benjaminy, Shelly; Jacob, Karen J; Illes, Judy

    2015-02-25

    Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship-a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship. We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants. Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism. Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients' decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.

  9. Burnout among family and general practitioners

    Directory of Open Access Journals (Sweden)

    Ghaida M.J. Al-Shoraian

    2011-12-01

    Full Text Available Background: Job burnout is an important syndrome that can deplete the emotional health aspects of physicians. Its impacts are reflected both on the physicians and their patients through undermining the performance of physicians and degrading the quality of the administered medical care leading to dissatisfaction of the patients about the medical service. Objectives: This study is formulated to compare the prevalence of high burnout among family physicians and general practitioners and reveal the predictors of high grades of burnout among physicians. Subjects and methods: A cross sectional study was carried out. Out of 378 physicians working in two health regions in Kuwait, 200 physicians returned a filled questionnaire, of these 105 were family physicians and the rest were primary health care physicians. Maslach Burnout Inventory–Human Service Survey tool was used to estimate high degree of burnout on three domains, namely emotional exhaustion, depersonalization and personal accomplishment. Results: General practitioners were more likely to suffer from high grades of emotional exhaustion (63.2% than family physicians (19.0%. They also suffered from high grade of depersonalization (65.3% compared with family physicians (27.6%. Those suffering from high grades of personal accomplishment burnout (inverse score constituted 61.1% of primary health care physicians and 33.3% of family physicians. Those suffering from grades for the three burnout domain constituted more than one third of primary health care physicians (36.8% compared with only 5.7% of family physicians. Type of physician job and marital status proved to be significant predictors of high grades of burnout. Conclusion: Burnout is more common among primary care than family physicians. Searching for and eliminating all sources of stress in the primary health care centers in addition to training of these physicians on coping strategies to deal with stress at work seems to be an important

  10. Long term effects of parenting and family characteristics on delinquency of male young adults

    NARCIS (Netherlands)

    Hoeve, M.; Smeenk, W.; Loeber, R.; Southamer-Loeber, M.; van der Laan, P.H.; Gerris, J.R.; Dubas, J.S.

    2007-01-01

    Drawing from the criminology literature and family studies, we investigated the long-term effects of established family risk factors and parenting styles on male young adult delinquency. We used data sets from two longitudinal studies, the Pittsburgh Youth Study (N474) and the Child-Rearing and

  11. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania--a qualitative study.

    Science.gov (United States)

    Tomasik, Tomasz; Windak, Adam; Domagala, Alicja; Dubas, Katarzyna; Sumskas, Linas; Rosinski, Jerzy

    2011-03-25

    The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1) educational, (2) clinical, (3) organisational. A qualitative content analysis was performed. Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.

  12. Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians.

    Science.gov (United States)

    Raptis, Stavroula; Chen, Jia Ning; Saposnik, Florencia; Pelyavskyy, Roman; Liuni, Andrew; Saposnik, Gustavo

    2017-01-01

    Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF). It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. To evaluate the association between family physicians' risk preferences (aversion risk and ambiguity) and therapeutic recommendations (anticoagulation) in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks). The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Overall, 23.3% (17/73) of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate analysis showed that aversion to ambiguity was associated with appropriate change to anticoagulation therapy in the management of AF (OR 5.48, 95% CI 1.08-27.85). Physicians' willingness to take individual risk in multiple domains was associated with lower errors (OR 0.16, 95% CI 0.03-0.86). Physicians' aversion to ambiguity and willingness to take risks are associated with appropriate therapeutic decisions in the management of AF for primary stroke prevention. Further large scale studies are needed.

  13. Are family physicians comprehensively using electronic medical records such that the data can be used for secondary purposes? A Canadian perspective.

    Science.gov (United States)

    Tu, Karen; Widdifield, Jessica; Young, Jacqueline; Oud, William; Ivers, Noah M; Butt, Debra A; Leaver, Chad A; Jaakkimainen, Liisa

    2015-08-13

    With the introduction and implementation of a variety of government programs and policies to encourage adoption of electronic medical records (EMRs), EMRs are being increasingly adopted in North America. We sought to evaluate the completeness of a variety of EMR fields to determine if family physicians were comprehensively using their EMRs and the suitability of use of the data for secondary purposes in Ontario, Canada. We examined EMR data from a convenience sample of family physicians distributed throughout Ontario within the Electronic Medical Record Administrative data Linked Database (EMRALD) as extracted in the summer of 2012. We identified all physicians with at least one year of EMR use. Measures were developed and rates of physician documentation of clinical encounters, electronic prescriptions, laboratory tests, blood pressure and weight, referrals, consultation letters, and all fields in the cumulative patient profile were calculated as a function of physician and patient time since starting on the EMR. Of the 167 physicians with at least one year of EMR use, we identified 186,237 patients. Overall, the fields with the highest level of completeness were for visit documentations and prescriptions (>70%). Improvements were observed with increasing trends of completeness overtime for almost all EMR fields according to increasing physician time on EMR. Assessment of the influence of patient time on EMR demonstrated an increasing likelihood of the population of EMR fields overtime, with the largest improvements occurring between the first and second years. All of the data fields examined appear to be reasonably complete within the first year of adoption with the biggest increase occurring the first to second year. Using all of the basic functions of the EMR appears to be occurring in the current environment of EMR adoption in Ontario. Thus the data appears to be suitable for secondary use.

  14. Evaluating perceptions of community-based physicians from a high-retention clerkship.

    Science.gov (United States)

    Gillies, Ralph A; Jester, David M; Hobbs, Joseph

    2005-10-01

    This study's objective was to ascertain factors contributing to high retention of community-based sites and their physicians in a 3-decade-old family medicine clerkship. Focus groups were conducted with community-based physicians from the Medical College of Georgia's family medicine clerkship. Transcripts were analyzed using an iterative process regarding physicians' initial and ongoing motivations for participating in the clerkship. Thirteen physicians participated. Six themes were generated: family medicine promotion, valued role of teaching, leadership style, clerkship ownership, resources, and challenges. In addition to intrinsic motivators such as valuing the role of teaching the next generation of physicians and promoting the family medicine specialty, the participative leadership style of a clerkship may be an important factor in physicians' decision to teach in a clerkship. The physicians in this study described having collegial working relationships with the clerkship leaders and receiving consistent support in implementing objectives. Physicians attributed their high level of involvement and investment as a product of being respected partners in defining the clerkship. Financial support and teaching resources were also considered salient. A follow-up study with a larger population is warranted to support the importance of leadership style and other external motivating factors toward a clerkship's physician retention.

  15. Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

    Science.gov (United States)

    Oshman, Lauren D; Combs, Gene N

    2016-05-01

    Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  18. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

    Science.gov (United States)

    2011-01-01

    Background The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. Methods A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1) educational, (2) clinical, (3) organisational. A qualitative content analysis was performed. Results Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. Conclusions In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education. PMID:21435277

  19. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

    Directory of Open Access Journals (Sweden)

    Sumskas Linas

    2011-03-01

    Full Text Available Abstract Background The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. Methods A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clinical settings, were held in Poland and Lithuania. Seven well-informed health care experts were recruited in both countries to provide information during the in-depth interviews. In both formats, questions were devoted to three main areas of health promotion and disease prevention competences: (1 educational, (2 clinical, (3 organisational. A qualitative content analysis was performed. Results Lithuanian and Polish family physicians/general practitioners view preventive care as one of their main responsibilities. Among 3 areas of competences, participants identified clinical competences as the most important in everyday practice. They also acknowledged that organisational and educational competences might be below the level required for effective preventive care. Only clinical competences were indicated as sufficiently developed during under- and post-graduate medical education. Conclusions In addressing current health promotion and disease prevention challenges, teachers of family medicine need to critically consider the training that currently exists for physicians. Development of a high-quality preventive service is not only a matter of proper education in the clinical field but also requires training in practice organisation and patient education.

  20. A Correlational Study of Self-Directed Learning Readiness and Learning Activity Preference for Continuing Medical Education among Family Physicians

    Science.gov (United States)

    Barrett, Theresa J.

    2014-01-01

    This quantitative, nonexperimental, correlational study sought to determine whether a relationship exists between family physicians' levels of self-directed learning readiness (SDLR) and their preferences for continuing medical education (CME) activities. The study also sought to determine whether years in clinical practice or size of clinical…

  1. Level of male involvement and associated factors in family planning services utilization among married men in Debremarkos town, Northwest Ethiopia.

    Science.gov (United States)

    Kassa, Mihretie; Abajobir, Amanuel Alemu; Gedefaw, Molla

    2014-12-02

    Men's participation is crucial to the success of family planning programs and women's empowerment and associated with better outcomes in reproductive health such as contraceptive acceptance and continuation, and safer sexual behaviors. Limited choice and access to methods, attitudes of men towards family planning, perceived fear of side-effects, poor quality of available services, cultural or religious oppositions and gender-based barriers are some of the reasons for low utilization of family planning. Hence, this study assessed the level of male involvement in family planning services utilization and its associated factors in Debremarkos town, Northwest Ethiopia. A community-based cross-sectional study was conducted from October to November, 2013. Multi-stage sampling technique was used to select 524 eligible samples. Data were collected by using semi-structured questionnaires. Epi Info and SPSS were used to enter and analyze the data; univariate, bivariate and logistic regression analyses were performed to display the outputs. Only 44 (8.4%) respondents were using or directly participating in the use of family planning services mainly male condoms. The reasons mentioned for the low participation were the desire to have more children, wife or partner refusal, fear of side effects, religious prohibition, lack of awareness about contraceptives and the thinking that it is the only issue for women. Opinion about family planning services, men approval and current use of family planning methods were associated with male involvement in the services utilization. In this study, the level of male involvement was low. Lack of information, inaccessibility to the services and the desire to have more children were found to be the reasons for low male involvement in family planning services utilization. Governmental and nongovernmental organizations, donors and relevant stakeholders should ensure availability, accessibility and sustained advocacy for use of family planning

  2. Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain

    Directory of Open Access Journals (Sweden)

    Élise Roy

    2017-01-01

    Full Text Available Aim. To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP. Methodology. An online survey was carried out in 2016. Results. Of 636 respondents (43.0% men; 54.3% ≥ 50 years old, 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree, dependence (73.2%, and lack of support (75.4% were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7% had recently (last five years taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions. This study provides insights into Québec family physicians’ concerns, practices, and needs with respect to the management of CNCP. Physicians’ difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.

  3. Adoption of new drugs by physicians: a survival analysis

    Directory of Open Access Journals (Sweden)

    Garjón Francisco

    2012-03-01

    Full Text Available Abstract Background New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists. Methods Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care. The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method. Results The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first. Conclusions The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent

  4. Do Breast Cancer Patients Tested in the Oncology Care Setting Share BRCA Mutation Results with Family Members and Health Care Providers?

    International Nuclear Information System (INIS)

    Vadaparampil, S. T.; Malo, T.; Cruz, C. D. L.; Christie, J.; Vadaparampil, S. T.

    2012-01-01

    BRCA genetic test results provide important information to manage cancer risk for patients and their families. Little is known on the communication of genetic test results by mutation status with family members and physicians in the oncology care setting. As part of a longitudinal study evaluating the impact of genetic counseling and testing among recently diagnosed breast cancer patients, we collected patients' self-reported patterns of disclosure. Descriptive statistics characterized the sample and determined the prevalence of disclosure of BRCA test results to family members and physicians. Of 100 patients who completed the baseline and the 6-month followup survey, 77 reported pursuing testing. The majority shared test results with female first-degree relatives; fewer did with males. Participants were more likely to share results with oncologists compared to surgeons, primary care physicians, or other specialty physicians. These findings suggest that while breast cancer patients may communicate results to at-risk female family members and their medical oncologist, they may need education and support to facilitate communication to other first-degree relatives and providers

  5. An evaluation of family physicians' educational needs and experiences in health promotion and disease prevention in Poland and Lithuania - a qualitative study

    OpenAIRE

    Tomasik, Tomasz; Windak, Adam; Domagala, Alicja; Dubas, Katarzyna; Sumskas, Linas; Rosinski, Jerzy

    2011-01-01

    Abstract Background The aim of this study is to explore the views of family physicians/general practitioners about the most important competences in health promotion and diseases prevention and areas where these competences might be below the desired level. Methods A qualitative, descriptive study, combining two data collection techniques, was conducted in two Eastern European countries in June and July 2009. Focus groups numbering 10 and 9 physicians, respectively, practising in various clin...

  6. Motivational determinants among physicians in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Souares Aurélia

    2010-07-01

    Full Text Available Abstract Introduction Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. Methods A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Results Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Conclusion Motivational determinants differed

  7. Motivational determinants among physicians in Lahore, Pakistan.

    Science.gov (United States)

    Malik, Ahmad Azam; Yamamoto, Shelby Suzanne; Souares, Aurélia; Malik, Zeeshan; Sauerborn, Rainer

    2010-07-09

    Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Motivational determinants differed across different levels of care, sectors and genders. Nonetheless, the

  8. Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives.

    Science.gov (United States)

    Weeks, William B; Lazarus, Arthur; Wallace, Amy E

    2008-01-01

    In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.

  9. Mad scientists, compassionate healers, and greedy egotists: the portrayal of physicians in the movies.

    Science.gov (United States)

    Flores, Glenn

    2002-07-01

    Cinematic depictions of physicians potentially can affect public expectations and the patient-physician relationship, but little attention has been devoted to portrayals of physicians in movies. The objective of the study was the analysis of cinematic depictions of physicians to determine common demographic attributes of movie physicians, major themes, and whether portrayals have changed over time. All movies released on videotape with physicians as main characters and readily available to the public were viewed in their entirety. Data were collected on physician characteristics, diagnoses, and medical accuracy, and dialogue concerning physicians was transcribed. The results showed that in the 131 films, movie physicians were significantly more likely to be male (p film physicians has declined steadily in recent decades. Movie physicians are most commonly surgeons (33%), psychiatrists (26%), and family practitioners (18%). Physicians were portrayed negatively in 44% of movies, and since the 1960s positive portrayals declined while negative portrayals increased. Physicians frequently are depicted as greedy, egotistical, uncaring, and unethical, especially in recent films. Medical inaccuracies occurred in 27% of films. Compassion and idealism were common in early physician movies but are increasingly scarce in recent decades. A recurrent theme is the "mad scientist," the physician-researcher that values research more than patients' welfare. Portrayals of physicians as egotistical and materialistic have increased, whereas sexism and racism have waned. Movies from the past two decades have explored critical issues surrounding medical ethics and managed care. We conclude that negative cinematic portrayals of physicians are on the rise, which may adversely affect patient expectations and the patient-physician relationship. Nevertheless, films about physicians can serve as useful gauges of public opinion about the medical profession, as tools for medical education, and as

  10. Relationships between family physicians’ referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians

    Directory of Open Access Journals (Sweden)

    Olson Robert A

    2012-05-01

    Full Text Available Abstract Background The primary objective of this research was to assess the relationship between FPs’ knowledge of palliative radiotherapy (RT and referral for palliative RT. Methods 1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge. Results The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%. The majority of FPs correctly identified that painful bone metastases (91%, airway obstruction (77%, painful local disease (85%, brain metastases (76% and spinal cord compression (79% can be effectively treated with RT, though few were aware that hemoptysis (42% and hematuria (31% can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p  Conclusions Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.

  11. Nigerian physicians' knowledge, attitude and practices regarding ...

    African Journals Online (AJOL)

    Nigerian physicians' knowledge, attitude and practices regarding diabetes ... conducted among physicians in four towns in four different States in Nigeria, ... Only 36.8% of the participants knew that children with diabetes should eat family diet.

  12. Health promoting attitudes and behaviors of emergency physicians: exploring gender differences.

    Science.gov (United States)

    Rondeau, Kent V; Francescutti, Louis H; Cummings, Garnet E

    2006-01-01

    The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention. A mail survey of 325 male and 97 female Canadian emergency physicians. Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts. The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

  13. The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs.

    Science.gov (United States)

    Edwardson, Nicholas; Bolin, Jane N; McClellan, David A; Nash, Philip P; Helduser, Janet W

    2016-04-01

    Demand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure. Using previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted. Baseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention. A national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Leveraging Their Family Capital: How Latino Males Successfully Navigate the Community College

    Science.gov (United States)

    Sáenz, Victor B.; García-Louis, Claudia; Drake, Anna Peterson; Guida, Tonia

    2018-01-01

    Objective: The purpose of this study is to apply Yosso's community cultural wealth framework to the experiences of Latino male community college students to understand how they balance family obligations, work, and academics while also navigating their educational pathways. Method: The research team conducted 23 semistructured focus groups with…

  15. Insulin initiation status of primary care physicians in Turkey, barriers to insulin initiation and knowledge levels about insulin therapy: A multicenter cross-sectional study.

    Science.gov (United States)

    Ates, Elif; Set, Turan; Saglam, Zuhal; Tekin, Nil; Karatas Eray, Irep; Yavuz, Erdinc; Sahin, Mustafa Kursat; Selcuk, Engin Burak; Cadirci, Dursun; Cubukcu, Mahcube

    2017-10-01

    Our aim was to evaluate the insulin initiation status, barriers to insulin initiation and knowledge levels about treatment administered by primary care physicians (PCP). We conducted our study in accordance with a multicenter, cross-sectional design in Turkey, between July 2015 and July 2016. A questionnaire inquiring demographic features, status of insulin initiation, obstacles to insulin initiation and knowledge about therapy of the PCPs was administered during face-to-face interviews. 84 PCPs (19%) (n=446, mean age=41.5±8.4years, 62.9% male and 90.0% ministry certified family physicians) initiated insulin therapy in the past. Most of the stated primary barriers (51.9%, n=230) were due to the physicians. The most relevant barrier was "lack of clinical experience" with a rate of 19% (n=84 of the total). The average total knowledge score was 5.7±2.0 for the family medicine specialist, and 3.8±2.1 for the ministry certified family physicians (p=0.000, maximum knowledge score could be 10). The status of insulin initiation in Turkey by the primary care physicians is inadequate. Medical education programs and health care systems may require restructuring to facilitate insulin initiation in primary care. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  16. Physician gender effects in medical communication: a meta-analytic review.

    Science.gov (United States)

    Roter, Debra L; Hall, Judith A; Aoki, Yutaka

    2002-08-14

    Physician gender has been viewed as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians facilitate more open and equal exchange and a different therapeutic milieu from that of male physicians. However, studies in this area are generally based on small samples, with conflicting results. To systematically review and quantify the effect of physician gender on communication during medical visits. Online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source, such as audiotape, videotape, or direct observation, and large national or regional studies in which physician report was used to establish length of visit, were identified through bibliographic and computerized searches. Twenty-three observational studies and 3 large physician-report studies reported in 29 publications met inclusion criteria and were rated. The Cohen d was computed based on 2 reviewers' (J.A.H. and Y.A.) independent extraction of quantitative information from the publications. Study heterogeneity was tested using Q statistics and pooled effect sizes were computed using the appropriate effects model. The characteristics of the study populations were also extracted. Female physicians engage in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. There were no gender differences evident in the amount, quality, or manner of biomedical information giving or social conversation. Medical visits with female physicians are, on average, 2 minutes (10%) longer than those with male physicians. Obstetrics and gynecology may present a different pattern than that of primary care, with male physicians demonstrating higher levels of

  17. An Analytical Comparison of the Opinions of Physicians Working in Emergency and Trauma Surgery Departments at Tabriz and Vienna Medical Universities Regarding Family Presence during Resuscitation.

