Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death. PMID:7632208
Radi, Joshua; Brisson, Michael; Line, Michael
The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.
Cawley, J F; Ott, J E; DeAtley, C A
Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.
Jones, Ian W.; Hooker, Roderick S.
Abstract Objective To analyze the health policies related to physician assistants (PAs) and to understand the factors influencing this medical work force movement. Quality of evidence This work combines a review of the literature and qualitative information, and it serves as a historical bookmark. The approach was selected when attempts to obtain reports or literature using customary electronic bibliography (PubMed, CINAHL, Google Scholar, EBSCO, and MEDLINE) searches in English and French, from 1970 through 2010, identified only 14 documents (including gray literature) of relevance. Reports, provincial documents, and information from developers of the PA movement supplemented the literature base. Main message The historical development of the role of PAs in Canada spans 2 decades. There are now more than 250 PAs, most working in family medicine and emergency medicine. Enabling legislation for PAs has been formalized in Manitoba, and 3 provinces have recognized PAs in various policy statements or initiatives. Three universities and 1 military training centre have enrolled more than 120 students in PA programs. Retired PAs of the Canadian Forces, returning ex-patriot Canadians who had trained as PAs in PA programs in the United States, and American immigrants are working as PAs in Canada. Demonstration projects are under way to better understand the usefulness of PAs in various medical settings. Conclusion For a public health policy enactment of this size and effect, the literature on PAs in Canada is sparse and limited. In spite of this, PA employment is expanding, family medicine practices are using PAs, and there is enabling legislation planned. The result will likely be increased use of PAs. Documentation about PAs, review of their use, and outcomes research are needed to evaluate this new type of clinician in Canadian society. PMID:21402955
... medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may practice in any setting in which a physician provides care. This allows doctors to focus their skills and knowledge in a more effective way. PAs ...
Hooker, Roderick S
A rheumatology postgraduate fellowship for physician assistants was inaugurated in 2004 as a pilot initiative to supplement shortages in rheumatologists. An administrative analysis documented that each PA trainee achieved a high level of rheumatology exposure and proficiency. Classes in immunology, rheumatology, and internal medicine augmented clinical training. Faculty and trainees considered PA postgraduate training in rheumatology worthwhile.
Cawley, James F; Eugene Jones, P; Miller, Anthony A; Orcutt, Venetia L
Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.
Selecting resources for physician assistants is challenging and can be overwhelming. Although several core lists exist for nursing, allied health, and medical libraries, judging the scope and level of these resources in relation to the information needs of the physician assistant is difficult. Medical texts can be highly specialized and very expensive, in essence, “overkill” for the needs of the physician assistant. This bibliography is meant to serve as a guide to appropriate medical texts for physician assistants. Titles were selected from the Brandon/Hill list, Doody's Electronic Journal, and various other reference resources. Resources were evaluated based on the subject and scope, audience, authorship, cost, and currency. The collection includes 195 titles from 33 specialty areas. Standard texts in each area are also included. PMID:11465687
Physician-assisted suicide in Germany is limited by criminal law and disapproved by professional authorities. A physician who is willing to help a demented patient in terminating his life has to be definitely sure that the disease does not interfere with the patient's capacity for decision-making. In cases of early dementia the reason why assisted suicide will usually be requested is not the actual suffering of the patient but his negative expectations for the future. As long as there are sufficient opportunities for palliative care, the progressive course of the dementia process does not imply a state of unbearable suffering which could justify an assisted suicide. Nevertheless there may be certain circumstances--as for instance the value that an individual attributes to his integrity or to the narrative unity of his life--which might possibly provide an ethical justification for the assistance in life termination. A physician who helps a demented person in performing a suicidal act does not necessarily oppose essential principles of medical ethics. Yet, especially with regard to possible societal consequences of physician-assisted suicide in dementia, the rejecting attitude of medical authorities against that activity must be considered as well founded and legitimate. Deviations from these general guidelines ought to be respected as long as they are limited to exceptional situations and correspond to a thorough consideration of a physician's professional duties. They should remain open to public control, but not be ultimately specified by unequivocal normative regulations.
Kuhn, Lisa; Kranz, Peter L.; Koo, Felix; Cossio, Griselda; Lund, Nick L.
Twenty-seven full-time students within the Physician Assistant Studies Program at The University of Texas--Pan American were anonymously surveyed to determine their levels of stress while enrolled in their first semester. The majority of respondents reported that their stress levels at this point in the program tell within the moderate to…
Eifel, Raymond Leo
Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…
Health Careers of Ohio, Columbus.
The document provides information on the name of the program, the institution, prerequisites, length of course, and certificate or degree offered for 81 programs for the training of physician assistants as part of Operation MEDIHC (Military Experience Directed Into Health Careers). Fifty-three programs are in primary care; the remaining 28 are…
Blumm, Robert M; Condit, Doug
Recent surveys performed by the AAPA estimate that in 2002 approximately 183 million visits were made to PAs and 223 million medications were prescribed or recommended by PAs. The AAPA estimates that just more than 46,000 PAs currently are in clinical practice, with New York and California having the largest numbers of practicing PAs. Helen Keller said, "The most pathetic person in the world is the person who has sight but no vision." Most individuals accept life and its shortcomings, but visionaries are different. They see not only that which is evident, but also that which exists in imagination. Visionary physicians and surgeons who aided in the creation of the physician assistant and use of PAs in surgery include: Eugene Stead, MD; John Kirklin, MD, FACS; E. Harvey Estes, Jr., MD; Richard Smith, MD, FACS; and Marvin Giledman, MD. They believed that well-educated nonphysicians could work alongside physicians as a team and, thus, expand the delivery of health care in America. PAs have crossed into the new millennium with new challenges. Together, as a team with supervising surgeons, PAs can meet the challenges and establish new alliances that will alleviate today's constraints. As Rear Adm. Kenneth P. Moritsugu, MD, MPH, Deputy Surgeon General, said, "Physician assistants are ideal partners and professionals in the nation's health system. They are colleagues with physicians to assure improved access to quality health care in a cost-effective manner.
Mottiar, Miriam; Grant, Cameron; McVey, Mark J
Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. It is difficult to predict the potential demand for PAD in Canada. This paper highlights other countries' experiences with PAD in order to shed light on this question and to forecast issues that Canadian physicians will face once the change to the law comes into effect. At present, there is no legislative scheme in place to regulate the conduct of PAD. Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada.
Godkins, T R
Although American medicine has vastly improved the delivery of medical care during the last half-century, there are still many problems confronting our health care delivery system. The physician assistant concept is but one attempt of many to alleviate the problem of access to health care of an acceptable quality. Another concept is national health insurance as a measure to bridge the economic gaps in medical care not met by Medicare, Medicaid, and private health insurance; and to make better use of all health resources. Physician assistants can have a beneficial impact on health care under national health insurance by: improving access to care; keeping practice costs down; and improving the quality of care provided. A program of national health insurance will undoubtedly create increased public demand to provide more health services than currently offered by federal programs. National health insurance can succeed only if an appropriate financing mechanism is developed and valid attempts are made to utilize available manpower such as physician assistants. These issues are discussed.
Zenz, Julia; Tryba, Michael; Zenz, Michael
This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.
A curriculum consisting of four modules is presented to help nurse practitioners, physician assistants, and physicians develop team practices and improve and increase the utilization of nurse practitioners and physician assistants in primary care settings. The curriculum was prepared in 1981-1982 by the California Area Health Education Center…
A manual is presented to help incorporate team development into training programs for nurse practitioners, physician assistants, and primary care physicians. It is also directed to practitioners who wish to improve teamwork and is designed to improve the utilization of the nurse practitioners and physician assistants. A group of one or more…
Miles, D L; Rushing, W A
In an effort to improve the health care in a rural county in Southern Appalachia, physicians' assistants (MEDEX) have been employed in the offices of three general practitioners over a three-year period. This program was evaluated using a before-after and experimental-control (county) design, utilizing data both from physician office contracts and a continuing survey of the populations of the experimental and control counties. Results show the following: 1) utilization (average office visits per week) increased; 2) types of care (preventive versus curative) remained stable; 3) the hospitalization rate increased continuously during the three years for those physicians using physicians' assistants; and 4) the physicians' assistant functioned more as a physician substitute than as an assistant. It is concluded that although use of physicians' assistants may increase utilization rates, they may not reduce the long-range cost of medical care through providing more preventive or ambulatory (as opposed to hospital) care.
... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...
... in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...
... in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...
... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...
... specified in paragraph (d) of this section. (a) For assistant-at-surgery services, 65 percent of the amount that would be allowed under the physician fee schedule if the assistant-at-surgery service was furnished by a physician. (b) For services (other than assistant-at-surgery services) furnished in...
Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.
Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of 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 adversarial, most physicians are…
Hooker, Roderick S; Muchow, Ashley N
As part of healthcare reform, physician assistants (PAs) are needed to help mitigate the physician shortage in the United States. This requires understanding the population of clinically active PAs for accurate prediction purposes. An inventory projection model of PAs drew on historical trends, the PA stock, graduation estimates, retirement trends, and PA intent to retire data. A new source of licensed health professionals, Provider 360 Database, was obtained to augment association information. Program growth and graduate projections indicated an annual 4.7% trend in new entrants to the workforce, offset by annual attrition estimates of 2.9%. As of 2013, there were 84,064 licensed PAs in the United States. The stock and flow equation conservatively predicts the supply of PAs to be 125,847 by 2026. Although the number of clinically active PAs is projected to increase at least by half by 2026, substantial gaps remain in understanding career trends and early attrition influences. Furthermore, education production could be constrained by inadequate clinical training sites and scarcity of faculty.
Brock, Douglas M; Wick, Keren H; Evans, Timothy C; Gianola, F J
The physician assistant (PA) profession originated to train former medics and corpsmen for a new civilian health care career. However, baccalaureate degree prerequisites to training present barriers to discharged personnel seeking to enter this profession. A survey was administered (2006-2007) to all MEDEX Northwest PA program graduates who had entered with military experience. The survey addressed attitudes toward the profession, PA education, and practice and how military experience influenced their education and careers. The response rate was 46.4%, spanning all branches of the military. Respondents reported military experience positively impacting ability to handle stress and work in health care teams and that patients and colleagues viewed their military background positively. Most (75.5%) respondents did not hold a bachelor's degree at matriculation. Veterans bring substantial health care training to the PA profession. However, program prerequisites increasingly present barriers to entry. Veterans' contributions to health care and the consequences of losing this resource are discussed.
Hooker, Roderick S; Muchow, Ashley N
A census of physician assistants in the United States is necessary to help legislators make policy decisions about the profession. In 2013, a PA status analysis was undertaken using a novel data source derived from state licensure. The Provider 360 Database was probed for all licensed PAs, and 84,064 were identified. Duplicates, sanctioned, deceased, and dual-licensed were reconciled. In the aggregate, the mean age was 42 years (median 45; mode 32; range 22-74) and 75% of US licensed PAs were women. Statewide distribution per capita ranged from 60 per 100,000 in Alaska to 3.9 per 100,000 in Mississippi; the US mean was 26.8. The robustness of this database draws on active licensure data to identify clinically active PAs. Such refinements and details contribute to health workforce research such as census, modeling, retirement trends, and labor participation rates.
Henry, Lisa R
Medical anthropology is a subfield of anthropology that investigates how culture influences people's ideas and behaviors regarding health and illness. Medical anthropology contributes to the understanding of how and why health systems operate the way they do, how different people understand and interact with these systems and cultural practices, and what assets people use and challenges they may encounter when constructing perceptions of their own health conditions. The goal of this article is to highlight the methodological tools and analytical insights that medical anthropology offers to the study of physician assistants (PAs). The article discusses the field of medical anthropology; the advantages of ethnographic and qualitative research; and how medical anthropology can explain how PAs fit into improved health delivery services by exploring three studies of PAs by medical anthropologists.
... Documents#0;#0; ] Proclamation 8579 of October 6, 2010 National Physician Assistants Week, 2010 By the... shortages. During National Physician Assistants Week, we honor these dedicated medical professionals and.... As we recognize their countless contributions this week, we also pay tribute to the kind...
Jacobson, Cardell K; Smith, Darron T
Two recent reports using different data sets concluded that female physician assistants (PAs) earn substantially less than male PAs. Similar data comparing the effect of race and ethnicity on salary have not been compiled. This article examines the possibility of racial and ethnic salary disparities in PA salaries using data from the 2009 survey of members of the American Academy of Physician Assistants.
Pearlman, Robert A; Hsu, Clarissa; Starks, Helene; Back, Anthony L; Gordon, Judith R; Bharucha, Ashok J; Koenig, Barbara A; Battin, Margaret P
OBJECTIVE To obtain detailed narrative accounts of patients' motivations for pursuing physician-assisted suicide (PAS). DESIGN Longitudinal case studies. PARTICIPANTS Sixty individuals discussed 35 cases. Participants were recruited through advocacy organizations that counsel individuals interested in PAS, as well as hospices and grief counselors. SETTING Participants' homes. MEASUREMENTS AND RESULTS We conducted a content analysis of 159 semistructured interviews with patients and their family members, and family members of deceased patients, to characterize the issues associated with pursuit of PAS. Most patients deliberated about PAS over considerable lengths of time with repeated assessments of the benefits and burdens of their current experience. Most patients were motivated to engage in PAS due to illness-related experiences (e.g., fatigue, functional losses), a loss of their sense of self, and fears about the future. None of the patients were acutely depressed when planning PAS. CONCLUSIONS Patients in this study engaged in PAS after a deliberative and thoughtful process. These motivating issues point to the importance of a broad approach in responding to a patient's request for PAS. The factors that motivate PAS can serve as an outline of issues to explore with patients about the far-reaching effects of illness, including the quality of the dying experience. The factors also identify challenges for quality palliative care: assessing patients holistically, conducting repeated assessments of patients' concerns over time, and tailoring care accordingly. PMID:15836526
Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William
A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.
Park, Melissa; Cherry, Donald; Decker, Sandra L
The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care. Projections of the future physician workforce predict declines in the supply of physicians and decreasing physician work hours for primary care. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics.
Barutta, Joaquín; Vollmann, Jochen
Even among advocates of legalising physician-assisted death, many argue that this should be done only once palliative care has become widely available. Meanwhile, according to them, physician-assisted death should be banned. Four arguments are often presented to support this claim, which we call the argument of lack of autonomy, the argument of existing alternatives, the argument of unfair inequalities and the argument of the antagonism between physician-assisted death and palliative care. We argue that although these arguments provide strong reasons to take appropriate measures to guarantee access to good quality palliative care to everyone who needs it, they do not justify a ban on physician-assisted death until we have achieved this goal.
Aquinas's conception of the relationship of faith and reason calls into question the arguments and some of the conclusions advanced in contributions to the debate on physician-assisted suicide by David Thomasma and H. Tristram Engelhardt. An understanding of the nature of theology as based on revelation calls into question Thomasma's theological argument in favor of physician-assisted suicide based on the example of Christ and the martyrs. On the other hand, unaided reason calls into question his assumptions about the nature of death as in some cases a good for the human person. Finally, if Aquinas is right about the relationship of faith and reason, Engelhardt's sharp contrast between "Christian" and "secular" approaches to physician-assisted suicide needs reconsideration, although his conclusions about physician-assisted suicide would find support.
Neal, Jeremy H; Neal, Laura D M
Self-directed learning (SDL) portfolios are underused in the educational process and should be considered by physician assistant (PA) programs. Clinicians such as PAs are responsible for self-identifying their learning needs, competencies, and ongoing educational requirements. This article introduces an outline for SDL in the PA profession, for direct use by learners and indirect use by educators. Without a plan, many professionals may lack the insight, motivation, and knowledge needed to improve their skill set and establish goals for individual lifelong learning. This study conducted a review of the literature. Then, by incorporating SDL portfolios into PA educational methodologies, it constructed a concept map for individuals to monitor, self-direct, and actively participate in their own learning in academic settings and throughout their career.
This article explores the role of the physician in the Assisted Dying Bill, which is currently progressing through the House of Lords. The Supreme Court decision in Nicklinson and Others has alerted Parliament to the possibility that the current prohibition against assisted suicide may breach Article 8 of the European Convention in relation to the right to choose how to end one's life. In this article, the role of healthcare professionals in the proposed legalisation of physician-assisted suicide is examined, together with consideration of key ethical concerns over who might be permitted to access assisted dying. Whether the proposed law presents an ethically sound alternative to the current prohibition against assisting in suicide is not clear, but Parliament must now respond in order to address human rights issues and the call to legalise medically assisted suicide.
Álvarez-Del Río, Asunción
Some persons with refractory and unbearable suffering caused by an illness or medical condition wish to die by euthanasia or physician assisted suicide in order to have a certain and painless death. Physicians who agree to help a patient to die have previously confirmed that his/her illness cannot be cured, his/her suffering cannot be relieved and he/ she is of sound mind. Being well informed of his/her condition, the patient arrives to the conclusion that in his/her situation being death is better that being alive. How to explain that there are very few places in which physicians are allowed to help their patients to die? The main arguments against legalizing physician-assisted death are analyzed in this article.
Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Galanos, Antonis; Vlahos, Lambros
The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide (P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death.
Frileux, Stephanie; Sastre, Maria Teresa Munoz; Antonini, Sophie; Mullet, Etienne; Sorum, Paul Clay
Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the…
Blevins, Dean; Preston, Thomas A.; Werth, James L., Jr.
The present study describes the characteristics and attitudes of non-terminally ill persons who support physician-assisted death (PAD) along with their expectations and preferences for care in the future. Participants (N=101) completed a survey assessing current affect and attitudes and those expected if terminally ill. Participants' responses…
Kiser, Jerry D.
With the shift in Americans' beliefs regarding legalizing physician-assisted suicide for the terminally ill, counselors must be prepared to counsel clients who have decided to end their lives. For counselors to avoid violating the ethical guidelines established by the American Counseling Association (ACA) regarding these clients, a reevaluation of…
Glennon, Virginia B.; Greenberg, Suzanne B.
A handbook for supervisors of students training as physician assistants is presented, based in part on workshops and interviews conducted at Northeastern University (Massachusetts). Topics include: the role and attributes of the supervisor, needs of adult learners and adult learning styles, beginning the supervisory process, use of skills in…
Fowkes, Virginia; And Others
Traditionally, nurse practitioners and physician's assistants have been trained separately. In l977, the Family Nurse Practitioner Program at the University of California, Davis, and the Primary Care Associate Program at Stanford University merged clinical curricula. The cooperative program is described and its first year evaluated. (Author/JMD)
Anzalone, Justin; Mathews, Asha; Suprenant, Michael; Herman, Lawrence
Of 1,254 practicing physician assistants (PAs) who completed a survey, 91% were familiar with direct-to-consumer advertising (DTCA). When asked about their general perception, 96% of PAs were neutral or unfavorable towards DTCA. PAs felt that DTCA encouraged patients to make atypical medication requests, overlook the PA's medical opinion, and seek other health care providers.
Hooker, Roderick S.; Cipher, Daisha J.
Context: Physician assistants (PAs) and nurse practitioners (NPs) have licensure to practice in all states and they have prescriptive authority in 47 and 40 states, respectively. However, there have been no published studies from a national standpoint comparing urban and rural settings. Purpose: The objective of this study was to describe the…
Coniglio, David Martin
An increasing demand for education of physician assistants (PAs) has resulted in rapid growth in the number of PA educational programs. Faculty for these programs may be recruited from existing programs. Understanding faculty turnover intention is important to guide faculty development and to improve faculty retention. The purpose of this research…
Moore, Miranda A; Coffman, Megan; Cawley, James F; Crowley, Diana; Miller, Anthony; Klink, Kathleen
This study seeks to investigate how physician assistants (PAs) finance their education and to characterize the educational debt of PA students. Data from the 2011 American Academy of PAs (AAPA)-Physician Assistant Education Association Graduating Student Survey were used to explore the educational debt of PA students. The median total educational debt of a PA student graduating in 2011 was $80,000. Little financial assistance, other than student loans, is available to PA students. Eighty-five percent of PA students report owing some PA education debt amount, with 23% owing at least $100,000. This study provides a baseline look at PA student debt loads as a starting point for more detailed and robust research into new graduate specialty choices and PA career migration into other specialties. Further research is needed to explore the effect of student debt on students' specialty choices.
Swanchak, Lori E.
Background: The recent advancements in medicine and the subsequent need for additional clinical training have resulted in the awarding of Clinical Doctorate (CD) Degrees for several allied health professionals. Few studies have been conducted within the physician assistant (PA) profession related to changing the entry-level degree for PAs to a…
van Bruchem-van de Scheur, Ada; van der Arend, Arie; van Wijmen, Frans; Abu-Saad, Huda Huijer; ter Meulen, Ruud
This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half (45%) of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses (58.2%) found it too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics (62.9%) and inserting an infusion needle to administer the euthanatics (54.1%) should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide.
Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E
Background Legislation on physician‐assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians. Objective To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Design Cross‐sectional mailing survey. Participants 1052 (48% response rate) physicians licensed by the state of Vermont. Results Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Conclusions Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. PMID:17601867
Bowen, Sarah; Botting, Ingrid; Huebner, Lori-Anne; Wright, Brock; Beaupre, Beth; Permack, Sheldon; Jones, Ian; Mihlachuk, Ainslie; Edwards, Jeanette; Rhule, Chris
Abstract Objective To determine effective strategies for introducing physician assistants (PAs) in primary care settings and provide guidance to support ongoing provincial planning for PA roles in primary care. Design Time-series research design using multiple qualitative methods. Setting Manitoba. Participants Physician assistants, supervising family physicians, clinic staff, members of the Introducing Physician Assistants into Primary Care Steering Committee, and patients receiving care from PAs. Methods The PA role was evaluated at 6 health care sites between 2012 and 2014; sites varied in size, funding models, geographic locations (urban or rural), specifics of the PA role, and setting type (clinic or hospital). Semistructured interviews and focus groups were conducted; patient feedback on quality improvement was retrieved; observational methods were employed; and documents were reviewed. A baseline assessment was conducted before PA placement. In 2013, there was a series of interviews and focus groups about the introduction of PAs at the 3 initial sites; in 2014 interviews and focus groups included all 6 sites. Main findings The concerns that were expressed during baseline interviews about the introduction of PAs (eg, community and patient acceptance) informed planning. Most concerns that were identified did not materialize. Supervising family physicians, site staff, and patients were enthusiastic about the introduction of PAs. There were a few challenges experienced at the site level (eg, front-desk scheduling), but they were perceived as manageable. Unanticipated challenges at the provincial level were identified (eg, diagnostic test ordering). Increased attachment and improved access—the goals of introducing PAs to primary care—were only some of the positive effects that were reported. Conclusion This first systematic multisite evaluation of PAs in primary care in Canada demonstrated that with appropriate collaborative planning, PAs can effectively
Baker, K E
A physician assistant (PA) is a licensed health care professional and dependent practitioner. The profession began in the 1960s and accredited programs now number 110 nationwide. PAs practice in every specialty, including dermatology, and their clinical duties vary tremendously. Research has shown enhanced productivity and increased patient satisfaction in practices using PAs. Most third-party payers cover services provided by PAs, making them ideally suited in this era of increasing managed care.
Mayo, David J; Gunderson, Martin
One of the most potent arguments against physician-assisted death hinges on the worry that people with disabilities will be subtly coerced to accept death prematurely. The argument is flawed. There is nothing new in PAD: the risk of coercion is already present in current policies about end of life care. And to hold that any such risk is too much is tacitly to endorse vitalism and to deny that people with disabilities are capable of choosing authentically.
A substantial majority of Canadians favours a change to the Criminal Code which would make it legally permissible, subject to careful regulation, for patients suffering from incurable physical illness to opt for either physician assisted suicide (PAS) or voluntary active euthanasia (VAE). This discussion will focus primarily on the arguments for and against decriminalizing physician assisted suicide, with special reference to the British Columbia case of Lee Carter vs. Attorney General of Canada. The aim is to critique the arguments and at the same time to describe the contours of the current Canadian debate. Both ethical and legal issues raised by PAS are clarified. Empirical evidence available from jurisdictions which have followed the regulatory route is presented and its relevance to the slippery slope argument is considered. The arguments presented by both sides are critically assessed. The conclusion suggested is that evidence of harms to vulnerable individuals or to society, consequent upon legalization, is insufficient to support continued denial of freedom to those competent adults who seek physician assistance in hastening their death.
Frileux, S; Lelievre, C; Munoz, S; Mullet, E; Sorum, P
Objectives: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact. Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels). Participants: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France. Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA. Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability. Conclusions: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people. PMID:14662811
Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros
The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p < 0.0005) reported that in the case of a cardiac or respiratory arrest, they would not attempt to revive a terminally ill cancer patient. Only 1.9% of physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p = 0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.
Lopes, John E; Delellis, Nailya O
Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.
Herman, Lawrence; McGinnity, John G; Doll, Michael; Peterson, Eric D; Russell, Amanda; Largay, Joseph
Overweight and obesity compose a chronic disease process of epidemic proportions that presents on a continuum, likely affecting nearly two out of every three patients treated by physician assistants (PAs). However, meaningful and actionable definitions, including but not limited to anthropometric and clinical descriptors, are needed. The effective treatment of overweight and obesity requires an efficient and timely process of screening, diagnosis, evaluation of complications, staging, and clear algorithmic management. PAs are trained as primary care providers and can diagnose and treat overweight and obese patients regardless of practice setting and across the spectrum of the disease and patient's age.
... 42 Public Health 2 2010-10-01 2010-10-01 false Nurse practitioner and physician assistant services... Clinic and Federally Qualified Health Center Services § 405.2414 Nurse practitioner and physician... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who...
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Whitney, Simon N; Brown, Byron W; Brody, Howard; Alcser, Kirsten H; Bachman, Jerald G; Greely, Henry T
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
Anderson, D M; Hampton, M B
Evidence based on productivity measures, salaries and costs of medical education indicates that physician assistants and nurse practitioners are cost-effective. Managed care suggests that health maintenance organizations (HMOs) would seek to utilize these professionals. Moreover, underserved rural areas would utilize physician assistants and nurse practitioners to provide access. This study examined the role of payment sources in the utilization of physician assistants and nurse practitioners using the 1994 National Hospital Ambulatory Medical Care Survey (NHAMCS) conducted by the National Center for Health Statistics, U.S. Centers for Disease Control and Prevention. Rural vs. urban results were compared. The study found that significant rural-urban differences exist in the relationships between payment sources and the utilization of physician assistants and nurse practitioners. The study also found that payment source affects varied for physicians, physician assistants and nurse practitioners who saw outpatients in hospital settings. Surprisingly, prepaid and HMO types of reimbursements are shown to have no relationship with physician assistant and nurse practitioner utilization, and this finding is the same for both rural and urban patient visits. After controlling for other influences, the study shows that physicians, physician assistants and nurse practitioners are each as likely as the other to be present at a rural managed care visit. However, physicians are much more likely than physician assistants and nurse practitioners to be present at an urban managed care visit.
Dahl, E; Levy, N
In her paper, The case for physician assisted suicide: not (yet) proven, Bonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide. In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide. PMID:16731731
Berghmans, Ron; Widdershoven, Guy; Widdershoven-Heerding, Ineke
In the Netherlands, euthanasia and physician-assisted suicide (PAS) are considered acceptable medical practices in specific circumstances. The majority of cases of euthanasia and PAS involve patients suffering from cancer. However, in 1994 the Dutch Supreme Court in the so-called Chabot-case ruled that "the seriousness of the suffering of the patient does not depend on the cause of the suffering", thereby rejecting a distinction between physical (or somatic) and mental suffering. This opened the way for further debate about the acceptability of PAS in cases of serious and refractory mental illness. An important objection against offering PAS to mentally ill patients is that this might reinforce loss of hope, and demoralization. Based on an analysis of a reported case, this argument is evaluated. It is argued that offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be ethically acceptable.
Pedersen, Donald M; Pedersen, Kathy J; Santitamrongpan, Verapan
Although there have been recent democratic reforms in Myanmar (formerly known as Burma), for nearly 60 years there has been a consistent history of human rights violations as part of a civil war waged by the Myanmar military, known as the Tatmadaw. Approximately 3,500 villages have been destroyed by the Tatmadaw during the half-century of civil war. Oppression against minority groups, including the Karen, Karenni, Kachin, Mon, Shan, Chin, and Muslims has adversely affected the health outcomes of these vulnerable populations. Since the mid 1990s, medics have been providing care for the ethnic minorities who were displaced from their homes by the civil war and who live in the jungles of eastern Burma as well as in the refugee camps and towns in the border areas of Thailand. This article will look at how these medics are providing care similar to that provided by physician assistants in the United States.
