Physicians as parents

PubMed Central

Parsons, Wanda L.; Duke, Pauline S.; Snow, Pamela; Edwards, Alison

2009-01-01

Abstract OBJECTIVE To investigate the experiences of physicians as parents and to see if there were any differences in the parenting challenges perceived by male and female physicians. DESIGN Mailed survey. SETTING Newfoundland and Labrador. PARTICIPANTS The survey was mailed to 180 male and 180 female licensed physicians, with a response rate of 60% (N = 216). MAIN OUTCOME MEASURES Self-reported experiences of being a parent and a physician. RESULTS Female physicians reported spending significantly more time on child care activities and domestic activities than their male counterparts did (P < .001). There was no significant difference in the number of professional hours between the 2 sexes, but income was significantly lower for female physicians (P < .001). More women than men had positive physician-parent role models, although very few physicians of either sex had such role models. Female physicians reported bearing the most responsibility for the day-to-day functioning of the family; male physicians relied on their female partners to carry out the main family responsibilities. Women reported feeling guilty about their performance as mothers and as doctors. Male physicians reported regrets about the lack of time with family. CONCLUSION Although women make up an increasing percentage of the physician work force in Canada, they still face challenges as they continue to take primary responsibility for child care and domestic activities. Women are torn between their careers and their families and sometimes feel inadequate in both roles. Male physicians regret having a lack of time with family. Strategies need to be employed in both the workplace and at home to achieve an acceptable balance between being a physician and being a parent. PMID:19675267

Simple prediction scores predict good and devastating outcomes after stroke more accurately than physicians.

PubMed

Reid, John Michael; Dai, Dingwei; Delmonte, Susanna; Counsell, Carl; Phillips, Stephen J; MacLeod, Mary Joan

2017-05-01

physicians are often asked to prognosticate soon after a patient presents with stroke. This study aimed to compare two outcome prediction scores (Five Simple Variables [FSV] score and the PLAN [Preadmission comorbidities, Level of consciousness, Age, and focal Neurologic deficit]) with informal prediction by physicians. demographic and clinical variables were prospectively collected from consecutive patients hospitalised with acute ischaemic or haemorrhagic stroke (2012-13). In-person or telephone follow-up at 6 months established vital and functional status (modified Rankin score [mRS]). Area under the receiver operating curves (AUC) was used to establish prediction score performance. five hundred and seventy-five patients were included; 46% female, median age 76 years, 88% ischaemic stroke. Six months after stroke, 47% of patients had a good outcome (alive and independent, mRS 0-2) and 26% a devastating outcome (dead or severely dependent, mRS 5-6). The FSV and PLAN scores were superior to physician prediction (AUCs of 0.823-0.863 versus 0.773-0.805, P < 0.0001) for good and devastating outcomes. The FSV score was superior to the PLAN score for predicting good outcomes and vice versa for devastating outcomes (P < 0.001). Outcome prediction was more accurate for those with later presentations (>24 hours from onset). the FSV and PLAN scores are validated in this population for outcome prediction after both ischaemic and haemorrhagic stroke. The FSV score is the least complex of all developed scores and can assist outcome prediction by physicians. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com

Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial.

PubMed

van Osch, Mara; van Dulmen, Sandra; van Vliet, Liesbeth; Bensing, Jozien

2017-08-01

To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain. Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed. Positive affect-oriented communication reduced anxiety (p<0.001), negative mood (p=0.001), and increased satisfaction (p<0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p<0.001) and outcome expectancies (p<0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001). Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best. Continued medical training is needed to harness placebo-effects of medical communication into practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Can outcome-based continuing medical education improve performance of immigrant physicians?

PubMed

Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Association Between Physician Teamwork and Health System Outcomes Following Coronary Artery Bypass Grafting

PubMed Central

Hollingsworth, John M.; Funk, Russell J.; Garrison, Spencer A.; Owen-Smith, Jason; Kaufman, Samuel A.; Pagani, Francis D.; Nallamothu, Brahmajee K.

2017-01-01

Background Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether “teamwork” (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Methods and Results Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system’s teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (standard deviation for the bipartite clustering coefficient was 0.09). While health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (e.g., physician staff size, surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Conclusions Health systems with physicians who tend to work together in tightly knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. PMID:28263939

Association Between Physician Teamwork and Health System Outcomes After Coronary Artery Bypass Grafting.

PubMed

Hollingsworth, John M; Funk, Russell J; Garrison, Spencer A; Owen-Smith, Jason; Kaufman, Samuel A; Pagani, Francis D; Nallamothu, Brahmajee K

2016-11-01

Patients undergoing coronary artery bypass grafting (CABG) must often see multiple providers dispersed across many care locations. To test whether teamwork (assessed with the bipartite clustering coefficient) among these physicians is a determinant of surgical outcomes, we examined national Medicare data from patients undergoing CABG. Among Medicare beneficiaries who underwent CABG between 2008 and 2011, we mapped relationships between all physicians who treated them during their surgical episodes, including both surgeons and nonsurgeons. After aggregating across CABG episodes in a year to construct the physician social networks serving each health system, we then assessed the level of physician teamwork in these networks with the bipartite clustering coefficient. Finally, we fit a series of multivariable regression models to evaluate associations between a health system's teamwork level and its 60-day surgical outcomes. We observed substantial variation in the level of teamwork between health systems performing CABG (SD for the bipartite clustering coefficient was 0.09). Although health systems with high and low teamwork levels treated beneficiaries with comparable comorbidity scores, these health systems differed over several sociocultural and healthcare capacity factors (eg, physician staff size and surgical caseload). After controlling for these differences, health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality. Health systems with physicians who tend to work together in tightly-knit groups during CABG episodes realize better surgical outcomes. As such, delivery system reforms focused on building teamwork may have positive effects on surgical care. © 2016 American Heart Association, Inc.

The Effect of Message Content and Clinical Outcome on Patients' Perception of Physician Compassion: A Randomized Controlled Trial.

PubMed

Tanco, Kimberson; Azhar, Ahsan; Rhondali, Wadih; Rodriguez-Nunez, Alfredo; Liu, Diane; Wu, Jimin; Baile, Walter; Bruera, Eduardo

2018-03-01

In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the impact of the clinical outcome of the patient on patient's perception of physician's level of compassion and professionalism has not been previously studied. Our aim was to determine if the reported clinical outcome modified the patient's perception of physician compassion, professionalism, impression, and preference for physician. One hundred twenty-eight advanced cancer patients in an outpatient Supportive Care Center were randomized to complete validated questionnaires about patients' perception of physician's level of compassion, professionalism, impression, and preference of physician for themselves and their family after watching scripted videos depicting a physician delivering an MO versus a less optimistic (LO) message followed by a clinical vignette depicting a worse outcome. Median age was 61 years and 55% were female. There was no difference in compassion score after the vignette in the MO and LO groups. However, there were significantly worse overall impression and professionalism scores in both the MO and LO groups after the vignette. In the MO group, preference for the physician for themselves and their family significantly decreased after the vignette. Seeing a worse clinical outcome did not change the patients' appraisal of an inappropriately optimistic physician. However, it reduced the overall impression of both physicians that conveyed an MO or an LO message and it also resulted in less likelihood of choosing the MO physician for themselves and their family. The study found that a patient's perception of a physician's compassion did not change after reading a vignette describing a negative clinical outcome, regardless of whether the physician had given a more or a less optimistic message to the patient. However, the results suggested that patients perceived worse professionalism

Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.

PubMed

Rose, Danielle E; Tisnado, Diana M; Tao, May L; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2012-06-01

Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n=111; patient n=411). After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). © Health Research and Educational Trust.

Impact of Burnout on Organizational Outcomes, the Influence of Legal Demands: The Case of Ecuadorian Physicians.

PubMed

Ochoa, Paola

2018-01-01

Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of

Impact of Burnout on Organizational Outcomes, the Influence of Legal Demands: The Case of Ecuadorian Physicians

PubMed Central

Ochoa, Paola

2018-01-01

Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of

Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review.

PubMed

du Bois, Andreas; Rochon, Justine; Pfisterer, Jacobus; Hoskins, William J

2009-02-01

Ovarian cancer outcome varies among different institutions, regions, and countries. This systematic review summarizes the available data evaluating the impact of different physician and hospital characteristics on outcome in ovarian cancer patients. A MEDLINE database search for pertinent publications was conducted and reference lists of each relevant article were screened. Experts in the field were contacted. Selected studies assessed the relationship between physician and/or hospital specialty or volume and at least one of the outcomes of interest. The primary outcome was survival. Additional parameters included surgical outcome (debulking), completeness of staging, and quality of chemotherapy. The authors independently reviewed each article and applied the inclusion/exclusion criteria. The quality of each study was assessed by focusing on strategies to control for important prognostic factors. Forty-four articles met inclusion criteria. Discipline and sub-specialization of the primary treating physician were identified as the most important variable associated with superior outcome. Evidence showing a beneficial impact of institutional factors was weaker, but followed the same trend. Hospital volume was hardly related to any outcome parameter. The limited evidence available showed considerable heterogeneity and has to be interpreted cautiously. Better utilization of knowledge about institutional factors and well-established board certifications may improve outcome in ovarian cancer. Patients and primary-care physicians should select gynecologic oncologists for primary treatment in countries with established sub-specialty training. Policymakers, insurance companies, and lay organizations should support development of respective programs.

Outcome following physician supervised prehospital resuscitation: a retrospective study

PubMed Central

Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T; Brøchner, Anne C

2015-01-01

Background Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus to investigate ambulance runs initially assigned ‘life-saving missions’ with emphasis on long-term outcome in patients treated by the Mobile Emergency Care Unit (MECU) in Odense, Denmark Methods All MECU runs are registered in a database by the attending physician, stating, among other parameters, the treatment given, outcome of the treatment and the patient's diagnosis. Over a period of 80 months from May 1 2006 to December 31 2012, all missions in which the outcome of the treatment was registered as ‘life saving’ were scrutinised. Initial outcome, level of competence of the caretaker and diagnosis of each patient were manually established in each case in a combined audit of the prehospital database, the discharge summary of the MECU and the medical records from the hospital. Outcome parameters were final outcome, the aetiology of the life-threatening condition and the level of competences necessary to treat the patient. Results Of 25 647 patients treated by the MECU, 701 (2.7%) received prehospital ‘life saving treatment’. In 596 (2.3%) patients this treatment exceeded the competences of the attending emergency medical technician or paramedic. Of these patients, 225 (0.9%) were ultimately discharged to their own home. Conclusions The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus supports the concept of applying specialists in anaesthesiology in the prehospital setting especially when treating patients with cardiac arrest, patients in

Recruitment and retention of rural physicians: outcomes from the rural physician associate program of Minnesota.

PubMed

Halaas, Gwen Wagstrom; Zink, Therese; Finstad, Deborah; Bolin, Keli; Center, Bruce

2008-01-01

Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. To examine RPAP outcomes in recruiting and retaining rural primary care physicians. The RPAP database, including moves and current practice settings, was examined using descriptive statistics. On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting.

Implementation of the physician assistant in Dutch health care organizations: primary motives and outcomes.

PubMed

van Vught, Anneke J A H; van den Brink, Geert T W J; Wobbes, Theo

2014-01-01

Physician assistants (PAs) are trained to perform medical procedures that were traditionally performed by medical physicians. Physician assistants seem to be deployed not only to increase efficiency but also to ensure the quality of care. What is not known is the primary motive for employing PAs within Dutch health care and whether the employment of the PAs fulfills the perceived need for them. Supervising medical specialists who used PAs in their practices were interviewed about their primary motives and outcomes. The interviews were semistructured. Two scientists coded the findings with respect to motives and outcomes. In total, 55 specialists were interviewed about their motives for employing a PA, and 15 were interviewed about the outcomes of employing a PA. With respect to the primary motives for employing a PA, the most frequent motive was to increase continuity and quality of care, followed by relieving the specialist's workload, increasing efficiency of care, and substituting for medical residents. The outcomes were found to be consistent with the motives. In conclusion, the primary motive for employing a PA in Dutch health care is to increase continuity and quality of care.

Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

PubMed Central

Brehaut, Jamie C; Poses, Roy; Shojania, Kaveh G; Lott, Alison; Man-Son-Hing, Malcolm; Bassin, Elise; Grimshaw, Jeremy

2007-01-01

Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1) prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2) initiation of anticoagulation for patients with atrial fibrillation (AF), where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2) to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes) for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be able to identify which

International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials.

PubMed

Orbai, Ana-Maria; de Wit, Maarten; Mease, Philip; Shea, Judy A; Gossec, Laure; Leung, Ying Ying; Tillett, William; Elmamoun, Musaab; Callis Duffin, Kristina; Campbell, Willemina; Christensen, Robin; Coates, Laura; Dures, Emma; Eder, Lihi; FitzGerald, Oliver; Gladman, Dafna; Goel, Niti; Grieb, Suzanne Dolwick; Hewlett, Sarah; Hoejgaard, Pil; Kalyoncu, Umut; Lindsay, Chris; McHugh, Neil; Shea, Bev; Steinkoenig, Ingrid; Strand, Vibeke; Ogdie, Alexis

2017-04-01

To identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities. We conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups to identify domains important to people with PsA; (3) two international surveys with patients and physicians to prioritise domains; (4) an international face-to-face meeting with patients and physicians using the nominal group technique method to agree on the most important domains; and (5) presentation and votes at the Outcome Measures in Rheumatology (OMERACT) conference in May 2016. All phases were performed in collaboration with patient research partners. We identified 39 unique domains through the SLR (24 domains) and international focus groups (34 domains). 50 patients and 75 physicians rated domain importance. During the March 2016 consensus meeting, 12 patients and 12 physicians agreed on 10 candidate domains. Then, 49 patients and 71 physicians rated these domains' importance. Five were important to >70% of both groups: musculoskeletal disease activity, skin disease activity, structural damage, pain and physical function. Fatigue and participation were important to >70% of patients. Patient global and systemic inflammation were important to >70% of physicians. The updated PsA core domain set endorsed by 90% of OMERACT 2016 participants includes musculoskeletal disease activity, skin disease activity, pain, patient global, physical function, health-related quality of life, fatigue and systemic inflammation. The updated PsA core domain set incorporates patients' and physicians' priorities and evolving PsA research. Next steps include identifying outcome measures that adequately assess these domains. 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/.

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

PubMed

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

2014-10-01

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

Characteristics and outcomes for women physicians who work reduced hours.

PubMed

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 < or = 0.001), lower burnout (r = -0.22, p = 0.03), better marital role quality (r = 0.28, p = 0.006), and higher life satisfaction (r = 0.29, p = 0.005). Women physicians who work their preferred number of hours achieve the best balance of

Physicians' participatory decision-making and quality of diabetes care processes and outcomes: results from the triad study.

PubMed

Heisler, M; Tierney, E; Ackermann, R T; Tseng, C; Narayan, K M Venkat; Crosson, J; Waitzfelder, B; Safford, M M; Duru, K; Herman, W H; Kim, C

2009-09-01

In participatory decision-making (PDM), physicians actively engage patients in treatment and other care decisions. Patients who report that their physicians engage in PDM have better disease self-management and health outcomes. We examined whether physicians' diabetes-specific treatment PDM preferences as well as their self-reported practices are associated with the quality of diabetes care their patients receive. 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n=4198) in 10 US health plans across the country and their physicians (n=1217). We characterized physicians' diabetes care PDM preferences and practices as 'no patient involvement,' 'physician-dominant,' 'shared,' or 'patient-dominant' and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients'satisfaction with physician communication; and (3) whether patients' A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control. Most physicians preferred 'shared' PDM (58%) rather than 'no patient involvement' (9%), 'physician-dominant' (28%) or 'patient dominant' PDM (5%). However, most reported practicing 'physician-dominant' PDM (43%) with most of their patients, rather than 'no patient involvement' (13%), 'shared' (37%) or 'patient-dominant' PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred 'shared' PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03-3.07] and patients of physicians who preferred 'patient-dominant' treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04-2.39] than those of providers who preferred 'no patient involvement' in treatment decision-making. There were no differences in patients' satisfaction with their

Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia.

PubMed

Janssen, Patricia A; Ryan, Elizabeth M; Etches, Duncan J; Klein, Michael C; Reime, Birgit

2007-06-01

The impact of midwifery versus physician care on perinatal outcomes in a population of women planning birth in hospital has not yet been explored. We compared maternal and newborn outcomes between women planning hospital birth attended by a midwife versus a physician in British Columbia, Canada. All women planning a hospital birth attended by a midwife during the 2-year study period who were of sufficiently low-risk status to meet eligibility requirements for home birth as defined by the British Columbia College of Midwives were included in the study group (n=488). The comparison group included women meeting the same eligibility requirements but planning a physician-attended birth in hospitals where midwives also practiced (n=572). Outcomes were ascertained from the British Columbia Reproductive Care Program Perinatal Registry to which all hospitals in the province submit data. Adjusted odds ratios for women planning hospital birth attended by a midwife versus a physician were significantly reduced for exposure to cesarean section (OR 0.58, 95% CI 0.39-0.86), narcotic analgesia (OR 0.26, 95% CI 0.18-0.37), electronic fetal monitoring (OR 0.22, 95% CI 0.16-0.30), amniotomy (OR 0.74, 95% CI 0.56-0.98), and episiotomy (OR 0.62, 95% CI 0.42-0.93). The odds of adverse neonatal outcomes were not different between groups, with the exception of reduced use of drugs for resuscitation at birth (OR 0.19, 95% CI 0.04-0.83) in the midwifery group. A shift toward greater proportions of midwife-attended births in hospitals could result in reduced rates of obstetric interventions, with similar rates of neonatal morbidity.

Physician empathy: definition, outcome-relevance and its measurement in patient care and medical education.

PubMed

Neumann, Melanie; Scheffer, Christian; Tauschel, Diethard; Lutz, Gabriele; Wirtz, Markus; Edelhäuser, Friedrich

2012-01-01

The present study gives a brief introduction into 1. the definition of physician empathy (PE) and 2. its influence on patients' health outcomes. Furthermore 3. we present assessment instruments to measure PE from the perspective of the patient and medical student. The latter topic will be explored in detail as we conducted a pilot study on the German versions of two self-assessment instruments of empathy, which are mostly used in medical education research, namely the "Jefferson Scale of Physician Empathy, Student Version" (JSPE-S) and the "Interpersonal Reactivity Index" (IRI). We first present an overview of the current empirical and theoretical literature on the definition and outcome-relevance of PE. Additionally, we conducted basic psychometric analyses of the German versions of the JSPE-S and the IRI. Data for this analyses is based on a cross-sectional pilot-survey in N=44 medical students and N=63 students of other disciplines from the University of Cologne. PE includes the understanding of the patient as well as verbal and non-verbal communication, which should result in a helpful therapeutic action of the physician. Patients' health outcomes in different healthcare settings can be improved considerably from a high quality empathic encounter with their clinician. Basic psychometric results of the German JSPE-S and IRI measures show first promising results. PE as an essential and outcome-relevant element in the patient-physician relationship requires more consideration in the education of medical students and, thus, in medical education research. The German versions of the JSPE-S and IRI measures seem to be promising means to evaluate these education aims and to conduct medical education research on empathy.

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

PubMed

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.

Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making.

PubMed

Daniels, Lisa M; Sorita, Atsushi; Kashiwagi, Deanne T; Okubo, Masashi; Small, Evan; Polley, Eric C; Sawatsky, Adam P

2018-05-01

Potentially preventable admissions are a target for healthcare cost containment. To identify rates of, characterize associations with, and explore physician decision-making around potentially preventable admissions. A comparative cohort study was used to determine rates of potentially preventable admissions and to identify associated factors and patient outcomes. A qualitative case study was used to explore physicians' clinical decision-making. Patients admitted from the emergency department (ED) to the general medicine (GM) service over a total of 4 weeks were included as cases (N = 401). Physicians from both emergency medicine (EM) and GM that were involved in the cases were included (N = 82). Physicians categorized admissions as potentially preventable. We examined differences in patient characteristics, admission characteristics, and patient outcomes between potentially preventable and control admissions. Interviews with participating physicians were conducted and transcribed. Transcriptions were systematically analyzed for key concepts regarding potentially preventable admissions. EM and GM physicians categorized 22.2% (90/401) of admissions as potentially preventable. There were no significant differences between potentially preventable and control admissions in patient or admission characteristics. Potentially preventable admissions had shorter length of stay (2.1 vs. 3.6 days, p < 0.001). There was no difference in other patient outcomes. Physicians discussed several provider, system, and patient factors that affected clinical decision-making around potentially preventable admissions, particularly in the "gray zone," including risk of deterioration at home, the risk of hospitalization, the cost to the patient, and the presence of outpatient resources. Differences in provider training, risk assessment, and provider understanding of outpatient access accounted for differences in decisions between EM and GM physicians. Collaboration between EM and

Cardiac surgical outcomes improvement led by a physician champion working with a nurse clinical coordinator.

PubMed

Stanford, John R; Swaney-Berghoff, Laurie; Recht, Kimberly

2012-01-01

Cardiac surgical outcomes improvement in a community hospital was driven by a physician champion working with a nurse clinical coordinator. Specific system improvements implemented were (1) nurse checklists of vital signs, cardiovascular function parameters, and life support appliance operation; (2) use of the EuroSCORE system of preoperative patient risk assessment; (3) monthly morbidity and mortality conferences; and (4) daily patient progress tracking. The hospital received 1 star (bottom 12% of hospitals for quality outcomes) from the Society of Thoracic Surgeons Adult Cardiac Database in 2006 prior to program inception, 2 stars (middle 76% of hospitals for quality outcomes) in 2007 and 2008, and 3 stars (top 12% of hospitals) in 2009. The physician and nurse together combined a strategy for clinical improvement with the cultural practices at the hospital to ensure that system improvements approved at the strategic level were implemented at the point of care. Both strategy and culture must be addressed to ensure patient outcomes improvement.

Electronic medical records and physician stress in primary care: results from the MEMO Study

PubMed Central

Babbott, Stewart; Manwell, Linda Baier; Brown, Roger; Montague, Enid; Williams, Eric; Schwartz, Mark; Hess, Erik; Linzer, Mark

2014-01-01

Background Little has been written about physician stress that may be associated with electronic medical records (EMR). Objective We assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout. Design and participants 379 primary care physicians and 92 managers at 92 clinics from New York City and the upper Midwest participating in the 2001–5 Minimizing Error, Maximizing Outcome (MEMO) Study. A latent class analysis identified clusters of physicians within clinics with low, medium and high EMR functions. Main measures We assessed physician-reported stress, burnout, satisfaction, and intent to leave the practice, and predictors including time pressure during visits. We used a two-level regression model to estimate the mean response for each physician cluster to each outcome, adjusting for physician age, sex, specialty, work hours and years using the EMR. Effect sizes (ES) of these relationships were considered small (0.14), moderate (0.39), and large (0.61). Key results Compared to the low EMR cluster, physicians in the moderate EMR cluster reported more stress (ES 0.35, p=0.03) and lower satisfaction (ES −0.45, p=0.006). Physicians in the high EMR cluster indicated lower satisfaction than low EMR cluster physicians (ES −0.39, p=0.01). Time pressure was associated with significantly more burnout, dissatisfaction and intent to leave only within the high EMR cluster. Conclusions Stress may rise for physicians with a moderate number of EMR functions. Time pressure was associated with poor physician outcomes mainly in the high EMR cluster. Work redesign may address these stressors. PMID:24005796

Outcomes of a Novel Training Program for Physician-Scientists: Integrating Graduate Degree Training With Specialty Fellowship.

PubMed

Wong, Mitchell D; Guerrero, Lourdes; Sallam, Tamer; Frank, Joy S; Fogelman, Alan M; Demer, Linda L

2016-02-01

Although physician-scientists generally contribute to the scientific enterprise by providing a breadth of knowledge complementary to that of other scientists, it is a challenge to recruit, train, and retain physicians in a research career pathway. To assess the outcomes of a novel program that combines graduate coursework and research training with subspecialty fellowship. A retrospective analysis was conducted of career outcomes for 123 physicians who graduated from the program during its first 20 years (1993-2013). Using curricula vitae, direct contact, and online confirmation, data were compiled on physicians' subsequent activities and careers as of 2013. Study outcomes included employment in academic and nonacademic research, academic clinical or private practice positions, and research grant funding. More than 80% of graduates were actively conducting research in academic, institutional, or industrial careers. The majority of graduates (71%) had academic appointments; a few (20%) were in private practice. Fifty percent had received career development awards, and 19% had received investigator-initiated National Institutes of Health (NIH) R01 or equivalent grants. Individuals who obtained a PhD during subspecialty training were significantly more likely to have major grant funding (NIH R series or equivalent) than those who obtained a Master of Science in Clinical Research. Trainees who obtained a PhD in a health services or health policy field were significantly more likely to have research appointments than those in basic science. Incorporation of graduate degree research, at the level of specialty or subspecialty clinical training, is a promising approach to training and retaining physician-scientists.

Improving outcomes of hospitalized patients: the Physician Relationships, Improvising, and Sensemaking intervention protocol.

PubMed

Leykum, Luci K; Lanham, Holly J; Provost, Shannon M; McDaniel, Reuben R; Pugh, Jacqueline

2014-11-26

Our goal is to improve the safety and effectiveness of inpatient care. Rather than focus on improving process of care, we focus on the social structure within physician teams. We have developed the Physician Relationships, Improvising, and Sensemaking (PRISm) intervention to improve the way physician teams round, enabling them to better relate, make sense of their patients' conditions, and improvise in uncertain clinical situations. We are currently studying the impact of PRISm on adverse events and complications in hospitalized patients. This manuscript describes the PRISm intervention. PRISm is a structured communication tool consisting of three components: daily briefings before rounds; use of the Situation, Task, Intent, Concern, and Calibrate (STICC) framework during rounds as part of the discussion of individual patients; and debriefings after rounds. We are implementing the PRISm intervention on eight inpatient medical and surgical physician teams in the South Texas Veterans Health Care System. We are assessing PRISm impact on the way team members relate to each other, round, and discuss patients through pre- and post-implementation observations and surveys. We are also assessing PRISm impact on complications and adverse events. Finally, we are interviewing physicians regarding their experience using the intervention. Our results will allow us to begin to understand the potential impact of interventions designed to improve how providers relate to each other, improvise, and make sense of what is happening as a strategy for improving inpatient care. Our in-depth data collection will enable us to assess how relationships, improvising, and sensemaking influence patient outcomes, potentially through creating shared mental models or enhancing distributed cognition during clinical reasoning. Finally, our results will lay the groundwork for larger implementation studies to improve clinical outcomes through improving how providers, and providers, patients, and

Processes and experiences of Portugal's international recruitment scheme of Colombian physicians: Did it work?

PubMed

Masanet, Erika

2017-08-01

The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished. Copyright © 2017 Elsevier B.V. All rights reserved.

Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable

PubMed Central

Aubrey-Bassler, Kris; Cullen, Richard M.; Simms, Alvin; Asghari, Shabnam; Crane, Joan; Wang, Peizhong Peter; Godwin, Marshall

2015-01-01

Background: Previous research has suggested that obstetric outcomes are similar for deliveries by family physicians and obstetricians, but many of these studies were small, and none of them adjusted for unmeasured selection bias. We compared obstetric outcomes between these provider types using an econometric method designed to adjust for unobserved confounding. Methods: We performed a retrospective population-based cohort study of all Canadian (except Quebec) hospital births with delivery by family physicians and obstetricians at more than 20 weeks gestational age, with birth weight greater than 500 g, between Apr. 1, 2006, and Mar. 31, 2009. The primary outcomes were the relative risks of in-hospital perinatal death and a composite of maternal mortality and major morbidity assessed with multivariable logistic regression and instrumental variable–adjusted multivariable regression. Results: After exclusions, there were 3600 perinatal deaths and 14 394 cases of maternal morbidity among 799 823 infants and 793 053 mothers at 390 hospitals. For deliveries by family physicians v. obstetricians, the relative risk of perinatal mortality was 0.98 (95% confidence interval [CI] 0.85–1.14) and of maternal morbidity was 0.81 (95% CI 0.70–0.94) according to logistic regression. The respective relative risks were 0.97 (95% CI 0.58–1.64) and 1.13 (95% CI 0.65–1.95) according to instrumental variable methods. Interpretation: After adjusting for both observed and unobserved confounders, we found a similar risk of perinatal mortality and adverse maternal outcome for obstetric deliveries by family physicians and obstetricians. Whether there are differences between these groups for other outcomes remains to be seen. PMID:26303244

Physicians' and patients' perspectives on office-based dispensing: the central role of the physician-patient relationship.

PubMed

Ogbogu, P; Fleischer, A B; Brodell, R T; Bhalla, G; Draelos, Z D; Feldman, S R

2001-02-01

To describe physicians' and patients' reasons for participating in office-based sales of dermatologic products. Survey data on the attitudes, opinions, and beliefs of dermatologists and their patients were analyzed. A market research study of office-based selling. Thirty dermatologists involved in direct selling from the office, 20 dermatologists not involved in direct selling, 22 patients who purchase products from their dermatologists' offices, and 25 office managers. The hypotheses of this study were formulated after the market research study had been done. The main outcome measure was the physicians' and patients' reported reasons for patients purchasing skin care products from dermatologists rather than from retail stores. "Trust" was the most frequent reason cited by physicians for patient purchases, while "physician knowledge" was the most frequent reason cited by the purchasing patients. The most common location to display the products was the waiting room (20 [67%] of the physicians). The most common types of products sold included glycolic acid products (15 [50%]), moisturizers (13 [43%]), sunscreens (12 [40%]), and alpha-hydroxy acid products other than glycolic acid (9 [30%]). The interaction between physicians who sell products in their offices and their patients is highlighted by 2 key elements of the physician-patient relationship: trust and physician knowledge.

Does specialist physician supply affect pediatric asthma health outcomes?

PubMed

Filler, Guido; Kovesi, Tom; Bourdon, Erik; Jones, Sarah Ann; Givelichian, Laurentiu; Rockman-Greenberg, Cheryl; Gilliland, Jason; Williams, Marion; Orrbine, Elaine; Piedboeuf, Bruno

2018-04-05

Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into "peer groups" by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011. At the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p < 0.0001). Saskatchewan, which has a lower pediatrician and pediatric asthma specialist supply, had a higher asthma admission rate than Manitoba. Our data suggest that there is an inverse relationship between asthma admissions and pediatrician and asthma specialist supply.

Physician, heal thyself

PubMed Central

Blais, Régis; Safianyk, Catherine; Magnan, Anne; Lapierre, André

2010-01-01

ABSTRACT OBJECTIVE To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received. DESIGN Mailed questionnaire. SETTING Quebec. PARTICIPANTS A total of 126 physicians who used QPHP services between 1999 and 2004. MAIN OUTCOME MEASURES Users’ overall rating of the QPHP services, their opinions about the program, and whether their situations improved as a result of accessing QPHP services. RESULTS Ninety-two of the 126 physicians surveyed returned their completed questionnaires, providing a response rate of 73%. Most respondents thought that the QPHP services were good or excellent (90%), most would use the program again (86%) or recommend it (96%), and most thought the Quebec physician associations and the Collège des médecins du Québec should continue funding the QPHP (97%). Most respondents thought the service confidentiality was excellent (84%), as was staff professionalism (82%), and 62% thought the quality of the services they were referred to was excellent. However, only 57% believed their situations had improved with the help of the QPHP. CONCLUSION The QPHP received good marks from its users. Given the effects of physician burnout on patients and on the health care system, it is not only a personal problem, but also a collective problem. Thus, actions are needed not only to set up programs like the QPHP for those suffering from burnout, but also to prevent these types of problems. Because family physicians are likely to be the first ones consulted by their physician patients in distress, they play a key role in acknowledging these problems and referring those colleagues to the appropriate help programs when needed. PMID:20944027

How physicians describe outcomes to HCV therapy: prevalence and meaning of "cure" during provider-patient in-office discussions of HCV.

PubMed

Hamilton, Heidi E; Gordon, Cynthia; Nelson, Meaghan; Cotler, Scott J; Martin, Paul

2008-04-01

How physicians convey information about hepatitis C virus (HCV) impacts patients' perceptions of treatment outcomes and informed therapy decisions. However, HCV patients reported difficulties communicating with their physicians in a recent study. Another study showed that 45% of patients did not understand projected response rates conveyed by providers, and patients with unfavorable projected treatment outcomes were more likely to lack understanding. This article analyzes naturally occurring patient-provider interactions to evaluate physicians' use of the word 'cure', and framing of HCV response as optimistic, pessimistic, or neutral, to suggest possible reasons why patients with unfavorable projected sustained virologic response rates might perceive their odds as more favorable than they are. Gastroenterologists, allied health professionals, and HCV patients were video and audio-recorded during regular scheduled visits. Recordings were transcribed and analyzed using validated sociolinguistic techniques. Sixty-three percent of physicians used the word 'cure' in 38% of visits involving response discussions. 'Cure' most frequently meant 'absolute cure' and occurred more commonly in visits conducted before therapy initiation, and with patients having favorable genotypes. Physicians hedged the meaning of 'cure' in 29% of visits. Moreover, 69.5% of response-related utterances were framed optimistically. HCV dialogs are characterized by the prevalence of 'cure' and optimistic framing. These positive language attributes could potentially contribute to the misunderstanding regarding the projected response rates. During treatment outcome discussions, the physicians should attempt to (1) operate using the same definition of the therapy outcome as the patient, (2) balance medically accurate information with patient comprehension, and (3) consider possible consequences of discussing treatment options on the basis of message framing.

Improving physician-patient communication in cancer care: outcome of a workshop for oncologists.

PubMed

Baile, W F; Lenzi, R; Kudelka, A P; Maguire, P; Novack, D; Goldstein, M; Myers, E G; Bast, R C

1997-01-01

Physicians caring for cancer patients receive little formal training in difficult communications such as breaking bad news, discussing life support, and addressing patients' emotional concerns. The authors conducted a three-day workshop in communication skills for nine oncology attendings and three fellows. Topics for the workshop were selected by participants by a pre-workshop questionnaire. Small groups of four to five participants interviewed simulated patients who role-played scripts based on the selected topics. Sessions on self-awareness and one on planning for continuing the work of the group after the workshop were included. Responses to pretest and posttest questionnaires showed that the workshop increased the participants' confidence in a number of communication areas and also in managing physician burnout. Process issues such as patient death and expectations for cure were also discussed. Interactive workshops offer a promising way of teaching communication skills and aspects of the physician-patient relationship to oncologists. Conclusions regarding outcome, however, are preliminary and tentative, and long-term results are uncertain.

Adoption of clinical decision support systems in a developing country: Antecedents and outcomes of physician's threat to perceived professional autonomy.

PubMed

Esmaeilzadeh, Pouyan; Sambasivan, Murali; Kumar, Naresh; Nezakati, Hossein

2015-08-01

The basic objective of this research is to study the antecedents and outcomes of professional autonomy which is a central construct that affects physicians' intention to adopt clinical decision support systems (CDSS). The antecedents are physicians' attitude toward knowledge sharing and interactivity perception (about CDSS) and the outcomes are performance expectancy and intention to adopt CDSS. Besides, we include (1) the antecedents of attitude toward knowledge sharing-subjective norms, social factors and OCB (helping behavior) and (2) roles of physicians' involvement in decision making, computer self-efficacy and effort expectancy in our framework. Data from a stratified sample of 335 Malaysian physicians working in 12 public and private hospitals in Malaysia were collected to test the hypotheses using Structural Equation Modeling (SEM). The important findings of our research are: (1) factors such as perceived threat to professional autonomy, performance expectancy, and physicians' involvement in making decision about CDSS have significant impact on physicians' intention to adopt CDSS; (2) physicians' attitude toward knowledge sharing, interactivity perception and computer self-efficacy of physicians play a crucial role in influencing their perceived threat to professional autonomy; and (3) social network, shared goals and OCB (helping behavior) impact physicians' attitude toward knowledge sharing. The findings provide a comprehensive understanding of the factors that influence physicians' intention to adopt CDSS in a developing country. The results can help hospital managers manage CDSS implementation in an effective manner. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The effect of ACGME resident duty hour reforms on outcomes of physicians after completion of residency

PubMed Central

Jena, Anupam B.; Schoemaker, Lena; Bhattacharya, Jayanta

2014-01-01

In 2003, work hours for physicians in training (residents) were mandatorily reduced to be no more than 80 hours per week, leading to the hotly debated but unexplored issue of whether physicians today are less well trained as a result of these work hour reforms. Using a unique database of nearly all hospitalizations in Florida during 2000–2009 which were linked to detailed information on the medical training history of the physician of record for each hospitalization, we studied whether hospital mortality and length of stay for internists varied according to the number of years an internist was exposed to the 2003 duty hour regulations during their own residency. Using a difference-in-difference analysis which compared trends in outcomes of junior physicians pre- and post-2003 to a control group of senior physicians who were not exposed to these reforms during their own residency, we found that the 2003 reforms did not affect the quality of physician training reflected by hospital mortality and length of stay. PMID:25288430

Physician pattern of patient notification of test results.

PubMed

Thiedke, Carolyn C; Hoeft, Katherine A; Pearson, William S

2005-01-01

To discover how community-based family physicians notify patients of test results and whether there are differences based on sex, length of time in practice, reimbursement status, employment status,or percentage of practice in managed care. We mailed a survey to 500 randomly selected members of the South Carolina chapter of the American Academy of Family Physicians. All analyses were preformed using SASTM version 8.2. Both descriptive and inferential statistics were used to analyze the collected data. A total of 367 physicians responded (73% response rate). The main outcome variable was the time each physician spent notifying patients of test results: a mean of 20.86 +/- 18.3 minutes per day(range 0-120 minutes/day). Women physicians and those with more than 75% managed care were significantly more likely to spend more than the median time notifying patients of test results. Physicians vary in the amount of time they spend notifying patients of their test results, with female physicians and those with more than 75% of their practice in managed care spending more time than do male physicians and physicians with less managed care.

The effect of physician staffing model on patient outcomes in a medical progressive care unit.

PubMed

Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

2016-04-01

Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

Creating regional consensus for starting school later: a physician-driven approach in southern Maine.

PubMed

Collins, Tracey Ann; Indorf, Christopher; Klak, Thomas

2017-12-01

In April 2016, several contiguous school districts and an independent high school academy in southern Maine voted simultaneously to start school later, beginning with the 2016-17 academic year. They became Maine's first school districts to implement the American Academy of Pediatrics' 1 and the American Medical Association's 2 health policy recommendations that middle and high schools should not start before 8:30 AM. Local physicians' presentations to school staff and parents on the medical evidence of the health benefits of a later start solidified early consensus. The action required special permission from the Maine Municipal Association to hold a joint school board vote, impacted approximately 6500 students across the region, resulted in no increase in busing costs, and took 8 months to implement after the first formal school board discussions. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Mentorship and job satisfaction among Navy family physicians.

PubMed

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.