    Science.gov (United States)

    Soleimanpour, Hassan; Behringer, Wilhelm; Tabrizi, Jafar Sadegh; Sarahrudi, Kambiz; Golzari, Samad E J; Hajdu, Stefan; Rasouli, Maryam; Nikakhtar, Mehdi; Mehdizadeh Esfanjani, Robab

    2015-01-01

    The present study evaluated the opinions of physicians working in the emergency and trauma surgery departments of Vienna Medical University, in Austria, and Tabriz Medical University, in Iran, regarding the presence of patients' relatives during resuscitation. In a descriptive-analytical study, the data obtained from questionnaires that had been distributed randomly to 40 specialists and residents at each of the participating universities were analyzed. The questionnaire consisted of two sections aimed at capturing the participants' demographic data, the participants' opinions regarding their support for the family's presence during resuscitation, and the multiple potential factors affecting the participants' attitudes, including health beliefs, triggers that could facilitate the procedure, self-efficacy, intellectual norms, and perceived behavioral control. The questionnaire also included a direct question (Question 16) on whether the participants approved of family presence. Each question could be answered using a Likert-type scale. The results showed that the mean scores for Question 16 were 4.31 ± 0.64 and 3.57 ± 1.31 for participants at Vienna and Tabriz universities, respectively. Moreover, physicians at Vienna University disapproved of the presence of patients' families during resuscitation to a higher extent than did those at Tabriz University (P = 0.018). Of the studied prognostic factors affecting the perspectives of Vienna Medical University's physicians, health beliefs (P = 0.000; B = 1.146), triggers (P = 0.000; B = 1.050), and norms (P = 0.000; B = 0.714) were found to be significant. Moreover, of the studied prognostic factors affecting the perspectives of Tabriz Medical University's physicians, health beliefs (P = 0.000; B = 0.875), triggers (P = 0.000; B = 1.11), self-efficacy (P = 0.001; B = 0.5), and perceived behavioral control (P = 0.03; B = 0.713) were significant. Most physicians at Vienna and Tabriz Medical universities were not open

  18. Male-Partnered Bisexual Women's Perceptions of Disclosing Sexual Orientation to Family Across the Transition to Parenthood: Intensifying Heteronormativity or Queering Family?

    Science.gov (United States)

    Goldberg, Abbie E; Allen, Katherine R; Ellawala, Themal; Ross, Lori E

    2018-01-01

    Drawing from queer and communication privacy management frameworks, this study examines the narratives of 22 bisexual, male-partnered women who were interviewed during the perinatal period and one year postnatally about their disclosures of sexual identity to family of origin. Most women rarely discussed their sexual identity with family; participants who had disclosed described such disclosures as provoking discomfort. Some women stated that their parental status seemed to invalidate the need to talk about their sexual history or identity with family, due its declining salience and increased concerns about judgment. This study reveals how partnership and parenthood statuses contribute to the intensification of heteronormative pressures in relation to family. Therapists should attend to the role of heteronormative values regarding partnering, family-building, and parenting. © 2017 American Association for Marriage and Family Therapy.

  19. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

    Science.gov (United States)

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

    2015-04-01

    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  20. Gender disparities in research productivity among 9952 academic physicians.

    Science.gov (United States)

    Eloy, Jean Anderson; Svider, Peter F; Cherla, Deepa V; Diaz, Lucia; Kovalerchik, Olga; Mauro, Kevin M; Baredes, Soly; Chandrasekhar, Sujana S

    2013-08-01

    The number of women in medicine has increased considerably over the past 3 decades, and they now comprise approximately half of medical school matriculants. We examine whether gender disparities in research productivity are present throughout various specialties and compare these findings to those previously described among otolaryngologists. Bibliometric analysis. Research productivity, measured by the h-index, was calculated for 9,952 academic physicians representing 34 medical specialties. Additionally, trends in how rate of research productivity changed throughout different career stages were compared. Women were underrepresented at the level of professor and in positions of departmental leadership relative to their representation among assistant and associate professors. Male faculty had statistically higher research productivity both overall (H = 10.3 ± 0.14 vs. 5.6 ± 0.14) and at all academic ranks. For the overall sample, men and women appeared to have equivalent rates of research productivity. In internal medicine, men had higher early-career productivity, while female faculty had productivity equaling and even surpassing that of their male colleagues beyond 20 to 25 years. Men and women had equivalent productivity in surgical specialties throughout their careers, and similar rates in pediatrics until 25 to 30 years. Female academic physicians have decreased research productivity relative to men, which may be one factor contributing to their underrepresentation at the level of professor and departmental leader relative to their proportions in junior academic ranks. Potential explanations may include fewer woman physicians in the age groups during which higher academic ranks are attained, greater family responsibilities, and greater involvement in clinical service and educational contributions. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Who steers the ship? Rural family physicians' views on collaborative care models for patients with dementia.

    Science.gov (United States)

    Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew

    2014-01-01

    Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.

  2. The Comparison of Relationship between Family Communication Patterns and Self Concept with Coping Styles in Male and Female Students

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    R Taheri

    2012-10-01

    Full Text Available Background & Aim: Since people have different coping styles, the purpose of the present research was to compare the relationship between family communication patterns and self-concept with coping styles among male and female students of Eram Higher Education Institution in Shiraz. Methods: In the present correlation study conducted in 2011 at Eram Higher Education Institution in Shiraz, 229 participants (91 males &119 females were selected by simple random sampling method. Data was collected by using the revised version of family communication patterns questionnaire (RFCP, Koerner & Fitz patrik (2002, Beck's Self-concept Test (CST (1990 and Coping Inventory for Stressful Situations (CISS Endler & Parker (1990. Data was analyzed using correlation matrix & independent t-test analysis. Results: According to the result, there was significant correlation between family communication patterns and self-concept with coping styles among male and female students. In the female group, task oriented coping and avoidance oriented coping with conversation orientation and emotion oriented coping with conforming orientation showed positive significant correlation. In male group avoidance orientation coping with conversation orientation and emotion oriented coping with conforming orientation showed positive significant correlation. Also, related to self concept variable, results showed female students task oriented coping and avoidance oriented coping had significant correlation with the self concept variable, but the male students avoidance oriented coping had significant correlation with the self concept variable(P<0/05. Also, the result showed significant difference between two male and female students, in emotion oriented coping, so the female group, emotion oriented coping with (51/48 was more than the orientation within the male group with (48/18, (p<0.05. Conclusion: Family communication patterns and the concept are effective on coping styles. Therefore

  3. Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians

    Science.gov (United States)

    Litzkendorf, Svenja; Schmidt, Katharina; Pauer, Frédéric; Damm, Kathrin; Frank, Martin; Graf von der Schulenburg, Johann-Matthias

    2017-01-01

    Background Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. Objective The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information—especially examining quantifiable preference weights—between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. Methods The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results’ significance. Results A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean

  4. [Opinion and Participation in the Regional Early Breast Cancer Detection Program in 2007 on the part of family physicians from a health district in the Autonomous Community of Madrid, Spain].

    Science.gov (United States)

    Garrido Elustondo, Sofía; Sánchez Padilla, Elisabeth; Ramírez Alesón, Victoria; González Hernández, Ma José; González Navarro, Andrés; López Gómez, Carlos

    2008-01-01

    Mammogram screening is the most effective method for the early detection of breast cancer. The objective of this study is to evaluate the degree of knowledge, the opinion and the participation in the early breast cancer detection program on the part of the family physicians of the Autonomous Community of Madrid. The population studied was comprised of family physicians from Madrid Health District Seven. An anonymous, self-administered questionnaire comprised of 30 questions grouped into physicians characteristics and opinion concerning the early breast cancer detection programs. A total of 46% of the physicians replied. A total of 94% of the physicians believed that it is their duty to inform their patients concerning preventive activities, including breast cancer screening, and 95% believed their advice to be useful for convincing women to have a mammogram. A total of 72% believed information to be lacking on this program. During the time when mammograms are being taken at their centres, 24% of the physicians surveyed always or almost always ask the women if they have any doubts or would like further information, 43% having set up appointments for them and 95% advising them to have a mammogram taken. The family physicians have a good opinion of the early breast cancer detection program and feel their advice to be effective for improving the participation in the program. They report lack of information and inform women about the program to only a small degree.

  5. Family physician clinical inertia in glycemic control among patients with type 2 diabetes.

    Science.gov (United States)

    Bralić Lang, Valerija; Bergman Marković, Biserka; Kranjčević, Ksenija

    2015-02-05

    Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia. This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15-25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur. A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics. Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.

  6. The ethical ideologies of psychologists and physicians: a preliminary comparison.

    Science.gov (United States)

    Hadjistavropoulos, Thomas; Malloy, David C; Sharpe, Donald; Fuchs-Lacelle, Shannon

    2003-01-01

    The ethical ideologies of psychologists (who provide health services) and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors (e.g., family views) in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional cultures in which practitioners are trained and socialized.

  7. [Association of family dynamic structure and parental rearing style with male larcenists].

    Science.gov (United States)

    Zheng, Yu; Liu, Xie-he

    2010-11-01

    To explore the association of parental rearing style and family dynamic structure with male larcenists. A questionnaire survey was undertaken in 280 male imprisoned larcenists and 420 healthy controls with a General Information Questionnaire and EMBU (Egna Minnen Beträlffande Uppfostran). Statistically significant differences were found between the two groups in the following items: 'only child in the family', 'not lived with father before age 5', 'father died', 'mother died', 'both parents died', 'parents divorced', 'lived with father only (mother absence) before age 5', 'adult with father alive (mother died)' and 'adult with mother alive (father died)'. The two groups also experienced significant differences in 'emotional warmth', 'severe punishment', 'over-intervention from both parents', 'favored child from mother', 'father rejection' and 'father over-protection'. Men with single father (mother absence) before age 5 and those who have experienced death of any parents, 'emotional warmth', 'severe punishment', 'over-intervention from both parents', 'favored child from mother', 'father rejection' and 'father over-protection' are more likely to commit theft crime.

  8. Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives

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    Maureen B Fagan DNP, MHA, FNP-BC

    2015-11-01

    Full Text Available With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received by patients/families and to ultimately change physician practice to reflect patient family–centered principles. We conducted a clinician survey and found promising results indicating that patient/family narratives can be effective at educating physicians about patient family–centered care.

  9. Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec's Family Medicine Groups.

    Science.gov (United States)

    Coyle, Natalie; Strumpf, Erin; Fiset-Laniel, Julie; Tousignant, Pierre; Roy, Yves

    2014-06-01

    New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care. Using provincial administrative data, we created a population cohort of Quebec's vulnerable patients. We collected data before the advent of FMGs on patients' demographic characteristics, chronic illnesses and health service use, and their physicians' demographics, and practice characteristics. Multivariate regression was used to identify key predictors of joining a FMG among both patients and physicians. Patients who eventually enrolled in a FMG were more likely to be female, reside outside of an urban region, have a lower SES status, have diabetes and congestive heart failure, visit the emergency department for ambulatory sensitive conditions and be hospitalized for any cause. They were also less likely to have hypertension, visit an ambulatory clinic and have a usual provider of care. Physicians who joined a FMG were less likely to be located in urban locations, had fewer years in medical practice, saw more patients in hospital, and had patients with lower morbidity. Physicians' practice characteristics and patients' health status and health care service use were important predictors of joining a FMG. To avoid basing policy decisions on tenuous evidence, policymakers and researchers should account for differential selection into team-based primary health care models. Copyright © 2014. Published by Elsevier Ireland Ltd.

  10. Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries.

    Science.gov (United States)

    Morita, Tatsuya; Oyama, Yasuhiro; Cheng, Shao-Yi; Suh, Sang-Yeon; Koh, Su Jin; Kim, Hyun Sook; Chiu, Tai-Yuan; Hwang, Shinn-Jang; Shirado, Akemi; Tsuneto, Satoru

    2015-08-01

    Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient. The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians. A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed. A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important. There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country

  11. Physician gender and patient-centered communication: a critical review of empirical research.

    Science.gov (United States)

    Roter, Debra L; Hall, Judith A

    2004-01-01

    Physician gender has stimulated a good deal of interest as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians are more patient-centered in their communication with patients. Our objective is to synthesize the results of two meta-analytic reviews the effects of physician gender on communication in medical visits within a communication framework that reflects patient-centeredness and the functions of the medical visit. We performed online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and BIOETHICS), and a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source such as audiotape, videotape, or direct observation were identified through bibliographic and computerized searches. Medical visits with female physicians were, on average, two minutes (10%) longer than those of male physicians. During this time, female physicians engaged in significantly more communication that can be considered patient-centered. They engaged in more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. Moreover, the patients of female physicians spoke more overall, disclosed more biomedical and psychosocial information, and made more positive statements to their physicians than did the patients of male physicians. Obstetrics and gynecology may present a pattern different from that of primary care: Male physicians demonstrated higher levels of emotionally focused talk than their female colleagues. Female primary care physicians and their patients engaged in more communication that can be considered patient-centered and had longer visits than did their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns might differ in some subspecialties from

  12. Conocimientos de los médicos de familia sobre lepra Knoledge of the family physicians about leprosy

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    Isora Montenegro Valera

    2006-09-01

    Full Text Available Se realizó un estudio observacional descriptivo de tipo transversal para investigar el nivel de conocimientos de los Médicos de Familia sobre la lepra en el municipio de Limonar, durante el período de marzo a diciembre de 2002. Participaron en el estudio 36 Médicos de Familia de consultorios pertenecientes al Policlínico Docente “Nelson Fernández” de Limonar. Los datos fueron procesados en el sistema estadístico SPSS-10. Se utilizaron técnicas estadísticas como el cálculo del Chi cuadrado y la prueba de Kruskall Wallis para explorar la asociación significativa entre variables y comparar promedios entre muestras independientes. Se obtuvo como resultado que existe desconocimiento por parte de los Médicos de Familia acerca de la enfermedad, ya que solamente la cuarta parte de ellos alcanzó la puntuación mínima indispensable considerada para realizar un diagnóstico y tratamiento correcto de la enfermedad. Se demostró la importancia de la especialización de los médicos en la consolidación y enriquecimiento de los conocimientos relacionados con esta enfermedad y su declinación con el decursar de los años de graduado. En base a los resultados se recomendaron las audiencias diana para una efectiva intervención educativa en la Atención Primaria de Salud en este municipio.An observational descriptive cross-sectional study was conducted to investigate the level of knowledge of the family physicians about leprosy in Limonar municipality from March to December, 2002. 36 family physicians from the offices corresponding to "Nelson Fernández" Teaching Polyclinic, in Limonar, participated in the study. Data were processed by the SPSS-10 statistical system. Statistical tests as the chi square test and Kruskall Wallis' test were used to explore the significant association between the variables and to compare averages among independent samples. It was found that there exists lack of knowledge about the disease, since only a fourth of

  13. Colorectal cancer screening of high-risk populations: A national survey of physicians

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    White Pascale M

    2012-01-01

    Full Text Available Abstract Background The incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009. Results The average knowledge score was 37 ± 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were "patient refusal" and "lack of insurance reimbursement." Conclusions There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer.

  14. Communication-related allegations against physicians caring for premature infants.

    Science.gov (United States)

    Nguyen, J; Muniraman, H; Cascione, M; Ramanathan, R

    2017-10-01

    Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

  15. Patient-physician communication regarding electronic cigarettes.

    Science.gov (United States)

    Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D

    2015-01-01

    Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  16. 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

  17. Recognition of anxiety disorders by family physicians after rigorous medical record case extraction Results of the Netherlands Study of Depression and Anxiety

    NARCIS (Netherlands)

    Janssen, Evelien H. C.; van de Ven, Peter M.; Terluin, Berend; Verhaak, Peter F. M.; van Marwijk, Harm W. J.; Smolders, Mirrian; van der Meer, Klaas; Penninx, Brenda W. J. H.; van Hout, Hein P. J.

    2012-01-01

    Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient

  18. Recognition of anxiety disorders by family physicians after rigorous medical record case extraction: results of the Netherlands Study of Depression and Anxiety.

    NARCIS (Netherlands)

    Janssen, E.H.C.; Ven, P.M. van de; Terluin, B.; Verhaak, P.F.M.; Marwijk, H.W.J. van; Smolders, M.; Meer, K. van der; Penninx, B.W.J.H.; Hout, H.P.J. van

    2012-01-01

    Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient

  19. Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians.

    Science.gov (United States)

    Babac, Ana; Litzkendorf, Svenja; Schmidt, Katharina; Pauer, Frédéric; Damm, Kathrin; Frank, Martin; Graf von der Schulenburg, Johann-Matthias

    2017-11-20

    Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information-especially examining quantifiable preference weights-between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results' significance. A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean age=48 years, age range=17-87 years

  20. Relationship Between Family Power Structure, Marital Conflicts, and Mental Health in Male Retirees of Alborz Province Department, Iran Ministry of Education

    Directory of Open Access Journals (Sweden)

    Maryam Soleimani

    2016-01-01

    Conclusion: The results of the research indicate that power structure of family and marital conflicts can affect mental health of male retirees. And more unequal power structure of family and more marital conflicts can lead to decrease in mental health of male retirees.

  1. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families

    OpenAIRE

    Kimsma, G.K.

    2010-01-01

    In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards...

  2. Physician suicide.

    Science.gov (United States)

    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.

  3. Job satisfaction of primary care physicians in Switzerland: an observational study.

    Science.gov (United States)

    Goetz, Katja; Jossen, Marianne; Szecsenyi, Joachim; Rosemann, Thomas; Hahn, Karolin; Hess, Sigrid

    2016-10-01

    Job satisfaction of physicians is an important issue for performance of a health care system. The aim of the study was to evaluate the job satisfaction of primary care physicians in Switzerland and to explore associations between overall job satisfaction, individual characteristics and satisfaction with aspects of work within the practice separated by gender. This cross-sectional study was based on a job satisfaction survey. Data were collected from 176 primary care physicians working in 91 primary care practices. Job satisfaction was measured with the 10-item Warr-Cook-Wall job satisfaction scale. Stepwise linear regression analysis was performed for physicians separated by gender. The response rate was 92.6%. Primary care physicians reported the highest level of satisfaction with 'freedom of working method' (mean = 6.45) and the lowest satisfaction for 'hours of work' (mean = 5.38) and 'income' (mean = 5.49). Moreover, some aspects of job satisfaction were rated higher by female physicians than male physicians. Within the stepwise regression analysis, the aspect 'opportunity to use abilities' (β = 0.644) showed the highest association to overall job satisfaction for male physicians while for female physicians it was income (β = 0.733). The presented results contribute to an understanding of factors that influence levels of satisfaction of female and male physicians. Therefore, research and intervention about job satisfaction should consider gender as well as the stereotypes that come along with these social roles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Workplace bullying and post-traumatic stress symptoms among family physicians in Lithuania: An occupation and region specific approach

    OpenAIRE

    Vilija Malinauskiene; Staale Einarsen

    2014-01-01

    Objectives: The study investigated associations between workplace bullying and post-traumatic stress symptoms as compared to and controlled for associations between the latter and other psychosocial stress factors at work and in everyday life. The study employed a representative sample of Lithuanian family physicians, hence investigated a particularly resourceful occupational group in a geographical region earlier found to have a high risk context for exposure to bullying at work. Material an...

  5. Association of ALOX15 gene polymorphisms with obesity-related phenotypes in Chinese nuclear families with male offspring

    Institute of Scientific and Technical Information of China (English)

    Yao-hua KE; Chun WANG; Yun-qiu HU; Miao LI; Yu-juan LIU; Wen-zhen FU; Zhen-lin ZHANG; Wen-jin XIAO; Jin-wei HE; Hao ZHANG; Jin-bo YU; Wei-wei HU; Jie-mei GU; Gao GAO; Hua YUE

    2012-01-01

    Aim:Genetic variation in ALOX12,which encoded human 12-lipoxygenase,was found to be associated with fat mass in young Chinese men.The objective of this study was to investigate the relationship between single nucleotide polymorphisms (SNPs) and haplotypes in the ALOX15 gene and obesity-related phenotypes in Chinese nuclear families with male offspring.Methods:We recruited 1,296 subjects from 427 nuclear families with male offspring and genotyped five SNPs (rs9894225,rs748694,rs2619112,rs2619118,and rs916055) in the ALOX15 gene locus.The total fat mass (TFM),trunk fat mass (tFM),leg fat mass (LFM) and arm fat mass (AFM) were measured using dual-energy X-ray absorptiometry (DXA).The percentage of fat mass (PFM) was the ratio of TFM and body weight.The association between SNPs and haplotypes of ALOX15 and obesity-related phenotypic variation was measured using quantitative transmission disequilibrium test (QTDT).Results:Using QTDT to measure family-based genetic association,we found that rs916055 had a statistically significant association with PFM (P=0.038),whereas rs916055 had a marginal but statistically insignificant association with tFM (P=0.093).The multipleparameter 1000 permutations test agreed with the family-based association results:both showed that rs916055 had a statistically significant association with PFM (P=0.033).Conclusion:rs916055 in ALOX15 gene was significantly associated with the percentage of fat mass in Chinese nuclear families with male offspring in the family-based association study using QTDT approach.