Since November 2015, businesslike assisted suicide is punishable in Germany. But who acts businesslike? The majority of the German population prefers to make own decisions about the circumstances of their arriving death, and many of them would also accept (physician) assisted suicide if necessary. Only a minority of physicians plead for prohibiting assisted suicide in general. In the end everyone should be able to take position on his own. No one is obliged to use or execute assisted suicide.
Dill, Michael J; Pankow, Stacie; Erikson, Clese; Shipman, Scott
Impending physician shortages in the United States will necessitate greater reliance on physician assistants and nurse practitioners, particularly in primary care. But how willing are Americans to accept that change? This study examines provider preferences from patients' perspective, using data from the Association of American Medical Colleges' Consumer Survey. We found that about half of the respondents preferred to have a physician as their primary care provider. However, when presented with scenarios wherein they could see a physician assistant or a nurse practitioner sooner than a physician, most elected to see one of the other health care professionals instead of waiting. Although our findings provide evidence that US consumers are open to the idea of receiving care from physician assistants and nurse practitioners, it is important to consider barriers to more widespread use, such as scope-of-practice regulations. Policy makers should incorporate such evidence into solutions for the physician shortage.
Gadbois, Emily A.; Miller, Edward Alan; Tyler, Denise; Intrator, Orna
Nurse practitioners and physician assistants can alleviate some of the primary care shortage facing the United States, but their scope-of-practice is limited by state regulation. This study reports both cross-sectional and longitudinal trends in state scope-of-practice regulations for nurse practitioners and physician assistants over a 10-year period. Regulations from 2001 to 2010 were compiled and described with respect to entry-to-practice standards, physician involvement in treatment/diagnosis, prescriptive authority, and controlled substances. Findings indicate that most states loosened regulations, granting greater autonomy to nurse practitioners and physician assistants, particularly with respect to prescriptive authority and physician involvement in treatment and diagnosis. Many states also increased barriers to entry, requiring high levels of education before entering practice. Knowledge of state trends in nurse practitioner and physician assistant regulation should inform current efforts to standardize scope-of-practice nationally. PMID:25542195
Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen
Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More…
... 42 Public Health 2 2010-10-01 2010-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...
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... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
... 42 Public Health 2 2014-10-01 2014-10-01 false Services and supplies incident to nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker... nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or...
... 42 Public Health 2 2013-10-01 2013-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...
... 42 Public Health 2 2011-10-01 2011-10-01 false Services and supplies incident to nurse... Services and supplies incident to nurse practitioner and physician assistant services. (a) Services and supplies incident to a nurse practitioner's or physician assistant's services are reimbursable under...
... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse...
Miller, Anthony A., Ed.
This report summarizes a project that focused on the future of the education of physician assistants. The panel of expert presenters represented physician assistant (PA) educators, educators of other health care professionals, employers of PAs, health care oriented foundations, a health care workforce expert, and members of the PA profession. The…
Smith, Garrett O
Currently, nephrology PAs remain a small group. According to 2003 census data from The American Academy of Nephrology Physician Assistants, only 98 of 20,646 survey respondents identified themselves as practicing in nephrology. The future of PAs or nurse practitioners in nephrology is not only very bright, but is also an absolute necessity. We have known for many years that the number of individuals with kidney disease in the United States is increasing at a rate that outpaces our ability to develop and train nephrologists. This has resulted in an ever-increasing ratio of patients to clinical nephrologists. The workload for management of dialysis patients on a daily basis is becoming exhaustive and will not improve. The fastest growing segment of dialysis patients is now people in their 70s and 80s, and they bring with them multiple chronic health problems that are affected by dialysis and the treatment of their renal disease. The result is the need for closer monitoring, not less. The role of physician extenders can have a very positive impact for this patient population. Being the eyes, ears, nose, and fingers of our nephrologists can help in avoiding potential major problems in the outpatient arena. There is not a magic formula in caring for this patient population; it is a matter of spending time and becoming familiar with our patients, a premium most nephrologists do not have at present. It is not a matter of willingness; it is a matter of capability, of being in more than one place, and of having time to make the patient assessments. I think there is a great opportunity for nephrologists to create a new segment of providers to assist them in these endeavors. They can sponsor PAs as preceptors before graduation so that the students can have the opportunity to see what it takes to care for this population, the level of medicine they need to learn, and the responsibility they will need to accept. The nephrologist will benefit from working with a PA that has a
Everett, Christine M; Thorpe, Carolyn T; Palta, Mari; Carayon, Pascale; Gilchrist, Valerie J; Smith, Maureen A
Team-based care involving physician assistants and/or nurse practitioners (PA/NPs) in the patient-centered medical home is one approach to improving care quality. However, little is known about how to incorporate PA/NPs into primary care teams. Using data from a large physician group, we describe the division of patients and services (e.g., acute, chronic, preventive, other) between primary care providers for older diabetes patients on panels with varying levels of PA/NP involvement (i.e., no role, supplemental provider, or usual provider of care). Panels with PA/NP usual providers had higher proportions of patients with Medicaid, disability, and depression. Patients with physician usual providers had similar probabilities of visits with supplemental PA/NPs and physicians for all service types. However, patients with PA/NP usual providers had higher probabilities of visits with a supplemental physician. Understanding how patients and services are divided between PA/NPs and physicians will assist in defining provider roles on primary care teams.
Hanlon, T.; Weiss, M.; Rees, J.
of the pharmaceutical service whilst at the same respecting the personal beliefs of those who object to cooperating in the ending of a life. Key Words: Professional ethics • pharmacy ethics • community pharmacy • bioethics • physician-assisted suicide • euthanasia PMID:11055040
Kontaxakis, Vp; Paplos, K G; Havaki-Kontaxaki, B J; Ferentinos, P; Kontaxaki, M-I V; Kollias, C T; Lykouras, E
Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.
Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen
Suicide and assisted suicide are not criminal acts in Germany. However, attempting suicide may create a legal duty for physicians to try to save a patient's life. This study presents data on medical students' legal knowledge and ethical views regarding physician assisted suicide (PAS). The majority of 85 respondents held PAS to be illegal. More than a third of the students viewed PAS in certain situations to be ethically acceptable whereas a smaller proportion thought that it should be legal. Compared with German physicians the medical students taking part in this study were less opposed to PAS. The majority perceived the undergraduate training concerning ethical aspect of assisted death as deficient.
Glicken, Anita Duhl
Once again, experts predict a shortage of health care providers by 2020. The physician assistant (PA) profession was created in the 1960s to address a similar need. Currently, there are 141 accredited PA training programs in the United States, 75 of them established in the 10 years between 1993 and 2002. Historically, PA education and practice models have been responsive to the ever-changing landscape of health care. It may be the profession's flexibility and adaptability that has enabled it to survive and flourish in a competitive service environment. The growth of new PA programs mandates a need for continuing faculty development, as increasing numbers of educators hail primarily from clinical practice and come equipped with minimal teaching experience. PA faculty development addresses these new recruits' needs to develop model curricula, implement new courses, and enhance instruction-all with the goal of improving both access to and quality of health care.The author describes the impact of Health Resources and Service Administration Title VII, Section 747 (Title VII) contracts in addressing this need. Title VII-funded PA education projects, considered innovative at the time of implementation, included both faculty development workshops that promoted active learning of basic teaching and administrative skills and new curricula designed to enhance faculty teaching in genomics and practice management. These projects and others resulted in enduring professional resources that have not only strengthened the PA community but also enjoyed broad applicability within other health professions groups.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
Hooker, Roderick S.; Cawley, James F.; Everett, Christine M.
Objective A component of health-care reform in 2010 identified physician assistants (PAs) as needed to help mitigate the expected doctor shortage. We modeled their number to predict rational estimates for workforce planners. Methods The number of PAs in active clinical practice in 2010 formed the baseline. We used graduation rates and program expansion to project annual growth; attrition estimates offset these amounts. A simulation model incorporated historical trends, current supply, and graduation amounts. Sensitivity analyses were conducted to systematically adjust parameters in the model to determine the effects of such changes. Results As of 2010, there were 74,476 PAs in the active workforce. The mean age was 42 years and 65% were female. There were 154 accredited educational programs; 99% had a graduating class and produced an average of 44 graduates annually (total n=6,776). With a 7% increase in graduate entry rate and a 5% annual attrition rate, the supply of clinically active PAs will grow to 93,099 in 2015, 111,004 in 2020, and 127,821 in 2025. This model holds clinically active PAs in primary care at 34%. Conclusions The number of clinically active PAs is projected to increase by almost 72% in 15 years. Attrition rates, especially retirement patterns, are not well understood for PAs, and variation could affect future supply. While the majority of PAs are in the medical specialties and subspecialties fields, new policy steps funding PA education and promoting primary care may add more PAs in primary care than the model predicts. PMID:21886331
Henry, Lisa R.; Hooker, Roderick S.; Yates, Kathryn L.
Purpose: A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. Methods: A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic…
Module fourteen of the EPEC-O Self-Study Original Version focuses on the skills that the physician can use to respond both compassionately and confidently to a request, not on the merits of arguments for or against legalizing physician-assisted suicide (PAS) or euthanasia.
Rakofsky, Jeffrey J; Ferguson, Britnay A
Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient's psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well.
Guichon, Juliet; Alakija, Pauline; Doig, Christopher; Mitchell, Jan; Thibeault, Pascal
Although the practice of physician-assisted dying (hereinafter "PAD") will soon be lawful in Canada, opponents of PAD claim that it might result in involuntary deaths. The Supreme Court of Canada in Carter v. Canada (Attorney General) rejected such arguments holding that involuntary deaths are preventable provided that jurisdictions devise stringent limits to the practice of PAD and that these stringent limits are "scrupulously monitored and enforced". This article examines the question of how best to engage in scrupulous monitoring of physician-assisted dying. At present, the province of Quebec has legislated, and three expert groups have proposed the creation of new administrative offices to monitor the practice of PAD (these groups are the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying, the External Panel on Options for a Legislative Response to Carter v. Canada, and the Canadian Medical Association). This article argues that scrupulous monitoring can be better achieved by requiring explicit mandatory notification of all physician-assisted deaths to coroners and medical examiners, rather than by creating new administrative offices. It is more effective, efficient and prudent to use already existing coroner and medical examiner death reporting and investigative frameworks to report physician-assisted deaths than to create new, untried, parallel and potentially more expensive administrative offices. In Canada, almost all provincial and territorial statutes that govern the official actions of coroners and medical examiners currently require the reporting of non-natural deaths, which include those that will be attributable to PAD. To achieve the scrupulous monitoring of PAD required by the Supreme Court, provincial and territorial governments, in collaboration with the federal government, should. 1. review their coroner and fatality statutes to clarify that physician-assisted deaths (as non-natural deaths) are mandatorily notifiable; 2
Background An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention. Methods We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist. Results Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%). Conclusion Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on
Royce, J. M.; Ashford, A.; Resnicow, K.; Freeman, H. P.; Caesar, A. A.; Orlandi, M. A.
This study was designed to increase smoking cessation rates, quit attempts, and cutting down among low-income African Americans using brief clinician advice in conjunction with socioculturally appropriate self-help smoking cessation/relapse prevention materials. Physicians and nurses were instructed in the National Cancer Institute's smoking intervention at inservice sessions. Smokers interviewed in a Harlem, New York clinic waiting room were recontacted 7 months later by telephone or mail (77% response). Residents receiving the intervention reported a 21% cessation rate at follow-up. An additional 27% decreased cigarette intake by at least 50%. Those reporting follow-up abstinence were significantly more likely to designate a quit date at baseline. They were also more likely to be men, employed, and have a nonsmoking partner. Smokers who decreased their cigarette intake significantly were older, employed, less nicotine-dependent (eg, delayed their wake-up cigarette), and more likely to use project materials. Physician advice had a significant impact both on patients' cutting down at least 50% and patients' watching the project video. Designation of a quit date and using project materials had a significant impact on making serious quit attempts. Results corroborate large sample, randomized, controlled trials with noninner-city physicians. We conclude that clinician smoking advice for every patient is warranted. PMID:7752283
Volz, Nico B.; Fringer, Ryan; Walters, Bradford; Kowalenko, Terry
Introduction Horizontal violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among emergency department (ED) attending physicians, residents, and mid-level providers (MLPs). Methods We sent an electronic survey to emergency medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in three unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily) they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care. Results Of the 122 survey invitations 91 were completed, yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault) to 34.1% (Q4: been shouted at). Fourteen of these behaviors were most prevalent in the attending cohort, six were most prevalent in the MLP cohort, and three of the behaviors were most prevalent in the resident cohort. Conclusion The HV behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2%) indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients. PMID:28210353
Cawley, James F
Graduate medical education (GME) is funded by taxpayers through Medicare subsidies that pay for physician residency training, primarily to teaching hospitals. The Institute of Medicine (IOM) recently conducted a study of US GME and issued a series of recommendations for future policy reform. This commentary examines the major elements of proposed reforms for GME and offers analysis of those that may pertain specifically to physician assistant education now and in the future.
Sulmasy, Daniel P; Travaline, John M; Mitchell, Louise A; Ely, E Wesley
This article is a complement to "A Template for Non-Religious-Based Discussions Against Euthanasia" by Melissa Harintho, Nathaniel Bloodworth, and E. Wesley Ely which appeared in the February 2015 Linacre Quarterly. Herein we build upon Daniel Sulmasy's opening and closing arguments from the 2014 Intelligence Squared debate on legalizing assisted suicide, supplemented by other non-faith-based arguments and thoughts, providing four nontheistic arguments against physician-assisted suicide and euthanasia: (1) "it offends me"; (2) slippery slope; (3) "pain can be alleviated"; (4) physician integrity and patient trust. Lay Summary: Presented here are four non-religious, reasonable arguments against physician-assisted suicide and euthanasia: (1) "it offends me," suicide devalues human life; (2) slippery slope, the limits on euthanasia gradually erode; (3) "pain can be alleviated," palliative care and modern therapeutics more and more adequately manage pain; (4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm.
Levy, Tal Bergman; Azar, Shlomi; Huberfeld, Ronen; Siegel, Andrew M; Strous, Rael D
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables.
Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan
Recent positive doping cases and a series of mistakes of medical doctors of the International Federation of Basketball have reopened the debate about the role of medical doctor in elite sport. This study shows that some sports physicians involved in recent positive doping cases are insufficiently aware of the nuances of doping regulations and, most importantly, of the list of prohibited substances. Moreover, several team doctors are shown to have exercised poor judgement in relation to these matters with the consequence that athletes are punished for doping offences on the basis of doctors' negligence. In such circumstances, athletes' rights are jeopardised by a failure of the duty of care that (sports) physicians owe their athlete patients. We argue that, with respect to the World Anti Doping Code, antidoping governance fails to define, with sufficient clarity, the role of medical doctors. There is a need for a new approach emphasising urgent educational and training of medical doctors in this domain, which should be considered prior to the revision of the next World Anti Doping Code in 2013 in order to better regulate doctor's conduct especially in relation to professional errors, whether negligent or intentional.
Candilis, P J; Appelbaum, K L
In June 1997, the Supreme Court decided that statutes proscribing physicians from providing lethal medication for use by competent, terminally ill patients do not violate the Due Process or Equal Protection Clauses of the Constitution. The Court returned the question of physician-assisted suicide to the states, but did not foreclose future review of state laws that may be too restrictive of care at the end of life. The conceptual distinctions between assisted suicide, refusal of life-sustaining treatment, and administration of pain medication to terminally ill patients were endorsed as important guideposts for future analyses.
van der Meer, S; de Veen, R C; Noorthoorn, E O; Kraan, H F
A 71-year-old man suffering from vascular dementia since four years asked for physician-assisted suicide. In the Netherlands physician-assisted suicide, which is forbidden by law, remains an intricate dilemma in medical practice. As far as it concerns untreatable terminal patients who decide to put an end to their lives in agreement with and assisted by their physician, procedures are well defined. The present case may be used as an example in the development of a protocol for physician-assisted suicide in patients who are not terminal in the short term, but who suffer unbearably with no prospect of remission. After the protocol securing various formal and medical consequences was run through, the patient was assisted by handling him a high-dose solution of a barbiturate which he drank himself. The procedure incorporates several second and third opinions. First, the chief psychiatrist of the psychiatric hospital assesses the request. Second, a committee consisting of a number of independent professionals form a second opinion. They have no direct responsibility in the treatment of the patient. The patient also may consult an independent consultant psychiatrist with specific knowledge in the domain of his disorder for a third opinion. This procedure was found legally as well as medically sound, and was approved by the public prosecutor after consultation with the Dutch forum of Procurators-General.
Onwuteaka-Philipse, B D; van der Wal, G; Kostense, P J; van der Maas, P J
Consultation with another physician is considered to be an important safeguard of the practice of euthanasia and physician-assisted suicide. The objective is to describe the frequency and characteristics of consultation in cases of euthanasia or physician-assisted suicide (EAS) in the Netherlands. Data from two cross-sectional descriptive nationwide surveys, carried out in 1995, were used. Questionnaires were mailed to physicians attending 6060 deaths, identified from death certificates, and a stratified sample of 405 physicians were interviewed. In 1990, a cross-sectional descriptive postal survey of a random sample of 1042 general practitioners took place. Consultation took place in 63% of cases of EAS in the Netherlands, in 99% of the cases reported to the public prosecutor and in approximately 37% of unreported cases. In almost half of the unreported cases the decision had been discussed less formally with at least one colleague. In 1990, 7% of general practitioners met all 8 criteria for good consultation; this increased to 64% in 1995. Of the respondents, 26% had at some time advised against performing euthanasia or assisted suicide when acting as a consultant. This study shows that approximately two thirds of all cases of EAS are safeguarded by consultation. Although in the majority of these cases the consultation is of good quality, there is certainly still room for improvement. The quality of consultation could be improved, for instance, by appointing independent and specifically trained consultants.
This article presents a comparative analysis of euthanasia and physician-assisted suicide policy in The Netherlands and the state of Oregon in the United States. The topics of euthanasia and physician-assisted suicide are discussed in the context of the historical setting of The Netherlands and the United States with special emphasis placed on public opinion, role of the courts and the legislative bodies, and opinions of physicians. Major similarities and differences in the laws of The Netherlands and Oregon are discussed. The article examines whether the passage of the law has led to a slide down the slippery slope in The Netherlands and Oregon as had been suggested by the opponents of the law. The article concludes that the empirical evidence does not support the contention of the opponents. However, the author argues that the potential for this happening is much greater in The Netherlands than in Oregon.
Fraher, Erin P; Morgan, Perri; Johnson, Anna
Physician workforce projections often include scenarios that forecast physician shortages under different assumptions about the deployment of physician assistants (PAs) and nurse practitioners (NPs). These scenarios generally assume that PAs and NPs are an interchangeable resource and that their specialty distributions do not change over time. This study investigated changes in PA and NP specialty distribution in North Carolina between 1997 and 2013. The data show that over the study period, PAs and NPs practiced in a wide range of specialties, but each profession had a specific pattern. The proportion of PAs-but not NPs-reporting practice in primary care dropped significantly. PAs were more likely than NPs to report practice in urgent care, emergency medicine, and surgical subspecialties. Physician workforce models need to account for the different and changing specialization trends of NPs and PAs.
Carr, Mark F; Bergman, Brett A
: Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.
Margalith, Ilana; Musgrave, Catherine F.; Goldschmidt, Lydia
A survey of 190 Israeli nursing students found that just over half were opposed to legalization of physician-assisted dying. Exposure to theory about euthanasia or clinical oncology experience had a small effect on these attitudes. Religious beliefs and degree of religiosity were significant determinants of these attitudes. (Contains 23…
Argues that the function of medicine as an art and as a social institution is impeded when the rhetorical nature of its practice is ignored. Offers a case study of two texts widely cited as landmarks in the physician-assisted suicide debate of the 1990s, examining their rhetorical organization and its impact on their reception. (SR)
Manetta, Ameda A.; Wells, Janice G.
Presents results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. (BF)
Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.
Purpose: To identify characteristics and outcomes of patients who use physician assistants and nurse practitioners (PA/NPs) as a usual source of care. Methods: Cross sectional analysis using the telephone and mail surveys of the Wisconsin Longitudinal Study (WLS), a prospective cohort study of Wisconsin high school graduates and selected siblings…
Minette, William P.
This study was conducted to design an educational program for physician's assistant that would conform to the American Medical Association's essential requirements for the occupation and to determine the feasibility of establishing such a program at Pitt Technical Institute in North Carolina. The investigation covered selection procedures,…
... 42 Public Health 2 2014-10-01 2014-10-01 false Nurse practitioner, physician assistant, and certified nurse midwife services. 405.2414 Section 405.2414 Public Health CENTERS FOR MEDICARE & MEDICAID... AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services § 405.2414...
1 Major General Spurgeon Neel and the Army Physician Assistant: A Case Study of Policy Change Richard Glade ...a survey, which interestingly, made no attempt to study it. In 2005, Captain John Hughes surveyed every battalion and brigade commander at Fort
Drass, Kriss A.
Examines the differences in perspective and training of nurse practitioners and physician assistants, and effects of these on their interactive strategies with patients. Shows how the macro issue of differences in occupational perspective can be incorporated into micro studies of the form and content of talk in social interactions. (SR)
Rizzolo, Lawrence J.; Rando, William C.; O'Brien, Michael K.; Garino, Alexandria; Stewart, William B.
There is little consensus among programs that train physician assistants (PAs) regarding how much time should be devoted to the study of anatomy, what should be included, or how it should be taught. Similar concerns led us to redesign anatomy for medical students and introduce clinically engaged anatomy, an approach designed in collaboration with…
Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline
Purpose: Nursing facilities with nurse practitioners or physician assistants (NPs or PAs) have been reported to provide better care to residents. Assuming that freestanding nursing homes in urban areas that employ these professionals are making an investment in medical infrastructure, we test the hypotheses that facilities in states with higher…
The responses of some nursing organizations regarding the establishment of collaborative relationships in the nursing profession may be responsible for the development of the physician assistant profession. The nursing profession should examine these responses while planning strategies to cope with the current chaos in health care. (JOW)
Gladhart, Stephen; Crespo, Merideth
Wichita State's physician's assistant program, located on the Wichita Veteran's Administration Center campus in Wichita, Kansas, is described in this status report. Established with 12 students in January 1973, the program includes didactic and clinical training for two years and meets the "Essentials of an Approved Educational Program for…
McClurg, Ronald B.
An analysis of survey responses from a sample of orthopaedic physician's assistants on competency characteristics for their occupation is presented in this document. (Orthopaedic physician's assistant is one of seventeen occupation groups included in this research.) The competencies are reported in five categories: (1) those competencies selected…
Meyer, Kimberly E.
The purpose of this dissertation was to evaluate learning transfer achieved by physician assistant students comparing two instructional methods, human patient simulation and electronic clinical case studies. This prospective, randomized, mixed-methods study utilized first and second-year physician assistant student volunteers taking a pretest and…
Curlin, Farr A; Nwodim, Chinyere; Vance, Jennifer L; Chin, Marshall H; Lantos, John D
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians' religious characteristics, ethnicity, and experience caring for dying patients.
Appelbaum, Paul S
Laws permitting physician-assisted death in the United States currently are limited to terminal conditions. Canada is considering whether to extend the practice to encompass intractable suffering caused by mental disorders, and the question inevitably will arise in the United States. Among the problems seen in countries that have legalized assisted death for mental disorders are difficulties in assessing the disorder's intractability and the patient's decisional competence, and the disproportionate involvement of patients with social isolation and personality disorders. Legitimate concern exists that assisted death could serve as a substitute for creating adequate systems of mental health treatment and social support.
Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'.
Cavanagh, Kim; Lessard, Donovan; Britt, Zach
In its 20th year, the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) is a student self-assessment that can assist physician assistant (PA) students and PA program faculty in identifying strengths and areas in need of improvement in the didactic and clinical phases of PA education. In this reflection, we provide an overview of the history of PACKRAT and outline some of its benefits for students and PA programs, as well as its generative role in assessment within PA studies. Taking a broader view of PACKRAT's impact on assessment for the PA profession, we outline the research on its benefits and its use to maximize student performance, as well as how it has promoted the development of additional assessment tools.
Chalupa, Robyn L; Hooker, Roderick S
Physician assistants (PAs) have worked alongside surgeons since the 1970s, yet little is known about their postgraduate education, roles, distribution, and compensation. In 2015, an estimated 8,900 PAs were employed in orthopedics (9.4% of all clinically active PAs in the United States). This study analyzed surveys undertaken by Physician Assistants in Orthopaedic Surgery (PAOS) from 2009 to 2015 and found that most PAs working in orthopedics (85%) reported regularly assisting in surgery. Demand for PAs in orthopedics is expected to grow because of population growth, increasing incidence of musculoskeletal conditions, shortages of surgeons, and changing technology. Improved data acquisition and more detailed analyses are needed to better understand the nature of this specialized workforce.
Tamayo-Velázquez, María-Isabel; Simón-Lorda, Pablo; Cruz-Piqueras, Maite
The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken.
Landry, Joshua T; Foreman, Thomas; Kekewich, Michael
On February 6th 2015 the Supreme Court of Canada (SCC) released their decision on Carter v Canada (Attorney General) to uphold a judgment from a lower court which determined that the current prohibition in Canada on physician-assisted dying violated the s. 7 [Charter of Rights and Freedoms] rights of competent adults whose medical condition causes intolerable suffering. The purpose of this piece is to briefly examine current regulations from Oregon (USA), Belgium, and the Netherlands, in which physician-assisted death and/or euthanasia is currently permitted, as well as from the province of Quebec which recently passed Bill-52, "An Act Respecting End-of-Life Care." We present ethical considerations that would be pertinent in the development of policies and regulations across Canada in light of this SCC decision: patient and provider autonomy, determining a relevant decision-making standard for practice, and explicating challenges with the SCC criteria for assisted-death eligibility with special consideration to the provision of assisted-death, and review of assisted-death cases. [It is not the goal of this paper to address all questions related to the regulation and policy development of euthanasia and assisted death in Canada, but rather to stimulate and guide the conversations in these areas for policy makers, professional bodies, and regulators.].
Pols, Hans; Oak, Stephanie
The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in The Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.
Kidd, Vasco Deon; Cawley, James F; Kayingo, Gerald
Recognition is growing within the medical academic community that future clinicians will need the tools to understand and influence health policy decisions. With the passage of the Patient Protection and Affordable Care Act of 2010, future clinicians will need not only clinical competence for successful practice but also an understanding of how health systems function. Although the fourth edition of the Accreditation Standards for Physician Assistant Education contains provisions and stipulations for the teaching of health topics in general and health policy specifically, physician assistant (PA) educators retain little consensus regarding either learning objectives or specific rubrics for teaching these important concepts. In this article, we discuss approaches for teaching health policy, delineate useful educational resources for PA faculty, and propose a model curriculum.
Rurup, Mette L; Onwuteaka-Philipsen, Bregje D; Van Der Wal, Gerrit
In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general population, and 87 relatives of patients who died after euthanasia or physician-assisted suicide. The general population and relatives were more in favor than physicians. Fifteen percent of the general population and 36% of the relatives thought a suicide pill should be made available.
Hooker, Roderick S; Cawthon, Elisabeth A
The 1965 White House Conference on Health brought together the best minds and the boldest ideas to deal with the nation's pressing health provider needs. The Community Health Clinics Act and the Duke University physician assistant (PA) program were among the many initiatives announced at this conference. The authors explore the conference proceedings, link them with other historical documents and events, and suggest that this conference was a contributing factor to the contemporary PA movement.
Anneser, Johanna; Jox, Ralf J.; Thurn, Tamara; Borasio, Gian Domenico
Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. Results: Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of
Lee, William; Price, Annabel; Rayner, Lauren; Hotopf, Matthew
Background Assisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalising physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law. Methods We conducted a postal survey of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide. Results The corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect. Conclusion More senior doctors in England and Wales oppose any step towards the legalisation of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation. PMID:19261197
Hicks, Madelyn Hsiao-Rei
Background A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. Discussion Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. Summary The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards. PMID:16792812
Lipuma, Samuel H
A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings.
Khan, Farooq; Tadros, George
Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients' wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time.
Khan, Farooq; Tadros, George
Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients’ wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time. PMID:23833354
... science. Many applicants already have experience as registered nurses or as EMTs and paramedics before they apply ... Job Duties ENTRY-LEVEL EDUCATION 2015 MEDIAN PAY Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners Nurse anesthetists, ...