Risk as Feelings in the Effect of Patient Outcomes on Physicians' Subsequent Treatment Decisions: A Randomized Trial and Manipulation Validation

PubMed Central

Hemmerich, Joshua A; Elstein, Arthur S; Schwarze, Margaret L; Moliski, Elizabeth G; Dale, William

2013-01-01

The present study tested predictions derived from the Risk as Feelings hypothesis about the effects of prior patients' negative treatment outcomes on physicians' subsequent treatment decisions. Two experiments at The University of Chicago, U.S.A., utilized a computer simulation of an abdominal aortic aneurysm (AAA) patient with enhanced realism to present participants with one of three experimental conditions: AAA rupture causing a watchful waiting death (WWD), perioperative death (PD), or a successful operation (SO), as well as the statistical treatment guidelines for AAA. Experiment 1 tested effects of these simulated outcomes on (n=76) laboratory participants' (university student sample) self-reported emotions, and their ratings of valence and arousal of the AAA rupture simulation and other emotion inducing picture stimuli. Experiment 2 tested two hypotheses: 1) that experiencing a patient WWD in the practice trial's experimental condition would lead physicians to choose surgery earlier, and 2) experiencing a patient PD would lead physicians to choose surgery later with the next patient. Experiment 2 presented (n=132) physicians (surgeons and geriatricians) with the same experimental manipulation and a second simulated AAA patient. Physicians then chose to either go to surgery or continue watchful waiting. The results of Experiment 1 demonstrated that the WWD experimental condition significantly increased anxiety, and was rated similarly to other negative and arousing pictures. The results of Experiment 2 demonstrated that, after controlling for demographics, baseline anxiety, intolerance for uncertainty, risk attitudes, and the influence of simulation characteristics, the WWD experimental condition significantly expedited decisions to choose surgery for the next patient. The results support the Risk as Feelings hypothesis on physicians' treatment decisions in a realistic AAA patient computer simulation. Bad outcomes affected emotions and decisions, even with

Risk as feelings in the effect of patient outcomes on physicians' future treatment decisions: a randomized trial and manipulation validation.

PubMed

Hemmerich, Joshua A; Elstein, Arthur S; Schwarze, Margaret L; Moliski, Elizabeth Ghini; Dale, William

2012-07-01

The present study tested predictions derived from the Risk as Feelings hypothesis about the effects of prior patients' negative treatment outcomes on physicians' subsequent treatment decisions. Two experiments at The University of Chicago, U.S.A., utilized a computer simulation of an abdominal aortic aneurysm (AAA) patient with enhanced realism to present participants with one of three experimental conditions: AAA rupture causing a watchful waiting death (WWD), perioperative death (PD), or a successful operation (SO), as well as the statistical treatment guidelines for AAA. Experiment 1 tested effects of these simulated outcomes on (n = 76) laboratory participants' (university student sample) self-reported emotions, and their ratings of valence and arousal of the AAA rupture simulation and other emotion-inducing picture stimuli. Experiment 2 tested two hypotheses: 1) that experiencing a patient WWD in the practice trial's experimental condition would lead physicians to choose surgery earlier, and 2) experiencing a patient PD would lead physicians to choose surgery later with the next patient. Experiment 2 presented (n = 132) physicians (surgeons and geriatricians) with the same experimental manipulation and a second simulated AAA patient. Physicians then chose to either go to surgery or continue watchful waiting. The results of Experiment 1 demonstrated that the WWD experimental condition significantly increased anxiety, and was rated similarly to other negative and arousing pictures. The results of Experiment 2 demonstrated that, after controlling for demographics, baseline anxiety, intolerance for uncertainty, risk attitudes, and the influence of simulation characteristics, the WWD experimental condition significantly expedited decisions to choose surgery for the next patient. The results support the Risk as Feelings hypothesis on physicians' treatment decisions in a realistic AAA patient computer simulation. Bad outcomes affected emotions and decisions, even

Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization.

PubMed

Matzke, Gary R; Moczygemba, Leticia R; Williams, Karen J; Czar, Michael J; Lee, William T

2018-05-22

The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. Significant improvements ( p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The growing number of female physicians: meanings, values, and outcomes.

PubMed

Phillips, Susan P

2013-12-19

Throughout the developed world the proportion of women in professions such as medicine is increasing. This commentary uses Haklai et al's nuanced report on the feminization of medicine in Israel as a starting point. I discuss whether gender shifts are an outcome of more egalitarian attitudes towards women overall, or instead arise from men choosing other professions, the extent of the shift, and its meaning for the quantity and quality of medical care. The discussion is embedded in more fundamental concepts such as the aims of medical practice and the best indicators of effective care. I reflect on concerns about lower female physician productivity at a time when the proportion of female physicians still remains below parity in almost all countries. Medicine is embedded in the principles and expectations of the community being served. The profession's values and practices both shape and are shaped by those of that larger community. As cultures move toward equality, proportional representation of women and men in medicine will follow, while remaining limitations to gender equality will be mirrored in opportunities and restrictions for women in medicine. This is a commentary on http://www.ijhpr.org/content/2/1/37/.

History and Outcomes of 50 Years of Physician-Scientist Training in Medical Scientist Training Programs.

PubMed

Harding, Clifford V; Akabas, Myles H; Andersen, Olaf S

2017-10-01

Physician-scientists are needed to continue the great pace of recent biomedical research and translate scientific findings to clinical applications. MD-PhD programs represent one approach to train physician-scientists. MD-PhD training started in the 1950s and expanded greatly with the Medical Scientist Training Program (MSTP), launched in 1964 by the National Institute of General Medical Sciences (NIGMS) at the National Institutes of Health. MD-PhD training has been influenced by substantial changes in medical education, science, and clinical fields since its inception. In 2014, NIGMS held a 50th Anniversary MSTP Symposium highlighting the program and assessing its outcomes. In 2016, there were over 90 active MD-PhD programs in the United States, of which 45 were MSTP supported, with a total of 988 trainee slots. Over 10,000 students have received MSTP support since 1964. The authors present data for the demographic characteristics and outcomes for 9,683 MSTP trainees from 1975-2014. The integration of MD and PhD training has allowed trainees to develop a rigorous foundation in research in concert with clinical training. MSTP graduates have had relative success in obtaining research grants and have become prominent leaders in many biomedical research fields. Many challenges remain, however, including the need to maintain rigorous scientific components in evolving medical curricula, to enhance research-oriented residency and fellowship opportunities in a widening scope of fields targeted by MSTP graduates, to achieve greater racial diversity and gender balance in the physician-scientist workforce, and to sustain subsequent research activities of physician-scientists.

Interprofessional Education: What Measurable Learning Outcomes Are Realistic for the Physician Assistant Profession?

PubMed

Lohenry, Kevin; Lie, Désirée; Fung, Cha-Chi; Crandall, Sonia; Bushardt, Reamer L

2016-06-01

To compare physician assistant (PA) students' attitudes regarding interprofessional education by students' seniority, gender, age, and previous experience with interprofessional education. The validated 19-item Readiness for Interprofessional Learning Scale and the 12-item Interdisciplinary Education Perception Scale were administered to matriculating and graduating PA students from 2 US institutions (N = 186). Primary outcomes were score differences by subgroup and institution using independent sample t-tests. We also examined scale validity measured by Cronbach's alpha (internal consistency) and Pearson correlation coefficients (concurrent validity). Student demographics at both institutions were similar. Initial comparisons did not demonstrate significant institutional differences. Consequently, data were combined for subsequent analyses. Matriculating students had significantly higher mean Readiness for Interprofessional Learning Scale scores than did graduating students. No significant differences were found by gender, age, or previous interprofessional education exposure for either scale. Both scales demonstrated high internal consistency (Readiness for Interprofessional Learning Scale α = 0.93; Interdisciplinary Education Perception Scale α = 0.84). Physician assistant student attitudes regarding interprofessional education are very positive at matriculation and are less positive at graduation. Physician assistant student attitudes do not vary by gender, age, or previous interprofessional education exposure. Physician assistant educators should ensure that students' interprofessional education exposure makes full use of the students' initial positive attitudes and focuses on skill development for interprofessional education competencies.

Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

PubMed

Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

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.

Variations in patient response to tiered physician networks.

PubMed

Sinaiko, Anna D

2016-06-01

Prior studies found that tiered provider networks channel patients to preferred providers in certain contexts. This paper evaluates whether the effects of tiered physician networks vary for different types of patients. Cross-sectional analysis of fiscal year 2009 to 2010 administrative enrollment and claims data on nonelderly beneficiaries in Massachusetts Group Insurance Commission health plans. Main outcome measures are physician market share among new patients and the percent of physician's patients who switch away. We utilized estimated fixed effects linear regression models that were stratified by patient characteristics. Physicians with the worst tier rankings had lower market share among new patients who are older and sicker, or male, representing losses in market share of 10% and 15%, respectively, than other tiered physicians. A poor tier ranking did not affect physician market share of new patients who are female or younger. There was no effect of a physician's tier ranking on the proportion of patients who switch to other doctors among any groups of patients. Loyalty to their own physicians is pervasive across groups of patients. Physicians with poor tier rankings lost market share among new patients who are older and sicker, and among new male patients. Together, these findings suggest that tiered network designs have the potential for the greatest impact on value in healthcare over time, as more patients seek new relationships with physicians.

Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review.

PubMed

Lovink, Marleen H; Persoon, Anke; Koopmans, Raymond T C M; Van Vught, Anneke J A H; Schoonhoven, Lisette; Laurant, Miranda G H

2017-09-01

To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long-term care facilities and primary healthcare for the ageing population (primary aim) and to describe what influences the implementation (secondary aim). Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians. A systematic literature review. PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL, Web of Science; searched January 1995-August 2015. Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary. Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level. Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions. © 2017 John Wiley & Sons Ltd.

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

PubMed

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 <. 001. In respective multivariate models for female and male physicians, age and academic positions were significantly related to a higher number of published 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

Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature.

PubMed

Mansukhani, Meghna P; Kolla, Bhanu Prakash; Surani, Salim; Varon, Joseph; Ramar, Kannan

2012-07-01

Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.

Recruitment and Retention of Rural Physicians: Outcomes from the Rural Physician Associate Program of Minnesota

ERIC Educational Resources Information Center

Halaas, Gwen Wagstrom; Zink, Therese; Finstad, Deborah; Bolin, Keli; Center, Bruce

2008-01-01

Context: Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with…

The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes.

PubMed

Leykum, Luci K; Chesser, Hannah; Lanham, Holly J; Carla, Pezzia; Palmer, Ray; Ratcliffe, Temple; Reisinger, Heather; Agar, Michael; Pugh, Jacqueline

2015-12-01

Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients. Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients' outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates. Eleven inpatient medicine teams' daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework. Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included. Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn's tests. Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001). Improving sensemaking may be a strategy for improving patient outcomes, fostering a

Physician Expectations of Treatment Outcomes for Patients With Brain Metastases Referred for Whole Brain Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barnes, Elizabeth A., E-mail: toni.barnes@sunnybrook.c; Chow, Edward; Tsao, May N.

2010-01-15

Purpose: Patients with advanced cancer are referred to our Rapid Response Radiotherapy Program for quick access to palliative radiotherapy. The primary objective of this prospective study was to determine the physician expectations of the treatment outcomes for patients with brain metastases referred for whole brain radiotherapy (WBRT). The secondary objectives were to determine the factors influencing the expectations and to examine the accuracy of the physician-estimated patient survival. Methods and Materials: Patients were identified during a 17-month period. The referring physicians were sent a survey by facsimile to be completed and returned before the patient consultation. Information was sought onmore » the patient's disease status, the physician's expectations of WBRT, the estimated patient survival and performance status, and physician demographic data. Results: A total of 137 surveys were sent out, and the overall response rate was 57.7%. The median patient age was 66 years (range, 35-87), 78.5% had multiple brain metastases, 42.3% had a controlled primary tumor, and 62.3% had extracranial disease. WBRT was thought to stabilize neurologic symptoms, improve quality of life, and allow for a Decadron (dexamethasone) taper by >=94.9% of the referring physicians; 87.0% thought WBRT would improve performance status; 77.9% thought it would improve neurologic symptoms; and 40.8% thought it would improve survival. The referring physicians estimated patient survival as a median of 6.0 months; however, the actual survival was a median of 2.5 months, for a median individual difference of 1.9 months (p < .0001). Conclusion: Physicians referring patients with brain metastases for consideration of WBRT are often overly optimistic when estimating the clinical benefit of the treatment and overestimate patient survival. These findings highlight the need for education and additional research in this field.« less

Patient-reported outcomes in type 2 diabetes mellitus: patients' and primary care physicians' perspectives in the Spanish health care system.

PubMed

Franch-Nadal, Josep; Labrador Barba, Elena; Gómez-García, M Carmen; Buil-Cosiales, Pilar; Millaruelo, José Manuel; Peña, María Luisa Orera

2015-01-01

Understanding patients' and physicians' perceptions of type 2 diabetes mellitus (T2DM) management and treatment has important implications for diabetes care, allowing the identification of clinical practice issues that could be improved, leading to patients' better understanding of the illness and, consequently, healthier self-management behaviors. The objective of this study was to identify differences between physicians' and T2DM patients' perceptions related to health status, patient-reported outcomes assessments, and T2DM management and treatment, in routine clinical practice in Spain. This was an observational, cross-sectional study including 1,012 T2DM patients and 974 physicians from 47 and 52 Spanish provinces, respectively. An electronic structured self-administered questionnaire containing 17 questions was designed aiming to address both physicians' and patient's perceptions on overall T2DM health status and patient-reported outcomes. T2DM patients perceived a worse health status (40% reported having a "good" and 38% a "neither good nor bad" health status) compared with physicians' perceptions (77% thought patients had a "good" health status). Most patients answered being "satisfied" or "neither satisfied nor unsatisfied" with the given information, while physicians considered that patients were "satisfied" or "very satisfied" with the information for self-monitoring blood glucose and treatment administration. Fifty-seven percent of patients reported that medical recommendations were "important", while 58% of physicians considered it as "very important". Fifty-three percent of patients perceived that their current T2DM treatment suited their preferences "quite a lot", and this was lower than the proportion of physicians (69%) that believed this for their patients. Additionally, a lower percentage of patients (53%) than physicians (79%) believed that their treatment improved their health-related quality of life "quite a lot". All differences between

Nurse-driven, protocol-directed weaning from mechanical ventilation improves clinical outcomes and is well accepted by intensive care unit physicians.

PubMed

Danckers, Mauricio; Grosu, Horiana; Jean, Raymonde; Cruz, Raul B; Fidellaga, Amelita; Han, Qifa; Awerbuch, Elizabeth; Jadhav, Nagesh; Rose, Keith; Khouli, Hassan

2013-08-01

Ventilator weaning protocols can improve clinical outcomes, but their impact may vary depending on intensive care unit (ICU) structure, staffing, and acceptability by ICU physicians. This study was undertaken to examine their relationship. We prospectively examined outcomes of 102 mechanically ventilated patients for more than 24 hours and weaned using nurse-driven protocol-directed approach (nurse-driven group) in an intensivist-led ICU with low respiratory therapist staffing and compared them with a historic control of 100 patients who received conventional physician-driven weaning (physician-driven group). We administered a survey to assess ICU physicians' attitude. Median durations of mechanical ventilation (MV) in the nurse-driven and physician-driven groups were 2 and 4 days, respectively (P = .001). Median durations of ICU length of stay (LOS) in the nurse-driven and physician-driven groups were 5 and 7 days, respectively (P = .01). Time of extubation was 2 hours and 13 minutes earlier in the nurse-driven group (P < .001). There was no difference in hospital LOS, hospital mortality, rates of ventilator-associated pneumonia, or reintubation rates between the 2 groups. We identified 4 independent predictors of weaning duration: nurse-driven weaning, Acute Physiology and Chronic Health Evaluation II score, vasoactive medications use, and blood transfusion. Intensive care unit physicians viewed this protocol implementation positively (mean scores, 1.59-1.87 on a 5-point Likert scale). A protocol for liberation from MV driven by ICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients for more than 24 hours without adverse effects and was well accepted by ICU physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

Physician-assisted death. Opinions of a sample of Mexican physicians.

PubMed

Lisker, Rubén; Alvarez Del Rio, Asunción; Villa, Antonio R; Carnevale, Alessandra

2008-05-01

There is insufficient information on what Mexicans think of physician-assisted death, a problem that is currently being discussed in our legislative bodies. This paper discusses the findings among a sample of physicians. The sample was formed by 2097 physicians from several specialties employed by a Mexican government health system, distributed throughout the country. Each physician received a structured questionnaire exploring what they thought of two different scenarios related to physician-assisted death: 1) intolerable suffering of patients; and 2) persistent vegetative state (PVS). Questions included data on several personal characteristics of the respondents and two open-ended questions asking the reasons why they answered the main questions as they did. There was an overall response rate of 47.3%. Approximately 40% agreed with physicians helping terminally ill patients request to die because of intolerable suffering caused by incurable diseases, whereas 44% said no and the rest were undecided. This was statistically different from the answers to the scenario where the relatives of a patient in a PVS ask their physician to help him or her die, where 48% of respondents said yes, and 35% said no. The main reasons to say yes in both scenarios were respect for patients or family autonomy and to avoid suffering, whereas those opposed cited other ethical and mainly religious considerations. The variable with the highest probability to approve both scenarios was of a legal nature, whereas strong religious beliefs were against accepting physician-assisted death. The group was evenly divided with approximately 40% each between those for and against the idea of helping die a patient and approximately 20% were undecided.

German Ambulatory Care Physicians' Perspectives on Continuing Medical Education--A National Survey

ERIC Educational Resources Information Center

Kempkens, Daniela; Dieterle, Wilfried E.; Butzlaff, Martin; Wilson, Andrew; Bocken, Jan; Rieger, Monika A.; Wilm, Stefan; Vollmar, Horst C.

2009-01-01

Introduction: This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. Methods: A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were…

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

PubMed Central

Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

2017-01-01

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

A qualitative study of emergency physicians' perspectives on PROMS in the emergency department.

PubMed

Dainty, Katie N; Seaton, Bianca; Laupacis, Andreas; Schull, Michael; Vaillancourt, Samuel

2017-09-01

There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To better understand the root of this challenge, we looked to ED physicians' perspectives on their role, relationships and responsibilities to inform future development and implementation of patient-reported outcome measures (PROMs). ED physicians from hospitals across Canada were invited to participate in interviews using a snowballing sampling technique. Semistructured interviews were conducted by phone with questions focused on the role and practice of ED physicians, their relationship with their patients and their thoughts on patient-reported feedback as a mechanism for quality improvement. Transcripts were analysed using a modified constant comparative method and interpretive descriptive framework. Interviews were completed with 30 individual physicians. Respondents were diverse in location, training and years in practice. Physicians reported being interested in 'objective' postdischarge information including adverse events, readmissions, other physicians' notes, etc in a select group of complex patients, but saw 'patient-reported' feedback as less valuable due to perceived biases. They were unsure about the impact of such feedback mainly because of the episodic nature of their work. Concerns about timing, as well as about their legal and ethical responsibilities to follow-up if poor patient outcomes are reported, were raised. Data collection and feedback are key elements of a learning health system. While patient-reported outcomes may have a role in feedback, ED physicians are conflicted about the actionability of such data and ethical implications, given the inherently episodic nature of their work. These findings have important implications for PROM design and implementation in this unique clinical setting. Published by the BMJ Publishing Group Limited. For permission to use

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

PubMed

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

2017-06-01

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

Leadership development programs for physicians: a systematic review.

PubMed

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

2015-05-01

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

The effect of HMO penetration on physician retirement.

PubMed

Kletke, P R; Polsky, D; Wozniak, G D; Escarce, J J

2000-12-01

To examine the effect of HMO penetration on physician retirement. We linked together historical data from the Physician Masterfile of the American Medical Association for successive years to track changes in physicians' activity status between 1980 and 1997. We used a multivariate discrete-time survival model to examine how the probability of physician retirement was affected by the level of HMO penetration in the physician's market area, controlling for other physician and market characteristics. The study population included all active allopathic patient-care physicians in the United States who reached age 55 between the years of 1980 and 1996. The main outcome measure was physician retirements as reported on the Physician Masterfile. HMO penetration had a statistically significant positive effect on the retirement probabilities of generalists and medical/surgical specialists, but it s effect on hospital-based specialists and psychiatrists was not significant . For generalists regression-adjusted retirement probabilities were roughly 13 percent greater in high-penetration markets (HMO penetration of 45 percent ) than in low-penetration markets (HMO penetration of 5 percent ). For medical/surgical specialist s regression-adjusted retirement probabilities were roughly 17 percent greater in high-penetration markets than in low-penetration markets. Our findings suggest that many older physicians have found it preferable to retire rather than adapt their practices to an environment with a high degree of managed care penetration . Because the number of physicians entering the older age categories will increase rapidly over the next 20 years, the growth of managed care and other influences on physician retirement will play an increasingly important role in determining the size of the physician workforce.

[The living conditions of Jewish physicians in Frankfort on Main in the late Middle Ages and Early Modern Times].

PubMed

Treue, W

1998-01-01

During almost the entire period covered in this article (ca. 1345-1745), the living conditions of Jewish physicians in the Free Imperial City of Frankfort on Main depended to a large extent on the attitudes of the Town Council. The Council, with its increasingly absolutist conception of government, supervised Jewish doctors very closely; on the other hand, it also protected them against the recurrent attacks of Christian physicians, pharmacists and clergymen. The Council understood the importance of the Jewish community to the city's economy, and the contribution of Jewish physicians to the welfare of the city and the neighboring principalities. Until the late 15th century, Jewish medical students were not admitted to European universities; the unique exception was Padua. Hence, arguments against Jewish physicians revolved around their lack of academic qualifications. Such claims were weakened at the end of the 16th century, when the first Jewish graduates from Padua University arrived in Frankfort. The opening of Western European universities in the 17th and 18th centuries enabled increasing numbers of Jews to obtain academic training. The medical profession had become a tradition in many Jewish families, beginning in the Middle Ages; and this tradition was now reinforced and complemented by academic credentials.

Cross-sectional survey of Good Samaritan behaviour by physicians in North Carolina

PubMed Central

Garneau, William M; Harris, Dean M; Viera, Anthony J

2016-01-01

Objective To assess the responses of physicians to providing emergency medical assistance outside of routine clinical care. We assessed the percentage who reported previous Good Samaritan behaviour, their responses to hypothetical situations, their comfort providing specific interventions and the most likely reason they would not intervene. Setting Physicians residing in North Carolina. Participants Convenience sample of 1000 licensed physicians. Intervention Mailed survey. Design Cross-sectional study conducted May 2015 to September 2015. Main outcome and measures Willingness of physicians to act as Good Samaritans as determined by the last opportunity to intervene in an out-of-office emergency. Results The adjusted response rate was 26.1% (253/970 delivered). 4 out of 5 physicians reported previous opportunities to act as Good Samaritans. Approximately, 93% reported acting as a Good Samaritan during their last opportunity. There were no differences in this outcome between sexes, practice setting, specialty type or experience level. Doctors with greater perceived knowledge of Good Samaritan law were more likely to have intervened during a recent opportunity (p=0.02). The most commonly cited reason for potentially not intervening was that another health provider had taken charge. Conclusions We found the frequency of Good Samaritan behaviour among physicians to be much higher than reported in previous studies. Greater helping behaviour was exhibited by those who expressed more familiarity with Good Samaritan law. These findings suggest that physicians may respond to legal protections. PMID:26966061

Management of Simple Clavicle Fractures by Primary Care Physicians.

PubMed

Stepanyan, Hayk; Gendelberg, David; Hennrikus, William

2017-05-01

The clavicle is the most commonly fractured bone. Children with simple fractures are often referred to orthopedic surgeons by primary care physician to ensure adequate care. The objective of this study was to show that simple clavicle fractures have excellent outcomes and are within the scope of primary care physician's practice. We performed a retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling. Primary outcomes were bony union, pain, and function. The patients with simple clavicle fractures had excellent outcomes with no complications or complaints of pain or restriction of their activities of daily living. The outcomes are similar whether treated by an orthopedic surgeon or a primary care physician. The cost to society and the patient is less when the primary care physician manages the fracture. Therefore, primary care physicians should manage simple clavicle fractures.

Adult bacterial meningitis-a quality registry study: earlier treatment and favourable outcome if initial management by infectious diseases physicians.

PubMed

Grindborg, Ö; Naucler, P; Sjölin, J; Glimåker, M

2015-06-01

Acute bacterial meningitis (ABM) is challenging for the admitting physician because it is a rare but fulminant disease, usually presenting without typical symptoms, and rapid treatment is pivotal. The purpose of this study was to evaluate the effect of initial management by infectious diseases (ID) physicians vs. non-ID physicians. A total of 520 consecutive adults (>17 years old), 110 with initial ID management and 410 with non-ID management, registered in the Swedish quality registry for community-acquired ABM January 2008 to December 2013, were analysed retrospectively. Primary outcome was appropriate treatment with antibiotics and corticosteroids <1 hour from admission. Secondary analyses were mortality during hospital stay and persisting neurological and hearing deficits at follow-up after 2 to 6 months. Differences in diagnostic treatment sequences also were analysed. Appropriate treatment <1 hour from admission was achieved significantly more often (41%) by ID physicians vs. non-ID physicians (24%) with an odds ratio (OR) of 2.4 (95% confidence interval [CI]: 1.40 to 4.14; p < 0.01) adjusted for confounders. The door-to-antibiotic time was significantly shorter, and significantly more patients were administered corticosteroids together with the first doses of antibiotics in the ID group. A trend of decreased mortality (4.5% vs. 8.0%) and sequelae at follow-up (24% vs. 44%; adjusted OR 0.55: 95% CI 0.31 to 1.00; p 0.05) were observed in the ID group vs. the non-ID group. Antibiotics were started without prior neuroimaging more often in the ID group (86% vs. 57%; p < 0.001). Initial management at the emergency department by ID physicians is associated with earlier appropriate treatment, more appropriate diagnostic treatment sequences and favourable outcome. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures

PubMed Central

2011-01-01

Background Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional inpatient physicians who maintain hospital privileges with concurrent outpatient practices. Methods Articles on hospitalist performance published between January 1996 and December 2010 were identified through MEDLINE, Embase, Science Citation Index, CINAHL, NHS Economic Evaluation Database and a hand-search of reference lists, key journals and editorials. Comparative evaluations presenting original, quantitative data on processes, efficiency or clinical outcome measures of care between hospitalists, community-based physicians and traditional academic attending physicians were included (n = 65). After proposing a conceptual framework for evaluating inpatient physician performance, major findings on quality are summarized according to their percentage change, direction and statistical significance. Results The majority of reviewed articles demonstrated that hospitalists are efficient providers of inpatient care on the basis of reductions in their patients' average length of stay (69%) and total hospital costs (70%); however, the clinical quality of hospitalist care appears to be comparable to that provided by their colleagues. The methodological quality of hospitalist evaluations remains a concern and has not improved over time. Persistent issues include insufficient reporting of source or sample populations (n = 30), patients lost to follow-up (n = 42) and estimates of effect or random variability (n = 35); inappropriate use of statistical tests (n = 55); and failure to adjust for established confounders (n = 37). Conclusions Future research should include an expanded focus on

Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction

PubMed Central

Chen, Jersey; Rathore, Saif S; Wang, Yongfei; Radford, Martha J; Krumholz, Harlan M

2006-01-01

BACKGROUND Patients and purchasers prefer board-certified physicians, but whether these physicians provide better quality of care and outcomes for hospitalized patients is unclear. OBJECTIVE We evaluated whether care by board-certified physicians after acute myocardial infarction (AMI) was associated with higher use of clinical guideline recommended therapies and lower 30-day mortality. SUBJECTS AND METHODS We examined 101,251 Medicare patients hospitalized for AMI in the United States and compared use of aspirin, β-blockers, and 30-day mortality according to the attending physicians' board certification in family practice, internal medicine, or cardiology. RESULTS Board-certified family practitioners had slightly higher use of aspirin (admission: 51.1% vs 46.0%; discharge: 72.2% vs 63.9%) and β-blockers (admission: 44.1% vs 37.1%; discharge: 46.2% vs 38.7%) than nonboard-certified family practitioners. There was a similar pattern in board-certified Internists for aspirin (admission: 53.7% vs 49.6%; discharge: 78.2% vs 68.8%) and β-blockers (admission: 48.9% vs 44.1%; discharge: 51.2% vs 47.1). Board-certified cardiologists had higher use of aspirin compared with cardiologists certified in internal medicine only or without any board certification (admission: 61.3% vs 53.1% vs 52.1%; discharge: 82.2% vs 71.8% vs 71.5%) and β-blockers (admission: 52.9% vs 49.6% vs 41.5%; discharge: 54.7% vs 50.6% vs 42.5%). In multivariate regression analyses, board certification was not associated with differences in 30-day mortality. CONCLUSIONS Treatment by a board-certified physician was associated with modestly higher quality of care for AMI, but not differences in mortality. Regardless of board certification, all physicians had opportunities to improve quality of care for AMI. PMID:16637823

Collaboration between family physicians and psychologists

PubMed Central

Grenier, Jean; Chomienne, Marie-Hélène; Gaboury, Isabelle; Ritchie, Pierre; Hogg, William

2008-01-01

OBJECTIVE To explore factors affecting collaboration between family physicians and psychologists. DESIGN Mailed French-language survey. SETTING Eastern Ontario. PARTICIPANTS Family physicians practising in the area of the Réseau des services de santé en français de l’Est de l’Ontario. MAIN OUTCOME MEASURES Physicians’ knowledge and understanding of the qualifications of psychologists and the regulations governing their profession; beliefs regarding the effectiveness of psychological treatments; views on the integration of psychologists into primary care; and factors affecting referrals to psychologists. RESULTS Of 457 surveys sent, 118 were returned and analyzed (27% of surveys delivered). Most family physicians were well aware that there were evidence-based psychological interventions for mental health and personal difficulties, and some knew that psychological interventions could help with physical conditions. Physicians had some knowledge about the qualifications and training of psychologists. Many physicians reported being uncomfortable providing counseling themselves owing to time constraints, the perception that they were inadequately trained for such work, and personal preferences. The largest barrier to referring patients to psychologists was cost, since services were not covered by public health insurance. Some physicians were deterred from referring by previous experience of not receiving feedback on patients from psychologists. Increased access to clinical psychologists through collaborative care was considered a desirable goal for primary health care. CONCLUSIONS Family physicians know that there are evidence-based psychological interventions for mental health issues. Psychologists need to communicate better about their credentials and what they can offer, and share their professional opinions and recommendations on referred patients. Physicians would welcome practice-based psychological services and integrated interdisciplinary collaboration

Performance assessment. Family physicians in Montreal meet the mark!

PubMed Central

Goulet, François; Jacques, André; Gagnon, Robert; Bourbeau, Denis; Laberge, Denis; Melanson, Jacques; Ménard, Claude; Racette, Pierre; Rivest, Raymond

2002-01-01

OBJECTIVE: To assess the clinical performance of a representative non-volunteer sample of family physicians in metropolitan Montreal, Que. DESIGN: Assessment of clinical performance was based on inspection visits to offices, peer review of medical records, and chart-stimulated recall interviews. The procedure was the one usually followed by the Professional Inspection Committee of the Collège des médecins du Québec. SETTING: Family physicians' practices in metropolitan Montreal. PARTICIPANTS: One hundred randomly selected family physicians. INTERVENTIONS: For each physician, 30 randomly chosen patient charts with data on three to five previous visits were reviewed using explicit criteria and a standard scale using global scores from 1 to 5 (unacceptable to excellent). MAIN OUTCOME MEASURES: Scores were assigned for office practices; record keeping; number of continuing medical education (CME) activities; and quality of clinical performance assessed in terms of investigation plan, diagnostic accuracy, treatment plan, and relevance of care. RESULTS: Overall performance was judged to be good to excellent for 98% of physicians in their private practices; for 90% of physicians concerning CME activities; for 94% of physicians concerning their clinical performance in terms of quality of care; and for 75% of physicians as to record keeping. There was a link between record keeping and quality of care as well as between the number of CME activities and quality of care. CONCLUSION: The overall clinical performance of family physicians in the greater Montreal region is excellent. PMID:12228963

Facilitating collaboration between pharmacists and physicians using an iterative interview process

PubMed Central

Chui, Michelle A.; Stone, Jamie A.; Odukoya, Olufumilola K.; Maxwell, Leigh

2014-01-01

Objective To elicit and describe mutually agreed upon common problems and subsequent solutions resulting from a facilitated face-to-face meeting between pharmacists and physicians. Design Descriptive, exploratory, non-experimental study. Setting Wisconsin from October to December 2011. Participants Physicians and community pharmacists Intervention Face-to-face semi-structured interviews with pharmacists and physicians from the same community, informed by previous individual interviews. Main outcome measure Methods to enhance collaboration and barriers to implementing collaboration between pharmacists and physicians Results Physicians and pharmacists generated ideas in which collaboration could improve patient care, including controlled substance monitoring, medication adherence, collaborative practice agreements for point of service issues, and a mechanism for urgent communication. Methods on how to collaborate on these issues were also discussed. Conclusions Bringing physicians and pharmacists together for a face-to-face interaction that was informed by information gained in previous individual interviews successfully stimulated conversation on ways in which each profession could help the other provide optimal patient care. This interaction appeared to dispel assumptions and build trust. Results of this project may provide pharmacists with the confidence to reach out to their physician colleagues. PMID:24362573

Physician-patient interaction in reproductive counseling.

PubMed

Lipkin, M

1996-09-01

To review the scientific and clinical bases for effective patient counseling in contraceptive care. All articles and chapters in the Annotated Bibliography of Doctor Patient Communication of the Task Force on Doctor and Patient of the American Academy on Physician and Patient were searched and included. This is an expert-derived data base based on MEDLINE review from 1969 to 1994 and including expert-selected additions from PsychLit and a variety of other social science data bases, books, and reviews. Expert consensus was used from the Committee on Bibliography of the American Academy on Physician and Patient. The doctor-patient interaction is the main determinant of the accuracy and completeness of patient data, diagnostic accuracy, efficiency in the encounter, compliance, patient understanding of problems, and patient and physician satisfaction. Yet this critical skill is inadequately taught and practiced, with serious consequences for patient care and physician job satisfaction. Use of the 14 structural elements (preparing the environment, preparing oneself, observation, greeting, introduction, detecting and overcoming barriers to communication, surveying problems, negotiating a priority problem, developing a narrative thread, establishing the life context of the patient, establishing a safety net, presenting findings and options, negotiating plans, and closing) and three functions (gathering information, developing a therapeutic relationship, and patient education) and their associated behaviors improves encounter results significantly. Other helpful activities are patient activation, facilitating partnership, review of findings and plans, eliciting and responding to patients' attitudes and emotions about contraception and fertility, and use of empathy and positive regard. The use of scientifically derived, empirically validated interview skills substantially improves outcomes in contraceptive and other patient education and counseling. Use of appropriate

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

PubMed

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 < 0.001); higher trust in physician (5.10 vs. 3.00, F = 39.7, P < 0.001); and lower scores for anger (2.49 vs. 3.78, F = 18.0, P < 0.001), sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P < 0.001), and disgust (2.45 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.

Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study

PubMed Central

Williams, Eric S; Konrad, Thomas R; Linzer, Mark; McMurray, Julia; Pathman, Donald E; Gerrity, Martha; Schwartz, Mark D; Scheckler, William E; Douglas, Jeff

2002-01-01

Objective To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. Data Sources Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. Study Design A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. Principle Findings The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. Conclusions These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both “physician friendly” and “family friendly” seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.

Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?

PubMed

Heslin, Kevin C; Andersen, Ronald M; Ettner, Susan L; Kominski, Gerald F; Belin, Thomas R; Morgenstern, Hal; Cunningham, William E

2005-10-01

Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8-12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

Can complexity science inform physician leadership development?

PubMed

Grady, Colleen Marie

2016-07-04

Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical

Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences.

PubMed

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.

Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada.

PubMed

Paré, Guy; Raymond, Louis; Guinea, Ana Ortiz de; Poba-Nzaou, Placide; Trudel, Marie-Claude; Marsan, Josianne; Micheneau, Thomas

2015-10-01

The importance and potential value of office-based electronic health record (EHR) systems is being recognized internationally. We thus sought to better understand how EHRs are actually being used by family physicians and what they perceive to be the main performance outcomes for themselves and their medical practices. We conducted a survey of family physicians practicing in medical practices in Quebec, Canada (n =331). Bivariate and multivariate statistical analyses were conducted to characterize EHR usage behaviors and assess the perceived performance outcomes of these systems. EHR systems "as-used" vary substantively from one family physician to another in terms of the capabilities that are actually mobilized by them. Significant differences between "basic" and "advanced" users were observed in terms of the EHR system's characteristics and perceived performance outcomes. Physicians were also clustered under three profiles that could be clearly distinguished from one another, in terms of the extent to which their performance and their practice's performance was impacted by their EHR usage. Physicians that are "highly impacted" by their EHR system are those who have the longest usage experience and make the most extended use of their system's capabilities. Our study indicates that only a minority of family physicians in our sample use most of the features available in their EHR system. Consequently, few physicians perceive gaining significant performance improvements from such systems. Future research must identify the factors that motivate primary care physicians to assimilate EHR systems in a more extensive manner. Copyright © 2015. Published by Elsevier Ireland Ltd.

On assessing the quality of physicians' clinical judgment: the search for outcome variables.

PubMed

Wainer, Howard; Mee, Janet

2004-12-01

A primary question that must be resolved in the development of tasks to assess the quality of physicians' clinical judgment is, "What is the outcome variable?" One natural choice would seem to be the correctness of the clinical decision. In this article, we use data on the diagnosis of urinary tract infections among young girls to illustrate why, in many clinical situations, this is not a useful variable. We propose instead a judgment weighted by the relative costs of an error. This variable has the disadvantage of requiring expert judgment for scoring, but the advantage of measuring the construct of interest.

Occupational physicians and environmental medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ducatman, A.M.

1993-03-01

Physicians who practice environmental medicine seek to identify and to prevent patient and population exposures that cause adverse human health outcomes. Epidemiologic, toxicologic, clinical, and public health skills essential to this enterprise are indistinguishable from those of the occupational physician. Several important controversies illustrate the essential role of occupational physicians in environmental health science and policy, including environmental asbestos, dioxin, electromagnetic fields, and carcinogenicity testing. Our continuing involvement in environmental issues is predicted by three conditions, each unlikely to change. The human remains the animal of greatest interest; the natural experiment will have been performed (however unwittingly); and the workmore » site will continue to provide that first and clearest setting for measuring the outcome. Therefore, residency training must be expanded so that future occupational and environmental physicians will recognize their fundamental role in environmental health. The results of our industry cross factory walls with ease. So must our efforts.« less

Graduating into a downturn: Are physicians recession proof?

PubMed

Chen, Alice; Sasso, Anthony Lo; Richards, Michael R

2018-01-01

An extensive literature documents immediate and persistent adverse labor market outcomes for individuals graduating into an economic downturn, but these effects are heterogeneous across sectors, occupations, and skill levels. In particular, the impact of recessions on the labor market outcomes for new physician graduates remains unknown. We leverage a unique dataset on New York physicians to analyze if and how the Great Recession impacted the labor market of physicians who have completed their residency and fellowship training and are seeking their first job. We find that these physicians do not delay labor market entry and their job searches and other employment outcomes are unaffected by the business cycle. The collage of evidence demonstrates that new graduates were largely unfazed by the recent downturn, which sharply contrasts with other highly educated, high remunerating occupations. Copyright © 2017 John Wiley & Sons, Ltd.

Physician attitudes toward industry: a view across the specialties

PubMed Central

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

2010-01-01

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

Willingness to follow breast cancer. Survey of family physicians.