  6. Typology of Family Parenting Styles and Its Influence on Male Adolescents’ Tendency to Drugs

    OpenAIRE

    Mohammad Yasin Seifi, G; Majid Saffarinia; Sara Kalantari M

    2013-01-01

    Aim: Narcotics and consequences of their consumers is one of the basic challenges of modern societies. Since family and parenting styles have an important impact on children's psycho social development, the present study investigated the effects of typology of family parenting on drug tendency in adolescent. Method: To do so, a sample of 375 male students was selected of Borujen public high school students in 1389-1390 academic years by multistage cluster random sampling. Sheffer Parenting st...

  7. Prescription opioid use and misuse: piloting an educational strategy for rural primary care physicians.

    Science.gov (United States)

    Srivastava, Anita; Kahan, Meldon; Jiwa, Ashifa

    2012-04-01

    To evaluate the feasibility and effectiveness of a multifaceted educational intervention to improve the opioid prescribing practices of rural family physicians in a remote First Nations community. Prospective cohort study. Sioux Lookout, Ont. Family physicians. Eighteen family physicians participated in a 1-year study of a series of educational interventions on safe opioid prescribing. Interventions included a main workshop with a lecture and interactive case discussions, an online chat room, video case conferencing, and consultant support. Responses to questionnaires at baseline and after 1 year on knowledge, attitudes, and practices related to opioid prescribing. The main workshop was feasible and was well received by primary care physicians in remote communities. At 1 year, physicians were less concerned about getting patients addicted to opioids and more comfortable with opioid dosing. Multifaceted education and consultant support might play an important role in improving family physician comfort with opioid prescribing, and could improve the treatment of chronic pain while minimizing the risk of addiction.

  8. Factors associated with family-centered involvement in family practice--a cross-sectional multivariate analysis.

    Science.gov (United States)

    Deutsch, Tobias; Frese, Thomas; Sandholzer, Hagen

    2014-01-01

    The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians' family-centered involvement and expected patient receptiveness, perceived impact of the family's influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family's influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.

  9. Analysis of Work Performance of Family Planning Field Workers in Male Family Planning Program in Cilacap District

    OpenAIRE

    Suryani, Untari Fajar; Nurjazuli, Nurjazuli; Arso, Septo Pawelas

    2013-01-01

    Target of MDG's to reach maternal mortality rate of 102/100.000 live-births and infantmortality rate of 23/1000 live-births had been performed by improving maternal health throughincreasing contraceptive prevalence rate and decreasing unmet need. Percentage of male withpermanent birth control in Cilacap district was in the lowest rank, 0.16%. Success of familyplanning program could not be separated from work performance of PLKB (family planning field workers); assessment of PLKB work performa...

  10. Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

    Science.gov (United States)

    Pluye, Pierre; Grad, Roland M; Johnson-Lafleur, Janique; Granikov, Vera; Shulha, Michael; Marlow, Bernard; Ricarte, Ivan Luiz Marques

    2013-01-01

    We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

  11. Family physicians and youth tobacco-free education: outcomes of the Colorado Tar Wars program.

    Science.gov (United States)

    Cain, Jeffrey J; Dickinson, W Perry; Fernald, Douglas; Bublitz, Caroline; Dickinson, L Miriam; West, David

    2006-01-01

    Tar Wars is a national school-based tobacco-free education program operated by the American Academy of Family Physicians. The Tar Wars lesson uses an interactive 45-min session taught by volunteer family physicians in 4th- and 5th-grade classrooms and focuses on the short-term image-based consequences of tobacco use. In this study, we evaluated the effectiveness of the Tar Wars program in Colorado with both quantitative and qualitative measures. Students participating in the quantitative evaluation were tested before and after a Tar Wars teaching session using a 14-question test covering the short-term and image-based consequences of tobacco use, cost of smoking, tobacco advertising, and social norms of tobacco use. Qualitative evaluation of the program included guided telephone interviews and focus groups with participating students, teachers, and presenters. Quantitative evaluation showed statistically significant improvement in correct responses for the 14 questions measured with an average increase in correct responses from 8.95 to 10.23. Three areas recommended by the Centers for Disease Control (CDC) for youth tobacco prevention showed greater change in correct responses, including cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. Qualitative evaluation found that the overall message of the session was well received, that previously known tobacco information was reinforced by its presentation in a novel format, and that new information learned included cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. The Tar Wars lesson plan is effective in increasing students' understanding about the short-term consequences of tobacco use, cost of tobacco use, truth of tobacco advertising, and peer norms. Tar Wars meets the CDC guidelines as one component of effective comprehensive youth tobacco prevention.

  12. Race, income, and education: associations with patient and family ratings of end-of-life care and communication provided by physicians-in-training.

    Science.gov (United States)

    Long, Ann C; Engelberg, Ruth A; Downey, Lois; Kross, Erin K; Reinke, Lynn F; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W; Back, Anthony L; Curtis, J Randall

    2014-04-01

    Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families.

  13. A survey to assess family physicians' motivation to teach undergraduates in their practices.

    Science.gov (United States)

    May, Marcus; Mand, Peter; Biertz, Frank; Hummers-Pradier, Eva; Kruschinski, Carsten

    2012-01-01

    In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs' motivation to teach medical students in their practices is lacking. To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). 'Helping others' and 'interest' were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.

  14. A Study of the Educationally Influential Physician.

    Science.gov (United States)

    Kaufman, David M.; Ryan, Kurt; Hodder, Ian

    1999-01-01

    A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…

  15. Clinical Impact of a Pharmaceutical Care Programme Developed in a Family Health Unit: Results of a Pharmacist-Physician Collaboration in the Treatment of Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Mónica Condinho

    2016-07-01

    Full Text Available Introduction: The positive impact of pharmacist-physician collaborative care has been reported in the international literature, although examples of this impact are limited in Portugal. We aim to underline the clinical added value for hypertensive patients that results from pharmacist-physician collaborations. Methods: A community trial was conducted at a Portuguese family health unit for 19 months. The intervention group was randomly selected from the global records and members of the group received pharmaceutical care in addition to physician care. The comparison group received only physician care. Both groups were comparable at the beginning of the study. In the intervention group, we analysed the hypertensive patients to evaluate the impact of pharmacist-physician collaboration on the patients’ blood pressure levels. This evaluation was performed by comparing the obtained blood pressure levels with the levels at baseline and between the groups. Results: A total of 17 patients with hypertension were enrolled in the pharmaceutical care programme, 12 of whom were female. The mean age was 68.50±3.26 years and, on average, each patient consumed 6.06±0.93 medicinal products. Thirteen patients were uncontrolled. Compared with the baseline, the intervention group achieved mean reductions of 28.85±5.90 mmHg (p < 0.0005 and 11.23±2.75 mmHg (p < 0.005 in their systolic and diastolic blood pressure, respectively. Considering the comparison group, improvements of 18.63±6.44 mmHg (p = 0.011 in systolic blood pressure and 9.03±2.63 mmHg ( p < 0.005 in diastolic blood pressure were observed. Conclusion: Pharmacist-physician collaborative care adds clinical value to the typical physician care provided to hypertensive patients within the context of a Portuguese family health unit.

  16. Taking care of patients--does it matter whether the physician is a woman?

    OpenAIRE

    Arnold, R M; Martin, S C; Parker, R M

    1988-01-01

    Researchers have recently begun to compare male and female physicians' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians' medical knowledge. Male and female physi...

  17. Physicians' Counseling of Adolescents Regarding E-Cigarette Use.

    Science.gov (United States)

    Pepper, Jessica K; Gilkey, Melissa B; Brewer, Noel T

    2015-12-01

    Electronic cigarette (e-cigarette) use now surpasses the use of conventional cigarettes among U.S. adolescents. Given the important role of physicians in preventing adolescent risk behaviors, we sought to understand how physicians communicate about e-cigarettes when counseling adolescent patients and their parents. We also explored physicians' support for regulations aimed at discouraging adolescents' e-cigarette use. A national U.S. sample of 776 pediatricians and family medicine physicians who provide primary care to adolescent patients completed an online survey in Spring 2014. Many physicians (41%) would, if asked, tell their patients that e-cigarettes are less harmful than cigarettes, and a substantial minority (24%) would recommend e-cigarettes to adolescents for smoking cessation. Most physicians reported routinely screening adolescent patients for cigarette smoking but few routinely screened for e-cigarette use (86% vs. 14%; p buying e-cigarettes. Physicians infrequently screen or counsel their adolescent patients about e-cigarette use, although e-cigarettes often come up during visits. Additional efforts by physicians could help prevent future use by adolescents. Recommending e-cigarettes as a smoking cessation aid to adolescent patients is inadvisable given the lack of evidence for efficacy in that population. As federal regulation of e-cigarettes remains in limbo, pediatricians and family medicine physicians can offer a powerful voice for informing regulations aimed at reducing use by adolescents. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  18. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences.

    Science.gov (United States)

    Zarif Sanaiey, Nahid; Karamnejad, Sahar; Rezaee, Rita

    2015-04-01

    Assessment and prioritization are the first steps of planning. According to the family physician's idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians' educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique.  Content validity of the questionnaire and its reliability were confirmed by the experts' opinion and Cronbach's alpha of 80%.  The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ), t-test, ANOVAs). A significance level of mental health (SQ= 0.38), and environmental and professional health was the lowest priority (SQ= _0.24). Additionally, within each of the areas above specific priorities were determined. Based on the results of this study, gender, graduation date, cooperation time, and university they were educated in did not affect expressing educational needs (p>0.05). The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%). In the areas of environmental and professional health and health education, compliance was zero. The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational needs.

  19. Primary Care Physicians' Perspectives About HPV Vaccine.

    Science.gov (United States)

    Allison, Mandy A; Hurley, Laura P; Markowitz, Lauri; Crane, Lori A; Brtnikova, Michaela; Beaty, Brenda L; Snow, Megan; Cory, Janine; Stokley, Shannon; Roark, Jill; Kempe, Allison

    2016-02-01

    Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3)identify characteristics associated with not discussing it. A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined. Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11-12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys,52% and 41% ostrongly recommen. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11-12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss , those who occasionally/rarely discuss(18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1-3.5), be male (aOR: 1.8 [95% CI: 1.1-3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3-4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1-6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4-17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8-6.4]). Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates. Copyright © 2016 by the American Academy of Pediatrics.

  20. Couple based family planning education: changes in male involvement and contraceptive use among married couples in Jimma Zone, Ethiopia.

    Science.gov (United States)

    Tilahun, Tizta; Coene, Gily; Temmerman, Marleen; Degomme, Olivier

    2015-07-21

    Family planning contributes substantially in achieving the Millennium Development Goals. Recently, male involvement has gained considerable attention in family planning programs but the implementation thereof remains a challenge. In that context, our study aimed at measuring the effect of a six-month-long family planning education program on male involvement in family planning, as well as on couples' contraceptive practice. We conducted a quasi-experimental research among 811 married couples in Jimma Zone, southwest Ethiopia. Our study consisted of an intervention and a control group for comparative purpose; and surveyed before and after the implementation of the intervention. The intervention consisted of family planning education, given to both men and women at the household level in the intervention arm, in addition to monthly community gatherings. During the intervention period, households in the control group were not subject to particular activities but had access to routine health care services. We obtained follow-up data from 760 out of 786 (96.7%) couples who were originally enrolled in the survey. Findings were compared within and between groups before and after intervention surveys. At the baseline, contraceptive use in both control and intervention households were similar. After the intervention, we observed among men in the intervention arm a significantly higher level of willingness to be actively involved in family planning compared to the men in the control arm (p family planning issues was less reported within the control group, both in the case of men and women ((p = 0.031) and (p family planning educational intervention, which includes both spouses and promotes spousal communication, might be useful to foster contraceptive practice among couples. The results also offer practical information on the benefits of male involvement in family planning as a best means to increase contraceptive use. Thus, providing opportunities to reinforce

  1. Use and perceptions of information among family physicians: sources considered accessible, relevant, and reliable.

    Science.gov (United States)

    Kosteniuk, Julie G; Morgan, Debra G; D'Arcy, Carl K

    2013-01-01

    The research determined (1) the information sources that family physicians (FPs) most commonly use to update their general medical knowledge and to make specific clinical decisions, and (2) the information sources FPs found to be most physically accessible, intellectually accessible (easy to understand), reliable (trustworthy), and relevant to their needs. A cross-sectional postal survey of 792 FPs and locum tenens, in full-time or part-time medical practice, currently practicing or on leave of absence in the Canadian province of Saskatchewan was conducted during the period of January to April 2008. Of 666 eligible physicians, 331 completed and returned surveys, resulting in a response rate of 49.7% (331/666). Medical textbooks and colleagues in the main patient care setting were the top 2 sources for the purpose of making specific clinical decisions. Medical textbooks were most frequently considered by FPs to be reliable (trustworthy), and colleagues in the main patient care setting were most physically accessible (easy to access). When making specific clinical decisions, FPs were most likely to use information from sources that they considered to be reliable and generally physically accessible, suggesting that FPs can best be supported by facilitating easy and convenient access to high-quality information.

  2. Marital and Parental Satisfaction of Married Physicians with Children

    Science.gov (United States)

    Warde, Carole M; Moonesinghe, Kushan; Allen, Walter; Gelberg, Lillian

    1999-01-01

    OBJECTIVE To evaluate personal and professional factors associated with marital and parental satisfaction of physicians. STUDY DESIGN Cross-sectional study. PARTICIPANTS A survey was sent to equal numbers of licensed male and female physicians in a Southern California county. Of 964 delivered questionnaires, 656 (68%) were returned completed. Our sample includes 415 currently married physicians with children, 64% male and 36% female. MEASUREMENTS AND MAIN RESULTS Ratings of marital and parental satisfaction were measured on a 5-point Likert scale, 5 being extremely satisfied. Prevalence of work and home life factors was also evaluated. The mean score for marital satisfaction was 3.92 (range 1.75–5.0). Approximately half of the physicians reported high levels of marital satisfaction (63% of male physicians and 45% of female physicians). The gender difference disappeared after adjusting for age differences. Two factors were associated with high marital satisfaction: a supportive spouse (odds ratio [OR] 10.37; 95% confidence interval [CI] 2.66, 40.08) and role conflict (OR 0.61; 95% CI 0.42, 0.88). The mean score for parental satisfaction was 3.43 (range 1.0–5.0), and approximately two thirds of both male and female physicians reported at least moderate levels of parental satisfaction. The major factors associated with parental satisfaction were a supportive spouse (OR 2.24; 95% CI 1.32, 3.80), role conflict (OR 0.35; 95% CI 0.23, 0.53), salaried practice setting (OR 2.14; 95% CI 1.21, 3.81), marriage to a spouse working in a profession (OR 2.14; 95% CI 1.21, 3.81), and marriage to a spouse working as a homemaker (OR 2.33; 95% CI 1.20, 4.56). Number of hours worked was not found to be related to either satisfaction score, but rather to an intervening variable, role conflict. CONCLUSIONS For physicians with children, our study indicates that minimizing the level of role conflict and having a supportive spouse are associated with higher levels of marital and

  3. Type 2 diabetes family histories, body composition and fasting glucose levels: a cross-section analysis in healthy sedentary male and female.

    Science.gov (United States)

    Bianco, Antonino; Pomara, Francesco; Thomas, Ewan; Paoli, Antonio; Battaglia, Giuseppe; Petrucci, Marco; Proia, Patrizia; Bellafiore, Marianna; Palma, Antonio

    2013-01-01

    Diabetes type 2 is a world wide spread disease with a multifactorial pathogenetic evolution. Various factors like obesity, physical inactivity and poor lifestyle habits contribute to its development. The aim of this study was to verify if in young healthy sedentary male and female there is positive correlation between family history to type 2 diabetes and an increase in body weight and fat mass, or alterations in basal glycemia values. Totally183 male and 237 female healthy sedentary subjects were analysed in 2012, in Italy. They were divided in three groups: FH(+) with first degree family history, FH(++) with second degree family history and FH(-) with no family history. Anthropometrics, body composition and blood parameters were assessed. Male had the highest BMI values (Plife-style changes, such as increased physical activity and controlled quantity and quality of food intake.

  4. Adolescents of the U.S. National Longitudinal Lesbian Family Study: male role models, gender role traits, and psychological adjustment

    NARCIS (Netherlands)

    Bos, H.; Goldberg, N.; van Gelderen, L.; Gartrell, N.

    2012-01-01

    This article focuses on the influence of male role models on the lives of adolescents (N = 78) in the U.S. National Longitudinal Lesbian Family Study. Half of the adolescents had male role models; those with and those without male role models had similar scores on the feminine and masculine scales

  5. Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

    Science.gov (United States)

    Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

    2017-10-01

    Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

  6. Family Physicians' Perceived Prevalence, Safety, and Screening for Cigarettes, Marijuana, and Electronic-Nicotine Delivery Systems (ENDS) Use during Pregnancy.

    Science.gov (United States)

    Northrup, Thomas F; Klawans, Michelle R; Villarreal, Yolanda R; Abramovici, Adi; Suter, Melissa A; Mastrobattista, Joan M; Moreno, Carlos A; Aagaard, Kjersti M; Stotts, Angela L

    2017-01-01

    Assess perceptions of prevalence, safety, and screening practices for cigarettes and secondhand smoke exposure (SHSe), marijuana (and synthetic marijuana), electronic nicotine delivery systems (ENDS; eg, e-cigarettes), nicotine-replacement therapy (NRT), and smoking-cessation medications during pregnancy, among primary care physicians (PCPs) providing obstetric care. A web-based, cross-sectional survey was e-mailed to 3750 US physicians (belonging to organizations within the Council of Academic Family Medicine Educational Research Alliance). Several research groups' questions were included in the survey. Only physicians who reported providing "labor and delivery" obstetric care responded to questions related to the study objectives. A total of 1248 physicians (of 3750) responded (33.3%) and 417 reported providing labor and delivery obstetric care. Obstetric providers (N = 417) reported cigarette (54%), marijuana (49%), and ENDS use (24%) by "Some (6% to 25%)" pregnant women, with 37% endorsing that "Very Few (1% to 5%)" pregnant women used ENDS. Providers most often selected that very few pregnant women used NRT (45%), cessation medications (ie, bupropion or varenicline; 37%), and synthetic marijuana (23%). Significant proportions chose "Do not Know" for synthetic marijuana (58%) and ENDS (27%). Over 90% of the sample perceived that use of or exposure to cigarettes (99%), synthetic marijuana (99%), SHS (97%), marijuana (92%), or ENDS (91%) were unsafe during pregnancy, with the exception of NRT (44%). Providers most consistently screened for cigarette (85%) and marijuana use (63%), followed by SHSe in the home (48%), and ENDS (33%) and synthetic marijuana use (28%). Fewer than a quarter (18%) screened consistently for all substances and SHSe. One third (32%) reported laboratory testing for marijuana and 3% reported laboratory testing for smoking status. This sample of PCPs providing obstetric care within academic settings perceived cigarettes, marijuana, and ENDS

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

    Science.gov (United States)

    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.

  8. Race, Income, and Education: Associations with Patient and Family Ratings of End-of-Life Care and Communication Provided by Physicians-in-Training

    Science.gov (United States)

    Engelberg, Ruth A.; Downey, Lois; Kross, Erin K.; Reinke, Lynn F.; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W.; Back, Anthony L.; Curtis, J. Randall

    2014-01-01

    Abstract Background: Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. Objective: To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. Methods: As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Results: Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Conclusions: Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families. PMID:24592958

  9. Physicians' fees and public medical care programs.

    Science.gov (United States)

    Lee, R H; Hadley, J

    1981-01-01

    In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

  10. [Family medicine and functional somatic syndromes].