Roberts, L W; Muskin, P R; Warner, T D; McCarty, T; Roberts, B B; Fidler, D C
The objective of this study was to investigate the views of consultation-liaison (C-L) psychiatrists on assisted-death practices. A 33-question anonymous survey was distributed at the Academy of Psychosomatic Medicine Annual Meeting in November 1995. The instrument explored perceptions of acceptability of assisted death in six hypothetical patient situations as performed by four possible agents. The response rate was 48% (184 conference attendees participated, i.e., completed and returned the surveys). With little variability, the respondents were unwilling to perform assisted death personally and also did not support assisted death as performed by nonphysicians. The respondents were somewhat more accepting of referral or other physicians' involvement in such practices. Assisted death was viewed differently than withdrawal of life support. Several variables were analyzed for their influences on the views expressed. The C-L psychiatrists in this study expressed opposition to assisted death practices. Their views varied somewhat depending on the patient vignette and the agent of death assistance. The authors conclude that C-L psychiatrists may wish to develop their present therapeutic and evaluative role in patient care to alleviate suffering, without hastening patient death.
Zenz, Julia; Rissing-van Saan, Ruth; Zenz, Michael
Background In late 2015, Germany passed a law (§ 217 StGB) prohibiting persons from aiding others in committing suicide on a regular, repetitive basis. Despite intensive societal debate and surveys about assisted dying, the present study was the first to examine attitudes towards the new legal regulation among professionals. Methods In early 2016, all participants of a congress on palliative care received a one-page anonymous questionnaire to complete until the end of the conference. The questionnaire consisted of questions regarding assisted suicide and the new law. The participants were asked to express their agreement or disagreement on a 4 to 5-point Likert scale. Results 457 questionnaires (48 %) were completed, 138 from physicians, 318 from nurses, 1 non specified. More than 80 % knew about the new law. Only half of the respondents supported it. 54 % felt that the law did not sufficiently differentiate between an illegal form of assisted suicide and a form exempt from prosecution. For more than 40 % the new law made no sense. Conclusion Professionals engaged in terminal care were reluctant to support a criminal liability of "business-like" physician-assisted suicide and suspected greater uncertainty among professionals in end of life care.
Tsou, Jonathan Y
In this article, I argue that depression and suicide are natural kinds insofar as they are classes of abnormal behavior underwritten by sets of stable biological mechanisms. In particular, depression and suicide are neurobiological kinds characterized by disturbances in serotonin functioning that affect various brain areas (i.e., the amygdala, anterior cingulate, prefrontal cortex, and hippocampus). The significance of this argument is that the natural (biological) basis of depression and suicide allows for reliable projectable inferences (i.e., predictions) to be made about individual members of a kind. In the context of assisted suicide, inferences about the decision-making capacity of depressed individuals seeking physician-assisted suicide are of special interest. I examine evidence that depression can hamper the decision-making capacity of individuals seeking assisted suicide and discuss some implications.
Everett, Christine; Thorpe, Carolyn; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A
One approach to the patient-centered medical home, particularly for patients with chronic illnesses, is to include physician assistants (PAs) and nurse practitioners (NPs) on primary care teams. Using Medicare claims and electronic health record data from a large physician group, we compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. Outcomes were generally equivalent in thirteen comparisons. In four comparisons, outcomes were superior for the patients receiving care from PAs or NPs, but in three other comparisons the outcomes were superior for patients receiving care from physicians only. Specific roles performed by PAs and NPs were associated with different patterns in the measure of the quality of diabetes care and use of health care services. No role was best for all outcomes. Our findings suggest that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams. Accordingly, training and policy should continue to support role flexibility for these health professionals.
Timmermans, Marijke J C; van Vught, Anneke J A H; Maassen, Irma T H M; Draaijer, Lisette; Hoofwijk, Anton G M; Spanier, Marcel; van Unen, Wijnand; Wensing, Michel; Laurant, Miranda G H
Objectives To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment. Design We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together. Setting This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care. Participants Participant included staff physicians, residents, PAs and nurses. Results The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors. Conclusions 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent. PMID:27864243
Morgan, Perri; Humeniuk, Katherine M; Everett, Christine M
As physician assistant (PA) roles expand and diversify in the United States and around the world, there is a pressing need for research that illuminates how PAs may best be selected, educated, and used in health systems to maximize their potential contributions to health. Physician assistant education programs are well positioned to advance this research by collecting and organizing data on applicants, students, and graduates. Our PA program is creating a permanent longitudinal education database for research that contains extensive student-level data. This database will allow us to conduct research on all phases of PA education, from admission processes through the professional practice of our graduates. In this article, we describe our approach to constructing a longitudinal student-level research database and discuss the strengths and limitations of longitudinal databases for research on education and the practice of PAs. We hope to encourage other PA programs to initiate similar projects so that, in the future, data can be combined for use in multi-institutional research that can contribute to improved education for PA students across programs.
Sjöstrand, Manne; Helgesson, Gert; Eriksson, Stefan; Juth, Niklas
Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient's best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible.
Dhuper, Sunil; Choksi, Sonia
This study describes a comparative analysis of replacing medical residents with physician assistants and hospitalists on patient outcomes in a community hospital. Prospective data during the physician assistants-hospitalists service for 2 years was compared with 2 years of retrospective data of the medical residents model. Outcome measures included mortality, adverse events, readmissions, and patient satisfaction. For physician assistants- hospitalists versus medical residents models, all-cause and case mix index-adjusted mortality was 107/5508 (1.94%) and 0.019 versus 156/5458 (2.85%) and 0.029, respectively (P < or = .001). The adverse event cases were 9 versus 5 ( P = .29), and the readmission rate within 30 days was 64 versus 69 (P = .34). Patient satisfaction was 95% versus 96% (P = .33). Quality of care provided by the physician assistants-hospitalists model was equivalent. All-cause and case mix index- adjusted mortality was significantly lower during the physician assistants-hospitalists period.Although the application of these findings to other institutions requires further study, the authors found no intrinsic barriers that would impede implementation elsewhere.
Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J.; Freidl, Wolfgang
Background Euthanasia remains a controversial topic in both public discourses and legislation. Although some determinants of acceptance of euthanasia and physician-assisted death have been identified in previous studies, there is still a shortage of information whether different forms of euthanasia are supported by the same or different sub-populations and whether authoritarian personality dispositions are linked to attitudes towards euthanasia. Methods A large, representative face-to-face survey was conducted in Austria in 2014 (n = 1,971). Respondents faced three scenarios of euthanasia and one of physician assisted death differing regarding the level of specificity, voluntariness and subject, requiring either approval or rejection: (1) abstract description of euthanasia, (2) abstract description of physician-assisted suicide, (3) the case of euthanasia of a terminally-ill 79-year old cancer patient, and (4) the case of non-voluntary, physician assisted death of a severely disabled or ill neonate. A number of potential determinants for rejection ordered in three categories (socio-demographic, personal experience, orientations) including authoritarianism were tested via multiple logistic regression analyses. Results Rejection was highest in the case of the neonate (69%) and lowest for the case of the older cancer patient (35%). A consistent negative impact of religiosity on the acceptance across all scenarios and differential effects for socio-economic status, area of residence, religious confession, liberalism, and authoritarianism were found. Individuals with a stronger authoritarian personality disposition were more likely to reject physician-assisted suicide for adults but at the same time also more likely to approve of physician-assisted death of a disabled neonate. Conclusion Euthanasia in adults was supported by a partially different sub-population than assisted death of disabled neonates. PMID:25906265
Gopal, Abilash A
Physician-assisted suicide (PAS) is one of the most provocative topics facing society today. Given the great responsibility conferred on physicians by recent laws allowing PAS, a careful examination of this subject is warranted by psychiatrists and other specialists who may be consulted during a patient's request for PAS. In this article, recent evidence regarding the implementation of PAS in the United States and The Netherlands is reviewed. Support is found for some concerns about PAS, such as the possibility that mental illness occurs at higher rates in patients requesting PAS, but not for other concerns, such as the fear that PAS will be practiced more frequently on vulnerable populations (the slippery-slope argument). These data and common arguments for and against PAS are discussed with an emphasis on the tension between values, such as maximizing patient autonomy and adhering to professional obligations, as well as the need for additional research that focuses more directly on the patient-centered perspective. Implications of the available evidence are discussed and lead to a consideration of mental anguish in terminally ill patients including aspects of existential distress and an acknowledgment of the importance of tailoring end-of-life care to the distinct set of values and experiences that shape each patient's perspective. The article concludes with a discussion of an expanding role for psychiatrists in evaluating patients who request PAS.
Opponents of the legalization of physician assisted suicide (PAS) often claim that physicians must not give a helping hand to suicidal patients because (i) it is morally forbidden to help somebody to carry out an action which is inherently irrational and which will probably cause him severe harm, and (ii) the act of self-killing is necessarily irrational and self-harming. The article focuses on the second premise of this paternalistic argument against the moral permissibility of PAS and its legalization. First, it is shown that this premise can be understood in two ways, depending on whether the predicate "irrational" is taken to refer to a human being's lack of the capacity to decide and act rationally or irrationally, or to the property of the decision to end one's life. Whereas the first variant of the premise stating that all suicidal individuals lack the capacity to act rationally can only be verified or falsified by empirical studies, the second assumption is a normative one which only philosophy can deal with. Restated in another way, it says that is always rationally forbidden to kill oneself because the decision to end one's own life is necessarily irrational. The five arguments which have been brought forward to justify this claim are analyzed and criticized. It is argued that there is no valid argument for the necessary irrationality of suicide. Hence, the claim that PAS is morally forbidden and, therefore, ought not to be legalized cannot rest on that premise.
Claxton-Oldfield, Stephen; Miller, Kathryn
The purpose of this study was to examine the attitudes of hospice palliative care (HPC) volunteers who provide in-home support (n = 47) and members of the community (n = 58) toward the issue of physician-assisted suicide (PAS). On the first part of the survey, participants responded to 15 items designed to assess their attitudes toward PAS. An examination of individual items revealed differences in opinions among members of both the groups. Responses to additional questions revealed that the majority of volunteers and community members (1) support legalizing PAS; (2) would choose HPC over PAS for themselves if they were terminally ill; and (3) think Canadians should place more priority on developing HPC rather than on legalizing PAS. The implications of these findings are discussed.
Duffy, Olivia Anne
On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who "clearly consents to the termination of life" and has a "grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering.
"Sentenced to life". In German newspaper and journal articles as well as on television a controversial debate has emerged about the right-to-die. In history and many Western countries people have always been discussing assisted suicide. Under Oregon's Death with Dignity Act, terminally ill adult Oregonians are allowed to obtain and use prescriptions from their physicians for self-administered, lethal medications. The Oregon Public Health Division is required by the Act to collect information on compliance and to issue an annual report. This has been made public. According to these data, there was no slippery slope. In addition, no philosophical arguments can be put forward for the absolute prohibition against suicide of the terminally ill. This should give impetus to efforts to find solutions for the patients in all Western countries.
Day, Charles S; Boden, Scott D; Knott, Patrick T; O'Rourke, Nancy C; Yang, Brian W
Growth estimates and demographic shifts of the population of the United States foreshadow a future heightened demand for musculoskeletal care. Although many articles have discussed this growing demand on the musculoskeletal workforce, few address the inevitable need for more musculoskeletal care providers. As we are unable to increase the number of orthopaedic surgeons because of restrictions on graduate medical education slots, physician assistants (PAs) and nurse practitioners (NPs) represent one potential solution to the impending musculoskeletal care supply shortage. This American Orthopaedic Association (AOA) symposium report investigates models for advanced practice provider integration, considers key issues affecting PAs and NPs, and proposes guidelines to help to assess the logistical and educational possibilities of further incorporating NPs and PAs into the orthopaedic workforce in order to address future musculoskeletal care needs.
Brock, Douglas; Bolon, Shannon; Wick, Keren; Harbert, Kenneth; Jacques, Paul; Evans, Timothy; Abdullah, Athena; Gianola, F J
The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.
Boiano, James M; Steege, Andrea L
Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among
Kibe, Lucy Wachera
Several consultation stations have been set up in an unfinished stone building. My team is made up of a Kenyan physician assistant (called clinical officer), a Kenyan medical student, and me, a US physician assistant student. We are huddled around a small worn-out square table. A middle-aged woman and her two children, ages 2 and 6, approach the table. They have traveled 2 miles to the medical camp. The children, covered in dust, are emaciated with protruding abdomens, dry skin, and congested noses. The clinical officer (CO) conducts a brief interview in Swahili, the Kenyan national language. The mother explains that they have been coughing up thick yellow sputum for a week and have no appetite. They've also had diarrhea for a couple of weeks. I examine the children, who are obviously scared. Hot, moist skin. They are both running a fever. I listen to the lungs: reduced lung sounds. The protruding abdomens are rock hard. I report the findings to the team. The CO turns to the Kenyan medical student and me and quizzes us on differential diagnoses with rationale for each. We come up with malaria, pneumonia, TB, and worm infestation. Due to limited resources, medical diagnosis in Kenya relies heavily on history and physical exam. The CO explains that comorbid conditions are probable. Luckily, we have malaria-testing kits at the camp. They test negative for malaria. We decide to treat them for pneumonia. We also offer them a free hot meal, toothbrushes, T-shirts, coloring paper, and crayons. The children manage to smile. The mother is so grateful, she cries.
Hussain, Tariq; White, Patrick
Background A bill to legalise assisted dying in the UK has been proposed in Parliament's House of Lords three times since 2003. The House of Lords Select Committee concluded in 2005 that ‘the few attempts to understand the basis of doctors' views have shown equivocal data varying over time’. Fresh research was recommended to gain a fuller understanding of health sector views. Aim To examine GPs' views of the practice of physician-assisted suicide as defined by the 2005/2006 House of Lords (Joffe) Bill and views of their role in the proposed legislation; and to explore the influences determining GPs' views on physician-assisted suicide. Design of study Qualitative interview study. Setting Primary care in South London, England. Method Semi-structured interviews with GPs were conducted by a lead interviewer and analysed in a search for themes, using the framework approach. Results Thirteen GPs were interviewed. GPs who had not personally witnessed terminal suffering that could justify assisted dying were against the legislation. Some GPs felt their personal religious views, which regarded assisted dying as morally wrong, could not be the basis of a generalisable medical ethic for others. GPs who had witnessed a person's suffering that, in their opinion, justified physician-assisted suicide were in favour of legislative change. Some GPs felt a specialist referral pathway to provide assisted dying would help to ensure proper standards were met. Conclusion GPs' views on physician-assisted suicide ranged from support to opposition, depending principally on their interpretation of their experience of patients' suffering at the end of life. The goal to lessen suffering of the terminally ill, and apprehensions about patients being harmed, were common to both groups. Respect for autonomy and the right of self-determination versus the need to protect vulnerable people from the potential for harm from social coercion were the dominant themes. PMID:19861029
Haider-Markel, Donald P.; Joslyn, Mark R.
As a political issue, death and dying topics only sometimes reach the political agenda. However, some issues, such as physician-assisted suicide (PAS) have been highly salient. This article explores attitudes toward PAS by examining the malleability of opinion when respondents are exposed to issue frames and when specific messengers present those…
Werth, James L., Jr.; Gordon, Judith R.
After providing background material related to the Supreme Court cases on "physician-assisted suicide" (Washington v. Glucksberg, 1997, and Vacco v. Quill, 1997), this article presents the amicus curiae brief that was submitted to the United States Supreme Court by 2 national mental health organizations, a state psychological association, and an…
Hardigan, Patrick C.; Cohen, Stanley R.
This study compared personality traits of students in five health professions. The Myers-Briggs Type Indicator was completed by 1,508 osteopathic students, 654 pharmacy students, 165 physical therapy students, 211 physician assistant students, and 70 occupational therapy students. Comparing the extrovert/introvert dimension revealed that pharmacy…
Congress of the U.S., Washington, DC. Office of Technology Assessment.
This case study was conducted to analyze the cost-effectiveness of nurse practitioners (NPs), physicians' assistants (PAs), and certified nurse midwives (CNMs) by examining (1) the contributions of each group in meeting health-care needs; (2) the effect of changing the method of payment for their services on the health-care delivery system; and…
De Bruijn-Geraets, Daisy P; Van Eijk-Hustings, Yvonne JL; Vrijhoef, Hubertus JM
Aim The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Background Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives. Design A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data. Methods Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter. Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011. Conclusion This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis. PMID:24684631
Cawley, James F; Jones, P Eugene
Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsorship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning number of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.
Boudreau, J Donald
The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and residents would inevitably and necessarily be implicated. It is my perspective that everyone in the profession, including those charged with educating future generations of physicians, has a critical interest in participating in this ongoing debate. I explore potential implications for medical education of a widespread sanctioning of physician-inflicted and physician-assisted death. My analysis, which uses a consequential-basis approach, leads me to conclude that euthanasia, when understood to include physician aid in hastening death, is incommensurate with humanism and the practice of medicine that considers healing as its overriding mandate. I ask readers to imagine the consequences of being required to teach students how to end their patients' lives and urge medical educators to remain cognizant of their responsibility in upholding long-entrenched and foundational professional values. PMID:22319424
Bakerjian, Debra; Harrington, Charlene
The purpose of this research was to examine factors associated with the use of advanced practice nurse and physician assistant (APN/PA) visits to nursing home (NH) patients compared with those by primary care physicians (PCPs). This was a secondary analysis using Medicare claims data. General estimation equations were used to determine the odds of NH residents receiving APN/PA visits. Ordinary least squares analyses were used to examine factors associated with these visits. A total of 5,436 APN/PAs provided care to 27% of 129,812 residents and were responsible for 16% of the 1.1 million Medicare NH fee-for-service visits in 2004. APN/PAs made an average of 33 visits annually compared with PCPs (21 visits). Neuropsychiatric and acute diagnoses and patients with a long-stay status were associated with more APN/PA visits. APN/PAs provide a substantial amount of care, but regional variations occur, and Medicare regulations constrain the ability of APN/PAs to substitute for physician visits.
The muteness in the Qur'an about suicide due to intolerable pain and a firm opposition to suicide in the hadith literature formed a strong opinion among Muslims that neither repentance nor the suffering of the person can remove the sin of suicide or mercy 'killing' (al-qatl al-rahim), even if these acts are committed with the purpose of relieving suffering and pain. Some interpretations of the Islamic sources even give advantage to murderers as opposed to people who commit suicide because the murderers, at least, may have opportunity to repent for their sin. However, people who commit suicide are 'labeled' for losing faith in the afterlife without a chance to repent for their act. This paper claims that Islamic spiritual care can help people make decisions that may impact patients, family members, health care givers and the whole community by responding to questions such as 'What is the Islamic view on death?', 'What is the Islamic response to physician-assisted suicide and other forms of euthanasia?', 'What are the religious and moral underpinnings of these responses in Islam?'
Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng
Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng
Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055
Objective—Consultation of another physician is an important method of review of the practice of euthanasia. For the project "support and consultation in euthanasia in Amsterdam" which is aimed at professionalising consultation, a protocol for consultation was developed to support the general practitioners who were going to work as consultants and to ensure uniformity. Participants—Ten experts (including general practitioners who were experienced in euthanasia and consultation, a psychiatrist, a social geriatrician, a professor in health law and a public prosecutor) and the general practitioners who were going to use the protocol. Evidence—There is limited literature on consultation: discursive articles and empirical studies describing the practice of euthanasia. Consensus—An initial draft on the basis of the literature was commented on by the experts and general practitioners in two rounds. Finally, the protocol was amended after it had been used during the training of consultants. Conclusions—The protocol differentiates between steps that are necessary in a consultation and steps that are recommended. Guidelines about four important aspects of consultation were given: independence, expertise, tasks and judgment of the consultant. In 97% of 109 consultations in which the protocol was used the consultant considered the protocol to be useful to a greater or lesser extent. Although this protocol was developed locally, it also employs universal principles. Therefore it can be of use in the development of consultation elsewhere. Key Words: Euthanasia • assisted suicide • consultation • quality assurance • protocol PMID:11579191
Duffy, Olivia Anne
On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who “clearly consents to the termination of life” and has a “grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”1 The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry’s role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering. PMID:26720829
Martin, K E
Access to primary care continues to be a concern in rural areas. The deficit of primary care providers in rural environments has the potential to increase the role of physician assistants (PAs) in the system of rural health care delivery. Little is known about the conditions, sites, and patterns of practice of PAs and their distribution in Pennsylvania, the state with the largest rural population. To learn more about these providers in rural and urban settings and their willingness to practice in underserved areas, the author conducted a census of all PAs who hold a Pennsylvania license. Survey results revealed significant rural-urban differences in socioeconomic, demographic, and practice profile parameters. Providers in rural areas are more likely than urban counterparts to practice primary care in a primary care practice setting; see more patients per week; and are the principal provider of care for a higher percentage of their patients. Experience with managed care is greater for urban PAs. A rural PA is more likely than an urban PA to practice in an underserved area. For both rural and urban PAs who practice primary care, significant differences were noted in their willingness to practice in a rural underserved area, compared to PAs who do not practice primary care.
Solomon, Louis M; Noll, Rebekka C
End-of-life decisions are among the most difficult to make or study. When we examined these decisions made under the auspices and protection of stringent state laws, we found no gender bias among patients who chose to end their lives in the face of documented debilitating and terminal diseases. However, in the case of euthanasia as practiced by Jack Kevorkian, we found significant statistical bias against women. Moreover, other data have questioned whether all of Kevorkian's patients did, in fact, have debilitating and terminal illnesses. In this article, we explore why a gender disparity exists in end-of-life decision making. We conclude that if physician-assisted suicide and euthanasia are to be integrated into any end-of-life medical care policy, stringent legal and medical safeguards will be required. Institution of these safeguards should prevent selection bias in a vulnerable population hastening death for reasons other than medically justifiable conditions or issues of individual autonomy, and should ensure that end-of-life decisions are truly reflective of competent personal choice, free from economic considerations or societal pressure.
Cuperus-Bosma, J M; van der Wal, G; Looman, C W; van der Maas, P J
OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. PMID:10070632
We compared and contrasted physician assistant and physical therapy profession admissions processes based on the similar number of accredited programs in the United States and the co-existence of many programs in the same school of health professions, because both professions conduct similar centralized application procedures administered by the same organization. Many studies are critical of the fallibility and inadequate scientific rigor of the high-stakes nature of health professions admissions decisions, yet typical admission processes remain very similar. Cognitive variables, most notably undergraduate grade point averages, have been shown to be the best predictors of academic achievement in the health professions. The variability of non-cognitive attributes assessed and the methods used to measure them have come under increasing scrutiny in the literature. The variance in health professions students’ performance in the classroom and on certifying examinations remains unexplained, and cognitive considerations vary considerably between and among programs that describe them. One uncertainty resulting from this review is whether or not desired candidate attributes highly sought after by individual programs are more student-centered or graduate-centered. Based on the findings from the literature, we suggest that student success in the classroom versus the clinic is based on a different set of variables. Given the range of positions and general lack of reliability and validity in studies of non-cognitive admissions attributes, we think that health professions admissions processes remain imperfect works in progress. PMID:24810020
Graeff, Evelyn C; Vail, Marianne; Maldonado, Ana; Lund, Maha; Galante, Steve; Tataronis, Gary
The effect that classroom response systems, or clickers, have on knowledge retention and student satisfaction was studied in a physician assistant program. A clicker, a device similar to a remote control, was used by students to answer questions during lectures. This new technology has been marketed to educators as beneficial in keeping students actively involved and increasing their attentiveness in the classroom. To date, the results of studies on knowledge retention with the use of clickers have been mixed. For this pilot study, the students were divided into two groups with a pre- and post-test given in order to evaluate knowledge retention. One group received lectures in a traditional format, while the other group received the lectures incorporating clicker response questions. After the test scores from four lectures were analyzed, the incorporation of clickers did not alter knowledge retention. Retention of knowledge from both groups was similar and no statistical difference was found. However, student satisfaction regarding the use of clickers was positive. Students reported that clickers kept them more actively involved, increased attentiveness, and made lectures more enjoyable. Although the pilot study did not show a greater improvement in knowledge retention with the use of clickers, further research is needed to assess their effectiveness.
Bowden, Briana S.; Ball, Lisa
Objective: The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems. Methods: This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals. Results: Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice. Conclusion: The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care. PMID:26771903
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
In Germany, physician-assisted euthanasia involves numerous risks for the attending physician under criminal and professional law. In the absence of clear legal provisions, four different categories of euthanasia have been developed in legal practice and the relevant literature: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. The so-called "help during the dying process" by administering medically indicated analgesic drugs without a life-shortening effect is exempt from punishment if it corresponds to the will of the patient. If the physician omits to give such analgesic drugs although the patient demands them, this is deemed a punishable act of bodily injury. The same applies if the physician administers analgesics against the will of the patient. Medically indicated pain treatment which has a potential or certain life-shortening effect (indirect active euthanasia) is permitted under certain conditions: if there are no alternative and equally suitable treatment options without the risk of shortening the patient's life, if the patient has given his consent to the treatment and if the physician does not act with the intention to kill. The deliberate killing of a dying or terminally ill patient for the purpose of ending his suffering (direct active euthanasia) is prohibited. This includes both deliberately killing a patient against or without his will (by so-called "angels of death") and the killing of a patient who expressly and earnestly demands such an act from his physician (killing on request/on demand). Physician-assisted suicide is generally not liable to punishment in Germany. Nevertheless, the action may be subject to punishment if the physician omits to rescue the life of an unconscious suicide victim. "Palliative sedation" is regarded as a special case. It may become necessary if certain symptoms in the terminal stage of a fatal disease unbearable for the patient cannot be controlled by any other
Ewton, Tiffany A; Lingas, Elena O
Lesbian, gay, bisexual, and transgender (LGBT) medical providers in the United States have historically faced discrimination from their peers. To assess current workplace culture and attitudes, and to evaluate awareness of workplace and professional policies regarding LGBT discrimination, we sent a cross-sectional survey to 163 PAs (Physician Assistants). Respondents had an overall positive attitude towards LGBT providers, yet the majority was not aware of relevant policy statements (>60%). A significant association existed between policy awareness and LGBT inclusivity (P<.025) and confidence reporting anti-gay harassment (P=.017). Despite improved societal attitudes toward LGBT providers, non-discriminatory work environments for LGBT physician assistants may relate to greater awareness of specific workplace policy standards.
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
Under German criminal law, euthanasia assisted by the attending physician involves the risk of criminal prosecution. However, in the absence of clear legal provisions, the law concerning euthanasia has been primarily developed by court rulings and jurisprudential literature in the last 30 years. According to a traditional classification there are four categories of euthanasia: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. However, there is still no generally accepted definition for the general term "euthanasia". The development of the law on the permissibility of euthanasia was strongly influenced by the conflict between the right of self-determination of every human being guaranteed by the Constitution and the constitutional mandate of the state to protect and maintain human life. The decisions of the German Federal Court of Justice on euthanasia in the criminal trials "Wittig" (1984), "Kempten" (1994) and "Putz" (2010) as well as the ruling of the 12th Division for Civil Matters of the Federal Court of Justice (2003) are of special importance. Some of these decisions were significantly influenced by the discussions in the jurisprudential literature. However, the German Bundestag became active for the first time as late as in 2009 when it adopted the 3rd Guardianship Amendment Act, which also contains provisions on the legal validity of a living will independent of the nature and stage of an illness. In spite of the new law, an analysis of the "Putz" case makes it especially clear that the criminal aspects of legal issues at the end of a person's life still remain controversial. It is to be expected that this issue will remain the subject of intensive discussion also in the next few years.
Background The physician assistant (PA) profession is a nationally recognized medical profession in the United States of America (USA). However, relatively little is known regarding national trends of the PA workforce. Methods We examined the 1980-2007 USA Census data to determine the demographic distribution of the PA workforce and PA-to-population relationships. Maps were developed to provide graphical display of the data. All analyses were adjusted for the complex census design and analytical weights provided by the Census Bureau. Results In 1980 there were about 29 120 PAs, 64% of which were males. By contrast, in 2007 there were approximately 97 721 PAs with more than 66% of females. In 1980, Nevada had the highest estimated rate of 40 PAs per 100 000 persons, and North Dakota had the lowest rate (three). The corresponding rates in 2007 were about 85 in New Hampshire and ten in Mississippi. The levels of PA education have increased from less than 21% of PAs with four or more years of college in 1980, to more than 65% in 2007. While less than 17% of PAs were of minority groups in 1980, this figure rose to 23% in 2007. Although nearly 70% of PAs were younger than 35 years old in 1980, this percentage fell to 38% in 2007. Conclusion The trends of sustained increase and geographic variation in the PA workforce were identified. Educational level, percentage of minority, and age of the PA workforce have increased over time. Major causes of the changes in the PA workforce include educational factors and federal legislation or state regulation. PMID:19941662
Hepp, Shelanne L.; Suter, Esther; Nagy, Dwayne; Knorren, Tanya; Bergman, Joseph W.