PubMed Central

Worster, A.; Bass, M. J.; Wood, M. L.

1996-01-01

OBJECTIVE: To identify the experience and willingness of family physicians to accept follow-up care of patients treated for stage I breast cancer. DESIGN: Mailed questionnaire. PARTICIPANTS: One hundred eighty-nine family physicians in southwestern Ontario with oversampling of female physicians and physicians practising more than 20 km from a cancer clinic. MAIN OUTCOME MEASURE: Willingness to follow breast cancer patients and time after treatment family physicians would be willing to begin follow-up care. RESULTS: We had an 81.5% response rate. Of the 154 respondents, 53% had been involved previously in the 5-year, follow-up care of a patient with breast cancer and 77.1% believed it appropriate for family physicians to assume responsibility for follow-up care in all or most cases. If asked by a patient, the family, or an oncologist to provide follow-up care, 90.1% of family physicians reported they would accept this responsibility. Willingness to follow breast cancer patients was not associated with sex, years in practice, proximity to a cancer clinic, or certification status but was associated with having previously provided such care (P = .043). Of those willing to care for these patients, almost 90% would prefer to start within 1 year of treatment. CONCLUSION: Although only half the respondents had experience in providing follow-up care to breast cancer patients, most were willing to take on this role, especially if asked. PMID:9222575

Can Outcome-Based Continuing Medical Education Improve Performance of Immigrant Physicians?

ERIC Educational Resources Information Center

Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Introduction: Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians…

Career satisfaction of US women physicians: results from the Women Physicians' Health Study. Society of General Internal Medicine Career Satisfaction Study Group.

PubMed

Frank, E; McMurray, J E; Linzer, M; Elon, L

1999-07-12

Despite major changes in health care, the prevalence and predictors of career satisfaction have not recently been comprehensively studied in either women or men physicians. The Women Physicians' Health Study surveyed a nationally representative random sample (n = 4501 respondents; response rate, 59%) of US women physicians. Using univariate and logistic regression analyses, we examined personal and professional characteristics that were correlated with 3 major outcomes: career satisfaction, desire to become a physician again, and desire to change one's specialty. Women physicians were generally satisfied with their careers (84% usually, almost always, or always satisfied). However, 31% would maybe, probably, or definitely not choose to be a physician again, and 38% would maybe, probably, or definitely prefer to change their specialty. Physician's age, control of the work environment, work stress, and a history of harassment were independent predictors of all 3 outcomes, with younger physicians and those having least work control, most work stress, or having experienced severe harassment reporting the most dissatisfaction. The strongest association (odds ratio, 11.3; 95% confidence interval, 7.3-17.5; P<.001) was between work control and career satisfaction. Other significant predictors (P<.01) of outcomes included birthplace, ethnicity, sexual orientation, having children, stress at home, religious fervor, mental health, specialty, practice type, and workload. Women physicians generally report career satisfaction, but many, if given the choice, would not become a physician again or would choose a different specialty. Correctable factors such as work stress, harassment, and poor control over work environment should be addressed to improve the recruitment and retention of women physicians.

A qualitative study of physicians' own wellness-promotion practices

PubMed Central

Weiner, Eric L; Swain, Geoffrey R; Wolf, Barbara; Gottlieb, Mark

2001-01-01

Objective To delineate the specific practices that physicians use to promote their own well-being. Design, setting, and participants 304 members of a primary care practice-based research group responded by mail to a survey on physician well-being. From the original survey, 130 subjects responded to an open-ended survey item regarding their own wellness-promotion practices. Methods Qualitative content analysis was used to identify the common themes in the physicians' responses to the open-ended question. A validated 18-item instrument, the Scales of Psychological Well-Being (SPWB), was used for measurement. Main outcome measures Similarities and differences between the various wellness-promotion practices that respondents reported using and associations between the use of these practices and SPWB scores. Results The 5 primary wellness-promotion practices that evolved from thematic analysis of the survey responses included “relationships,” “religion or spirituality,” “self-care,” “work,” and “approaches to life.” The use of the last type of practice was significantly associated with increased psychological well-being (SPWB) scores compared with the use of any of the other wellness-promotion practice categories (P<0.01), and there was a trend toward increased well-being among users of any category of wellness-promotion practices. Comments by our respondents provide specific descriptions of how physicians attend to their emotional, spiritual, and psychological well-being. Conclusion Physicians use a variety of approaches to promote their own well-being, which sort themselves into 5 main categories and appear to correlate with improved levels of psychological well-being among users. PMID:11154656

What works in genomics education: outcomes of an evidenced-based instructional model for community-based physicians.

PubMed

Reed, E Kate; Johansen Taber, Katherine A; Ingram Nissen, Therese; Schott, Suzanna; Dowling, Lynn O; O'Leary, James C; Scott, Joan A

2016-07-01

Education of practicing health professionals is likely to be one factor that will speed appropriate integration of genomics into routine clinical practice. Yet many health professionals, including physicians, find it difficult to keep up with the rapid pace of clinical genomic advances and are often uncomfortable using genomic information in practice. Having identified the genomics educational needs of physicians in a Silicon Valley-area community hospital, we developed, implemented, and evaluated an educational course entitled Medicine's Future: Genomics for Practicing Doctors. The course structure and approach were based on best practices in adult learning, including interactivity, case-based learning, skill-focused objectives, and sequential monthly modules. Approximately 20-30 physicians attended each module. They demonstrated significant gains in genomics knowledge and confidence in practice skills that were sustained throughout and following the course. Six months following the course, the majority of participants reported that they had changed their practice to incorporate skills learned during the course. We believe the adult-learning principles underlying the development and delivery of Medicine's Future were responsible for participants' outcomes. These principles form a model for the development and delivery of other genomics educational programs for health professionals.Genet Med 18 7, 737-745.

Geographic distribution of physicians in Portugal.

PubMed

Isabel, Correia; Paula, Veiga

2010-08-01

The main goals of this paper are to (1) analyse the inequality in geographic distribution of physicians and its evolution, (2) estimate the determinants of physician density, and (3) assess the importance of competitive and agglomerative forces in location decisions. The analysis of the geographic distribution of physicians is based on the ratio of general practitioners (GPs) and specialists to 1,000 inhabitants. The inequality is measured using Gini indices, coefficients of variation, and physician-to-population ratios. The econometric models were estimated by ordinary least squares. The data used refer to 1996 and 2007. The impact of the growing number of physicians, and therefore potential increased competition, on geographic distribution during the period studied was small. Nonetheless, there is evidence of competitive forces acting on the dynamics of doctor localisation. Geographic disparities in physician density are still high, and appear to be due mainly to geographic income inequality.

Do Physicians Spend More Time with Non-English-Speaking Patients?

PubMed Central

Tocher, Thomas M; Larson, Eric B

1999-01-01

OBJECTIVE To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians’ perceptions of their time use with a questionnaire. SETTING Primary care internal medicine clinic at a county hospital. PATIENTS/PARTICIPANTS One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians. MEASUREMENTS AND MAIN RESULTS Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90.4%), (both p < .01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients. CONCLUSIONS There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients’ satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers. PMID:10337040

Outcome of parent-physician communication skills training for pediatric residents.

PubMed

Nikendei, Christoph; Bosse, Hans Martin; Hoffmann, Katja; Möltner, Andreas; Hancke, Rabea; Conrad, Corinna; Huwendiek, Soeren; Hoffmann, Georg F; Herzog, Wolfgang; Jünger, Jana; Schultz, Jobst-Hendrik

2011-01-01

communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients' parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design. parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n=14) participated in a communication training with standardized parents. Control-group physicians (n=14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training. regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p<.024) and tended to perform better in exploring parents' problems (p<.081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p<.046). even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy. PRACTISE IMPLICATIONS: briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice. 2010 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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.

Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

PubMed

Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

2009-11-01

Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

Family physician practice visits arising from the Alberta Physician Achievement Review

PubMed Central

2013-01-01

Background Licensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice. Methods Retrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group. Results Reports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence. Conclusion This study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians. PMID:24010980

The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.

PubMed

Al-Amin, Mona; Makarem, Suzanne C

2016-01-01

The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.

Gainsharing Strategies, Physician Champions, Getting Physician Buy In.

PubMed

Anoushiravani, Afshin A; Nunley, Ryan M

2017-06-01

As healthcare spending continues to outpace economic growth, legislators and healthcare economists have explored many processes aimed at improving efficiency and reducing waste. Gainsharing or the general concept that organizations and their employees can work together to continually improve outcomes at reduced expenditures in exchange for a portion of the savings has been shown to be effective within the healthcare system. Although gainsharing principles may be applicable to healthcare organizations and their physician partners, specific parameters should be followed when implementing these arrangements. This article will discuss 10 gainsharing strategies aimed at properly aligning healthcare organizations and physicians, which if followed will ensure the successful implementation of gainsharing initiatives. Copyright © 2017. Published by Elsevier Inc.

In for the long haul. Which family physicians plan to continue delivering babies?

PubMed Central

Klein, Michael C.; Kelly, Ann; Spence, Andrea; Kaczorowski, Janusz; Grzybowski, Stefan

2002-01-01

OBJECTIVE: To compare characteristics of family physicians planning to discontinue or stay in intrapartum care. DESIGN: Self-administered questionnaire. SETTING: Department of Family Practice at Children's and Women's Health Centre of British Columbia. PARTICIPANTS: Ninety-five family physicians who attended at least one birth at the Health Centre between April 1997 and August 1998. MAIN OUTCOME MEASURES: Intention to leave or stay in family practice maternity care, physician characteristics and beliefs. RESULTS: Forty-five percent (43/95) of family physicians planned to leave maternity care within the next 5 years. Physicians planning to leave had more negative attitudes about the alternative birthing centre, doulas, and practising in free-standing settings without on-site obstetricians; were more likely to report missing personal events because they had put their maternity patients first; were less likely to make housecalls during women's labour; and were more likely to be paid through fee-for-service. CONCLUSION: Being paid by fee-for-service, having negative attitudes toward non-traditional maternity care, and conflict between maternity care and personal life were associated with intention to leave intrapartum care. PMID:12166012

Physician behavioral adaptability: A model to outstrip a "one size fits all" approach.

PubMed

Carrard, Valérie; Schmid Mast, Marianne

2015-10-01

Based on a literature review, we propose a model of physician behavioral adaptability (PBA) with the goal of inspiring new research. PBA means that the physician adapts his or her behavior according to patients' different preferences. The PBA model shows how physicians infer patients' preferences and adapt their interaction behavior from one patient to the other. We claim that patients will benefit from better outcomes if their physicians show behavioral adaptability rather than a "one size fits all" approach. This literature review is based on a literature search of the PsycINFO(®) and MEDLINE(®) databases. The literature review and first results stemming from the authors' research support the validity and viability of parts of the PBA model. There is evidence suggesting that physicians are able to show behavioral flexibility when interacting with their different patients, that a match between patients' preferences and physician behavior is related to better consultation outcomes, and that physician behavioral adaptability is related to better consultation outcomes. Training of physicians' behavioral flexibility and their ability to infer patients' preferences can facilitate physician behavioral adaptability and positive patient outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Trends in physician referrals in the United States, 1999-2009.

PubMed

Barnett, Michael L; Song, Zirui; Landon, Bruce E

2012-01-23

Physician referrals play a central role in ambulatory care in the United States; however, little is known about national trends in physician referrals over time. The objective of this study was to assess changes in the annual rate of referrals to other physicians from physician office visits in the United States from 1999 to 2009. We analyzed nationally representative cross-sections of ambulatory patient visits in the United States, using a sample of 845 243 visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2009, focusing on the decade from 1999 to 2009. The main outcome measures were survey-weighted estimates of the total number and percentage of visits resulting in a referral to another physician across several patient and physician characteristics. From 1999 to 2009, the probability that an ambulatory visit to a physician resulted in a referral to another physician increased from 4.8% to 9.3% (P < .001), a 94% increase. The absolute number of visits resulting in a physician referral increased 159% nationally during this time, from 41 million to 105 million. This trend was consistent across all subgroups examined, except for slower growth among physicians with ownership stakes in their practice (P = .02) or those with the majority of income from managed care contracts (P = .007). Changes in referral rates varied according to the principal symptoms accounting for patients' visits, with significant increases noted for visits to primary care physicians from patients with cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms. The percentage and absolute number of ambulatory visits resulting in a referral in the United States grew substantially from 1999 to 2009. More research is necessary to understand the contribution of rising referral rates to costs of care.

Market effects on electronic health record adoption by physicians.

PubMed

Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

2008-01-01

Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

Aligning with physicians to regionalize services.

PubMed

Fink, John

2014-11-01

When effectively designed and implemented, regionalization allows a health system to coordinate care, eliminate redundancies, reduce costs, optimize resource utilization, and improve outcomes. The preferred model to manage service lines regionally will depend on each facility's capabilities and the willingness of physicians to accept changes in clinical delivery. Health systems can overcome physicians' objections to regionalization by implementing a hospital-physician alignment structure that gives a measure of shared control in the management of the organization.

Qualitative study of employment of physician assistants by physicians

PubMed Central

Taylor, Maureen T.; Wayne Taylor, D.; Burrows, Kristen; Cunnington, John; Lombardi, Andrea; Liou, Michelle

2013-01-01

Abstract Objective To explore the experiences and perceptions of Ontario physician assistant (PA) employers about the barriers to and benefits of hiring PAs. Design A qualitative design using semistructured interviews. Setting Rural and urban eastern and southwestern Ontario. Participants Seven family physicians and 7 other specialists. Methods The 14 physicians participated in semistructured interviews, which were audiorecorded and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis. Main findings Physician-specific benefits to hiring PAs included increased flexibility, the opportunity to expand practice, the ability to focus more time on complex patients, overall reduction in work hours and stress, and an opportunity for professional fellowship. Physicians who hired PAs without government financial support said PAs were affordable as long as they were able to retain them. Barriers to hiring PAs included uncertainty about funding, the initial need for intensive supervision and training, and a lack of clarity around delegation of acts. Conclusion Physicians are motivated to hire PAs to help deal with long wait times and long hours, but few are expecting to increase their income by taking on PAs. Governments, medical colleges, educators, and regulators must address the perceived barriers to PA hiring in order to expand and optimize this profession. PMID:24235209

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

PubMed

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.

Evaluating a physician leadership development program - a mixed methods approach.

PubMed

Throgmorton, Cheryl; Mitchell, Trey; Morley, Tom; Snyder, Marijo

2016-05-16

Purpose - With the extent of change in healthcare today, organizations need strong physician leaders. To compensate for the lack of physician leadership education, many organizations are sending physicians to external leadership programs or developing in-house leadership programs targeted specifically to physicians. The purpose of this paper is to outline the evaluation strategy and outcomes of the inaugural year of a Physician Leadership Academy (PLA) developed and implemented at a Michigan-based regional healthcare system. Design/methodology/approach - The authors applied the theoretical framework of Kirkpatrick's four levels of evaluation and used surveys, observations, activity tracking, and interviews to evaluate the program outcomes. The authors applied grounded theory techniques to the interview data. Findings - The program met targeted outcomes across all four levels of evaluation. Interview themes focused on the significance of increasing self-awareness, building relationships, applying new skills, and building confidence. Research limitations/implications - While only one example, this study illustrates the importance of developing the evaluation strategy as part of the program design. Qualitative research methods, often lacking from learning evaluation design, uncover rich themes of impact. The study supports how a PLA program can enhance physician learning, engagement, and relationship building throughout and after the program. Physician leaders' partnership with organization development and learning professionals yield results with impact to individuals, groups, and the organization. Originality/value - Few studies provide an in-depth review of evaluation methods and outcomes of physician leadership development programs. Healthcare organizations seeking to develop similar in-house programs may benefit applying the evaluation strategy outlined in this study.

Ontario family physician readiness to collaborate with community pharmacists on drug therapy management.

PubMed

Pojskic, Nedzad; Mackeigan, Linda; Boon, Heather; Ellison, Philip; Breslin, Curtis

2011-03-01

Empirical evidence suggests that pharmacist-physician collaboration can improve patients' clinical outcomes; however, such collaboration occurs relatively infrequently in the community setting. There has been little research on physicians' perspectives of such collaboration. To ascertain Ontario family physician readiness to collaborate with community pharmacists on drug therapy management. The survey instrument was based on the transtheoretical model of behavior change. It enquired about 3 physician behaviors that represented low-, mid-, and high-level collaboration with pharmacists. The survey was distributed by fax or mail to a random sample of 848 Ontario family physicians and general practitioners, stratified by practice location (urban/rural). The response rate was 36%. Most respondents reported conversing with community pharmacists about a patient's drug therapy management 5 or fewer times per week. Eighty-four percent reported that they regularly took community pharmacists' phone calls, whereas 78% reported that they sometimes sought pharmacists' recommendations regarding their patients' drug therapy. Twenty-eight percent reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% unaware of such a service. There were no differences in physician readiness to engage in any of the 3 collaborative behaviors in urban versus rural settings. More accurate patient medication lists were perceived as the main advantage (pro) of collaborating with community pharmacists and pharmacists' lack of patient information as the main disadvantage (con). Collectively, perceived pros of collaboration were positive predictors of physician readiness to collaborate on all 3 behaviors, whereas perceived cons were negative predictors for the low- and mid-level behaviors. Female physicians were more likely than males to seek pharmacists' recommendations, whereas more experienced physicians were more likely to refer patients to

Physicians' evaluations of patients' decisions to refuse oncological treatment

PubMed Central

van Kleffens, T; van Leeuwen, E

2005-01-01

Objective: To gain insight into the standards of rationality that physicians use when evaluating patients' treatment refusals. Design of the study: Qualitative design with indepth interviews. Participants: The study sample included 30 patients with cancer and 16 physicians (oncologists and general practitioners). All patients had refused a recommended oncological treatment. Results: Patients base their treatment refusals mainly on personal values and/or experience. Physicians mainly emphasise the medical perspective when evaluating patients' treatment refusals. From a medical perspective, a patient's treatment refusal based on personal values and experience is generally evaluated as irrational and difficult to accept, especially when it concerns a curative treatment. Physicians have a different attitude towards non-curative treatments and have less difficulty accepting a patient's refusal of these treatments. Thus, an important factor in the physician's evaluation of a treatment refusal is whether the treatment refused is curative or non-curative. Conclusion: Physicians mainly use goal oriented and patients mainly value oriented rationality, but in the case of non-curative treatment refusal, physicians give more emphasis to value oriented rationality. A consensus between the value oriented approaches of patient and physician may then emerge, leading to the patient's decision being understood and accepted by the physician. The physician's acceptance is crucial to his or her attitude towards the patient. It contributes to the patient's feeling free to decide, and being understood and respected, and thus to a better physician–patient relationship. PMID:15738431

Building physician resilience.

PubMed

Jensen, Phyllis Marie; Trollope-Kumar, Karen; Waters, Heather; Everson, Jennifer

2008-05-01

To explore the dimensions of family physician resilience. Qualitative study using in-depth interviews with family physician peers. Hamilton, Ont. Purposive sample of 17 family physicians. An iterative process of face-to-face, in-depth interviews that were audiotaped and transcribed. The research team independently reviewed each interview for emergent themes with consensus reached through discussion and comparison. Themes were grouped into conceptual categories. Four main aspects of physician resilience were identified: 1) attitudes and perspectives, which include valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations; 2) balance and prioritization, which include setting limits, taking effective approaches to continuing professional development, and honouring the self;3) practice management style, which includes sound business management, having good staff, and using effective practice arrangements; and 4) supportive relations, which include positive personal relationships, effective professional relationships, and good communication. Resilience is a dynamic, evolving process of positive attitudes and effective strategies.

Consequences of ADHD medication use for children's outcomes.

PubMed

Dalsgaard, Søren; Nielsen, Helena Skyt; Simonsen, Marianne

2014-09-01

This paper estimates effects of early ADHD medication use on key human capital outcomes for children diagnosed with ADHD while using rarely available register based data on diagnoses and prescription drug purchases. Our main identification strategy exploits plausible exogenous assignment of children to hospitals with specialist physicians, while our analysis of health outcomes also allows for an individual level panel data strategy. We find that the behavior of specialist physicians varies considerably across hospitals and that the prescribing behavior does affect the probability that a given child is treated. Results show that children diagnosed with ADHD in pharmacological treatment have fewer hospital contacts if treated and that treatment to some extent protects against criminal behavior. Copyright © 2014 Elsevier B.V. All rights reserved.

Physician Surveys to Assess Customary Care in Medical Malpractice Cases

PubMed Central

Hartz, Arthur; Lucas, Joshua; Cramm, Timothy; Green, Michael; Bentler, Suzanne; Ely, John; Wolfe, Steven; James, Paul

2002-01-01

OBJECTIVE Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING Iowa. PARTICIPANTS Community and academic primary care physicians and relevant specialists. INTERVENTIONS Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may

Physician Agency and Patient Survival*

PubMed Central

Jacobson, Mireille G.; Chang, Tom Y.; Earle, Craig C.; Newhouse, Joseph P.

2017-01-01

We investigate the role of physician agency in determining health care supply and patient outcomes. We show that an increase in health care supply due to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior rationing of effective care. Furthermore, physician market structure matters in determining the welfare effects of changes in private physician incentives. We then analyze a change to Medicare fees that caused physicians to increase their provision of chemotherapy. We find that this increase in treatment improved patient survival, extending median life expectancy for lung cancer patients by about 18%. Consistent with the model, we find that while the treatment response was larger in less concentrated markets, survival improvements were larger in more concentrated markets. PMID:28133401

How female and male physicians' communication is perceived differently.

PubMed

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.

Impact of managed care on physicians' decisions to manipulate reimbursement rules: an explanatory model.

PubMed

VanGeest, Jonathan; Weiner, Saul; Johnson, Timothy; Cummins, Deborah

2007-07-01

To develop and test an explanatory model of the impact of managed care on physicians' decisions to manipulate reimbursement rules for patients. A self-administered mailed questionnaire of a national random sample of 1124 practicing physicians in the USA. Structural equation modelling was used. The main outcome measure assessed whether or not physicians had manipulated reimbursement rules (such as exaggerated the severity of patients conditions, changed billing diagnoses, or reported signs or symptoms that the patients did not have) to help patients secure coverage for needed treatment or services. The response rate was 64% (n = 720). Physicians' decisions to manipulate reimbursement rules for patients are directly driven not only by ethical beliefs about gaming the system but also by requests from patients, the perception of insufficient time to deliver care, and the proportion of Medicaid patients. Covert advocacy is also the indirect result of utilization review hassles, primary care specialty, and practice environment. Managed care is not just a set of rules that physicians choose to follow or disobey, but an environment of competing pressures from patients, purchasers, and high workload. Reimbursement manipulation is a response to that environment, rather than simply a reflection of individual physicians' values.

Predictors of physician career satisfaction, work-life balance, and burnout.

PubMed

Keeton, Kristie; Fenner, Dee E; Johnson, Timothy R B; Hayward, Rodney A

2007-04-01

To explore factors associated with physician career satisfaction, work-life balance, and burnout focusing on differences across age, gender, and specialty. A cross-sectional, mailed, self-administered survey was sent to a national sample of 2,000 randomly-selected physicians, stratified by specialty, age, and gender (response rate 48%). Main outcome measures included career satisfaction, burnout, and work-life balance. Scales ranged from 1 to 100. Both women and men report being highly satisfied with their careers (79% compared with 76%, P<.01), having moderate levels of satisfaction with work-life balance (48% compared with 49%, P=.24), and having moderate levels of emotional resilience (51% compared with 53%, P=.09). Measures of burnout strongly predicted career satisfaction (standardized beta 0.36-0.60, P<.001). The strongest predictor of work-life balance and burnout was having some control over schedule and hours worked (standardized beta 0.28, P<.001, and 0.20-0.32, P<.001, respectively). Physician gender, age, and specialty were not strong independent predictors of career satisfaction, work-life balance, or burnout. This national physician survey suggests that physicians can struggle with work-life balance yet remain highly satisfied with their career. Burnout is an important predictor of career satisfaction, and control over schedule and work hours are the most important predictors of work-life balance and burnout. II.

Do female primary care physicians practise preventive care differently from their male colleagues?

PubMed Central

Woodward, C. A.; Hutchison, B. G.; Abelson, J.; Norman, G.

1996-01-01

OBJECTIVE: To assess whether female primary care physicians' reported coverage of patients eligible for certain preventive care strategies differs from male physicians' reported coverage. DESIGN: A mailed survey. SETTING: Primary care practices in southern Ontario. PARTICIPANTS: All primary care physicians who graduated between 1972 and 1988 and practised in a defined geographic area of Ontario were selected from the Canadian Medical Association's physician resource database. Response rate was 50%. MAIN OUTCOME MEASURES: Answers to questions on sociodemographic and practice characteristics, attitudes toward preventive care, and perceptions about preventive care behaviour and practices. RESULTS: In general, reported coverage for Canadian Task Force on the Periodic Health Examination's (CTFPHE) A and B class recommendations was low. However, more female than male physicians reported high coverage of women patients for female-specific preventive care measures (i.e., Pap smears, breast examinations, and mammography) and for blood pressure measurement. Female physicians appeared to question more patients about a greater number of health risks. Often, sex of physician was the most salient factor affecting whether preventive care services thought effective by the CTFPHE were offered. However, when evidence for effectiveness of preventive services was equivocal or lacking, male and female physicians reported similar levels of coverage. CONCLUSION: Female primary care physicians are more likely than their male colleagues to report that their patients eligible for preventive health measures as recommended by the CTFPHE take advantage of these measures. PMID:8969856

Job Satisfaction Among Academic Family Physicians.

PubMed

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.

Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care 1

PubMed Central

Amthauer, Camila; da Cunha, Maria Luzia Chollopetz

2016-01-01

ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital. PMID:27579934

Physicians' perceptions of mobile technology for enhancing asthma care for youth.

PubMed

Schneider, Tali; Panzera, Anthony Dominic; Martinasek, Mary; McDermott, Robert; Couluris, Marisa; Lindenberger, James; Bryant, Carol

2016-06-01

This study assessed physicians' receptivity to using mobile technology as a strategy in patient care for adolescents with asthma. Understanding physicians' perceived barriers and benefits of integrating mobile technology in adolescents' asthma care and self-management is an initial step in enhancing overall patient and disease outcomes. We conducted in-depth interviews with second- and third-year pediatric residents and attending physicians who oversee pediatric residents in training (N = 27) at an academic medical center in the southeastern United States. We identified both benefits from and barriers to broader use of mobile technologies for improving asthma outcomes in adolescents. Resident physicians demonstrated greater readiness for integrating these technologies than did attending physicians. Prior to adoption of mobile technologies in the care of adolescent asthma patients, barriers to implementation should be understood. Prior to widespread adoption, such systems will need to be evaluated against traditional care for demonstration of patient outcomes that improve on the current situation. © The Author(s) 2014.

Physician's emerging roles relating to trends in health information technology.

PubMed

David Johnson, J

2014-08-12

Objective: To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers. Methods: Trends and related developments concerning the changing roles of physicians based on prior literature reviews. Results: Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance. Conclusion: A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of physicians.

Physician-patient communication in the primary care office: a systematic review.

PubMed

Beck, Rainer S; Daughtridge, Rebecca; Sloane, Philip D

2002-01-01

The physician-patient interview is the key component of all health care, particularly of primary medical care. This review sought to evaluate existing primary-care-based research studies to determine which verbal and nonverbal behaviors on the part of the physician during the medical encounter have been linked in empirical studies with favorable patient outcomes. We reviewed the literature from 1975 to 2000 for studies of office interactions between primary care physicians and patients that evaluated these interactions empirically using neutral observers who coded observed encounters, videotapes, or audiotapes. Each study was reviewed for the quality of the methods and to find statistically significant relations between specific physician behaviors and patient outcomes. In examining nonverbal behaviors, because of a paucity of clinical outcome studies, outcomes were expanded to include associations with patient characteristics or subjective ratings of the interaction by observers. We found 14 studies of verbal communication and 8 studies of nonverbal communication that met inclusion criteria. Verbal behaviors positively associated with health outcomes included empathy, reassurance and support, various patient-centered questioning techniques, encounter length, history taking, explanations, both dominant and passive physician styles, positive reinforcement, humor, psychosocial talk, time in health education and information sharing, friendliness, courtesy, orienting the patient during examination, and summarization and clarification. Nonverbal behaviors positively associated with outcomes included head nodding, forward lean, direct body orientation, uncrossed legs and arms, arm symmetry, and less mutual gaze. Existing research is limited because of lack of consensus of what to measure, conflicting findings, and relative lack of empirical studies (especially of nonverbal behavior). Nonetheless, medical educators should focus on teaching and reinforcing behaviors known

Attitudes of pharmacists and physicians to antibiotic policies in hospitals.

PubMed

Adu, A; Simpson, J M; Armour, C L

1999-06-01

Antibiotic therapy in hospitals has substantial impact on patient outcome and the pharmacy drug budget. Antibiotic policies have been implemented by some hospitals to improve the quality of patient outcome and cost of antibiotic therapy. Antibiotic policies impose certain requirements on pharmacists and physicians. Pharmacists' and physicians' attitudes to and opinions about antibiotic policies are likely to affect the usefulness of such policies. To determine the attitudes of pharmacists and physicians to antibiotic policies in New South Wales (NSW) hospitals. Pharmacists and physicians in NSW public hospitals were surveyed to determine their attitudes to and opinions on antibiotic policies. A simple one-stage cluster sample of 241 pharmacists and a two-stage cluster sample of 701 physicians were obtained. Factor analysis was used to identify the attitudinal dimensions. General linear modelling was used to investigate the effects of predictor variables on outcome variables. The response rates were 91% and 77% for pharmacists and physicians, respectively. Factor analysis identified three dimensions of attitude to antibiotic policies: that they encourage rational antibiotic use; that they improve the quality of antibiotic prescribing and that they are associated with some problems. The reliability of these factors (Cronbach's alpha) ranged from 0.71 to 0.74, and was 0.90 for the overall attitude scale. Pharmacists and physicians had a positive overall attitude to antibiotic policies. Whereas physicians recognize that antibiotic policies improve the quality of prescribing, this was highly correlated with identification of problems (alpha = 0.71). In urban hospitals, pharmacists were more likely than physicians to associate antibiotics with problems. There was a positive overall attitude to hospital antibiotic policies expressed by pharmacists and physicians.

Review on Factors Influencing Physician Guideline Adherence in Cardiology.

PubMed

Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

2018-04-09

Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

The goals of communicating bad news in health care: do physicians and patients agree?

PubMed Central

Sweeny, Kate; Shepperd, James A.; Han, Paul K. J.

2011-01-01

Abstract Background  Communicating bad news serves different goals in health care, and the extent to which physicians and patients agree on the goals of these conversations may influence their process and outcomes. However, we know little about what goals physicians and patients perceive as important and how the perceptions of physicians and patients compare. Objective  To compare physicians’ and patients’ perceptions of the importance of different communication goals in bad news conversations. Design  Survey‐based descriptive study. Participants  Physicians in California recruited via a medical board mailing list (n = 67) and patients (n = 77) recruited via mailing lists and snowball recruitment methods. Measurements  Physicians reported their experience communicating bad news, the extent to which they strive for various goals in this task and their perceptions of the goals important to patients. Patients reported their experience receiving bad news, the goals important to them and their perceptions of the goals important to physicians. Main results  Physicians and patients were quite similar in how important they personally rated each goal. However, the two groups perceived differences between their values and the values of the other group. Conclusions  Physicians and patients have similar perceptions of the importance of various goals of communicating bad news, but inaccurate perceptions of the importance of particular goals to the other party. These findings raise important questions for future research and clinical practice. PMID:21771225

Providing physicians with feedback on medication adherence for people with chronic diseases taking long-term medication.

PubMed

Zaugg, Vincent; Korb-Savoldelli, Virginie; Durieux, Pierre; Sabatier, Brigitte

2018-01-10

adherence may improve processes of care (e.g. more medication changes, dialogue with patient, management of uncontrolled hypertension) compared to usual care (four studies, 2780 patients). None of the studies reported an adverse event due to the intervention. The certainty of evidence was low for all outcomes, mainly due to high risk of bias, high heterogeneity across studies, and indirectness of evidence. Across nine studies, we observed little or no evidence that provision of feedback to physicians regarding their patients adherence to prescribed medication improved medication adherence, patient outcomes, or health resource use. Feedback about medication adherence may improve processes of care, but due to the small number of studies assessing this outcome and high risk of bias, we cannot draw firm conclusions on the effect of feedback on this outcome. Future research should use a clear, standardised definition of medication adherence and cluster-randomisation to avoid the risk of contamination.

Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men.

PubMed

Shin, Eun-Seok; Lee, Cheol Whan; Ahn, Jung-Min; Lee, Pil Hyung; Chang, Mineok; Kim, Min-Ju; Yoon, Sung-Han; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Park, Seung-Jung

2018-02-15

The clinical outcomes for women compared with men undergoing left main PCI were sparse. We compared the characteristics and long-term outcomes in women versus men after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main CAD. We identified 2328 patients (545 women; 1783 men) with unprotected left main CAD who received PCI with DES between January 2007 and December 2013 in the Interventional Cardiology Research In-cooperation Society-left MAIN revascularization (IRIS-MAIN) registry. The primary outcome was a composite of death from any cause, myocardial infarction, or stroke. The median follow-up time was 2.9years (interquartile range: 1.0-4.1years). Women were older, had a higher incidence of insulin-requiring diabetes mellitus and hypertension, and more commonly presented with acute coronary syndrome than men. Left main ostial lesion was more common in women, whereas left main bifurcation lesion with more extensive CAD was more common in men. The incidence of primary outcome was similar between the two groups (10.8% vs. 10.8%, respectively, log-rank p=0.587). The results were similar after adjustment for baseline variables and consistent across major subgroups. The need for target lesion revascularization was significantly higher in women than in men (8.8% vs. 5.7%, respectively, p<0.05) but the sex bias was not confirmed after adjusting for confounders. Women, as compared to men, had different clinical and lesion characteristics but similar long-term outcomes after PCI with DES for left main CAD. Copyright © 2017 Elsevier B.V. All rights reserved.

UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS TO COMBAT PHYSICIAN SHORTAGES IN THE MILITARY TRAUMA SYSTEM: WORKING TOWARDS IMPROVED OUTCOMES

DTIC Science & Technology

2016-10-01

MILITARY TRAUMA SYSTEM: WORKING TOWARDS IMPROVED OUTCOMES by April J. Dunlevy, Maj, USAF, NC A Research Report Submitted to the Faculty In...developed to aid in efforts to provide safe , effective and efficient care. One barrier to this goal is the current national shortage of physician...healthcare system. 5 Preface I have been working in healthcare for 24 years, practicing in both civilian and military facilities

Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making

PubMed Central

Evers-Casey, Sarah; Graden, Sarah; Schnoll, Robert

2015-01-01

Rationale: Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in “next steps” consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Objective: Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Methods: Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of “success” probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Measurements and Main Results: Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Conclusions: Important presuppositions regarding the potential “success” of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors. PMID:25664676

HYPERTENSION IMPROVEMENT PROJECT (HIP): RANDOMIZED TRIAL OF QUALITY IMPROVEMENT FOR PHYSICIANS AND LIFESTYLE MODIFICATION FOR PATIENTS

PubMed Central

Svetkey, Laura P.; Pollak, Kathryn I.; Yancy, William S.; Dolor, Rowena J.; Batch, Bryan C.; Samsa, Greg; Matchar, David B.; Lin, Pao-Hwa

2009-01-01

Despite widely publicized hypertension treatment guidelines for physicians and lifestyle recommendations for patients, blood pressure control rates remain low. In community-based primary care clinics, we performed a nested, 2×2 randomized, controlled trial of physician intervention vs. control and/or patient intervention vs. control. Physician Intervention included internet-based training, self-monitoring, and quarterly feedback reports. Patient Intervention included 20 weekly group sessions followed by 12 monthly phone counseling contacts, and focused on weight loss, DASH dietary pattern, exercise, and reduced sodium intake. The primary outcome was change in systolic blood pressure at 6 months. Eight primary care practices (32 physicians) were randomized to Physician Intervention or Control. Within those practices, 574 patients were randomized to Patient Intervention or Control. Patients’ mean age was 60 years, 61% female, 37% African American. BP data were available for 91% of patients at 6 months. The main effect of Physician Intervention on systolic blood pressure at 6 months, adjusted for baseline pressure, was 0.3 mmHg (95% CI −1.5 to 2.2; p = 0.72). The main effect of the Patient Intervention was −2.6 mmHg (95% CI −4.4, −0.7; p = 0.01). The interaction of the 2 interventions was significant (p = 0.03); the largest impact was observed with the combination of Physician and Patient Intervention (−9.7 ± 12.7 mmHg). Differences between treatment groups did not persist at 18 months. Combined physician and patient intervention lowers blood pressure; future research should focus on enhancing effectiveness and sustainability of these interventions. PMID:19920081

The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study.

PubMed

Hunt, Jacquelyn S; Siemienczuk, Joseph; Gillanders, William; LeBlanc, Benjamin H; Rozenfeld, Yelena; Bonin, Kerry; Pape, Ginger

2009-01-01

To determine the impact of a physician-directed, multifaceted health information technology (HIT) system on diabetes outcomes. A pre/post-interventional study. The setting was Providence Primary Care Research Network in Oregon, with approximately 71 physicians caring for 117 369 patients in 13 clinic locations. The study covered Network patients with diabetes age 18 years and older. The study intervention included implementation of the CareManager HIT system which augments an electronic medical record (EMR) by automating physician driven quality improvement interventions, including point-of-care decision support and care reminders, diabetes registry with care prompts, performance feedback with benchmarking and access to published evidence and patient educational materials. The primary clinical measures included the change in mean value for low density lipoprotein (LDL) target <100 mg/dL or 2.6 mmol/l, blood pressure (BP) target <130/80 mmHg and glycated haemoglobin (HbA1c) target <7%, and the proportion of patients meeting guideline-recommended targets for those measures. All measures were analysed using closed and open cohort approaches. A total of 6072 patients were identified at baseline, 70% of whom were continuously enrolled during the 24-month study. Significant improvements were observed in all diabetes related outcomes except mean HbA1c. LDL goal attainment improved from 32% to 56% (P=0.002), while mean LDL decreased by 13 mg/dL (0.33 mmol/l, P=0.002). BP goal attainment increased significantly from 30% to 52%, with significant decreases in both mean systolic and diastolic BP. The proportion of patients with an HbA1c below 7% was higher at the end of the study (P=0.008). Mean patient satisfaction remained high, with no significant difference between baseline and follow-up. Total Relative Value Units per patient per year significantly increased as a result of an increase in the number of visits in year one and the coding complexity throughout. Implementation

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data

PubMed Central

Ly, Dan P; Seabury, Seth A

2015-01-01

Objectives To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. Design Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. Setting United States. Participants 48 881 physicians, 10 086 dentists, 13 883 pharmacists, 159 044 nurses, 18 920 healthcare executives, 59 284 lawyers, and 6 339 310 other non-healthcare professionals. Main outcome measures Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). Results After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. Conclusions Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable

Sex differences in physician salary in U.S. public medical schools

PubMed Central

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

Incorporation of Scribes Into the Inflammatory Bowel Disease Clinic Improves Quality of Care and Physician Productivity.