    Science.gov (United States)

    Nago, Naoki

    2009-09-01

    Between psychosomatic medicine and psychiatry, FSS (functional somatic syndromes) patients are often visiting a family doctor. For FSS, the role of family physicians is large, but the family physicians are not required for the role of diagnosis and treatment of FSS. Rather, appropriate referral to a specialist to exclude organic disease is important and a role as the coordinator is large to the patient to refuse a psychiatric consultation. To serve as a role for such coordination, a family physician has to response the patient's emotional side and focus on the construction of the doctor-patient relationship and response. I also think of structuralism medicine approach to describe disease from the meta-level as a new procedure to the patient. This approach consists of 4 components, 'entity', 'phenomenon', 'words', and 'I'. This may be a useful approach to family physicians who coordinate the overall for FSS patients' management.

  11. Sex-Role Stereotyping of Nurses and Physicians on Prime-Time Television: A Dichotomy of Occupational Portrayals.

    Science.gov (United States)

    Kalisch, Philip A; Kalisch, Beatrice J.

    1984-01-01

    Analysis of prime-time television portrayals of nurses and physicians (1950-80) shows extreme levels of both sexual and occupational stereotyping. TV nurses are 99 percent female; TV physicians are 95 percent male. The TV image of female professional nurses is of total dependence on and subservience to male physicians. (Author/CMG)

  12. Longitudinal Effects of Family Factors on Alcohol Use among African American and White Non-Hispanic Males during Middle School

    Science.gov (United States)

    Horton, E. Gail; Gil, Andres

    2008-01-01

    This study examined the longitudinal effects of five family factors (familism, parent derogation, parent-child communication, family alcohol problems, and family drug problems) on intensity of alcohol use among a sample of 451 African American and White non-Hispanic males from early to mid-adolescence (sixth through eighth grades). Results…

  13. Gender in medicine – an issue for women only? A survey of physician teachers' gender attitudes

    Directory of Open Access Journals (Sweden)

    Westman Göran

    2003-11-01

    Full Text Available Abstract Background During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. Method Questionnaires were sent to all 468 senior physicians (29 % women, at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. Results The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. Conclusions To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in

  14. Standardised classification of pre-release development in male-brooding pipefish, seahorses, and seadragons (Family Syngnathidae)

    Science.gov (United States)

    2012-01-01

    Background Members of the family Syngnathidae share a unique reproductive mode termed male pregnancy. Males carry eggs in specialised brooding structures for several weeks and release free-swimming offspring. Here we describe a systematic investigation of pre-release development in syngnathid fishes, reviewing available data for 17 species distributed across the family. This work is complemented by in-depth examinations of the straight-nosed pipefish Nerophis ophidion, the black-striped pipefish Syngnathus abaster, and the potbellied seahorse Hippocampus abdominalis. Results We propose a standardised classification of early syngnathid development that extends from the activation of the egg to the release of newborn. The classification consists of four developmental periods – early embryogenesis, eye development, snout formation, and juvenile – which are further divided into 11 stages. Stages are characterised by morphological traits that are easily visible in live and preserved specimens using incident-light microscopy. Conclusions Our classification is derived from examinations of species representing the full range of brooding-structure complexity found in the Syngnathidae, including tail-brooding as well as trunk-brooding species, which represent independent evolutionary lineages. We chose conspicuous common traits as diagnostic features of stages to allow for rapid and consistent staging of embryos and larvae across the entire family. In view of the growing interest in the biology of the Syngnathidae, we believe that the classification proposed here will prove useful for a wide range of studies on the unique reproductive biology of these male-brooding fish. PMID:23273265

  15. Standardised classification of pre-release development in male-brooding pipefish, seahorses, and seadragons (Family Syngnathidae

    Directory of Open Access Journals (Sweden)

    Sommer Stefan

    2012-12-01

    Full Text Available Abstract Background Members of the family Syngnathidae share a unique reproductive mode termed male pregnancy. Males carry eggs in specialised brooding structures for several weeks and release free-swimming offspring. Here we describe a systematic investigation of pre-release development in syngnathid fishes, reviewing available data for 17 species distributed across the family. This work is complemented by in-depth examinations of the straight-nosed pipefish Nerophis ophidion, the black-striped pipefish Syngnathus abaster, and the potbellied seahorse Hippocampus abdominalis. Results We propose a standardised classification of early syngnathid development that extends from the activation of the egg to the release of newborn. The classification consists of four developmental periods – early embryogenesis, eye development, snout formation, and juvenile – which are further divided into 11 stages. Stages are characterised by morphological traits that are easily visible in live and preserved specimens using incident-light microscopy. Conclusions Our classification is derived from examinations of species representing the full range of brooding-structure complexity found in the Syngnathidae, including tail-brooding as well as trunk-brooding species, which represent independent evolutionary lineages. We chose conspicuous common traits as diagnostic features of stages to allow for rapid and consistent staging of embryos and larvae across the entire family. In view of the growing interest in the biology of the Syngnathidae, we believe that the classification proposed here will prove useful for a wide range of studies on the unique reproductive biology of these male-brooding fish.

  16. Reproductive Health of Women in Rural Areas of East Azerbaijan – Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study

    Science.gov (United States)

    Alizadeh, Mahasti; Jabbari Birami, Hossein; Moradi, Siavash

    2015-01-01

    Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province. PMID:26744731

  17. Reproductive Health of Women in Rural Areas of East Azerbaijan – Iran, before and after Implementation of rural Family Physician Program: an Ecologic Study

    Directory of Open Access Journals (Sweden)

    Mahasti Alizadeh

    2015-12-01

    Full Text Available Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031 and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031 after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.

  18. Neural Correlates of Impulsivity in Healthy Males and Females with Family Histories of Alcoholism

    Science.gov (United States)

    DeVito, Elise E; Meda, Shashwath A; Jiantonio, Rachel; Potenza, Marc N; Krystal, John H; Pearlson, Godfrey D

    2013-01-01

    Individuals family-history positive (FHP) for alcoholism have increased risk for the disorder, which may be mediated by intermediate behavioral traits such as impulsivity. Given the sex differences in the risk for and clinical presentation of addictive disorders, risk for addiction may be differentially mediated by impulsivity within FHP males and females. FHP (N=28) and family-history negative (FHN, N=31) healthy, non-substance-abusing adults completed an fMRI Go/No-Go task and were assessed on impulsivity and alcohol use. Effects of family history and sex were investigated as were associations between neural correlates of impulse control and out-of-scanner measures of impulsivity and alcohol use. FHP individuals showed greater activation in the left anterior insula and inferior frontal gyrus during successful inhibitions, an effect that was driven primarily by FHP males. Higher self-reported impulsivity and behavioral discounting impulsivity, but not alcohol use measures, were associated with greater BOLD signal in the region that differentiated the FHP and FHN groups. Impulsivity factors were associated with alcohol use measures across the FHP and FHN groups. These findings are consistent with increased risk for addiction among FHP individuals being conferred through disrupted function within neural systems important for impulse control. PMID:23584260

  19. Physician work intensity among medical specialties: emerging evidence on its magnitude and composition.

    Science.gov (United States)

    Horner, Ronnie D; Szaflarski, Jerzy P; Ying, Jun; Meganathan, Karthikeyan; Matthews, Gerald; Schroer, Brian; Weber, Debra; Raphaelson, Marc

    2011-11-01

    Similarities and differences in physician work intensity among specialties are poorly understood but have implications for quality of care, patient safety, practice organization and management, and payment. To determine the magnitude and important dimensions of physician work intensity for 4 specialties. Cross-sectional assessment of work intensity associated with actual patient care in the examination room or operating room. A convenience sample of 45 family physicians, 20 general internists, 22 neurologists, and 21 surgeons, located in Kansas, Kentucky, Maryland, Ohio, and Virginia. Work intensity measures included the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Subjective Work Assessment Technique (SWAT), and Multiple Resource Questionnaire. Stress was measured by the Dundee Stress State Questionnaire. Physicians reported similar magnitude of work intensity on the NASA-TLX and Multiple Resource Questionnaire. On the SWAT, general internists reported work intensity similar to surgeons but significantly lower than family physicians and neurologists (P=0.035). Surgeons reported significantly higher levels of task engagement on the stress measure than the other specialties (P=0.019), significantly higher intensity on physical demand (P NASA-TLX than the other specialties (P=0.003). Surgeons reported the lowest intensity for temporal demand of all specialties, being significantly lower than either family physicians or neurologists (P=0.014). Family physicians reported the highest intensity on the time dimension of the SWAT, being significantly higher than either general internists or surgeons (P=0.008). Level of physician work intensity seems to be similar among specialties.

  20. Awareness and treatment of alcohol dependence in Japan: results from internet-based surveys in persons, family, physicians and society.

    Science.gov (United States)

    Taguchi, Yurie; Takei, Yoshiyuki; Sasai, Ryoko; Murteira, Susana

    2014-01-01

    To understand current awareness of, and views on, treatment of alcohol dependence in Japan. (a) Nationwide internet-based survey of 520 individuals, consisting of 52 diagnosed alcohol-dependent (AD) persons, 154 potentially alcohol-dependent (ADP) persons, 104 family members and 106 friends/colleagues of AD persons, and 104 general individuals, derived from a consumer panel where the response rate was 64.3%. We enquired into awareness about the treatment of alcohol dependence and patient pathways through the healthcare network. (b) Nationwide internet-based survey of physicians (response rate 10.1% (2395/23,695) to ask 200 physicians about their management of alcohol use disorders). We deduced that 10% of alcohol-dependent Japanese persons had ever been diagnosed with alcohol dependence, with only 3% ever treated. Regarding putative treatment goals, 20-25% of the AD and ADP persons would prefer to attempt to abstain, while 60-75% preferred 'reduced drinking.' A half of the responding physicians considered abstinence as the primary treatment goal in alcohol dependence, while 76% considered reduced drinking as an acceptable goal. AD and ADP persons in Japan have low 'disease awareness' defined as 'understanding of signs, symptoms and consequences of alcohol use disorders,' which is in line with the overseas situation. The Japanese drinking culture and stigma toward alcohol dependence may contribute to such low disease awareness and current challenging treatment environment. While abstinence remains the preferred treatment goal among physicians, reduced drinking seems to be an acceptable alternative treatment goal to many persons and physicians in Japan. © The Author 2014. Medical Council on Alcohol and Oxford University Press.

  1. A DRD1 haplotype is associated with risk for autism spectrum disorders in male-only affected sib-pair families.

    Science.gov (United States)

    Hettinger, Joe A; Liu, Xudong; Schwartz, Charles E; Michaelis, Ron C; Holden, Jeanette J A

    2008-07-05

    Individuals with autism spectrum disorders (ASDs) have impairments in executive function and social cognition, with males generally being more severely affected in these areas than females. Because the dopamine D1 receptor (encoded by DRD1) is integral to the neural circuitry mediating these processes, we examined the DRD1 gene for its role in susceptibility to ASDs by performing single marker and haplotype case-control comparisons, family-based association tests, and genotype-phenotype assessments (quantitative transmission disequilibrium tests: QTDT) using three DRD1 polymorphisms, rs265981C/T, rs4532A/G, and rs686T/C. Our previous findings suggested that the dopaminergic system may be more integrally involved in families with affected males only than in other families. We therefore restricted our study to families with two or more affected males (N = 112). There was over-transmission of rs265981-C and rs4532-A in these families (P = 0.040, P = 0.038), with haplotype TDT analysis showing over-transmission of the C-A-T haplotype (P = 0.022) from mothers to affected sons (P = 0.013). In addition, haplotype case-control comparisons revealed an increase of this putative risk haplotype in affected individuals relative to a comparison group (P = 0.004). QTDT analyses showed associations of the rs265981-C, rs4532-A, rs686-T alleles, and the C-A-T haplotype with more severe problems in social interaction, greater difficulties with nonverbal communication and increased stereotypies compared to individuals with other haplotypes. Preferential haplotype transmission of markers at the DRD1 locus and an increased frequency of a specific haplotype support the DRD1 gene as a risk gene for core symptoms of ASD in families having only affected males. Copyright 2008 Wiley-Liss, Inc.

  2. A survey to assess family physicians' motivation to teach undergraduates in their practices.

    Directory of Open Access Journals (Sweden)

    Marcus May

    Full Text Available BACKGROUND: In Germany, family physicians (FPs are increasingly needed to participate in undergraduate medical education. Knowledge of FPs' motivation to teach medical students in their practices is lacking. PURPOSE: To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. METHODS: The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. RESULTS: A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%. 'Helping others' and 'interest' were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. CONCLUSION: German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods.

  3. Does training family physicians in shared decision making promote optimal use of antibiotics for acute respiratory infections? Study protocol of a pilot clustered randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Côté Luc

    2007-11-01

    Full Text Available Abstract Background In North America, although it varies according to the specific type of acute respiratory infections (ARI, use of antibiotics is estimated to be well above the expected prevalence of bacterial infections. The objective of this pilot clustered randomized controlled trial (RCT is to assess the feasibility of a larger clustered RCT aiming at evaluating the impact of DECISION+, a continuing professional development (CPD program in shared decision making, on the optimal use of antibiotics in the context of ARI. Methods/design This pilot study is a cluster RCT conducted with family physicians from Family Medicine Groups (FMG in the Quebec City area, Canada. Participating FMG are randomised to an immediate DECISION+ group, a CPD program in shared decision making, (experimental group, or a delayed DECISION+ group (control group. Data collection involves recruiting five patients consulting for ARI per physician from both study groups before (Phase 1 and after (Phase 2 exposure of the experimental group to the DECISION+ program, and after exposure of the control group to the DECISION+ program (Phase 3. The primary outcome measures to assess the feasibility of a larger RCT include: 1 proportion of contacted FMG that agree to participate; 2 proportion of recruited physicians who participate in the DECISION+ program; 3 level of satisfaction of physicians regarding DECISION+; and 4 proportion of missing data in each data collection phase. Levels of agreement of the patient-physician dyad on the Decisional Conflict Scale and physicians' prescription profile for ARI are performed as secondary outcome measures. Discussion This study protocol is informative for researchers and clinicians interested in designing and/or conducting clustered RCT with FMG regarding training of physicians in shared decision making. Trial Registration ClinicalTrials.gov Identifier: NCT00354315

  4. Physician wages across specialties: informing the physician reimbursement debate.

    Science.gov (United States)

    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.

  5. 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.

  6. Relationships between family physicians’ referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians

    International Nuclear Information System (INIS)

    Olson, Robert A; Lengoc, Sonca; Tyldesley, Scott; French, John; McGahan, Colleen; Soo, Jenny

    2012-01-01

    The primary objective of this research was to assess the relationship between FPs’ knowledge of palliative radiotherapy (RT) and referral for palliative RT. 1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge. The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%). The majority of FPs correctly identified that painful bone metastases (91%), airway obstruction (77%), painful local disease (85%), brain metastases (76%) and spinal cord compression (79%) can be effectively treated with RT, though few were aware that hemoptysis (42%) and hematuria (31%) can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p < 0.001) and tested (p = 0.02) knowledge. FPs had higher mean knowledge scores if they received post-MD training in palliative care (12% higher; p < 0.001) or radiotherapy (15% higher; p = 0.002). There was a strong relationship between FPs referral for palliative radiotherapy and both self-assessed knowledge (p < 0.001) and tested knowledge (p = 0.01). Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT

  7. The impact of gender stereotypes on the evaluation of general practitioners' communication skills: an experimental study using transcripts of physician-patient encounters.

    Science.gov (United States)

    Nicolai, Jennifer; Demmel, Ralf

    2007-12-01

    The present study has been designed to test for the effect of physicians' gender on the perception and assessment of empathic communication in medical encounters. Eighty-eight volunteers were asked to assess six transcribed interactions between physicians and a standardized patient. The effects of physicians' gender were tested by the experimental manipulation of physicians' gender labels in transcripts. Participants were randomly assigned to one of two testing conditions: (1) perceived gender corresponds to the physician's true gender; (2) perceived gender differs from the physician's true gender. Empathic communication was assessed using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews. A 2 (physician's true gender: female vs. male)x2 (physician's perceived gender: female vs. male)x2 (rater's gender: female vs. male) mixed multivariate analysis of variance (MANOVA) yielded a main effect for physician's true gender. Female physicians were rated higher on empathic communication than male physicians irrespective of any gender labels. The present findings suggest that gender differences in the perception of physician's empathy are not merely a function of the gender label. These findings provide evidence for differences in male and female physicians' empathic communication that cannot be attributed to stereotype bias. Future efforts to evaluate communication skills training for general practitioners may consider gender differences.

  8. Using Nurse Ratings of Physician Communication in the ICU To Identify Potential Targets for Interventions To Improve End-of-Life Care.

    Science.gov (United States)

    Ramos, Kathleen J; Downey, Lois; Nielsen, Elizabeth L; Treece, Patsy D; Shannon, Sarah E; Curtis, J Randall; Engelberg, Ruth A

    2016-03-01

    Communication among doctors, nurses, and families contributes to high-quality end-of-life care, but is difficult to improve. Our objective was to identify aspects of communication appropriate for interventions to improve quality of dying in the intensive care unit (ICU). This observational study used data from a cluster-randomized trial of an interdisciplinary intervention to improve end-of-life care at 15 Seattle/Tacoma area hospitals (2003-2008). Nurses completed surveys for patients dying in the ICU. We examined associations between nurse-assessed predictors (physician-nurse communication, physician-family communication) and nurse ratings of patients' quality of dying (nurse-QODD-1). Based on 1173 nurse surveys, four of six physician-nurse communication topics were positively associated with nurse-QODD-1: family questions, family dynamics, spiritual/religious issues, and cultural issues. Discussions between nurses and physicians about nurses' concerns for patients or families were negatively associated. All physician-family communication ratings, as assessed by nurses, were positively associated with nurse-QODD-1: answering family's questions, listening to family, asking about treatments patient would want, helping family decide patient's treatment wishes, and overall communication. Path analysis suggested overall physician-family communication and helping family incorporate patient's wishes were directly associated with nurse-QODD-1. Several topics of physician-nurse communication, as rated by nurses, were associated with higher nurse-rated quality of dying, whereas one topic, nurses' concerns for patient or family, was associated with poorer ratings. Higher nurse ratings of physician-family communication were uniformly associated with higher quality of dying, highlighting the importance of this communication. Physician support of family decision making was particularly important, suggesting a potential target for interventions to improve end-of-life care.

  9. Career satisfaction and retention of a sample of women physicians who work reduced hours.

    Science.gov (United States)

    Barnett, Rosalind C; Gareis, Karen C; Carr, Phyllis L

    2005-03-01

    To better understand the career satisfaction and factors related to retention of women physicians who work reduced hours and are in dual-earner couples in comparison to their full-time counterparts. Survey of a random sample of female physicians between 25 and 50 years of age working within 25 miles of Boston, whose names were obtained from the Board of Registration in Medicine in Massachusetts. Interviewers conducted a 60-minute face-to-face closed-ended interview after interviewees completed a 20-minute mailed questionnaire. Fifty-one full-time physicians and 47 reduced hours physicians completed the study; the completion rate was 49.5%. The two groups were similar in age, years as a physician, mean household income, number of children, and presence of an infant in the home. Reduced hours physicians in this sample had a different relationship to experiences in the family than full-time physicians. (1) When reduced hours physicians had low marital role quality, there was an associated lower career satisfaction; full-time physicians report high career satisfaction regardless of their marital role quality. (2) When reduced hours physicians had low marital role or parental role quality, there was an associated higher intention to leave their jobs than for full-time physicians; when marital role or parental role quality was high, there was an associated lower intention to leave their jobs than for full-time physicians. (3) When reduced hours physicians perceived that work interfering with family was high, there was an associated greater intention to leave their jobs that was not apparent for full-time physicians. Women physicians in this sample who worked reduced hours had stronger relationships between family experiences (marital and parental role quality and work interference with family) and professional outcomes than had their full-time counterparts. Both career satisfaction and intention to leave their employment are correlated with the quality of home life for

  10. ?You don?t want to lose that trust that you?ve built with this patient??: (Dis)trust, medical tourism, and the Canadian family physician-patient relationship

    OpenAIRE

    Crooks, Valorie A; Li, Neville; Snyder, Jeremy; Dharamsi, Shafik; Benjaminy, Shelly; Jacob, Karen J; Illes, Judy

    2015-01-01

    Background Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship—a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medic...