Background Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care. Methods A mixed-methods evaluation was conducted using semi-structured interviews (n = 38), health care provider (n = 28) and patient surveys (n = 47), and 2 years of clinic data on new patients. Data from a double operating room experiment detailed expected versus actual times for 3 phases of surgery (pre, during, post). Results Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons’ patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected. Conclusion After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies. PMID:28234216
Woodruff, Roger; Pettus, Katherine; Downing, Julia; Buitrago, Rosa; Munyoro, Esther; Venkateswaran, Chitra; Bhatnagar, Sushma; Radbruch, Lukas
Abstract Background: Reports about regulations and laws on Euthanasia and Physician Assisted Suicide (PAS) are becoming increasingly common in the media. Many groups have expressed opposition to euthanasia and PAS while those in favor argue that severely chronically ill and debilitated patients have a right to control the timing and manner of their death. Others argue that both PAS and euthanasia are ethically legitimate in rare and exceptional cases. Given that these discussions as well as the new and proposed laws and regulations may have a powerful impact on patients, caregivers, and health care providers, the International Association for Hospice and Palliative Care (IAHPC) has prepared this statement. Purpose: To describe the position of the IAHPC regarding Euthanasia and PAS. Method: The IAHPC formed a working group (WG) of seven board members and two staff officers who volunteered to participate in this process. An online search was performed using the terms “position statement”, “euthanasia” “assisted suicide” “PAS” to identify existing position statements from health professional organizations. Only statements from national or pan-national associations were included. Statements from seven general medical and nursing associations and statements from seven palliative care organizations were identified. A working document including a summary of the different position statements was prepared and based on these, an initial draft was prepared. Online discussions among the members of the WG took place for a period of three months. The differences were reconciled by email discussions. The resulting draft was shared with the full board. Additional comments and suggestions were incorporated. This document represents the final version approved by the IAHPC Board of Directors. Result: IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to
Oravec, Geoffrey J.; Artino, Anthony R.; Hickey, Patrick W.
Background The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. Methods and Findings An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean = 5.74). Perceived benefit was greatest for the United States (mean = 5.56) and self (mean = 5.39) compared to the target population (mean = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R2 = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean = 6.10) than either Army (mean = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean = 5.60, Cohen's d = 0.46, p<.01) physicians. Conclusions Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals. PMID:23555564
Weiner, J P; Steinwachs, D M; Williamson, J W
This study empirically examines the practices of non-physician providers (NPPs) within three large competitive health maintenance organizations (HMOs), as well as the physicians' and NPPs' views regarding the ideal role of NPPs. These roles are compared with NPP delegation patterns incorporated in the modeling methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). GMENAC recommended relatively high levels of delegation by physicians to NPPs. One of the HMO sites made use of NPPs at rates even higher than GMENAC's national ideals, while the rates at the other two were lower. The normative ideals for pediatric NPPs developed at each HMO were consistently higher than their actual roles. Concerns with acceptance and the role of NPPs are clearly no longer issues. Instead, the limits on NPP involvement appear to relate to considerations of costs, availability, and the increasing numbers of physicians competing for similar opportunities.
Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad
Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% – 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures
Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad
Breast cancer is the most common type of cancer among women. The important key to treat the breast cancer is early detection of it because according to many pathological studies more than 75% - 80% of all abnormalities are still benign at primary stages; so in recent years, many studies and extensive research done to early detection of breast cancer with higher precision and accuracy. Infra-red breast thermography is an imaging technique based on recording temperature distribution patterns of breast tissue. Compared with breast mammography technique, thermography is more suitable technique because it is noninvasive, non-contact, passive and free ionizing radiation. In this paper, a full automatic high accuracy technique for classification of suspicious areas in thermogram images with the aim of assisting physicians in early detection of breast cancer has been presented. Proposed algorithm consists of four main steps: pre-processing & segmentation, feature extraction, feature selection and classification. At the first step, using full automatic operation, region of interest (ROI) determined and the quality of image improved. Using thresholding and edge detection techniques, both right and left breasts separated from each other. Then relative suspected areas become segmented and image matrix normalized due to the uniqueness of each person's body temperature. At feature extraction stage, 23 features, including statistical, morphological, frequency domain, histogram and Gray Level Co-occurrence Matrix (GLCM) based features are extracted from segmented right and left breast obtained from step 1. To achieve the best features, feature selection methods such as minimum Redundancy and Maximum Relevance (mRMR), Sequential Forward Selection (SFS), Sequential Backward Selection (SBS), Sequential Floating Forward Selection (SFFS), Sequential Floating Backward Selection (SFBS) and Genetic Algorithm (GA) have been used at step 3. Finally to classify and TH labeling procedures
Michigan State Board of Education, Lansing.
These six guides on identifying and assisting the gifted school-age child are specifically addressed to either clinical social workers, school social workers, school counselors, nurses, physicians, and psychologists. Each leaflet examines the role of the target professional in providing assistance to gifted children. For example, the social…
Kopp, Steven W
End of life decisions, such as physician-assisted suicide (PAS), have continued to be controversial as health care policy, moral, and individual health care issues. This study considers knowledge of end of life options and death attitudes as predictors of attitudes toward PAS. Data were gathered from approximately 300 adults through a mailing sent to a household research panel. Validated measures of attitudes toward PAS, knowledge about that state's assisted suicide laws, demographics, and attitudes toward death as measured through the Death Attitude Profile-Revised (DAP-R) were collected and analyzed. The data indicate that attitudes toward PAS are a function of knowledge of end of life options as well as death attitudinal factors.
Kenny, Robert Wade
This article considers the narrative testimonial as a rhetorical form in the service of public judgment, with particular attention to the witness's credibility and communicative competence. The author argues that a narrator and witness, as a participant-observer of the events recounted, must generate a story that does not compromise her credibility as a moral agent within the text, and that the capacity to do so is largely a function of communicative competence. Carol Loving's recent book concerning her son's physician assisted suicide is critically assessed to illustrate the primary argument. The critique attempts to show that she neither creates a substantial argument for physician assisted suicide, nor does she warrant her role as a spokesperson for the issue because her narrative violates formative features of maternal identity. Loving's narrative also unintentionally reveals motivational clusters that conflict with and compromise the primary argument, thereby subverting the process of persuasive appeal. Whereas mothers are often mediators for their children in health matters ranging from colds, to psychiatric issues, to matters of death and dying, the failure of Carol Loving in this text, as well as its analysis, should be instructive and cautionary to health professionals who rely on maternal discourse in handling patients, as well as audiences who rely on narrative testimonials as content in their deliberation of public issues.
Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.
Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545
Curlin, Farr A.; Nwodim, Chinyere; Vance, Jennifer L.; Chin, Marshall H.; Lantos, John D.
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients. PMID:18198363
This Board of Trustees report calls for reaffirmation of the position of the American Medical Association (AMA) in opposition to physicians assisting their patients in committing suicide. The AMA maintains that the appropriate step for physicians is not to assist a patient in death but to provide compassion and palliative care. In providing end-of-life care, the option of allowing physicians to intentionally cause the death of patients is a line that should not be crossed. This position is based on the historical role of physicians as advocates for healing. The report discusses AMA activity to design and implement a comprehensive physician education plan on end-of-life care in response to the House of Delegates' action in adopting Board of Trustees Report 48-I-95, "Quality Care at the End of Life." This plan will further the AMA's commitment that patients should receive high quality care during every stage of life, including the end of life. The goal of this educational campaign is to advance the medical culture by making palliative treatment and care directions based on values-based advance care planning the standard of care for meeting the needs of patients at the end of life. The basis for this activity will be the acknowledgment that physicians, while unable to always provide a cure, should always be able to relieve suffering, address the psychological needs of patients at the end of life, add value to remaining life, and help patients die with dignity. The report presents information on state legislative activities and judicial actions relating to physician-assisted suicide. The report also presents a discussion on the ethical under-pinnings against physician participation in patients' suicides. This report recommends that: the AMA reaffirm current policies 140.952 and 140.966 (AMA Policy Compendium), in accordance with Council on Ethical and Judicial Affairs Opinion 2.211 (opposition to physician-assisted suicide); the AMA initiate an educational campaign to
Gather, Jakov; Vollmann, Jochen
Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.
Clark, A R; Monroe, J R; Feldman, S R; Fleischer, A B; Hauser, D A; Hinds, M A
with new conditions without the physician being on site, opening up the possibility for satellite offices in remote areas. Just as dermatologists may move toward specialization in surgery, cosmetics, or medical dermatology, PAs may do the same, filling a niche in a particular practice. As in other specialties, patient acceptance of seeing dermatology PAs has not been a significant problem. Continued access to the dermatologist remains unfettered, but, over time, many patients become willing to see either. Are PAs likely to become future competitors of dermatologists? Genuinely concerned dermatologists worry that a dermatology-trained PA will become part of a gatekeeper system that impedes patient access to dermatologists. This is not happening and is not at all likely to become a trend, for a number of reasons. First, primary care cannot compete with dermatology practices in remuneration for PAs. Just as financial benefits in high-production specialty practices entice physicians, the same benefits entice PAs as well. Second, according to member surveys of the SDPA, virtually 100% of fellow members work with dermatologists. Although PAs can work in any type of practice and evaluate dermatologic symptoms just as a general practitioner would, PAs who specialize in dermatology primarily practice with dermatologists, a collegial association most PAs seek out. PAs have steadfastly maintained their dependent, noncompetitive relationship with physicians and would not have it any other way. Although PAs see a good number of patients (2.8 million) with dermatologic symptoms, the NAMCS data indicate that most (72%) of these patients are also seen by a physician. Third, physicians are ultimately responsible for the actions of their PA employee. A general practitioner not trained to perform excisions or manage certain dermatologic conditions should not allow a PA to perform such duties. Similar to much of medicine, the PA profession continues to evolve, with many members moving awa
Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J
If physician-assisted suicide/euthanasia is legalised in the UK, this may be the work of GPs. In the absence of recent or comprehensive evidence about GPs' views on either legalisation or willingness to take part, a questionnaire survey of all Welsh GPs was conducted of whom 1202 (65%) responded. Seven hundred and fifty (62.4% of responders) and 671 (55.8% of responders) said that they did not favour a change in the law to allow physician-assisted suicide/voluntary euthanasia respectively. These data provide a rational basis for determining the position of primary care on this contentious issue. PMID:16762127
Kaissi, Amer; Kralewski, John; Dowd, Bryan
This study examines the financial and organizational factors that are associated with the employment of nurse practitioners (NPs) and physician assistants (PAs) in medical group practices. The source of the data is a survey of 128 medical group practices in Minnesota. The findings suggest that the employment of NPs and PAs and their ratios to primary care physicians (PCPs) in practices that employ them are influenced by the organizational characteristics of the group practice but not by the degree of financial risk sharing for patient care. Although neither the number of years of experience in financial risk sharing nor more revenue from capitation payment contracts were related to employment of these midlevel practitioners (MLPs), large practices, those located in rural locations, not-for-profit practices, and those that scored low on cohesive cultural traits were more likely to employ MLPs. The data provide insights into the market for MLPs and the potential for these clinicians in the future health care system. As medical group practices become larger and have more organizational capacity, they can likely be expected to increase the employment of MLPs and integrate them into their organizations.
Some issues in medical ethics have been present throughout the history of medicine, and thus provide us with an opportunity to ascertain: (1) whether there is progress in medical ethics; and (2) what it means to do good medical ethics. One such perennial issue is physician assistance in dying (PAD). This paper provides an account of the PAD debate in this journal over the last 40 years. It concludes that there is some (but limited) progress in the debate. The distinctions, analogies and hypothetical examples have proliferated, as have empirical studies, but very little has changed in terms of the basic arguments. The paper further argues that many of the contributions to the debate fail to engage fully with the concerns people have about the legal introduction of PAD in the healthcare system, perhaps because many of the contributions sit on the borderline between academic analysis and social activism.
Gather, Jakov; Vollmann, Jochen
For many years there has been a controversial international debate on physician-assisted suicide (PAS). While proponents of PAS regularly refer to the unbearable suffering and the right of self-determination of incurably ill patients, critics often warn about the diverse risks of abuse. In our article, we aim to present ethical arguments for and against PAS for patients in an early stage of dementia. Our focus shall be on ethical questions of autonomy, conceptual and empirical findings on competence and the assessment of mental capacity to make health care decisions. While the capacity to make health care decisions represents an ethically significant precondition for PAS, it becomes more and more impaired in the course of the dementia process. We present conditions that should be met in order to ethically justify PAS for patients with dementia. From both a psychiatric and an ethical perspective, a thorough differential diagnosis and an adequate medical and psychosocial support for patients with dementia considering PAS and their relatives should be guaranteed. If, after due deliberation, the patient still wishes assistance with suicide, a transparent and documented assessment of competence should be conducted by a professional psychiatrist.
Panaitescu, Catalina; Moffat, Mandy A; Williams, Siân; Pinnock, Hilary; Boros, Melinda; Oana, Cristian Sever; Alexiu, Sandra; Tsiligianni, Ioanna
Background: Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). Aim: To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. Methods: A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. Results: Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. Conclusions: Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption. PMID:25010432
Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.
This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…
Nestler, David M.; Fratzke, Alesia R.; Church, Christopher J.; Scanlan-Hanson, Lori; Sadosty, Annie T.; Halasy, Michael P.; Finley, Janet L.; Boggust, Andy; Hess, Erik P.
Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing eight pilot days to eight control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results Three hundred fifty-three patients were included on pilot days, and 371 on control days. LOS was shorter on pilot days than control days (median 229 minutes [IQR 168 to 303 minutes] vs. 270 minutes [IQR 187 to 372 minutes], p < 0.001). Waiting room times were similar between pilot and control days (median 69 minutes [IQR 20 to 119 minutes] vs. 70 minutes [IQR 19 to 137 minutes], p = 0.408), but treatment room times were shorter (median 151 minutes [IQR 92 to 223 minutes] vs. 187 minutes [IQR 110 to 254 minutes], p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41 minute decrease in median total LOS, and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days. PMID:23167853
Spicer, David; Paul, Sonia; Tang, Tom; Chen, Charlie; Chase, Jocelyn
Background Little prior research has been conducted regarding resident physicians’ opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents’ opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD. Methods We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Results Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians. Interpretation Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need. PMID:28344712
Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.; van der Wal, Gerrit; van der Heide, Agnes; van Der Maas, Paul J.
In the Netherlands there has been ongoing debate in the past 10 years about the availability of a hypothetical "suicide pill", with which older people could end their life in a dignified way if they so wished. Data on attitudes to the suicide pill were collected in the Netherlands from 410 physicians, 1,379 members of the general…
Walker-Renshaw, Barbara; Finley, Margot
In this article, the authors address the question of whether the Supreme Court of Canada's decision in Carter v. Canada leaves open the possibility that persons with severe, treatment-refractory mental illness may lawfully seek a physician-assisted death. If so, how will health care providers distinguish between suicidal ideation and intent that is a symptom of the pathology of a treatable mental illness, on the one hand; and suicidal ideation and intent that is, perhaps, a capable and thoughtful response to a "grievous and irremediable" condition, on the other hand? Mental illness is the most common risk factor for suicide. If physician-assisted death becomes an accepted practice in mental health care, how will that be reconciled with the well-established impetus in mental health care to prevent suicide? The authors consider the competing ethical values of beneficence and promoting patient autonomy, in the context of the recovery movement in mental health care.
Raho, Joseph A; Miccinesi, Guido
Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma's particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility--a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices.
Oliveira, Kathleen De; North, Sara; Beck, Barbra; Hopp, Jane
Purpose: As the United States health care model progresses towards medical teams and the country’s population continues to diversify, the need for health professional education programs to develop and implement culturally specific interprofessional education (IPE) becomes increasingly imperative. A wide range of models exists for delivering and implementing IPE in health education, but none have included the cultural components that are vital in educating the health professional. Methods: A cross-cultural decentralized IPE model for physician assistant (PA) and physical therapy (PT) students was developed. This three-part IPE series was created using an established cultural curricular model and began with the exploration of self, continued with the examination of various dimensions of culture, and concluded with the exploration of the intersection between health and culture. We assessed student satisfaction of the IPE experiences and students’ engagement and attitudes towards IPE using a three-item open-ended questionnaire administered after each cross-cultural activity and the Interprofessional Education Series Survey (IESS) upon the completion of the series. Results: IESS responses showed that PA and PT students reported benefits in interprofessional collaboration and cultural awareness and expressed overall satisfaction with the series. Qualitative analysis revealed growth in student response depth consistent with the scaffolded focus of each IPE module in the series. Conclusion: The trends in this three-part series suggest that institutions looking to develop culturally inclusive IPE educational initiatives may have success through a decentralized model mirroring the effective cultural progression focused on addressing exploration of self, examination of various dimensions of culture, and exploration of the intersection between health and culture. PMID:26072900
Hill, Robert; And Others
In an effort to mitigate the maldistribution of U.S. physicians, a rural satellite clinic was established in 1973 to serve the 1,239 citizens of Yale, Oklahoma. The clinic was manned by a graduate of the two year Physician's Associate program at the University of Oklahoma who was under the supervision and employ of a pediatrician located 20 miles…
Otte, Ina C; Jung, Corinna; Elger, Bernice; Bally, Klaus
GPs usually care for their patients for an extended period of time, therefore, requests to not only discontinue a patient's treatment but to assist a patient in a suicide are likely to create intensely stressful situations for physicians. However, in order to ensure the best patient care possible, the competent communication about the option of physician assisted suicide (PAS) as well as the assessment of the origin and sincerity of the request are very important. This is especially true, since patients' requests for PAS can also be an indicator for unmet needs or concerns. Twenty-three qualitative semi-structured interviews were conducted to in-depth explore this multifaceted, complex topic while enabling GPs to express possible difficulties when being asked for assistance. The analysis of the gathered data shows three main themes why GPs may find it difficult to professionally communicate about PAS: concerns for their own psychological well-being, conflicting personal values or their understanding of their professional role. In the discussion part of this paper we re-assess these different themes in order to ethically discuss and analyse how potential barriers to professional communication concerning PAS could be overcome.
Kaplan, K J; O'Dell, J; Dragovic, L J; McKeon, M C; Bentley, E; Telmet, K L
This report presents an update of the Kevorkian-Reding physician-assisted (or physician-aided) deaths to include the ninety-three publicly acknowledged cases as of November 25, 1998. These deaths are divided into ten distinct time phases. The following trends emerge. Over two-thirds of the decedents are women, the ratio of females to males varying widely with phase. The proportion of women seems to be the highest when Kevorkian is free to act as he wants and lowest when he seems to be acting under legal or political restraints. Based on autopsy results, only 29.0 percent of the cases are terminal, this percentage being higher among men (37.9%) than among women (25.4%). However, 66.7% of the decedents were disabled, no significant difference emerging between men and women. Further, five out of the six decedents showing no apparent anatomical sign of disease at autopsy were women. Over 80 percent of the physician-assisted deaths are cremated, approximately twice as high a proportion as that emerging for suicides in Michigan and four times as high as cremations occurring with regard to overall deaths. Finally, death by carbon monoxide decreases dramatically with time phase while the use of the contraption dubbed the "suicide machine" increases, suggesting an increasing routinization over time. Finally, during the ninth and tenth phases, Kevorkian's aims and his own suicidality emerge more clearly involving 1) harvesting organs and 2) threat of starving himself in prison if he is convicted. Phase 10 can be seen as an escalation from assisted death to overt euthanasia, repeating the same need for a demonstration (Thomas Youk) that was first exhibited in Phase I (Janet Adkins).
Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in
Maehara, Tadaaki; Nishida, Hiroshi; Watanabe, Takashi; Tominaga, Ryuji; Tabayashi, Koichi
The healthcare system surrounding surgeons is collapsing due to Japan's policy of limiting health expenditure, market fundamentalism, shortage of healthcare providers, unfavorable working environment for surgeons, increasing risk of malpractice suits, and decreasing number of those who desire to pursue the surgery specialty. In the USA, nonphysician and mid-level clinicians such as nurse practitioners (NPs) and physician assistants (PAs) have been working since the 1960s, and the team approach to medicine which benefits patients is functioning well. One strategy to avoid the collapse of the Japanese surgical healthcare system is introducing the NP/PA system. The division of labor in medicine can provide high-quality, safe healthcare and increase the confidence of the public by contributing to: reduced postoperative complications; increased patient satisfaction; decreased length of postoperative hospital stay: and economic benefits. We have requested that the Ministry of Health, Labor and Welfare establish a Japanese NP/PA system to care for patients more efficiently perioperatively. The ministry has decided to launch a trial profession called "tokutei (specifically qualified) nurse" in February 2010. These nurses will be trained and educated at the Master's degree level and allowed to practice several predetermined skill sets under physician supervision. We hope that all healthcare providers will assist in transforming the tokutei nurse system into a Japanese NP/PA system.
Chan, Benny; Somerville, Margaret
In its landmark decision Carter v Canada (Attorney General), the Supreme Court of Canada ruled that the criminal prohibition on physician-assisted suicide and euthanasia for certain persons in certain circumstances violated their rights to life, liberty, and security of the person in sec. 7 of the Canadian Charter of Rights and Freedoms and thus was unconstitutional. The Supreme Court in effect overruled its earlier decision, Rodriguez v British Columbia (Attorney General), which upheld the prohibition as constitutionally valid, on the basis of changes in Charter jurisprudence and in the social facts since Rodriguez was decided. We argue that the Supreme Court's Carter decision shows conceptual disagreements with its Rodriguez decision concerning the nature and scope of the sec. 7-protected interests and the accompanying principles of fundamental justice. Not only do these conceptual differences have little to do with the changes that the Court in Carter invoked for 'revisiting' Rodriguez, the Court's articulation of the sec. 7 interests, particularly the right to life, and the principles of fundamental justice, especially the principle of over breadth, are problematic on their own terms. Furthermore, the way in which the Court dealt with evidence regarding abuses in permissive jurisdictions is also subject to criticism. We recommend that if, as now seems inevitable, legislation is introduced, it should mandate that assisted suicide and euthanasia be performed by specially licensed non-medical personnel and only on the authorization of a Superior Court judge. We also reject the key recommendations recently issued by the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying.
Elam, Carol L.; Seaver, Daniel C.; Berres, Peter N.; Brandt, Barbara F.
Each year, a large number of students begin college with aspirations of entering a health profession. High school teachers and guidance counselors as well as college admission counselors and prehealth advisors can assist students by providing current information regarding general entrance requirements to health professions programs. The purpose of…
Rys, Sam; Deschepper, Reginald; Mortier, Freddy; Deliens, Luc; Bilsen, Johan
The distinction between continuous sedation until death (CSD) and physician-assisted death (PAD) has become a topic of medical ethical debate. We conducted 6 focus groups to examine how nursing home clinicians perceive this distinction. For some, the difference is clear whereas others consider CSD a form of euthanasia. Another group situates CSD between pain relief and ending life. Arguments for these perspectives refer to the following themes: intention, dosage of sedative drugs, unconsciousness, and the pace of the dying process. Generally, CSD is considered emotionally easier to deal with since it entails a gradual dying process. Nursing home clinicians have diverging perceptions of the relation between CSD and PAD; some consider CSD to be more than a purely palliative measure, that is, also as a means to hasten death.
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
The generic term "passive euthanasia" includes different issues dealing with the omission, discontinuation or termination of life-sustaining or life-prolonging medical treatments. The debate around passive euthanasia focuses on the constitutional right of self-determination of every human being on the one hand and the constitutional mandate of the State to protect human life on the other. Issues of passive euthanasia always require a differentiated approach. Essentially, it comes down to the following: In Germany, the human right of self-determination includes the right to prohibit the performance of life-sustaining treatments, even if this leads to the death of the patient. A physician who does not take life-sustaining treatment measures because this is the free will expressed by the patient is not subject to prosecution. On the other hand, if the physician treats the patient against his will, this can be deemed a punishable act of bodily injury. The patient's will is decisive even if his concrete state of health does no longer allow him to freely express his will. In the Patient's Living Will Act of 2009, the German legislator clarified the juridical assessment of such constellations being of particular relevance in practice. A written living will of a person in which he requests to take or not to take certain medical treatment measures in case that he is no longer able to make the decision himself shall be binding for the people involved in the process of medical treatment. If there is no living will, the supposed will of the patient shall be relevant. In its judgment in the "Putz case", the German Federal Court of Justice ruled in 2010 that actions terminating a life-sustaining treatment that does not correspond to the patient's will must be limited to letting an already ongoing disease process run its course. In this context it is not important, however, whether treatment is discontinued by an active act or by omission. Under certain circumstances, the
The Systems Approach to Functional Job Analysis. Task Analysis of the Physician's Assistant: Volume II--Curriculum and Phase I Basic Core Courses and Volume III--Phases II and III--Clinical Clerkships and Assignments.
Wake Forest Univ., Winston Salem, NC. Bowman Gray School of Medicine.
This publication contains a curriculum developed through functional job analyses for a 24-month physician's assistant training program. Phase 1 of the 3-phase program is a 6-month basic course program in clinical and bioscience principles and is required of all students regardless of their specialty interest. Phase 2 is a 6 to 10 month period of…
Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 4. Clinic QPCB Task Sort for Clinical Physician Assistants--Dermatology, ENT, Opththalmology, Orthopedics, and Urology.
Technomics, Inc., McLean, VA.
This publication is Attachment 4 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties for clinical physician assistants. (BT)
Tracy, Octavious; Birchette-Pierce, Cheryl
Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…
Hains, Carrie-Anne Marie; Hulbert-Williams, Nicholas J
Public and healthcare professionals differ in their attitudes towards euthanasia and physician-assisted suicide (PAS), the legal status of which is currently in the spotlight in the UK. In addition to medical training and experience, religiosity, locus of control and patient characteristics (eg, patient age, pain levels, number of euthanasia requests) are known influencing factors. Previous research tends toward basic designs reporting on attitudes in the context of just one or two potentially influencing factors; we aimed to test the comparative importance of a larger range of variables in a sample of nursing trainees and non-nursing controls. One hundred and fifty-one undergraduate students (early-stage nursing training, late-stage nursing training and non-nursing controls) were approached on a UK university campus and asked to complete a self-report questionnaire. Participants were of mixed gender and were on average 25.5 years old. No significant differences in attitude were found between nursing and non-nursing students. There was a significant positive correlation between higher religiosity and positive attitude toward euthanasia (r=0.19, p<0.05) and a significant negative relationship between internal locus of control and positive attitude toward PAS (r=-0.263, p<0.01). Multivariate analyses revealed differing predictor models for attitudes towards euthanasia and PAS, and confirm the importance of individual differences in determining these attitudes. The unexpected direction of association between religiosity and attitudes may reflect a broader cultural shift in attitudes since earlier research in this area. Furthermore, these findings suggest it possible that experience, more than training itself, may be a bigger influence on attitudinal differences in healthcare professionals.
Terlouw, T J
During the eighties of the 19th century several physical education teachers who were engaged in physical therapy activities, so called 'heilgynasten', believed that only a solid organization of serious, educated and well-trained heilgymnasten could bring about a positive change in the situation at hand in the field of physical therapy. On September 1st 1889 the 'Genootschap ter beoefening van de Heilgymnastiek in Nederland' ('Society for practising heilgymnastiek in the Netherlands') was founded. The main aim of its members was to establish a state-exam, a public trainingschool as well as to ensure proper legislation for this 'new' profession. In this paper the focus of attention is on the founding of the 'Genootschap' and the reactions it provoked from organizations and practitioners in the fields of physical education and medicine during the first years of its existance. One could say that at first the 'Genootschap' was tolerated. Several well-known Dutch physicians joined the 'Genootschap' as 'extraordinary-member'. Very soon however, some physicians came to see the activities of this organization as a threat to the process of differentiation and specialization in the field of orthopaedic surgery that had just began. They emphasized that the 'heilgymnasten' who worked relatively independent from physicians in the field of physical therapy had no legal status; in fact they argued that these practitioners were actually breaking the law. A solution to these problems was sought through law-suits against 'heilgymnasten' to ensure that they would only practise physical therapy under supervision of physicians. In a next article the plight of one of the Dutch 'heilgymnasten', Hendrik Soeter, who can be considered as a 'victim' of this strategy, will be discussed in more detail. The Dutch 'heilgymnasten' did finally gain a legal status for their profession, but they had to wait for that untill more than fifty years after the foundation of the 'Genootschap'.