PubMed

Ewelukwa, Ofor; Perez, Roque; Carter, Lee Ellen; Fernandez, Alyka; Glover, Sarah

2018-02-15

Electronic health records (EHRs), despite their positive attributes, increase physician workload and decrease efficiency. The aim of this study was to evaluate the impact of scribes in the Inflammatory Bowel Disease Clinic on improvement of the physician-patient relationship, physician productivity, clinical efficiency, and achievement of some Physician Quality Reporting System (PQRS) metrics. We analyzed of pre- and postscribe data between fiscal years 2015 (FY15) and 2016 (FY16) using data from patients at the Inflammatory Bowel Clinic at the University of Florida. The main outcomes were patient satisfaction scores (PSS), qualitative physician interview, clinic appointment lengths, work relative value units (wRVUs), level of coding, revenue, and PQRS data on bone density screening and vaccination. PSS increased from 6.8/10 to 9.2/10 (P < 0.01), clinic appointment length decreased by 13.5 minutes (P < 0.05), and documentation stress decreased. Clinic visits increased by 76, leading to an increase in work RVUs by 332.55, total charges billed by $71,439, and total charges collected by $27,387 between the first quarters of FY15 and FY16. The extra revenue for the first quarter was 536% higher than the salary of the scribe for the same period ($4302.84). There was a 1.8-fold increase in referrals for bone density scans and 2.9-fold and 4.8-fold increases in vaccination rates for influenza and pneumonia, respectively. The use of scribes improved the physician-patient relationship, clinical efficiency, physician productivity, bone density screening, and vaccinations for flu and pneumonia. If adopted by health systems, it may lead to significant cost savings and improved clinical outcomes.

Impact of physician empathy on migraine disability and migraineur compliance.

PubMed

Attar, Hatim S; Chandramani, Srinath

2012-08-01

We aim to establish the role that perceived physician empathy plays in determining migraineurs' outcomes and compliance with migraine management plans. We checked for associations between perceived physician empathy and clinical outcomes as well as compliance with management plans. 63 migraineurs were enrolled between July and September 2011. Questionnaire administered at the time of inclusion into the study included self-assessment of disability due to migraine (Migraine Disability Assessment Test) followed by migraineurs' assessment of physician empathy (Consultation and Relational Empathy Measure). Three months later, a telephonic questionnaire ascertained changes in disability due to migraine and compliance with migraine treatment. Data was entered in Microsoft Excel 2010 and analyzed using SPSS 17. Pearson's correlation was employed to analyze the significance of relationship between variables. P-value of less than 0.05 has been considered statistically significant. Statistically significant positive Pearson's correlations are seen between perceived empathy and decrease in migraine disability and symptoms over three months (P < 0.05). Significant positive relationships are also seen between perceived empathy and compliance with diet/meal timings, exercising, de-stressing/sleep pattern modification and medications (P < 0.05). Self-reported compliance is significantly correlated with improved patient outcomes (P < 0.05). Substantial positive associations are found between perceived physician empathy and migraineurs' outcomes and compliance with management plans. This emphasizes the importance of empathy in migraineur-physician communication.

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study

PubMed Central

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke JAH; Schoonhoven, Lisette; Koopmans, Raymond TCM; Laurant, Miranda GH

2017-01-01

Introduction In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. Methods and analysis This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context–mechanism–outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. Ethics and dissemination The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. PMID

Clinical trials attitudes and practices of Latino physicians.

PubMed

Ramirez, Amelie G; Wildes, Kimberly; Talavera, Greg; Nápoles-Springer, Anna; Gallion, Kipling; Pérez-Stable, Eliseo J

2008-07-01

Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. Chi-square analyses showed significant (p<0.05) associations of physician race/ethnicity and clinical trials involvement, type of trial for which the physician is likely to recommend a patient, belief in scientific value, and factors that would influence recommendation for a patient to participate. Multivariate analyses resulted in several significant (p<0.05) predictors of clinical trials outcomes, including physician race/ethnicity. Latino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.

The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy.

PubMed

Del Canale, Stefano; Louis, Daniel Z; Maio, Vittorio; Wang, Xiaohong; Rossi, Giuseppina; Hojat, Mohammadreza; Gonnella, Joseph S

2012-09-01

To test the hypothesis that scores of a validated measure of physician empathy are associated with clinical outcomes for patients with diabetes mellitus. This retrospective correlational study included 20,961 patients with type 1 or type 2 diabetes mellitus from a population of 284,298 adult patients in the Local Health Authority, Parma, Italy, enrolled with one of 242 primary care physicians for the entire year of 2009. Participating physicians' Jefferson Scale of Empathy scores were compared with occurrence of acute metabolic complications (hyperosmolar state, diabetic ketoacidosis, coma) in diabetes patients hospitalized in 2009. Patients of physicians with high empathy scores, compared with patients of physicians with moderate and low empathy scores, had a significantly lower rate of acute metabolic complications (4.0, 7.1, and 6.5 per 1,000 patients, respectively, P < .05). Logistic regression analysis showed physicians' empathy scores were associated with acute metabolic complications: odds ratio (OR) = 0.59 (95% confidence interval [CI], 0.37-0.95, contrasting physicians with high and low empathy scores). Patients' age (≥69 years) also contributed to the prediction of acute metabolic complications: OR = 1.7 (95% CI, 1.2-1.4). Physicians' gender and age, patients' gender, type of practice (solo, association), geographical location of practice (mountain, hills, plain), and length of time the patient had been enrolled with the physician were not associated with acute metabolic complications. These results suggest that physician empathy is significantly associated with clinical outcome for patients with diabetes mellitus and should be considered an important component of clinical competence.

Prevalence of Burnout Among Pain Medicine Physicians and Its Potential Effect upon Clinical Outcomes in Patients with Oncologic Pain or Chronic Pain of Nononcologic Origin.

PubMed

Riquelme, Irene; Chacón, José-Ignacio; Gándara, Alba-Violeta; Muro, Inmaculada; Traseira, Susana; Monsalve, Vicente; Soriano, José-Francisco

2018-01-19

To evaluate the prevalence of burnout among physicians treating patients with chronic pain and to assess the potential relationships between the presence of burnout and patients' clinical outcomes such as pain relief, satisfaction with pain control, and quality of life. An observational, prospective, and noncomparative study. Pain medicine clinics. Physicians from medical departments involved in the management of chronic pain. Patients aged ≥18 years who exhibited moderate chronic pain lasting at least three months. Physicians were evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Patients were evaluated with the Charlson Comorbidity Index, the Brief Pain Inventory-Short Form (BPI-SF), the EuroQol-5D (EQ-5D), and ad hoc instruments for evaluating satisfaction with pain control, the extent to which the treatment met patients' expectations, and subjective impressions of improvement. Of the 301 physician participants, 22 (7.3%, 95% confidence interval [CI] = 4.9 to 10.8) met the criteria of burnout. Burnout was higher among physicians from pain units, while none of the 35 primary care physicians reported burnout. The presence of burnout was positively associated with patients' pain relief (odds ratio [OR] = 1.423, 95% CI = 1.090 to 1.858) but not with satisfaction with pain control or quality of life. Of the remaining independent variables, being treated by pain unit physicians was significantly associated with worse pain relief (OR = 0.592, 95% CI = 0.507 to 0.691), lower satisfaction (β = -0.680, 95% CI = -0.834 to -0.525), and worse quality of life (β = -4.047, 95% CI = -5.509 to -2.585) compared with being treated by physicians from other specialties (e.g., traumatologists, oncologists, etc.). Our study shows a lack of negative or clinically relevant (as shown by the negligible to small effect sizes) impact of burnout on patient-reported outcomes (namely, pain relief, satisfaction, and quality of life) in patients with

Prevalence of Health-Related Behaviors among Physicians and Medical Trainees

ERIC Educational Resources Information Center

Hull, Sharon K.; DiLalla, Lisabeth F.; Dorsey, J. Kevin

2008-01-01

Objective: The authors studied the prevalence of health-promoting and health-risking behaviors among physicians and physicians-in-training. Given the significant potential for negative outcomes to physicians' own health as well as the health and safety of their patients, examination of the natural history of this acculturation process about…

Social media and physicians: Exploring the benefits and challenges.

PubMed

Panahi, Sirous; Watson, Jason; Partridge, Helen

2016-06-01

Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community. © The Author(s) 2014.

Scientific activity and working hours of physicians in university hospitals: results from the Innsbruck and Salzburg physician lifestyle assessment (TISPLA).

PubMed

Steger, Bernhard; Colvin, Hans Peter; Rieder, Josef

2009-01-01

Controllable lifestyle has become an important factor influencing career decision-making among physicians. In academic medicine, doctors are required to combine both patient care and research in their daily routine. Insufficient release of clinicians for research during contracted work hours may lead to increased weekly working hours in academic medical centers and deter medical graduates from academia. We tested for an association between numbers of scientific publications and an increased hourly workload among physicians. This was a cross-sectional online survey among all salaried physicians working in the university hospitals of Innsbruck and Salzburg, Austria. The main outcome measures were the self-reported total number of scientific papers published in peer-reviewed medical journals over the past two years and self-reported working hours. Of 590 returned surveys, 393 were fully completed and included in the study. The sample was stratified into three groups according to scientific output in the past two years: Group A, >/= 6 publications; Group B, 1-5 publications; Group C, no publications. Men were more likely than women to have a scientific publication: in Group A there was a male predominance of 75%, whereas in Group C only 48% were men (P = 0.0034). A total of 59% (n = 232) of all participants had not published a scientific article in the past two years (Group C) and worked a mean of 58.3 +/- 12 h/week. Physicians in Group B (n = 113) had published 2.4 +/- 1.4 papers and worked 62.8 +/- 12.9 h/week; those in Group A (n = 48) had published 11.5 +/- 6.6 papers and worked 73 +/- 13.1 h/week (P < 0.0001). In Group A, research accounted for only 13.3% of total work time but for 60% of overtime hours, reflecting the fact that research was mainly performed during overtime. Research activity among clinicians in academic medical centers is associated with significantly increased overtime hours. Measures need to be taken to allow medical graduates an academic

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

PubMed Central

Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

2016-01-01

Context: For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. Objective: To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Design: Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Main Outcome Measures: Primary measure was satisfaction with one’s day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Results: Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2–9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. Conclusion: It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction. PMID:27057819

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

PubMed

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

2015-01-01

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

Bedside interprofessional rounds: perceptions of benefits and barriers by internal medicine nursing staff, attending physicians, and housestaff physicians.

PubMed

Gonzalo, Jed D; Kuperman, Ethan; Lehman, Erik; Haidet, Paul

2014-10-01

Interprofessional collaboration improves the quality of care, but integration into workflow is challenging. Although a shared conceptualization regarding bedside interprofessional rounds may enhance implementation, little work has investigated providers' perceptions of this activity. To evaluate the perceptions of nurses, attending physicians, and housestaff physicians regarding the benefits/barriers to bedside interprofessional rounds. Observational, cross-sectional survey of hospital-based medicine nurses, attending physicians, and housestaff physicians. Descriptive, nonparametric Wilcoxon rank sum and nonparametric correlation were used. Bedside interprofessional rounds were defined as "encounters including 2 physicians plus a nurse or other care provider discussing the case at the patient's bedside." Eighteen items related to "benefits" and 21 items related to "barriers" associated with bedside interprofessional rounds. Of 171 surveys sent, 149 were completed (87%). Highest-ranked benefits were related to communication/coordination, including "improves communication between nurses-physicians;" lowest-ranked benefits were related to efficiency, process, and outcomes, including "decreases length-of-stay" and "improves timeliness of consultations." Nurses reported most favorable ratings for all items (P < 0.05). Rank order for 3 provider groups showed high correlation (r = 0.92, P < 0.001). Highest-ranked barriers were related to time, including "nursing staff have limited time;" lowest-ranked barriers were related to provider- and patient-related factors, including "patient lack of comfort." Rank order of barriers among all groups showed moderate correlation (r = 0.62-0.82). Although nurses perceived greater benefit for bedside interprofessional rounds than physicians, all providers perceived coordination/teamwork benefits higher than outcomes. To the extent the results are generalizable, these findings lay the foundation for facilitating

Physician retirement: a case for concern in Canadian hospitals.

PubMed Central

Gillies, J H; Ross, L C

1984-01-01

Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process. PMID:6744174

Emergency physicians accumulate more stress factors than other physicians-results from the French SESMAT study.

PubMed

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

2011-05-01

France is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical system's first line of defence. The authors prepared a comprehensive questionnaire using established scales measuring various aspects of working conditions, satisfaction and health of salaried physicians and pharmacists. It was made available online, and the two major associations of emergency physicians promoted its use. 3196 physicians filled out the questionnaire. Among them were 538 emergency physicians. To avoid bias, 1924 physicians were randomly selected from the total database to match the demographic characteristics of France's physician population: 42.5% women, 57.5% men, 8.2% < 35 years old, 33.8% 35-44 years old, 34.5% 45-54 years old and 23.6% ≥ 55 years old. The distribution of physicians in the 23 administrative regions and by speciality was also precisely taken into account. This representative sample was used to compare subgroups of physicians by speciality. The outcomes indicate that the intent to leave the profession (ITL) was quite prevalent across French physicians and even more so among emergency physicians (17.4% and 21.4% respectively), and burnout was highly prevalent (42.4% and 51.5%, respectively). Among the representative sample and among emergency physicians, work-family conflict (OR=4.47 and OR=6.14, respectively) and quality of teamwork (OR=2.21 and OR=5.44, respectively) were associated with burnout in a multivariate analysis, and these risk factors were more prevalent among emergency physicians than other types. A serious lack of quality of teamwork appears to be associated with a higher risk of ITL (OR=3.92 among the physicians in the representative sample and OR=4.35 among emergency physicians), and burnout doubled the risk of ITL in multivariate analysis. In order to prevent the premature departure of French doctors, it is important to improve

The patient physician relationship in the Internet age: future prospects and the research agenda.

PubMed

Gerber, B S; Eiser, A R

2001-01-01

In the "Internet Age," physicians and patients have unique technological resources available to improve the patient physician relationship. How they both utilize online medical information will influence the course of their relationship and possibly influence health outcomes. The decision-making process may improve if efforts are made to share the burden of responsibility for knowledge. Further benefits may arise from physicians who assist patients in the information-gathering process. However, further research is necessary to understand these differences in the patient physician relationship along with their corresponding effects on patient and physician satisfaction as well as clinical outcomes.

Relation Between Physicians' Work Lives and Happiness.

PubMed

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.

Physician-Pharmacist collaboration in a pay for performance healthcare environment.

PubMed

Farley, T M; Izakovic, M

2015-01-01

Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

Patient-Physician Communication About Code Status Preferences: A Randomized Controlled Trial

PubMed Central

Rhondali, Wadih; Perez-Cruz, Pedro; Hui, David; Chisholm, Gary B.; Dalal, Shalini; Baile, Walter; Chittenden, Eva; Bruera, Eduardo

2013-01-01

Purpose Code status discussions are important in cancer care. The best modality for such discussions has not been established. Our objective was to determine the impact of a physician ending a code status discussion with a question (autonomy approach) versus a recommendation (beneficence approach) on patients' do-not-resuscitate (DNR) preference. Methods Patients in a supportive care clinic watched two videos showing a physician-patient discussion regarding code status. Both videos were identical except for the ending: one ended with the physician asking for the patient's code status preference and the other with the physician recommending DNR. Patients were randomly assigned to watch the videos in different sequences. The main outcome was the proportion of patients choosing DNR for the video patient. Results 78 patients completed the study. 74% chose DNR after the question video, 73% after the recommendation video. Median physician compassion score was very high and not different for both videos. 30/30 patients who had chosen DNR for themselves and 30/48 patients who had not chosen DNR for themselves chose DNR for the video patient (100% v/s 62%). Age (OR=1.1/year) and white ethnicity (OR=9.43) predicted DNR choice for the video patient. Conclusion Ending DNR discussions with a question or a recommendation did not impact DNR choice or perception of physician compassion. Therefore, both approaches are clinically appropriate. All patients who chose DNR for themselves and most patients who did not choose DNR for themselves chose DNR for the video patient. Age and race predicted DNR choice. PMID:23564395

How does burnout affect physician productivity? A systematic literature review.

PubMed

Dewa, Carolyn S; Loong, Desmond; Bonato, Sarah; Thanh, Nguyen Xuan; Jacobs, Philip

2014-07-28

Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, "How does burnout affect physician productivity?" A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However

How does burnout affect physician productivity? A systematic literature review

PubMed Central

2014-01-01

Background Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, “How does burnout affect physician productivity?” Methods A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. Results The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between

Drug addiction among Quebec physicians.

PubMed Central

Wallot, H.; Lambert, J.

1982-01-01

Data collected by the Quebec Board of Physicians show that during the 5 years from 1974 to 1978 the prevalence of addiction to opiates among Quebec physicians was 2.8/1000. The physician addicts had greater mobility and a higher attrition rate than their peers. The typical addict was male, a general practitioner and married. He often suffered from pain, fatigue, overwork, and financial and marital difficulties. His addiction had begun at approximately 35 years of age and had become evident about 3 1/2 years later. Meperidine was the preferred opiate. Some of the physicians lost their licences to practise for variable periods of time; for these the prognosis was gloomy. Depression was the main psychiatric disorder diagnosed. PMID:7074490

Nurse-physician communication - An integrated review.

PubMed

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

2017-12-01

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

Trends in the Work Hours of Physicians in the United States

PubMed Central

Staiger, Douglas O.; Auerbach, David I.; Buerhaus, Peter I.

2010-01-01

Context Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed. Objectives To estimate trends in hours worked by US physicians and assess for association with physician fees. Design, Setting, and Participants A retrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N=116 733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001. Main Outcome Measure Self-reported hours worked in the week before the survey. Results After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996–1998 to 51.0 hours per week in 2006–2008; 95% confidence interval [CI], 5.3%–9.0%; P<.001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%–13.7%; P<.001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%–7.7%; P<.001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%–10.2%; P<.001) and working outside of the hospital (6.4%; 95% CI, 4.1%–8.7%; P<.001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%–6.5%; P=.008) and working in the hospital (4.0%; 95% CI, 0.4%–7.6%; P=.03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52

A Physician's Perspective On Vertical Integration.

PubMed

Berenson, Robert A

2017-09-01

Vertical integration has been a central feature of health care delivery system change for more than two decades. Recent studies have demonstrated that vertically integrated health care systems raise prices and costs without observable improvements in quality, despite many theoretical reasons why cost control and improved quality might occur. Less well studied is how physicians view their newfound partnerships with hospitals. In this article I review literature findings and other observations on five aspects of vertical integration that affect physicians in their professional and personal lives: patients' access to physicians, physician compensation, autonomy versus system support, medical professionalism and culture, and lifestyle. I conclude that the movement toward physicians' alignment with and employment in vertically integrated systems seems inexorable but that policy should not promote such integration either intentionally or inadvertently. Instead, policy should address the flaws in current payment approaches that reward high prices and excessive service use-outcomes that vertical integration currently produces. Project HOPE—The People-to-People Health Foundation, Inc.

Physicians' preferences for asthma guidelines implementation.

PubMed

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.

Role of family physicians in an urban hospital

PubMed Central

Neimanis, Ieva; Woods, Anne; Zizzo, Angelo; Dickson, Robert; Levy, Richard; Goebel, Cindy; Corsini, John; Burns, Sheri; Gaebel, Kathryn

2017-01-01

Abstract Objective To investigate changes in family doctors’ attitudes about and participation in hospital activities and inpatient care in an urban hospital family medicine department from 1977 to 1997 and 2014. Design Cross-sectional survey design. Setting The Department of Family Medicine at St Joseph’s Healthcare Hamilton in Ontario. Participants Family physicians affiliated with the Department of Family Medicine at St Joseph’s Healthcare Hamilton were surveyed in 2014. Data were compared with findings from similar surveys administered at this institution in 1977 and 1997. Main outcome measures Family physicians’ roles in hospital activities, attitudes toward the role of the family physician in the hospital setting, and the barriers to and facilitators of maintaining this role. Results A total of 93 physicians returned completed surveys (37.3% response rate). In 2014, half of the respondents provided some inpatient care. This patient care was largely supportive and newborn care (71.7% and 67.4%, respectively). In 2014, 47.3% believed the quality of care would suffer (compared with 92.1% in 1977 and 87.5% in 1997) if they were not involved in patient care in the hospital. There was also a considerable shift away from the 1977 and 1997 perception that the family physician had a role as patient advocate: 92.0% and 95.3%, respectively, compared with only 49.5% in the 2014 survey. Conclusion Family physicians’ hospital activities and attitudes continued to change from 1977 to 1997 and 2014 in this urban hospital setting. Most of the respondents had stopped providing direct inpatient care, with a few continuing to provide supportive care. Despite this, most respondents still see a role for the Department of Family Medicine within the hospital as a focus for identifying with their family physician community, a place to interact with other specialist colleagues, and a source of some continuing medical education. PMID:28292802

Transformative professional development of physicians as educators: assessment of a model.

PubMed

Armstrong, Elizabeth G; Doyle, Jennifer; Bennett, Nancy L

2003-07-01

Medical education reform has been the clarion call of U.S. medical educators and policymakers for two decades. To foster change and seed reform, Harvard Medical School created a professional development program for physicians and scientists actively engaged in educating future physicians that sought to transform both participants and their schools. This study focused on identifying the long-term effects of a professional development program on physician educators. A follow-up survey of the 1995-97 cohorts of the Harvard Macy Program for Physician Educators was conducted by sending the 99 program participants a questionnaire two years after their participation. Main outcome measures studied were individual changes as reflected in participants' self-reported shifts in teaching behaviors, academic productivity, career advancement, and sense of commitment. A total of 63 participants completed the questionnaire, for a response rate of 63.6%. Two years following participation in the program, a majority (88.8%) of respondents reported that participation had significantly affected their professional development, including long-term changes in teaching behaviors (77.8%), engagement in new educational activities from committee work (86%) to grant funding (52.4%), and renewed vitality/identification of themselves as educators. Long-term follow-up of participants enrolled in an intensive program for physician educators suggests that professional development programs that create an immersion experience designed in a high-challenge, high-support environment, emphasizing experiential and participatory activities can change behaviors in significant ways, and that these changes endure over time.

Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

PubMed

Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

2005-03-01

Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p < 0.001). Most of the 22 physicians (91%) reported that the diary enabled them to better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

African Migrant Patients’ Trust in Chinese Physicians: A Social Ecological Approach to Understanding Patient-Physician Trust

PubMed Central

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

2015-01-01

Background Patient trust in physicians is a critical determinant of health seeking behaviors, medication adherence, and health outcomes. A crisis of interpersonal trust exists in China, extending throughout multiple social spheres, including the healthcare system. At the same time, with increased migration from Africa to China in the last two decades, Chinese physicians must establish mutual trust with an increasingly diverse patient population. We undertook a qualitative study to identify factors affecting African migrants’ trust in Chinese physicians and to identify potential mechanisms for promoting trust. Methods / Principal Findings We conducted semi-structured, in-depth interviews with 40 African migrants in Guangzhou, China. A modified version of the social ecological model was used as a theoretical framework. At the patient-physician level, interpersonal treatment, technical competence, perceived commitment and motive, and language concordance were associated with enhanced trust. At the health system level, two primary factors influenced African migrants’ trust in their physicians: the fee-for-service payment system and lack of continuity with any one physician. Patients’ social networks and the broader socio-cultural context of interactions between African migrants and Chinese locals also influenced patients’ trust of their physicians. Conclusions These findings demonstrate the importance of factors beyond the immediate patient-physician interaction and suggest opportunities to promote trust through health system interventions. PMID:25965064

Physician Perspectives on Long-Term Relationships and Friendships with Patients: A National Assessment.

PubMed

Hines, Harrison G; Avila, Cynthia J; Rudakevych, Tanya M; Curlin, Farr A; Yoon, John D

2017-11-01

Shifts in the healthcare environment have introduced challenges to the long-term continuity of the doctor-patient relationship. This study examines whether certain demographic or religious characteristics of physicians are associated with maintaining long-term relationships (LTRs) and/or friendships with their patients and describes physicians' opinions regarding the influence of such patient relationships on health outcomes. In 2011, survey responses were obtained from 1289 US physicians from various specialties. Physicians answered 8 items that assessed their opinions regarding their friendships, sense of meaningfulness, and experience in LTRs. The χ 2 test was used to examine bivariate associations between each demographic characteristic and physician responses to the importance of LTRs. The survey included 2 questions about the duration of physician practice and the number of patients seen in a typical week, 4 questions about perceived meaningfulness and friendship in the doctor-patient relationship, and 2 questions about the doctor-patient relationship setting. The adjusted survey response rate was 69% (1289/1863), 43% of physicians indicated that many or most of their patient relationships are LTRs, and 13.7% indicated they consider many or most of their patients to be friends. Just fewer than half of physicians (45.1%) perceive LTRs to have a great impact on clinical outcomes, 64.8% believe that LTRs contribute to patient trust, and 52.2% believe that LTRs are more likely to cause a patient to follow a physician's medical recommendations. This study presents a representative picture of US physicians' perceptions regarding relationships with patients. Physicians generally perceive LTRs to have a positive impact on patients' clinical outcomes, although the majority of physicians report they have few or no such relationships.

Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.

PubMed

Lovink, Marleen Hermien; Persoon, Anke; van Vught, Anneke J A H; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H

2017-06-08

In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government. © Article author(s) (or their employer(s) unless otherwise stated

The impact of physician weight discussion on weight loss in US adults.

PubMed

Pool, Andrew C; Kraschnewski, Jennifer L; Cover, Lindsay A; Lehman, Erik B; Stuckey, Heather L; Hwang, Kevin O; Pollak, Kathryn I; Sciamanna, Christopher N

2014-01-01

The increasing prevalence of overweight and obesity in the United States and worldwide is at epidemic levels. Physicians may play a vital role in addressing this epidemic. We aimed to examine the association of a physician's discussion of patients’ weight status with self-reported weight loss. We hypothesized that physician discussion of patients’ being overweight is associated with increased weight loss in patients with overweight and obesity. Data analysis of participants (n = 5054) in the National Health and Nutritional Examination Survey (NHANES) in 2005-2008. The main outcome was rates of self-reported weight loss and the association with physicians’ discussion of their patients’ weight status. Overweight and obese participants were significantly more likely to report a 5% weight loss in the past year if their doctor had told them they were overweight (adjusted OR (AOR) 1.88; 95% CI 1.45-2.44; AOR 1.79; 95% CI 1.30-2.46, respectively). Physicians’ direct discussion of their patients’ weight status is associated with clinically significant patient weight loss and may be a targetable intervention. Further studies are needed to determine if increasing physician discussion of patients’ weight status leads to significant weight loss. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.

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

PubMed

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 (p<.0001), longer duration of the physician-patient relationship (p =.02), and female gender (p =.04) were significantly associated with better 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 <.0001) and less advanced disease stage (p =.009) were associated with better communication. In multivariable models relating physician and practice characteristics

Direct-to-consumer advertising and the patient-physician relationship.

PubMed

Shah, Mansi B; Bentley, John P; McCaffrey, David J; Kolassa, E Mick

2005-06-01

Differences in attitudes of patients and physicians toward direct-to-consumer advertising (DTCA) of prescription medications may influence the patient-physician relationship, which may in turn influence health care outcomes. The objective of this study was to provide empirical evidence to show how the patient-physician relationship may be influenced by DTCA. The study used a cross-sectional research design. Pharmacists at 71 pharmacies were asked to distribute self-report survey instruments to patients who used either a proton-pump inhibitor or a nonsedating antihistamine by prescription. Data were collected between March and June 2003. Hierarchical multiple regression was used to assess the research propositions. A usable response rate of 7.3% (n=326) was obtained. About 95% of the sample had seen an advertisement for either a proton-pump inhibitor or a nonsedating antihistamine. Response to DTCA was significantly related to the patient's satisfaction with the physician and the patient's evaluation of communication, even after controlling for demographic variables and length of the patient-physician relationship. Other outcome variables (trust, relationship commitment, and average visit time) were not significantly related to DTCA response. Post hoc analyses revealed that DTCA responders, who asked their doctor to prescribe a specific product after seeing its advertisement, rated satisfaction and communication lower than the DTCA nonresponders. Additional follow-up analyses showed that these findings were largely attributed to patients in the proton-pump inhibitor group. The findings suggest that response to DTCA may be significantly related to patients' evaluation of communication quality and their satisfaction with the physician. However, these findings may not generalize to all medical conditions or types of patient. Furthermore, DTCA response does not appear to be related to other patient-physician relationship outcome variables. Given these findings, key

The association between hypertension-specific care management processes and blood pressure outcomes in US-based physician organizations.

PubMed

Wong, Ken; Smalarz, Amy; Wu, Ning; Boulanger, Luke; Wogen, Jenifer

2011-01-01

of hypertensive patients along with the patients' associated clinical data demonstrated better BP control (currently controlled BP: beta coefficient = 0.282, P = .034; currently uncontrolled BP: beta coefficient = -0.292, P = .023). However, use of the following practices had a negative correlation with BP control: case management (changes in systolic BP: beta coefficient 1.649, P = .022; changes in diastolic BP: beta coefficient = 0.910, P = .078), follow-up for missed appointments (changes in systolic BP: beta coefficient = 0.937, P = .041; changes in diastolic BP: beta coefficient = 0.165, P = .627), adopted written evidence-based standards of care to treat hypertension (changes in systolic BP: beta coefficient = 0.985, P = .032; changes in diastolic BP: beta coefficient = 0.346, P = .305), and checklists for tests and interventions (changes in systolic BP: beta coefficient = 1.586, P = .004; changes in diastolic BP: beta coefficient = 0.938, P = .019). Findings from this multisite study provide evidence that the presence of some hypertension-specific CMP in physician organizations may be associated with better BP outcomes among hypertensive patients. In particular, patients may benefit from physician efforts to improve medication fill compliance as well as organizational monitoring of hypertensive patients and their clinical data. Further research is warranted to better assess the relationship between CMP and treatment of chronic diseases such as hypertension over time. Copyright © 2011 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Delivery of Operative Pediatric Surgical Care by Physicians and Non-Physician Clinicians in Malawi

PubMed Central

Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

2014-01-01

Background Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. Methods We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. Results A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Discussion Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. PMID:24560846

Playing cards on asthma management: A new interactive method for knowledge transfer to primary care physicians

PubMed Central

Boulet, Louis-Philippe; Borduas, Francine; Bouchard, Jacques; Blais, Johanne; Hargreave, Frederick E; Rouleau, Michel

2007-01-01

OBJECTIVES: To describe an interactive playing card workshop in the communication of asthma guidelines recommendations, and to assess the initial evaluation of this educational tool by family physicians. DESIGN: Family physicians were invited to participate in the workshop by advertisements or personal contacts. Each physician completed a standardized questionnaire on his or her perception of the rules, content and properties of the card game. SETTING: A university-based continuing medical education initiative. PARTICIPANTS: Primary care physicians. MAIN OUTCOME MEASURES: Physicians’ evaluation of the rules, content and usefulness of the program. RESULTS: The game allowed the communication of relevant asthma-related content, as well as experimentation with a different learning format. It also stimulated interaction in a climate of friendly competition. Participating physicians considered the method to be an innovative tool that facilitated reflection, interaction and learning. It generated relevant discussions on how to apply guideline recommendations to current asthma care. CONCLUSIONS: This new, interactive, educational intervention, integrating play and scientific components, was well received by participants. This method may be of value to help integrate current guidelines into current practice, thus facilitating knowledge transfer to caregivers. PMID:18060093

Impact of Physician Asthma Care Education on Patient Outcomes

ERIC Educational Resources Information Center

Cabana, Michael D.; Slish, Kathryn K.; Evans, David; Mellins, Robert B.; Brown, Randall W.; Lin, Xihong; Kaciroti, Niko; Clark, Noreen M.

2014-01-01

Objective: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. Methods: We conducted a randomized trial in 10 regions in the United States. Primary care providers were…

Physician self-disclosure in primary care visits: enough about you, what about me?

PubMed

McDaniel, Susan H; Beckman, Howard B; Morse, Diane S; Silberman, Jordan; Seaburn, David B; Epstein, Ronald M

2007-06-25

The value of physician self-disclosure (MD-SD) in creating successful patient-physician partnerships has not been demonstrated. To describe antecedents, delivery, and effects of MD-SD in primary care visits, we conducted a descriptive study using sequence analysis of transcripts of 113 unannounced, undetected, standardized patient visits to primary care physicians. Our main outcome measures were the number of MD-SDs per visit; number of visits with MD-SDs; word count; antecedents, timing, and effect of MD-SD on subsequent physician and patient communication; content and focus of MD-SD. The MD-SDs included discussion of personal emotions and experiences, families and/or relationships, professional descriptions, and personal experiences with the patient's diagnosis. Seventy-three MD-SDs were identified in 38 (34%) of 113 visits. Ten MD-SDs (14%) were a response to a patient question. Forty-four (60%) followed patient symptoms, family, or feelings; 29 (40%) were unrelated. Only 29 encounters (21%) returned to the patient topic preceding the disclosure. Most MD-SDs (n=62; 85%) were not considered useful to the patient by the research team. Eight MD-SDs (11%) were coded as disruptive. Practicing primary care physicians disclosed information about themselves or their families in 34% of new visits with unannounced, undetected, standardized patients. There was no evidence of positive effect of MD-SDs; some appeared disruptive. Primary care physicians should consider when self-disclosing whether other behaviors such as empathy might accomplish their goals more effectively.

Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder.

PubMed

Gaines, Robin; Missiuna, Cheryl; Egan, Mary; McLean, Jennifer

2008-01-24

Developmental Coordination Disorder (DCD) is a chronic neurodevelopmental condition that affects 5-6% of children. When not recognized and properly managed during the child's development, DCD can lead to academic failure, mental health problems and poor physical fitness. Physicians, working in collaboration with rehabilitation professionals, are in an excellent position to recognize and manage DCD. This study was designed to determine the feasibility and impact of an educational outreach and collaborative care model to improve chronic disease management of children with DCD. The intervention included educational outreach and collaborative care for children with suspected DCD. Physicians were educated by and worked with rehabilitation professionals from February 2005 to April 2006. Mixed methods evaluation approach documented the process and impact of the intervention. Physicians: 750 primary care physicians from one major urban area and outlying regions were invited to participate; 147 physicians enrolled in the project. Children: 125 children were identified and referred with suspected DCD. The main outcome was improvement in knowledge and perceived skill of physicians concerning their ability to screen, diagnose and manage DCD. At baseline 91.1% of physicians were unaware of the diagnosis of DCD, and only 1.6% could diagnose condition. Post-intervention, 91% of participating physicians reported greater knowledge about DCD and 29.2% were able to diagnose DCD compared to 0.5% of non-participating physicians. 100% of physicians who participated in collaborative care indicated they would continue to use the project materials and resources and 59.4% reported they would recommend or share the materials with medical colleagues. In addition, 17.6% of physicians not formally enrolled in the project reported an increase in knowledge of DCD. Physicians receiving educational outreach visits significantly improved their knowledge about DCD and their ability to identify and

Physicians and Insider Trading.

PubMed

Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven

2015-12-01

Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.

Effect of part-time practice on patient outcomes.

PubMed

Parkerton, Patricia H; Wagner, Edward H; Smith, Dean G; Straley, Hugh L

2003-09-01

Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. To determine whether patient outcomes vary with physicians' clinic hours. Cross-sectional retrospective design assessing primary care practices in 1998. All 25 outpatient-clinics of a single medical group in western Washington. One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time). Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender). While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323). Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.

PubMed

Green-McKenzie, Judith; Emmett, Edward A

2017-10-01

Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

Types and Distribution of Payments From Industry to Physicians in 2015

PubMed Central

Tringale, Kathryn R.; Marshall, Deborah; Mackey, Tim K.; Connor, Michael; Murphy, James D.

2017-01-01

Importance Given scrutiny over financial conflicts of interest in health care, it is important to understand the types and distribution of industry-related payments to physicians. Objective To determine the types and distribution of industry-related payments to physicians in 2015 and the association of physician specialty and sex with receipt of payments from industry. Design, Setting, and Participants Observational, retrospective, population-based study of licensed US physicians (per National Plan & Provider Enumeration System) linked to 2015 Open Payments reports of industry payments. A total of 933 295 allopathic and osteopathic physicians. Outcomes were compared across specialties (surgery, primary care, specialists, interventionalists) and between 620 166 male (66.4%) and 313 129 female (33.6%) physicians using regression models adjusting for geographic Medicare-spending region and sole proprietorship. Exposures Physician specialty and sex. Main Outcomes and Measures Reported physician payment from industry (including nature, number, and value), categorized as general payments (including consulting fees and food and beverage), ownership interests (including stock options, partnership shares), royalty or license payments, and research payments. Associations between physician characteristics and reported receipt of payment. Results In 2015, 449 864 of 933 295 physicians (133 842 [29.8%] women), representing approximately 48% of all US physicians were reported to have received $2.4 billion in industry payments, including approximately $1.8 billion for general payments, $544 million for ownership interests, and $75 million for research payments. Compared with 47.7% of primary care physicians (205 830 of 431 819), 61.0% of surgeons (110 604 of 181 372) were reported as receiving general payments (absolute difference, 13.3%; 95% CI, 13.1-13.6; odds ratio [OR], 1.72; P < .001). Surgeons had a mean per-physician reported payment value of $6879

Treatment of Depression in Voluntary Versus Mandated Physicians.

PubMed

Johnson, R Scott; Fowler, J Christopher; Sikes, Kristi A; Allen, Jon G; Oldham, John M

2015-12-01

Few if any publications discuss the effectiveness of voluntary versus mandated treatment for impaired physicians. This retrospective case-control study compared the recovery rates of physicians whose treatment was mandated or coerced by either licensure boards or employers (mandated physicians) with the rates for physicians admitted voluntarily (voluntary physicians) to the Menninger Clinic's Professionals in Crisis program from 2009 through 2012. Beck Depression Inventory (BDI)-II scores served as the primary outcome measure. At the time of admission, voluntary physicians were more depressed, but the improvement rates in the voluntary and mandated groups did not differ significantly. In addition, the two groups differed neither in rates of return to the healthy range of BDI-II scores, nor in whether BDI-II scores had decreased by at least two standard deviations by the time of discharge. These findings suggest that state physician health programs can continue to mandate physicians into treatment despite concerns that mandatory treatment may be less efficacious than voluntary treatment. © 2015 American Academy of Psychiatry and the Law.

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

PubMed

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

2018-03-28

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

Invited Article: Threats to physician autonomy in a performance-based reimbursement system.

PubMed

Larriviere, Daniel G; Bernat, James L

2008-06-10

Physician autonomy is currently threatened by the external application of pay for performance standards and required conformity to practice guidelines. This phenomenon is being driven by concerns over the economic viability of increasing per capita health care expenditures without a concomitant rise in favorable health outcomes and by the unjustified marked variations among physicians' practice patterns. Proponents contend that altering the reimbursement system to encourage physicians to make choices based upon the best available evidence would be one way to ensure better outcomes per health care dollar spent. Although physician autonomy is most easily justified when decisions are made by appealing to the best available evidence, incentivizing decision-making risks sacrificing physician autonomy to political and social forces if the limitations of evidence-based medicine are not respected. Any reimbursement system designed to encourage physicians to utilize the best available evidence by providing financial incentives must recognize physicians who try to play to the numbers as well as physicians who refuse to follow the best available evidence if doing so would conflict with good medicine or patient preferences. By designing, promulgating, and updating evidence-based clinical practice guidelines, medical specialty societies can limit threats to physician autonomy while improving medical practice.