  11. Equipping family physician trainees as teachers: a qualitative evaluation of a twelve-week module on teaching and learning

    OpenAIRE

    de Villiers, Marietjie R; Cilliers, Francois J; Coetzee, Francois; Herman, Nicoline; van Heusden, Martie; von Pressentin, Klaus B

    2014-01-01

    Background There is a dire need to expand the capacity of institutions in Africa to educate health care professionals. Family physicians, as skilled all-rounders at district level, are potentially well placed to contribute to an extended training platform in this context. To play this role, they need to both have an understanding of their specialist role that incorporates teaching and be equipped for their role as trainers of current and future health workers and specialists. A teaching and l...

  12. Correlates of midlife career achievement among women physicians.

    Science.gov (United States)

    Graves, P L; Thomas, C B

    1985-08-09

    In the context of a longitudinal study, we explored factors contributing to midlife career achievement among 108 women physicians. Three groups were formed, based on medical specialty, specialty board certification, and professorial appointment. Using analysis of variance procedures, the career groups were compared on measures obtained during medical school and on marital status, family size, and three health measures in midlife. Of the youthful measures, academic standing, father's socioeconomic status, and early family (specifically father-daughter) relationships were found to be associated with midlife achievement. Furthermore, a clear association was observed between success and good health in midlife. Married women formed the majority in all groups; no differences in family size were found. We conclude that career achievement among women physicians is influenced less by marriage and family size than by motivational and personality factors shaped in early life.

  13. THE BUDGET, THE FAMILY PHYSICIAN AND THE PATIENT A DIFFERENT APPROACH.

    Science.gov (United States)

    Keidar, Ilan

    2014-10-01

    Modern medicine offers better health and longer life expectancy, yet consumes huge budgets. The Israeli Health Insurance Law (IHIL) regulates the delivery of health services to all Israel's residents through Health Maintenance Organizations (HMOS). These organizations confront constant struggles with their budgets and have to reduce expenses as much as possible (without harming the health level rendered). In the constant necessity to restrain expenses are embedded difficulties that might cause unrest to the Public Health System (PHS). At the edge of the public health spear are the Family Physicians (FPS) who have not only to supply the best possible medicine to their patients, and at the same time confront budgetary constraints that have the potential to hinder the level of rendered medicine, but also have, at times, to mediate between the conflicting interests of their patients' wish to receive the best available health measures, the FP own medical believes, the HMO's directives and, between the FPS wish, to keep up the number of their (content) patients. One of the World Health Organization's (WHO) concepts, like Israel's one, is that soul and body are inseparable and must be addressed simultaneously in the process of healing. Real life at the Family Physicians' clinics shows, at times, that despite the Israeli physicians' very high professional level, and the Israeli Health System (IHS)'s high efficiency, such a process, due to budgetary constraints, workload and various other reasons, does not always take place and, on the personal level, there are patients who feel that the "system" has treated them incorrectly and in an unsatisfactory manner. Unsatisfied and restless patients might cause undesirable consequences to the "system", like losing faith in one's FP and HMO, which might lead to the patients' reduced cooperation in the healing process, lawsuits amplification, patients leaving their FPS and their HMOs etc. Addressing the patient's soul and body as an

  14. Family planning in Santiageo, Chile: the male viewpoint.

    Science.gov (United States)

    Hall, M F

    1971-07-01

    To obtain the male viewpoint toward family planning in the Chilean population, 561 men (aged 18-54) in Santiago from upper, middle, and lower socioeconomic levels were interviewed on their birth control attitudes and practices and compared with a random probability sample of 240 men from a nearby rural village. Tabulation of the interviews showed that a majority of both unmarried and married men identified themselves as active participants in birth control discussions. Younger husbands tended to have had more experience with contraception than older husbands, and respondents in higher socioeconomic levels showed a greater use of contraception (75%) than men in the lower class or village sample (35%). 23% of those in the village sample who did not use contraception cited reasons such as lack of knowledge and money or fear of harmful effects, while only 2% of the upper class in the urban sample cited such reasons. Approval of abortion for their wives was expressed by around 40% of all respondents. Approval of abortion in general ranged from 81% in cases of probable fetal deformity to 31% in single girls. Questions on sexual relations revealed that the median age for the first sexual intercourse was 16 years. 91% of the unmarried men were sexually active at a median frequence of once every 2 weeks, and contraception, if used, was most frequently oral or male devices. Among married men, sexual relations occurred at a median frequency of once every 4 days, with contraception, if used, most likely being an intrauterine device. All of the respondents tended to favor dissemination of contraceptive information more readily to men than women. Approval of providing this information to single girls was directly related to economic status. The schools were readily accepted as a forum for contraceptive discussion. The father was by far the preferred principal source of information for a son (44%) rather than friends (6%), but the respondents themselves got their information from

  15. Physician assistant wages and employment, 2000-2025.

    Science.gov (United States)

    Quella, Alicia; Brock, Douglas M; Hooker, Roderick S

    2015-06-01

    This study sought to assess physician assistant (PA) wages, make comparisons with other healthcare professionals, and project their earnings to 2025. The Bureau of Labor Statistics PA employment datasets were probed, and 2013 wages were used to explore median wage differences between large employer categories and 14 years of historical data (2000-2013). Median wages of PAs, family physicians and general practitioners, pharmacists, registered nurses, advanced practice nurses, and physical therapists were compared. Linear regression was used to project the PA median wage to 2025. In 2013, the median hourly wage for a PA employed in a clinical role was $44.70. From 2000 to 2013, PA wages increased by 40% compared with the cumulative inflation rate of 35.3%. This suggests that demand exceeds supply, a finding consistent with similar clinicians such as family physicians. A predictive model suggests that PA employment opportunities and remuneration will remain high through 2025.

  16. Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters.

    Science.gov (United States)

    Rajalin, Mia; Hirvikoski, Tatja; Jokinen, Jussi

    2013-05-15

    Family studies, including twin and adoption designs, have shown familial transmission of suicidal behaviors. Early environmental risk factors have an important role in the etiology of suicidal behavior. The aim of the present study was to assess the impact of family history of suicide and childhood trauma on suicide risk and on severity of suicide attempt in suicide attempters. A total of 181 suicide attempters were included. Family history of suicide was assessed with the Karolinska Suicide History Interview or through patient records. Childhood trauma was assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behavior in childhood (between 6 and 14 years of age) and during adult life (15 years or older). Suicide intent was measured with the Freeman scale. Male suicide attempters with a positive family history of suicide made more serious and well planned suicide attempts and had a significantly higher suicide risk. In logistic regression, family history of suicide and exposure to interpersonal violence as a child were independent predictors of suicide in male suicide attempters. The information about family history of suicide and exposure to interpersonal violence as a child derives from the patients only. In the first part of the inclusion period the information was collected from patient records. The results of this study imply that suicides among those at biological risk might be prevented with the early recognition of environmental risks. Copyright © 2012 Elsevier B.V. All rights reserved.

  17. Conflicts Within the Family and Within the Couple as Contextual Factors in the Determinism of Male Sexual Dysfunction.

    Science.gov (United States)

    Boddi, Valentina; Fanni, Egidia; Castellini, Giovanni; Fisher, Alessandra Daphne; Corona, Giovanni; Maggi, Mario

    2015-12-01

    The deterioration of a couple's relationship has been previously associated with impairment in male sexual function. Besides a couple's dystonic relationship, other stressors can unfavorably influence dyadic intimacy. A largely neglected etiopathogenetic factor affecting couple sexuality is the frustration caused by conflicts within the family. To evaluate the possible associations between male sexual dysfunction (SD) and conflictual relationships within the couple or the family. A consecutive series of 3,975 men, attending the Outpatient Clinic for SD for the first time, was retrospectively studied. Conflicts within the family and within the couple were assessed using two standard questions: "Are there any conflicts at home," and "Do you have a difficult relationship with your partner?" respectively, rating 0 = normal relationships, 1 = occasional quarrels, and 2 = frequent quarrels or always. Several clinical, biochemical, and psychological (Middlesex Hospital Questionnaire) parameters were studied. Among the 3,975 patients studied, we observed a high prevalence of conflicts within the family and within the couple (32% vs. 21.2%). When compared with the rest of the sample, subjects reporting both type of conflicts showed a higher prevalence of psychiatric comorbidities. Hence, all data were adjusted for this parameter and for age. Family and couple conflicts were significantly associated with free floating anxiety, depression symptoms, and with a higher risk of subjective (self-reported) and objective (peak systolic velocity at the penile color Doppler ultrasound conflicts. This study indicates that the presence of often unexplored issues, like conflicts within the family or within the couple, can represent an important contextual factor in the determinism of male SD. © 2015 International Society for Sexual Medicine.

  18. Characteristics and outcomes for women physicians who work reduced hours.

    Science.gov (United States)

    Carr, Phyllis L; Gareis, Karen C; Barnett, Rosalind C

    2003-05-01

    To understand the characteristics of women physicians who work reduced hours in dual-earner couples and how such work schedules affect the quality of the marital role, parental role, and job role, as well as indicators of psychological distress, burnout, career satisfaction, and life satisfaction. Survey of a random sample of female physicians between 25 and 50 years of age, working within 25 miles of Boston, whose names were obtained from the Registry of Board Certification in Medicine in Massachusetts. Interviewers conducted a 60-minute face-to-face close-ended interview after a 20-minute mailed questionnaire had been completed. Fifty-one full-time physicians and 47 reduced-hours physicians completed the study, for a completion rate of 49.5%. There was no difference in age, number of years as a physician, mean household income, number of children, or presence of an infant in the home between reduced-hours and full-time physicians. Reduced-hours physicians, however, were more likely to be in a generalist specialty (40% vs. 12%, p = 0.001) and to spend a greater portion of their time in patient care (64.5% vs. 50.1%, p = 0.003) and less time in research (4.9% vs. 18.0%, p = 0.002) than full-time physicians. In addition, there was no difference between the two groups in the perception of work interfering with family life (1.8 vs. 1.7, p = 0.17; scale 1-7 with 7 high) or family life interfering with work (1.4 vs. 1.5, p = 0.62). Physicians who worked their preferred number of hours (25% of full-time and 57% of reduced-hours physicians), regardless of full-time (self-reported hours 35-90 hours per week) or reduced-hours (20-60 hours per week) status, reported better job role quality (r = 0.35, p = 0.001), schedule fit (r = 0.41, p Women physicians who work their preferred number of hours achieve the best balance of work and family outcomes.

  19. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Directory of Open Access Journals (Sweden)

    Hsiu-Nien Shen

    2015-02-01

    Full Text Available Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years physicians (n = 4303 and matched non-medical persons (control were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively, whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively. Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79; by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures.

  20. Older Male Physicians Have Lower Risk of Trochanteric but Not Cervical Hip Fractures

    Science.gov (United States)

    Shen, Hsiu-Nien; Lin, Wei-Ting; Lu, Chin-Li; Li, Chung-Yi

    2015-01-01

    Background: Osteoporosis is pathophysiologically related to trochanteric fractures, and this condition is more preventable by lifestyle modifications than cervical fractures. We investigated whether older physicians, who are health-conscious people, are at a lower risk of hip fractures because of fewer trochanteric fractures. Methods: Data regarding older (≥65 years) physicians (n = 4303) and matched non-medical persons (control) were retrieved from Taiwan’s National Health Insurance claims. All of the subjects were obtained from NHIRD with index dates from 1 January 2000 to 31 December 2008. Cox proportional hazard and competing risk regression models were established to estimate the hazard ratio (HR) of hip fracture associated with older physicians. Results: The incidence rates of trochanteric fractures were lower in older physicians than in controls (1.73 and 3.07 per 1000 person-years, respectively), whereas the rates of cervical fractures were similar between the two groups (2.45 and 2.12 per 1000 person-years, respectively). Older physicians yielded 46% lower hazard of trochanteric fractures than controls (adjusted HR 0.54, 95% confidence interval 0.37–0.79); by contrast, hazards of cervical fractures were comparable between the two groups. The HRs estimated from the competing risk models remained unchanged. Conclusions: Our findings indicated that health risk awareness may pose a significant preventive effect on trochanteric hip fractures. PMID:25689999

  1. Sex differences in physician salary in U.S. public medical schools

    Science.gov (United States)

    Jena, Anupam B.; Olenski, Andrew R.; Blumenthal, Daniel M.

    2017-01-01

    Importance Limited evidence exists on salary differences between male and female academic physicians, largely due to difficulty obtaining data on salary and factors influencing salary. Existing studies have been limited by reliance on survey-based approaches to measuring sex differences in earnings, lack of contemporary data, small sample sizes, or limited geographic representation. Objective To analyze sex differences in earnings among U.S. academic physicians. Design, setting, and participants Freedom of Information laws mandate release of salary information of public university employees in several states. In 12 states with salary information published online, we extracted salary data on 10,241 academic physicians at 24 public medical schools. We linked this data to a unique physician database with detailed information on sex, age, years of experience, faculty rank, specialty, scientific authorship, NIH funding, clinical trial participation, and Medicare reimbursements (proxy for clinical revenue). We estimated sex differences in salary adjusting for these factors. Exposure Physician sex Main outcome measures Annual salary Results Female physicians had lower unadjusted salaries than male physicians ($206,641 vs. $257,957; difference $51,315; 95% CI $46,330–$56,301). Sex differences persisted after multivariable adjustment ($227,782 vs. $247,661; difference $19,878; 95% CI $15,261–$24,495). Sex differences in salary varied across specialties, institutions, and faculty ranks. Female full and associate professors had comparable adjusted salaries to those of male associate and assistant professors, respectively. Conclusions and relevance Among physicians with faculty appointments at 24 U.S. public medical schools, significant sex differences in salary exist even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue. PMID:27400435

  2. A profile of solo/two-physician practices.

    Science.gov (United States)

    Lee, Doohee; Fiack, Kelly James; Knapp, Kenneth Michael

    2014-01-01

    Understanding practice behaviors of solo/dual physician ownership and associated factors at the national level is important information for policymakers and clinicians in response to the Affordable Care Act (ACA) of 2010, but poorly understood in the literature. We analyzed nationally representative data (n = 4,720). The study results reveal nearly 33% of the sample reported solo/two-physician practices. Male/minority/older physicians, psychiatrists, favor small practices. Greater market competition was perceived and less charity care was given among solo/two-physician practitioners. The South region was favored by small physician practitioners. Physicians in solo or two-person practices provided fewer services to chronic patients and were dissatisfied with their overall career in medicine. Small practices were favored by international medical graduates (IMGs) and primary care physicians (PCPs). Overall our data suggest that the role of solo/dual physician practices is fading away in the delivery of medicine. Our findings shed light on varied characteristics and practice behaviors of solo/two-physician practitioners, but more research may be needed to reevaluate the potential role of small physician practitioners and find a way to foster a private physician practice model in the context of the newly passed ACA of 2010.

  3. Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan.

    Science.gov (United States)

    Hajizadeh, Shayesteh; Tehrani, Fahimeh Ramezani; Simbar, Masoumeh; Farzadfar, Farshad

    2016-01-01

    The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density. In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline. After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03-0.25) in women's awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women's preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22-0.85); P>0.001). The results of this study showed that an increase in the density of midwives

  4. Mental and physical effects of Tanshin funin, posting without family, on married male workers in Japan.

    Science.gov (United States)

    Nakadaira, Hiroto; Yamamoto, Masaharu; Matsubara, Toh

    2006-03-01

    This paper investigates the effects of tanshin funin, a posting without family, on the health of married male workers. A prospective study using the pair-matched method was performed. One hundred and twenty-nine married male tanshin funin workers in their 40s and 50s and as many matched workers living with their family (regular workers) participated. Fewer tanshin funin workers took breakfast everyday (OR=3.3, phealth problems, namely headache (OR=4.7, p=0.013) and gastric/duodenal ulcers (OR=8.7, pmental stress were thus important effects of tanshin funin. Tanshin funin workers should be provided with health and lifestyle education programs and mental health care before and during tanshin funin. Doctors and nurses in the healthcare departments of companies should play a leading role.

  5. Male ICU nurses' experiences of taking care of dying patients and their families: a gender analysis.

    Science.gov (United States)

    Wu, Tammy W; Oliffe, John L; Bungay, Vicky; Johnson, Joy L

    2015-01-01

    Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants' practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers. © The Author(s) 2014.

  6. Attitudes toward Assisted Suicide: Does Family Context Matter?

    Science.gov (United States)

    Frey, Laura M; Hans, Jason D

    2016-01-01

    Little is known about how family-related contextual variables impact attitudes toward assisted suicide. A probability sample (N = 272) responded to a multiple-segment factorial vignette designed to examine the effects of 6 variables-patient sex, age, type of illness, relationship status, parenthood status, and family support-on attitudes toward physician- and family-assisted suicide. Respondents were more likely to support physician-assisted suicide if they heard about an older patient or a patient experiencing physical pain than a younger patient or one suffering from depression, respectively. For family-assisted suicide, respondent support was higher when the patient had physical pain than depression, and when the patient's spouse or friend was supportive of the wish to die than unsupportive. Attitudes about physician and family obligation to inform others were affected by type of illness, relationship status, family support, and respondent education and religiosity. The experience of pain, motivations for family involvement, confidentiality issues, and physicians' biases concerning assisted suicide are discussed.

  7. 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

  8. Dinosaurs, Hospital Ecosystems, and the Future of Family Medicine

    Science.gov (United States)

    Glazner, Cherie

    2008-01-01

    The continued presence of the family physician within hospital systems is key to family medicine remaining an attractive, viable specialty in the ever-evolving world of medicine. One physician muses about her place in this complex ecosystem and believes that family physicians lose their voice and thus risk their own extinction when they opt out of hospital practice. PMID:18626038

  9. Physicians' preferences for asthma guidelines implementation.

    Science.gov (United States)

    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.

  10. The Reconstituted Family

    OpenAIRE

    Talbot, Yves

    1981-01-01

    The reconstituted or step-family is becoming more prevalent. The physician who cares for families should be acquainted with the different aspects of such family structure and family functioning. This will enable professionals to better understand and assist their patients, by anticipating the different stresses related to the new family formation, and supporting their adaptation.