Rosenbach, Joan K.
Professional requirements for physicians specializing in nephrology were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for nephrology, a nephrology Delphi panel reviewed reference and incidence-prevalence and utilization data for 34 conditions that are treated in the…
van der Heide, Agnes
Several countries have adopted laws that regulate physician assistance in dying. Such assistance may consist of providing a patient with a prescription of lethal medication that is self-administered by the patient, which is usually referred to as (physician) assistance in suicide, or of administering lethal medication to a patient, which is referred to as euthanasia. The main aim of regulating physician assistance in dying is to bring these practices into the open and to provide physicians with legal certainty. A key condition in all jurisdictions that have regulated either assistance in suicide or euthanasia is that physicians are only allowed to engage in these acts upon the explicit and voluntary request of the patient. All systems that allow physician assistance in dying have also in some way included the notion that physician assistance in dying is only accepted when it is the only means to address severe suffering from an incurable medical condition. Arguments against the legal regulation of physician assistance in dying include principled arguments, such as the wrongness of hastening death, and arguments that emphasize the negative consequences of allowing physician assistance in dying, such as a devaluation of the lives of older people, or people with chronic disease or disabilities. Opinion polls show that some form of accepting and regulating euthanasia and physician assistance in suicide is increasingly supported by the general population in most western countries. Studies in countries where physician assistance in dying is regulated suggest that practices have remained rather stable in most jurisdictions and that physicians adhere to the legal criteria in the vast majority of cases.
... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2...
... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2...
...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d)...
...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d)...
...) STANDARDS AND CERTIFICATION REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES Requirements for Long Term... may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d)...
Wake Forest Univ., Winston Salem, NC. Bowman Gray School of Medicine.
Utilizing a systematic sampling technique, the professional activities of small groups of pediatricians, family practitioners, surgeons, obstetricians, and internists were observed for 4 or 5 days by a medical student who checked a prearranged activity sheet every 30 seconds to: (1) identify those tasks and activities an assistant could be trained…
catheterization prescribing birth control pills prescribing narcotics treating hypertension delivering babies treating post surgical cases assisting in surgery...catheterization -3 prescribing birth control 1;i 11 -4 treating victims of poisoning -5 doing physical exams for nuclear surety -6 prescribing narcotics -7...narrative summaries. o__ physica, exams for reieet o.. do urinary tract catheterization. administer local anesthesia. prescribe birth control pills
Assessment of Assistance in Smoking Cessation Therapy by Pharmacies in Collaboration with Medical Institutions- Implementation of a Collaborative Drug Therapy Management Protocol Based on a Written Agreement between Physicians and Pharmacists.
Watanabe, Fumiyuki; Shinohara, Kuniko; Dobashi, Akira; Amagai, Kenji; Hara, Kazuo; Kurata, Kaori; Iizima, Hideo; Shimakawa, Kiyoshi; Shimada, Masahiko; Abe, Sakurako; Takei, Keiji; Kamei, Miwako
This study built a protocol for drug therapy management (hereinafter "the protocol") that would enable continuous support from the decision making of smoking cessation therapy to the completion of therapy through the collaboration of physicians and community pharmacists, after which we evaluated whether the use of this protocol would be helpful to smoking cessation therapy. This study utilized the "On the Promotion of Team-Based Medical Care", a Notification by the Health Policy Bureau as one of the resources for judgment, and referred to collaborative drug therapy management (CDTM) in the United States. After the implementation of this protocol, the success rate of smoking cessation at the participating medical institutions rose to approximately 70%, approximately 28-point improvement compared to the rate before the implementation. In addition to the benefits of the standard smoking cessation program, this result may have been affected by the intervention of pharmacists, who assisted in continuing cessation by advising to reduce drug dosage as necessary approximately one week after the smoking cessation, when side effects and the urge to smoke tend to occur. Additionally, the awareness survey for the intervention group revealed that all respondents, including patients who failed to quit smoking, answered that they were satisfied to the question on general satisfaction. The question about the reason for successful cessation revealed that the support by pharmacists was as important as, or more important than, that by physicians and nurses. This infers that the pharmacists' active engagement in drug therapy for individual patients was favorably acknowledged.
The moral difference or equivalence between continuous sedation until death and physician-assisted death: word games or war games?: a qualitative content analysis of opinion pieces in the indexed medical and nursing literature.
Rys, Sam; Deschepper, Reginald; Mortier, Freddy; Deliens, Luc; Atkinson, Douglas; Bilsen, Johan
Continuous sedation until death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. Some argue that CSD is morally equivalent to physician-assisted death (PAD), that it is a form of "slow euthanasia." A qualitative thematic content analysis of opinion pieces was conducted to describe and classify arguments that support or reject a moral difference between CSD and PAD. Arguments pro and contra a moral difference refer basically to the same ambiguous themes, namely intention, proportionality, withholding artificial nutrition and hydration, and removing consciousness. This demonstrates that the debate is first and foremost a semantic rather than a factual dispute, focusing on the normative framework of CSD. Given the prevalent ambiguity, the debate on CSD appears to be a classical symbolic struggle for moral authority.
Paterick, Timothy J; Paterick, Barbara B; Paterick, Timothy E
Good Samaritan laws are designed to encourage individuals, including physicians, to gratuitously render medical care in emergency situations. Through these laws, immunity from civil liability is provided to physicians who act in good faith to provide emergency care gratis. Historically, emergency care involved medical assistance given to persons in motor vehicle crashes or other emergency situations in which bystanders were present. Protection of physicians from allegations of negligence was a tactic of the legislative and judicial systems to encourage active clinical participation, rather than cautious nonparticipation, in emergency care. In some states and under defined circumstances, the immunity may apply in the hospital setting, as well as in the physician's office. Legislatures have continued to amend the statutes to expand the protection provided to physicians who offer emergency care. Judicial construction of the nature and scope of physician immunity has similarly expanded.
... assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section... delegate tasks to: (i) A certified physician assistant or a certified nurse practitioner, or (ii) A clinical nurse specialist who— (A) Is acting within the scope of practice as defined by State law; and...
Mackay, J M; Lamb, C W
Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.
Walker Keegan, Deborah
Transition is a natural progression for physicians in a medical practice. At some point, at least one physician will seek to deviate from the work norm of the group, either due to retirement, need for part-time status, or other reason. Medical practices that have a formal transition plan in place have a competitive advantage over other practices in terms of physician recruitment and retention. Not only do the formal transition plans permit physicians to proactively plan for work slowdown, but they also permit the medical practice to ensure its financial health and effectively position itself for the future. Key issues addressed in physician transition plans include governance, continuity of care, eligibility, time limits, on-call schedules, practice overhead, and physician compensation.
... for authorizing certified physician assistants and certified nurse practitioners (non-physicians) to... certified nurse practitioners will be allowed to issue referrals to patients for physical therapy... if based on a referral from a certified physician assistant or certified nurse practitioner....
Cohn, Kenneth H; Schwartz, Richard W
Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.
Cummings, Simone Marie; Merlo, Lisa; Cottler, Linda B.
The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs. PMID:21745042
Most people who endorse physician-assisted suicide are against commercially assisted suicide - a suicide assisted by professional non-medical providers against payment. The article questions if this position - endorsement of physician-assisted suicide on the one hand and rejection of commercially assisted suicide on the other hand - is a coherent ethical position. To this end the article first discusses some obvious advantages of commercially assisted suicide and then scrutinizes six types of argument about whether they can justify the rejection of commercially assisted suicide while simultaneously endorsing physician-assisted suicide. The conclusion is that they cannot provide this justification and that the mentioned position is not coherent. People who endorse physician-assisted suicide have to endorse commercially assisted suicide as well, or they have to revise their endorsement of physician-assisted suicide.
Puri, Ajay K; Bhaloo, Taj; Kirshin, Toby; Mithani, Akber
In 2003, St. Vincent's Hospital (SVH) closed its doors. The authors investigate the involvement of the medical staff in the successful closure of SVH using the Physician Engagement (PE) Model. This 10-strategy model is based on engagement, communication, education and support. Results were gathered by surveys, unstructured interviews and meetings. Data suggested that engaging physicians in the process was favourable, particularly by using the PE model. Six recommendations are given to assist administrators/decision-makers in future closures.
Ambulatory Care Clinics 1Improper at ER 1 Combat: Arms Level OP Non -Specialty I As a GMO 1 74 24. How PA is best utilized? OP Primary Care Clinic...interest to the Army PAs include pay, promotions, degree completion, continuing medical education, and pro - fessional utilization. The present findings...Officer PAs in the Army, with a best case estimate of approximately 600 interested non -Army PA graduates and a worst case estimate of 108 non - Army PA
In the wake of the 2010 earthquake in Haiti, medical relief organizations and individual practitioners mobilized to provide assistance. Here, an emergency medicine physician who worked with a Louisiana-based team in the mountains in one of the hardest hit areas relates his experiences. PMID:21734848
MacStravic, R C
Physicians' referring and admitting behavior as well as their clinical management practices are major determinants of hospitals' profitability under prospective payment. Four techniques are available to hospitals that seek to increase market share: Recruitment and retention strategies. In planning the mix of specialties represented on staff, hospitals should consider the effects of a physician's practice on the hospital's case mix. Peer pressure. Peer review programs in hospitals as well as through medical or specialty societies may help persuade physicians to alter their use of services. Education and information programs. Hospitals can assist physicians in patient management by conducting economic grand rounds, developing committees to study and communicate cost data to physicians, and providing information on alternatives to hospitalization. Incentives. Putting physicians at risk by linking planned expenditures to hospital financial performance can influence practice patterns. Other techniques include offering limited partnerships to medical staff members and merging the hospital and medical staff into one corporation. Hospitals may also need to influence physicians away from ventures that compete directly with the institution, such as ambulatory surgery centers.
Linney, B J
Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.
... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member...
... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member...
Hill, Micah J; DeCherney, Alan H
Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools.
Olson, E A
Physicians take into account many factors when making referral decisions, primarily provider expertise, good communication and good patient care. This professional paper will show that provider expertise and patient care are the most important factors in referral decisions, and that physicians rely primarily on direct experience for the information necessary to make a referral choice.
The question of whether there is justification for physicians to participate in state-sanctioned corporal punishment has prompted long and heated debates around the world. Several recent and high-profile sentences requiring physician assistance have brought the conversation to Saudi Arabia. Whether a physician is asked to participate actively or to assess prisoners' ability to withstand this form of punishment, can there be an ethical justification for medical training and skills being put toward these purposes? The aim of this article is to examine aspects of Islamic law along with the different professional and religious obligations of Saudi Arabian physicians, and how these elements may inform the debate.
Peluchette, Joy V; Karl, Katherine A; Coustasse, Alberto
This article investigates the opinions of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. We analyzed 290 comments posted on online discussion boards and found that most (51.7%) were opposed to physicians being Facebook "friends" with patients and many (42%) were opposed to physicians having any kind of Facebook presence. Some believed that health care organizations should have a social media policy and provide social media training. We conclude with suggestions for how health care administrators can provide assistance to physicians and effectively manage their social media presence.
Stewart, E E
Physician group practices that lease office space should consider several issues before signing a lease. These issues include whether to hire a broker to assist in the search for office space, negotiating lease provisions that pertain to compliance with the Americans with Disabilities Act; confidentiality of patient records; proper disposal of medical waste and other hazardous materials; compliance with occupational safety standards; quiet enjoyment; and utility use. In addition, physician group practices that lease office space from other healthcare providers must ensure that the lease terms conform with antifraud and abuse safe harbor regulations.
Schiff, Anthony Hunter
Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive
Weisz, George M.; Grzybowski, Andrzej
The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903–2000) and Bronislawa Fejgin (1883–1943). PMID:27487308
Dubinsky, Isser; Feerasta, Nadia; Lash, Rick
Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.
These questions are addressed: What does it mean to be a physician, and how can a physician continue his education? Where is his place in family crises? The psychosomatic point of view of diseases is not a specialty, but a concept, a basic attitude, a global principle encompassing all medical specialties. In particular, disorders of relations and basic needs are discussed in the context of a novel therapeutic access. The doctor as a 'drug' corresponds to a therapeutic alliance, also in group work. The problems of communication, even as a flash, influence the language of the patient and the physician. In the tension between anxiety and trust, psychosomatic thinking and medical intervention come to life also for the experience of disease and in the search for a meaning. The physician is not as much an achiever than a provider.
Weisz, George M
The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.
Blais, Régis; Safianyk, Catherine; Magnan, Anne; Lapierre, André
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
Genuis, S J
Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever‐proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for “freedom of conscience” that principled physicians require to practise medicine in keeping with their personal ethical orientation. PMID:16597808
Although many healthcare professionals are turning to the general public to increase market share and referrals, they should be directing their attention to physicians instead. One of the major challenges facing hospitals is determining physician needs. A survey may be necessary to identify physicians' perceptions, attitudes, values, expectations, market, and hospital loyalty. Another important research document is the physician profile, which includes each doctor by age, specialty, office location, admitting and outpatient referral activity, financial contribution, and referral and other affiliations. Surveying should not end with the physician. One of the best means of evaluating patient and physician satisfaction is by questioning physicians' office staff. To centralize physician services, a number of hospitals have established physician liaison programs, which bridge the gap between the hospital and the physician's office, heighten physician satisfaction, and increase referrals. Physician orientation is a key element of most outreach programs, providing an opportunity to develop relationships with new physicians. Other means of directly aiding physicians are physician referral services and practice enhancement and assistance.
When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria.
This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.
Because both computerized physician order entry (CPOE) systems and mobile technologies such as handheld devices have the potential to greatly impact the industry's future, IT vendors, hospitals, and clinicians are simply merging them into a logical convergence--"CPOE on a handheld"--with an expectation of full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices. For these trends to succeed together, however, this expectation must be revised to establish a distinct category--mobile physician order entry (MPOE)--that is different from CPOE in form, function, and implementation.
Choong, Kartina A; Barrett, Martin
When assisting the courts in criminal proceedings, the work of forensic physicians are leaning more towards the preparation of written evidence rather than the giving of oral evidence in person. For this, they may be asked to serve either as professional witnesses or expert witnesses. These 2 roles have nevertheless been a constant source of confusion among forensic physicians. In view of this, the article aims to highlight the similarities and differences between these 2 roles particularly in relation to the preparation of written evidence. It will take a close look at the forms of written evidence which forensic physicians are expected to produce in those distinct capacities and the attending duties, evidentiary rules and legal liabilities. Through this, the work aspires to assist forensic physicians undertake those responsibilities on a more informed footing.
Beltramini, R F; Sirsi, A K
Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed.
Allison, D J; Blinco, K
Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs.
Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Eskildsen, Anette Gjetrup; Saedder, Eva Aggerholm; Nielsen, Lars Peter
Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record.
The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.
Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven
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.
Romani, Maya; Ashkar, Khalil
Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians’ quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as
Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times
Background Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Methods Pragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. Results The intervention’s median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19–4:38] during comparator shifts. The intervention’s median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02–2:14]. The intervention’s median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention’s left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43–4:16]) and low acuity patients (1:10 95th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the
This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.
A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India. PMID:27843823
Webster, Ann A.; And Others
The data presented in this document are the results of a survey of physician extenders currently practicing in Michigan as of November 1973. "Physician extender" is a term used for personnel who assist or collaborate with the physician in providing patient care, which means that nurses with additional training who are functioning in…
Cameron, I A
Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients.
Cameron, Ian A.
Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients. PMID:21267273
de Micheli-Serra, Alfredo
Socrates is considered the great classic moralist, although he was not the first to take care of man and morality. Aristotle instituted ethics as an autonomous science and clearly defined its fields, its methods and its purposes, formulating the concept of "happy medium". In the Aristotelian methodology we find traces of Hippocrates, who believed that the physician must always consider the peculiar aspects and that the individual characteristics' determinations can be reached by sensitivity. Once these particularities have been proved, the physician must rely on the "happy medium". Only Stoics could discover, and gradually elaborate, the concept of natural law. Apparently they were the first to establish the classic distinction between the theorical or ideal morality and the practical morality, which is accessible to all people. They refused to compare wisdom, entirely turned inward, with the medical art, which does not constitute an aim by itself. Modern authors assert that, with stoicism, the notion we can denominated wisdom's humanism rised. Today it is admitted that "medicine is more than simply learning medical data.... Physicians must have a wisdom learned from human finitude. They will need this wisdom to tackle the health care policy debates in the next decades". This would be a major cultural undertaking.
Kiraly, Laszlo N; McClave, Stephen A; Neel, Dustin; Evans, David C; Martindale, Robert G; Hurt, Ryan T
Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification.
Coyle, Susan L
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.
Sheng, O R; Hu, P J; Chau, P Y; Hjelm, N M; Tam, K Y; Wei, C P; Tse, J
Physicians' acceptance of telemedicine is an important managerial issue facing health-care organizations that have adopted, or are about to adopt, telemedicine. Most previous investigations of the acceptance of telemedicine have lacked theoretical foundation and been of limited scope. We examined technology acceptance and usage among physicians and specialists from 49 clinical departments at eight public tertiary hospitals in Hong Kong. Out of the 1021 questionnaires distributed, 310 were completed and returned, a 30% response rate. The preliminary findings suggested that use of telemedicine among clinicians in Hong Kong was moderate. While 18% of the respondents were using some form of telemedicine for patient care and management, it accounted for only 6.3% of the services provided. The intensity of their technology usage was also low, accounting for only 6.8% of a typical telemedicine-assisted service. These preliminary findings have managerial implications.
Woodward, Christel; Adams, Orvill
The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada's licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years). The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties—surgery, anesthesia, obstetrics and gynecology, and radiology—may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text] PMID:3995440
Jameson, M G
Physicians have actively participated in the political processes of American democracy throughout the nation's history. The purpose of this study was to compare physicians' participation in public office during the first and second centuries of American democracy. Following the commencement of the US Congress, physicians were active members of the legislative branch. However, physicians' membership in Congress has diminished significantly in modern times. The executive and judicial branches of the federal government have recorded only marginal representation by physicians and none during the 20th century.
Fraunfelder, F T; Fraunfelder, N
The number of disability claims by physicians has skyrocketed during the last decade. One of the primary reasons for this escalation is decreased job satisfaction brought about by managed care. Certain physician groups are more vulnerable to the stress of advanced managed care: solo practitioners, specialists and subspecialists, certain generalists, doctors with independent personalities, middle-aged or near-retirement physicians, impaired physicians, and those whose practices are almost solely contract driven. Based on analysis of physician disability claims, certain protective measures are recommended to relieve stress and promote survival in today's health care market.
Devore, Cynthia DiLaura; Wheeler, Lani S M
The American Academy of Pediatrics recognizes the important role physicians play in promoting the optimal biopsychosocial well-being of children in the school setting. Although the concept of a school physician has existed for more than a century, uniformity among states and school districts regarding physicians in schools and the laws governing it are lacking. By understanding the roles and contributions physicians can make to schools, pediatricians can support and promote school physicians in their communities and improve health and safety for children.
Healing depends on a caring, involved physician. In his story "Ward Number Six," Anton Chekhov illustrated how patients suffer when physicians become apathetic. Reading this story may inspire physicians to resist apathy and assume greater responsibility for the social conditions that impact on their patients' well-being. It may also stimulate physicians' imagination in such a way as to improve their ability to empathize with their patients. Finally, the act of reading itself--particularly reading great literature such as "Ward Number Six," can help rejuvenate those physicians who struggle with their own apathy.
Task analyses are provided for two duty areas for the occupation of medical assistant in the medical assisting cluster. Five tasks for the duty area "providing therapeutic measures" are as follows: assist with dressing change, apply clean dressing, apply elastic bandage, assist physician in therapeutic procedure, and apply topical…
Ford, Amasa B.; Ransohoff, David F.
Innovative solutions in training or retraining of health workers to meet the nationwide primary care deficiency are summarized. Programs described concern nurse clinicians, practitioners, and midwives; physicians' assistants; medical assistants, laboratory technicians, and secretaries; dental assistants, hygienists, and laboratory technicians;…
Join Together, Boston, MA.
Treatment is one component of a strategy to reduce substance abuse. It can include detoxification; inpatient counseling; outpatient counseling; therapeutic communities; and self help groups. Referrals can take place in settings such as emergency rooms; employee assistance programs; churches; and physicians' offices. Unmet treatment needs can cause…
Leeman, Phyllis A.
Designed to develop 12th-grade multiple competencies courses, this curriculum prepares the student to assist a physician, dentist, or other health professional with the management of a medical office and to perform basic health services procedures. Course descriptions are provided for the two courses in the curriculum: medical services assistant…
The roles of the team physician are much more than providing medical coverage at a sport's event. The team physician has numerous administrative and medical responsibilities. The development of an emergency action plan is an essential administrative task as an example. The implementation of the components of this plan requires the team physician to have the necessary medical knowledge and skill. An expertise in returning an athlete to play after an injury or other medical condition is a unique attribute of the trained team physician. The athlete's return to participation needs to start with the athlete's safety and best medical interests but not inappropriately restrict the individual from play. The ability to communicate on numerous levels needs to be a characteristic of the team physician. There are several potential ethical conflicts the team physician needs to control. These conflicts can create unique medicolegal issues. The true emphasis of the team physician is to focus on what is best for the athlete.
Vlassov, V; Ushakov, I
The program for training pilot-physicians was started in 1952. It was the first and the only one in the history of the USSR/Russia. Young military physicians from different military forces and graduates of the Saratov Military Medical Faculty were invited to participate in the program. Selected military physicians were sent for 2 yr of flight training. Six graduates from Omsk School became bomber pilots, while eight graduates from Chuguev School were appointed instructor pilots. Special positions and regulations for pilot-physicians were not created. Some pilot-physicians continued their aviation career, and some returned to medicine. For a short time a limited number of pilot-physician positions existed in the research institute in Moscow. Two graduates from this program were appointed to these positions. One of the pilot-physicians became a cosmonaut; and at least six obtained scientific degrees in medicine and made significant contributions to the development of aerospace medicine.
Gjerdingen, D K; Simpson, D E; Titus, S L
Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.
Fanburg, John D; Leone, Alyson M
Dermatologists will enter into a number of different contracts during their professional careers. It is important that in each agreement they enter, dermatologists reap the benefits that they aspire for and understand the consequences of each provision. This article addresses just a few of the different issues that arise in physician contracting, such as choosing the appropriate form of business entity; the importance of a writing; term and termination of the contract; compensation models; benefits, vacation and other time off included in the contract; malpractice insurance; and restrictive covenants. Each provision should be carefully analyzed to ensure that it will protect the best interests of the dermatologist in that situation.
Anastakis, Dimitri J
As stakeholders vie for increasingly limited resources in health care, physicians would be well advised to hone their skills of negotiation. Negotiation is defined as a strategy to resolve a divergence of interests, be they real or perceived, where common interests also exist. Negotiation requires effective communication of goals, needs, and wants. The "basic needs" model of negotiation is best suited to the current health care environment. In this model, negotiator must to be able to identify their needs in the negotiation, establish their best alternative to a negotiated agreement, and identify their strategies and tactics for the negotiation.
353 Physician Event Reporting: Training the Next Generation of Physicians Quang-Tuyen Nguyen, Joanna Weinberg, Lee H. Hilborne Abstract...and the quality of health care by explicitly educating and training the next generation of physicians in these areas. Although quality of care is...implicit in most medical and other professional school curricula, medical students generally are not given the training necessary to meet the specific
Buzek, Joanna, Ed.
The concept of the physician's assistant has become a topic of heightened concern and discussion as illustrated by the papers in this publication which reflect the interests of government, allied medical educators, and organized medicine in developing the concept as a new health manpower resource. Papers are: (1) "The Research and Development…
Jolly, E; Blum, H L
Questions about inheritance in all kinds of diseases and defects are commonly asked of nearly all physicians. In attempting to answer these questions, however, the physician is often hampered by lack of formal instruction in clinical genetics. Since the health department, if it is to carry out its epidemiologic function, must be as concerned over the increasing identification of genetic agents in disease as it is and has been over environmental disease agents, it should come to represent a source of assistance not now generally available to the physician. In short, as it carries out those activities by which its store of general genetic information is increased, and until other sources of genetic consultation become reasonably available, the health department can be of real service to physicians as a resource to which they may turn for help when dealing with families wanting genetic information. Such a service has been provided experimentally for the last two years by the Contra Costa County Health Department. This program calls for the taking of family pedigrees by public health nurses on families with questions of a genetic nature who are health department clients and on families who are referred by their private physicians for this service. An interpretation of each pedigree is made by the department's physician in charge of the program and submitted to the family's physician for his use in counseling the family. Evidence to date suggests the process can be a highly useful service to the practitioner and his patient.
Panahi, Sirous; Watson, Jason; Partridge, Helen
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.
Burr, Bill D.; And Others
An expanded concept of continuing medical education (CME) is reported that fills the needs of both physicians and mid-level practitioners (nurse practitioners or physician's assistants). The Family Practice Refresher Course sponsored by the University of California, Davis, School of Medicine and its evaluation are described. (LBH)
Aliev, R T; Koliado, V B; Neŭmark, A I; Nasedkina, T V
The article presents the design of automated working place of physician andrologist. This working place assists in resolving problems physician and nurse deals with in the everyday practice. This approach enhances the quality of case monitoring in patients with andrologic pathology, significantly expands the possibilities of prevention, treatment and rehabilitation of andrologic patients and develops the prerequisites in further development of dispanserization monitoring.
Torke, Alexia M; Alexander, G Caleb; Lantos, John; Siegler, Mark
The physician-patient relationship is a cornerstone of the medical encounter and has been analyzed extensively. But in many cases, this relationship is altered because patients are unable to make decisions for themselves. In such cases, physicians rely on surrogates, who are often asked to "speak for the patient." This view overlooks the fundamental fact that the surrogate decision maker cannot be just a passive spokesperson for the patient but is also an active agent who develops a complex relationship with the physician. Although there has been much analysis of the ethical guidelines by which surrogates should make decisions, there has been little previous analysis of the special features of the physician-surrogate relationship. Such an analysis seems crucial as the population ages and life-sustaining technologies improve, which is likely to make surrogate decision making even more common. We outline key issues affecting the physician-surrogate relationship and provide guidance for physicians who are making decisions with surrogates.
Washburn, E R
Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.
Grossman, Joy M; Cohen, Genna
While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital's ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals' willingness to provide support and physicians' acceptance of hospital assistance.
Ruco, A; Walsh, C M; Cooper, M A; Rabeneck, L
Colorectal cancer (CRC) is one of the most common cancers in women and men worldwide. Training non-physicians including nurses, nurse practitioners, and physician assistants to perform endoscopy can provide the opportunity to expand access to CRC screening as demand for endoscopic procedures continues to grow. A formal program, incorporating didactic instruction and hands-on practice in addition to oversight, is required to train non-physicians to perform endoscopy as safely and effectively as physicians. Additionally, the context in which the non-physician endoscopy program is organized will dictate key program characteristics including remuneration, participant recruitment and professional and legal considerations. This review explores the evidence in support of non-physician based endoscopy, potential challenges in implementing non-physician endoscopy and requirements for a high-quality program to support training and implementation.
Herbert, Carol P.
The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987
Wilson, Douglas M.C.; Ciliska, Donna; Singer, Joel; Williams, Kimberly; Alleyne, Julia; Lindsay, Elizabeth
This trial took 22 volunteer family physicians and randomly exposed some to training intervention and some to no training to study the effect on frequency and quality of exercise prescription to ambulatory adults. During the 6 weeks after training, the trained physicians addressed the issue of exercise with 35.3% of patients. The untrained physicians discussed exercise with only 8.6% of their patients. PMID:21221270
Lima, Julie C; Intrator, Orna; Wetle, Terrie
Objectives To develop a measure of the perceptions of nursing home (NH) Directors of Nursing (DON) on the adequacy of physician care and to examine its variation as well as its construct validity. Design A nationwide cross-sectional study with primary data collection Setting 2043 NHs surveyed August 2009 – April 2011 Participants Directors of Nursing (DONs) and NH Administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH. Measurements Ten items were used to create three domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called “Effectiveness of Physician Accountability and Communication” (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH Administrators. RESULTS The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of Do-Not-Resuscitate orders, the frequency that the Medical Director checked on the medical care delivered by attending physician, the tightness of nursing home's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and ER visits could be reduced with greater physician attention to resident needs. Conclusion As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting. PMID:25858283
Berge, Keith H.; Seppala, Marvin D.; Schipper, Agnes M.