Physician empowerment programme; a unique workshop for physician-managers of community clinics.

PubMed

Maza, Yafit; Shechter, Efrat; Pur Eizenberg, Neta; Segev, Efrat Gortler; Flugelman, Moshe Y

2016-10-14

The physician manager role in the health care system is invaluable as they serve as role models and quality setters. The requirements from physician managers have become more demanding and the role less prestigious; yet burnout and its prevention in this group have received little attention. Physician leadership development programmes have generally dealt directly with skill and knowledge acquisition. The aim of this research was to evaluate an intensive workshop designed to modify attitudes and improve skills of physician-managers of community clinics, through focus on personal well-being and empowerment. Two hundred fifty six physicians affiliated with Clalit Health Services, the largest health maintenance organization in Israel, participated in 16 IMPACT courses during the years 2013-2015. The programme comprised five full days during a two-week period, including an overnight and follow-up meetings three and six weeks later. Theoretical knowledge, experiential learning, practical tools, deep personal exercises, and simulations were conveyed through individual and group work. Topics included: models of self-awareness, outcome thinking, determining a personal and organizational vision, and creating a personal approach to leadership. At the end of each course, and by email at 6 or more months after completion of the course, participants were asked to anonymously respond to closed questions (on a scale of 1-6) and an open question. Mean scores for the contribution of IMPACT to participants' role of physician manager were 5.3 at the end of the course, and 4.7 at 6 or more months later. Mean scores at 6 or more months were 5.0 regarding the contribution of the programme to personal development, 4.4 regarding satisfaction in the role of physician manager, and 4.6 regarding their coping with managerial dilemmas. A workshop that focused on personal growth and self-awareness increased physicians' job satisfaction and their sense of managerial capability, coping with

Responsibilities in cancer preventive care in Greece. A physicians' survey.

PubMed

Zacharias, Georgios; Xilomenos, Apostolos; Koukourakis, Georgios; Kamposioras, Konstantinos; Mauri, Davide; Chasioti, Dimitra; Bristianou, Magdalini; Ferentinos, Georgios; Levantakis, Ioannis; Tsali, Lamprini; Valachis, Antonis; Karampoiki, Vassiliki

2008-04-01

Colorectal cancer is the second leading cause of cancer death in European countries. Differences in screening implementation may explain USA vs. European survival differences. The proportion of European primary care physicians advising colorectal screening has been reported to be inconsistent. We therefore hypothesised the presence of a belief-related bias among European physicians regarding who is responsible for cancer screening delivery. To index beliefs in cancer screening implementation among a wide sample of Greek physicians. Study design Cross-sectional survey. Three hundred and sixty-six physicians involved in primary care activities in 15 provinces answered a questionnaire about responsibility in cancer screening delivery. Results 22.4% and 7.6% of physicians declared that the health system and the patients, respectively, have the main responsibility for cancer screening implementation, while 70 % advocated patient-health system co-responsibility. Beliefs were statistically correlated to age (p=0.039) and specialisation category (p=0.002). Patients' will was mainly indicated by internists, trainee internists and physicians older than 30, while GPs, trainee GPs and house officers were mainly health system-oriented. Worryingly, when physicians were asked about which specialty should inform the population, 81% indicated family doctor (for-fee-service) while the involvement of free-from-fee specialities was inconsistent. A considerable disorientation about responsibilities in cancer screening delivery was observed in our study sample. Continual medical education and clear redefinition of primary care physicians' activities are required.

Physician-patient communication in rheumatology: a systematic review.

PubMed

Georgopoulou, Sofia; Prothero, Louise; D'Cruz, David P

2018-05-01

The nature of physician-patient interaction can have a significant impact on patient outcomes through information-sharing and disease-specific education that can enhance patients' active involvement in their care. The aim of this systematic review was to examine all the empirical evidence pertaining to aspects of physician-patient communication and its impact on patient outcomes. A systematic search of five electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL, and Web of Science) was undertaken from earliest record to December 2016. Studies were eligible if they: (1) included adult participants (18 years or over) with a diagnosis of a rheumatic condition; (2) were of quantitative, qualitative or mixed methods design; (4) were surveys, observational and interventional studies; (5) were published in the English language; and (6) reported findings on either various physician-patient communication aspects alone or in combination with physical and psychological outcomes. Searches identified 455 papers. Following full-text retrieval and assessment for eligibility and quality, ten studies were included in the review; six quantitative, one mixed methods, and three qualitative papers. Higher levels of trust in the physician and active patient participation in the medical consultation were linked to lower disease activity, better global health, less organ damage accrual, greater treatment satisfaction with fewer side effects from the medication, more positive beliefs about control over the disease, and about current and future health. Future research could focus on the design and implementation of interventions incorporating communications skills and patient-education training.

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

PubMed

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.

Clinical Outcome Metrics for Optimization of Robust Training

NASA Technical Reports Server (NTRS)

Ebert, D.; Byrne, V. E.; McGuire, K. M.; Hurst, V. W., IV; Kerstman, E. L.; Cole, R. W.; Sargsyan, A. E.; Garcia, K. M,; Foy, M. H.; Dulchavsky, S. A.;

Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach.

PubMed

Uddin, Shahadat

2016-02-04

A patient-centric care network can be defined as a network among a group of healthcare professionals who provide treatments to common patients. Various multi-level attributes of the members of this network have substantial influence to its perceived level of performance. In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using health insurance claim dataset. From these networks, this study then constructed physician collaboration networks based on the concept of patient-sharing network among physicians. A multi-level regression model was then developed to explore the impact of different attributes that are organised at two levels on hospitalisation cost and hospital length of stay. For Level-1 model, the average visit per physician significantly predicted both hospitalisation cost and hospital length of stay. The number of different physicians significantly predicted only the hospitalisation cost, which has significantly been moderated by age, gender and Comorbidity score of patients. All Level-1 findings showed significance variance across physician collaboration networks having different community structure and density. These findings could be utilised as a reflective measure by healthcare decision makers. Moreover, healthcare managers could consider them in developing effective healthcare environments.

Ethical Principles for Physician Rating Sites

PubMed Central

2011-01-01

During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial

Physician-patient communication at diagnosis of type 2 diabetes and its links to patient outcomes: New results from the global IntroDia® study.

PubMed

Polonsky, William H; Capehorn, Matthew; Belton, Anne; Down, Susan; Alzaid, Aus; Gamerman, Victoria; Nagel, Friedericke; Lee, Jisoo; Edelman, Steven

2017-05-01

To investigate patient experiences during the diagnosis of type 2 diabetes mellitus (T2DM), focusing on how physician-patient communication at diagnosis influences patients' psychosocial stress and subsequent self-management and outcomes. We surveyed adults with T2DM in 26 countries in a large cross-national study of physician-patient communication during early T2DM treatment (IntroDia®). The self-report questionnaire assessed retrospectively patient experiences during diagnosis conversations (focusing on 43 possible conversational elements, and communication quality) and potential effects on patient-reported outcomes. Data from 3628 people with T2DM who had been prescribed oral treatment at diagnosis were analysed. Exploratory factor analyses of the conversational elements yielded four coherent, meaningful factors: Encouraging (Cronbach's α=0.86); Collaborative (α=0.88); Recommending Other Resources (α=0.75); and Discouraging (α=0.72). Patient-perceived communication quality (PPCQ) at diagnosis was positively associated with Encouraging (β=+1.764, p<0.001) and Collaborative (β=+0.347, p<0.001), negatively associated with Discouraging (β=-1.181, p<0.001) and not associated with Recommending Other Resources (β=+0.087, p=0.096), using a stable path model. PPCQ was associated with less current diabetes distress, greater current well-being and better current self-care. Conversation elements comprising factors associated with better PPCQ (Encouraging and Collaborative) were recalled more frequently by patients than elements associated with poor PPCQ (Discouraging). Better physician-patient communication at T2DM diagnosis may contribute to subsequent greater patient well-being and self-care, and may be enhanced by greater physician use of Collaborative and Encouraging conversation elements. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical Outcome Metrics for Optimization of Robust Training

NASA Technical Reports Server (NTRS)

Ebert, D.; Byrne, V. E.; McGuire, K. M.; Hurst, V. W., IV; Kerstman, E. L.; Cole, R. W.; Sargsyan, A. E.; Garcia, K. M.; Reyes, D.; Young, M.

2016-01-01

Introduction: The emphasis of this research is on the Human Research Program (HRP) Exploration Medical Capability's (ExMC) "Risk of Unacceptable Health and Mission Outcomes Due to Limitations of In-Flight Medical Capabilities." Specifically, this project aims to contribute to the closure of gap ExMC 2.02: We do not know how the inclusion of a physician crew medical officer quantitatively impacts clinical outcomes during exploration missions. The experiments are specifically designed to address clinical outcome differences between physician and non-physician cohorts in both near-term and longer-term (mission impacting) outcomes. Methods: Medical simulations will systematically compare success of individual diagnostic and therapeutic procedure simulations performed by physician and non-physician crew medical officer (CMO) analogs using clearly defined short-term (individual procedure) outcome metrics. In the subsequent step of the project, the procedure simulation outcomes will be used as input to a modified version of the NASA Integrated Medical Model (IMM) to analyze the effect of the outcome (degree of success) of individual procedures (including successful, imperfectly performed, and failed procedures) on overall long-term clinical outcomes and the consequent mission impacts. The procedures to be simulated are endotracheal intubation, fundoscopic examination, kidney/urinary ultrasound, ultrasound-guided intravenous catheter insertion, and a differential diagnosis exercise. Multiple assessment techniques will be used, centered on medical procedure simulation studies occurring at 3, 6, and 12 months after initial training (as depicted in the following flow diagram of the experiment design). Discussion: Analysis of procedure outcomes in the physician and non-physician groups and their subsets (tested at different elapsed times post training) will allow the team to 1) define differences between physician and non-physician CMOs in terms of both procedure performance

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.

PubMed

Pirnejad, Habibollah; Niazkhani, Zahra; van der Sijs, Heleen; Berg, Marc; Bal, Roland

2008-11-01

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration. To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses. Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced. This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.

The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department.

PubMed

Schoenfeld, Elizabeth M; Goff, Sarah L; Elia, Tala R; Khordipour, Errel R; Poronsky, Kye E; Nault, Kelly A; Lindenauer, Peter K; Mazor, Kathleen M

2016-12-01

Shared decision making (SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department (ED), little is known about emergency physicians' (EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase "shared decision making," but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance

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

PubMed

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.

Effectiveness of an Intervention to Teach Physicians How to Assist Patients to Quit Smoking in Argentina

PubMed Central

Mejia, Raul; Kaplan, Celia P.; Gregorich, Steven E.; Livaudais-Toman, Jennifer; Peña, Lorena; Alderete, Mariela; Schoj, Veronica; Alderete, Ethel

2016-01-01

Abstract Introduction: We evaluated an intervention to teach physicians how to help their smoking patients quit compared to usual care in Argentina. Methods: Physicians were recruited from six clinical systems and randomized to intervention (didactic curriculum in two 3-hour sessions) or usual care. Smoking patients who saw participating physicians within 30 days of the intervention (index clinical visit) were randomly sampled and interviewed by telephone with follow-up surveys at months 6 and 12 after the index clinical visit. Outcomes were tobacco abstinence (main), quit attempt in the past month, use of medications to quit smoking, and cigarettes per day. Repeated measures on the same participants were accommodated via generalized linear mixed models. Results: Two hundred fifty-four physicians were randomized; average age 44.5 years, 53% women and 12% smoked. Of 1378 smoking patients surveyed, 81% were women and 45% had more than 12 years of education. At 1 month, most patients (77%) reported daily smoking, 20% smoked some days and 3% had quit. Mean cigarettes smoked per day was 12.9 ( SD = 8.8) and 49% were ready to quit within the year. Intention-to-treat analyses did not show significant group differences in quit rates at 12 months when assuming outcome response was missing at random (23% vs. 24.1%, P = .435). Using missing=smoking imputation rule, quit rates were not different at 12 months (15.6% vs. 16.4% P = .729). Motivated smokers were more likely to quit at 6 months (17.7% vs. 9.6%, P = .03). Conclusions: Training in tobacco cessation for physicians did not improve abstinence among their unselected smoking patients. PMID:26175459

Geriatric Training Needs of Nursing-Home Physicians

ERIC Educational Resources Information Center

Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur

2009-01-01

Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

Determinants of Rural Physicians' Life and Job Satisfaction

ERIC Educational Resources Information Center

Lavanchy, Marcel; Connelly, Ian; Grzybowski, Stefan; Michalos, Alex C.; Berkowitz, Jonathan; Thommasen, Harvey V.

2004-01-01

Objective: To identify and quantify factors that contribute to rural physicians' satisfaction with their jobs and life as a whole. Design: Cross-sectional, mailed survey. Study population: Family physicians practicing in rural communities eligible for British Columbia's Northern and Isolation Allowance. Main measures: Demographics, Domain…

Global pricing for cardiac care: hard lessons for physicians and hospitals.

PubMed

Goodroe, J H; Murphy, D A

1993-01-01

The challenges associated with global contracting are becoming apparent as more experience is gained. Contracts held by an open medical staff hospital provide an ever-changing equation. High-cost physicians can join the staff and alter the cost and quality outcomes that the hospital and physicians may anticipate. Also, physicians want to have assurances on how fee distribution is determined. For these reasons, some physicians are developing private contracting vehicles that assure their future. Managed competition is encouraging these creative models to respond to the market demands of payers; in some markets, these vehicles are creating the demand. It is important for both physicians and hospitals to be open to new creative models. Hospitals that insist on controlling the situation decrease its potential success. Flexibility ensures the ability of both entities to respond to new market demands. From the payer perspective, global contracting represents predictability of price and dependability of service. It encourages an economic relationship of dependence between a hospital and its physicians. Utilization of service is no longer the payers' problem; instead, the provider is asking the questions and managing the situation to assure that both quality and economic efficiency outcomes are achieved.

When doctors go to business school: career shoices of physician-MBAs.

PubMed

Ljuboja, Damir; Powers, Brian W; Robbins, Benjamin; Huckman, Robert; Yeshwant, Krishnan; Jain, Sachin H

2016-06-01

There has been substantial growth in the number of physicians pursing Master of Business Administration (MBA) degrees over the past decade, but there is continuing debate over the utility of these programs and the career outcomes of their graduates. The authors analyzed the clinical and professional activities of a large cohort of physician-MBAs by gathering information on 206 physician graduates from the Harvard Business School MBA program who obtained their degrees between 1941 and 2014. Key outcome measures that were examined include medical specialty, current professional activity, and clinical practice. Chi square tests were used to assess the correlations in the data. Among the careers that were tracked (n = 195), there was significant heterogeneity in current primary employment. The most common sectors were clinical (27.7%), investment banking/finance (27.0%), hospital/provider administration (11.7%), biotech/device/pharmaceutical (10.9%), and entrepreneurship (9.5%). Overall, 84% of physician-MBAs entered residency; approximately half (49.3%) remained clinically active in some capacity and only one-fourth (27.7%) reported clinical medicine as their primary professional role. Among those who pursued residency training, the most common specialties were internal medicine (39.3%), emergency medicine (10.4%), orthopedic surgery (9.2%), and general surgery (8.6%). Physician-MBAs trained in internal medicine were significantly more likely to remain clinically active (63.8% vs 42.4%; P = .01). Clinical activity and primary employment in a clinical role decreased after degree conferment. After completing their education, a majority of physician-MBAs divert their primary professional focus away from clinical activity. These findings reveal new insights into the career outcomes of physician-MBAs.

Characteristics of sick-listing cases that physicians consider problematic--analyses of written case reports.

PubMed

Engblom, Monika; Alexanderson, Kristina; Rudebeck, Carl Edvard

2009-01-01

The aim was to discern common characteristics in the sick-listing cases that physicians in general practice and occupational health services find problematic. Descriptive categorization within a narrative theoretical framework. Sickness-insurance course for physicians in general practice and occupational health services. A total of 195 case reports written by 195 physicians. Main outcome measures. Categories of features regarding medical, work, and social situation as well as medical interventions. Beside age and sex, the following information was often provided: family situation, stressful life events, occupation, problem at work, considerations concerning diagnoses, medical investigations, treatments, and vocational rehabilitation measures. Two-thirds of the patients had been sickness absent for more than a year. The most common type of case reports concerned women, employed in non-qualified nursing occupations, and sick listed due to mental disorders. The most common measures taken by the physicians were referrals to psychotherapy and/or physiotherapy, and prescribing antidepressants (SSRI). Facts about alcohol habits were rarely provided in the cases. Some of the circumstances, such as prolonged sick-listing, are likely to be more or less inevitable in problematic sick-listing cases. Other circumstances, such as stress-full life events, more closely reflect what the reporting physicians find problematic. The categories identified can be regarded as markers of problematic sick-listing cases in general practice and occupational health service.

Hope and persuasion by physicians during informed consent.

PubMed

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.

Hope and Persuasion by Physicians During Informed Consent

PubMed Central

Miller, Victoria A.; Cousino, Melissa; Leek, Angela C.; Kodish, Eric D.

2014-01-01

Purpose 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. Patients and Methods 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. Results 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. Conclusion 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. PMID:25199753

Should Physicians Have Facial Piercings?

PubMed Central

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

2005-01-01

OBJECTIVE 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. DESIGN Survey. SETTING Teaching hospital in the southeastern United States. PARTICIPANTS Emergency department patrons and medical school faculty physicians. INTERVENTIONS 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. MEASUREMENTS AND MAIN RESULTS 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. CONCLUSIONS 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

Speaking Up: How Patient and Physician Voices Shaped a Trial to Improve Goals-of-Care Discussions.

PubMed

Solomon, Rachel; Smith, Cardinale; Kallio, Jay; Fenollosa, Amy; Benerofe, Barbara; Jones, Laurence; Adelson, Kerin; Gonsky, Jason P; Messner, Carolyn; Bickell, Nina A

2017-08-01

Patients with advanced cancer benefit from early goals-of-care (GoC) conversations, but few facilitators are known. We describe the process and outcomes of involving patient and physician stakeholders in the design and development of a trial, funded by the Patient-Centered Outcomes Research Institute (PCORI), to enhance oncologists' communication skills and their propensity to facilitate productive, meaningful GoC discussions with patients with advanced cancer. We recruited oncologists, palliative care physicians, and patient stakeholders to participate in proposal development, intervention design and modification, identification of outcome measures, and refinement of study tools. Formats for exchange included 1:1 structured interviews, workshops, and stakeholder meetings. Patient and physician voices helped craft and implement a study of an intervention to enhance oncologists' ability to facilitate GoC discussions with patients with advanced cancer. Physician inputs guided the creation of an oncologist and palliative care physician "joint visit" intervention at a turning point in disease management. Patient inputs impacted on the language used, outcome measures assessed, and approaches used to introduce patients to the intervention visit. Stakeholder input informed the development of a novel intervention that physicians seemed to find both valuable and in sync with their needs and their practice schedules. Where communication about difficult subjects and shared decision making are involved, including multiple stakeholder groups in study design, implementation, and outcomes measurement may have far-reaching effects.

German physicians "on strike"--shedding light on the roots of physician dissatisfaction.

PubMed

Janus, Katharina; Amelung, Volker Eric; Gaitanides, Michael; Schwartz, Friedrich Wilhelm

2007-08-01

Over the past few years, students in Germany have been dropping out of medical school at increasing rates, and the number of physicians choosing to work abroad or in non-medical professions has been growing. A recent study (the "Ramboll Study") commissioned by the Health Ministry concluded that German physicians' dissatisfaction with existing monetary and non-monetary incentive systems during training and subsequent practice was the main reason for these trends. Among those physicians who have remained in the workforce, there is a similar dissatisfaction, reflected in part by a general strike in 2006 by German physicians in favour of higher wages and better working conditions. To better understand the decision-making process of physicians which is highly determined by the satisfaction they experience in their work life and to extract the factors that contribute to their satisfaction. We surveyed all physicians who spent more than 50% of their time in patient care (and less than 50% in research) at the teaching hospital of the Hannover Medical School (839, after exclusion of pre-test participants). Based on existing satisfaction studies, we designed a self-administered questionnaire that contained 28 items, including items measuring several dimensions of physician job satisfaction; the monetary and non-monetary incentives the physicians experienced in the recent past; other job-related potential confounding factors and socio-demographic questions. Respondents were asked to rate each job satisfaction item on five-point Likert scales regarding both satisfaction with and importance of the item. Data were analysed using descriptive statistics, factor and correlation analyses. Our data suggest that non-monetary factors are important determinants of physician job satisfaction, perhaps more important than monetary incentives that may augment or reduce physicians' base incomes. Factor analysis revealed seven principal factors of which decision-making and recognition

Physicians' perspectives on clinical pharmacy services in Northern Sweden: a qualitative study.

PubMed

Vinterflod, Charlotta; Gustafsson, Maria; Mattsson, Sofia; Gallego, Gisselle

2018-01-24

In many countries, clinical pharmacists are part of health care teams that work to optimize drug therapy and ensure patient safety. However, in Sweden, clinical pharmacy services (CPSs) in hospital settings have not been widely implemented and regional differences exist in the uptake of these services. Physicians' attitudes toward CPSs and collaborating with clinical pharmacists may facilitate or hinder the implementation and expansion of the CPSs and the role of the clinical pharmacist in hospital wards. The aim of this study was to explore physicians' perceptions regarding CPSs performed at hospital wards in Northern Sweden. Face-to-face semi-structured interviews were conducted with a purposive sample of nine physicians who had previously worked with clinical pharmacists between November 2014 and January 2015. Interviews were digitally recorded, transcribed and analysed using a constant comparison method. Different themes emerged regarding physicians' views of clinical pharmacy; two main interlinked themes were service factors and pharmacist factors. The service was valued and described in a positive way by all physicians. It was seen as an opportunity for them to learn more about pharmacological treatment and also an opportunity to discuss patient medication treatment in detail. Physicians considered that CPSs could improve patient outcomes and they valued continuity and the ability to build a trusting relationship with the pharmacists over time. However, there was a lack of awareness of the CPSs. All physicians knew that one of the pharmacist's roles is to conduct medication reviews, but most of them were only able to describe a few elements of what this service encompasses. Pharmacists were described as "drug experts" and their recommendations were perceived as clinically relevant. Physicians wanted CPSs to continue and to be implemented in other wards. All physicians were positive regarding CPSs and were satisfied with the collaboration with the clinical

Mobile health apps in Sweden: what do physicians recommend?

PubMed

Zhang, Yiping; Koch, Sabine

2015-01-01

Currently over 50,000 mobile health apps are available worldwide. In general, they are considered as innovations potentially delivering benefits to patients. Physicians are considered as potential channels to disseminate these innovations to patients. However, physicians' behavior in this regard has not been studied. To capture physicians' attitudes towards recommending health apps to patients and to describe factors influencing physicians' behavior, taking the specifics of an early adopter country, Sweden, into account. Diffusion of Innovation theory, the Health App Maturity Model and the Six Hurdles Model were used to construct a web-based survey that was answered by 44 Swedish physicians. Survey results were followed up with 2 individual interviews. Descriptive statistics were used for quantitative data analysis and recursive abstraction for qualitative data analysis. Only a small group of physicians currently recommend mobile health apps to their patients. However, most physicians have a positive attitude and perceive improvement of patients' self-management ability as main benefit of health apps. Main perceived weaknesses include the lack of evidence-based content and lack of multi-language support. Regulation of health apps under the Medical Device Directive is asked for to assure quality and patient safety. Innovators and early adopters play an important role in the diffusion of mobile health apps. Interpersonal communication is seen as the most effective way for physicians gaining information and also motivates them to recommend mobile health apps to their patients. Physicians' knowledge about certified websites to ensure quality is however low.

Gender, family status and physician labour supply.

PubMed

Wang, Chao; Sweetman, Arthur

2013-10-01

With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis. Although both male and female physicians have statistically indistinguishable hours of market work when never married and without children, married male physicians have higher market hours, and their hours are unchanged or increased with parenthood. In contrast, female physicians have lower market hours when married, and much lower hours when a parent. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcomes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician's spouse is much less likely to be employed, and if employed, has lower market hours in the presence of children. In contrast, a female physician's spouse is more likely to be employed if there are three or more children. Both male and female physicians have lower hours of work when married to another physician. Overall, there is no gender difference in physician market labour supply after controlling for family status and demographics. Copyright © 2013 Elsevier Ltd. All rights reserved.

Two dimensions of trust in physicians in OECD-countries.

PubMed

Saarinen, Arttu Olavi; Räsänen, Pekka; Kouvo, Antti

2016-01-01

The purpose of this paper is to analyse citizens' trust in physicians in 22 OECD countries. The authors measure trust in physicians using items on generalised and particularised trust. Individual-level data are received from the ISSP Research Group (2011). The authors also utilise macro variables drawn from different data banks. Data were analysed using descriptive statistics and xtlogit regression models. The main micro-level hypothesis is that low self-reported health is strongly associated with lower trust in physicians. The second micro-level hypothesis is that frequent meetings with physicians result in higher trust. The third micro-level hypothesis assumes that males, and older and better educated respondents, express higher trust compared to others. The first macro-level hypothesis is that lower income inequality leads to higher trust in physicians. The second macro-level hypothesis is that greater physician density leads to higher trust in physicians. The authors found that the influence of individual and macro-level characteristics varies between trust types. Results indicate that both trust types are clearly associated with individual-level determinants. However, only general trust in physicians has weak associations with macro-level indicators (mainly physician density) and therefore on institutional cross-country differences. It seems that particularised trust in a physician's skills is more restricted to the individuals' health and their own experiences meeting doctors, whereas general trust likely reflects attitudes towards the prevalent profession in the country. The findings hold significance for healthcare systems research and for research concerning social trust generally.

The Physician Payments Sunshine Act: Data Evaluation Regarding Payments to Ophthalmologists

PubMed Central

Chang, Jonathan S.

2014-01-01

Objective/Purpose To review data for ophthalmologists published online from the Physician Payments Sunshine Act. Design Retrospective data review using a publicly available electronic database Methods: Main Outcome Measures A database was downloaded from the Centers for Medicare and Medicaid Services (CMS) Website under Identified General Payments to Physicians and a primary specialty of ophthalmology. Basic statistical analysis was performed including mean, median and range of payments for both single payments and per provider. Data were also summarized by category of payment, geographic region and compared with other surgical subspecialties. Results From August 1, 2013 to December 31, 2013, a total of 55,996 individual payments were reported to 9,855 ophthalmologists for a total of $10,926,447. The mean amount received in a single payment was $195.13 (range $0.04–$193,073). The mean amount received per physician ID was $1,108 (range $1–$397,849) and median amount $112.01. Consulting fees made up the largest percentage of fees. There was not a large difference in payments received by region. The mean payments for the subspecialties of dermatology, neurosurgery, orthopedic surgery and urology ranged from $954–$6,980, and median payments in each field by provider identifier ranged from $88–$173. Conclusions A large amount of data was released by CMS for the Physician Payment Sunshine Act. In ophthalmology, mean and median payments per physician did not vary greatly from other surgical subspecialties. Most single payments were under $100, and most physicians received less than $500 in total payments. Payments for consulting made up the largest category of spending. How this affects patient perception, patient care and medical costs warrants further study. PMID:25578254

Physician performance feedback in a Canadian academic center.

PubMed

Garvin, Dennis; Worthington, James; McGuire, Shaun; Burgetz, Stephanie; Forster, Alan J; Patey, Andrea; Gerin-Lajoie, Caroline; Turnbull, Jeffrey; Roth, Virginia

2017-10-02

Purpose This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization. Design/methodology/approach A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions. Findings This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met. Originality/value This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

Learning about new products: an empirical study of physicians' behavior.

PubMed

Ferreyra, Maria Marta; Kosenok, Grigory

2011-01-01

We develop and estimate a model of market demand for a new pharmaceutical, whose quality is learned through prescriptions by forward-looking physicians. We use a panel of antiulcer prescriptions from Italian physicians between 1990 and 1992 and focus on a new molecule available since 1990. We solve the model by calculating physicians' optimal decision rules as functions of their beliefs about the new pharmaceutical. According to our counterfactuals, physicians' initial pessimism and uncertainty can have large, negative effects on their propensity to prescribe the new drug and on expected health outcomes. In contrast, subsidizing the new good can mitigate informational losses.

The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1.050 U.S. Physicians

PubMed Central

Lo, Bernard; Pollack, Lance; Donelan, Karen; Catania, Joe; Lee, Ken; Zapert, Kinga; Turner, Rachel

2003-01-01

Background Public use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload. Methods Cross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%). Results Eighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2). Conclusions The quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research. PMID:14517108

International variations in primary care physician consultation time: a systematic review of 67 countries

PubMed Central

Neves, Ana Luisa; Oishi, Ai; Tagashira, Hiroko; Verho, Anistasiya; Holden, John

2017-01-01

Objective To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. Design and outcome measures This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. Results One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. Conclusion There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress. PMID:29118053

Predicting the scope of practice of family physicians.

PubMed

Wong, Eric; Stewart, Moira

2010-06-01

To identify factors that are associated with the scope of practice of FPs and GPs who have office-based practices. Secondary univariable and multivariable analyses of cross-sectional data from the 2001 National Family Physician Workforce Survey conducted by the College of Family Physicians of Canada. Canada. General community of FPs and GPs who spent most of their clinical time in office settings. Demographic characteristics and scope of practice score (SPS), which was the number of 12 selected medical services provided by office-based FPs and GPs. The multivariable model explained 35.1% of the variation in the SPS among participants. Geographic factors of provincial division and whether or not the population served was rural explained 30.5% of the variation in the SPS. Male physician sex, younger physician age, being in group practice, greater access to hospital beds, less access to specialists, main practice setting of an academic teaching unit, mixed method physician payment, additional structured postresidency training, and greater number of different types of allied health professionals in the main practice setting were also associated with higher SPSs. Geographic factors were the strongest determinants of scope of practice; physician-related factors, availability of health care resources to the main practice setting, and practice organization factors were weaker determinants. It is important to understand how and why geographic factors influence scope of practice, and whether a broad scope of practice independent of population needs benefits the population. This study supports primary care renewal efforts that use mixed payment systems, incorporate allied health care professionals into family and general practices, and foster group practices.

Factors influencing palliative care. Qualitative study of family physicians' practices.

PubMed Central

Brown, J. B.; Sangster, M.; Swift, J.

1998-01-01

OBJECTIVE: To examine factors that influence family physicians' decisions to practise palliative care. DESIGN: Qualitative method of in-depth interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care. METHOD: Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. MAIN OUTCOME FINDINGS: The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care. CONCLUSIONS: Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine. PMID:9612588

Impact of physician-less pediatric critical care transport: Making a decision on team composition.

PubMed

Kawaguchi, Atsushi; Nielsen, Charlene C; Saunders, L Duncan; Yasui, Yutaka; de Caen, Allan

2018-06-01

To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions. Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects. In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team. No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Physician empathy and listening: associations with patient satisfaction and autonomy.

PubMed

Pollak, Kathryn I; Alexander, Stewart C; Tulsky, James A; Lyna, Pauline; Coffman, Cynthia J; Dolor, Rowena J; Gulbrandsen, Pål; Ostbye, Truls

2011-01-01

Motivational Interviewing (MI) is used to help patients change their behaviors. We sought to determine if physician use of specific MI techniques increases patient satisfaction with the physician and perceived autonomy. We audio-recorded preventive and chronic care encounters between 40 primary care physicians and 320 of their overweight or obese patients. We coded use of MI techniques (eg, empathy, reflective listening). We assessed patient satisfaction and how much the patient felt the physician supported him or her to change. Generalized estimating equation models with logit links were used to examine associations between MI techniques and patient perceived autonomy and satisfaction. Patients whose physicians were rated as more empathic had higher rates of high satisfaction than patients whose physicians were less empathic (29% vs 11%; P = .004). Patients whose physicians made any reflective statements had higher rates of high autonomy support than those whose physicians did not (46% vs 30%; P = .006). When physicians used reflective statements, patients were more likely to perceive high autonomy support. When physicians were empathic, patients were more likely to report high satisfaction with the physician. These results suggest that physician training in MI techniques could potentially improve patient perceptions and outcomes.

Physician awareness of enhanced prenatal services for medicaid-insured pregnant women.

PubMed

Raffo, Jennifer E; Gary, Monica; Forde, Gareth K; Meghea, Cristian I; Roman, Lee Anne

2014-01-01

Medicaid enhanced prenatal service (EPS) programs, including care coordination, were developed to improve birth outcomes for low-income pregnant women. In Michigan, less than a third of eligible pregnant women are enrolled in services. Physician or medical clinics provide referrals to community-based EPS. The objective of this study was to examine physician knowledge and perceptions of EPS. A cross-sectional survey of obstetric providers was conducted in 2009. A questionnaire was created to assess understanding of the EPS program. The study was conducted in an urban Michigan community. Participants included a convenience sample (N = 56) of community Obstetrics and Gynecology attending physicians and resident physicians within a single, large health system. Outcome measures included knowledge of the program and patient participation, referral practices, perceptions of the program, value for patients and providers, appropriateness of physicians to provide program referrals, and barriers to referring. Findings indicated that most physicians (84%) had little familiarity with EPS, 60% did not personally refer to EPS, 54% did not know whether other office staff referred to EPS, and 65% were unaware whether their patients received EPS. Yet, more than 90% of physicians reported that EPS would benefit their patients and believed that it was appropriate for them to refer all their eligible patients. Further efforts should be made to better understand how physicians and EPS providers could function together on behalf of patients. Statewide Medicaid-sponsored EPS programs could serve as a valuable patient and physician resource for psychosocial risk screening, care management, education, and referral support if better utilized.

Let physicians be physicians.

PubMed

Nicoletti, Betsy

2008-01-01

On a recent visit to his physician, a friend reported that the physician spent 95% of the visit hunched over a laptop computer, leaving it only for a quick listen to his heart and lungs. The remarkable thing is, in medical circles the story is unremarkable. Many consider it the norm now. Who thought it was a good idea to turn physicians into typists? Does it make sense that the most highly educated person in the building is doing data entry? How is patient care improved if the physician is hunched over a laptop computer in the exam room?

Developing physicians as catalysts for change.

PubMed

George, Aaron E; Frush, Karen; Michener, J Lloyd

2013-11-01

Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.

Physician perspectives on the burden and management of asthma in six countries: The Global Asthma Physician Survey (GAPS).

PubMed

Chapman, Kenneth R; Hinds, David; Piazza, Peter; Raherison, Chantal; Gibbs, Michael; Greulich, Timm; Gaalswyk, Kenneth; Lin, Jiangtao; Adachi, Mitsuru; Davis, Kourtney J

2017-11-23

Despite recognition of asthma as a growing global issue and development of global guidelines, asthma treatment practices vary between countries. Several studies have reported patients' perspectives on asthma control. This study presents physicians' perspectives and strategies for asthma management. Physicians seeing ≥4 adult patients with asthma per month in Australia, Canada, China, France, Germany, and Japan were surveyed (N=1809; ≈300 per country). A standardised questionnaire was developed for this study and administered by telephone, online or face-to-face. Statistics were weighted to account for the sampling scheme. Physicians estimated that 71% of their adult patients received maintenance medication, with adherence monitored by 76-97% of physicians. Perceived major barriers to patient adherence included: patients taking treatment as needed; acceptance of symptoms; and patients not perceiving treatment benefits. Written action plans (37%) and technology (15%) were seldom employed by physicians to aid patients' asthma management. Physicians rarely (10%) used validated patient-reported questionnaires to monitor asthma control, instead monitoring selected symptoms, exacerbations, and/or lung function measurements. Awareness of single maintenance and reliever therapy (SMART/MART) varied among countries (56-100%); although most physicians (72%) had prescribed SMART/MART, the majority (91%) co-prescribed a short-acting bronchodilator at least some of the time. These results show that physicians generally do not employ standardised tools to monitor asthma control or to manage its treatment and that despite high awareness of SMART/MART, the strategy appears to be commonly misapplied. Better education for patients and physicians is required to improve asthma management and resulting patient outcomes.

Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial

PubMed Central

Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Angus, Derek C; Yealy, Donald M; Wallace, David J; Barnato, Amber E

2017-01-01

Abstract Objective To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Design Randomized clinical trial. Setting Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. Participants 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Interventions Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Main outcome measures Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. Results 149 (81%) physicians in the game arm and 148 (80%) in the traditional

Behavioral Indices in Medical Care Outcome: The Working Alliance, Adherence, and Related Factors

PubMed Central

Boylan, Laura S.; Fontanella, Jessie A.

2008-01-01

Background The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome. Objective Cognitive and emotional dimensions of the physician–patient relationship were examined in relation to patients’ ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients’ adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment. Design The study was based on an ex-post facto field correlation design. Participants One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study. Interventions Surveys given to participants. Measurements We used the following measurements: Physician–Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire. Main Results The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49). Conclusions Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes. PMID:18972089

How primary care physicians' attitudes toward risk and uncertainty affect their use of electronic information resources.

PubMed

McKibbon, K Ann; Fridsma, Douglas B; Crowley, Rebecca S

2007-04-01

The research sought to determine if primary care physicians' attitudes toward risk taking or uncertainty affected how they sought information and used electronic information resources when answering simulated clinical questions. Using physician-supplied data collected from existing risk and uncertainty scales, twenty-five physicians were classified as risk seekers (e.g., enjoying adventure), risk neutral, or risk avoiders (e.g., cautious) and stressed or unstressed by uncertainty. The physicians then answered twenty-three multiple-choice, clinically focused questions and selected two to pursue further using their own information resources. Think-aloud protocols were used to collect searching process and outcome data (e.g., searching time, correctness of answers, searching techniques). No differences in searching outcomes were observed between the groups. Physicians who were risk avoiding and those who reported stress when faced with uncertainty each showed differences in searching processes (e.g., actively analyzing retrieval, using searching heuristics or rules). Physicians who were risk avoiding tended to use resources that provided answers and summaries, such as Cochrane or UpToDate, less than risk-seekers did. Physicians who reported stress when faced with uncertainty showed a trend toward less frequent use of MEDLINE, when compared with physicians who were not stressed by uncertainty. Physicians' attitudes towards risk taking and uncertainty were associated with different searching processes but not outcomes. Awareness of differences in physician attitudes may be key in successful design and implementation of clinical information resources.

FRAMING EFFECTS ON PHYSICIANS' JUDGMENT AND DECISION MAKING.

PubMed

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.

Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece.