  11. Physician variation in perceived barriers to personal health

    Directory of Open Access Journals (Sweden)

    Rubenfire M

    2012-01-01

    Full Text Available Adam RB Kosteva1, Brian M Salata1, Sangeetha Mahadevan Krishnan2, Michael Howe3, Alissa Weber3, Melvyn Rubenfire2,3, Elizabeth A Jackson2,31Michigan Cardiovascular Research and Reporting Program, 2Division of Cardiovascular Medicine, 3Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USAObjective: Physicians’ personal health habits are associated with their counseling habits regarding physical activity. We sought to examine physicians’ own barriers to a healthy lifestyle by level of training and gender.Methods: Physicians at a major teaching hospital were surveyed regarding their lifestyle habits and barriers to healthy habits. The frequency of reported barriers was examined by years in practice (trainees vs staff physicians and gender.Results: 183 total responses were received. Over 20% of respondents were overweight. Work schedule was cited as the greatest barrier to regular exercise in 70.5% of respondents. Trainees were more likely to cite time constraints or cost as a barrier to a healthy diet compared to staff physicians. Staff physicians were more likely to report the time to prepare healthy foods as a barrier. For both trainees and staff physicians, time was a barrier to regular exercise. For trainees work schedule was a barrier, while both work schedule and family commitments were top barriers cited by staff physicians. Women were more likely to report family commitments as a barrier than men. Respondents suggested healthier options in vending machines and the hospital cafeteria, healthy recipes, and time and/or facilities for exercise at work as options to help overcome these barriers.Conclusion: Work schedules and family commitments are frequently reported by providers as barriers to healthy lifestyle. Efforts to reduce such barriers may lead to improved health habits among providers.Keywords: diet, exercise, counseling, prevention, gender, barriers, health

  12. Demands, values, and burnout: relevance for physicians.

    Science.gov (United States)

    Leiter, Michael P; Frank, Erica; Matheson, Timothy J

    2009-12-01

    T o explore the interaction between workload and values congruence (personal values with health care system values) in the context of burnout and physician engagement and to explore the relative importance of these factors by sex, given the distinct work patterns of male and female physicians. National mailed survey. Canada. A random sample of 8100 Canadian physicians (response rate 40%, N = 3213); 2536 responses (from physicians working more than 35 hours per week) were analyzed. Levels of burnout, values congruence, and workload, by sex, measured by the Maslach Burnout Inventory-General Scale and the Areas of Worklife Scale. Results showed a moderate level of burnout among Canadian physicians, with relatively positive scores on exhaustion, average scores on cynicism, and mildly negative scores on professional efficacy. A series of multiple regression analyses confirmed parallel main effect contributions from manageable workload and values congruence. Both workload and values congruence predicted exhaustion and cynicism for men and women (P = .001). Only values congruence provided a significant prediction of professional efficacy for both men and women (P = .001) These predictors interacted for women on all 3 aspects of burnout (exhaustion, cynicism, and diminished efficacy). Howevever, overall levels of the burnout indicators departed only modestly from normative levels. W orkload and values congruence make distinct contributions to physician burnout. Work overload contributes to predicting exhaustion and cynicism; professional values crises contribute to predicting exhaustion, cynicism, and low professional efficacy. The interaction of values and workload for women in particular has implications for the distinct work-life patterns of male and female physicians. Specifically, the congruence of individual values with values inherent in the health care system appeared to be of greater consequence for women than for men.

  13. Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care.

    Science.gov (United States)

    Huang, Kevin B; Weber, Urs; Johnson, Jennifer; Anderson, Nathanial; Knies, Andrea K; Nhundu, Belinda; Bautista, Cynthia; Poskus, Kelly; Sheth, Kevin N; Hwang, David Y

    2018-01-01

    An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not. Between March 2013 and December 2015, we administered the Family Satisfaction in the ICU 24 survey to family members of adult neuroscience ICU patients. We compared the mean score for the survey subsection regarding shared decision making (graded on a 100-point scale), as well as individual survey items, between those who reported the patient's PCP involvement in any medical decision making versus those who did not. Among 263 respondents, there was no difference in mean overall decision-making satisfaction scores for those who reported involvement (81.1; SD = 15.2) versus those who did not (80.1; SD = 12.8; P = .16). However, a higher proportion reporting involvement felt completely satisfied with their 1) inclusion in the ICU decision making process (75.9% vs 61.4%; P = .055), and 2) control over the care of the patient (73.6% vs 55.6%; P = .02), with no difference regarding consistency of clinical information provided by the medical team (64.8% vs 63.5%; P = 1.00). Families who report involvement of a patient's PCP in medical decision making for critically ill patients may be more satisfied than those who do not with regard to specific aspects of ICU decision making. Further research would help understand how best to engage PCPs in shared decisions. © Copyright 2018 by the American Board of Family Medicine.

  14. Offering the full range of contraceptive options: a survey of interest in vasectomy training in the US family planning community.

    Science.gov (United States)

    Nguyen, Brian T; Jochim, Andrea L; Shih, Grace H

    2017-05-01

    To assess current practices regarding female and male sterilization counseling and provision, as well as determine interest in providing vasectomy among family planning specialists. Members of the US-based network of family planning fellowship physicians (current fellows, graduates and faculty) received a Web-based survey from November 2015 through January 2016 regarding current sterilization preferences and practices, as well as interest in obtaining training in vasectomy counseling and procedure. Nearly 60% (n=178/302) of family planning fellowship providers responded to the survey. While 62% (111/178) of respondents reported counseling their patients about vasectomy at least most of the time and 57% (102/178) recommended vasectomy over female sterilization, few (8/178; 4 trained in family medicine and 4 trained in obstetrics and gynecology) had performed a vasectomy in the last year. Nearly 90% (158/178) of respondents were somewhat or very interested in receiving training on vasectomy counseling; 58% (103/178) desired procedural training. Desire for training was associated with being male and receiving residency training in family medicine. Few family planning fellowship physicians provide vasectomy, and the majority expressed being at least somewhat interested in receiving further training. Vasectomy is more effective, safer and less expensive than female sterilization but is less common than female sterilization. One barrier to vasectomy access is the low number of vasectomy providers. Creating a structured vasectomy training program through the family planning fellowship may help to increase the number of vasectomy providers. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Abdominal Aortic Diameter Is Increased in Males with a Family History of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Mejnert Jørgensen, Trine; Houlind, K; Green, A

    2014-01-01

    and a half times increased prevalence of AAA compared with +FH with male relatives with AAA with an OR of 2.65. CONCLUSIONS: First-degree male relatives of AAA patients have wider aortas and a twofold higher prevalence of AAA compared with the age adjusted background population. The prevalence of AAA...... measurement of maximum antero-posterior aortic diameter. Family history obtained by questionnaire. Multivariate regression analysis was used to test for confounders: age, sex, smoking, comorbidity and medication. RESULTS: From the screened cohort, 569 participants had at least one first degree relative...

  16. Routine programs of health care systems as an opportunity toward communication skills training for family physicians: A randomized field trial.

    Science.gov (United States)

    Zamani, Ahmad Reza; Motamedi, Narges; Farajzadegan, Ziba

    2015-01-01

    To have high-quality primary health care services, an adequate doctor-patient communication is necessary. Because of time restrictions and limited budget in health system, an effective, feasible, and continuous training approach is important. The aim of this study is to assess the appropriateness of a communication skills training program simultaneously with routine programs of health care system. It was a randomized field trial in two health network settings during 2013. Twenty-eight family physicians through simple random sampling and 140 patients through convenience sampling participated as intervention and control group. The physicians in the intervention group (n = 14) attended six educational sessions, simultaneous organization meeting, with case discussion and peer education method. In both the groups, physicians completed communication skills knowledge and attitude questionnaires, and patients completed patient satisfaction of medical interview questionnaire at baseline, immediately after intervention, and four months postintervention. Physicians and health network administrators (stakeholders), completed a set of program evaluation forms. Descriptive statistics and Chi-square test, t-test, and repeated measure analysis of variance were used to analyze the data. Use of routine program as a strategy of training was rated by stakeholders highly on "feasibility" (80.5%), "acceptability" (93.5%), "educational content and method appropriateness" (80.75%), and "ability to integrating in the health system programs" (approximate 60%). Significant improvements were found in physicians' knowledge (P Communication skills training program, simultaneous organization meeting was successfully implemented and well received by stakeholders, without considering extra time and manpower. Therefore it can be a valuable opportunity toward communication skills training.

  17. Time management: a review for physicians.

    Science.gov (United States)

    Brunicardi, F. C.; Hobson, F. L.

    1996-01-01

    This article reviews the basic concepts and techniques of time management as they relate to a medical lifestyle. Essential tools are described to help the physician reassess and sharpen skills for handling intensifying demands and constraints of juggling patient care, research, teaching, and family responsibilities. The historical background and principles of time management for three popular "best selling" techniques are critiqued. In addition, a fourth technique, or model, of time management is introduced for physician use. PMID:8855650

  18. Relation Between Physicians' Work Lives and Happiness.

    Science.gov (United States)

    Eckleberry-Hunt, Jodie; Kirkpatrick, Heather; Taku, Kanako; Hunt, Ronald; Vasappa, Rashmi

    2016-04-01

    Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. We sampled 2000 full-time physician members of the American Academy of Family Physicians. Respondents completed a demographics questionnaire, questions about workload, the Physician Wellness Inventory, the Maslach Burnout Inventory, and the Subjective Happiness Scale. We performed a hierarchical regression analysis with the burnout and wellness subscales as predictor variables and physician happiness as the outcome variable. Our response rate was 22%. Career purpose, personal accomplishment, and perception of workload manageability had significant positive correlations with physician happiness. Distress had a significant negative correlation with physician happiness. A sense of career meaning and accomplishment, along with a lack of distress, are important factors in determining physician happiness. The number of hours a physician works is not related to happiness, but the perceived ability to manage workload was significantly related to happiness. Wellness-promotion efforts could focus on assisting physicians with skills to manage the workload by eliminating unnecessary tasks or sharing workload among team members, improving feelings of work accomplishment, improving career satisfaction and meaning, and managing distress related to patient care.

  19. Medicare payment changes and physicians' incomes.

    Science.gov (United States)

    Weeks, William B; Wallace, Amy E

    2002-01-01

    An effort to control the physician portion of Medicare expenditures and to narrow the income gap between primary care and procedure-based physicians was effected through t he enactment of the Medicare Fee Schedule (MFS). To determine whether academic and private sector physicians' incomes had demonstrated changes consistent with payment changes, we collected income information from surveys of private sector physicians and academic physicians in six specialties: (1) family practice; (2) general internal medicine; (3) psychiatry; (4) general surgery; (5) radiology; and (6) anesthesiology. With the exception of general internal medicine, the anticipated changes in Medicare revenue were not closely associated with income changes in either the academic or private sector group. Academic physicians were underpaid, relative to their private sector counterparts, but modestly less so at the end of the period examined. Our findings suggest that using changes in payment schedules to change incomes in order to influence the attractiveness of different specialties, even with a very large payer, may be ineffective. Should academic incomes remain uncompetitive with private sector incomes, it may be increasingly difficult to persuade physicians to enter academic careers.

  20. An exploratory study of mother-daughter physicians: an intergenerational comparison of professional and personal experiences.

    Science.gov (United States)

    Shrier, Diane K; Shrier, Lydia A

    2005-12-01

    Physician daughters of physician mothers may experience unique advantages in their career development and in combining career and family. The objective of this exploratory study, the first on mother-daughter physicians, was to compare the professional and personal characteristics of physician mothers and their physician daughters. Two hundred fourteen families with at least one mother-daughter physician pair were identified through a nationwide search; 84% of the mothers and 87% of the daughters contacted returned a 56-item questionnaire. Data were analyzed to compare professional and personal characteristics of the subset of mothers and daughters who had both responded (n = 136 pairs). Compared to their physician mothers, physician daughters were less satisfied with their career, less likely to feel in control of their work environment, more likely to report moderate or severe daily stress at work, and less likely to want their children to become physicians or to want to become physicians again if they were to relieve their lives. They were also less likely to want to change specialties. Physician daughters were more likely than their physician mothers to be 30 years or older when they had their first child, to have taken parental leave, and to have a spouse who took parental leave and less likely to experience their caregiving as a hindrance to their professional work and advancement. Despite the availability of a physician mother role model, physician daughters reported less career satisfaction and more work-related stress than their physician mothers. These findings warrant further exploration and support the need for new work-family paradigms in medicine.

  1. [Assessment of IDC-Pal as a Diagnostic Tool for Family Physicians to Identify Patients with Complex Palliative Care Needs in Germany: a Pilot Study].

    Science.gov (United States)

    Comino, María Rosa Salvador; Garcia, Victor Regife; López, Maria Auxiliadora Fernández; Feddersen, Berend; Roselló, María Luisa Martin; Sanftenberg, Linda; Schelling, Jörg

    2017-07-11

    Background Palliative medicine is an essential component of the health care system. Basic palliative care should be provided by primary care services (family physician and home nursing) with palliative-medical basic qualification. Often it is very difficult to identify patients that would profit from a specialized palliative care team. For the evaluation of the case complexity of a palliative patient, we present a Spanish diagnostic tool IDC-Pal, which tries to specify when, why and where a palliative patient should be referred. The aims of this study were the translation and cultural adaptation of the diagnostic tool for complexity in palliative care IDC-Pal to the German language, and the measurement of its feasibility and face validity. Methods During the first phase, a forward-backward translation with linguistic and cultural adaptation of the tool IDC-Pal as well as the validation of its content by a review committee was performed. During the second phase, the preliminary version of the tool was tested by 38 family physicians that were asked for a qualitative assessment using a 10-points Likert scale (1 = "strongly disagree" and 10 = "totally agree"). Finally, a definitive version was developed. Results The translation and adaptation were achieved without major problems. Both feasibility and apparent validity of the tool IDC-Pal were rated as high. The mean response in the Likert scale was 7.79, with a SD of 0.36. Participants strongly agreed on the apparent validity of the tool with a mean of 7.82 and a SD of 0.26 and on its feasibility with a mean of 7.79, and a SD of 0.39. Conclusions A conceptually, culturally and linguistically equivalent version of the original instrument IDC-Pal was obtained. German family physicians agreed on the usability of IDC-Pal as a tool for rating the case complexity of palliative patients. These results indicate that physicians in Bavaria and eventually in Germany could benefit of the full validation of IDC-Pal. © Georg Thieme

  2. Smoking habits and attitudes towards smoking among Estonian physicians.

    Science.gov (United States)

    Pärna, K; Rahu, K; Rahu, M

    2005-05-01

    This study examined the smoking habits and attitudes towards smoking among Estonian physicians. Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.

  3. Physician Acceptance of Pharmacist Recommendations about Medication Prescribing Errors in Iraqi Hospitals

    Directory of Open Access Journals (Sweden)

    ALI AZEEZ ALI AL-JUMAILI

    2016-08-01

    Full Text Available The objectives of this study were to measure the incidence and types of medication prescribing errors (MPEs in Iraqi hospitals, to calculate for the first time the percentage of physician agreement with pharmacist medication regimen review (MRR recommendations regarding MPEs, and to identify the factors influencing the physician agreement rate with these recommendations. Methods: Fourteen pharmacists (10 females and 4 males reviewed each hand-written physician order for 1506 patients who were admitted to two public hospitals in Al-Najaf, Iraq during August 2015. The pharmacists identified medication prescribing errors using the Medscape WebMD, LCC phone application as a reference. The pharmacists contacted the physicians (2 females and 34 males in-person to address MPEs that were identified. Results: The pharmacists identified 78 physician orders containing 99 MPEs with an incidence of 6.57 percent of all the physician orders reviewed. The patients with MPEs were taking 4.8 medications on average. The MPEs included drug-drug interactions (65.7%, incorrect doses (16.2%, unnecessary medications (8.1%, contra-indications (7.1%, incorrect drug duration (2%, and untreated conditions (1%. The physicians implemented 37 (37.4% pharmacist recommendations. Three factors were significantly related to physician acceptance of pharmacist recommendations. These were physician specialty, pharmacist gender, and patient gender. Pediatricians were less likely (OR= 0.1 to accept pharmacist recommendations compared to internal medicine physicians. Male pharmacists received more positive responses from physicians (OR=7.11 than female pharmacists. Lastly, the recommendations were significantly more likely to be accepted (OR= 3.72 when the patients were females. Conclusions: The incidence of MPEs is higher in Iraqi hospitalized patients than in the U.S. and U.K, but lower than in Brazil, Ethiopia, India, and Croatia. Drug-drug interactions were the most common type of

  4. Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction.

    Science.gov (United States)

    Prasad, Shailendra; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle; Kozhimannil, Katy

    2018-02-01

    Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data. Using logistic regression models, we assessed the proportion of a hospital's maternity care physicians employed by the hospital and estimated its association with utilization of low-risk and nonindicated cesareans, and nonindicated labor induction. Rural hospitals that employed family physicians but not obstetricians had lower cesarean rates among low-risk pregnancies. Rural hospitals that employed only obstetricians did not show a relationship between employment and procedure utilization. Across hospitals with both obstetricians and family physicians, a 10% higher proportion of obstetricians employed was associated with 4.6% higher low-risk cesarean rates (4.6% [0.7%-8.4%]), while no significant relationship was found for the proportion of family physicians employed by a hospital. In rural US hospitals, associations between physician employment and obstetric procedure use differed by physician mix and the types of physicians employed. © 2017 National Rural Health Association.

  5. The Role of Machismo and the Hispanic Family in the Etiology and Treatment of Alcoholism in Hispanic American Males.

    Science.gov (United States)

    Panitz, Daniel R.; And Others

    1983-01-01

    Discusses alcohol abuse among Hispanic males of Mexican and Puerto Rican origin and the cultural and familial factors which both enable alocholism and serve as tools in overcoming it. The positive ideals of machismo may be enlisted in family therapy through supportive rather than reconstructive therapies. (Author/JAC)

  6. An Examination of Family Physicians Plan Implementation in Rural ...

    African Journals Online (AJOL)

    Razieh Mirzaeian

    recognizing the advantages and disadvantages of this Plan based ... physicians and health care managers and employees working in the Borujen town (n=62). ..... Nworie J. Using the Delphi technique in educational technology research.

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

    Science.gov (United States)

    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.

  8. The practice and earnings of preventive medicine physicians.

    Science.gov (United States)

    Salive, M E

    1992-01-01

    A shortage of preventive medicine (PM) physicians exists in the United States. Researchers know little about these physicians' earnings and practice characteristics. The American College of Preventive Medicine (ACPM) mailed a survey to all self-identified PM physicians on the American Medical Association (AMA) Physician Masterfile. A total of 3,771 (54%) responded; respondents' sex and region of residence were typical for PM physicians in general, with a slight excess of older physicians and those reporting board certification. A total of 2,664 (71%) were working full time, with median earnings of $85,000 (mean $90,000). Among full-time physicians, relatively higher earnings were associated with the following characteristics: male sex; age 45 to 64 years; major source of income from clinical, business, or industrial sources, rather than governmental or academic; and PM board certification. Full-time PM physicians earned much less than office-based private practitioners in several primary care specialties in 1989. The gap in earnings between PM specialists in government positions and those in the private sector is also substantial. Both disparities may require creative solutions.

  9. Physician career satisfaction within specialties

    Directory of Open Access Journals (Sweden)

    Kravitz Richard L

    2009-09-01

    Full Text Available Abstract Background Specialty-specific data on career satisfaction may be useful for understanding physician workforce trends and for counseling medical students about career options. Methods We analyzed cross-sectional data from 6,590 physicians (response rate, 53% in Round 4 (2004-2005 of the Community Tracking Study Physician Survey. The dependent variable ranged from +1 to -1 and measured satisfaction and dissatisfaction with career. Forty-two specialties were analyzed with survey-adjusted linear regressions Results After adjusting for physician, practice, and community characteristics, the following specialties had significantly higher satisfaction levels than family medicine: pediatric emergency medicine (regression coefficient = 0.349; geriatric medicine (0.323; other pediatric subspecialties (0.270; neonatal/prenatal medicine (0.266; internal medicine and pediatrics (combined practice (0.250; pediatrics (0.250; dermatology (0.249;and child and adolescent psychiatry (0.203. The following specialties had significantly lower satisfaction levels than family medicine: neurological surgery (-0.707; pulmonary critical care medicine (-0.273; nephrology (-0.206; and obstetrics and gynecology (-0.188. We also found satisfaction was significantly and positively related to income and employment in a medical school but negatively associated with more than 50 work-hours per-week, being a full-owner of the practice, greater reliance on managed care revenue, and uncontrollable lifestyle. We observed no statistically significant gender differences and no differences between African-Americans and whites. Conclusion Career satisfaction varied across specialties. A number of stakeholders will likely be interested in these findings including physicians in specialties that rank high and low and students contemplating specialty. Our findings regarding "less satisfied" specialties should elicit concern from residency directors and policy makers since they

  10. Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer.

    Science.gov (United States)

    Bell, Robert A; McDermott, Haley; Fancher, Tonya L; Green, Michael J; Day, Frank C; Wilkes, Michael S

    2015-03-01

    Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. Randomized two-group design. 121 California and Pennsylvania community physicians. Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer. Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer. Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03). Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.