Although the nature and scope of addictive disease are commonly reported in the lay press, the problem of physician addiction has largely escaped the public's attention. This is not due to physician immunity from the problem, because physicians have been shown to have addiction at a rate similar to or higher than that of the general population. Additionally, physicians' addictive disease (when compared with the general public) is typically advanced before identification and intervention. This delay in diagnosis relates to physicians' tendency to protect their workplace performance and image well beyond the time when their life outside of work has deteriorated and become chaotic. We provide an overview of the scope and risks of physician addiction, the challenges of recognition and intervention, the treatment of the addicted physician, the ethical and legal implications of an addicted physician returning to the workplace, and their monitored aftercare. It is critical that written policies for dealing with workplace addiction are in place at every employment venue and that they are followed to minimize risk of an adverse medical or legal outcome and to provide appropriate care to the addicted physician. PMID:19567716
Reschovsky, James; Cassil, Alwyn; Pham, Hoangmai H
This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally representative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. Since this Data Bulletin examines the extent of physician practice ownership or leasing of medical equipment, the sample was limited to 2,750 physicians practicing in community-based, physician-owned practices, who represent 58 percent of all physicians surveyed. Physicians employed by hospitals, who practiced in hospital-based settings or who worked in hospital-owned practices were excluded.
Thamrin, Cindy; Stern, Georgette; Frey, Urs
There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment.
Scott, I; Phelps, G; Dalton, S
Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills.
Physician engagement has never been more important in this environment of healthcare reform--yet few healthcare organizations can define it or identify the elements of engagement that make increasing it possible. This may explain why a recent survey of physicians on the specifics regarding engagement from their perspective found, among other things, that levels of engagement over the past three years have increased at a lukewarm pace, at best. The survey confirmed that feeling engaged was very important to physicians' job satisfaction. It delved into what was important to them--and where there are gaps between what they want and what they are currently experiencing in their organizations--at a granular level, as well as measuring their current levels of engagement with their organizations and their work. It also explored the impact that feelings of engagement have on physicians' decisions around accepting or leaving a job or practice. A companion survey with administrators pointed out areas where there were gaps between their perceptions and those of physicians. The results point to actions that healthcare organizations can take to increase engagement--and, by extension, participation and buy-in--among their physician populations to reach critical goals and achieve greater success with key initiatives at a time of increasing physician shortages and competition between health systems for top physician talent.
Mueller, Keith J; MacKinney, A Clinton; McBride, Timothy D
Medicare payment disproportionately impacts rural physicians compared to urban. For example, 51% of rural physicians, compared to 44% of urban physicians, receive at least 38% of their payments from Medicare.1 Thus, the Medicare physician payment system is of significant rural interest. In this policy brief, we present the effects of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 on physician payment rates in rural areas. Specifically, we examine the impact of creating a floor of 1.00 in the geographic practice cost index (GPCI) for work expense. We also show the effects of the Medicare incentive payment (MIP) for providing services in shortage areas and of the bonus for practicing in a physician scarcity area. Our principal findings are the following: (1) Increases to the GPCI for work expense accounted for a substantial percentage of the two-year increases in total payment to physicians in rural payment areas. (2) Increases in the conversion factor (CF) (base payment) accounted for most of the increases in total payment in all but 6 of the 89 Medicare payment localities; in those 6 areas, the dominant factor was GPCI adjustment. (3) Bonus payments are a more direct means of targeting increased payments to physicians in specific areas than is a general increase in one part of the payment formula.
Kasman, Deborah L.
An experienced physician-teacher shares her own experiences with loss in medicine and loss in her personal life. Through personal writings during her divorce, she exemplifies the healing effect writing can have during difficult transformations that occur in life. She shares her bias that physicians need to accept and own their emotions and can use…
Baily, Mary Ann
There has been much debate among health care professionals over how physicians should be paid for their services. This paper addresses the topic through an economic and ethical analysis. It starts from the premise that fairness and cost effectiveness should be the goals of a good physician reimbursement system. Using the goals of fairness and cost effectiveness as measures, it examines the current market model. Finding that the current model provides neither fairness nor cost effectiveness, the paper compares the structure of the physician services market to the assumptions made by economists in the idealized market model. Two major imperfections are found in the former. These imperfections are an asymmetry in information between patient and physician, and the uneven and unpredictable distribution of health needs. These two imperfections are examined in light of the goals set out in the beginning of the paper. The paper finds that, given the imperfections, physician reimbursement as it currently exists is incompatible with the goals of fairness and cost effectiveness. In conclusion, several recommendations are made, most significantly a broadening of the interpretation of physician agency, i.e., physician as "agent," and the switch from a fee-for-service physician payment system to a salaried medical practice.
Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading.
Herman, Colman M.; Rodowskas, Christopher A.
Reviews the studies of researchers who have attempted to identify the sources of drug information, both professional and commercial, utilized by physicians, discussing relationship between physicians' sources and the choice of drugs and severity of conditions being treated. Also notes new sources of drug information being considered by the Food…
Johns, H E; Moser, H R
In this study, it was found that consumers generally favor advertising by physicians. They felt that newspaper and professional magazines were more appropriate media for such advertising than television, radio, billboards, telephones, direct mail, and popular magazines. Finally, most consumers have not seen physicians advertise, but of those who have, most have noticed such advertising in a newspaper.
Bagat, Mario; Sekelj Kauzlarić, Katarina
Aim To analyze the physician labor market in Croatia with respect to the internship and employment opportunities, Croatian needs for physicians and specialists, and trends in physician labor market in the European Union (EU) in the context of EU enlargement. Methods Data were collected from the Ministry of Health and Social Welfare, the Croatian Employment Service, and the Croatian Institute for Public Health. We compared the number of physicians waiting for internship before and 14 months after the implementation of the State Program for Intern Employment Stimulation. Also, the number of employed specialists in internal medicine, general surgery, gynecology and obstetrics, and pediatrics was compared with estimated number of specialists that will have been needed by the end of 2007. Average age of hospital physicians in the four specialties was determined and the number of Croatian physicians compared with the number of physicians in EU countries. Results The number of unemployed physicians waiting for internship decreased from 335 in 2003 to 82 in 2004, while a total number of unemployed physicians decreased from 436 to 379 (χ2 = 338, P<0.001). In October 2004, 79.3% of unemployed physicians waited for internship <6 months; of them, 89.2% waited for internship <3 months. In February 2005, 365 unemployed physicians were registered at the Croatian Employment Service and that number has been decreasing in the last couple of years. The number of employed specialists was lower than the estimated number of specialists needed in the analyzed specialists, as defined by the prescribed standards. A shortage of 328 internists, 319 surgeons, 209 gynecologists, and 69 pediatricians in Croatian hospitals is expected in 2007. Conclusion The lack of employment incentive seems to be the main reason for the large number of unemployed physicians waiting for internship before the implementation of the Employment Stimulation Program. According to the number of physicians per 100
Advertising by physicians is a relatively recent phenomenon. Historically, most professions prohibited licensed members from engaging in speech activities that proposed a commercial transaction-advertising. However the history of a physician's legal right to advertise is not the main focus of this article. A brief review of the past, present, and possible future of such rights might assist readers in understanding the revolutionary constitutional and commercial speech changes that have occurred over the past three decades. A physician's legal right to advertise has developed as part of the evolutionary interpretation of the First Amendment of the U.S. Constitution. The purposes of this study were to determine (a) consumers' attitudes toward advertising by physicians and (b) whether city of residence, occupation, age, sex, race, marital status, number of children in household, total family household income, and education of the consumer accounted for any significant difference in attitude toward physicians who advertise. The intent was to discover information that would be useful to physicians in planning marketing strategies and improving the quality of their advertising. The study seems to confirm the belief of many marketing professionals that advertising and marketing clearly have a place in the future of health care services.
Siegler, E L; Levin, B W
Communication with dying patients and their families requires special skills to assist them in this extremely stressful period. This article begins with a case that illustrates many of the challenges of communicating with the dying. It then reviews the literature about communication with older patients at the end of life, focusing on physician-patient discussions, decision-making, advance directives, and cultural factors. The article concludes with a practical discussion of problems that physicians may encounter when working with older patients at the end of life and their families and recommendations to improve communication.
Hurst, S; Hull, S; DuVal, G; Danis, M
Background: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. Objective: To identify strategies used by physicians in dealing with ethical difficulties in their practice. Design, setting, and participants: National survey of internists, oncologists, and intensive care specialists by computer assisted telephone interviews (n = 344, response rate = 64%). As part of this survey, we asked physicians to tell us about a recent ethical dilemma they had encountered in their medical practice. Transcripts of their open-ended responses were analysed using coding and analytical elements of the grounded theory approach. Main measurements: Strategies and approaches reported by respondents as part of their account of a recent ethical difficulty they had encountered in their practice. Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as the
Klein, Lawrence E.; And Others
Physicians in an experimental group were surveyed to assess their knowledge of the effectiveness, cost, and side effects of antibiotics, and a tutorial was developed to modify some prescribing patterns. Prescribing patterns were statistically different. (Author/MLW)
Hudon, Catherine; Lambert, Mireille; Almirall, José
Abstract Objective To evaluate the reliability and validity of the newly developed Physician Enabling Skills Questionnaire (PESQ) by assessing its internal consistency, test-retest reliability, concurrent validity with patient-centred care, and predictive validity with patient activation and patient enablement. Design Validation study. Setting Saguenay, Que. Participants One hundred patients with at least 1 chronic disease who presented in a waiting room of a regional health centre family medicine unit. Main outcome measures Family physicians’ enabling skills, measured with the PESQ at 2 points in time (ie, while in the waiting room at the family medicine unit and 2 weeks later through a mail survey); patient-centred care, assessed with the Patient Perception of Patient-Centredness instrument; patient activation, assessed with the Patient Activation Measure; and patient enablement, assessed with the Patient Enablement Instrument. Results The internal consistency of the 6 subscales of the PESQ was adequate (Cronbach α = .69 to .92). The test-retest reliability was very good (r = 0.90; 95% CI 0.84 to 0.93). Concurrent validity with the Patient Perception of Patient-Centredness instrument was good (r = −0.67; 95% CI −0.78 to −0.53; P < .001). The PESQ accounts for 11% of the total variance with the Patient Activation Measure (r2 = 0.11; P = .002) and 19% of the variance with the Patient Enablement Instrument (r2 = 0.19; P < .001). Conclusion The newly developed PESQ presents good psychometric properties, allowing for its use in practice and research. PMID:26889507
Stukel, Therese A; Glazier, Richard H; Schultz, Susan E; Guan, Jun; Zagorski, Brandon M; Gozdyra, Peter; Henry, David A
Background Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. Methods We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed “loyalty” as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. Results We identified 78 multispecialty physician networks, comprising 12 410 primary care physicians, 14 687 specialists, and 175 acute care hospitals serving a total of 12 917 178 people. Median network size was 134 723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. Interpretation We demonstrated the feasibility
Adler-Milstein, Julia; Jha, Ashish K
In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not.
Jha, Ashish K
In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not. PMID:22517802
Wallace, Jean E; Lemaire, Jane B; Ghali, William A
When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.
... range of knowledge about medications and how the human body works and responds to the stress of surgery at all stages of a procedure. Think of physician anesthesiologists as your seat belt during ...
Dummit, Laura A
The Medicare program's physician payment method is intended to control spending while ensuring beneficiary access to physician services, but there are signs that it may not be working. The physician's role in the health care delivery system as the primary source of information and treatment options, together with growing demand for services and the imperfect state of knowledge about appropriate service use, challenge Medicare's ability to achieve these two goals. This issue brief describes the history of physician spending and the contribution of escalating service use and intensity of services to the rise in Medicare outlays, setting the stage for further discussion about the use of the Medicare payment system to control spending and ensure access.
Jacobson, P D; Pomfret, S D
The Employee Retirement Income Security Act (ERISA), enacted in 1974 to regulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in the relationship between themselves and managed care organizations (MCOs), including how it can influence clinical decision making and physician autonomy. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs. We analyze ERISA litigation trends in 4 areas: professional liability, utilization management, state legislative initiatives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should support efforts to amend ERISA, thus allowing greater state regulatory oversight of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.
Rijkenberg, A M; van Sprundel, M; Stassijns, G
Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and
Leichner, P.; Harper, D.
Physicians have been accused by some feminist writers of having traditional views on sex roles that make them part of society's oppressive power structure and therefore responsible in part for the high incidence of psychologic problems and drug dependency among women. To assess whether physicians' attitudes towards women are indeed polarized in a traditional fashion, a sex role ideology questionnaire was given to all practising physicians belonging to the Manitoba Medical Association. Overall the physicians were found to be more feminist than male college students and a group of women with traditional beliefs. Psychiatrists, who had the highest adjusted group mean score on a sex role ideology scale (high indicating feminist beliefs), were found to be significantly more feminist than family practitioners, surgeons, and obstetricians and gynecologists, although not more so than internists, radiologists, pediatricians and anesthesiologists. These findings do not support the assumption that physicians have traditional views that reflect those of society. However, the significant differences between specialties emphasize the need for educating physicians and medical students in the behaviour of women. PMID:7104916
Hiersche, H D
On February 2, 1975 the Federal Constitutional Court gave the indications for abortion. But the regulations are often misunderstood and are often contravened by mistake. Hence the following explanations are for the assistance of physicians. The sections discussed are sec. 218 (abortion), 218a (indications for abortion), 218b (abortion without advising the woman), 219 (abortion without a physician's order), 219a (wrongful physician's order), 219b (soliciting abortion), 219c (transporting the instruments used for abortion), and 219d (definition). The law recognizes only medical indications for abortion: the purely medical indication, the indication of damage to the fetus, the criminological indication, and the indication from extreme emergency. The law states clearly that no one is compelled to perform an abortion, whatever the consequences for the mother and fetus might be. The law provides for stages of notification: 1) the personal physician must provide in writing a well-grounded indication for abortion; 2) in the absence of a purely medical indication, the woman must at least 3 days before rupture request assistance from a social service agency or a physician with appropriate knowledge and skill; 3) the woman must have explained to her all aspects of abortion, not only the purely medical, but also the arguments of various kinds against it; and 4) the physician who undertakes to do the abortion is responsible for ensuring that all provisions of the law have been satisfied. The law provides that abortion may be done only in a hospital, i.e., a place where special arrangements for it may be made; it cannot be done on an outpatient basis.
Levine, R. J.
Inherent in the dual role of physician-researcher is a conflict of interest arising out of the competing objectives of research and medical practice. Most commentary and policy recommendations on this conflict of interest have focused on the problems that arise in negotiations for informed consent. These are not, however, the only problems presented by this conflict; they are not necessarily even the most important. In order to deal with these problems, several commentators have suggested various procedural safeguards to protect the interests of the patient-subject--for example, separating the roles of physician and researcher, or introducing third parties into the relationship in order to assist in the initial or continuing negotiations for informed consent. In my view, the necessity for special procedural protections of patient-subject interests should be a discretionary judgment of the Institutional Review Board (IRB). In determining the need for special procedural protections for any research protocol, the IRB should consider three factors. To the extent that any one of these or a combination of two or more seems to present a problem, the IRB should consider it increasingly important to recommend special procedural protections: 1. There are serious impairments of the prospective subjects' capacities to consent. 2. The risk of physical or psychological injury presented by procedures done in the interests of research exceeds the threshold of "a minor increment above minimal risk." 3. The protocol is designed to introduce, test, evaluate, or compare therapeutic, diagnostic, or prophylactic maneuvers. PMID:1519378
Dedouit, F; Tournel, G; Barguin, P; Becart-Robert, A; Hedouin, V; Gosset, D
Nearly two billion passengers travel each year on commercial air flights. More elderly people and/or people with a pre-existing condition are taking to the air and with the anticipated growth of air travel, in-flight illnesses and injuries are expected to increase as well. Even if in-flight medical events and deaths are still uncommon, physician passengers are occasionally called upon to render assistance. Although no case law exists as yet in France, physicians who often travel on commercial flights should be aware of the risks they run if they do not respond to the well-known call, 'Is there a doctor on board?', or if they assist a sick passenger. This paper describes in-flight resources available to a physician who is called upon to treat an ill or injured passenger. Two questions concerning the French physician passenger are discussed: What are the liabilities of the physician who does not respond to the call of a medical event aboard an aircraft? What are the liabilities of the physician providing assistance to a sick passenger? The different liabilities and also the legal status of the French physician passenger are examined.
Boom, R; Chavez-Oest, J; Gonzalez, C; Cantu, M A; Rivero, F; Reyes, A; Aguilar, E; Santamaria, J
Clinical data were collected in 194 cases of jaundiced patients treated at the "Adolfo Lopez Mateos" ISSSTE Hospital in Mexico City from July 1985 to July 1986. A copy of the clinical history of each patient was given to each of four physicians--one recently graduated from medical school, another in his first year of gastroenterology, and two others who were experienced gastroenterologists. The same clinical data were processed by a computer set up to use a modified Danish COMIC algorithm. All physicians and the computer technician were blinded to the "gold standard" pathologic diagnoses, with which their diagnoses were compared. Accuracy rates of the physicians in distinguishing intrahepatic (medical) from extrahepatic (surgical) jaundice were 78%, 86%, 86%, and 91%, and the accuracy of computer-assisted diagnoses was 96%. Chi-squared analysis of the diagnoses of three of the physicians and those of the computer showed significant differences (p between 0.1 and 0.01). For the diagnoses of the remaining physician, however, no significant difference was found after chi-squared continuity correction.
This article provides step-by-step instructions on how to complete the strategic planning needed to ensure success in physician recruitment efforts, outlines how to build a successful recruitment team, and provides helpful advice to avoid common recruiting mistakes that can sabotage the recruitment efforts of even the best practices. This article discusses the role of the in-house hospital recruiter in the recruitment process, how to evaluate independent search firms, how to make use of the physicians in your group to ensure success during a site visit, and how to ensure that your new hire will be able to successfully develop a practice. The article also discusses how to find and use benchmarking data to ensure that your compensation package is competitive, and provides advice on how to help your new physician hit the ground running.
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de Micheli, Alfredo
The fundamental aspects of Erasmus's ethic humanism consisted of ideals of universal peace and tolerance. These ideals are exposed in the great works of his maturity Colloquia and Adagia read and meditated on by renaissance physicians in England, Spain, Germany, Italy, and also in the New Spain. Erasmus's readers were learned and numerous. Among his pupils and supporters in Spain were humanist physicians of Madrid such as Doctors Suárez and Juan de Jarava. Other supporters were in the group of the Sevillian physicians and naturalists. Among the Erasmist physicians, residing in other regions was doctor Andrés Laguna, who translated into Spanish the Dioscorides treatise on medical botany. Many physicians living in New Spain owned copies of Erasmian works, such as Doctors Pedro López (the second) and Juan de la Fuente, who was in charge of the first medical chair at the University of Mexico. The protophysician Francisco Hernández, in response to a petition of Archbishop Pedro Moya de Contreras, wrote a Christian catechism of Erasmian influence, destined for humanists in NewSpain. As asserted by Johan Huizinga, Erasmus was the sole humanist who really wrote for everyone, i.e. for all cultured people.
Shaw, S; Goplen, G; Houston, D S
OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring. PMID:8625024
Rudnick, Abraham; Eastwood, Diane
As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011).
The purpose of the manual is to provide the medical assisting student a text which presents the common laboratory procedures in use today in physician's offices. The procedures for performing a complete urinalysis are outlined, along with those for carrying out various hematological tests. Information is also presented to help the student learn to…
Bergen, A F
Numerous resources exist for consumers who wish to explore the benefits of assistive technology. Consumers can tap into the knowledge base of rehabilitation technology suppliers, therapists, and physicians, and follow a step-by-step process to use new technologies to improve their daily lives.
Flaherty, Emalee G; Sege, Robert
Physicians systematically underidentify and underreport cases of child abuse. These medical errors may result in continued abuse, leading to potentially severe consequences. We have reviewed a number of studies that attempt to explain the reasons for these errors. The findings of these various studies suggest several priorities for improving the identification and reporting of child maltreatment: Improve continuing education about child maltreatment. Continuing education should focus not only on the identification of maltreatment but also on management and outcomes. This education should include an explanation of the role of CPS investigator and the physician's role in an investigation. The education should provide physicians with a better understanding of the overall outcome for children reported to CPS to help physicians gain perspective on the small number of maltreated children they may care for in their practice. This education should emphasize that the majority of maltreated children will benefit from CPS involvement. New York is the only state that mandates all physicians, as well as certain other professionals, take a 2-hour course called Identification and Reporting of Child Abuse and Maltreatment prior to licensing. Cited studies in this article suggest that such a mandate might be expected to improve identification and reporting, thereby encouraging other states to adopt similar regulations. Give physicians the opportunity to debrief with a trained professional after detecting and reporting child abuse. The concept of child abuse and the gravity of the decision to report can be troubling to the reporter. The debriefing could include discussions of uncomfortable feelings physicians may experience related to their own countertransference reactions. Provide resources to assist physicians in making the difficult determination of suspected maltreatment. The role of accessible telephone consultation should be evaluated, along with formalized collaborations
Harris, John M; Kaplan, Karin Chernoff
Strong hospitals and health systems should be on the lookout for opportunities today to acquire physician businesses at depressed fair market values. In some instances, an outright purchase of physicians' interest in a physician-hospital joint venture may be preferable; in others, the hospital may benefit more from simply increasing its interest in the venture. A critical part of the strategy should be taking steps to ensure the physicians remain engaged, including addressing physicians' income goals and need for control.
Christ, L. W. A. C.; Harris, A. L.; Korchinski, E. D.
This study was conducted to examine the characteristics of ‘initial visits’ by patients, contrasted with ‘average visits’, to discover what is needed to establish a satisfactory patient-physician relationship leading to long term continuous care. In the initial visit, the patient presents with a relatively simple problem which will enable the physician to demonstrate his ability without unduly taxing his skills. This suggests that patients create an opportunity for a thorough face-to-face contact to provide an opportunity for the physician to display his ability so that the patient's desire for a long term relationship can be achieved. The study also suggests that patients' expectations have changed in proportion to changes in the mode of medical practice. PMID:21308071
... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...
... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians....
... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...
... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians....
... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of...
The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs.
Jacobs, Jeffrey P; Lahey, Stephen J; Nichols, Francis C; Levett, James M; Johnston, George Gilbert; Freeman, Richard K; St Louis, James D; Painter, Julie; Yohe, Courtney; Wright, Cameron D; Kanter, Kirk R; Mayer, John E; Naunheim, Keith S; Rich, Jeffrey B; Bavaria, Joseph E
Strategies to value physician work continue to evolve. The Society of Thoracic Surgeons and The Society of Thoracic Surgeons National Database have an increasingly important role in this evolution. An understanding of the Current Procedural Terminology (CPT) system (American Medical Association [AMA], Chicago, IL) and the Relative Value Scale Update Committee (RUC) is necessary to comprehend how physician work is valued. In 1965, with the dawn of increasingly complex medical care, immense innovation, and the rollout of Medicare, the need for a common language describing medical services and procedures was recognized as being of critical importance. In 1966, the AMA, in cooperation with multiple major medical specialty societies, developed the CPT system, which is a coding system for the description of medical procedures and medical services. The RUC was created by the AMA in response to the passage of the Omnibus Budget Reconciliation Act of 1989, legislation of the United States of America Federal government that mandated that the Centers for Medicare & Medicaid Services adopt a relative value methodology for Medicare physician payment. The role of the RUC is to develop relative value recommendations for the Centers for Medicare & Medicaid Services. These recommendations include relative value recommendations for new procedures or services and also updates to relative value recommendations for previously valued procedures or services. These recommendations pertain to all physician work delivered to Medicare beneficiaries and propose relative values for all physician services, including updates to those based on the original resource-based relative value scale developed by Hsaio and colleagues. In so doing, widely differing work and services provided can be reviewed and comparisons of their relative value (to each other) can be established. The resource-based relative value scale assigns value to physician services using relative value units (RVUs), which consist
Meyer, Donald J; Price, Marilyn
In the United States, oversight of health care practitioners is delegated to a matrix of health care entities including but not limited to the state medical board which licenses physicians in the relevant jurisdiction. Typically, these organizations have their own codes of professional conduct. When a physician joins one of these health care organizations, legally the physician has entered into a contract with the organization and agreed to be bound by its regulations and procedures. The organization's peer review of a member physician for reasons of investigating questions of health care quality may require a psychiatric fitness for duty evaluation. That assessment is a forensic psychiatric examination to assist the peer review body much as an expert witness would assist the trier of fact in a criminal or civil law adjudication. Experts can better perform these functions if they are familiar with the legal differences that define these agencies' service under administrative as compared to civil or criminal law and procedures.
... Mortality Series 21. Data on Natality, Marriage, and Divorce Series 22. Data from the National Natality and ... Compilations of Data on Natality, Mortality, Marriage, and Divorce Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard ...
Lewitzka, Dr U; Bauer, R
Suicidal thoughts and behavior have been a part of human nature since the beginning of mankind. In his autobiographical work From my Life: Poetry and Truth Goethe summarized two important aspects: "Suicide is an event of human nature which, whatever may be said and done with respect to it, demands the sympathy of every man, and in every epoch must be discussed anew". The authors of this article aim to motivate the readership to question and analyze this complex topic and the accompanying multifaceted positions with a summarized presentation of historical aspects and the more recent political developments.
Hendin, Herbert; Foley, Kathleen
This Article examines the Oregon Death with Dignity Act from a medical perspective. Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The problem lies primarily with the Oregon Public Health Division ("OPHD"), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients. We make explicit suggestions for what OPHD would need to do to change that.
McBride, Jennifer M.; Drake, Richard L.
Healthcare providers in all areas and levels of education depend on their knowledge of anatomy for daily practice. As educators, we are challenged with teaching the anatomical sciences in creative, integrated ways and often within a condensed time frame. This article describes the organization of a clinical anatomy course with a peer taught…
Ross, David S.; Ferguson, Alishia; Herbert, David L.
Context: Physicians need to consider medical-legal issues when volunteering their time to assist with community mass-participation and athletic events. This article also reviews medical-legal aspects of the volunteer physician’s out-of-state practice. Seven cases illustrate the importance of expertise and planning to avoid legal issues for the volunteer event physician. Evidence Acquisition: Relevant studies, expert opinion, medical-legal legislation, and medical-legal cases were reviewed. Results: Physicians typically make 4 common assumptions regarding these types of events: Good Samaritan legislation, event liability insurance, personal liability insurance, and waivers. We discuss the intent of these assumptions and the reality of how, or how not, they provide any protection to the volunteer event physician. Conclusion: The intent of this article is to make physicians aware of medial-legal issues when volunteering their time for community and athletic events. PMID:24459551
Given that the enactment of the Patient Protection and Affordable Care Act of 2010 is expected to generate forces toward physician-hospital integration, this study examined an understudied, albeit important, area of costs incurred in physician-hospital integration. Such costs were analyzed through 24 semi-structured interviews with physicians and hospital administrators in a multiple-case, inductive study. Two extreme types of physician-hospital arrangements were examined: an employed model (ie, integrated salary model, a group of physicians integrated by a hospital system) and a private practice (ie, a physician or group of physicians who are independent of economic or policy control). Interviews noted that integration leads to 3 evident costs, namely, monitoring, coordination, and cooperation costs. Improving our understanding of the kinds of costs that are incurred after physician-hospital integration will help hospitals and physicians to avoid common failures after integration.
Winter, Robin O.
Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…
Wisconsin Univ., Madison. Dept. of Postgraduate Medical Education.
This document reports the procedures and data of a study designed to examine the hypotheses that medical practices do vary significantly. Detailed data on 76 participants were collected; three mechanisms were developed to determine the needs of primary care physicians. These mechanism were: subjective analysis by both participants and study staff,…
Trueswell, R.W.; Rubenstein, A.H.
The purpose of this study was to provide some preliminary data about the information-searching behavior of the physician in order to (1) facilitate the development of models describing the search behavior and (2) provide the behavioral data necessary for the development of effective information retrieval systems for use by the medical profession.…
Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.
Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)
Heller, R H
Prudent examination and knowing how to ask the "right questions" can enable hospital marketers and planners to find the most accurate and appropriate database. The author compares the comprehensive AMA physician database with the less expensive MEDEC database to determine their strengths and weaknesses.