PubMed

Kostopoulou, Olga; Lionis, Christos; Angelaki, Agapi; Ayis, Salma; Durbaba, Stevo; Delaney, Brendan C

2015-06-01

In a recent randomized controlled trial, providing UK family physicians with 'early support' (possible diagnoses to consider before any information gathering) was associated with diagnosing hypothetical patients on computer more accurately than control. Another group of physicians, who gathered information, gave a diagnosis, and subsequently received a list of possible diagnoses to consider ('late support'), were no more accurate than control, despite being able to change their initial diagnoses. To replicate the UK study findings in another country with a different primary health care system. All study materials were translated into Greek. Greek family physicians were randomly allocated to one of three groups: control, early support and late support. Participants saw nine scenarios in random order. After reading some information about the patient and the reason for encounter, they requested more information to diagnose. The main outcome measure was diagnostic accuracy. One hundred fifty Greek family physicians participated. The early support group was more accurate than control [odds ratio (OR): 1.67 (1.21-2.31)]. Like their UK counterparts, physicians in the late support group rarely changed their initial diagnoses after receiving support. The pooled OR for the early support versus control comparison from the meta-analysis of the UK and Greek data was 1.40 (1.13-1.67). Using the same methodology with a different sample of family physicians in a different country, we found that suggesting diagnoses to consider before physicians start gathering information was associated with more accurate diagnoses. This constitutes further supportive evidence of a generalizable effect of early support. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

What is competent communication behaviour of patients in physician consultations? - Chronically-ill patients answer in focus groups.

PubMed

Schmidt, Erika; Schöpf, Andrea C; Farin, Erik

2017-09-01

Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient's perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two ('documentation of patient and clinician views') in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.

Physician Perceptions and Beliefs about Generating and Providing a Clinical Summary of the Office Visit.

PubMed

Emani, S; Ting, D Y; Healey, M; Lipsitz, S R; Ramelson, H; Suric, V; Bates, D W

2015-01-01

A core measure of the meaningful use of EHR incentive program is the generation and provision of the clinical summary of the office visit, or the after visit summary (AVS), to patients. However, little research has been conducted on physician perceptions and beliefs about the AVS. Evaluate physician perceptions and beliefs about the AVS and the effect of the AVS on workload, patient outcomes, and the care the physician delivers. A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who are participating in the meaningful use EHR incentive program. Of the 1 795 physicians at both AMCs participating in the incentive program, 853 completed the survey for a response rate of 47.5%. Eighty percent of the respondents reported that the AVS was easy (very easy or quite easy or somewhat easy) to generate and provide to patients. Nonetheless, more than three-fourths of the respondents reported a negative effect of generating and providing the AVS on workload of office staff (78%) and workload of physicians (76%). Primary care physicians had more positive beliefs about the effect of the AVS on patient outcomes than specialists (p<0.001) and also had more positive beliefs about the effect of the AVS on the care they delivered than specialists (p<0.001). Achieving the core meaningful use measure of generating and providing the AVS was easy for physicians but it did not necessarily translate into positive beliefs about the effect of the AVS on patient outcomes or the care the physician delivered. Physicians also had negative beliefs about the effect of the AVS on workload. To promote positive beliefs among physicians around the AVS, organizations should obtain physician input into the design and implementation of the AVS and develop strategies to mitigate its negative impacts on workload.

Physician Perceptions and Beliefs about Generating and Providing a Clinical Summary of the Office Visit

PubMed Central

Ting, D.Y.; Healey, M.; Lipsitz, S.R.; Ramelson, H.; Suric, V.; Bates, D.W.

2015-01-01

Summary Background A core measure of the meaningful use of EHR incentive program is the generation and provision of the clinical summary of the office visit, or the after visit summary (AVS), to patients. However, little research has been conducted on physician perceptions and beliefs about the AVS. Objectives Evaluate physician perceptions and beliefs about the AVS and the effect of the AVS on workload, patient outcomes, and the care the physician delivers. Methods A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who are participating in the meaningful use EHR incentive program. Results Of the 1 795 physicians at both AMCs participating in the incentive program, 853 completed the survey for a response rate of 47.5%. Eighty percent of the respondents reported that the AVS was easy (very easy or quite easy or somewhat easy) to generate and provide to patients. Nonetheless, more than three-fourths of the respondents reported a negative effect of generating and providing the AVS on workload of office staff (78%) and workload of physicians (76%). Primary care physicians had more positive beliefs about the effect of the AVS on patient outcomes than specialists (p<0.001) and also had more positive beliefs about the effect of the AVS on the care they delivered than specialists (p<0.001). Conclusions Achieving the core meaningful use measure of generating and providing the AVS was easy for physicians but it did not necessarily translate into positive beliefs about the effect of the AVS on patient outcomes or the care the physician delivered. Physicians also had negative beliefs about the effect of the AVS on workload. To promote positive beliefs among physicians around the AVS, organizations should obtain physician input into the design and implementation of the AVS and develop strategies to mitigate its negative impacts on workload. PMID:26448799

Nurse/physician communication through a sensemaking lens: shifting the paradigm to improve patient safety.

PubMed

Manojlovich, Milisa

2010-11-01

Physician-nurse communication has been identified as one of the main obstacles to progress in patient safety. Breakdowns in communication between physicians and nurses often result in errors, many of which are preventable. Recent research into nurse/physician communication has borrowed heavily from team literature, tending to study communication as one behavior in a larger cluster of behaviors. The multicluster approach to team research has not provided enough analysis of and attention to communication alone. Research into communication specifically is needed to understand its crucial role in teamwork and safety. A critique of the research literature on nurse/physician communication published since 1992 revealed 3 dominant themes: settings and context, consensus building, and conflict resolution. A fourth implicit theme, the temporal nature of communication, emerged as well. These themes were used to frame a discussion on sensemaking: an iterative process arising from dialogue when 2 or more people share their unique perspectives. As a theoretical model, sensemaking may offer an alternative lens through which to view the phenomenon of nurse/physician communication and advance our understanding of how nurse/physician communication can promote patient safety. Sensemaking may represent a paradigm shift with the potential to affect 2 spheres of influence: clinical practice and health care outcomes. Sensemaking may also hold promise as an intervention because through sensemaking consensus may be built and errors possibly prevented. Engaging in sensemaking may overcome communication barriers without realigning power bases, incorporate contextual influences without drawing attention away from communicators, and inform actions arising from communication.

Nurse versus physician-led care for the management of asthma.

PubMed

Kuethe, Maarten C; Vaessen-Verberne, Anja A P H; Elbers, Roy G; Van Aalderen, Wim M C

2013-02-28

Asthma is the most common chronic disease in childhood and prevalence is also high in adulthood, thereby placing a considerable burden on healthcare resources. Therefore, effective asthma management is important to reduce morbidity and to optimise utilisation of healthcare facilities. To review the effectiveness of nurse-led asthma care provided by a specialised asthma nurse, a nurse practitioner, a physician assistant or an otherwise specifically trained nursing professional, working relatively independently from a physician, compared to traditional care provided by a physician. Our scope included all outpatient care for asthma, both in primary care and in hospital settings. We carried out a comprehensive search of databases including The Cochrane Library, MEDLINE and EMBASE to identify trials up to August 2012. Bibliographies of relevant papers were searched, and handsearching of relevant publications was undertaken to identify additional trials. Randomised controlled trials comparing nurse-led care versus physician-led care in asthma for the same aspect of asthma care. We used standard methodological procedures expected by The Cochrane Collaboration. Five studies on 588 adults and children were included concerning nurse-led care versus physician-led care. One study included 154 patients with uncontrolled asthma, while the other four studies including 434 patients with controlled or partly controlled asthma. The studies were of good methodological quality (although it is not possible to blind people giving or receiving the intervention to which group they are in). There was no statistically significant difference in the number of asthma exacerbations and asthma severity after treatment (duration of follow-up from six months to two years). Only one study had healthcare costs as an outcome parameter, no statistical differences were found. Although not a primary outcome, quality of life is a patient-important outcome and in the three trials on 380 subjects that

The Evolution of the Physician Role in the Setting of Increased Non-physician Clinicians in Sub-Saharan Africa: An Insistence on Timing and Culturally-Sensitive, Purposefully Selected Skill Development Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".

PubMed

Binagwaho, Agnes; Sarriera, Gabriela; Eagan, Arielle

2016-07-09

As Eyal et al put forth in their piece, Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians, task-shifting across sub-Saharan Africa through non-physician clinicians (NPCs) has led to an improvement in access to health services in the context of physician-shortages. Here, we offer a commentary to the piece by Eyal et al, concurring that physician's roles should evolve into specialized medicine and that skills in mentorship, research, management, and leadership may create more holistic physicians clinical services. We believe that learning such non-clinical skills will allow physicians to improve the outcome of their clinical services. However, at the risk of a local, clinical brain drain as physicians shift to explore beyond the clinical sphere, we advocate strongly for increased caution to be exercised by leadership over the encouragement of this evolution. In the context of still-present physician shortages across many developing countries, we advocate to analyze this changing role and to purposefully select each new skill according to the context, giving careful consideration to the timing and degree of its evolution. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effort-reward imbalance and depression among private practice physicians.

PubMed

Tsutsumi, Akizumi; Kawanami, Shoko; Horie, Seichi

2012-02-01

Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians. This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association (n = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI. Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43-5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36-7.92). Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.

Shared presence in physician-patient communication: A graphic representation.

PubMed

Ventres, William B; Frankel, Richard M

2015-09-01

Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care--all deceptive in their simplicity but, in fact, highly complex--or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients. (c) 2015 APA, all rights reserved).

Sexual Outcomes and Satisfaction with Hysterectomy: Influence of Patient Education

PubMed Central

Bradford, Andrea; Meston, Cindy

2010-01-01

Introduction Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. Aim The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. Methods We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3–12 months. Participants volunteered in response to a Web-based advertisement. Main Outcome Measures Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. Results Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. Conclusion Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy. PMID:17087803

The impact of 24-hr, in-hospital pediatric critical care attending physician presence on process of care and patient outcomes*.

PubMed

Nishisaki, Akira; Pines, Jesse M; Lin, Richard; Helfaer, Mark A; Berg, Robert A; Tenhave, Thomas; Nadkarni, Vinay M

2012-07-01

Attending physicians are only required to provide in-hospital coverage during daytime hours in many pediatric intensive care units. An in-hospital 24-hr pediatric intensive care unit attending coverage model has been increasingly popular, but the impact of 24-hr, in-hospital attending coverage on care processes and outcomes has not been reported. We compared processes of care and outcomes before and after the implementation of a 24-hr in-hospital pediatric intensive care unit attending physician model. Retrospective comparison of before and after cohorts. A single large, academic tertiary medical/surgical pediatric intensive care unit. : Pediatric intensive care unit admissions in 2000-2006. Transition to 24-hr from 12-hr in-hospital pediatric critical care attending physician coverage model in January 2004. A total of 18,702 patients were admitted to intensive care unit: 8,520 in 24 hrs; 10,182 in 12 hrs. Duration of mechanical ventilation was lower (median 33 hrs [interquartile range 12-88] vs. 48 hrs [interquartile range 16-133], adjusted reduction of 35% [95% confidence interval 25%-44%], p < .001) and intensive care unit length of stay was shorter (median 2 days [interquartile range 1-4] vs. 2 days [interquartile range 1-5], adjusted p < .001) for 24 hr vs. 12 hr coverage. The reduction in mechanical ventilation hours was similar when noninvasive, mechanical ventilation was included in ventilation hours (median 42 hrs vs. 56 hrs, adjusted reduction in ventilation hours: 33% [95% confidence interval 20-45], p < .001). Intensive care unit mortality was not significantly different (2.2% vs. 2.5%, adjusted p =.23). These associations were consistent across daytime and nighttime admissions, weekend and weekday admissions, and among subgroups with higher Pediatric Risk of Mortality III scores, postsurgical patients, and histories of previous intensive care unit admission. Implementation of 24-hr in-hospital pediatric critical care attending coverage was associated

[An online emergency physician survey - demography, education and experience of German emergency physicians].

PubMed

Ilper, H; Kunz, T; Walcher, F; Zacharowski, K; Byhahn, C

2013-04-01

German emergency patients are treated by (emergency) physicians (EP). The entry level to emergency medicine differs. Manual skills experience (e. g. tracheal intubation) and knowledge of guidelines are minimum requirements. It is currently unclear who works as an EP and what medical experience he or she has. The anonymous survey was online from 10/15/2010 to 11/16/2011 and distribution was supported by leading physicians informing society members. Online networks informed independent physicians. 2091 EP took part, 1991 datasets were evaluated, 100 datasets were excluded. All results are shown as mean ± standard deviation and range (minimum - maximum). Mean age of the EP was 42 ± 8 years (26-71 years), 80 % (n = 1604) were male, 20 % (n = 387) were female. Participants finished medical school in 1997 ± 8 years (1964-2010). Base specialty during rotation was anesthesiology 59 %, internal medicine 32 %, surgery 26 %, trauma surgery/orthopedics 21 %, others 16 %. Consultants were 75 %. Main income source was answered as "hospital physician" by 77 %, "resident doctor" by 15 %, "professional emergency physician" by 7 %. The participants use a widespread chance for CME (Continuing Medical Education). The participants appear experienced in medicine and emergency medicine. They use a widespread chance for CME. Most of the participants work in anaesthesiology. © Georg Thieme Verlag KG Stuttgart · New York.

[Do physicians' gender and workload affect patients?].

PubMed

Finnvold, Jon Erik

2008-10-23

The article discusses the effect of general practitioners' gender and workload on patients' experience with consultation time, waiting hours, use of out-of-hours services and planned health visits. Data were retrieved from the 2003 version of Statistics Norway's household panel study (5000 persons) and the National Insurance administration's register of regular general practitioners. Health condition was the most important factor related to patient experiences. A high workload was neither associated with more frequent use of out-of-hours services nor satisfaction with time spent in consultation. These results apply to physicians of both genders. Patients who used a female physician with a large workload had to wait longer for an appointment and more often reported dissatisfaction with the waiting time; this was not the case for male physicians. However, male physicians with a low workload had shorter waiting times. Patients who use practitioners with a high workload may have chosen their doctor more deliberately than others, which may be an explanation for few negative outcomes for physicians with a high workload. It is unlikely that these physicians would be as popular if the patients had fewer appointments, shorter consultations or more often had to use the out-of-hours services. Longer waiting time for appointments with female doctors may be related to more part time work, and the fact that female physicians more often are engaged in group practices.

Counties Without a Physician.

ERIC Educational Resources Information Center

Getz, Virginia

1982-01-01

Uses a budgeting technique to determine if free-market incentives or forces would provide an economic base sufficient to support medical professionals who might practice in the approximately 140 U.S. counties that lack a physician (located mainly in a narrow band from west Texas north through South Dakota). (AH)

Evaluation of Physicians' Cognitive Styles.

PubMed

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

2014-07-01

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

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

PubMed

Rothenfluh, Fabia; Schulz, Peter J

2017-05-01

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

Practices and outcomes of self-treatment with helminths based on physicians' observations.

PubMed

Liu, J; Morey, R A; Wilson, J K; Parker, W

2017-05-01

The successful use of helminths as therapeutic agents to resolve inflammatory disease was first recorded 40 years ago. Subsequent work in animal models and in humans has demonstrated that the organisms might effectively treat a wide range of inflammatory diseases, including allergies, autoimmune disorders and inflammation-associated neuropsychiatric disorders. However, available information regarding the therapeutic uses and effects of helminths in humans is limited. This study probes the practices and experiences of individuals 'self-treating' with helminths through the eyes of their physicians. Five physicians monitoring more than 700 self-treating patients were interviewed. The results strongly support previous indications that helminth therapy can effectively treat a wide range of allergies, autoimmune conditions and neuropsychiatric disorders, such as major depression and anxiety disorders. Approximately 57% of the self-treating patients observed by physicians in the study had autism. Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis. However, approximately 1% of paediatric patients experienced severe gastrointestinal pains with the use of H. diminuta, although the symptoms were resolved with an anti-helminthic drug. Further, exposure to helminths apparently did not affect the impaired comprehension of social situations that is the hallmark of autism. These observations point toward potential starting points for clinical trials, and provide further support for the importance of such trials and for concerted efforts aimed at probing the potential of helminths, and perhaps other biologicals, for therapeutic use.

Understanding of prognosis among parents of children with cancer: parental optimism and the parent-physician interaction.

PubMed

Mack, Jennifer W; Cook, E Francis; Wolfe, Joanne; Grier, Holcombe E; Cleary, Paul D; Weeks, Jane C

2007-04-10

Patients often overestimate their chances of surviving cancer. Factors that contribute to accurate understanding of prognosis are not known. We assessed understanding of likelihood of cure and functional outcome among parents of children with cancer and sought to identify factors that place parents at risk for overly optimistic beliefs about prognosis. We conducted a cross-sectional survey of 194 parents of children with cancer (response rate, 70%) who were treated at the Dana-Farber Cancer Institute and Children's Hospital in Boston, MA, and the children's physicians. Parent and physician expectations for likelihood of cure and functional outcome were compared. In 152 accurate or optimistic parents, we determined factors associated with accurate understanding of likelihood of cure compared with optimism. The majority of parents (61%) were more optimistic than physicians about the likelihood of cure. Parents' beliefs about other outcomes of cancer treatment were similar (quality-of-life impairment, P = .70) or more pessimistic (physical impairment, P = .01; intellectual impairment, P = .01) than physicians' beliefs. Parents and physicians were more likely to agree about chances of cure when physicians had confidence in knowledge of prognosis (odds ratio [OR] = 2.55, P = .004) and allowed parents to take their preferred decision-making role (OR = 1.89, P = .019). Parents of children with cancer are overly optimistic about chances of cure but not about other outcomes of cancer therapy. Parents tend to be overly optimistic about cure when physicians have little confidence and when the decision-making process does not meet parents' preferences. These findings suggest that physicians are partly responsible for parents' unrealistic expectations about cure.

Difficulties facing physician mothers in Japan.

PubMed

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

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

PubMed Central

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

1995-01-01

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 methodology of literature research in general. This article reports on a survey of the literature on information use by family physicians. Eleven relevant research publications could be found. The data showed that family physicians used colleagues most often as information sources, followed by journals and books. This outcome corresponded with results in other professions. Several factors influenced the use of information sources by family physicians, including the physical, functional, and intellectual accessibility of the source; the physician's age; participation by the physician in research or education; the social context of the physician; practice characteristics; and the stage of the information-gathering process. The publications studied suggested ways to improve information gathering in the areas of computerization, education, library organization, and journal articles. PMID:7703946

Social Media Use Among Physicians and Trainees: Results of a National Medical Oncology Physician Survey.

PubMed

Adilman, Rachel; Rajmohan, Yanchini; Brooks, Edward; Urgoiti, Gloria Roldan; Chung, Caroline; Hammad, Nazik; Trinkaus, Martina; Naseem, Madiha; Simmons, Christine; Adilman, Rachel; Rajmohan, Yanchini; Brooks, Edward; Roldan Urgoiti, Gloria; Chung, Caroline; Hammad, Nazik; Trinkaus, Martina; Naseem, Madiha; Simmons, Christine

2016-01-01

Cancer management requires coordinated care from many health care providers, and its complexity requires physicians be up to date on current research. Web-based social media support physician collaboration and information sharing, but the extent to which physicians use social media for these purposes remains unknown. The complex field of oncology will benefit from increased use of online social media to enhance physician communication, education, and mentorship. To facilitate this, patterns of social media use among oncologists must be better understood. A nine-item survey investigating physician social media use, designed using online survey software, was distributed via e-mail to 680 oncology physicians and physicians in training in Canada. Responses were analyzed using descriptive statistics. A total of 207 responses (30%) were received; 72% of respondents reported using social media. Social media use was highest, at 93%, in respondents age 25 to 34 years and lowest, at 39%, in those age 45 to 54 years. This demonstrates a significant gap in social media use between younger users and mid- to late-career users. The main barrier to use was lack of free time. The identified gap in social media use between age cohorts may have negative implications for communication in oncology. Despite advancements in social media and efforts to integrate social media into medical education, most oncologists and trainees use social media rarely, which, along with the age-related gap in use, may have consequences for collaboration and education in oncology. Investigations to further understand barriers to social media use should be undertaken to enhance physician collaboration and knowledge sharing through social media.

Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians.

PubMed

Dresser, Caleb; Periyanayagam, Usha; Dreifuss, Brad; Wangoda, Robert; Luyimbaazi, Julius; Bisanzo, Mark

2017-09-01

Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients. This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 were analyzed in Microsoft Excel. Overall, 112 Emergency Department patients were included in the analysis and 96% received some form of laboratory testing, imaging, medication, or procedure in the ED, prior to surgery. 72% of surgical patients referred by ED received preoperative antibiotics, and preoperative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 h of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72 h. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%. Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa's current acute surgical care model and will benefit from further study and expansion.

Dental complications of gastro-oesophageal reflux disease: guidance for physicians.

PubMed

Lee, Robert J; Aminian, Amin; Brunton, Paul

2017-06-01

There is potential for gastro-oesophageal reflux disease (GORD) to be under-diagnosed by physicians. A quick, focused examination, requiring no special equipment, of a patients' dentition can assist in making a more accurate diagnosis where GORD is suspected. Guidance is provided for physicians as to what intra-oral signs are suggestive of intrinsic dental erosion, which is a clinical feature of GORD and its associated conditions. Use of this information will, it is suggested, improve outcomes for patients where GORD is suspected. © 2016 Royal Australasian College of Physicians.

Physician nurse care: A new use of UMLS to measure professional contribution

PubMed Central

Boyd, Andrew D.; Lopez, Karen Dunn; Lugaresi, Camillo; Macieira, Tamara; Sousa, Vanessa; Acharya, Sabita; Balasubramanian, Abhinaya; Roussi, Khawllah; Keenan, Gail M.; Lussier, Yves A.; ‘John’ Li, Jianrong; Burton, Michel; Di Eugenio, Barbara

2018-01-01

Background Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. Objective The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. Methods 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted “physician terms” from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create “nursing terms”. The physician’s and nurse’s terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. Results We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions’ documentation. On average, physicians’ discharge summaries contain 27 terms and nurses’ documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between

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

PubMed

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

2013-04-01

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

The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: Supply-need mismatch

PubMed Central

Alter, David A; Stukel, Therese A; Newman, Alice

2008-01-01

BACKGROUND: While health service use appears to be positively correlated with resource availability, no study has explored the interactions among health service supply, cardiovascular disease burden and health service use. The objective of the present study was to examine the relationship among cardiovascular evaluation and management intensity, physician supply and cardiovascular disease burden in the Canadian population. METHODS: The present cross-sectional, population-based study consisted of adult residents in Ontario in 2001. Cardiac evaluation and management intensity, the main outcome measure, was measured at the individual level, and consisted of receiving one or more of the following services: noninvasive cardiac testing, coronary angiography and statin use (the latter among individuals 65 years of age and older). Mortality was the secondary outcome measure. Cardiovascular disease burden, and cardiologist and primary care physician supply were measured at the regional (ie, county) level. Analyses were adjusted for age and sex using Poisson regression, accounting for regional clustering. RESULTS: Regional per capita cardiologist supply varied more than twofold across regions, but was inversely related to the regional cardiovascular disease burden (r=−0.34, P=0.01). Primary care physician supply was relatively evenly distributed across regions. Residents in areas with more cardiologists were more likely to receive some form of cardiac intervention (RR=1.074, 95% CI 1.066 to 1.082 per additional cardiologist per 100,000). Those in areas with more primary care physicians were also more likely to receive noninvasive cardiac testing (RR=1.056, 95% CI 1.051 to 1.061 per six additional primary care physicians per 100,000). However, the intensity of provision of cardiac health services was unrelated to regional cardiovascular disease burden and was not associated with improved survival. CONCLUSIONS: The mismatch between physician supply and cardiac disease burden

Hope Modified the Association between Distress and Incidence of Self-Perceived Medical Errors among Practicing Physicians: Prospective Cohort Study

PubMed Central

Hayashino, Yasuaki; Utsugi-Ozaki, Makiko; Feldman, Mitchell D.; Fukuhara, Shunichi

2012-01-01

The presence of hope has been found to influence an individual's ability to cope with stressful situations. The objective of this study is to evaluate the relationship between medical errors, hope and burnout among practicing physicians using validated metrics. Prospective cohort study was conducted among hospital based physicians practicing in Japan (N = 836). Measures included the validated Burnout Scale, self-assessment of medical errors and Herth Hope Index (HHI). The main outcome measure was the frequency of self-perceived medical errors, and Poisson regression analysis was used to evaluate the association between hope and medical error. A total of 361 errors were reported in 836 physician-years. We observed a significant association between hope and self-report of medical errors. Compared with the lowest tertile category of HHI, incidence rate ratios (IRRs) of self-perceived medical errors of physicians in the highest category were 0.44 (95%CI, 0.34 to 0.58) and 0.54 (95%CI, 0.42 to 0.70) respectively, for the 2nd and 3rd tertile. In stratified analysis by hope score, among physicians with a low hope score, those who experienced higher burnout reported higher incidence of errors; physicians with high hope scores did not report high incidences of errors, even if they experienced high burnout. Self-perceived medical errors showed a strong association with physicians' hope, and hope modified the association between physicians' burnout and self-perceived medical errors. PMID:22530055

Characteristics and Outcomes of Adult Inpatients With Malnutrition.

PubMed

Vest, Michael T; Papas, Mia A; Shapero, Mary; McGraw, Patty; Capizzi, Amanda; Jurkovitz, Claudine

2017-12-27

The diagnosis of malnutrition remains controversial. Furthermore, it is unknown if physician diagnosis of malnutrition impacts outcomes. We sought to compare outcomes of patients with physician diagnosed malnutrition to patients recognized as malnourished by registered dietitians (RDs), but not physicians, and to describe the impact of each of 6 criteria on the diagnosis of malnutrition. We conducted a retrospective cohort study of adult patients identified as meeting criteria for malnutrition. Pediatric, psychiatric, maternity, and rehabilitation patients were excluded. Patient demographics, clinical data, malnutrition type and criteria, nutrition interventions, and outcomes were abstracted from the electronic medical record. RDs identified malnutrition for 291 admissions during our study period. This represents 4.1% of hospital discharges. Physicians only diagnosed malnutrition on 93 (32%) of these cases. Physicians diagnosed malnutrition in 43% of patients with a body mass index <18.5 but only 26% of patients with body mass index higher than 18.5. Patients with a physician diagnosis had a longer length of stay (mean 14.9 days vs 7.1 days) and were more likely to receive parenteral nutrition (PN) (20.4% vs 4.6%). Of the patients, 62% had malnutrition due to chronic illness. Of the 6 criteria used to identify malnourished patients, weight loss and reduced energy intake were the most common. Malnutrition is underrecognized by physicians. However, further research is needed to determine if physician recognition and treatment of malnutrition can improve outcomes. The most important criteria for identifying malnourished patients in our cohort were weight loss and reduced energy intake. © 2017 American Society for Parenteral and Enteral Nutrition.

Comparing Smoking Cessation Outcomes in Nurse-Led and Physician-Led Primary Care Visits.

PubMed

Byers, Marcia A; Wright, Patricia; Tilford, John Mick; Nemeth, Lynne S; Matthews, Ellyn; Mitchell, Anita

Smoking is a significant public health concern in the United States, yet 50% of patients do not receive recommended tobacco use screening and counseling. This project compared smoking cessation rates in newly reimbursable nurse-led wellness visits with rates in physician-led visits. Although the findings were not statistically significant, they suggested that smoking cessation is at least equivalent in patients who attend nurse-led visits compared with physician-led visits and may be higher.

Conflict management training and nurse-physician collaborative behaviors.

PubMed

Boone, Brenda N; King, Major L; Gresham, Louise S; Wahl, Patricia; Suh, Eunice

2008-01-01

Collaboration between nurses and physicians continues to be elusive although it is a desirable goal for most in health care. This study used a quasi-experimental design to evaluate the outcomes of a conflict resolution (management) training program on nurses' perception of their collaboration with the physicians with whom they work. Results showed no differences between the experimental and control groups following the intervention. Individual readiness and evaluation of the antecedents of collaboration should be determined before implementing such an intervention.

The impact of occupational hazards and traumatic events among Belgian emergency physicians.

PubMed

Somville, Francis J; De Gucht, Véronique; Maes, Stan

2016-04-27

Emergency Physicians (EPs) are regularly confronted with work related traumatic events and hectic work conditions. Several studies mention a high incidence of post-traumatic stress disorder (PTSD) and psychosomatic complaints in EP. The main objective of this study is to examine the contribution of demographics, traumatic events, life events, the occurrence of occupational hazards and social support to post-traumatic stress symptoms (PTSS), psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. For this study questionnaires were distributed to Belgian Emergency Physicians, These include, as determinants socio-demographic characteristics, traumatic events, life events, the occurrence of physical hazards, occurrences of violence, occurrence of situations that increase the risk of burnout and social support by supervisors and colleagues (LQWQ-Med), and as outcomes PTSS (IES), psychological distress (BSI), somatic complaints (PHQ 15), perceived fatigue (CIS20 R) and job satisfaction (LQWQ-MD). The response rate was 52.3 %. Hierarchical multiple regression analysis was performed to examine the association between the determinants and each of the outcomes. Emergency Physicians are particularly vulnerable to post-traumatic and chronic stress consequences due to repetitive exposure to work related traumatic incidents such as serious injuries or death of a child/adolescent. One out of three Emergency Physicians met sub-clinical levels of anxiety and 14.5 % met a clinical level of PTSD, short for Post-Traumatic Stress Disorder. Levels of fatigue were high but not directly related to traumatic events and occupational hazards. Social support from colleagues was found to have a beneficial effect on these complaints. Job satisfaction seems to have a protective factor. All of these not only affect the Emergency Physicians themselves, but can also have an adverse impact on patient care. EPs are, according to our and other studies

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

PubMed

Sidat, Mohsin M

2016-07-02

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

Identifying the Educationally Influential Physician: A Systematic Review of Approaches

ERIC Educational Resources Information Center

Kronberger, Matthew P.; Bakken, Lori L.

2011-01-01

Introduction: Previous studies have indicated that educationally influential physicians' (EIPs) interactions with peers can lead to practice changes and improved patient outcomes. However, multiple approaches have been used to identify and investigate EIPs' informal or formal influence on practice, which creates study outcomes that are difficult…

Workplace Bullying Among Family Physicians: A Gender Focused Study.

PubMed

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.

The role of physician staffing of helicopter emergency medical services in prehospital trauma response.

PubMed

Garner, Alan A

2004-08-01

The crewing of Helicopter Emergency Medical Service (HEMS) for scene response to trauma patients is generally considered to be controversial, particularly regarding the role of physicians. This is reflected in HEMS in Australia with some services utilizing physician crewing for all prehospital missions. Others however, use physicians for selected missions only whilst others do not use physicians at all. This review seeks to determine whether the literature supports using physicians in addition to paramedics in HEMS teams for prehospital trauma care. Studies were excluded if they compared physician teams with basic life support teams (BLS) teams rather than paramedics. Ambulance officers were considered to be paramedics where they were able to administer intravenous fluids and use a method of airway management beyond bag-valve-mask ventilation. Studies were excluded if the skill set of the ambulance team was not defined, the level of staffing of the helicopter service was not stated, team composition varied without reporting outcomes for each team type, patient outcome data were not reported, or the majority of the transports were interhospital rather than prehospital transports.

A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training.

PubMed

Patterson, Fiona; Cousans, Fran; Coyne, Iain; Jones, Jo; Macleod, Sheona; Zibarras, Lara

2017-05-15

Treating patients is complex, and research shows that there are differences in cognitive resources between physicians who experience difficulties, and those who do not. It is possible that differences in some cognitive resources could explain the difficulties faced by some physicians. In this study, we explore differences in cognitive resources between different groups of physicians (that is, between native (UK) physicians and International Medical Graduates (IMG); those who continue with training versus those who were subsequently removed from the training programme); and also between physicians experiencing difficulties compared with the general population. A secondary evaluation was conducted on an anonymised dataset provided by the East Midlands Professional Support Unit (PSU). One hundred and twenty one postgraduate trainee physicians took part in an Educational Psychology assessment through PSU. Referrals to the PSU were mainly on the basis of problems with exam progression and difficulties in communication skills, organisation and confidence. Cognitive resources were assessed using the Wechsler Adult Intelligence Scale (WAIS-IV). Physicians were categorised into three PSU outcomes: 'Continued in training', 'Removed from training' and 'Active' (currently accessing the PSU). Using a one-sample Z test, we compared the referred physician sample to a UK general population sample on the WAIS-IV and found the referred sample significantly higher in Verbal Comprehension (VCI; z = 8.78) and significantly lower in Working Memory (WMI; z = -4.59). In addition, the native sample were significantly higher in Verbal Comprehension than the UK general population sample (VCI; native physicians: z = 9.95, p < .001, d = 1.25), whilst there was a lesser effect for the difference between the IMG sample and the UK general population (z = 2.13, p = .03, d = 0.29). Findings also showed a significant difference in VCI scores between those physicians who were 'Removed

Private practice outcomes: validated outcomes data collection in private practice.

PubMed

Goldstein, Jack

2010-10-01

Improved patient care is related to validated outcome measures requiring the collection of three distinct data types: (1) demographics; (2) patient outcome measures; and (3) physician treatment. Previous impediments to widespread data collection have been: cost, office disruption, personnel requirements, physician motivation, data integration, and security. There are currently few means to collect data to be used for collaborative analysis. We therefore developed an inexpensive, patient-centric mechanism to reduce redundant data entry, limiting cost and personnel requirements. Using an intuitive touch-screen kiosk interface program, all data elements have been captured in a private practice setting since 2000. Developed for small to medium sized offices, this is scalable to larger organizations. Questionnaire navigation is patient driven, with demographics shared with EMR and billing systems. Integration of billing and EMR with outcomes minimizes cost and personnel time. Data are deidentified locally and may be centrally shared. Since data are entered by the patients, minimal personnel costs are incurred. Physician disincentives are minimized with cost reduction, time savings and ease of use. To date, we have collected high level data on most total joint patients, with excellent patient compliance. By addressing impediments to broad application, we may enable widespread local data collection in all practice settings. Data may be shared centrally, allowing comparative effectiveness research to become a reality. Future success will require broad physician participation, uniformity of data collected, and designation of a central site for receipt of data and its collaborative comparative analysis.

The effect of patient race and blood pressure control on patient-physician communication.

PubMed

Cené, Crystal W; Roter, Debra; Carson, Kathryn A; Miller, Edgar R; Cooper, Lisa A

2009-09-01

Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. Communication behaviors and visit length from coding of audiotapes. After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

Pain patients' experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome.

PubMed

Edlund, Sara M; Wurm, Matilda; Holländare, Fredrik; Linton, Steven J; Fruzzetti, Alan E; Tillfors, Maria

2017-10-01

Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients' perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients' perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored. A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored. Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity

Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs.

PubMed

Newcomer, Lee N

2012-04-01

More-sophisticated chemotherapy regimens have improved the outlook for cancer patients since the 1970s, but the payment system for cancer chemotherapy has not changed during that time span. The "buy and bill" approach for reimbursement provides incentives for medical oncologists to use expensive medications when less costly alternatives that deliver similar results are available. Furthermore, the system does nothing to assess how much value society derives from high-price drugs. This paper reviews the historical context of "buy and bill" reimbursement and considers the use of clinical pathways and bundled payments, two alternative strategies that are being tried to reward physicians for improving outcomes and reducing the total cost of cancer care.

Liability of emergency physicians for studies ordered in the emergency department: court cases and legal defenses.

PubMed

Moore, Gregory P

2011-02-01

Laboratory tests are frequently ordered in the Emergency Department (ED), with results returning at a later time. Emergency physicians (EPs) are frequently held liable when the test results are not followed-up. Recent legal malpractice cases are presented to provide examples of the medical-legal risks encountered when poor patient outcomes occur because the results of laboratory tests and other studies done in the ED are not followed-up and communicated to the patient. Emergency physicians are obligated to follow-up with patients when the results of laboratory and radiographic studies ordered in the ED are returned at a later time, and EPs are liable for any poor outcome if there is no follow-up. Appropriate follow-up mechanisms must be in place to improve patient outcomes and reduce the risk for the physician. Knowledge of the legal concepts of contributory negligence and comparative fault allows EPs to place themselves in an optimal position for a legal defense if a challenge is raised. It is imperative that abnormal results of tests done for ED evaluation and orders must be properly noted and followed-up. Optimal communication and relay of information to both the patient and the primary physician will reduce physician liability and enhance patient outcomes. Published by Elsevier Inc.

[Aggression as the cause of stress among physicians].

PubMed

Kowalczuk, Krystyna; Jankowiak, Barbara; Krajewska-Kułak, Elzbieta; Kułak, Wojciech; Klimaszewska, Krystyna; Kondzior, Dorota; Kowalewska, Beata

2009-01-01

Mental stress is inseparably connected with work. The stress reaction is favored by stagnation in life, lack of prospects for professional growth, uncertainty of stable employment, pressure to work reliably and flexibly, excessive workload, and lack of assigned duties. Interpersonal relations among members of the team represent another significant factor in the appearance and persistence of social pathology. Identification of forms and sources of aggression implicated in stress among physicians at the workplace. The study was performed in 501 physicians employed by inpatient and outpatient institutions in the province of Podlaskie. We used questionnaires assessing the intensity and type of aggression against physicians and the GHQ28 General Heath Questionnaire. The patient source of stress for physicians included hostile comportment (53%) and extortion (41%). The source of stress from superiors included vulgar acts in the presence of coworkers (18%) and threats (17%). Stress was also caused by raised voice of other physicians (44%) and nurses (25%). The main source of stress for physicians was aggression by patients and fellow physicians.

Using standardised patients to measure physicians' practice: validation study using audio recordings

PubMed Central

Luck, Jeff; Peabody, John W

2002-01-01

Objective To assess the validity of standardised patients to measure the quality of physicians' practice. Design Validation study of standardised patients' assessments. Physicians saw unannounced standardised patients presenting with common outpatient conditions. The standardised patients covertly tape recorded their visit and completed a checklist of quality criteria immediately afterwards. Their assessments were compared against independent assessments of the recordings by a trained medical records abstractor. Setting Four general internal medicine primary care clinics in California. Participants 144 randomly selected consenting physicians. Main outcome measures Rates of agreement between the patients' assessments and independent assessment. Results 40 visits, one per standardised patient, were recorded. The overall rate of agreement between the standardised patients' checklists and the independent assessment of the audio transcripts was 91% (κ=0.81). Disaggregating the data by medical condition, site, level of physicians' training, and domain (stage of the consultation) gave similar rates of agreement. Sensitivity of the standardised patients' assessments was 95%, and specificity was 85%. The area under the receiver operator characteristic curve was 90%. Conclusions Standardised patients' assessments seem to be a valid measure of the quality of physicians' care for a variety of common medical conditions in actual outpatient settings. Properly trained standardised patients compare well with independent assessment of recordings of the consultations and may justify their use as a “gold standard” in comparing the quality of care across sites or evaluating data obtained from other sources, such as medical records and clinical vignettes. What is already known on this topicStandardised patients are valid and reliable reporters of physicians' practice in the medical education settingHowever, validating standardised patients' measurements of quality of care in

Physicians' views on pay-for-performance as a reimbursement model: a quantitative study among Dutch surgical physicians.