  11. The perceived value of clinical pharmacy service provision by pharmacists and physicians: an initial assessment of family medicine and internal medicine providers.

    Science.gov (United States)

    Wietholter, Jon P; Ponte, Charles D; Long, Dustin M

    2017-10-01

    Few publications have addressed the perceptions of pharmacists and physicians regarding the value of clinical pharmacist services. A survey-based study was conducted to determine whether Internal Medicine (IM) and Family Medicine (FM) pharmacists and physicians differed in their attitudes regarding the benefits of collaboration in an acute care setting. The primary objective was to evaluate perceived differences regarding self-assessment of value between IM and FM pharmacists. The secondary objective was to evaluate perceived differences of clinical pharmacist benefit between IM and FM physicians. An eight-item questionnaire assessed the attitudes and beliefs of pharmacists and physicians regarding the value of clinical pharmacy services. Surveys were emailed and participants marked their responses using a 7-point Likert scale for each item. Demographic data and overall comments were collected from each participant. Overall, 167 surveys were completed. When comparing cumulative physician and pharmacist responses, none of the eight questions showed significant differences. Statistically significant differences were noted when comparing IM and FM clinical pharmacists on five of the eight survey items; for each of these items, FM pharmacists had more favourable perceptions than their IM counterparts. No statistically significant differences were noted when comparing responses of IM and FM physicians. This study found that FM pharmacists perceived a greater benefit regarding participation in inpatient acute care rounds when compared to their IM pharmacist counterparts. Future studies are necessary to determine if other medical specialties' perceptions of clinical pharmacy provision differ from our findings and to evaluate the rationale behind specific attitudes and behaviours. © 2016 Royal Pharmaceutical Society.

  12. Male-to-male transmission in extended pedigrees with multiple cases of autism

    Energy Technology Data Exchange (ETDEWEB)

    Hallmayer, J.; Spiker, D.; Lotspeich, L. [Stanford Univ., CA (United States)] [and others

    1996-02-16

    Despite strong genetic influences in autism, the true mode of inheritance remains unknown. Sex differences in autism have been described in both singleton and multiplex families: boys outnumber girls by 3 or 4 to 1, and so a sex-linked mode of transmission must also be considered. The key characteristic of X-linkage is that all sons of affected men are unaffected (no male-to-male transmission). In the present study, which is part of an ongoing linkage project in autism, we describe 77 multiplex autism families, 11 of who are affected cousin or half-sibling families. By using these families, it is possible to trace the path of genetic transmission and observe whether the hypothesis of X-linkage is tenable. Of 11 extended pedigrees from 77 multiplex families, six show male-to-male transmission; in these families, X-linkage can be excluded as the genetic basis for their autism. The data from the other five families are compatible with either an autosomal or an X-linked mode of transmission. The key point to emerge, then, is that autism cannot be exclusively an X-linked disorder; there must be an autosomal mode of transmission at least in some families. Thus we must consider the alternative hypotheses that autism is either entirely autosomal, or it is genetically heterogeneous, involving at least one autosomal locus with gender-specific expression, as well as a possible locus on the X-chromosome. 28 refs., 1 fig.

  13. The costs of preventing the spread of respiratory infection in family physician offices: a threshold analysis

    Directory of Open Access Journals (Sweden)

    Gray David

    2007-11-01

    Full Text Available Abstract Background Influenza poses concerns about epidemic respiratory infection. Interventions designed to prevent the spread of respiratory infection within family physician (FP offices could potentially have a significant positive influence on the health of Canadians. The main purpose of this paper is to estimate the explicit costs of such an intervention. Methods A cost analysis of a respiratory infection control was conducted. The costs were estimated from the perspective of provincial government. In addition, a threshold analysis was conducted to estimate a threshold value of the intervention's effectiveness that could generate potential savings in terms of averted health-care costs by the intervention that exceed the explicit costs. The informational requirements for these implicit costs savings are high, however. Some of these elements, such as the cost of hospitalization in the event of contacting influenza, and the number of patients passing through the physicians' office, were readily available. Other pertinent points of information, such as the proportion of infected people who require hospitalization, could be imported from the existing literature. We take an indirect approach to calculate a threshold value for the most uncertain piece of information, namely the reduction in the probability of the infection spreading as a direct result of the intervention, at which the intervention becomes worthwhile. Results The 5-week intervention costs amounted to a total of $52,810.71, or $131,094.73 prorated according to the length of the flu season, or $512,729.30 prorated for the entire calendar year. The variable costs that were incurred for this 5-week project amounted to approximately $923.16 per participating medical practice. The (fixed training costs per practice were equivalent to $73.27 for the 5-week intervention, or $28.14 for 13-week flu season, or $7.05 for an entire one-year period. Conclusion Based on our conservative estimates

  14. The Growth of a Family: A family-oriented approach to pregnancy care

    OpenAIRE

    Carroll, June C.; Biringer, Anne

    1991-01-01

    Caring for a family during pregnancy and birth is an ideal opportunity for family physicians to assess family functioning and help the family adjust to the birth of a new child. Stress and support systems can influence the course of pregnancy, including obstetric and perinatal outcomes. A family-centered approach can help patients during this critical stage of family development.

  15. Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study.

    Science.gov (United States)

    Wilson, Michael E; Rhudy, Lori M; Ballinger, Beth A; Tescher, Ann N; Pickering, Brian W; Gajic, Ognjen

    2013-06-01

    Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology. Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts. Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation. We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.

  16. Physician Religion and End-of-Life Pediatric Care: A Qualitative Examination of Physicians' Perspectives.

    Science.gov (United States)

    Bateman, Lori Brand; Clair, Jeffrey Michael

    2015-01-01

    Physician religion/spirituality has the potential to influence the communication between physicians and parents of children at the end of life. In order to explore this relationship, the authors conducted two rounds of narrative interviews to examine pediatric physicians' perspectives (N=17) of how their religious/spiritual beliefs affect end-of-life communication and care. Grounded theory informed the design and analysis of the study. As a proxy for religiosity/spirituality, physicians were classified into the following groups based on the extent to which religious/spiritual language was infused into their responses: Religiously Rich Responders (RRR), Moderately Religious Responders (MRR), and Low Religious Responders (LRR). Twelve of the 17 participants (71%) were classified into the RRR or MRR groups. The majority of participants suggested that religion/spirituality played a role in their practice of medicine and communication with parents in a myriad of ways and to varying degrees. Participants used their religious/spiritual beliefs to support families' spirituality, uphold hope, participate in prayer, and alleviate their own emotional distress emerging from their patients' deaths.

  17. Marital Construction of Family Power among Male-out-Migrant Couples in a Chinese Village: A Relation-Oriented Exchange Model

    Science.gov (United States)

    Zuo, Jiping

    2008-01-01

    This study examines marital construction of family power among male-out-migrant couples in a Chinese village in Guangxi Province. In-depth interviews show that male-out-migrant couples prefer joint decision making. When couples are in disputes, power tends to go to the ones who shoulder greater household-based responsibilities; in this case, they…

  18. Assessment of Turkish junior male physicians’ exposure to mobbing behavior

    Science.gov (United States)

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

    2012-01-01

    Aim To determine the extent of Turkish junior male physicians’ exposure to mobbing behavior and its correlation with physicians' characteristics. Methods 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. Results 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 (P Mobbing 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 (χ2 = 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). Conclusions 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. PMID:22911529

  19. The Effects of Cultural Differences on the Physician-Patient Relationship

    OpenAIRE

    Manassis, Katharina

    1986-01-01

    Differences between patients' and physicians' perceptions of illness can result in poor communication and unsatisfactory treatment results. These differences are more likely when the patient's cultural background is different from the physician's. This article provides a case history of a cultural conflict between a patient, the patient's family, and the medical care system. The beliefs and practices of people unfamiliar with the North American health care system are discussed, and physicians...

  20. The Sociological Study of the Effect of Family Structure on Social Health of Males

    Directory of Open Access Journals (Sweden)

    Naima Mohammadi

    Full Text Available Social health depends on different social and cultural factors. One of the most important suppliers of individual’s health is family structures and relations. In recent years due to functional changes in polygamous structure, there are threats against social health of men in Sarbaz city. In this research, to compare the rate of social health of men in polygamous and monogamous families in Sarbaz city we use a standard questionnaire of Shapiro & Keyes (2007. The population of this study consisted of 300 males who are residents of this city. They selected by using cluster sampling method. Gathered data were analyzed using SPSS software version 22. Findings from independent T-Test revealed that the average of social Coherence, Integration, Contribution and Actualization between men in polygamous families were significantly lower than monogamous. Based on these findings, we can conclude however a lot of traditional social customs were useful, functional and compatible and provide social acceptance, but today have become dysfunctional and threated social health of family members and community system face with crisis.

  1. The impact of gender and parenthood on physicians' careers--professional and personal situation seven years after graduation.

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Stamm, Martina; Buddeberg, Claus; Bauer, Georg; Häemmig, Oliver; Knecht, Michaela; Klaghofer, Richard

    2010-02-18

    The profile of the medical profession is changing in regard to feminization, attitudes towards the profession, and the lifestyle aspirations of young physicians. The issues addressed in this study are the careers of female and male physicians seven years after graduation and the impact of parenthood on career development. Data reported originates from the fifth assessment (T5) of the prospective SwissMedCareer Study, beginning in 2001 (T1). At T5 in 2009, 579 residents (81.4% of the initial sample at T1) participated in the questionnaire survey. They were asked about occupational factors, career-related factors including specialty choice and workplace, work-life balance and life satisfaction. The impact of gender and parenthood on the continuous variables was investigated by means of multivariate and univariate analyses of variance; categorical variables were analyzed using Chi-square tests. Female physicians, especially those with children, have lower rates of employment and show lower values in terms of career success and career support experiences than male physicians. In addition, parenthood has a negative impact on these career factors. In terms of work-life balance aspired to, female doctors are less career-oriented and are more inclined to consider part-time work or to continue their professional career following a break to bring up a family. Parenthood means less career-orientation and more part-time orientation. As regards life satisfaction, females show higher levels of satisfaction overall, especially where friends, leisure activities, and income are concerned. Compared to their male colleagues, female physicians are less advanced in their specialty qualification, are less prone to choosing prestigious surgical fields, have a mentor less often, more often work at small hospitals or in private practice, aspire less often to senior hospital or academic positions and consider part-time work more often. Any negative impact on career path and advancement is

  2. Male preventive health behaviors: perceptions from men, women, and clinical staff along the U.S. Mexico border.

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    Hunter, Jennifer B; Fernandez, Maria Lourdes; Lacy-Martinez, Charles R; Dunne-Sosa, Andrea M; Coe, M Kathryn

    2007-12-01

    Mexican American males have higher levels of total cholesterol and triglycerides, higher body mass indexes, and a higher prevalence of diabetes than do non-Hispanic White males. They are the least likely Hispanic subgroup to be insured, to have recently visited a physician, or to have preventive exams. To explore factors related to the use of preventive exams among mature men, and specifically among Mexican American men residing along the Arizona, United States/Sonora, Mexico border, information on barriers and motivating factors to male participation in preventive screening exams was collected. Interviews were conducted with mature men and women from a single border community and with clinical staff from three different border communities who deliver services to similar populations. Responses were triangulated. Common themes identified include health education/information/advertisement and female/family support as motivating factors and machismo/denial/fatalism as a barrier to male health-seeking behavior.

  3. Impact of patient satisfaction ratings on physicians and clinical care

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    Zgierska A

    2014-04-01

    Full Text Available Aleksandra Zgierska,1 David Rabago,1 Michael M Miller2–4 1Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, 2American Society of Addiction Medicine, Chevy Chase, MD, 3Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, 4Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA Background: Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. Objective: The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. Methods: A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. Results: One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians. The respondents were predominantly male (85% and practicing in solo or private practice (45%, hospital (43%, or academia (15%. The majority were ED (57%, followed by primary care (16% physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. Conclusion

  4. The Mindful Physician and Pooh

    Science.gov (United States)

    Winter, Robin O.

    2013-01-01

    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  5. Aversion to ambiguity and willingness to take risks affect therapeutic decisions in managing atrial fibrillation for stroke prevention: results of a pilot study in family physicians

    Directory of Open Access Journals (Sweden)

    Raptis S

    2017-09-01

    Full Text Available Stavroula Raptis,1,* Jia Ning Chen,2,* Florencia Saposnik,2 Roman Pelyavskyy,2 Andrew Liuni,3 Gustavo Saposnik2,4 On behalf of the Stroke Outcomes Research Canada Working Group (SORCan- www.sorcan.ca 1Applied Health Research Centre, Li Ka Shing Knowledge Institute, 2Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, 3Medical Department, Boehringer Ingelheim (Canada Ltd., Burlington, ON, Canada; 4Neuroeconomics and Decision Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland *These authors contributed equally to this work Background: Anticoagulation is the therapeutic paradigm for stroke prevention in patients with atrial fibrillation (AF. It is unknown how physicians make treatment decisions in primary stroke prevention for patients with AF. Objectives: To evaluate the association between family physicians’ risk preferences (aversion risk and ambiguity and therapeutic recommendations (anticoagulation in the management of AF for primary stroke prevention by applying concepts from behavioral economics. Methods: Overall, 73 family physicians participated and completed the study. Our study comprised seven simulated case vignettes, three behavioral experiments, and two validated surveys. Behavioral experiments and surveys incorporated an economic framework to determine risk preferences and biases (e.g., ambiguity aversion, willingness to take risks. The primary outcome was making the correct decision of anticoagulation therapy. Secondary outcomes included medical errors in the management of AF for stroke prevention. Results: Overall, 23.3% (17/73 of the family physicians elected not to escalate the therapy from antiplatelets to anticoagulation when recommended by best practice guidelines. A total of 67.1% of physicians selected the correct therapeutic options in two or more of the three simulated case vignettes. Multivariate

  6. [Gender as a key effect modifier of the relationship between physician work stressors and the acquired cardiovascular disorders].

    Science.gov (United States)

    Nedić, Olesja; Belkić, Karen; Filipović, Danka; Jocić, Neda

    2008-01-01

    To assess gender as an effect-modifier vis-â-vis exposure to work stressors and the acquired cardiovascular disorders (ACVDC). The Occupational Stress Index for physicians was used in a case-control study (>90% participation rate) among physicians in Novi Sad (Cases: 50 males and 51 females with ACVD, Referents: 46 males and 6l females without ACVD). Patterns of disease manifestation, sociodemography, risk factors, Minnesota Multiphasic Personality Inventory (MMPI) tendency and exposure to work stressors differed in male compared to female physicians with ACVD. Accounting for these covariates, the males with ACVD had significantly higher general-level threat avoidance vigilance scores (more witnessed accidents at work and expert-witnessing in court (p accounting for covariates. Females in the surgical care specialties with ACVD were exposed to significantly higher demands, speed-up, and need for constant high attention than their female colleagues without ACVD, after accounting for covariates. Gender is a key effect-modifier of the relationship between exposure to work stressors and ACVD among physicians. Intervention studies should consider gender-specific work stressors, as well as those specific to physicians.

  7. Interventions to Educate Family Physicians to Change Test Ordering

    Directory of Open Access Journals (Sweden)

    Roger Edmund Thomas MD, PhD, CCFP, MRCGP

    2016-03-01

    Full Text Available The purpose is to systematically review randomised controlled trials (RCTs to change family physicians’ laboratory test-ordering. We searched 15 electronic databases (no language/date limitations. We identified 29 RCTs (4,111 physicians, 175,563 patients. Six studies specifically focused on reducing unnecessary tests, 23 on increasing screening tests. Using Cochrane methodology 48.5% of studies were low risk-of-bias for randomisation, 7% concealment of randomisation, 17% blinding of participants/personnel, 21% blinding outcome assessors, 27.5% attrition, 93% selective reporting. Only six studies were low risk for both randomisation and attrition. Twelve studies performed a power computation, three an intention-to-treat analysis and 13 statistically controlled clustering. Unweighted averages were computed to compare intervention/control groups for tests assessed by >5 studies. The results were that fourteen studies assessed lipids (average 10% more tests than control, 14 diabetes (average 8% > control, 5 cervical smears, 2 INR, one each thyroid, fecal occult-blood, cotinine, throat-swabs, testing after prescribing, and urine-cultures. Six studies aimed to decrease test groups (average decrease 18%, and two to increase test groups. Intervention strategies: one study used education (no change: two feedback (one 5% increase, one 27% desired decrease; eight education + feedback (average increase in desired direction >control 4.9%, ten system change (average increase 14.9%, one system change + feedback (increases 5-44%, three education + system change (average increase 6%, three education + system change + feedback (average 7.7% increase, one delayed testing. The conclusions are that only six RCTs were assessed at low risk of bias from both randomisation and attrition. Nevertheless, despite methodological shortcomings studies that found large changes (e.g. >20% probably obtained real change.

  8. National survey by specialty of U.S. physicians' HPV screening practices.

    Science.gov (United States)

    McCree, Donna Hubbard; Leichliter, Jami S; Hogben, Matthew; St Lawrence, Janet S

    2003-02-01

    High-risk types of HPV are the primary cause of cervical cancer. This article reports HPV screening and diagnosis from a survey evaluating community-based physicians' screening, testing, and clinical practices for sexually transmitted diseases. Surveys mailed to physicians (n = 7,300) obtained information on patients they screen for HPV and cases of HPV diagnosed. Seventy percent (70%) of the physicians returned completed surveys. HPV screening was most frequently conducted in female patients by obstetrician/gynecologists and family practice physicians.

  9. How Physicians Support Mothers of Children with Duchenne Muscular Dystrophy.

    Science.gov (United States)

    Fujino, Haruo; Saito, Toshio; Matsumura, Tsuyoshi; Shibata, Saki; Iwata, Yuko; Fujimura, Harutoshi; Shinno, Susumu; Imura, Osamu

    2015-09-01

    Communicating about Duchenne muscular dystrophy and its prognosis can be difficult for affected children and their family. We focused on how physicians provide support to the mothers of children with Duchenne muscular dystrophy who have difficulty communicating about the condition with their child. The eligible participants were certified child neurologists of the Japanese Society of Child Neurology. Participants responded to questionnaires consisting of free descriptions of a vignette of a child with Duchenne muscular dystrophy and a mother. We analyzed 263 responses of the participants. We found 4 themes on advising mothers, involving encouraging communication, family autonomy, supporting family, and considering the child's concerns. These results provide a better understanding of the communication between physicians and family members who need help sharing information with a child with Duchenne muscular dystrophy. These findings will assist clinical practitioners in supporting families and the affected children throughout the course of their illness. © The Author(s) 2015.

  10. FACTORS THAT INCREASE LIKELIHOOD OF VIOLENCE IN THE FAMILY ANDSEEKING FOR HELP AT FAMILY PRACTITIONER. PILOT STUDY ABOUTVIOLENCE IN THE FAMILY

    Directory of Open Access Journals (Sweden)

    Polona Selič

    2008-08-01

    The study showed that investigation of medical files and evaluations of physicians aboutpossible factors, which increase the possibility of persons being exposed to violence are notso useful. Physicians are not equipped well enough to give needed help and support topersons exposed to violence in the family. Physicians do not feel that they are the right oneswho should in their practice help victims of violence

  11. FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

    Science.gov (United States)

    Bui, Thanh C; Krieger, Heather A; Blumenthal-Barby, Jennifer S

    2015-10-01

    This study aimed to assess physicians' susceptibility to framing effects in clinical judgment and decision making. A survey was administered online to 159 general internists in the United States. Participants were randomized into two groups, in which clinical scenarios varied in their framings: frequency vs percentage, with cost information vs without, female patient vs male patient, and mortality vs survival. Results showed that physicians' recommendations for patients in hypothetical scenarios were significantly different when the predicted probability of the outcomes was presented in frequency versus percentage form and when it was presented in mortality rate vs survival rate of the same magnitude. Physicians' recommendations were not different for other framing effects.