As marketing department missions continue to expand, more and more people are finding themselves not just recruiting customers, but doctors. The good news: May of the tips and tricks of direct marketing can be used to reach out to in-demand physicians.
Weisz, George M.
The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler. PMID:25120923
Schoj, Veronica; Mejia, Raul; Alderete, Mariela; Kaplan, Celia P.; Peña, Lorena; Gregorich, Steven E.; Alderete, Ethel; Pérez-Stable, Eliseo J.
Background Physician-implemented interventions for smoking cessation are effective but infrequently used. We evaluated smoking cessation practices among physicians in Argentina. Methods A self-administered survey of physicians from six clinical systems asked about smoking cessation counselling practices, barriers to tobacco use counselling and perceived quality of training received in smoking cessation practices. Results Of 254 physicians, 52.3% were women, 11.8% were current smokers and 52% never smoked. Perceived quality of training in tobacco cessation counselling was rated as very good or good by 41.8% and as poor/very poor by 58.2%. Most physicians (90%) reported asking and recording smoking status, 89% advised patients to quit smoking but only 37% asked them to set a quit date and 44% prescribed medications. Multivariate analyses showed that Physicians’ perceived quality of their training in smoking cessation methods was associated with greater use of evidence-based cessation interventions. (OR = 6.5; 95% CI = 2.2–19.1); motivating patients to quit (OR: 7.9 CI 3.44–18.5), assisting patients to quit (OR = 9.9; 95% CI = 4.0–24.2) prescribing medications (OR = 9.6; 95% CI = 3.5–26.7), and setting up follow-up (OR = 13.0; 95% CI = 4.4–38.5). Conclusions Perceived quality of training in smoking cessation was associated with using evidence-based interventions and among physicians from Argentina. Medical training programs should enhance the quality of this curriculum. PMID:27594922
House, Sherita; Havens, Donna
The purpose of this systematic review was to explore nurses' and physicians' perceptions of nurse-physician collaboration and the factors that influence their perceptions. Overall, nurses and physicians held different perceptions of nurse-physician collaboration. Shared decision making, teamwork, and communication were reoccurring themes in reports of perceptions about nurse-physician collaboration. These findings have implications for more interprofessional educational courses and more intervention studies that focus on ways to improve nurse-physician collaboration.
Selecky, Christobel; Peck, Charles A
The troubled economy and a new administration in Washington have reinvigorated the debate over the merits of disease management programs and the savings they bring to healthcare. At the forefront of the discussion are physicians who are discovering disease management's innovative approach to treating the chronically ill. Across the country, physicians are responding to evidence-based programs designed to improve patient outcomes that, at the same time, assist them in reaching pay-for-performance goals. New research shows that when disease management professionals provide physicians with credible information, course corrections are made more than 85% of the time.
Orman, M C
Early attempts to understand the causes of physician stress focused almost exclusively upon the role of external stressors and demands. Recent psychosocial and behavioral research, however, suggests that individual attitudes, beliefs, personality factors, and learned coping strategies probably play a more important role. In addition, such cognitive and behavioral tendencies are within the control of each individual, and clinical experience has shown that these factors can indeed be modified. Freudenberger noted that most health professionals who are experiencing high levels of stress fail to identify the role that they themselves play in generating such symptoms. Instead, they tend to blame others as the cause of their problems and tend to react cynically toward suggestions that they could benefit from help. A large-scale study of family physicians in North Carolina, conducted by May, Revicki, and Jones in 1983, confirmed the fact that most physicians who reported a high level of professional stress also tended to score high on measures of external locus of control--i.e. the perception that external or environmental factors are mainly responsible for one's problems or successes. My own experience in treating physicians and other people with stress tends to confirm these findings. More importantly, I have found that once individuals are helped to identify the role that their own cognitive and behavioral tendencies play in the origin of their stress, they can usually bring about impressive reductions in stress and tension without significant changes in environmental factors or demands. While many people advocate stress-releasing and other relaxation skills for physicians, I have found that such approaches are often counterproductive.(ABSTRACT TRUNCATED AT 250 WORDS)
Jian, Wei-yan; Xiong, Xian-jun; Li, Jing-hu; Ding, Yang; Wang, Li-li; Guo, Yan
This study compares physicians' regulations set by the United Kingdom, the United States, Canada and Germany which have typical healthcare systems. Physicians' regulations are defined in this study as four aspects: physicians' training and qualifications, career pathways, payment methods and behavior regulations. Strict access rules, practicing with freedom, different training models between general and special practitioners, health services priced by negotiations and regulations by professional organizations are the common features of physicians' regulations in these four western countries. Three aspects--introducing contract mechanism, enhancing the roles of professional organizations and extending physicians' practice space should be taken into account in China's future reform of physicians' regulations.
Time is the greatest negative financial burden that you accept as a sports medicine physician, because the only way to produce revenue as a physician is with your time. This cost measured in time of doing business as a team physician can be high. Unless being a team physician is very rewarding to you through personal satisfaction or the other intangible indirect benefits associated with the role, being a team physician may not be a good financial decision for you as a person and a physician, or for your practice and your family.
... Membership | JAMA Network | AMA Store DoctorFinder This online physician Locator helps you find a perfect match for ... with basic professional information on virtually every licensed physician in the United States. This includes more than ...
A joint venture is allowing the AMA to refine the physician data it sells to marketers. Physicians in the organization's heavily used database get some latitude in how information about them is distributed.
... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...
... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...
... correct a subluxation shown by X-ray or clinical findings. Physicians defined in this part may interpret their own X-rays. All physicians in these categories are authorized by the Director to render...
Individualized physician performance reports are an emerging phenomena. The narrative piece examines one physician’s experience with individualized physician performance reports. Reforming the data collection process could enhance the value of the reports to stakeholders. PMID:20838915
Gallucci, Armen; Deutsch, Thomas; Youngquist, Jaymie
The authors attempt to simplify the key elements to the process of negotiating successfully with private physicians. From their experience, the business elements that have resulted in the most discussion center on the compensation including the incentive plan. Secondarily, how the issue of malpractice is handled will also consume a fair amount of time. What the authors have also learned is that the intangible issues can often be the reason for an unexpectedly large amount of discussion and therefore add time to the negotiation process. To assist with this process, they have derived a negotiation checklist, which seeks to help hospital leaders and administrators set the proper framework to ensure successful negotiation conversations. More importantly, being organized and recognizing these broad issues upfront and remaining transparent throughout the process will help to ensure a successful negotiation.
PERSECHINO, Benedetta; FONTANA, Luca; BURESTI, Giuliana; RONDINONE, Bruna Maria; LAURANO, Patrizia; FORTUNA, Grazia; VALENTI, Antonio; IAVICOLI, Sergio
A good cooperation between occupational physicians and other healthcare professionals is essential in order to achieve an overall improvement of workers/patients’ well-being. Unfortunately, collaboration between occupational physicians and other physicians is often lacking or very poor. In this context, using a self-administered questionnaire, we investigated the cooperation of Italian occupational physicians with the National Health System (NHS) facilities and with the general practitioners in order to identify any potential critical issues that may hinder an effective and collaborative relationships between these professionals. The survey was conducted from October 2013 to January 2014. Nearly all of the interviewed occupational physicians have had contacts with colleagues of the Departments for Prevention and Occupational Health and Safety of the NHS. Regarding the relationship between occupational physicians and general practitioners findings showed that their cooperation is quite difficult and it would not seem a two-way collaboration. Cooperation between occupational physicians and NHS would benefit from the development of communication strategies and tools enhancing the support and assistance functions of the NHS facilities. The elaboration and subsequent application of operational guidelines and standardized procedures of communication would also improve collaboration between occupational physicians and general practitioners that is currently considered rather insufficient and incomplete. PMID:27733729
Forti, E M; Martin, K E; Jones, R L; Herman, J M
Family physicians provide the greatest proportion of care in rural communities. Yet, the number of physicians choosing family practice and rural practice has continued to decline. Undesirable aspects of rural practice, such as professional isolation and a lack of or inadequate resources, are assumed to be associated with this decline. This article reports on the practice support and continuing medical education needs of rural family physicians. A mail survey was conducted in 1993 on a purposive sample of family physicians in 39 of 67 rural-designated or urban Pennsylvania counties with low population densities. The physicians identified needs that included patient education materials and programs, community health promotion, federal regulation updates, technical assistance with computers and business management, database software and a videotape lending library, a drug hotline, and mini-fellowships on clinical skill development. A majority of respondents were willing to participate in clinical educational experiences for students and residents. Some physicians indicated a lack of interest in access to information through telecommunications, e.g., video conference referrals and consultations. Overall, findings revealed that family physicians need and are receptive to a variety of practice support and continuing education programs. A practice support program coupled with policy coordination among public and private organizations is likely to lessen complaints by rural primary care physicians.
An effective strategy for creating a viable physician compensation plan should include nine key steps or tactics: Get physicians on board early. Engage a physician champion. Create a compensation committee. Address department-level issues and differences. Verify the plan's affordability. Adopt a routine review schedule. Understand the payer environment and keep in contact with payers. Stay abreast of industry trends. Maintain an ongoing dialogue with physicians.
Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay
An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.
Cameron, R. D. A.
Fiber-optic endoscopy is an important investigation of the lower gastrointestinal tract, whether or not the radiologist has discovered a lesion. Colonoscopy affords a unique opportunity to visualize the entire colonic mucosa. At the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli. Most experienced endoscopists can reach the cecum in over 90% of patients. If colonoscopy is properly performed, it has a low risk of complications, such as perforation and bleeding. The few absolute contraindications include serious illnesses such as acute myocardial infarction and severe acute inflammatory bowel diseases. Family physicians referring patients for investigations of lower gastrointestinal problems should explain that colonoscopy is an adjunct to, not a replacement for, a barium enema examination. If possible they should find out what preparation the patient will require. PMID:21283399
Most doctors complete their medical training without sufficient knowledge of business and finance. This leads to inefficient financial decisions, avoidable losses, and unnecessary anxiety. A big part of the problem is that the existing options for gaining financial knowledge are flawed. The ideal solution is to provide a simple framework of financial literacy to all students: one that can be adapted to their specific circumstances. That framework must be delivered by an objective expert to young physicians before they complete medical training.
Scelles, Regine; Aubert-Godard, Anne; Gargiulo, Marcela; Avant, Monique; Gortais, Jean
In this study, 12 physicians and 12 care-givers were interviewed using semi-structured interviews. We explored physicians' experiences when they revealed a diagnosis. We also tried to understand which family members the physician was thinking of, with whom they identified themselves, and their first choice of the person to whom they prefer to…
Scharf, Eugene L; Jones, Lyell K
The increasing cost of attending medical school has contributed to increasing physician indebtedness. The burden of medical school debt has implications for physician career choice, professional satisfaction, and burnout. This opinion discusses the impact of physician indebtedness, the importance of improving debt awareness among neurology trainees, and program- and policy-level solutions to the debt crisis.
Herring, Malcolm; Forbes Kaufman, Rachel; Bogue, Richard
The importance of a person's spirit and eternal destiny are eclipsed in American medi- cine. The most alarming effect of this eclipse is that the prevalence of burnout among physicians is high (about 46 percent) and growing.' It is alarming because trends that deplete the physician's spirit tragically impair the physician's capacity as a healer and as one who renews the spirit.
... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...
... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...
... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...
Mohler, S R
In the U. S. there are 23 recognized medical specialty boards. One of these is preventive medicine. Within preventive medicine there are three areas: Aerospace Medicine, Occupational Medicine, and Public Health/General Preventive Medicine. The preventive medicine specialties have a common core of required training including biostatistics, epidemiology, health services administration and environmental health. These, plus associated topics are covered during year one of training. Year two of training involves clinical rotations specifically tailored to the eye, ear, heart, lungs and brain, plus flight training to the private pilot level, and a Masters Degree research project for the required thesis. During year three the physicians in aerospace medicine practice full-time aerospace medicine in a NASA or other government laboratory or a private facility. To date, more than 40 physicians have received aerospace medicine training through the Wright State University School of Medicine program. Among these are physicians from Japan, Australia, Taiwan, Canada and Mexico. In addition to the civilian program at Wright State University, there are programs conducted by the U. S. Air Force and Navy. The Wright State program has been privileged to have officers from the U. S. Army, Navy and Air Force. A substantial supporter of the Wright State program is the National Aeronautics and Space Administration and a strong space component is contained in the program.
Lavery, J V; Dickens, B M; Boyle, J M; Singer, P A
Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.
Fujino, Haruo; Saito, Toshio; Matsumura, Tsuyoshi; Shibata, Saki; Iwata, Yuko; Fujimura, Harutoshi; Shinno, Susumu; Imura, Osamu
Communicating about Duchenne muscular dystrophy and its prognosis can be difficult for affected children and their family. We focused on how physicians provide support to the mothers of children with Duchenne muscular dystrophy who have difficulty communicating about the condition with their child. The eligible participants were certified child neurologists of the Japanese Society of Child Neurology. Participants responded to questionnaires consisting of free descriptions of a vignette of a child with Duchenne muscular dystrophy and a mother. We analyzed 263 responses of the participants. We found 4 themes on advising mothers, involving encouraging communication, family autonomy, supporting family, and considering the child's concerns. These results provide a better understanding of the communication between physicians and family members who need help sharing information with a child with Duchenne muscular dystrophy. These findings will assist clinical practitioners in supporting families and the affected children throughout the course of their illness.
Leach, M. M.; Bethune, C.
Millions of adults have been sexually abused. Patients often confide in their family physicians concerning their abuse. Physicians must understand their own issues surrounding sexual abuse and its sequelae before they attempt to treat sexually abused patients. The PLISSIT model offers a practical guide for assisting abused adult patients. PMID:8924817
Gjerdingen, D K; Simpson, D E
Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.
Strecher, V J
The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.
Briscoe, Forrest; Konrad, Thomas R.
OBJECTIVES: To assess the level and determinants of African-American physicians' employment in health maintenance organizations (HMOs), particularly early in their careers. METHODS: We analyzed data from the 1991 and 1996 Young Physicians Surveys to assess racial differences in the likelihood of HMO employment (n = 3,705). Using multinomial logistic regression, we evaluated four explanations for an observed relationship between African-American physicians and HMO employment: human capital stratification among organizations, race-based affinity between physicians and patients, financial constraints due to debt burden, and different organizational hiring practices. Using binomial logistic regression, we also evaluated differences in the odds of being turned down for a prior practice position, of subsequently leaving the current practice organization and of later having career doubts. RESULTS: Without any controls, African-American physicians were 4.52 times more likely to practice in HMOs than Caucasian physicians. After controlling for human capital stratification, racial concordance and financial constraints, African-American physicians remained 2.48 times more likely to practice in HMOs than Caucasian physicians. In addition, 19.2% of African-American physicians in HMOs reported being turned down for another job, far more than any other racial/ethnic group in the HMO setting and any racial/ethnic group, including African-American physicians in the non-HMO setting (including all other practice locations). Five years later, those same African-American physicians from HMOs also reported significantly more turnover (7.50 times more likely than non-HMO African-American physicians to leave their current practice) and doubt about their careers (2.17 times more likely than non-HMO African-American physicians to express serious career doubts). CONCLUSIONS: African-American physicians were disproportionately hired into HMO settings, impacting their subsequent careers. PMID
Sorrel, Amy Lynn
The Association of American Medical Colleges has revamped the MCAT for the first time in nearly three decades. While the new exam retains the science-based testing historically included, it adds new topics and approaches meant to keep up with a rapidly changing health care delivery system. It aims to test and train aspiring physicians based less on memorizing scientific facts and more on competency: putting that scientific knowledge into practice. Questions on the new MCAT pertain to concepts such as self-identity, social stratification, and multiculturalism and ask students to apply them to certain scenarios.
López-Valpuesta, F J; Hevia, A; Castellanos, A; Vázquez, J A
We inquired to 200 physicians about the 50 pharmaceutical products most dispensed in Seville during 1989. The most significative results were: 68.5% of the inquired answered the questionnaire. 98.5% knew the product, but only 80.3% prescribed it. The principal sources of information to know the drug were books and scientific journals (67.3%), followed by detailers (62%). 86.1% knew the composition of the product, and 94.9% knew its indications. 71.5% described the side effects, 66.4% the contraindications, and 25.5% the interactions with other drugs. Only 56.9% mentioned a therapeutic alternative.
Mahady, Suzanne E
Demographic changes among junior doctors are driving demand for increased flexibility in advanced physician training, but flexible training posts are lacking. Suitable flexible training models include flexible full-time, job-share and part-time positions. Major barriers to establishing flexible training positions include difficulty in finding job-share partners, lack of funding for creating supernumerary positions, and concern over equivalence of educational quality compared with full-time training. Pilot flexible training positions should be introduced across the medical specialties and educational outcomes examined prospectively.
The physician rights may be classified in those related with his quality as a person, and those derived from his relationship with his patients and the institution to which he belongs. Among the first, liberty of expression, legal security, right of free association, the right of a dignified social position and neutral attitude towards the commitment of giving medical attention to whomever the patient may be. He has the right to receive a full and up-to-date training oriented to serve the community, supported by health institutions, and to have the means of utmost quality to give medical attention of the highest standard.
December is a busy month for holiday fun, but don't neglect your financial health! Physicians should review their business and personal finances at year end to ensure they are on target both for income generated and taxes paid. Preparing for the April 15 tax filing is aided by a thorough review in December. Payroll items such as W2s, 1099s, and employee benefits need to be reviewed. Retirement savings should be analyzed. Make sure to look at your business profit/loss statement and balance sheet. Personal contributions and other tax planning strategies need to be completed by the end of the year. Your CPA can help!
Penistan, J. L.
A clinical laboratory documentation system is described, suitable for community hospitals without computer services. The system is cumulative and is designed to provide the laboratory physician with the clinical information necessary for intelligent review and comment on the laboratory's findings. The mode of presentation of requests to the laboratory and lay-out of the reports to the clinicians are designed to make the two-way communication as close and personal as possible; to encourage the selection of those investigations likely to prove rewarding, and to discourage unnecessary investigation. The possibility of important data escaping notice is minimized. The system is economical in capital equipment, labour and supplies. PMID:4758594
Raybould, Ted P; Wrightson, A Stevens; Massey, Christi Sporl; Smith, Tim A; Skelton, Judith
Childhood oral disease is a significant health problem, particularly for vulnerable populations. Since a major focus of General Dentistry Program directors is the management of vulnerable populations, we wanted to assess their attitudes regarding the inclusion of physicians in the prevention, assessment, and treatment of childhood oral disease. A survey was mailed to all General Practice Residency and Advanced Education in General Dentistry program directors (accessed through the ADA website) to gather data. Spearman's rho was used to determine correlation among variables due to nonnormal distributions. Overall, Advanced General Dentistry directors were supportive of physicians' involvement in basic aspects of oral health care for children, with the exception of applying fluoride varnish. The large majority of directors agreed with physicians' assessing children's oral health and counseling patients on the prevention of dental problems. Directors who treated larger numbers of children from vulnerable populations tended to strongly support physician assistance with early assessment and preventive counseling.
Rudder, Meghan; Tsao, Lulu; Jack, Helen E
Recent passage of the Massachusetts law, An Act Relative to Substance Use, Treatment, Education, and Prevention, represents an admirable public health approach to substance use disorder (SUD), a stigmatized chronic disease that affects some of society's most vulnerable people. With its seven-day supply limit on first-time opioid prescriptions, this legislation takes an unusual approach to state government involvement in health care. By intervening in individual physicians' practices, state legislators have entered a space traditionally reserved for clinical teams. The seven-day supply limit and the process through which it was developed highlight competing priorities and dialogue between physicians and legislators, limits of physician self-regulation, and standards of evidence in policy making and health care. Addressing these issues requires both physicians and legislators to recognize and fulfill new responsibilities in order to better assist the populations they serve.
Holsinger, James W; Beaton, Benjamin
During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society.
... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to physician-administered drugs. 447.520 Section 447.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...
... 42 Public Health 4 2014-10-01 2014-10-01 false FFP: Conditions relating to physician-administered drugs. 447.520 Section 447.520 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for...
Gibson, Denise D.; Borges, Nicole J.
In its 2004 spring report, the Institute of Medicine (IOM) posits that Behavioral Sciences provides a perspective that can assist physicians in understanding their patients as embedded in a larger social and environmental context (Patricia A. Cuff and Neal Vanselow, Editors, Improving Medical Education: Enhancing the Behavioral and Social Science…
Woolf, Colin R.
Replies of 35 physicians practicing in rural Ontario detailed their learning needs for the Personal Continuing Education Plan. Desired structured learning topics emphasized updates on acute aspects of diseases in course format. Preferences for self-learning were for reprints rather than abstracts; 23 percent desired computer-assisted instruction.…
Pronovost, Peter J; Miller, Marlene R; Wachter, Robert M; Meyer, Gregg S
While advances in biomedicine are awesome, progress in patient safety and quality of care has proven slow and arduous. One factor contributing to the labored progress is the paucity of physician-leaders who can help advance the science and practice of quality and safety. This limited talent pool, which has particularly serious consequences in academic medical centers (AMCs), stems from insufficient training in quality and safety, which in turn owes to our collective failure to view the delivery of health care as a science. Even when AMCs have trained and skilled quality and safety leaders, the infrastructure to support their work is deficient, with poorly defined job descriptions, competing responsibilities, and limited formal roles in the medical school compared with the hospital. Though there is limited empiric evidence to guide recommendations, the authors support four initiatives to accelerate national progress on quality and safety: (1) invest in quality and safety science, (2) revise quality and safety governance in AMCs, and (3) integrate roles within the hospital and medical school. Many of these shortcomings can be addressed by creating a newly integrated role: the vice dean for quality and hospital director of quality and safety. For AMCs to achieve significant improvements in quality and safety, they must invest in physician-leaders and in the support these leaders need to carry out their educational and operational roles.
Garneau, William M; Harris, Dean M; Viera, Anthony J
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
During the past few months, the discussion over the physicians' "Right of Conscience" (ROC) has been on the rise. The intervention of politics in this issue shifts the discussion to a very specific and narrow area, namely the "reproductive health laws" which bear well-known predisposing attitudes. In this article, the physician's ROC is discussed in the context in which it naturally belongs: the Patient Physician Relationship (PPR). I suggest that the physicians' rights demand is a comprehensible, predictable, and even inevitable step as part of the "evolution" of the PPR. Thus, the most appropriate way to comprehend and tackle the demand for physicians' ROC is within the context of medical professionalism. While searching for practical solutions to the "reproductive health" problems, there is a need to recognize the ethical and practical implications of the change in the PPR and balance between patient and physician rights.
Paterick, Timothy E
The landscape of healthcare is changing rapidly. That landscape is now a business model of medicine. That rapid change resulting in a business model is affecting physicians professionally and personally. The new business model of medicine has led to large healthcare organizations hiring physicians as employees. The role of a physician as an employee has many limitations in terms of practice and personal autonomy. Employed physicians sign legally binding employment agreements that are written by the legal team working for the healthcare organization. Thus physicians should practice due diligence before signing the employment agreement. "Due diligence" refers to the care a reasonable person should take before entering into an agreement with another party. That reasonable person should seek expertise to represent his or her interests when searching a balanced agreement between the physician and organization.
Dickerson, David M; Naidu, Ramana K
In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Centers for Medicare and Medicaid Services any payments or transfers of value to physicians. These reports are not meant to prohibit relationships between physicians and industry, but rather to generate a searchable public database illustrating the purpose of the payment, the entities involved, and the timing of each occurrence. Although the bill is meant to reveal physician-industry relationships, the question of how society at large and the medical field will interpret these data are unknown. The purpose of this article is to inform physicians of the components of the Physician Payment Sunshine Act. We discuss several resultant challenges and suggest a framework for preparing for transparency reporting and its potential effects.
Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew
In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.
Piper, Llewellyn E
This timely article provides current information on an age-old issue of disruptive physician behavior within the hospital setting. Documented in medical literature over 100 years ago, disruptive physician behavior has been an ongoing challenge to the hospital staff and the quality of patient care in the hospital. Covered in this article are the negative consequences of disruptive physician behavior and the call to respond. If allowed to go unchecked, a physician exhibiting disruptive behavior may threaten a hospital's image, staff morale, finance, and quality of care. Failure to respond undermines the leadership of the hospital and the trust of the community in the hospital's mission. Included in this article are suggestions obtained from the literature and from the author's experience in responding to disruptive physician behavior. Of emphasis is a methodology that includes supporting bylaws and policies to manage disruptive physician behavior.
Drakulić, Velibor; Bagat, Mario; Golem, Ante-Zvonimir
The aim of this study was to show regional distribution of physicians in Croatia. Number of physicians members of the Croatian medical chamber and number of physicians in the system of mandatory health insurance were compared between the counties. In 2006 in Croatia there were 276 physicians per 100,000 inhabitants, i.e., 215 physicians per 100,000 inhabitants in the system of mandatory health insurance. The fewer number of physicians per 100,000 inhabitants in the system of mandatory health insurance, less then 150, were in Koprivnica-Krizevci County, Lika-Senj County and Vukovar-Srijem County, while the greatest number of physicians, more than 250 per 100,000 inhabitants, were in the City of Zagreb and Zagreb County, and Primorje-Gorski kotar County. There were significant differences in the number of physicians per 100,000 inhabitants between the counties (chi2 = 148.7, DF = 19, P < 0.001, chi2-test). Number of general practitioners (GPs) per 100,000 inhabitants in Croatia were 54.2, with range from 47.1 in Pozega-Slavonia County to 61.8 in Primorje-Gorski kotar County. Number of physician specialties in four basic specialties per 100,000 inhabitants in Croatian hospitals were for internal medicine 19.1, general surgery 11.0, gynecology and obstetrics 6.7 and pediatrics 7.8. There were significant differences in the number of physicians in four specialties (internal medicine, general surgery, gynecology and obstetrics and pediatrics) per 100,000 inhabitants between the counties (chi2 = 76.0, DF = 19, P < 0.001, chi2-test). Apart from the insufficient number of physicians in Croatia, an inadequate allocation of physicians in certain counties is also evident.
O'Malley, Ann S; Reschovsky, James D
After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.
Sewell, Abigail A
Past research yields mixed evidence regarding whether ethnoracial minorities trust physicians less than Whites. Using the 2002 and 2006 General Social Surveys, variegated ethnoracial differences in trust in physicians are identified by disaggregating a multidimensional physician trust scale. Compared to Whites, Blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are less likely than Whites to trust the fiduciary ethic, technical judgment, and interpersonal competence of doctors. Black-Latino differences in physician trust are a function of ethnoracial differences in parental nativity. The ways ethnoracial hierarchies are inscribed into power-imbalanced clinical exchanges are discussed.
Confucianism gradually permeated and influenced the development of TCM from the Song dynasty, and the term "Confucian physician" is still in use today. With the impact of Confucianism, whether in the compilation of the medical classics or the explanation and conclusion of the medical theories as well as in medical education and ethics, all developed dramatically. But the Confucianism had also a negative effect on the development of medicine. For example, SU Dong-po cured the epidemics with "Sheng san zi", but he exaggerated its action and recorded it. The later intellectuals learnt from him without differentiation and many people suffered. Another example is, with the influence of ideas of "serve the parents" and "help the public", adult children treated their parents by cutting their own thigh. Even some wealthy and intelligent people blindly applied the prescription without differentiation.
Thomas, Edward Llewellyn
The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician. He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics. PMID:5908727
Lyznicki, James M; McCaffree, Mary Anne; Robinowitz, Carolyn B
Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities.
Pcbs are widespread environmental contaminants present in virtually every mammal on earth. Great controversy and debate has been evoked over the past two decades concerning their potential toxicity. They, along with other organochlorine compounds such as DDT, have been reasonably well studied in field and experimental situations. In general, PCBs are not very toxic, especially in concentrations to which most people are exposed, even those who work in the industrial setting or who eat contaminated fish. In terms of environmental hazards to health, PCBs should be considered as relatively low on the list. The public cannot depend on media information as a source of objective knowledge on controversial compounds like PCBs. The family physician should be able to provide to concerned individuals objective information on the definition, sources and relative toxicity of PCBs. PMID:21267326
Thomas, E L
The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.
Thomson, W A; Denk, J P; Ferry, P G; Martinez-Wedig, C; Michael, L H
South Texas, one of the fastest growing regions in the country, remains among the most medically underserved, in part, because few students from South Texas enter medical school. To address this issue and to increase the diversity of the matriculant pool, Baylor College of Medicine (BCM) and The University of Texas-Pan American (UT-PA) established in 1994 the Premedical Honors College (PHC), a rigorous undergraduate program at UT-PA for students from South Texas high schools. Students who complete all PHC requirements and BCM prerequisites are accepted into BCM upon graduation from UT-PA. Those in good standing receive counseling, enrichment experiences, and tuition and fee waivers from UT-PA and BCM. The program is increasing the number of students from South Texas universities matriculating into medical school, and is expanding the involvement of local physicians in undergraduate education, heightening visibility for partner institutions, and becoming an effective, replicable bachelor of science/doctor of medicine model.
Burkhardt, Sandra; La Harpe, Romano
Assisted suicide is allowed in 3 states of the United States (Oregon, Washington, Montana) but only if performed by a physician.On the opposite, in Switzerland, at the beginning of the 20th century, the Swiss Penal Code referred to assisted suicide in the context of honor or an unhappy love affair. It was only in 1985 that Exit Deutsche Schweiz (Exit for German-speaking Switzerland) "medically" assisted the first patient to end his life.Even if authorized by the Swiss law upon certain conditions, assisted suicide is subject to debates for ethical reasons. The Swiss Academy of Medical Sciences described directives to guide physicians on this difficult subject.Different studies showed an increase in the number of medical-assisted suicide in Switzerland since the 1990s. Now, this number seems to be quite stable. Assisted suicide is authorized in a few hospitals under strict conditions (especially when returning home is impossible).Thus, according to the Swiss law, any person could perform assisted suicide; this is essentially performed by 3 main associations, using pentobarbital on medical prescription as lethal substance.Generally speaking, the Swiss population is rather in favor of assisted suicide. Among politics, the debate has been tough until 2010, when the Federal Council decided not to modify the Swiss Penal Code concerning assisted suicide.
Yee, Christine A
This paper investigates physician financial interests in ambulatory surgery centers (ASCs) using novel, longitudinal data that identify board members (directors) of ASCs in Florida. Improving on prior research, the estimated models in this paper disentangle physician director selection effects from the causal impact of these financial interests. The data suggest that even prior to their financial interest, physician directors had larger procedure volumes than non-directors. Physician directors also referred more lower-risk patients. On average, ASC board membership led to a 27% increase in a physician's procedure volume and a 16% increase in a physician's colonoscopy volume. Simulations suggest that 5% of the colonoscopies performed in Florida between 1997 and 2004 may have been due to physician ASC board membership. The evidence also suggests that physician directors steered patients from hospitals to their affiliate ASCs. In addition, they referred and/or treated more lower-risk patients as a result of board membership.
Dummit, Laura A
Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a primary care physician crisis? Why does compensation across physician specialties vary so widely? Can Medicare physician fee changes affect access to primary care? These questions defy simple answers. This issue brief lays out the latest information on physician workforce, compensation differences across physician specialties, and Medicare's physician fee-setting process.
... allcontacts/statewidecontacts.html . Some Area Agencies on Aging (AAA) have programs or link to services that assist ... obtain low-cost assistive technology. To locate your AAA, call the Eldercare Locator at 1-800-677- ...
... but they don't need full-time nursing care. Some assisted living facilities are part of retirement ... change. Assisted living costs less than nursing home care. It is still fairly expensive. Older people or ...
... help keep the dental office running smoothly. Important Qualities Detail oriented. Dental assistants must follow specific rules and protocols, such as infection control procedures, when helping dentists treat patients. Assistants also ...
Bank, Alan J; Gage, Ryan M
Objective Scribes are increasingly being used in clinics to assist physicians with documentation during patient care. The annual effect of scribes in a real-world clinic on physician productivity and revenue has not been evaluated. Methods We performed a retrospective study comparing the productivity during routine clinic visits of ten cardiologists using scribes vs 15 cardiologists without scribes. We tracked patients per hour and patients per year seen per physician. Average direct revenue (clinic visit) and downstream revenue (cardiovascular revenue in the 2 months following a clinic visit) were measured in 486 patients and used to calculate annual revenue generated as a result of increased productivity. Results Physicians with scribes saw 955 new and 4,830 follow-up patients vs 1,318 new and 7,150 follow-up patients seen by physicians without scribes. Physicians with scribes saw 9.6% more patients per hour (2.50±0.27 vs 2.28±0.15, P<0.001). This improved productivity resulted in 84 additional new and 423 additional follow-up patients seen, 3,029 additional work relative value units (wRVUs) generated, and an increased cardiovascular revenue of $1,348,437. Physicians with scribes also generated an additional revenue of $24,257 by producing clinic notes that were coded at a higher level. Total additional revenue generated was $1,372,694 at a cost of $98,588 for the scribes. Conclusion Physician productivity in a cardiology clinic was ∼10% higher for physicians using scribes. This improved productivity resulted in 84 additional new and 423 additional follow-up patients seen in 1 year. The use of scribes resulted in the generation of 3,029 additional wRVUs and an additional annual revenue of $1,372,694 at a cost of $98,588. PMID:26457055
Auat Cheein, Fernando A., Ed.
This book offers the reader new achievements within the Assistive Technology field made by worldwide experts, covering aspects such as assistive technology focused on teaching and education, mobility, communication and social interactivity, among others. Each chapter included in this book covers one particular aspect of Assistive Technology that…
Halaas, Gwen Wagstrom; Zink, Therese; Finstad, Deborah; Bolin, Keli; Center, Bruce
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…
Physicians are the influential force in the complex field of patient care delivery. Physicians determine when and where patient healthcare is delivered and affect 80% of the money spent on it. Computerized systems used in the delivery of healthcare information have become an integral part that physicians use to provide patient care. This study…
Bower, Elizabeth A.; English, Clea; Choi, Dongseok; Cedfeldt, Andrea S.; Girard, Donald E.
Introduction: Physician shortages in the United States are estimated to reach as high as 85 000 by 2020. One strategy for addressing the shortage is to encourage physicians who left clinical practice to return to work, but few programs exist to prepare physicians to reenter practice. The Divisions of Continuing Medical Education and Graduate…
Kayashima, R; Braun, K L
Surveyed about barriers to good end-of-life care were 804 Hawaii physicians in specialties most likely to care for dying patients. Responses were received by 367 (46%). The majority attended terminally ill patients within the past year and felt that the physician should be the first to tell a patient that he/she is dying. Yet 86% identified barriers to talking about end-of-life preferences and 94% identified barriers to providing good end-of-life care. Perceived as major barriers were family conflict about the best course of action, patient/family discomfort with or fear of death, and cultural/religious beliefs of the patient or family. Since relatively few respondents supported the concepts of physician-assisted suicide (32%) or physician-assisted death (18%), the alternative is for physicians to join with other concerned entities to help overcome the attitudinal, behavioral, educational, and economic barriers to providing appropriate, humane, and compassionate care for the dying.
Socolar, Rebecca R. S.
A survey of physicians (n=113) concerning their knowledge about child sexual abuse found several areas of inadequate knowledge, including assessment of chlamydia infection, Tanner staging, and documentation of historical and physical exam findings. Factors associated with better knowledge scores were physician participation in continuing medical…
Steinberg, Michael B.; Giovenco, Daniel P.; Delnevo, Cristine D.
Introduction Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician–patient communication regarding e-cigarettes. Methods A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient–provider e-cigarette communication, and attitudes towards tobacco harm reduction. Results Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Discussion Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction. PMID:26844056
Legha, Rupinder K
Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.
Kaufman, David M.; Ryan, Kurt; Hodder, Ian
A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…
In California, it is common for HMOs to capitate physician organizations (e.g., independent practice organizations and multispecialty medical groups) for all professional and outpatient ancillary services (and to share risk for inpatient care) under professional risk capitation contracts. This arrangement exports most of the financial risk from the HMO to the physician organization. When HMOs and physician organizations contract under these arrangements, HMOs delegate many of their administrative functions to physician organizations--giving the physician organization authority to make the decisions needed to manage capitated risk. As a result, administrators of physician organizations must be competent in such areas as provider network development, financial forecasting, utilization and quality management, contract negotiation, and establishing systems for claims, reporting, authorizations, and the like. In this study four HMO and 22 physician organization administrators were interviewed concerning key administrative competencies for managing capitation contracts. The competencies were assessed as key administrative work activities that required specific knowledge, skill, or ability to perform. Identifying these competencies is important for physician organizations preparing for capitated risk and will be essential for organizations preparing for HMO or Medicare capitation.
Legato, Marianne, J.
The number of physician-scientists in training decreased below the recommended level in 1976. Reasons young doctors are not attracted to research training and why these academic physicians are needed are discussed. The demise of the academic medical community will begin an ice age in American medicine. (SR)
Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.
Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…
Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat
Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature…
Harer, W B; el-Dawakhly, Z
Excavation of the tomb of Akhet-Hetep at Giza revealed a monument dedicated to his mother Peseshet, who is identified by many important titles including "Overseer of Women Physicians." She is probably the world's earliest known woman physician. She practiced at the time of the building of the great pyramids in Egypt, about 2500 BC.
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....
By providing everything from electronic mail to "virtual patients," computer technology and the Internet have made enormous resources available to physicians. Science writer Beth Ellenberger gives an overview of the different levels of Internet access, as well as the e-mail addresses of some medical resources that will be useful to physicians. Images p1305-a PMID:7736378
Richard, George V.; Zarconi, Joseph; Savickas, Mark L.
The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…
Ricketts, Thomas C.; Randolph, Randy
Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…
Evans, K R; Beltramini, R F
This study reports the findings of an investigation designed to explore the importance of prescription drug information source characteristics among physicians. Differences were found to exist among the importance ratings both in aggregate, and between, categories of physician specialty and years in practice. Conclusions for pharmaceutical marketers and the implications for future research efforts are discussed.
Norcini, John J.; Mazmanian, Paul E.
Physician migration is a complex and multifaceted phenomenon that is intimately intertwined with medical education. Imbalances in the production of physicians lead to workforce shortages and surpluses that compromise the ability to deliver adequate and equitable health care to large parts of the world's population. In this overview, we address a…
Bennett, Nancy L.; Casebeer, Linda L.; Kristofco, Robert E.; Strasser, Sheryl M.
Introduction: Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they…
Stevens, Rosemary; Vermeulen, Joan
The purpose of the study was to bring together available materials on the location, activity, and function of more than 63,000 foreign trained physicians in the United States; to review the political, economic, and organizational factors which have led to the current manpower situation; and to analyze these data in terms of physician manpower,…
In 1994, Chile had 15,451 active physicians (less than 70 years old) for a population of 14,027,344 with a ratio of 1 physician per 908 inhabitants, a satisfactory figure compared to other countries of similar socio-economical development. Ratios of 1:880 and 1:843 are projected for 1999 and 2004 respectively. The annual rate of physician's population growth (2.2%), that is superior to the general population's growth rate (1.6%), will increase to about 2.5% per annum in 2001 as a consequence of the creation of three new medical schools. However, the distribution of physicians along the country is unsatisfactory. While the capital (Metropolitan Region) has a ratio of 1 physician per 629 inhabitants, the figure for the Region of Maule is 1:2,113. Only two of ten regions, excepting the capital, have a ratio lower than 1:1,000. Sixty percent of physicians live in Santiago while only 40% of the general population does so, illustrating their high concentration. Median ratio in Chile, that better reflects the reality than the mean, is 1:1,280. The heterogeneous distribution of physicians in Chile is a sign of social inequity that must be corrected. In a free society a better physician distribution is achieved with economical and professional incentives given by health institutions.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Unqualified physicians. 40.52 Section 40.52 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS... Immigrants § 40.52 Unqualified physicians. INA 212(a)(5)(B) applies only to immigrant aliens described in...
... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Unqualified physicians. 40.52 Section 40.52 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS... Immigrants § 40.52 Unqualified physicians. INA 212(a)(5)(B) applies only to immigrant aliens described in...
... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Unqualified physicians. 40.52 Section 40.52 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS... Immigrants § 40.52 Unqualified physicians. INA 212(a)(5)(B) applies only to immigrant aliens described in...
... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Unqualified physicians. 40.52 Section 40.52 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS... Immigrants § 40.52 Unqualified physicians. INA 212(a)(5)(B) applies only to immigrant aliens described in...
... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Unqualified physicians. 40.52 Section 40.52 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH NONIMMIGRANTS AND IMMIGRANTS... Immigrants § 40.52 Unqualified physicians. INA 212(a)(5)(B) applies only to immigrant aliens described in...
Cervero, Ronald M.
Since the early 1960s, most discussions about the improvement of continuing medical education (CME) have begun by seeking a better understanding of how physicians learn. The goal of this movement has been to put physician learners and their learning needs, not new research findings, at the center of the educational process. This has led CME away…
... 42 Public Health 2 2014-10-01 2014-10-01 false Physicians' services. 410.20 Section 410.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.20 Physicians'...
... Examiners Examination, the Foreign Medical Graduate Examination in the Medical Sciences, the United States... physician will be under the direct supervision of a physician who is a U.S. citizen or resident alien and... activities involving direct patient care. Under these circumstances, the special eligibility...
Heins, M; Hendricks, J; Martindale, L; Smock, S; Stein, M; Jacobs, J
Attitudinal data obtained from interviewing random samples of women and men physicians in metropolitan Detroit indicated that women were generally more liberal and egalitarian than men. Older women were more liberal/egalitarian than older men while younger men were closer in attitudes to younger women. Within specialities, women and men physicians frequently held similar attitudinal scores; however, controlling for age, sex accounted for more variation than did specialty. A weighted combination of variables which together most significantly discriminated between age and sex subgroups pointed to a sensitivity dimension. This was stronger in the women; yet men demonstrating a similar sensitivity were found in almost every age and specialty grouping. Although younger men physicians are less conservative than older men physicians, both younger and older women physicians demonstrated strong liberalism/egalitarianism. PMID:507244
Greene, Jeremy A
Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.
Cassata, D M; Kirkman-Liff, B L
A questionnaire survey of residency trained graduates and nonresidency trained family physicians showed both groups reporting relatively infrequent practice of behavioral medicine. Referrals and counseling sessions/visits produce a combined total of 20 activities per month, or two to four percent of all patient encounters, even though the physicians in the sample reported that 33 percent of their diagnoses were behavioral/psychological. More than 85 percent of the physicians reported access to more than one mental health provider. The six most common health problems encountered in the office were depression, anxiety, obesity, marital discord, alcohol abuse, and sexual problems. Physicians responding to this survey expressed an interest in continuing education programs that emphasize individual, marital, and parenting counseling, and psychopharmacology. There is a major need to improve the mental health component of residency training, which will enable physicians to better manage psychosocial problems in practice settings.
Paterick, Barbara B; Waterhouse, Blake E; Paterick, Timothy E; Sanbar, Sandy S
Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.
Tortolani, A J; Cascardo-Weissman, D
The face of health care is changing daily due to pressures brought about by dissatisfied consumers, physicians, and employers. The authors of this article believe that the only way to bring about a better health care system is for physicians to take back the administration of the medical profession from the insurers. Physicians must take the financial risks necessary to innovate a medical system that will benefit themselves, their patients, and their patients' employers. This article presents the basic business concepts needed to establish physician provider networks (PPNs) as well as the benefits and pitfalls of the various types of associations into which a PPN can enter. Clearly, the future will belong to those physicians who have the foresight to invest their talents and their finances in the business aspects of managed care.
Cleverley, W O
Valuation of physician practices provides physicians with a benchmark of their business success and helps purchasers negotiate a purchase price. The Center for Healthcare Industry Performance Studies (CHIPS) recently conducted a survey of physician practice acquisitions. The survey collected data on salaries and benefits paid to physicians after practice acquisition, historical profitability of the acquired practice, and specific values assigned to both tangible and intangible assets in the practice. Some of the survey's critical conclusions include: hospitals tend to acquire unprofitable practices, value is based on historical revenues rather than historical profits, the importance of valuation methodology and payer mix is underestimated, tangible assets represent a large part of the purchase price, and hospitals tend to pay higher physician compensation than do other purchasers.
Wholey, Douglas R; Michail, Nina; Christianson, Jon; Knutson, David
This paper examines differences in availability, use, and perceived usefulness of disease management programs as reported by generalist and specialist physicians functioning as primary care providers in health plans. Implications of these differences are discussed in terms of the three types of purchasers: private insurers, Medicare, and Medicaid. The design is a cross-sectional mail and telephone mixed-mode survey. The data come from 23 health plans in five states (Florida, New York, Colorado, Pennsylvania, and Washington), including six metropolitan areas: Seattle, New York City, Miami, Pittsburgh, Philadelphia, and Denver. The study participants are 1,244 generalist and specialist physicians who contracted with health plans as primary care providers. They were drawn from a 2001 mail and telephone survey of 2,105 generalist and 1,693 specialist physicians serving commercial, Medicaid, and Medicare patients. Physician responses about use of disease management for their patients in the health plan and how useful they thought it was were regressed on physician, physician organization, and physician-health plan relationship characteristics. While generalist physicians are likely to report having disease management programs available and using them, specialists vary greatly in their response to the disease management programs. In contrast to physicians associated with commercial plans, implementation of disease management programs among physicians associated with Medicaid plans varied across states. Primary care providers trained in generalist areas of practice are more likely than specialists functioning as primary care providers to report that disease management programs are available and to use them. They also find them more useful than do specialists.
... 42 Public Health 5 2010-10-01 2010-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the...
Wilder-Curtis, L M; Pollack, E B
Physician recruitment incentives by hospitals continue to be popular in today's competitive health-care environment. A physician in private practice may also seek a hospital's assistance in recruiting a new colleague. In Conn Med 1989; 10:605-6, the authors discussed the prohibitions against private benefit and private inurement and their effect on recruitment packages. This article highlights new developments and Medicare/Medicaid fraud and abuse issues which may affect a tax-exempt hospital's status and, therefore, will dictate many of the terms of these packages.
Ramirez, Gregory J; Hulston, Nancy J; Kovac, Anthony L
Walter S. Sutton (1877-1916) was a physician, scientist, and inventor. Most of the work on Sutton has focused on his recognition that chromosomes carry genetic material and are the basis for Mendelian inheritance. Perhaps less well known is his work on rectal administration of ether. After Sutton's work on genetics, he completed his medical degree in 1907 and began a 2-year surgical fellowship at Roosevelt Hospital, New York City, NY, where he was introduced to the technique of rectal administration of ether. Sutton modified the work of others and documented 100 cases that were reported in his 1910 landmark paper "Anaesthesia by Colonic Absorption of Ether". Sutton had several deaths in his study, but he did not blame the rectal method. He felt that his use of rectal anesthesia was safe when administered appropriately and believed that it offered a distinct advantage over traditional pulmonary ether administration. His indications for its use included (1) head and neck surgery; (2) operations when ether absorption must be minimized due to heart, lung, or kidney problems; and (3) preoperative pulmonary complications. His contraindications included (1) cases involving alimentary tract or weakened colon; (2) laparotomies, except when the peritoneal cavity was not opened; (3) incompetent sphincter or anal fistula; (4) orthopnea; and (5) emergency cases. Sutton wrote the chapter on "Rectal Anesthesia" in one of the first comprehensive textbooks in anesthesia, James Tayloe Gwathmey's Anesthesia. Walter Sutton died of a ruptured appendix in 1916 at age 39.
The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information.
John Keats, son of an ostler , was born in London in 1795. Despite an early interest in literature he was, surprisingly, apprenticed to an apothecary and continued his medical training at Guy's Hospital, obtaining the Licentiate of the Society of Apothecaries in 1816. He never practiced medicine. His early poems were not well received, and for the young poet with very slender means, life was difficult. Tragedy was added to difficulty when tuberculosis, which had already caused the death of his mother and uncle, became apparent in his brother Tom, whom Keats nursed through his illness when the brothers were living together in Hampstead . Subsequently Keats developed the disease, but despite its rapid progress, he managed in a single year - 1819 - to produce some of the finest lyrical poetry in the language. He went to Italy in the hope of obtaining a cure but died in Rome in 1821, aged 25. Medicine certainly contributed to the man, but also something to the poet, Keats; his training and his family and personal experience of tuberculosis speak for themselves. More subtly , his medical experience influenced in some degree his ideas and even his choice of words. The interrelations of poet-patient and trainee-physician are examined in this essay.
Tucker, Joseph D; Cheng, Yu; Wong, Bonnie; Gong, Ni; Nie, Jing-Bao; Zhu, Wei; McLaughlin, Megan M; Xie, Ruishi; Deng, Yinghui; Huang, Meijin; Wong, William C W; Lan, Ping; Liu, Huanliang; Miao, Wei; Kleinman, Arthur
Objective To better understand the origins, manifestations and current policy responses to patient–physician mistrust in China. Design Qualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust. Setting Guangdong Province, China. Participants One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships. Results One of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust. Conclusions The blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives
... 42 Public Health 3 2010-10-01 2010-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician... HEALTH SERVICES Physicians and Other Practitioners § 414.50 Physician or other supplier billing...
... 42 Public Health 3 2011-10-01 2011-10-01 false Physician or other supplier billing for diagnostic tests performed or interpreted by a physician who does not share a practice with the billing physician... HEALTH SERVICES Physicians and Other Practitioners § 414.50 Physician or other supplier billing...
Nakayama, Don K
The objective was to examine the economic, ethical, and legal foundations for conflict of interest restrictions between physicians and pharmaceutical and medical device industries ("industry"). Recently academic medical centers and professional organizations have adopted policies that restrict permissible interactions between industry and physicians. The motive is to avoid financial conflicts of interest that compromise core values of altruism and fiduciary relationships. Productive relationships between industry and physicians provide novel drugs and devices of immense benefit to society. The issues are opposing views of medical economics, profit motives, medical professionalism, and extent to which interactions should be lawfully restricted. Industry goals are congruent with those of physicians: patient welfare, safety, and running a profitable business. Profits are necessary to develop drugs and devices. Physician collaborators invent products, refine them, and provide feedback and so are appropriately paid. Marketing is necessary to bring approved products to patients. Economic realities limit the extent to which physicians treat their patients altruistically and as fiduciaries. Providing excellent service to patients may be a more realistic standard. Statements from industry and the American College of Surgeons appropriately guide professional behavior. Preservation of industry-physician relationships is vital to maintain medical innovation and progress.
Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media's potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of interest. Some guidelines do not explicitly mention conflict of interest; others recommend only disclosure. Recommending disclosure fails to appreciate the unique features of social media that make adequate disclosure difficult to accomplish. Moreover, in emphasizing disclosure alone, current guidelines are inconsistent with medicine's general trend toward management or elimination, not just disclosure, of potential conflicts. Because social media sites typically rely on physicians' voluntary compliance with professional norms, physicians necessarily play a major role in shaping these norms' content and scope. To achieve the benefits of social media and ensure the veracity of social media content while preserving trust in the profession, physicians must reaffirm their commitment to disclose potential conflicts; advocate for better electronic disclosure mechanisms; and develop concrete management strategies-including, where necessary, the elimination of conflicts altogether.
Weiner, Jonathan P; Yeh, Susan; Blumenthal, David
Arguably, few factors will change the future face of the American health care workforce as widely and dramatically as health information technology (IT) and electronic health (e-health) applications. We explore how such applications designed for providers and patients will affect the future demand for physicians. We performed what we believe to be the most comprehensive review of the literature to date, including previously published systematic reviews and relevant individual studies. We estimate that if health IT were fully implemented in 30 percent of community-based physicians' offices, the demand for physicians would be reduced by about 4-9 percent. Delegation of care to nurse practitioners and physician assistants supported by health IT could reduce the future demand for physicians by 4-7 percent. Similarly, IT-supported delegation from specialist physicians to generalists could reduce the demand for specialists by 2-5 percent. The use of health IT could also help address regional shortages of physicians by potentially enabling 12 percent of care to be delivered remotely or asynchronously. These estimated impacts could more than double if comprehensive health IT systems were adopted by 70 percent of US ambulatory care delivery settings. Future predictions of physician supply adequacy should take these likely changes into account.
Purpose Pharmacists are uniquely trained to provide guidance to patients in the selection of appropriate non-prescription therapy. Physicians in Qatar may not always recognize how pharmacists function in assuring safe medication use. Both these health professional groups come from heterogeneous training and experiences before migrating to the country and these backgrounds could influence collaborative patient care. Qatar Petroleum (QP), the largest private employer in the country, has developed a pharmacist-guided medication consulting service at their primary care clinics, but physician comfort with pharmacists recommending drug therapy is currently unknown. The objective of this study is to characterize physician perceptions of pharmacists and their roles in a primary care patient setting in Qatar. Methods This cross-sectional survey was developed following a comprehensive literature review and administered in English and Arabic. Consenting QP physicians were asked questions to assess experiences, comfort and expectations of pharmacist roles and abilities to provide medication-related advice and recommend and monitor therapies. Results The median age of the 62 (77.5%) physicians who responded was between 40 and 50 years old and almost two-third were men (64.5%). Fourteen different nationalities were represented. Physicians were more comfortable with pharmacist activities closely linked to drug products than responsibilities associated with monitoring and optimization of patient outcomes. Medication education (96.6%) and drug knowledge (90%) were practically unanimously recognized as abilities expected of pharmacists, but consultative roles, such as assisting in drug regimen design were less acknowledged. They proposed pharmacist spend more time with physicians attending joint meetings or education events to help advance acceptance of pharmacists in patient-centered care at this site. Conclusions Physicians had low comfort and expectations of patient
Deep-space missions some times use close gravity-assist 'swingbys' of planets and moons to gain or lose velocity. These maneuvers increase the amount of mass that can be delivered and/or decrease mission flight times. The two Voyager spacecraft used gravity assists to leave the solar system. The Galileo spacecraft is using gravity assists to move among the various moons of Jupiter and the Cassini spacecraft will do similar maneuvers around Saturn.
Fischer, P M; Addison, L A; Koneman, E W; Crowley, J
The field of physicians' office laboratory testing has witnessed an increase in test volume and advances in technology, but little attention to educational issues. If this field is to continue to grow and to perform high-quality testing, primary care physicians will need to be trained in the role of laboratory director. Office staff will require "in the office" continuing education. Formal technician and technologist training will need to focus some attention on office test procedures. The development of these new educational programs will require the cooperative efforts of primary care physician educators, pathologists, allied health faculty, and the diagnostic equipment industry.
Copeland, W M
This article identifies and discusses the legal problems and pitfalls associated with the implementation of a physician recruitment program. Careful structuring is necessary to strike a balance meeting the requirements of both the Internal Revenue Code and the Medicare fraud and abuse provisions. The various tax considerations that may affect physician recruitment are comprehensively analyzed. Similar analysis is made of the Medicare fraud and abuse statute. Also included is a list of items that must be taken into consideration when embarking on a physician recruitment program.
... 42 Public Health 3 2013-10-01 2013-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....
... 42 Public Health 3 2014-10-01 2014-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....
... 42 Public Health 3 2012-10-01 2012-10-01 false Conditions of payment: Assistants at surgery in... Physician Services in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching... a fee schedule basis for the services of an assistant at surgery in a teaching hospital....
Warner, T D; Roberts, L W; Smithpeter, M; Rogers, M; Roberts, B; McCarty, T; Franchini, G; Geppert, C; Obenshain, S S
To explore medical students' views of assisted death practices in patient cases that describe different degrees and types of physical and mental suffering, an anonymous survey was administered to all students at one medical school. Respondents were asked about the acceptability of assisted death activities in five patient vignettes and withdrawal of life support in a sixth vignette. In the vignettes, actions were performed by four possible agents: the medical student personally; a referral physician; physicians in general; or non-physicians. Of 306 medical students, 166 (54%) participated. Respondents expressed opposition or uncertainty about assisted death practices in the five patient cases that illustrated severe forms of suffering which were secondary to amyotrophic lateral sclerosis, treatment-resistant depressive and somatoform disorders, antisocial and sexually violent behavior, or AIDS. Students supported the withdrawal of life support in the sixth vignette depicting exceptional futility secondary to AIDS. Students were especially opposed to their own involvement and to the participation of non-physicians in assisted death activities. Differences in views related to sex, religious beliefs, and personal philosophy were found. Medical students do not embrace assisted death practices, although they exhibit tolerance regarding the choices of medical colleagues. How these attributes of medical students will translate into future behaviors toward patients and peers remains uncertain. Medical educators must strive to understand the perspectives of physicians-in-training. Expanded, empirically informed education that is attuned to the attitudes of medical students may be helpful in fulfilling the responsibility of imparting optimal clinical care skills.