PubMed

Alqasim, Khalid M; Ali, Eman N; Evers, Silvia M; Hiligsmann, Mickaël

2016-01-01

To assess the views, knowledge, and experience of Dutch physicians with regard to the general objectives and values of the pay-for-performance (P4P) system, as the Dutch healthcare industry might find it useful, in terms of governance, to explore this approach further. A quantitative cross-sectional survey study was conducted among 48 physicians in surgical specialties in the Netherlands between May 2014 and July 2014. The survey questionnaire was designed to gather information regarding the intensity of feelings, on a 7-point Likert scale, toward statements that address the P4P system. Confidence intervals were calculated using the bootstrap technique with 1000 iterations. Physicians see a positive value in P4P for their organizations rather than for personal attainment (mean = 5.00; 95% CI = 4.62-5.39), even though they feared that P4P might put financial pressure on them (mean = 5.03; 95% CI = 4.50-5.54). They strongly share the view that other colleagues will resist adopting P4P as a business model (mean = 5.74; 95% CI = 5.43-6.04). Respondents stated that they would not leave their current jobs if P4P were to be incorporated in their organization. Physicians see value in P4P for their organizations, and consider that P4P could provide an incentive for improving medical outcomes. There seems to be potential for the P4P system in the Netherlands as participants expressed positive support for its values. There is an intersection of interests between the value of P4P and the physicians' aim of achieving quality outcomes; however, further studies would be needed to investigate perceptions about specific design features in a larger sample. In addition, prior to implementing P4P, broad education about the system should be provided in order to counteract pre-conceptions and prevent resistance.

Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries.

PubMed

Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B

2017-12-05

Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Treatment by locum tenens general internal medicine physicians. The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154

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

PubMed

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

2004-01-01

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

Physician communication coaching effects on patient experience

PubMed Central

Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

2017-01-01

Background Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients’ perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. Study design We designed a comprehensive physician-training module focused on improving specific “etiquette-based” physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent “always” scores for questions related to patients’ perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. Results A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent “always” responses, for the HCAHPS questions of doctors “treating patients with courtesy” “explaining things in a way patients could understand,” and “overall teamwork” showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors “keeping patient informed” (adjusted intercept shift 9.9% P = 0.019), “overall teamwork” (adjusted intercept shift 11%, P = 0.037), and “using words the patient could understand” (adjusted intercept shift 14.8%, p = 0.001). Conclusion A

Physician communication coaching effects on patient experience.

PubMed

Seiler, Adrianne; Knee, Alexander; Shaaban, Reham; Bryson, Christine; Paadam, Jasmine; Harvey, Rohini; Igarashi, Satoko; LaChance, Christopher; Benjamin, Evan; Lagu, Tara

2017-01-01

Excellent communication is a necessary component of high-quality health care. We aimed to determine whether a training module could improve patients' perceptions of physician communication behaviors, as measured by change over time in domains of patient experience scores related to physician communication. We designed a comprehensive physician-training module focused on improving specific "etiquette-based" physician communication skills through standardized simulations and physician coaching with structured feedback. We employed a quasi-experimental pre-post design, with an intervention group consisting of internal medicine hospitalists and residents and a control group consisting of surgeons. The outcome was percent "always" scores for questions related to patients' perceptions of physician communication using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and a Non-HCAHPS Physician-Specific Patient Experience Survey (NHPPES) administered to patients cared for by hospitalists. A total of 128 physicians participated in the simulation. Responses from 5020 patients were analyzed using HCAHPS survey data and 1990 patients using NHPPES survey data. The intercept shift, or the degree of change from pre-intervention percent "always" responses, for the HCAHPS questions of doctors "treating patients with courtesy" "explaining things in a way patients could understand," and "overall teamwork" showed no significant differences between surgical control and hospitalist intervention patients. Adjusted NHPPES percent excellent survey results increased significantly post-intervention for the questions of specified individual doctors "keeping patient informed" (adjusted intercept shift 9.9% P = 0.019), "overall teamwork" (adjusted intercept shift 11%, P = 0.037), and "using words the patient could understand" (adjusted intercept shift 14.8%, p = 0.001). A simulation based physician communication coaching method focused on specific "etiquette

Associations of psychosocial working conditions with health outcomes, quality of care and intentions to leave the profession: results from a cross-sectional study among physician assistants in Germany.

PubMed

Vu-Eickmann, Patricia; Li, Jian; Müller, Andreas; Angerer, Peter; Loerbroks, Adrian

2018-04-24

Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though. We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort-reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses. The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one's current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22). Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.

The Value That Infectious Diseases Physicians Bring to the Healthcare System.

PubMed

McQuillen, Daniel P; MacIntyre, Ann T

2017-09-15

While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee-sponsored study of ID physicians' positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach-better health, better care, and lower per capita cost-that is the principle tenet of healthcare system reform. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Barriers to Medical Error Reporting for Physicians and Nurses.

PubMed

Soydemir, Dilek; Seren Intepeler, Seyda; Mert, Hatice

2017-10-01

The purpose of the study was to determine what barriers to error reporting exist for physicians and nurses. The study, of descriptive qualitative design, was conducted with physicians and nurses working at a training and research hospital. In-depth interviews were held with eight physicians and 15 nurses, a total of 23 participants. Physicians and nurses do not choose to report medical errors that they experience or witness. When barriers to error reporting were examined, it was seen that there were four main themes involved: fear, the attitude of administration, barriers related to the system, and the employees' perceptions of error. It is important in terms of preventing medical errors to identify the barriers that keep physicians and nurses from reporting errors.

Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.

PubMed

van Schuppen, Hans; Bierens, Joost

2015-12-01

In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. A prospective observational study was carried out over a 2-month period, with one HEMS station covering six ambulance regions. Provider registration was recorded, supplemented by interviews of ambulance nurses and HEMS physicians. Competencies were categorized depending on whether the competency was specific for the nurse or physician, mutual or mutual with a qualitative difference. A total of 225 HEMS dispatches resulted in 117 cases with HEMS on-scene in the study region and 78 patients were included. In 35 (45%) patients, the HEMS physician provided additional treatment: in 19 (24%) patients, a physician-specific therapeutic competency, in nine (12%) patients, a mutual competency with a qualitative difference and in seven (9%) patients, both categories. The presence of the HEMS physician was considered more useful by both ambulance nurses (89 vs. 60%) and HEMS physicians (97 vs. 81%) when additional treatment was provided by the HEMS physician. HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.

How do family physicians measure blood pressure in routine clinical practice?

PubMed Central

Kaczorowski, Janusz; Myers, Martin G.; Gelfer, Mark; Dawes, Martin; Mang, Eric J.; Berg, Angelique; Grande, Claudio Del; Kljujic, Dragan

2017-01-01

Abstract Objective To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. Design A Web-based cross-sectional survey distributed by e-mail. Setting Stratified random sample of family physicians in Canada. Participants Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. Main outcome measures Physicians’ self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. Results A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. Conclusion Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both

Clinical utilization of musculoskeletal sonography involving non-physician rehabilitation providers: A scoping review

PubMed Central

Roll, Shawn C.; Asai, Christina; Tsai, Julieann

2015-01-01

Background Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers. Aim To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice. Design Scoping Review Setting Inpatient, Outpatient, Other Population Musculoskeletal conditions Methods Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included. Results Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses. Conclusion This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention. Clinical Rehabilitation Impact Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care. PMID:26201705

A conceptual model of physician work intensity: guidance for evaluating policies and practices to improve health care delivery.

PubMed

Horner, Ronnie D; Matthews, Gerald; Yi, Michael S

2012-08-01

Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries. To describe an initial conceptual model to facilitate further investigations of physician work intensity. A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature. The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment. The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

Physician-industry relations. Part 1: individual physicians.

PubMed

Coyle, Susan L

2002-03-05

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

Workplace violence against physicians in Turkey’s emergency departments: a cross-sectional survey

PubMed Central

Bayram, Başak; Çetin, Murat; Çolak Oray, Neşe; Can, İsmail Özgür

2017-01-01

Objective We aimed to determine the prevalence of violence directed at emergency department (ED) physicians in Turkey and confirm the factors influencing such violence. Design Cross-sectional survey study. Setting Country of Turkey. Participants Physicians currently practising in EDs in Turkey. Main outcome measures The prevalence of violence directed at physicians and factors that may influence it, such as physicians’ personal characteristics, ED characteristics and physicians’ opinions regarding the causes of and suggested methods of preventing violence. Results A total of 713 physicians participated. Of these, 78.1% reported being subjected to violence in the past year and 65.9% reported more than one such incident. Being subjected to violence was related to age (p=0.008), working in an ED with a high patient admission rate (p=0.018), current position (p<0.001), working outside regular work hours (p<0.001), working in a state hospital (p<0.001) and level of experience (p<0.001). Gender, type of patient typically seen, region and patient waiting period did not influence subjection to violence. The present safety precautions against violence do not appear to influence the prevalence of violence. Conclusions Our results indicated that ED physicians’ experience of violence is related to personal characteristics such as age and level of expertise, and hospital and ED characteristics such as high patient admission rates. Presently, no measures taken to reduce this violence have been proven effective. PMID:28663323

Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other physicians: analysis of a large, statewide database.

PubMed

Philbin, E F; Jenkins, P L

2000-03-01

The management of heart failure (HF) by cardiologists may be better than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinical trials. Whether cardiologists' management of HF is more or less cost-effective is up for debate. Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was obtained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between patients of cardiologists and patients of other physicians. A total of 44,926 patients were identified, with 10,506 (23%) receiving care from cardiologists, 28,300 (63%) from internists, 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of cardiologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Patients of cardiologists were more likely to undergo cardiac catheterization (9%) than those of internists (3%) and family practice (2%) physicians but had similar adjusted hospital length of stay and charges. Mortality and hospital readmission rates for HF were similar among the groups. Patients in the "other" group (managed mostly by surgeons) were the youngest, underwent more invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges. Cardiologists' management of HF is not economically disadvantageous. The relations among physician specialty, process of care, resource utilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.

Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

PubMed

Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

2017-04-01

Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis.

PubMed

Johnson, Judith; Panagioti, Maria

2018-06-05

To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety. MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before-after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and for improving physician confidence in delivering news and patient-reported depression/anxiety, respectively. Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74, 95% CI = 0.47-1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60, 95% CI = 0.26-0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results. Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length.

Sleep as a New Target for Improving Outcomes in Idiopathic Pulmonary Fibrosis.

PubMed

Mermigkis, Charalampos; Bouloukaki, Izolde; Schiza, Sophia E

2017-12-01

Idiopathic pulmonary fibrosis (IPF) is the most common type of interstitial pneumonia but remains a disease with a poor outcome. Two drugs, pirfenidone and nintedanib, have shown promising results at stalling disease progression; however, the interplay of sleep disruption or sleep disorders overall and in relation to medication effectiveness remains understudied. In the past, there was limited interest in the role of sleep in patients with IPF. Treating physicians tended to address only the daily disabling symptoms while disregarding the possible significant role of sleep alterations or coexisting sleep disorders. During the past few years, there has been more research related to sleep disturbances in patients with IPF and their possible role in sleep and overall life quality, disease progression, and outcome. In summary, sleep in patients with IPF is significantly impaired, with alterations in sleep architecture, changes in sleep breathing pattern, and decreases in oxygen saturation mainly during vulnerable rapid eye movement sleep. There also is evidence that OSA has an increased prevalence in these patients, playing an important role in the already worse sleep quality related to the disease itself. The focus of this review is not only to present current data related to sleep in patients with IPF but also to point out that therapy for sleep problems and OSA is likely to improve sleep and life quality as well as disease outcome. The main priority remains to increase awareness among treating physicians about early diagnosis of OSA in patients with IPF and to emphasize the need for intense future research, especially on the role of intermittent hypoxia superimposed on chronic hypoxia during sleep in patients with IPF. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Barriers to adherence to chronic obstructive pulmonary disease guidelines by primary care physicians

PubMed Central

Salinas, Gregory D; Williamson, James C; Kalhan, Ravi; Thomashow, Byron; Scheckermann, Jodi L; Walsh, John; Abdolrasulnia, Maziar; Foster, Jill A

2011-01-01

Purpose: Even with the dissemination of several clinical guidelines, chronic obstructive pulmonary disease (COPD) remains underdiagnosed and mismanaged by many primary care physicians (PCPs). The objective of this study was to elucidate barriers to consistent implementation of COPD guidelines. Patients and methods: A cross-sectional study implemented in July 2008 was designed to assess attitudes and barriers to COPD guideline usage. Results: Five hundred US PCPs (309 family medicine physicians, 191 internists) were included in the analysis. Overall, 23.6% of the surveyed PCPs reported adherence to spirometry guidelines over 90% of the time; 25.8% reported adherence to guidelines related to long-acting bronchodilator (LABD) use in COPD patients. In general, physicians were only somewhat familiar with COPD guidelines, and internal medicine physicians were significantly more familiar than family physicians (P < 0.05). In a multivariate model controlling for demographics and barriers to guideline adherence, we found significant associations with two tested guideline components. Adherence to spirometry guidelines was associated with agreement with guidelines, confidence in interpreting data, ambivalence to outcome expectancy, and ability to incorporate spirometry into patient flow. Adherence to LABD therapy guidelines was associated with agreement with guidelines and confidence in gauging pharmacologic response. Conclusions: Adherence to guideline recommendations of spirometry use was predicted by agreement with the recommendations, self-efficacy, perceived outcome expectancy if recommendations were adhered to, and resource availability. Adherence to recommendations of LABD use was predicted by agreement with guideline recommendations and self-efficacy. Increasing guideline familiarity alone may have limited patient outcomes, as other barriers, such as low confidence and outcome expectancy, are more likely to impact guideline adherence. PMID:21468169

Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide

PubMed Central

Whitney, Simon N; Brown, Byron W; Brody, Howard; Alcser, Kirsten H; Bachman, Jerald G; Greely, Henry T

2001-01-01

OBJECTIVE To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. DESIGN Confidential mail questionnaire. PARTICIPANTS A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. MEASUREMENTS Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. MAIN RESULTS Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P < .001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P < .001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. CONCLUSIONS Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide. PMID:11359546

Alarm bells ring: suicide among Chinese physicians

PubMed Central

Wang, Yu; Liu, Lei; Xu, Hongbin

2017-01-01

Abstract To our surprise, there were 2 Chinese doctors who committed suicide in the last 2 months. What are the reasons for more and more Chinese doctors to commit suicide? We present 18 cases of China's physicians who committed suicide. We summarized the main reasons for the suicide of Chinese doctors from 2004 to 2017, and the main causes included clinical working stress, Job title promotion requirements stress, tension between the doctors and patients, and shying away from necessary treatment of their illness. It is a cruel fact that more and more physicians died of suicide in China. We hope that suicide among Chinese doctors could be recognized so that it could be concerned with the understanding of human societies. PMID:28796079

Primary care physicians in underserved areas. Family physicians dominate.

PubMed Central

Burnett, W H; Mark, D H; Midtling, J E; Zellner, B B

1995-01-01

Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas. PMID:8553635

Impact of ITP on physician visits and workplace productivity.

PubMed

Tarantino, Michael D; Mathias, Susan D; Snyder, Claire F; Isitt, John J; Gernsheimer, Terry; Young, Joan

2010-02-01

To assess the impact of immune thrombocytopenic purpura (ITP) on primary care and specialist visits and workplace productivity. This was a cross-sectional, descriptive study comparing ITP patients to age- and gender-matched controls. Subjects completed a one-time web-based survey, which included questions on work loss, work productivity, and physician visits. ITP patients and controls were compared on these outcomes. For ITP patients, the relationship between work-related issues and physician visits with clinical characteristics (time since diagnosis, platelet count, number of treatments received, and an ITP-specific health-related quality of life measure, the ITP-PAQ) was explored. A total of 1002 ITP patients and 1031 controls completed the survey. On average, ITP patients were 46 years old, diagnosed 9 years ago, and had platelet counts of 148 x 10(9)/L; 37% had undergone splenectomy. More ITP patients had primary care (20% vs. 11%) and specialist (28% vs. 11%) visits in the past month versus controls (p < or = 0.001). Higher proportions of ITP patients have ever taken sick leave (56% vs. 30%), and missed chore hours in the past week (18% vs. 13%) (p < or = 0.003). ITP patients scored significantly worse than controls on all six work productivity items. Patients diagnosed within the past year were more likely to have specialist visits and to miss chore hours versus those diagnosed less recently. Worse ITP-PAQ scores and more ITP-related treatments were related to more physician visits and worse work-related and productivity outcomes. Platelet count is not associated with these outcomes. The study is limited by the potential for biased samples due to recruitment approaches, the inherent issues of a cross-sectional study design and recall bias in questionnaire responses. ITP was consistently associated with more physician visits and worse work and productivity outcomes. Future research should build on these findings by calculating a comprehensive cost

[Availability of physicians in Chile at the year 2004].

PubMed

Román, Oscar; Acuña, Miguel; Señoret, Miriam

2006-08-01

The number of physicians available in a given country, their efficiency, quality and specialization is of utmost epidemiological importance. To evaluate the availability of physicians in Chile. The information about the number of physicians in Chile up to the year 2004, was obtained from the Ministry of Health, national universities and the register of immigrant physicians since 1950. The total number of physicians licensed to practice was 25,542, of whom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004. The greater impact in the increment of available physicians was given by the immigration of professionals and by the increase in the number of physicians graduated from national universities, mainly from the new private universities. Forty two percent of physicians work at public services and 61% of these are certified specialists. The regional distribution of general practitioners and basic specialists is adequate. Along the country, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 and the general practitioner/beneficiary ratio is 2.3/10,000. The national information of available physicians, especially in the private sector, should be improved. Immigration of physicians should be regulated, maintaining validation examinations and a National Medical Test to assess medical proficiency should be instituted.

Canadian physicians' attitudes about and preferences regarding clinical practice guidelines

PubMed Central

Hayward, R S; Guyatt, G H; Moore, K A; McKibbon, K A; Carter, A O

1997-01-01

OBJECTIVE: To assess Canadian physicians' confidence in, attitudes about and preferences regarding clinical practice guidelines. DESIGN: Cross-sectional, self-administered mailed survey. PARTICIPANTS: Stratified random sample of 3000 Canadian physicians; 1878 (62.6%) responded. SETTING: Canada. OUTCOME MEASURES: Physicians' use of various information sources; familiarity with and confidence in guidelines; attitudes about guidelines and their effect on medical care; rating of importance of guidelines and other sources of information in clinical decision-making; rating of importance of various considerations in deciding whether to adopt a set of guidelines; and rating of usefulness of different formats for presenting guidelines. MAIN RESULTS: In all, 52% of the respondents reported using guidelines at least monthly, substantially less frequently than traditional information sources. Most of the respondents expressed confidence in guidelines issued by various physician organizations, but 51% to 77% were not confident in guidelines issued by federal or provincial health ministries or by health insurance plans. The respondents were generally positive about guidelines (e.g., over 50% strongly agreed that they are a convenient source of advice and good educational tools); however, 22% to 26% had concerns about loss of autonomy, the rigidity of guidelines and decreased satisfaction with medical practice. Endorsement by respected colleagues or major organizations was identified as very important by 78% and 62% of the respondents respectively in deciding whether to adopt a set of guidelines in their practice. User friendliness of the guidelines format was thought to be very important by 62%; short pamphlets, manuals summarizing a number of guidelines, journal articles and pocket cards summarizing guidelines were the preferred formats (identified as most useful by 50% to 62% of the respondents). CONCLUSIONS: Canadian physicians, although generally positive about guidelines

Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention.

PubMed

Schneider, Suzanne; Kingsolver, Karen; Rosdahl, Jullia

2014-01-01

Physicians in the United States increasingly confront stress, burnout, and other serious symptoms at an alarming level. As a result, there is growing public interest in the development of interventions that improve physician resiliency. The aim of this study is to evaluate the perceived impact of Physician Well-being Coaching on physician stress and resiliency, as implemented in a major medical center. Semi-structured interviews were conducted with 11 physician-participants, and three coaches of a Physician Well-being Coaching pilot focused on three main areas: life context, impacts of coaching, and coaching process. Interviewees were physicians who completed between three and eight individual coaching sessions between October 2012 and May 2013 through the Physician Well-being Coaching pilot program. Qualitative content analysis of the 11 physician interviews and three coach interviews using Atlas.ti to generate patterns and themes. Physician Well-being Coaching helped participants increase resilience via skill and awareness development in the following three main areas: (1) boundary setting and prioritization, (2) self-compassion and self-care, and (3) self-awareness. These insights often led to behavior changes and were perceived by physicians to have indirect but positive impact on patient care. Devaluing self-care while prioritizing the care of others may be a significant, but unnecessary, source of burnout for physicians. This study suggests that coaching can potentially help physicians alter this pattern through skill development and increased self-awareness. It also suggests that by strengthening physician self-care, coaching can help to positively impact patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

Strategies for Acing the Fundamentals and Mitigating Legal and Ethical Consequences of Poor Physician-Patient Communication.

PubMed

Brueck, MaryKatherine; Salib, Angelique M

2017-03-01

This article explores how the absence of effective verbal and nonverbal communication in the physician-patient encounter can lead to poor outcomes for patients and physicians alike. The article discusses legal and ethical topics physicians should consider during a medical encounter and provides educational and practical suggestions for improving effective communication between physicians and their patients. © 2017 American Medical Association. All Rights Reserved.

Physician control of needle and syringe during aspiration-injection procedures with the new reciprocating syringe.

PubMed

Sibbitt, Wilmer; Sibbitt, Randy R; Michael, Adrian A; Fu, Druce I; Draeger, Hilda T; Twining, Jon M; Bankhurst, Arthur D

2006-04-01

To evaluate physician control of needle and syringe during aspiration-injection syringe procedures by comparing the new reciprocating procedure syringe to a traditional conventional syringe. Twenty-six physicians were tested for their individual ability to control the reciprocating and conventional syringes in typical aspiration-injection procedures using a novel quantitative needle-based displacement procedure model. Subsequently, the physicians performed 48 clinical aspiration-injection (arthrocentesis) procedures on 32 subjects randomized to the reciprocating or conventional syringes. Clinical outcomes included procedure time, patient pain, and operator satisfaction. Multivariate modeling methods were used to determine the experimental variables in the syringe control model most predictive of clinical outcome measures. In the model system, the reciprocating syringe significantly improved physician control of the syringe and needle, with a 66% reduction in unintended forward penetration (p < 0.001) and a 68% reduction in unintended retraction (p < 0.001). In clinical arthrocentesis, improvements were also noted: 30% reduction in procedure time (p < 0.03), 57% reduction in patient pain (p < 0.001), and a 79% increase in physician satisfaction (p < 0.001). The variables in the experimental system--unintended forward penetration, unintended retraction, and operator satisfaction--independently predicted the outcomes of procedure time, patient pain, and physician satisfaction in the clinical study (p < or = 0.001). The reciprocating syringe reduces procedure time and patient pain and improves operator satisfaction with the procedure syringe. The reciprocating syringe improves physician performance in both the validated quantitative needle-based displacement model and in real aspiration-injection syringe procedures, including arthrocentesis.

Using attachment theory in medical settings: implications for primary care physicians.

PubMed

Hooper, Lisa M; Tomek, Sara; Newman, Caroline R

2012-02-01

Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.

Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis.

PubMed

Panagioti, Maria; Panagopoulou, Efharis; Bower, Peter; Lewith, George; Kontopantelis, Evangelos; Chew-Graham, Carolyn; Dawson, Shoba; van Marwijk, Harm; Geraghty, Keith; Esmail, Aneez

2017-02-01

Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = -0.29; 95% CI, -0.42 to -0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = -0.45; 95% CI, -0.62 to -0.28) compared with physician-directed interventions (SMD = -0.18; 95% CI, -0.32 to -0.03). Interventions delivered in

Association of Intrinsic Motivating Factors and Markers of Physician Well-Being: A National Physician Survey.

PubMed

Tak, Hyo Jung; Curlin, Farr A; Yoon, John D

2017-07-01

Although intrinsic motivating factors play important roles in physician well-being and productivity, most studies have focused on extrinsic motivating factors such as salary and work environment. To examine the association of intrinsic motivators with physicians' career satisfaction, life satisfaction, and clinical commitment, while accounting for established extrinsic motivators as well. A nationally representative survey of 2000 US physicians, fielded October to December 2011. Outcome variables were five measures of physician well-being: career satisfaction, life satisfaction, high life meaning, commitment to direct patient care, and commitment to clinical practice. Primary explanatory variables were sense of calling, personally rewarding hours per day, meaningful, long-term relationships with patients, and burnout. Multivariate logit models with survey design provided nationally representative individual-level estimates. Among 1289 respondents, 85.8% and 86.5% were satisfied with their career and life, respectively; 88.6% had high life meaning; 54.5% and 79.5% intended to retain time in direct patient care and continue clinical practice, respectively. Sense of calling was strongly positively associated with high life meaning (odds ratio [OR] 5.14, 95% confidence interval [95% CI] 2.87-9.19) and commitment to direct patient care (OR 2.50, 95% CI 1.53-4.07). Personally rewarding hours per day were most strongly associated with career satisfaction (OR 5.28, 95% CI 2.72-10.2), life satisfaction (OR 4.46, 95% CI 2.34-8.48), and commitment to clinical practice (OR 3.46, 95% CI 1.87-6.39). Long-term relationships with patients were positively associated with career and life satisfaction and high life meaning. Burnout was strongly negatively associated with all measures of physician well-being. Intrinsic motivators (e.g., calling) were associated with each measure of physician well-being (satisfaction, meaning, and commitment), but extrinsic motivators (e.g., annual

Shared liability? Consultants, pharmacists, and the emergency physician: legal cases and caveats.

PubMed

Moore, Joshua J; Matlock, Aaron G

2014-05-01

In caring for patients in the Emergency Department (ED), the emergency physician (EP) will often utilize consulting specialists and pharmacists. In the event of an untoward patient outcome, disagreement may arise regarding the liability of each provider. Here, we review a series of malpractice cases involving consulting physicians and pharmacists to illustrate the legal principles of physician-patient relationships and physician duty. Determination of liability in the courts will rest, in part, on whether a physician-patient relationship was formed via an "affirmative act". Consulting physicians may establish a relationship through an overt or implied agreement to participate in a patient's care, or by reviewing specific tests and studies for the purpose of diagnosis and treatment. The courts have defined the duty of the pharmacist to safely dispense medication, and have ascribed the duty to warn of medication side effects to the prescribing physician. Published by Elsevier Inc.

How do emergency physicians interpret prescription narcotic history when assessing patients presenting to the emergency department with pain?

PubMed

Grover, Casey A; Garmel, Gus M

2012-01-01

Narcotics are frequently prescribed in the Emergency Department (ED) and are increasingly abused. Prescription monitoring programs affect prescribing by Emergency Physicians (EPs), yet little is known on how EPs interpret prescription records. To assess how EPs interpret prescription narcotic history for patients in the ED with painful conditions. DESIGN/MAIN Outcome Measures: We created an anonymous survey of EPs consisting of fictitious cases of patients presenting to the ED with back pain. For each case, we provided a prescription history that varied in the number of narcotic prescriptions, prescribing physicians, and narcotic potency. Respondents rated how likely they thought each patient was drug seeking, and how likely they thought that the prescription history would change their prescribing behavior. We calculated κ values to evaluate interobserver reliability of physician assessment of drug-seeking behavior. We collected 59 responses (response rate = 70%). Respondents most suspected drug seeking in patients with greater than 6 prescriptions per month or greater than 6 prescribing physicians in 2 months. Medication potency did not affect physician interpretation of drug seeking. Respondents reported that access to a prescription history would change their prescribing practice in all cases. κ values for assessment of drug seeking demonstrated moderate agreement. A greater number of prescriptions and a greater number of prescribing physicians in the prescription record increased suspicion for drug seeking. EPs believed that access to prescription history would change their prescribing behavior, yet interobserver reliability in the assessment of drug seeking was moderate.

Preventing Conflicts of Interest of NFL Team Physicians.

PubMed

Rothstein, Mark A

2016-11-01

At least since the time of Hippocrates, the physician-patient relationship has been the paradigmatic ethical arrangement for the provision of medical care. Yet, a physician-patient relationship does not exist in every professional interaction involving physicians and individuals they examine or treat. There are several "third-party" relationships, mostly arising where the individual is not a patient and is merely being examined rather than treated, the individual does not select or pay the physician, and the physician's services are provided for the benefit of another party. Physicians who treat NFL players have a physician-patient relationship, but physicians who merely examine players to determine their health status have a third-party relationship. As described by Glenn Cohen et al., the problem is that typical NFL team doctors perform both functions, which leads to entrenched conflicts of interest. Although there are often disputes about treatment, the main point of contention between players and team physicians is the evaluation of injuries and the reporting of players' health status to coaches and other team personnel. Cohen et al. present several thoughtful recommendations that deserve serious consideration. Rather than focusing on their specific recommendations, however, I would like to explain the rationale for two essential reform principles: the need to sever the responsibilities of treatment and evaluation by team physicians and the need to limit the amount of player medical information disclosed to teams. © 2016 The Hastings Center.

The Physician-Patient Working Alliance in Hemodialysis Treatment.

PubMed

Fuertes, Jairo N; Rubinstein, Sofia; Reyes, Mariela; Iampornpipopchai, Pichet; Mujeeb, Shanza; Smith, Carroll R; Toporovsky, Arielle

2017-01-01

Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

Physicians working under the influence of alcohol: An analysis of past disciplinary proceedings and their outcomes.

PubMed

Sendler, Damian Jacob

2018-04-01

The intoxicated person may cause harm to others, often requiring expert evaluation for the determination of guilt. The primary aim of this study was to determine the mechanisms of mistakes that led 17 doctors accused of working under the influence of alcohol to face malpractice. We also wanted to clarify what were the legal, professional, and financial consequences - depending on specific patient outcomes. We based analysis on the review and meta-analysis of the past forensic evaluation reports of institution-run forensics programs. Furthermore, we apply thematic analysis using combination of grounded theory and Pierre Bourdieu's theoretical framework. During the 2010-2016 timeframe, the regional forensic service opinionated on 17 physicians (3F, 14M) subjected to disciplinary action due to providing treatment under the influence of alcohol. In total, there were 157 patients potentially affected by malpractice - out of those, four were harmed; only one qualified for compensation. In the remaining 153 patients - only 11 persons reported having had awareness about the doctors' intoxication and apparent inability to perform the job, yet they agreed to receive care. Overall, in over 90% of patients, the physician did not harm anyone to a degree threatening patient's life. The supporting staff did not report experiencing distress either. The results of a blood test for the presence of alcohol were available for only four cases. Therefore, it was impossible to analyze the correlation between intoxication level and performance in providing care. All in all, in our analysis - less than 10% of 157 patients' care were compromised by provider's intoxication, either due to a mistake in diagnosis, medical procedure, or lacking communication skills. For physicians, working under the influence of alcohol is an uncommon phenomenon, but when it occurs - patients are at risk for receiving poor treatment. Presented analysis indicates that patients - just as much as supporting staff

[Is there a physician on board?].

PubMed

Andersen, H T

1998-09-30

Physicians responding to emergency calls on board airliners in intercontinental traffic may not be aware of certain legal complications which may arise. For instance, the medical practitioner may hold a license valid in one country, the air carrier may be registered in another, and the patient may be a third state national. Legislation varies between nations, as do courts decisions. Physicians may not be aware of the laws and regulations which apply or of the subtle differences between terms and interpretations used in formal language. This article contains a scenario description from a commercial air liner in intercontinental transit carrying a patient unknown to the physician who responds to a call for medical assistance. The main considerations to be made, the more likely diagnoses and various strategies for immediate interventions are reviewed. Likewise, appraisal and use of medical equipment on board are discussed, as are issues concerning responsibility and liability when equipment is used in supposedly "trained hands". Main themes in the current international medico-legal debate are considered with emphasis on the "Good Samaritan Principle", the responsibility of commercial air carriers, and telemedicine with insurance against law suits. The article concludes with some practical advice to the travelling medical community.

[Is there a physician on board?].

PubMed

Andersen, H T

1998-11-01

Physicians responding to emergency calls on board airliners in intercontinental traffic may not be aware of certain legal complications which may arise. For instance, the medical practitioner may hold a license valid in one country, the air carrier may be registered in another, and the patient may be a third state national. Legislation varies between nations, as do court decisions. Physicians may be aware neither of the laws and regulations which apply nor the subtle differences between terms and interpretations used in formal language. This article contains a scenario description from a commercial air liner in intercontinental transit carrying a patient unknown to the physician who responds to a call for medical assistance. The main considerations to be made, the more likely diagnoses and various strategies for immediate interventions are reviewed. Likewise, appraisal and use of medical equipment on board are discussed, as are issues concerning responsibility and liability when equipment is used in supposedly "trained hands". Main themes in the current international medico-legal debate are considered with emphasis on the "Good Samaritan Principle", the responsibility of commercial air carriers, and telemedicine with insurance against law suits. The article concludes with some practical advice to the travelling medical community.

Physician Burnout: Improving Treatment Efficacy with Virtual Reality.

PubMed

Wiederhold, Brenda K; Riva, Giuseppe; Gaggioli, Andrea; Wiederhold, Mark D

2016-01-01

Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.

Work-place predictors of duration of breastfeeding among female physicians.

PubMed

Sattari, Maryam; Serwint, Janet R; Neal, Dan; Chen, Si; Levine, David M

2013-12-01

To identify work-related predictors of breastfeeding duration among female physicians. Data on 238 children were obtained from 50 female physicians, whose main affiliation was with Johns Hopkins University (Baltimore, MD), and 80 female physicians, whose main affiliation was with the University of Florida (Gainesville, FL). We used a mixed linear model to determine which variables were significant predictors of breastfeeding duration when controlling for maternal demographics and taking into account the clustering of observations on study location and mothers. Although female physicians intended to breastfeed 56% of the infants for at least 12 months and 97% of infants were breastfed at birth, only 34% of infants continued to receive breast milk at 12 months. Duration of lactation among female physicians correlated with the following work-related factors: (1) not having to make up missed call/work that occurred as result of pregnancy or maternity leave; (2) longer length of maternity leave; (3) sufficiency of time at work for milk expression; and (4) perceived level of support for breastfeeding efforts at work from colleagues, program director, or division/section chiefs. Our findings support the importance of work-related factors in breastfeeding maintenance among female physicians and suggest that a tailored intervention, providing time and institutional encouragement, might result in significant improvement in their breastfeeding duration. Copyright © 2013 Mosby, Inc. All rights reserved.

The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness.

PubMed

Soliman, Ivo W; Cremer, Olaf L; de Lange, Dylan W; Slooter, Arjen J C; van Delden, Johannes Hans J M; van Dijk, Diederik; Peelen, Linda M

2018-02-01

To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL). We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4. Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results. Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Potential Effects of Health Care Policy Decisions on Physician Availability

NASA Technical Reports Server (NTRS)

Garcia, Christopher; Goodrich, Michael

2011-01-01

Many regions in America are experiencing downward trends in the number of practicing physicians and the number of available physician hours, resulting in a worrisome decrease in the availability of health care services. Recent changes in American health care legislation may induce a rapid change in the demand for health care services, which in turn will result in a new supply-demand equilibrium . In this paper we develop a system dynamics model linking physician availability to health care demand and profitability. We use this model to explore scenarios based on different initial conditions and describe possible outcomes for a range of different policy decisions.

Psychological contracts: a new strategy for retaining reduced-hour physicians.

PubMed

Hartwell, Jennifer K

2010-01-01

As a retention strategy, healthcare organizations offer reduced-hour schedules to physicians seeking better work-family balance. However, this quantitative study of 94 full-time and reduced-hour female physicians in the Boston area found that working fewer hours helps physicians achieve better balance but does not improve their burnout or career satisfaction, or impact their intention to quit or leave the field of medicine. Instead, the findings demonstrate that psychological contract fulfillment, which reflects the subjective nature of the employment relationship, is more important than work hours, an objective job condition, in predicting intention to quit and these other outcomes. A fine-grained analysis is initiated uncovering the multidimensionality of the psychological contract construct. To integrate successful reduced-hour arrangements for physicians, medical managers are directed to the importance of understanding the composition of reduced-hour physicians' psychological contracts, specifically, their need to do challenging work, receive high levels of supervisor support, and promotion opportunities.

The Impact of Pay on Navy Physician Retention in a Health Care Reform Environment.

DTIC Science & Technology

1998-03-01

Analyses 33 6. Generalist Physician Supply Under Alternative Specialty Mix 33 7. Specialist Physician Supply Under Alternative Specialty Mix 34 8...Fiscal Years 1992 to 1997 40 5. Comparison of proposed alternative pay plans 54 6. Evaluation of expected outcomes of alternative pay plans 55 7...Explanatory variables with the expected sign of regression coefficient 76 8. Comparison of Navy physicians’ pay to alternative civilian pay for selected

Assessing Idaho Rural Family Physician Scope of Practice Over Time.

PubMed

Schmitz, David; Baker, Ed; MacKenzie, Lisa; Kinney, Logan; Epperly, Ted

2015-01-01

An important consideration determining health outcomes is to have an adequate supply of physicians to address the health needs of the community. The purpose of this investigation was to assess scope of practice factors for Idaho rural family physicians in 2012 and to compare these results to findings from a 2007 study. The target population in this study was rural family physicians in Idaho counties with populations of fewer than 50,000. Identical surveys and methods were utilized in both 2007 and 2012. The physician survey was mailed to 252 rural physicians and was returned by 89 for a response rate of 35.3%. Parametric and nonparametric statistical analyses were conducted to analyze the 2012 results and to assess changes in scope of practice across the time periods. The percentage of rural family physicians in Idaho in 2012 who provided prenatal care, vaginal deliveries, and nursing home care was significantly lower than the results from the 2007 survey. Female physicians were more likely to provide prenatal care and vaginal deliveries than males in 2012. Male physicians were more likely to provide emergency room coverage and esophagogastroduodenoscopy or colonoscopy services than females in 2012. Younger physicians were found to be more likely to provide inpatient admissions and mental health services in 2012 than older physicians. Employed physicians were more likely to provide cesarean delivery, other operating room services and emergency room coverage in 2012 than nonemployed physicians. Further research is needed to assess the root causes of these changes. © 2015 National Rural Health Association.

[International family medicine certification exam in Venezuela: the physician's experience].

PubMed

Ledesma-Solaeche, Flor Maria; Romero, Nerio Enrique; Atencio, Carlos Miguel; Pineda, Francisco; Fernández, Miguel Angel

2006-01-01

To present opinions of physicians participating in a pilot certification exam in the specialty of Family Medicine implemented in Venezuela, in December 2004, by the Mexican Board of Certification of Family Medicine A.C. Descriptive, transversal. Participant physicians (n:37) completed semi-structured questionnaries: one or two weeks before the exam, and immediately after it. 60% of participants were 41-50 years old and 80% women. All of them were practicing physicians; 49% had 5-10 year experience in family medicine. Main motivation to participate in the exam: the need for continuing learning (83%). Results showed their participation motivated continuing education (46%). Books were the most frequently utilized resource when preparing for the exam (54%). 94% were willing to take the exam again in the future, and all would recommend it to their colleagues. 49% said that examination should be taken every 3-4 years and should be voluntary (54%). 86% considered the content of the exam pertinent to their practice while 54% mentioned it was well adapted to their country's reality. Time for the exam was enough according to 71%, and number of questions was considered excessive by 89%. After the exam, 43% estimated to have personal prognosis for excellent or good outcomes. CONCLUSIONS. The international examination was satisfactory, stimulated desires of update, and the participants would repeat and recommend it in the future. The Mexican experience offers an example to put into practice, and the international collaboration would be a valid option to extend the certification processes in Latin America.

Heart rate variability changes in physicians working on night call.