  12. Physicians' attitudes toward the legalization of marijuana use.

    Science.gov (United States)

    Linn, L S; Yager, J; Leake, B

    1989-06-01

    We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.

  13. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    Science.gov (United States)

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

  14. Examining the Gap: Compensation Disparities between Male and Female Physician Assistants.

    Science.gov (United States)

    Smith, Noël; Cawley, James F; McCall, Timothy C

    Compensation disparities between men and women have been problematic for decades, and there is considerable evidence that the gap cannot be entirely explained by nongender factors. The current study examined the compensation gap in the physician assistant (PA) profession. Compensation data from 2014 was collected by the American Academy of PAs in 2015. Practice variables, including experience, specialty, and hours worked, were controlled for in an ordinary least-squares sequential regression model to examine whether there remained a disparity in total compensation. In addition, the absolute disparity in compensation was compared with historical data collected by American Academy of PAs over the previous 1.5 decades. Without controlling for practice variables, a total compensation disparity of $16,052 existed between men and women in the PA profession. Even after PA practice variables were controlled for, a total compensation disparity of $9,695 remained between men and women (95% confidence interval, $8,438-$10,952). A 17-year trend indicates the absolute disparity between men and women has not lessened, although the disparity as a percent of male compensation has decreased in recent years. There remain challenges to ensuring pay equality in the PA profession. Even when compensation-relevant factors such as experience, hours worked, specialty, postgraduate training, region, and call are controlled for, there is still a substantial gender disparity in PA compensation. Remedies that may address this pay inequality include raising awareness of compensation disparities, teaching effective negotiation skills, assisting employers as they develop equitable compensation plans, having less reliance on past salary in position negotiation, and professional associations advocating for policies that support equal wages and opportunities, regardless of personal characteristics. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  15. Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities.

    Science.gov (United States)

    Alers, Margret; Pepping, Tess; Bor, Hans; Verdonk, Petra; Hamberg, Katarina; Lagro-Janssen, Antoine

    2014-12-01

    Physician gender is associated with differences in the male-to-female ratio between specialities and with preferred working hours. We explored how graduating students' sex or full-time or part-time preference influences their speciality choice, taking work-life issues into account. Graduating medical students at Radboud University Medical Centre, the Netherlands participated in a survey (2008-2012) on career considerations. Logistic regression tested the influence of sex or working hour preference on speciality choice and whether work-life issues mediate. Of the responding students (N = 1,050, response rate 83, 73.3 % women), men preferred full-time work, whereas women equally opted for part time. More men chose surgery, more women family medicine. A full-time preference was associated with a preference for surgery, internal medicine and neurology, a part-time preference with psychiatry and family medicine. Both male and female students anticipated that foremost the career of women will be negatively influenced by family life. A full-time preference was associated with an expectation of equality in career opportunities or with a less ambitious partner whose career would affect family life. This increased the likelihood of a choice for surgery and reduced the preference for family medicine among female students. Gender specifically plays an important role in female graduates' speciality choice making, through considerations on career prospects and family responsibilities.

  16. Job and life satisfaction and preference of future practice locations of physicians on remote islands in Japan.

    Science.gov (United States)

    Nojima, Yoshiaki; Kumakura, Shunichi; Onoda, Keiichi; Hamano, Tsuyoshi; Kimura, Kiyoshi

    2015-05-26

    The objective of this research is to investigate job and life satisfaction and preference of future practice locations of physicians in rural and remote islands in Japan. A cross-sectional study was conducted for physicians who reside or resided on the Oki islands: isolated islands situated in the Sea of Japan between the Eurasian continent and the mainland of Japan. A questionnaire was sent to physicians on the Oki islands to evaluate physician satisfaction regarding job environment, career development, living conditions, salary, and support by local government. Data was analysed for 49 physicians; 47 were male and 2 were female, and the mean ± SD age was 44.3 ± 10.9 years. Among the variables related to physicians' satisfaction, most of the physicians (>90%) were satisfied with "team work" and "salary". On the other hand, the majority of physicians (approximately 70%) were not satisfied with the "opportunity to continue professional development". Age ≥ 50 years, graduates of medical schools other than Jichi Medical University (established in 1972 with the aim to produce rural physicians), self-selected the Oki islands as a practice location, and satisfaction in "work as a doctor", "opportunity to consult with peers about patients", "relationship with people in the community", and "acceptance by community" were found to be significant factors influencing the choice of the Oki islands as a future practice location. Factors influencing future practice locations on the remote islands were included in a self-reported questionnaire which illustrated the importance of factors that impact both the spouses and children of physicians. Improving work satisfaction, providing outreach support programmes for career development and professional support in rural practice, and building appropriate relationships between physicians and people in the community, which can in turn improve work satisfaction, may contribute to physicians' choices of practising medicine on rural and

  17. Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

    Science.gov (United States)

    Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

    2016-10-01

    . Copyright© the College of Family Physicians of Canada.

  18. Psychiatric rehabilitation education for physicians.

    Science.gov (United States)

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  19. Gender differences in the salaries of physician researchers.

    Science.gov (United States)

    Jagsi, Reshma; Griffith, Kent A; Stewart, Abigail; Sambuco, Dana; DeCastro, Rochelle; Ubel, Peter A

    2012-06-13

    It is unclear whether male and female physician researchers who perform similar work are currently paid equally. To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors. A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address. The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary. A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research. The mean salary within our cohort was $167,669 (95% CI, $158,417-$176,922) for women and $200,433 (95% CI, $194,249-$206,617) for men. Male gender was associated with higher salary (+$13,399; P = .001) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12,194 higher than observed. Gender differences in salary exist

  20. Physician Knowledge and Attitudes around Confidential Care for Minor Patients.

    Science.gov (United States)

    Riley, Margaret; Ahmed, Sana; Reed, Barbara D; Quint, Elisabeth H

    2015-08-01

    Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. Breaking bad news among cancer physicians

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    Sami Ayed Alshammary

    2017-01-01

    Full Text Available Background: Breaking bad news to patients with cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be well-discussed in the most gentle and comfortable manner. It is important that the disclosure is performed in a way that patients will not lose all hope and get very depressed, leading them to undergo an abrupt change of their outlook in life. Objective: The aim of this study was to explore the physicians' perceptions and perspectives of breaking bad news to cancer patients. Methods: A cross-sectional survey of all comprehensive cancer centre physicians currently working in a university teaching hospital in the Middle East was conducted from August to September 2016. Results: Sixty-eight percent responded to the survey. Eighty-four percent were comfortable with breaking bad news, and 70% had training in breaking bad news. Eighty-six percent of responders stated that patients should be told about their cancer. Almost 30% of the respondents stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that they would only tell the details to the patients if asked while 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent. About 51% of physicians wanted to discuss the bad news with the family members and patient together, whereas 24% stated that the patient alone should be involved in the discussion. Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and this highlights the necessity of taking into consideration the social circumstances in healthcare. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

  2. A survey of physicians knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS.

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    Nevin, Alexandra C; Parshuram, Christopher; Nulman, Irena; Koren, Gideon; Einarson, Adrienne

    2002-01-01

    Background Alcohol is the most widely used drug in the world that is a human teratogen whose use among women of childbearing age has been steadily increasing. It is also probable that Fetal Alcohol Syndrome is under diagnosed by physicians. The objectives of this study were twofold: 1) to evaluate the experience, knowledge and confidence of family physicians with respect to the diagnosis of FAS and 2) to evaluate physicians awareness of maternal drinking patterns. Methods and Participants A multiple choice anonymous questionnaire was sent to a randomly selected group of family physicians in the Metropolitan Toronto area. Results There was a 73% (75/103) total response rate; Overall, 6/75 (8%) of family physicians reported that they had actually diagnosed a child with FAS. 17.9% had suspicions but did not make a diagnosis and 12.7% reported making a referral to confirm the diagnosis. Physician rated confidence in the ability to diagnosis FAS was low, with 49% feeling they had very little confidence. 75% reported counselling pregnant women and 60.8% reported counselling childbearing women in general on the use of alcohol. When asked what screening test they used to detect the use of alcohol, 75% described frequency/quantity. Not a single respondent identified using the current accepted screening method for alcohol use (TWEAK) which is recommended by The Centre for Addiction and Mental Health. Conclusions Family physicians do not feel confident about diagnosing FAS. None of the physicians were aware of the current screening methods to accurately gage alcohol use in pregnant and childbearing women PMID:11860607

  3. Significance of gender in the attitude towards doctor-patient communication in medical students and physicians.

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    Löffler-Stastka, Henriette; Seitz, Tamara; Billeth, Sabrina; Pastner, Barbara; Preusche, Ingrid; Seidman, Charles

    2016-09-01

    Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed. A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires. Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient". This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.

  4. Psychosocial care for seriously injured children and their families: a qualitative study among emergency department nurses and physicians.

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    Alisic, Eva; Conroy, Rowena; Magyar, Joanne; Babl, Franz E; O'Donnell, Meaghan L

    2014-09-01

    Approximately one in five children who sustain a serious injury develops persistent stress symptoms. Emergency Department nurses and physicians have a pivotal role in psychosocial care for seriously injured children. However, little is known about staff's views on this role. Our aim was to investigate Emergency Department staff's views on psychosocial care for seriously injured children. We conducted semi-structured interviews with 20 nurses and physicians working in an Australian Paediatric Emergency Department. We used purposive sampling to obtain a variety of views. The interviews were transcribed verbatim and major themes were derived in line with the summative analysis method. We also mapped participants' strategies for child and family support on the eight principles of Psychological First Aid (PFA). Five overarching themes emerged: (1) staff find psychosocial issues important but focus on physical care; (2) staff are aware of individual differences but have contrasting views on vulnerability; (3) parents have a central role; (4) staff use a variety of psychosocial strategies to support children, based on instinct and experience but not training; and (5) staff have individually different wishes regarding staff- and self-care. Staff elaborated most on strategies related to the PFA elements 'contact and engagement', 'stabilization', 'connection with social supports' and least on 'informing about coping'. The strong notion of individual differences in views suggests a need for training in psychosocial care for injured children and their families. In addition, further research on paediatric traumatic stress and psychosocial care in the ED will help to overcome the current paucity of the literature. Finally, a system of peer support may accommodate wishes regarding staff care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Hope and persuasion by physicians during informed consent.

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    Miller, Victoria A; Cousino, Melissa; Leek, Angela C; Kodish, Eric D

    2014-10-10

    To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain. © 2014 by American Society of Clinical Oncology.

  6. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

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    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

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

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    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.

  8. Cytogenetic and molecular screening of the DAZ gene family in a population of infertile males

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    Nubia Amparo Ruiz Suárez

    2003-01-01

    Full Text Available The purpose of this study was to evalúate the frequency of Y chromosome structural, numerical, chromosomal and genetic abnormalities, as well as DAZ gene microdeletions in the Y chromosome in a population of infertile males. Genetic abnormalities have been established to date in up to 24% of males having severe abnormalities in their sperm (Dohle et al. 2002; deletion of the DAZ gene family (deleted in azoospermia is the most common cause. It has been found in 6% of the oligozoospermias and in 12% of the azoospermias (Van Landuyt et al. 2000. A popula­tion of 20 azoospermic and 10 oligozoospermic males was studied. Five males having normal sperm parameters were used as controls. Each sample was karyotyped (QFQ banding and underwent sY254, sY255 and sY257 mo­lecular amplification. Genetic study revealed alterations in 16.6% of the cases: 6.6% at chromosome level and 10% at molecule level. No chromosomal or molecular gene alterations were detected in control males. The frequencies found lead to a broader population-based study being recommended. They confirmed the need for performing judicious genetic counselling in infertile couples with male factor infertility to avoid or minimise the risks of trans-mitting these abnormalities to offspring and provide better prognosis for assisted reproductive techniques in such patients. Key words: azoospermia; oligozoospermia; microdeletions; ICSI

  9. Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty.

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    Fassiotto, Magali; Li, Jie; Maldonado, Yvonne; Kothary, Nishita

    2018-02-02

    Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014). Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics). Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014. A total of 3648 evaluations across 1066 physician faculty. Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation. This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine. Copyright © 2018 Association of Program Directors in Surgery. Published

  10. Contraceptive use by female physicians in the United States.

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    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.

  11. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences

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    NAHID ZARIF SANAIEY

    2015-04-01

    Full Text Available Introduction: Assessment and prioritization are the first steps of planning. According to the family physician’s idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians’ educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. Methods: In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique. Content validity of the questionnaire and its reliability were confirmed by the experts’ opinion and Cronbach’s alpha of 80%. The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ, t-test, ANOVAs. A significance level of 0.05. The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%. In the areas of environmental and professional health and health education, compliance was zero. Conclusions: The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational needs.

  12. Family medicine in Republic of Srpska

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    Račić Maja

    2015-01-01

    Full Text Available The Family Medicine Development Project in Republic of Srpska was an initiative funded by the Canadian International Development Agency (CIDA. The project introduced family medicine into undergraduate curricula, established three-years long program of residency in family medicine in 1999, created departments of family medicine in both medical schools, helped with the process of establishing a professional association of family physicians, worked with Ministries of health and social welfare to establish supportive policies for these activities, and regularly provided continuing medical education programs for family practitioners during the 13 years of the project. Today, three family medicine teaching centers exist in RS (Primary health care centers Banja Luka, Foča and Bijeljina where more than 600 physicians were educated either through residency or additional training program in family medicine. Almost 1000 primary care nurses completed additional training. Family medicine centered primary health care reform was a complex innovation, involving organizational, financial, clinical and relational changes. An important factor influencing the adoption of this complex innovation in RS was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. With political commitment, an enabling economic environment and equitable distribution of resources, comprehensive primary health has proved to be a better strategy in achieving the goal of health for all. However, although family medicine passed through long journey from imposition to partnership, there is still large place for the improvement.

  13. Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.

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    Tenner, C T; Herzog, K; Chaudhari, S; Bini, E J; Weinshel, E H

    2012-10-01

    Although vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for all patients with chronic hepatitis C virus (HCV) infection, physician vaccination practices are suboptimal. Since training for family medicine (FM) and internal medicine (IM) physicians differ, we hypothesised that there are differences in knowledge, attitudes and barriers regarding vaccination against HAV and HBV in patients with chronic HCV between these two groups. A two-page questionnaire was mailed to 3000 primary care (FM and IM) physicians randomly selected from the AMA Physician Masterfile in 2005. The survey included questions about physician demographics, knowledge and attitudes regarding vaccination. Among the 3000 physicians surveyed, 1209 (42.2%) returned completed surveys. There were no differences between respondents and non-respondents with regard to age, gender, geographic location or specialty. More FM than IM physicians stated that HCV+ patients should not be vaccinated against HAV (23.7% vs. 11.8%, p infection, physicians often do not test or vaccinate susceptible individuals. Interventions are needed to overcome the barriers identified and improve vaccination rates. © 2012 Blackwell Publishing Ltd.

  14. Women doctors in Norway: the challenging balance between career and family life.

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    Gjerberg, Elisabeth

    2003-10-01

    In most Western countries, women doctors are still underrepresented in the higher positions in the medical hierarchy and in the most prestigious specialities. A crucial question is whether family responsibilities affect female and male career differently. The article examines how Norwegian physicians balance their work and family responsibilities and demonstrates differences in the way doctors combine work and family obligations, between women and compared with men. Among women doctors, the probability of becoming a specialist decreased with an increasing number of children. Moreover, postponing the birth of the first child increased the probability of completing hospital specialities. Although more women than men work part-time, this was the case only for a small proportion of women doctors. Transition from full-time to part-time work is primarily an accommodating strategy to family responsibilities, however strongly influenced by variations in the opportunity structure of different specialities. The findings further demonstrate that being married to another doctor had a positive impact on the career, especially for women doctors.

  15. Prediabetes Screening and Treatment in Diabetes Prevention: The Impact of Physician Attitudes.

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    Mainous, Arch G; Tanner, Rebecca J; Scuderi, Christopher B; Porter, Maribeth; Carek, Peter J

    Detection and treatment of prediabetes is an effective strategy in diabetes prevention. However, most patients with prediabetes are not identified. Our objective was to evaluate the relationship between attitudes toward prediabetes as a clinical construct and screening/treatment behaviors for diabetes prevention among US family physicians. An electronic survey of a national sample of academic family physicians (n 1248) was conducted in 2016. Attitude toward prediabetes was calculated using a summated scale assessing agreement with statements regarding prediabetes as a clinical construct. Perceived barriers to diabetes prevention, current strategies for diabetes prevention, and perceptions of peers were also examined. Physicians who have a positive attitude toward prediabetes as a clinical construct are more likely to follow national guidelines for screening (58.4% vs 44.4; P prediabetes (36.4% vs 20.9%; P prediabetes varies significantly, and this variation is related to treatment/screening behaviors for diabetes prevention. © Copyright 2016 by the American Board of Family Medicine.

  16. Using the theory of reasoned action to determine physicians' intention to measure body mass index in children and adolescents.

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    Khanna, Rahul; Kavookjian, Jan; Scott, Virginia Ginger; Kamal, Khalid M; Miller, Lesley-Ann N; Neal, William A

    2009-06-01

    Over the past few decades, childhood obesity has become a major public health issue in the United States. Numerous public and professional organizations recommend that physicians periodically screen for obesity in children and adolescents using the body mass index (BMI). However, studies have shown that physicians infrequently measure BMI in children and adolescents. The purpose of this study was to use the theory of reasoned action (TRA) to explain physicians' intentions to measure BMI in children and adolescents. The study objectives were to (1) determine if attitude and subjective norm predict physicians' intention to measure BMI in children and adolescents; (2) determine if family physicians and pediatricians differ in terms of theoretical factors; and (3) assess differences in behavioral beliefs, outcome evaluations, normative beliefs, and motivation to comply among physicians based on their level of intention to measure BMI. A cross-sectional mailed survey of 2590 physicians (family physicians and pediatricians) practicing in 4 states was conducted. A self-administered questionnaire was designed that included items related to the TRA constructs. The association between the theoretical constructs was examined using correlation and regression analyses. Student's t test was used to determine differences between family physicians and pediatricians on theoretical constructs and to compare the underlying beliefs of nonintenders with intenders. The usable response rate was 22.8%. Less than half (44%) of the physicians strongly intended to measure BMI in children and adolescents. Together, the TRA constructs attitude and subjective norm explained up to 49.9% of the variance in intention. Pediatricians had a significantly (P<.01) higher intention to measure BMI as compared to family physicians. There were significant (P<.01) behavioral and normative belief differences between physicians who intend and those who do not intend to measure BMI. The TRA is a useful model

  17. Do Female and Male Employees in Iran Experience Similar Work-Family Interference, Job, and Life Satisfaction?

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    Karimi, Leila

    2009-01-01

    This study aims at examining gender differences in the experience of work-family interference and perceived job-life satisfaction in a group of Iranian employees. The participants in the study consist of 387 Iranian male and female employees from a variety of organizations. The results of t tests and multiple regression analysis using EQS 6.1…

  18. Factors associated to the career choice of family medicine among Japanese physicians: the dawn of a new era.

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    Ie, Kenya; Tahara, Masao; Murata, Akiko; Komiyama, Manabu; Onishi, Hirotaka

    2014-01-01

    Despite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan. From December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization. We extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics ("self-reliance," "pioneering spirit"), career direction ("community/rural-orientedness," "multifaceted orientation") and experience (e.g., "discomfort with fragmented care"). We divided the influencing factors that were identified for career choice into supporters (e.g., "role model"), conflict of career choice (e.g., "anxiety about diverse/broad practice"), and the dawn of a new era in family medicine in Japan (e.g., "lack of social recognition," "concern about livelihood," and "too few role models"). Although the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a "pioneering spirit" and an "attitude of self-training." Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, "concern about livelihood" was specific among our respondents and was related to career choice in the dawn period. "Community

  19. Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

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    Carrard, Valérie; Schmid Mast, Marianne; Jaunin-Stalder, Nicole; Junod Perron, Noëlle; Sommer, Johanna

    2018-05-01

    A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

  20. Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

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    Kuo Christina L

    2003-05-01

    Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.