PubMed

Malmberg, Birgitta; Persson, Roger; Flisberg, Per; Ørbaek, Palle

2011-03-01

Adverse effects by night-call duty have become an important occupational health issue. The aim of this study was to investigate whether the heart rate variability (HRV) differed during recovery from day work and night-call duty between distinct physician specialities. We studied the impact of a 16-h night-call duty on autonomic balance, measured by HRV, among two physician groups differing with respect to having to deal with life-threatening conditions while on call. Nineteen anaesthesiologists (ANEST) and 16 paediatricians and ear, nose and throat surgeons (PENT) were monitored by ambulatory digital Holter electrocardiogram (ECG). Heart rate variability was analysed between 21:00 and 22:00 after an ordinary workday, on night call and in the evening post-call. Absolute and normalized high-frequency power (HF, HFnu) were the main outcome variables, expressing parasympathetic influence on the heart. ANEST had lower HF power than PENT while on night call and post-daytime work (p < 0.05), but not at post-night call. In the whole group of physicians, HFnu was lower on call and post-daytime work compared with post-night-call duty (p < 0.05). The physiological recovery after night duty seemed sufficient in terms of HRV patterns for HFnu, reflecting autonomic balance and did not differ between specialities. However, the less dynamic HRV after daytime work and during night-call duty in the ANEST group may indicate a higher physiological stress level. These results may contribute to the improvement of night-call schedules within the health care sector.

When authenticity matters most: Physicians' regulation of emotional display and patient satisfaction.

PubMed

Yagil, Dana; Shnapper-Cohen, Moran

2016-10-01

The emotions expressed by physicians in medical encounters have significant impact on health outcomes and patient satisfaction. This study explored how physicians' regulation of displayed emotions affects patients' satisfaction, under low and high levels of patient distress and length of physician-patient acquaintance. Questionnaires were administered to 46 physicians and 230 of their patients (before and after the medical encounter) in outpatient clinics of two hospitals. Data were analyzed with hierarchical linear modeling which takes the nested data structure into account. We found a significant interaction effect of physician regulation of displayed emotions and patient distress on satisfaction: When distress was high, physician regulation of emotions was negatively related to patient satisfaction. The results also show a significant interaction effect of physician regulation of displayed emotions and length of physician-patient acquaintance: With a longer acquaintance, physician regulation of emotions was negatively related to patient satisfaction. The effect of the physicians' emotional display on patient satisfaction depends on contextual factors, such as patient distress and length of physician-patient acquaintance, which affect patients' emotional needs and expectations. When patients have high emotional involvement in the encounter it is suggested that physicians consider presenting genuine emotions to patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Nurse-physician collaboration in an academic medical centre: The influence of organisational and individual factors.

PubMed

Bowles, Darci; McIntosh, Georgia; Hemrajani, Reena; Yen, Miao-Shan; Phillips, Allison; Schwartz, Nathan; Tu, Shin-Ping; Dow, Alan W

2016-09-01

Ineffective physician-nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician-nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.

Manager-physician relationships: an organizational theory perspective.

PubMed

Kaissi, Amer

2005-01-01

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of

The Kubler-Ross model, physician distress, and performance reporting.

PubMed

Smaldone, Marc C; Uzzo, Robert G

2013-07-01

Physician performance reporting has been proposed as an essential component of health-care reform, with the aim of improving quality by providing transparency and accountability. Despite strong evidence demonstrating regional variation in practice patterns and lack of evidence-based care, public outcomes reporting has been met with resistance from medical professionals. Application of the Kubler-Ross 'five stages of grief' model--a conceptual framework consisting of a series of emotional stages (denial, anger, bargaining, depression, and acceptance) inspired by work with terminally ill patients--could provide some insight into why physicians are reluctant to accept emerging quality-reporting mechanisms. Physician-led quality-improvement initiatives are vital to contemporary health-care reform efforts and applications in urology, as well as other medical disciplines, are currently being explored.

Racial/Ethnic Variations in Physician Recommendations for Cardiac Revascularization

PubMed Central

Ibrahim, Said A.; Whittle, Jeff; Bean-Mayberry, Bevanne; Kelley, Mary E.; Good, Chester; Conigliaro, Joseph

2003-01-01

Objectives. We sought to examine whether physician recommendations for cardiac revascularization vary according to patient race. Methods. We studied patients scheduled for coronary angiography at 2 hospitals, one public and one private, between November 1997 and June 1999. Cardiologists were interviewed regarding their recommendations for cardiac resvacularization. Results. African American patients were less likely than Whites to be recommended for revascularization at the public hospital (adjusted odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12, 0.77) but not at the private hospital (adjusted OR = 1.69; 95% CI = 0.69, 4.14). Conclusions. Physician recommendations for cardiac revascularization vary by patient race. Further studies are needed to examine physician bias as a factor in racial disparities in cardiac care and outcomes. PMID:14534223

Making our offices universally accessible: guidelines for physicians

PubMed Central

Jones, K E; Tamari, I E

1997-01-01

OBJECTIVE: To develop recommendations for office-based physicians who wish to make their offices accessible to all patients. OPTIONS: Include taking steps to make offices more accessible, or not; offices may be accessible to varying degrees. OUTCOMES: Outcomes of accessibility involve patient-care, economic, ethical and legal issues. Stakeholders in these outcomes include patients, physicians, government and society. EVIDENCE: Data were obtained from a series of searches of MEDLINE, CINAHL and Healthstar (previously Health) databases for articles on disability and family medicine, primary (health) care and family practice, and on access and offices, and health services accessibility, and from a telephone survey of 50 stakeholders. VALUES: A high value was placed on services to persons with disabilities and on stakeholder input. Universal accessibility was valued as an overall goal; improved accessibility was also highly valued. BENEFITS, HARMS AND COSTS: Benefits to patients include improved access to care as guaranteed by the Canada Health Act and in keeping with provincial Human Rights Codes. Benefits to physicians include contact with a broader patient population and freedom from fear of litigation. Costs of improved accessibility vary depending on individual circumstances and on whether an office is being built or renovated; some improvement costs are minimal. RECOMMENDATIONS: All physicians should take measures to improve practice accessibility. Improved access should be considered in each of the following areas: transportation and entrance to the facility, entrance to the office, waiting rooms, rest rooms, examination rooms, general building features and other features. VALIDATION: No similar guidelines exist. To assess the content validity of these guidelines, the authors had a draft document reviewed by 18 stakeholders. All specific recommendations met the minimum criterion of adherence to current legislation, including national and provincial building

Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

PubMed

Meltzer, David O; Ruhnke, Gregory W

2014-05-01

Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure.

Minorities and Clinical Trials: Patients, Physicians, Clinical Trial Characteristics and their Environment

DTIC Science & Technology

2012-07-01

sites to assess their discussions with physicians, intentions and actual participation in prostate cancer clinical trials, attitudes and knowledge about...with physicians, intentions and actual participation in prostate cancer clinical trials, attitudes and knowledge about such trials, and barriers to and...calculated and compared across race/ethnicity. Examination of major outcomes included willingness to participate in, knowledge of, and attitudes towards

Primary Care Physicians' Experience with Disease Management Programs

PubMed Central

Fernandez, Alicia; Grumbach, Kevin; Vranizan, Karen; Osmond, Dennis H; Bindman, Andrew B

2001-01-01

OBJECTIVE To examine primary care physicians' perceptions of how disease management programs affect their practices, their relationships with their patients, and overall patient care. DESIGN Cross-sectional mailed survey. SETTING The 13 largest urban counties in California. PARTICIPANTS General internists, general pediatricians, and family physicians. MEASUREMENTS AND MAIN RESULTS Physicians' self-report of the effects of disease management programs on quality of patient care and their own practices. Respondents included 538 (76%) of 708 physicians: 183 (34%) internists, 199 (38%) family practitioners, and 156 (29%) pediatricians. Disease management programs were available 285 to (53%) physicians; 178 had direct experience with the programs. Three quarters of the 178 physicians believed that disease management programs increased the overall quality of patient care and the quality of care for the targeted disease. Eighty-seven percent continued to provide primary care for their patients in these programs, and 70% reported participating in major patient care decisions. Ninety-one percent reported that the programs had no effect on their income, decreased (38%) or had no effect (48%) on their workload, and increased (48%)) their practice satisfaction. CONCLUSIONS Practicing primary care physicians have generally favorable perceptions of the effect of voluntary, primary care-inclusive, disease management programs on their patients and on their own practice satisfaction. PMID:11318911

[Health care economics, uncertainty and physician-induced demand].

PubMed

Domenighetti, G; Casabianca, A

1995-10-21

The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.

Effects of dialogue groups on physicians' work environment.

PubMed

Bergman, David; Arnetz, Bengt; Wahlström, Rolf; Sandahl, Christer

2007-01-01

The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. The study assessed the impact of eight dialogue groups, which involved 60 physicians at a children's clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n = 68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

Outcomes of a program in business education for physicians and other health care professionals.

PubMed

Young, Mark A; Hough, Douglas E; Peskin, Michael R

2003-10-01

We sought to determine the expectations that graduates of one business of medicine program had upon enrollment and to ascertain fulfillment of those expectations after completion, as well as the extent to which participating in the program improved business skills and led to advancement in office practice or career development. A postal mail survey was conducted of graduates of The Johns Hopkins University's Business of Medicine Program, a year-long, four-course certificate program to educate midcareer academic and nonacademic physicians and other health care professionals about fundamental business practices and their application to health care. Surveys were sent to 285 graduates, and responses were received from 136 (48%) of them. Most respondents expected the program to expand their management skills, to enhance their knowledge of marketplace trends, and to advance their careers. These results were not correlated with respondents' age, sex, or profession (ie, physician, non-physician). More than 87% of respondents agreed that their overall expectations had been fulfilled by the time they completed the survey. Participants noted, however, that several expectations were unfulfilled upon replying to the survey. Programs designed to educate physicians and other health care professionals--in private practice, academia, or industry--about the business aspects of medicine can be effective but need to be designed carefully to integrate business theory and application to the medical setting.

Prescription opioid use and misuse: piloting an educational strategy for rural primary care physicians.

PubMed

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.

A randomized trial of two e-learning strategies for teaching substance abuse management skills to physicians.

PubMed

Harris, John M; Sun, Huaping

2013-09-01

To compare the educational effectiveness of two virtual patient (VP)-based e-learning strategies, versus no training, in improving physicians' substance abuse management knowledge, attitudes, self-reported behaviors, and decision making. The 2011-2012 study was a posttest-only, three-arm, randomized controlled trial in 90 resident and 30 faculty physicians from five adult medicine primary care training programs. The intervention was one of two 2-hour VP-based e-learning programs, designed by national experts to teach structured screening, brief interventions, referral, and treatment skills. One used traditional problem solving with feedback (unworked example), and the other incorporated an expert demonstration first, followed by problem solving with feedback (worked example). The main outcome measure was performance on the Physicians' Competence in Substance Abuse Test (P-CSAT, maximum score = 315), a self-administered, previously validated measure of physicians' competence in managing substance abuse. The survey was completed at the outset of the study and two months later. Overall P-CSAT scores were virtually identical (202-211, P > .05) between both intervention groups and the no-training control group at both times. Average faculty P-CSAT scores (221.9, 224.6) were significantly higher (P < .01) than resident scores (203.7, 202.5) at both times. This study did not provide evidence that a brief, worked example, VP-based e-learning program or a traditional, unworked, VP-based e-learning program was superior to no training in improving physicians' substance abuse management skills. The study did provide additional evidence that the P-CSAT distinguishes between physicians who should possess different levels of substance abuse management skills.

Global report on primary immunodeficiencies: 2018 update from the Jeffrey Modell Centers Network on disease classification, regional trends, treatment modalities, and physician reported outcomes.

PubMed

Modell, Vicki; Orange, Jordan S; Quinn, Jessica; Modell, Fred

2018-05-09

Primary immunodeficiencies (PI) are genetic defects of the immune system that result in chronic, serious, and often life-threatening infections, if not diagnosed and treated. Many patients with PI are undiagnosed, underdiagnosed, or misdiagnosed. In fact, recent studies have shown that PI may be more common than previously estimated and that as many as 1% of the population may be affected with a PI when all types and varieties are considered. In order to raise awareness of PI with the overall goal of reducing associated morbidity and mortality, the Jeffrey Modell Foundation (JMF) established a network of specialized centers that could better identify, diagnose, treat, and follow patients with PI disorders. Over the past decade, the Jeffrey Modell Centers Network (JMCN) has provided the infrastructure to accept referrals, provide diagnosis, and offer treatments. Currently, the network consists of 792 Expert Physicians at 358 institutions, in 277 cities, and 86 countries spanning 6 continents. JMF developed an annual survey for physician experts within the JMCN, using the categories and gene defects identified by the International Union of Immunological Societies Expert Committee for the Classification of PI, to report on the number of patients identified with PI; treatment modalities, including immunoglobulins, transplantation, and gene therapy; and data on gender and age. Center Directors also provided physician-reported outcomes and differentials pre- and post-diagnosis. The current physician-reported data reflect an increase in diagnosed patients, as well as those receiving treatment. Suspected patients are being identified and referred so that they can receive early and appropriate diagnosis and treatment. The significant increase in patients identified with a PI is due, in part, to expanding education and awareness initiatives, newborn screening, and the expansion of molecular diagnosis and sequencing. To our knowledge, this is the most extensive single

Nurses' professional values and attitudes toward collaboration with physicians.

PubMed

Brown, Sara S; Lindell, Deborah F; Dolansky, Mary A; Garber, Jeannie S

2015-03-01

Growing evidence suggests that collaborative practice improves healthcare outcomes, but the precursors to collaborative behavior between nurses and physicians have not been fully explored. The purpose of this descriptive correlational study was to describe the professional values held by nurses and their attitudes toward physician-nurse collaboration and to explore the relationships between nurses' characteristics (e.g. education, type of work) and professional values and their attitudes toward nurse-physician collaboration. This descriptive correlational study examines the relationship between nurses' professional values (Nurses Professional Values Scale-Revised) and their attitudes toward nurse-physician collaboration (Jefferson Scale of Attitudes toward Physician-Nurse Collaboration). Permission to conduct the study was received from the hospital, and the Institutional Review Boards of the healthcare system and the participating university. A convenience sample of 231 registered nurses from a tertiary hospital in the United States was surveyed. A significant positive relationship was found between nurses' professional values and better attitudes toward collaboration with physicians (r = .26, p < .01). Attitude toward collaboration with physicians was also positively associated with master's or higher levels of education (F(3, 224) = 4.379, p = .005). The results of this study can be helpful to nurse administrators who are responsible for developing highly collaborative healthcare teams and for nurse educators who are focused on developing professional values in future nurses. © The Author(s) 2014.

Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study

PubMed Central

2012-01-01

Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data: [1] availability for interprofessional communication, [2] relationship-building for effective communication, and [3] physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment in GIM, comparing the

Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians.

PubMed

van Rijssen, H J; Schellart, A J M; Berkhof, M; Anema, J R; van der Beek, Aj

2010-11-03

Physicians who hold medical disability assessment interviews (social insurance physicians) are probably influenced by stereotypes of claimants, especially because they have limited time available and they have to make complicated decisions. Because little is known about the influences of stereotyping on assessment interviews, the objectives of this paper were to qualitatively investigate: (1) the content of stereotypes used to classify claimants with regard to the way in which they communicate; (2) the origins of such stereotypes; (3) the advantages and disadvantages of stereotyping in assessment interviews; and (4) how social insurance physicians minimise the undesirable influences of negative stereotyping. Data were collected during three focus group meetings with social insurance physicians who hold medical disability assessment interviews with sick-listed employees (i.e. claimants). The participants also completed a questionnaire about demographic characteristics. The data were qualitatively analysed in Atlas.ti in four steps, according to the grounded theory and the principle of constant comparison. A total of 22 social insurance physicians participated. Based on their responses, a claimant's communication was classified with regard to the degree of respect and acceptance in the physician-claimant relationship, and the degree of dominance. Most of the social insurance physicians reported that they classify claimants in general groups, and use these classifications to adapt their own communication behaviour. Moreover, the social insurance physicians revealed that their stereotypes originate from information in the claimants' files and first impressions. The main advantages of stereotyping were that this provides a framework for the assessment interview, it can save time, and it is interesting to check whether the stereotype is correct. Disadvantages of stereotyping were that the stereotypes often prove incorrect, they do not give the complete picture, and the

Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians

PubMed Central

2010-01-01

Background Physicians who hold medical disability assessment interviews (social insurance physicians) are probably influenced by stereotypes of claimants, especially because they have limited time available and they have to make complicated decisions. Because little is known about the influences of stereotyping on assessment interviews, the objectives of this paper were to qualitatively investigate: (1) the content of stereotypes used to classify claimants with regard to the way in which they communicate; (2) the origins of such stereotypes; (3) the advantages and disadvantages of stereotyping in assessment interviews; and (4) how social insurance physicians minimise the undesirable influences of negative stereotyping. Methods Data were collected during three focus group meetings with social insurance physicians who hold medical disability assessment interviews with sick-listed employees (i.e. claimants). The participants also completed a questionnaire about demographic characteristics. The data were qualitatively analysed in Atlas.ti in four steps, according to the grounded theory and the principle of constant comparison. Results A total of 22 social insurance physicians participated. Based on their responses, a claimant's communication was classified with regard to the degree of respect and acceptance in the physician-claimant relationship, and the degree of dominance. Most of the social insurance physicians reported that they classify claimants in general groups, and use these classifications to adapt their own communication behaviour. Moreover, the social insurance physicians revealed that their stereotypes originate from information in the claimants' files and first impressions. The main advantages of stereotyping were that this provides a framework for the assessment interview, it can save time, and it is interesting to check whether the stereotype is correct. Disadvantages of stereotyping were that the stereotypes often prove incorrect, they do not give the

Beliefs About Control in the Physician-patient Relationship

PubMed Central

Street, Richard L; Krupat, Edward; Bell, Robert A; Kravitz, Richard L; Haidet, Paul

2003-01-01

OBJECTIVES Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant). DESIGN Stratified case-controlled study. PATIENTS/PARTICIPANTS Twenty family medicine and internal medicine physicians and 135 patients. MEASUREMENTS Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation. MAIN RESULTS Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation. CONCLUSIONS Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that

Public-on-private dual practice among physicians in public hospitals of Tigray National Regional State, North Ethiopia: perspectives of physicians, patients and managers.

PubMed

Abera, Goitom Gigar; Alemayehu, Yibeltal Kiflie; Herrin, Jeph

2017-11-10

Physicians who work in the private sector while also holding a salaried job in a public hospital, known as "dual practice," is one of the main retention strategies adopted by the government of Ethiopia. Dual practice was legally endorsed in Tigray National Regional State, Ethiopia in 2010. Therefore, the aim of this study was to explore the extent of dual practice, reasons why physicians engage in it, and its effects on public hospital services in this state in northern Ethiopia. A cross-sectional study using mixed methods was conducted from February to March 2011 in six geographically representative public hospitals of Tigray National Regional State. A semi-structured, self-administered questionnaire was distributed to all physicians working in the study hospitals, and an interviewer-administered, structured questionnaire was used to collect data from admitted patients. Focus group discussions were conducted with hospital governing boards. Quantitative and qualitative data were used in the analysis. Data were collected from 31 physicians and 449 patients in the six study hospitals. Six focus group discussions were conducted. Twenty-eight (90.3%) of the physicians were engaged in dual practice to some extent: 16 (51.6%) owned private clinics outside the public hospital, 5 (16.1%) worked part-time in outside private clinics, and 7 (22.6%) worked in the private wing of public hospitals. Income supplementation was the primary reason for engaging in dual practice, as reported by 100% of the physicians. The positive effects of dual practice from both managers' and physicians' perspectives were physician retention in the public sector. Ninety-one patients (20.3%) had been referred from a private clinic immediately prior to their current admission-a circular diversion pattern. Eighteen (19.8%) of the diverted patients reported that health workers in the public hospitals diverted them. Circular diversion pattern of referral system is the key negative consequence of dual

Proficiency in personal selling: prescription for physician marketing.

PubMed

Friedman, M L

1990-01-01

In a highly competitive and dynamic environment health care providers are turning to marketing techniques to compete. To date, the majority of marketing efforts in the health care industry have revolved around the use of promotional tools, mainly advertising, publicity and public relations. It is proposed here that personal selling is a neglected, but important, promotional tool for health care marketers, especially physicians. The analogy between physician and salesperson is drawn, various influence techniques commonly used in personal selling situations are discussed, and a methodology proposed for the systematic study of how physicians might adjust their use of such personal influence techniques to the situation so as to be more effective in terms of patient satisfaction and compliance.

Comparison of Physician-, Biomarker-, and Symptom-Based Strategies for Adjustment of Inhaled Corticosteroid Therapy in Adults With Asthma

PubMed Central

Calhoun, William J.; Ameredes, Bill T.; King, Tonya S.; Icitovic, Nikolina; Bleecker, Eugene R.; Castro, Mario; Cherniack, Reuben M.; Chinchilli, Vernon M.; Craig, Timothy; Denlinger, Loren; DiMango, Emily A.; Engle, Linda L.; Fahy, John V.; Grant, J. Andrew; Israel, Elliot; Jarjour, Nizar; Kazani, Shamsah D.; Kraft, Monica; Kunselman, Susan J.; Lazarus, Stephen C.; Lemanske, Robert F.; Lugogo, Njira; Martin, Richard J.; Meyers, Deborah A.; Moore, Wendy C.; Pascual, Rodolfo; Peters, Stephen P.; Ramsdell, Joe; Sorkness, Christine A.; Sutherland, E. Rand; Szefler, Stanley J.; Wasserman, Stephen I.; Walter, Michael J.; Wechsler, Michael E.; Boushey, Homer A.

2013-01-01

Context No consensus exists for adjusting inhaled corticosteroid therapy in patients with asthma. Approaches include adjustment at outpatient visits guided by physician assessment of asthma control (symptoms, rescue therapy, pulmonary function), based on exhaled nitric oxide, or on a day-to-day basis guided by symptoms. Objective To determine if adjustment of inhaled corticosteroid therapy based on exhaled nitric oxide or day-to-day symptoms is superior to guideline-informed, physician assessment–based adjustment in preventing treatment failure in adults with mild to moderate asthma. Design, Setting, and Participants A randomized, parallel, 3-group, placebo-controlled, multiply-blinded trial of 342 adults with mild to moderate asthma controlled by low-dose inhaled corticosteroid therapy (n=114 assigned to physician assessment–based adjustment [101 completed], n=115 to biomarker-based [exhaled nitric oxide] adjustment [92 completed], and n=113 to symptom-based adjustment [97 completed]), the Best Adjustment Strategy for Asthma in the Long Term (BASALT) trial was conducted by the Asthma Clinical Research Network at 10 academic medical centers in the United States for 9 months between June 2007 and July 2010. Interventions For physician assessment–based adjustment and biomarker-based (exhaled nitric oxide) adjustment, the dose of inhaled corticosteroids was adjusted every 6 weeks; for symptom-based adjustment, inhaled corticosteroids were taken with each albuterol rescue use. Main Outcome Measure The primary outcome was time to treatment failure. Results There were no significant differences in time to treatment failure. The 9-month Kaplan-Meier failure rates were 22% (97.5% CI, 14%-33%; 24 events) for physician assessment–based adjustment, 20% (97.5% CI, 13%-30%; 21 events) for biomarker-based adjustment, and 15% (97.5% CI, 9%-25%; 16 events) for symptom-based adjustment. The hazard ratio for physician assessment–based adjustment vs biomarker

A Systematic Review of Patients’ Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity

PubMed Central

Rocque, Rhea; Leanza, Yvan

2015-01-01

Communication difficulties persist between patients and physicians. In order to improve care, patients’ experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients’ experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients’ experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients’ experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients’ evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion

A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

PubMed

Rocque, Rhea; Leanza, Yvan

2015-01-01

Communication difficulties persist between patients and physicians. In order to improve care, patients' experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients' experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients' experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients' experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients' evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all

Frequency and nature of problems associated with sickness certification tasks: A cross-sectional questionnaire study of 5455 physicians

PubMed Central

Löfgren, Anna; Hagberg, Jan; Arrelöv, Britt; Ponzer, Sari; Alexanderson, Kristina

2007-01-01

Objective To study the frequency and nature of problems associated with physicians’ sickness certification practices. Design Cross-sectional questionnaire study. Setting Stockholm and Östergötland Counties in Sweden. Subjects Physicians aged ≤64 years, n =7665, response rate 71% (n =5455). Main outcome measures The frequency of consultations involving sickness certification, the frequency and nature of problems related to sickness certification. Results A total of 74% (n =4019) of the respondents had consultations including sickness certification at least a few times a year. About half of these physicians had sickness certification cases at least six times a week, and 1 out of 10 (9.4%) had this more than 20 times a week. The items that the highest percentage of physicians rated as very or fairly problematic included: handling conflicts with patients over certification, assessing work ability, estimating optimal length and degree of absence, and managing prolongation of sick leave initially certified by another physician. There were large differences in frequency and nature of problems between different types of clinics/practices. General practitioners had the highest frequency of problems concerning sickness certification while the lowest was found among specialists in internal medicine and surgery. Conclusion Sickness certification should be recognized as an important task also for physicians other than general practitioners. The physicians experienced problems with numerous tasks related to sickness certification and these varied considerably between types of clinics. The high rate of problems experienced may have consequences for the physicians’ work situation, for patients, and for society. PMID:17846937

Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing

PubMed Central

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

2017-01-01

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

The circle game: understanding physician migration patterns within Canada.

PubMed

Dauphinee, W Dale

2006-12-01

This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.

International variations in primary care physician consultation time: a systematic review of 67 countries.

PubMed

Irving, Greg; Neves, Ana Luisa; Dambha-Miller, Hajira; Oishi, Ai; Tagashira, Hiroko; Verho, Anistasiya; Holden, John

2017-11-08

To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress. © 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.

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

PubMed Central

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

Impact of physician distribution policies on primary care practices in rural Quebec.

PubMed

Da Silva, Roxane Borgès; Pineault, Raynald

2012-01-01

Accessibility and continuity of primary health care in rural Canada are inadequate, mainly because of a relative shortage of family physicians. To alleviate the uneven distribution of physicians in rural and urban regions, Quebec has implemented measures associated with 3 types of physician practices in rural areas. The objectives of our study were to describe the practices of these types of physicians in a rural area and to analyze the impact of physician distribution policies aimed at offsetting the lack of resources. Data were drawn from a medical administrative database and included information related to physicians' practices in the rural area of Beauce, Que., in 2007. The practices of permanently settled physicians in rural areas differ from those of physicians who substitute for short periods. Permanently settled physicians offer mostly primary care services, whereas physicians who temporarily substitute devote much of their time to hospital-based practice. Physician distribution policies implemented in Quebec to compensate for the lack of medical resources in rural areas have reduced the deficit in hospital care but not in primary care.

Physicians' perceptions of medical representative visits in Yemen: a qualitative study.

PubMed

Al-Areefi, Mahmoud Abdullah; Hassali, Mohamed Azmi; Ibrahim, Mohamed Izham b Mohamed

2013-08-20

The pharmaceutical industry invests heavily in promotion, and it uses a variety of promotional strategies to influence physicians' prescribing decisions. Within this context, medical representatives (MRs) are the key personnel employed in promoting their products. One significant consequence of the interactions between physicians and medical representatives is a conflict of interests which may contribute to the over prescribing of medications and thus negative effects on patients' health and economics. There is limited detailed information published on the reasons why physicians interact with pharmaceutical representatives. This study aims to qualitatively explore physicians' attitudes about interactions with medical representatives and their reasons for accepting the medical representatives' visits. In-depth interviews were used to gain a better understanding of physicians' perceptions of medical representative visits. A total of 32 physicians from both private and public hospitals were interviewed. The recordings of the interviews were transcribed verbatim and subject to thematic analysis using a framework analysis approach. The present qualitative study found that the majority of the physicians had positive interactions with medical representatives. The physicians' main reasons stated for allowing medical representatives' visits are the social contacts and mutual benefits they will gain from these representatives. They also emphasized that the meeting with representatives provides educational and scientific benefits. A few physicians stated that the main reasons behind refusing the meeting with medical representatives were lack of conviction about the product and obligation to prescribe medicine from the representative company. Most of the physicians believed that they were under marketing pressure to prescribe certain medicines. Although physicians are aware that the medical representatives could influence their prescribing decision, they welcome

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

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

2017-05-01

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

Deferred Personal Life Decisions of Women Physicians.

PubMed

Bering, Jamie; Pflibsen, Lacey; Eno, Cassie; Radhakrishnan, Priya

2018-05-01

Inadequate work-life balance can have significant implications regarding individual performance, retention, and on the future of the workforce in medicine. The purpose of this study was to determine whether women physicians defer personal life decisions in pursuit of their medical career. We conducted a survey study of women physicians ages 20-80 from various medical specialties using a combination of social media platforms and women physicians' professional listservs with 801 survey responses collected from May through November 2015. The primary endpoint was whether women physicians deferred personal life decisions in pursuit of their medical career. Secondary outcomes include types of decisions deferred and correlations with age, hours worked per week, specialty, number of children, and career satisfaction. Respondents were categorized into deferred and nondeferred groups. Personal decision deferments were reported by 64% of respondents. Of these, 86% reported waiting to have children and 22% reported waiting to get married. Finally, while 85% of women in the nondeferment group would choose medicine again as a career, only 71% of women in the deferment group would do so (p < 0.0001). Physicians who would choose medicine again cited reasons such as career satisfaction, positive patient interactions, and intellectual stimulation, whereas those who would not choose medicine again reported poor work-life balance, decreasing job satisfaction, and insurance/administrative burden. The results of this survey have significant implications on the future of the workforce in medicine. Overall, our analysis shows that 64% of women physicians defer important life decisions in pursuit of their medical career. With an increase in the number of women physicians entering the workforce, lack of support and deferred personal decisions have a potential negative impact on individual performance and retention. Employers must consider the economic impact and potential workforce

Family physicians' knowledge and screening of chronic hepatitis and liver cancer.

PubMed

Ferrante, Jeanne M; Winston, Dock G; Chen, Ping-Hsin; de la Torre, Andrew N

2008-05-01

Studies show that primary care providers may suboptimally diagnose, treat, or refer patients with hepatitis C virus (HCV) infection. In addition, little is known about family physicians' knowledge and practices regarding chronic hepatitis B virus (HBV) infection or monitoring for hepatocellular carcinoma (HCC). We used a cross-sectional mail survey of members of the New Jersey Academy of Family Physicians (n=217). Outcome measures were knowledge of risk factors, screening, counseling for chronic HCV and HBV, and screening for HCC. Mean knowledge score for risk factors was 79% (HBV) and 70% (HCV). Physicians who diagnosed >or= six cases per year had higher knowledge of HBV risk factors. Physicians in practice >20 years had lower knowledge of HCV risk factors. Mean knowledge score for counseling was 77%. About 25% screened for liver cancer. Screening for HCC in patients with HBV was related to years in practice, female physicians, and group practice. Physicians in academic settings were more likely to screen patients with HCV for HCC. Forty-two percent and 51% referred patients with chronic HBV and chronic HCV, respectively, to the specialist for total management. Family physicians have insufficient knowledge about screening and counseling for chronic hepatitis and hepatocellular carcinoma.

The impact of a physician's warning on recovery after alcoholism treatment.

PubMed

Walsh, D C; Hingson, R W; Merrigan, D M; Levenson, S M; Coffman, G A; Heeren, T; Cupples, L A

1992-02-05

To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later. Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not recall warnings were compared. A company-union employee assistance program. Two hundred problem drinkers, newly identified on the job, predominantly male, blue-collar workers. Drinking, drunkenness, average daily alcohol consumption, and impairment score. Among the 200 participants, 74% saw physicians in the index year; only 22% recalled warnings. Recall of a warning was associated with liver disease, continued drinking while ill, supervisors' job warnings, older age, and marijuana use. Two years later, those warned were more likely to be abstaining, and sober, and were less impaired. Recalling a physician's warning at intake into alcoholism treatment was associated with better prognosis 2 years later. However, among this group of employees whose drinking was serious enough to be identified on the job, fewer than a quarter recalled physicians' warnings, even though more than three quarters had seen physicians in the year preceding intake.

Electronic health record acceptance by physicians: testing an integrated theoretical model.

PubMed

Gagnon, Marie-Pierre; Ghandour, El Kebir; Talla, Pascaline Kengne; Simonyan, David; Godin, Gaston; Labrecque, Michel; Ouimet, Mathieu; Rousseau, Michel

2014-04-01

Several countries are in the process of implementing an Electronic Health Record (EHR), but limited physicians' acceptance of this technology presents a serious threat to its successful implementation. The aim of this study was to identify the main determinants of physician acceptance of EHR in a sample of general practitioners and specialists of the Province of Quebec (Canada). We sent an electronic questionnaire to physician members of the Quebec Medical Association. We tested four theoretical models (Technology acceptance model (TAM), Extended TAM, Psychosocial Model, and Integrated Model) using path analysis and multiple linear regression analysis in order to identify the main determinants of physicians' intention to use the EHR. We evaluated the modifying effect of sociodemographic characteristics using multi-group analysis of structural weights invariance. A total of 157 questionnaires were returned. The four models performed well and explained between 44% and 55% of the variance in physicians' intention to use the EHR. The Integrated model performed the best and showed that perceived ease of use, professional norm, social norm, and demonstrability of the results are the strongest predictors of physicians' intention to use the EHR. Age, gender, previous experience and specialty modified the association between those determinants and intention. The proposed integrated theoretical model is useful in identifying which factors could motivate physicians from different backgrounds to use the EHR. Physicians who perceive the EHR to be easy to use, coherent with their professional norms, supported by their peers and patients, and able to demonstrate tangible results are more likely to accept this technology. Age, gender, specialty and experience should also be taken into account when developing EHR implementation strategies targeting physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

Physician styles of patient management as a potential source of disparities: cluster analysis from a factorial experiment.

PubMed

Lutfey, Karen E; Gerstenberger, Eric; McKinlay, John B

2013-06-01

To identify styles of physician decision making (as opposed to singular clinical actions) and to analyze their association with variations in the management of a vignette presentation of coronary heart disease (CHD). Primary data were collected from primary care physicians in North and South Carolina. In a balanced factorial experimental design, primary care physicians viewed one of 16 (2(4)) video vignette presentations of CHD and provided detailed information about how they would manage the case. 256 MD primary care physicians were interviewed face-to-face in North and South Carolina. We identify three clusters depicting unique styles of CHD management that are robust to controls for physician (gender and level of experience) and patient characteristics (age, gender, socioeconomic status, and race) as well as key organizational features of physicians' work settings. Physicians in Cluster 1 "Cardiac" (N = 92) were more likely to focus on cardiac issues compared with their counterparts; physicians in Cluster 2 "Talkers" (N = 93) were more likely to give advice and take additional medical history; whereas physicians in Cluster 3 "Minimalists" (N = 71) were less likely than their counterparts to take action on any of the types of management behavior. Variations in styles of decision making, which encompass multiple outcome variables and extend beyond individual-level demographic predictors, may add to our understanding of disparities in health quality and outcomes. © Health Research and Educational Trust.

A randomized controlled trial of a pharmacist consultation program for family physicians and their elderly patients

PubMed Central

Sellors, John; Kaczorowski, Janusz; Sellors, Connie; Dolovich, Lisa; Woodward, Christel; Willan, Andrew; Goeree, Ron; Cosby, Roxanne; Trim, Kristina; Sebaldt, Rolf; Howard, Michelle; Hardcastle, Linda; Poston, Jeff

2003-01-01

Background Pharmacists can improve patient outcomes in institutional and pharmacy settings, but little is known about their effectiveness as consultants to primary care physicians. We examined whether an intervention by a specially trained pharmacist could reduce the number of daily medication units taken by elderly patients, as well as costs and health care use. Methods We conducted a randomized controlled trial in family practices in 24 sites in Ontario. We randomly allocated 48 randomly selected family physicians (69.6% participation rate) to the intervention or the control arm, along with 889 (69.5% participation rate) of their randomly selected community-dwelling, elderly patients who were taking 5 or more medications daily. In the intervention group, pharmacists conducted face-to-face medication reviews with the patients and then gave written recommendations to the physicians to resolve any drug-related problems. Process outcomes included the number of drug-related problems identified among the senior citizens in the intervention arm and the proportion of recommendations implemented by the physicians. Results After 5 months, seniors in the intervention and control groups were taking a mean of 12.4 and 12.2 medication units per day respectively (p = 0.50). There were no statistically significant differences in health care use or costs between groups. A mean of 2.5 drug-related problems per senior was identified in the intervention arm. Physicians implemented or attempted to implement 72.3% (790/1093) of the recommendations. Interpretation The intervention did not have a significant effect on patient outcomes. However, physicians were receptive to the recommendations to resolve drug-related problems, suggesting that collaboration between physicians and pharmacists is feasible. PMID:12847034

Clinical Outcome Metrics for Optimization of Robust Training

NASA Technical Reports Server (NTRS)

Ebert, Doug; Byrne, Vicky; Cole, Richard; Dulchavsky, Scott; Foy, Millennia; Garcia, Kathleen; Gibson, Robert; Ham, David; Hurst, Victor; Kerstman, Eric;

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

PubMed

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

2017-01-01

To describe the use of prehospital ultrasonography (PHUS) to support interventions, when used by physician and non-physician air medical crew (AMC), in a Canadian helicopter emergency medical service (HEMS). A retrospective review was conducted of consecutive patients who underwent ultrasound examination during HEMS care from January 1, 2009 through March 10, 2014. An a priori created data form was used to record patient demographics, type of ultrasound scan performed, ultrasound findings, location of scan, type of interventions supported by PHUS, factors that affected PHUS completion, and quality indicator(s). Data analysis was performed through descriptive statistics, Student's t-test for continuous variables, Z-test for proportions, and Mann-Whitney U Test for nonparametric data. Outcomes included interventions supported by PHUS, factors associated with incomplete scans, and quality indicators associated with PHUS use. Differences between physician and AMC groups were also assessed. PHUS was used in 455 missions, 318 by AMC and 137 by physicians. In combined trauma and medical patients, in the AMC group interventions were supported by PHUS in 26% of cases (95% CI 18-34). For transport physicians the percentage support was found to be significantly greater at 45% of cases (95% CI 34-56) p = < 0.006. Incomplete PHUS scans were common and reasons included patient obesity, lack of time, patient access, and clinical reasons. Quality indicators associated with PHUS were rarely identified. The use of PHUS by both physicians and non-physicians was found to support interventions in select trauma and medical patients. Key words: emergency medical services; aircraft; helicopter; air ambulance; ultrasonography; emergency care, prehospital; prehospital emergency care.

Environmental factors associated with physician's engagement in communication activities.

PubMed

Mazurenko, Olena; Hearld, Larry R

2015-01-01

Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician-patient and physician-physician communication occurs infrequently. The purpose of this study was to examine the relationship between a medical practice's external environment and physician engagement in communication activities. This was a cross-sectional examination of 4,299 U.S. physicians' self-reported engagement in communication activities. Communication was operationalized as physician's time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. Several environmental factors, including per capita income (odds ratio range, 1.17-1.38), urban location (odds ratio range, 1.08-1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47-13.22), poverty (odds ratio range, 0.80-0.97) and population rates (odds ratio range, 1.01-1.02), and the presence of a malpractice crisis (odds ratio range, 0.22-0.43), were significantly associated with communication. Certain aspects of a physician's external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers).