Science.gov

Sample records for physician assistants

  1. Physician Assistants in Dermatology

    PubMed Central

    2008-01-01

    Although physician assistants have played a key role in the delivery of medical care since the mid-1960s, their utilization in the dermatology specialty has been a more recent occurrence. Dermatology physician assistants have experienced tremendous growth over the last 10 years, largely due to the imbalance between patient demand for skin care services and a lack of supply in residency-trained dermatologists. Working under the supervision of dermatologists, physician assistants have been able to extend the reach of the physician and improve patient access to quality dermatologic care. PMID:21103320

  2. Physician-Assisted Suicide

    Cancer.gov

    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.

  3. Army Physicians' Attitudes Towards Physicians' Assistants.

    ERIC Educational Resources Information Center

    Stuart, Richard B.; Bair, Jeffrey H.

    In February 1972 the U. S. Army Medical Field Service School will commence training a new category of health personnel, to be known as the physicians' assistant. This type of allied health personnel will be an assistant to the physician, trained to do many of the traditional tasks usually performed by a physician, but requiring less education.…

  4. The future for physician assistants.

    PubMed

    Cawley, J F; Ott, J E; DeAtley, C A

    1983-06-01

    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.

  5. Veterans as physician assistants.

    PubMed

    Brock, Douglas; Evans, Timothy; Garcia, Drew; Bester, Vanessa; Gianola, F J

    2015-11-01

    The physician assistant (PA) profession emerged nearly 50 years ago to leverage the healthcare experience of Vietnam-era military trained medics and corpsmen to fill workforce shortages in medical care. In 2009, the American Recovery and Reinvestment Act Primary Care Training and Enhancement program was established to improve access to primary care. Training military veterans as PAs was again identified as a strategy to meet provider access shortages. However, fewer than 4% of veterans with military healthcare training are likely to apply to PA school and little is known regarding the factors that predict acceptance to training. In 2012, we surveyed all veteran applicants and a stratified random sample of nonveterans applying to PA training. We compare the similarities and differences between veteran and nonveteran applicants, application barriers, and the factors predicting acceptance. We conclude with a discussion of the link between modern veterans and the PA profession. PMID:26501578

  6. A Question of Identity: Physician Versus Physician's Assistant

    ERIC Educational Resources Information Center

    Fink, Paul Jay

    1975-01-01

    The role of the physician's assistant grew out of a need for a change in the health delivery system. However, the pressure for speed in the growth of this new concept did not allow for a gradual evolution, and has resulted in many discrepancies in the physician's assistant role. (PG)

  7. Guidelines for Physician's Assistant Programs in Illinois.

    ERIC Educational Resources Information Center

    Illinois State Inter-Agency Task Force on Health Manpower, Chicago.

    Developed by a 25-member committee representing health service institutions, educational institutions, manpower organizations, and professional groups, this publication contains guidelines for use in developing programs for physician's assistants. Suggestions are made for: (1) determining the role of the physician's assistant in relation to other…

  8. Physician's Assistants and Nurse Associates: A Review.

    ERIC Educational Resources Information Center

    Collins, M. Clagett; Bonnyman, G. Gordon

    The crisis in health care is one of the lack of delivery of health services to the consumer. This is, in part, secondary to the dearth and maldistribution of primary care physicians and the ineffective utilization of existing health manpower to deliver primary care. Physician's assistants and the expanded role of nurses in patient care as nurse…

  9. Professional integrity and physician-assisted death.

    PubMed

    Miller, F G; Brody, H

    1995-01-01

    The practice of voluntary physician-assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity.

  10. A medical book collection for physician assistants

    PubMed Central

    Grodzinski, Alison

    2001-01-01

    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

  11. A medical book collection for physician assistants.

    PubMed

    Grodzinski, A

    2001-07-01

    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

  12. The feminization of the physician assistant profession.

    PubMed

    Lindsay, Sally

    2005-01-01

    Although the physician assistant profession has historically been male-dominated, women now comprise over sixty percent of physician assistants (PAs) in the U.S. This paper explores the reason for the increase of women into the physician assistant profession in recent decades and whether gender differences exist in how PAs are utilized. Twenty-one qualitative interviews with male and female physician assistants and key informants were conducted to assess the reasons for the influx of women. In addition, data from the American Academy of Physician Assistants Census Survey (n = 16, 569) were analyzed to assess current gender differences in employment characteristics of PAs. In the interviews, female PAs reported entering the profession because it allowed them to practice within the medical model without having the high expense and demanding schedule of medical school. In fact, they claimed that the profession was quite compatible with family life. Significant gender differences were found in work characteristics, primary employer type, and practice specialty. Although women tend to concentrate in practice areas of women and children's health, evidence suggests that they are moving beyond these traditional roles into areas such as internal medicine and surgery. PMID:16260413

  13. [Physician-assisted suicide in dementia?].

    PubMed

    Lauter, H

    2011-01-01

    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.

  14. Physician-assisted dying: theory and reality.

    PubMed

    Meier, Diane E

    1992-01-01

    ...[T]here appears to be a conflation of physician-assisted suicide (the doctor makes the means of suicide available by, for example, writing a prescription for barbiturates) with active euthanasia (the doctor actively intervenes to kill the patient). I believe that these two entities are quite distinct in terms of several factors: they require very different roles for the physician, they involve distinct and disparate power relationships between physician and patient, and they would likely have a substantially different impact on the ethos of the medical profession. Thus, I would argue that it may be reasonable to support easing constraints on physician-assisted suicide while retaining them for active euthanasia, and that the distinction between the two entities should be addressed, particularly in discussions of legalization.

  15. Oregon: does physician-assisted suicide work?

    PubMed

    Rothschild, Alan

    2004-11-01

    Since November 1997, Oregon, a State in the United States of approximately 3.3 million people, has allowed physician-assisted suicide, although not euthanasia, by virtue of the Death with Dignity Act. Before the Act, physician-assisted suicide, as in Australia and other common law jurisdictions, was illegal. Under the Act, the Oregon Department of Human Services is required to collect information and provide an annual report. The Sixth Annual Report on Oregon's Death with Dignity Act was released on 10 March 2004. PMID:15575323

  16. The problem of physician-assisted suicide.

    PubMed

    Bernat, J L

    1997-01-01

    With the increasing acceptance of the right of patients to refuse life-sustaining treatment, some have argued that terminally ill patients have a corollary right to physician-assisted suicide (PAS) on request. However, there are important moral and legal distinctions between patients' refusals of therapy and requests for certain actions. Physicians must stop life-sustaining therapy when that therapy has been validly refused by patients. But physicians have no similar duty to provide actions, such as assistance in suicide, simply because they have been requested by patients. In deciding how to respond to patients' requests, physicians should use their judgment about the medical appropriateness of the request. The morality of PAS is debatable but it remains illegal in most jurisdictions. Advocates of legalizing PAS should fully understand three issues: (1) that such legalization would have a negative effect on the practice of palliative care and on the physician-patient relationship; (2) that legalization of voluntary euthanasia will follow the legalization of PAS; and (3) that involuntary euthanasia inevitably follows the legalization of voluntary euthanasia, as has occurred in the Netherlands over the past 12 years. Rather than suffer the harms resulting from legalizing PAS, our society should maintain its illegality and make an expanded effort to improve physicians' training and abilities to provide palliative care. PMID:9311070

  17. Physician Assistant Programs. Summary. Third Revised Edition.

    ERIC Educational Resources Information Center

    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…

  18. Clinical Teaching in Physicians Assistant Training Programs.

    ERIC Educational Resources Information Center

    And Others; Westberg, Jane

    1980-01-01

    A report on teaching in the clinical component of physician's assistant (PA) training programs is presented, based on information obtained through the authors' involvement in a PA faculty development project, and surveys of program directors and faculty. Topics include teacher qualifications, teaching methods and resources, and instructional…

  19. Assessment of Stress in Physician Assistant Students

    ERIC Educational Resources Information Center

    Kuhn, Lisa; Kranz, Peter L.; Koo, Felix; Cossio, Griselda; Lund, Nick L.

    2005-01-01

    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…

  20. Educational Decentralization and Deployment of Physician's Assistants.

    ERIC Educational Resources Information Center

    Fowkes, Virginia Kliner; And Others

    1983-01-01

    A community-based educational network was established to improve the deployment of physicians's assistants away from the original site of training in California's San Francisco Bay Area. The graduates' practice locations for a 7-year period was compared before and after the decentralization of the program. (Author/MLW)

  1. The Black Physician's Assistant: Problems and Prospects

    ERIC Educational Resources Information Center

    Schneller, Eugene Stewart; Weiner, Terry S.

    1978-01-01

    A study of the social origins, attitudes, and anticipated practice settings of black and white recruits to the physician's assistant occupation is reported. Various social attitudes, motivations, and differences in desire to practice in ghetto areas provide support for affirmative action policies in dealing with health manpower needs of medically…

  2. Leadership Attributes of Physician Assistant Program Directors

    ERIC Educational Resources Information Center

    Eifel, Raymond Leo

    2014-01-01

    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…

  3. Surgical physician assistants help solve contemporary problems.

    PubMed

    Blumm, Robert M; Condit, Doug

    2003-06-01

    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.

  4. Physician-assisted death and the anesthesiologist.

    PubMed

    Mottiar, Miriam; Grant, Cameron; McVey, Mark J

    2016-03-01

    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. PMID:26739697

  5. Physician assistants in Australasian emergency departments.

    PubMed

    Close, Benjamin; Zolcinski, Robert

    2016-08-01

    A physician assistant (PA) is a university qualified health professional who's primary role is to provide medical care under the direction and supervision of medical staff. This is a new profession in Australasia. The PA is well suited to working in both rural, regional and urban settings that deliver emergency medical care. A perspective is presented on their role and scope of practice within the Australasian emergency care system supported by some early findings from their use in a tertiary ED.

  6. Physician-Assisted Death in Canada.

    PubMed

    Browne, Alister; Russell, J S

    2016-07-01

    The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection.

  7. Physician-Assisted Death in Canada.

    PubMed

    Browne, Alister; Russell, J S

    2016-07-01

    The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection. PMID:27348822

  8. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2014-12-01

    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. PMID:25501920

  9. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death.

    PubMed

    Zenz, Julia; Tryba, Michael; Zenz, Michael

    2014-12-01

    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.

  10. A role for physician assistants in organ procurement.

    PubMed

    Anderson, M E

    2001-12-01

    Healthcare in the United States, as well as the environment in which physician assistants work, is rapidly changing. Consequently, the role of a physician assistant is expanding to meet the needs of patients and physicians of all specialties of medicine and surgery. In organ procurement, physician assistants can be a valuable asset to an organ procurement organization because of their medical education, versatility, and commitment to personalized care to organ donors and their families. Physician assistants are healthcare professionals who are uniquely qualified for a variety of roles within the organization: clinician, educator, consultant, donor and family liaison, and researcher.

  11. The Physician Assistant in Geriatric Long-Term Care

    ERIC Educational Resources Information Center

    Becker, Robert G.

    1976-01-01

    The Physician Assistant (PA) is a new health-care professional who is trained to function as a "physician extender." The author's experience with 71 PA students and graduate PA's at the Jewish Institute for Geriatric Care is described. (Author)

  12. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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...

  13. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  14. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  15. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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...

  16. 42 CFR 414.52 - Payment for physician assistants' services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

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

    ERIC Educational Resources Information Center

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

    2001-01-01

    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…

  18. Medical anthropology and the physician assistant profession.

    PubMed

    Henry, Lisa R

    2015-01-01

    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.

  19. 75 FR 62451 - National Physician Assistants Week, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-12

    ... hundred and thirty-fifth. (Presidential Sig.) [FR Doc. 2010-25706 Filed 10-8-10; 8:45 am] Billing code... 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...

  20. Physician Assistant Self-Directed Search Holland Codes

    ERIC Educational Resources Information Center

    LaBarbera, Dawn M.

    2005-01-01

    A mailed survey was used to identify the vocational interests of physician assistants (PAs) as measured by Holland's Self-Directed Search (SDS) Form R. A random sample of 2,323 PAs from the American Academy of Physician Assistants' mailing list was sent a survey to identify a pool of practicing PAs satisfied with their career choices for further…

  1. A Delphi Study to Identify Future Roles for Physician's Assistants.

    ERIC Educational Resources Information Center

    Shelton, Steven R.; And Others

    1984-01-01

    Survey responses revealed a prevailing attitude among physician's assistant educators that most physician's assistants would continue to work in primary care practices but that diversification in practice location would occur. A trend toward employment in various institutional settings is expected. (MLW)

  2. An Investigation of Physician Assistant and Medical Student Empathic Skills.

    ERIC Educational Resources Information Center

    Jarski, Robert W.

    1988-01-01

    A study compared the empathic skill levels of 14 (of 18) physician assistant students and 72 (of 170) medical students. It also examined students' self-perceptions of their skill levels. Medical students rated themselves lower than the observers, while physician assistant students rated themselves the same as the observers. Observers rated…

  3. An Analysis of the Professional Performance of Physician's Assistants

    ERIC Educational Resources Information Center

    Perry, Henry B., III

    1977-01-01

    The job performance of a national sample of 939 physician's assistants was assessed by both a self-rating scale and one completed by supervising physicians. Three quarters of the supervisors were greatly satisfied with their assistants. Amount of education and previous medical experience did not affect job performance. (Editor/LBH)

  4. The Physician's Assistant; An Approach to Improved Patient Care.

    ERIC Educational Resources Information Center

    Metropolitan Washington Regional Medical Program, Washington, DC.

    Presented are an overview of Physicians' Assistant programs in the United States and a study of their applicability to the Washington metropolitan area. The national overview includes information gathered from fourteen respondents to questionnaires sent to 30 physician assistant programs currently in operational or planning stages. Aspects…

  5. Legalizing physician-assisted suicide: some thoughts and concerns.

    PubMed

    Koenig, H G

    1993-08-01

    Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. In the United States, family physicians provide health care to many older adults with chronic or terminal illness whose numbers will increase as the elderly population expands. The legalization of physician-assisted suicide would affect the way American physicians practice medicine in unpredictable ways, yet physicians are participating relatively little in deliberations concerning this issue. The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter. PMID:8336099

  6. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 this... practitioner, physician assistant, nurse midwife, or specialized nurse practitioner; (4) Furnished under...

  7. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 this... practitioner, physician assistant, nurse midwife, or specialized nurse practitioner; (4) Furnished under...

  8. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 this... practitioner, physician assistant, nurse midwife, or specialized nurse practitioner; (4) Furnished under...

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

    PubMed

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

    2002-01-01

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

  10. Models of physician-assisted dying.

    PubMed

    Girsh, F

    1996-12-01

    Repeated surveys have shown that more than 70% of Americans support physician aid in dying for terminally ill mentally competent adults. Recent polls of physicians in Oregon and Michigan demonstrate majority support of those doctors for such a law while 25% of physicians surveyed in Washington admitted to already providing help. Models of how that would work have been spelled out in proposed legislation in the United States since 1988, other models come from the Northern Territory in Australia, from Holland, and from Jack Kevorkian's writing and actions as well as from other writers such as Dr Timothy Quill. PMID:9009461

  11. Physicians' voices on physician-assisted suicide: looking beyond the numbers.

    PubMed

    Curry, L; Schwartz, H I; Gruman, C; Blank, K

    2000-01-01

    Most empirical research examining physician views on physician-assisted suicide (PAS) has used quantitative methods to characterize positions and identify predictors of individual attitudes. This approach has generated limited information about the nature and depth of sentiments among physicians most impassioned about PAS. This study reports qualitative data provided by 909 physicians as part of a larger survey (N = 2,805) regarding attitudes toward and experiences with PAS and palliative care. Emergent themes illustrate important clinical, social, and ethical considerations in this area. The data illustrate the diverse and ardent responses that PAS evokes among certain physicians. The role of physicians' personal values is central to discussions about legalization of PAS. Polarized views such as those expressed by physicians in this study are not likely to be reconciled, thereby constraining the development of public policy regarding PAS.

  12. Decentralized Training for Physician's Assistants in Utah: An Evaluation.

    ERIC Educational Resources Information Center

    Wilson, William M.; And Others

    1983-01-01

    An experimental program to provide decentralized training and certification for Utah's physician's assistants unable to leave their own communities is evaluated. Original program goals were met, but it was learned that the methodology is inefficient and the program requires more teaching time than most physicians can contribute. (MSE)

  13. Retention of Physician Assistants in Rural Health Clinics

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.

    2007-01-01

    Context: Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs). Purpose: To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations. Methods: A qualitative…

  14. Examining Job Prospects and Training for Physician's Assistants

    ERIC Educational Resources Information Center

    Kacen, Alex

    1974-01-01

    Applicants to a physician's assistant program usually must have previous experience in the health field. Forty-nine institutions offering training programs are listed and job prospects, entrance requirements, degree programs offered and long-range prospects are discussed. (MW)

  15. Physician-assisted death with limited access to palliative care.

    PubMed

    Barutta, Joaquín; Vollmann, Jochen

    2015-08-01

    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. PMID:25614156

  16. Physician-assisted death with limited access to palliative care.

    PubMed

    Barutta, Joaquín; Vollmann, Jochen

    2015-08-01

    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.

  17. Treatment-resistant depression and physician-assisted death.

    PubMed

    MIller, Franklin G

    2015-11-01

    In a recent article, Udo Schuklenk and Suzanne van de Vathorst argued in favour of a legal option of physician-assisted death for patients with 'treatment-resistant' depression. In this commentary, I contend that their argument neglects the important consideration of the professional integrity of physicians. In light of this consideration, coupled with uncertainty about whether additional interventions with the patient can improve quality of life and restore the will to live, it is not appropriate to include patients with 'treatment-resistant' depression within a legal option of physician-assisted death. PMID:26401050

  18. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner, physician assistant, certified nurse...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker... nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker services. (a) Services and supplies incident to a nurse practitioner, physician...

  19. The Assisted Dying Bill and the role of the physician.

    PubMed

    Mullock, Alexandra

    2015-08-01

    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. PMID:25575506

  20. The Assisted Dying Bill and the role of the physician.

    PubMed

    Mullock, Alexandra

    2015-08-01

    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.

  1. [Euthanasia and physician assisted suicide: what is the problem?].

    PubMed

    Álvarez-Del Río, Asunción

    2014-01-01

    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.

  2. [Euthanasia and physician assisted suicide: what is the problem?].

    PubMed

    Álvarez-Del Río, Asunción

    2014-01-01

    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. PMID:25695246

  3. The attitudes of Greek physicians and lay people on euthanasia and physician-assisted suicide in terminally ill cancer patients.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Galanos, Antonis; Vlahos, Lambros

    2006-01-01

    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.

  4. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... nurse practitioner, physician assistant, nurse midwife, or specialized nurse practitioner who is... assistant, nurse midwife or specialized nurse practitioner who furnished the service is legally permitted to... practitioners, physician assistants, nurse midwives or specialized nurse practitioners are not covered if...

  5. A Report on an Emerging Occupation: The Physician's Assistant. The UCLA Allied Health Professions Projects.

    ERIC Educational Resources Information Center

    Kuritsky, Joel; Reeder, Glenn

    To determine the variety of physician's assistant programs already established and ascertain what specific tasks physicians are willing to delegate to assistants, the UCLA Allied Health Professions Project staff corresponded with schools having physicans's assistant programs, interviewed local physicians, and surveyed selected physicians regarding…

  6. The case for physician assisted suicide: not (yet) proven.

    PubMed

    Steinbock, B

    2005-04-01

    The legalization of physician assisted suicide (PAS) in Oregon and physician assisted death (PAD) in The Netherlands has revitalized the debate over whether and under what conditions individuals should be able to determine the time and manner of their deaths, and whether they should be able to enlist the help of physicians in doing so. Although the change in the law is both dramatic and recent, the basic arguments for and against have not really changed since the issue was debated by Glanville Williams and Yale Kamisar nearly 50 years ago. In this paper, the author argues in favour of Kamisar's consequentialist framework. Any change in law and social policy should not be based solely on individual cases, heart wrenching though these may be. Instead, we need to assess the need for PAS, and weigh this against the risks of mistake and abuse.

  7. A Structured Interview for the Selection of Physician's Assistant Students.

    ERIC Educational Resources Information Center

    Niebuhr, Bruce R.; And Others

    To improve the reliability of selection interviews, the faculty of the University of Texas Medical Branch physician's assistant program developed a structured fourteen-category interview. The thirty-minute interview was used to select from 94 applicants; each applicant was interviewed three times and independently rated on a five-point scale of…

  8. Physician Assistant and Nurse Practitioner Prescribing: 1997-2002

    ERIC Educational Resources Information Center

    Hooker, Roderick S.; Cipher, Daisha J.

    2005-01-01

    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…

  9. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs... 42 Public Health 2 2014-10-01 2014-10-01 false Physician assistants' services. 410.74 Section 410.74 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  10. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs... 42 Public Health 2 2011-10-01 2011-10-01 false Physician assistants' services. 410.74 Section 410.74 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  11. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physician assistants' services. 410.74 Section 410.74 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 §...

  12. Nurse Practitioners, Physician Assistants and Certified Nurse Midwives in California.

    ERIC Educational Resources Information Center

    California Univ., San Francisco. Center for California Health Workforce Studies.

    Surveys were mailed to all nurse practitioners (NPs), physician assistants (PAs) and certified nurse midwives (CNMs) registered in California, asking questions about education, labor force participation, specialty, and location and type of practice site, as well as the demographic characteristics of these professionals and their patients. Response…

  13. Acceptability for French People of Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Frileux, Stephanie; Sastre, Maria Teresa Munoz; Antonini, Sophie; Mullet, Etienne; Sorum, Paul Clay

    2004-01-01

    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…

  14. Characteristics of Persons Approving of Physician-Assisted Death

    ERIC Educational Resources Information Center

    Blevins, Dean; Preston, Thomas A.; Werth, James L., Jr.

    2005-01-01

    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…

  15. Counselors and the Legalization of Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Kiser, Jerry D.

    1996-01-01

    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…

  16. Factors Predicting Physician Assistant Faculty Intent to Leave

    ERIC Educational Resources Information Center

    Coniglio, David Martin

    2013-01-01

    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…

  17. The Perceptions of Changing the Entry-Level Degree for Physician Assistants to a Clinical Doctorate among Physician Assistant Students

    ERIC Educational Resources Information Center

    Swanchak, Lori E.

    2010-01-01

    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…

  18. Physician assisted suicide--the perspective of a neurologist.

    PubMed

    Singh, S; Sardana, V; Prasad, K; Behari, M

    2001-08-01

    Modern medicine has resulted in a better control and treatment of many diseases. This has provided a better life for patients with treatable disorders, but at the same times has prolonged the suffering of the patients with diseases that are not treatable. This is of particular importance for the patients with neurological diseases, as some of these conditions have a relentlessly progressive course and cause significant distress to the patient. Recent times have seen an expansion of the scope of the various "rights of the patient" and according to some, this includes the "right to die". As a result of this concept of regarding the autonomy of the patient, the phenomenon of physician assisted suicide has emerged and is a topic of intense debate amongst the physicians, social workers and politicians all over the world. The present article puts forth the current concepts and brings out the exact definitions of the terms like physician-assisted suicide, voluntary active euthanasia and voluntary passive euthanasia. It presents the statements made by the various societies and organisations regarding the PAS. It also brings forth the point of view of the authors about this aspect of medicine. The authors share the view of the various scientific organisations, and opine that though the idea of physician assisted suicide may be morally justifiable in certain circumstances, it should not be made legal.

  19. Dutch nurses' attitudes towards euthanasia and physician-assisted suicide.

    PubMed

    van Bruchem-van de Scheur, Ada; van der Arend, Arie; van Wijmen, Frans; Abu-Saad, Huda Huijer; ter Meulen, Ruud

    2008-03-01

    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.

  20. Attitudes toward physician‐assisted suicide among physicians in Vermont

    PubMed Central

    Craig, Alexa; Cronin, Beth; Eward, William; Metz, James; Murray, Logan; Rose, Gail; Suess, Eric; Vergara, Maria E

    2007-01-01

    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

  1. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse...

  2. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse...

  3. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse...

  4. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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 practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse...

  5. 42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 practitioner's... services. (a) General rule. A physician assistant's, nurse practitioner's, and clinical nurse...

  6. Potential of physician assistants to support primary care

    PubMed Central

    Bowen, Sarah; Botting, Ingrid; Huebner, Lori-Anne; Wright, Brock; Beaupre, Beth; Permack, Sheldon; Jones, Ian; Mihlachuk, Ainslie; Edwards, Jeanette; Rhule, Chris

    2016-01-01

    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

  7. Physician assisted suicide: the great Canadian euthanasia debate.

    PubMed

    Schafer, Arthur

    2013-01-01

    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.

  8. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros

    2008-10-01

    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. PMID:19051672

  9. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece.

    PubMed

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros

    2008-10-01

    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.

  10. Physician assistants and the disclosure of medical error.

    PubMed

    Brock, Douglas M; Quella, Alicia; Lipira, Lauren; Lu, Dave W; Gallagher, Thomas H

    2014-06-01

    Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs. PMID:24871235

  11. Advance directives, dementia, and physician-assisted death.

    PubMed

    Menzel, Paul T; Steinbock, Bonnie

    2013-01-01

    Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. PMID:23802899

  12. Origins of the physician assistant movement in the United States.

    PubMed

    Cawley, James F; Cawthon, Elisabeth; Hooker, Roderick S

    2012-12-01

    The 1960s saw a rethinking of health care delivery in the United States. The physician assistant (PA) emerged from that reconceptualization, along with the nurse midwife (CNM) and the nurse practitioner (NP). The PA, CNM, and NP were the product of demand for greater health care access, especially for the nation's poorer citizens. All three groups benefited from federal activism in health workforce policy. The PA had one characteristic not shared with the new nursing professionals: a connection in the public's mind with returning Vietnam War veterans. Several energetic trailblazers--notably Eugene Stead, Richard Smith, E. Harvey Estes, and Henry Silver--conceived and promoted their particular versions of the PA. The boosters of this new health professions movement worked through existing medical education programs and federal health care initiatives. Their efforts, sometimes informed by models of nonphysician health care abroad, received critical support from private philanthropy. Then, in 1969, the American Medical Association (AMA) rather unexpectedly gave its official approval to the concept of the PA. As optimistic as the originators of the PA movement were, even they did not anticipate the critical role PAs would play in health care delivery well into the new century. US physician assistants also continue to influence medical providers in other areas of the world. This paper re-examines the history of the physician assistant movement at the 50th anniversary of the concept. The authors use archival sources, policy analyses, interviews with principal figures, and secondary historical literature to explain the establishment of the PA movement in the 1960s and analyze its continuing influence. PMID:23600002

  13. Life insurance, living benefits, and physician-assisted death.

    PubMed

    Parker, Frederick R; Rubin, Harvey W; Winslade, William J

    2004-01-01

    One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.

  14. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 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...

  15. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 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...

  16. 42 CFR 405.2414 - Nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 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...

  17. The Physician's Assistant Profession: Results of a 1978 Survey of Graduates.

    ERIC Educational Resources Information Center

    Perry, Henry B.; Fisher, Donald W.

    1981-01-01

    The major findings of a 1978 national survey of 4,500 physician's assistants are described. Seventy-four percent of the respondents were working in primary care specialties, and two-thirds were located primarily in institutions. Physician's assistants were more likely than physicians to be working in nonurban areas. (Author/MLW)

  18. Prescribing Exercise for Older Adults: A Needs Assessment Comparing Primary Care Physicians, Nurse Practitioners, and Physician Assistants

    ERIC Educational Resources Information Center

    Dauenhauer, Jason A.; Podgorski, Carol A.; Karuza, Jurgis

    2006-01-01

    To inform the development of educational programming designed to teach providers appropriate methods of exercise prescription for older adults, the authors conducted a survey of 177 physicians, physician assistants, and nurse practitioners (39% response rate). The survey was designed to better understand the prevalence of exercise prescriptions,…

  19. The case for physician assisted suicide: how can it possibly be proven?

    PubMed

    Dahl, E; Levy, N

    2006-06-01

    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.

  20. New Role, New Country: introducing US physician assistants to Scotland

    PubMed Central

    Buchan, James; O'May, Fiona; Ball, Jane

    2007-01-01

    This paper draws from research commissioned by the Scottish Executive Health Department (SEHD). It provides a case study in the introduction of a new health care worker role into an already well established and "mature" workforce configuration It assesses the role of US style physician assistants (PAs), as a precursor to planned "piloting" of the PA role within the National Health Service (NHS) in Scotland. The evidence base for the use of PAs is examined, and ways in which an established role in one health system (the USA) could be introduced to another country, where the role is "new" and unfamiliar, are explored. The history of the development of the PA role in the US also highlights a sometimes somewhat problematic relationship between P nursing profession. The paper highlights that the concept of the PA role as a 'dependent practitioner' is not well understood or developed in the NHS, where autonomous practice within regulated professions is the norm. In the PA model, responsibility is shared, but accountability rests with the supervising physician. Clarity of role definition, and engendering mutual respect based on fair treatment and effective management of multi-disciplinary teams will be pre-requisites for effective deployment of this new role in the NHS in Scotland. PMID:17480211

  1. The Burmese medic: an international physician assistant analogue.

    PubMed

    Pedersen, Donald M; Pedersen, Kathy J; Santitamrongpan, Verapan

    2012-01-01

    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.

  2. THE CONTRIBUTIONS OF PHYSICIAN ASSISTANTS IN PRIMARY CARE SYSTEMS

    PubMed Central

    Hooker, Roderick S.; Everett, Christine M.

    2013-01-01

    Shortages of primary care doctors are occurring globally; one means of meeting this demand has been the use of physician assistants (PAs). Introduced in the United States in the late 1960s to address doctor shortages, the PA movement has grown to over 75,000 providers in 2011 and spread to Australia, Canada, Great Britain, The Netherlands, Germany, Ghana, and South Africa. A purposeful literature review was undertaken to assess the contribution of PAs to primary care systems. Contemporary studies suggest that PAs can contribute to the successful attainment of primary care functions, particularly the provision of comprehensive care, accessibility, and accountability. Employing PAs seems a reasonable strategy for providing primary care for diverse populations. PMID:21851446

  3. Nevada nurses' attitudes regarding physician-assisted suicide.

    PubMed

    Kowalski, S D

    1997-05-01

    This descriptive study of Nevada nurses (N = 539) indicates that nurses are evenly divided on the issue of physician-assisted suicide (PAS). Using hypothetical cases, the survey compares nurses' beliefs regarding withdrawal of life-support measures (92% agree, n = 489), double-effect euthanasia (85% agree, n = 447), PAS (53% agree, n = 280), and active euthanasia (44% agree, n = 235). Responses to arguments supporting or rejecting the legalization of PAS are presented. Arguments include: patient autonomy, relief of pain and suffering, death with dignity, decreased quality of life, relief of psychological and financial burdens, sacredness of life, use of adequate comfort measures, unenforceability of safeguards, the professional ethical code, and inappropriate motives. Seventy-five percent (n = 400) of Nevada nurses indicate they personally feel PAS may be justified in selected cases. Only 46% (n = 240) would be willing to participate in PAS if it were legalized. Selected written comments from respondents are included.

  4. Physician-assisted suicide in psychiatry and loss of hope.

    PubMed

    Berghmans, Ron; Widdershoven, Guy; Widdershoven-Heerding, Ineke

    2013-01-01

    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.

  5. Sex Stereotypes in the Self- and Ideal Descriptions of Physician's Assistant Students.

    ERIC Educational Resources Information Center

    Davis, Stephen W.; And Others

    1984-01-01

    Recent studies indicate that medical students perceive the ideal physician as having both stereotypically masculine and stereotypically feminine traits. The physician's assistant role and education combine skills from the traditional physician's role, along with caring from the traditional female nursing role. (MLW)

  6. [Each person has to make their own individual decision - arguments for physician assisted suicide].

    PubMed

    Posa, Andreas

    2016-06-01

    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. PMID:27305308

  7. [Each person has to make their own individual decision - arguments for physician assisted suicide].

    PubMed

    Posa, Andreas

    2016-06-01

    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.

  8. Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010

    PubMed Central

    Gadbois, Emily A.; Miller, Edward Alan; Tyler, Denise; Intrator, Orna

    2016-01-01

    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

  9. 42 CFR 405.2414 - Nurse practitioner, physician assistant, and certified nurse midwife services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Nurse practitioner, physician assistant, and... practitioner, physician assistant, and certified nurse midwife services. (a) Professional services are payable under this subpart if the services meet all of the following: (1) Furnished by a nurse...

  10. Academic Degrees and Clinical Practice Characteristics: The University of Washington Physician Assistant Program: 1969-2000

    ERIC Educational Resources Information Center

    Evans, Timothy C.; Wick, Keren H.; Brock, Douglas M.; Schaad, Douglas C.; Ballweg, Ruth

    2006-01-01

    Context: The physician assistant profession has been moving toward requiring master's degrees for new practitioners, but some argue this could change the face of the discipline. Purpose: To see if there is an association between physician assistants' academic degrees and practice in primary care, in rural areas, and with the medically underserved.…

  11. Physician Assistant Attitude and Expressed Intent to Work with Geriatric Patients

    ERIC Educational Resources Information Center

    Woolsey, Lisa J.

    2007-01-01

    This study evaluated the attitudes of physician assistant students (PAS) and practicing physician assistants (PA) toward geriatric patients and the expressed intent of PAS and practicing PAs toward practicing in the specialized field of geriatric medicine using a cross-sectional study design. The 233 participants each completed a questionnaire…

  12. The Physician Assistant Program: Training for a Medical Career without Medical School.

    ERIC Educational Resources Information Center

    Benathen, Isaiah A.

    1989-01-01

    Surveyed is a pre-physician assistant program by giving: definition of the career, a historical basis, medical practice settings, education, advantages, and an evaluation of the student population. Included is a table which shows the distribution of acceptances into the physician assistant programs for the medical and clinical phases of training.…

  13. Moving from Clinical Practice to Academe: An Analysis of Career Change for Physician Assistants

    ERIC Educational Resources Information Center

    Marciano, Gerard Jude

    2013-01-01

    Recruitment of qualified and motivated faculty for physician assistant education programs is difficult. While the causes of the difficulty may be many, the primary one is the physician assistants (PAs) must choose between clinical and academic practice in order to pursue a career in academe. Little if any research has been conducted in this area.…

  14. Physician Assistant. Curriculum Resource Document. Volume I: Role Delineation. Final Report.

    ERIC Educational Resources Information Center

    American Academy of Physicians' Assistants, Arlington, VA.

    Both the project report and the resultant role delineation for entry level physician assistants are included in this first volume of a two-volume report of a study which had two major purposes: (1) To further develop a role delineation for the assistant to the primary care physician and (2) to provide an educational resource for those involved in…

  15. Self-Assessment and Self-Paced Learning Modules for Physician Assistants. The Comprehensive Report.

    ERIC Educational Resources Information Center

    American Academy of Physician Assistants, Arlington, VA.

    A project was undertaken to refine an existing self-assessment system and to develop self-paced learning modules for use in the continuing education of physician assistants (PA). Included among the major activities of the project were the following: (1) modification of the existing criterion-referenced Physician Assistant Self-Assessment…

  16. Defining the Future Characteristics of Physician Assistant Education Proceedings (Alexandria, VA, August 16-17, 1996).

    ERIC Educational Resources Information Center

    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…

  17. Physician Assisted Suicide: Knowledge and Views of Fifth-Year Medical Students in Germany

    ERIC Educational Resources Information Center

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    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…

  18. Delivering a Multicultural Curriculum on the Cultural Competence of Physician Assistant Students

    ERIC Educational Resources Information Center

    De Oliveira, Katie

    2014-01-01

    The purpose of this study was to explore the effect the integration of a multicultural curriculum has on the perceived level of cultural competence of physician assistant students. A convergent parallel mixed-methods approach was utilized to collect the necessary data. The physician assistant students participated in focus-group sessions and a…

  19. Physician Assistants and Nurse Practitioners in Rural Washington Emergency Departments.

    PubMed

    Nelson, Scott C; Hooker, Roderick S

    2016-06-01

    One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.

  20. Federal and Provincial Responsibilities to Implement Physician-Assisted Suicide.

    PubMed

    Baker, David; Sharpe, Gilbert; Lauks, Rebeka

    2016-02-01

    In the most significant constitutional decision of the last generation, Carter v. Canada, the Supreme Court of Canada reversed itself and decided that it was possible for Parliament to enact safeguards that would be adequate to protect persons who are vulnerable in times of weakness, then proceeded to declare that Canadians were entitled to a s. 7 Charter right to physician-assisted death. David Baker and Gilbert Sharpe accepted the challenge issued by the Court and drafted a Bill to amend the Criminal Code in a manner they believed would strike a constitutional balance between providing access to the right declared by the Court and protecting the vulnerable. This article represents their attempt, along with co-author Rebeka Lauks, to explain many of the key provisions in their draft. Amongst the most noteworthy are their attempts to ensure that those choosing PAD are informed about quality of life, as well as treatment choices; to define vulnerability and to install safeguards adequate to protect persons while vulnerable; and finally a prior review process that would ensure both ready access to the Charter right declared by the Court and consistent and transparent application of the law. The authors have attempted to establish an alternative model to that currently in effect in the Benelux countries, which they regard as having been ineffective in achieving any of these objectives. PMID:27169208

  1. Federal and Provincial Responsibilities to Implement Physician-Assisted Suicide.

    PubMed

    Baker, David; Sharpe, Gilbert; Lauks, Rebeka

    2016-02-01

    In the most significant constitutional decision of the last generation, Carter v. Canada, the Supreme Court of Canada reversed itself and decided that it was possible for Parliament to enact safeguards that would be adequate to protect persons who are vulnerable in times of weakness, then proceeded to declare that Canadians were entitled to a s. 7 Charter right to physician-assisted death. David Baker and Gilbert Sharpe accepted the challenge issued by the Court and drafted a Bill to amend the Criminal Code in a manner they believed would strike a constitutional balance between providing access to the right declared by the Court and protecting the vulnerable. This article represents their attempt, along with co-author Rebeka Lauks, to explain many of the key provisions in their draft. Amongst the most noteworthy are their attempts to ensure that those choosing PAD are informed about quality of life, as well as treatment choices; to define vulnerability and to install safeguards adequate to protect persons while vulnerable; and finally a prior review process that would ensure both ready access to the Charter right declared by the Court and consistent and transparent application of the law. The authors have attempted to establish an alternative model to that currently in effect in the Benelux countries, which they regard as having been ineffective in achieving any of these objectives.

  2. Satisfaction of physician assistants and other nonphysician providers in a managed care setting.

    PubMed Central

    Freeborn, D K; Hooker, R S

    1995-01-01

    Health maintenance organizations have employed physician assistants, nurse practitioners, and other nonphysician providers for decades, yet there is little information on how satisfied these providers are with this form of practice. This paper examines how physician assistants evaluate their experience practicing in a large group model health maintenance organization and compares their attitudes and satisfaction levels with those of other nonphysician providers-nurse practitioners, optometrists, mental health therapists, and chemical dependency counselors. The data source is a 1992 survey of 5,000 nonphysician employees of a health maintenance organization. The survey instrument was a self-administrated questionnaire that included both structured and open-ended questions. The response rate averaged 88 percent for physician assistants and the other non-physician providers. Physician assistants expressed the most satisfaction with the amount of responsibility, support from coworkers, job security, working hours, supervision, and task variety. They were less satisfied with workload, control over the pace of work, and opportunities for advancement. Most physician assistants were also satisfied with pay and fringe benefits. Compared with other nonphysician providers, chemical dependency counselors expressed the highest levels of satisfaction across the various dimensions of work and optometrists the lowest. Nurse practitioners, chemical dependency counselors, and mental health professionals also tended to be satisfied with most aspects of practice in this setting. In a number of instances, they were more satisfied than the physician assistants. The findings are consistent with other studies that found health maintenance organizations to be favorable practice settings for physician assistants. The limits of physician assistant involvement and their role satisfaction and efficient use in HMOs are more likely to relate to physician attitudes and acceptance than to lack of

  3. Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

    PubMed

    Kontaxakis, Vp; Paplos, K G; Havaki-Kontaxaki, B J; Ferentinos, P; Kontaxaki, M-I V; Kollias, C T; Lykouras, E

    2009-10-01

    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. PMID:22218231

  4. Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

    PubMed

    Kontaxakis, Vp; Paplos, K G; Havaki-Kontaxaki, B J; Ferentinos, P; Kontaxaki, M-I V; Kollias, C T; Lykouras, E

    2009-10-01

    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.

  5. Physician assisted suicide: knowledge and views of fifth-year medical students in Germany.

    PubMed

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    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. PMID:16296559

  6. Physician assisted suicide: knowledge and views of fifth-year medical students in Germany.

    PubMed

    Schildmann, Jan; Herrmann, Eva; Burchardi, Nicole; Schwantes, Ulrich; Vollmann, Jochen

    2006-01-01

    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.

  7. Palliative care, assisted suicide and euthanasia: nationwide questionnaire to Swedish physicians.

    PubMed

    Valverius, E; Nilstun, T; Nilsson, B

    2000-03-01

    The objective of this study was to investigate what actually happens between physicians and adult patients in difficult end-of-life situations. We circulated an anonymous questionnaire to a randomized sample of 952 Swedish physicians registered in specialties comprising care of dying adult patients, 122 palliative care physicians, and 130 physicians from the Swedish Association for the Study of Pain. Of special interest were themes in conversations between the physicians and the patients, desires expressed by the patients, and actions performed by the physicians that might affect the patients' expected survival. The overall response rate was 79%. Of these, 63% of the randomized physicians, 95% of the palliative care physicians, and 43% of the Association for the Study of Pain physicians had more than occasionally treated dying adult patients during the past year. About half of them had discussed palliative care with all their dying patients, and more than half of the physicians had heard their patients expressing a wish to die. About one-third of all the physicians had given analgesic or other drugs in such doses that some of their patients' deaths were hastened. The same proportion had also been asked for active euthanasia, while 10% had been asked to assist suicide. No case of euthanasia and only a few cases of assisted suicide were reported. By implication, the study suggests that improving patients' awareness of the possibilities to relieve pain, anxiety and dyspnoea during the final days of life is an important way to reduce requests for active euthanasia.

  8. The perceptions of changing the entry-level degree for Physician Assistants to a Clinical Doctorate among Physician Assistant students

    NASA Astrophysics Data System (ADS)

    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 clinical doctorate. Methods. A descriptive, quantitative study assessing PA students' perceptions of changing the entry-level credential for PAs to a clinical doctorate was conducted with full-time students from 30 randomly selected PA programs utilizing the PA Doctorate Degree Survey. Results. Of the 30 PA programs selected, 83% (25) agreed and returned permission letters and 25% (486) of students completed survey. Of the respondents, 56.1% (272) were first year students and 43.0% (213) were second year students. Both groups had a negative perception of changing the entry-level degree for PAs to a clinical doctorate, however, first year PA students had a significantly higher perception score of the entry-level CD for PAs than second year students ( t(483)=2.116, p<.05). Significantly more first year students indicated they would seek a CD, if offered, compared to the second year students (chi 2 (1)5.832, p<.05). First year students had a significantly more positive perception that the CD will enhance the reputation of the profession than 2nd year students (U=25022.50, p<.05). Conclusions. The present findings lend additional support to previous studies endorsing the master's degree as the entry-level and terminal degree, and the majority of stakeholders seem to agree. However, some within the profession feel the entry-level doctorate degree for PAs is inevitable.

  9. Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants

    PubMed Central

    Sanchez, Guillermo V.; Hersh, Adam L.; Shapiro, Daniel J.; Cawley, James F.; Hicks, Lauri A.

    2016-01-01

    We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs. PMID:27704022

  10. The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.; Yates, Kathryn L.

    2011-01-01

    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…

  11. Two Training Programs: MEDEX, The Education-Deployment Interface, and Characteristics of Physician's Assistant Programs

    ERIC Educational Resources Information Center

    Lawrence, David McK.; Jewett, Robert E.

    1975-01-01

    David McK. Lawrence discusses the objectives, program components, strengths, and weaknesses of the MEDEX training model, an attempt to bridge the gap between academe and practicing physicians for the new health practitioners. Robert E. Jewet describes background, program highlights, and key issues in the physicians assistant (PA) training…

  12. Oregon physicians' responses to requests for assisted suicide: a qualitative study.

    PubMed

    Dobscha, Steven K; Heintz, Ronald T; Press, Nancy; Ganzini, Linda

    2004-06-01

    In 1997, the Oregon Death with Dignity Act was enacted, allowing physicians to prescribe lethal dosages of medication to competent, terminally ill patients who request them. To improve our understanding of physicians' reactions to requests for assisted suicide, we performed semistructured interviews of 35 Oregon physicians who had received requests from patients. Interviews were completed in 2000, and audiotaped, transcribed, and analyzed using qualitative techniques. Requests for assisted suicide had a powerful impact on physicians and their practices. Physicians often felt unprepared, and experienced apprehension and discomfort before and after receiving requests. Prominent sources of discomfort included concerns about adequately managing symptoms and suffering, not wanting to abandon patients, and incomplete understanding of patients' preferences, especially when physicians did not know patients well. Participation in assisted suicide required a large investment of time and was emotionally intense. Regardless of whether they prescribed or not, physicians did not express major regrets about their decisions. Requests often facilitated discussion of important issues, and many physicians felt that the process increased their confidence and assertiveness in discussing end-of-life issues with other patients. Physicians rarely sought support from colleagues; instead, they tended to discuss emotional aspects of their experiences with their spouses.

  13. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... furnished by a physician (a doctor of medicine or osteopathy, as set forth in section 1861(r)(1) of the Act... only if the services have been professionally performed by them and no facility or other...

  14. 42 CFR 410.74 - Physician assistants' services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... furnished by a physician (a doctor of medicine or osteopathy, as set forth in section 1861(r)(1) of the Act... only if the services have been professionally performed by them and no facility or other...

  15. Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments.

    PubMed

    Rakofsky, Jeffrey J; Ferguson, Britnay A

    2015-12-01

    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.

  16. Physician-assisted suicide: toward a comprehensive understanding. Report of the Task Force on Physician-assisted Suicide of the Society for Health and Human Values.

    PubMed

    1995-07-01

    This article is a modified version of the report of a 1992 task force established by the Society for Health and Human Values (SHHV) to develop a statement on physician-assisted suicide reflecting the concerns and attitudes of its members, who are health professionals and scholar-teachers concerned about the values dimensions of medicine. The report is not a set of position statements but instead a two-part series of explanations and questions that promote a thorough and searching examination of the issue of physician-assisted suicide and the diverse and sometimes opposing views that responsible people can have on that issue. Part I consists of five topics and the questions related to them that physicians should ask themselves before establishing a policy on assisted suicide. The topics examined in depth in these sections are the moral status of suicide; clinical and epidemiological aspects of suicide; the relevance of voluntary choice; the nature of professional duty; and social implications. Part II concerns questions that would be advisable for patients to contemplate to be sure they have thoroughly thought through their requests for suicide assistance. The report closes by asserting that discussion and debate on this issue are desirable, that medical education should introduce students to the skills of palliative and hospice care and all methods of sharing control over medical decisions with the patient and family, and that educators should address the full range of questions related to assisted suicide rather than only those oriented toward a single position or discipline.

  17. Some Considerations in the Development of a Physicians' Assistant Program in the U. S. Army.

    ERIC Educational Resources Information Center

    Morse, Dwight F., Jr.

    The purpose of the report is to examine some aspects of the national and Army's need for and programs to develop a new type of health care delivery assistant-referred to generally as the physician's assistant. The army's program is tentatively scheduled to begin in early 1972 with a class of 60 students. The projected title for the graduate of the…

  18. Scrupulous Monitoring of Physician-Assisted Dying: The Case for Mandatory Reporting to Coroners and Medical Examiners of All Physician-Assisted Deaths in Canada.

    PubMed

    Guichon, Juliet; Alakija, Pauline; Doig, Christopher; Mitchell, Jan; Thibeault, Pascal

    2016-02-01

    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

  19. Scrupulous Monitoring of Physician-Assisted Dying: The Case for Mandatory Reporting to Coroners and Medical Examiners of All Physician-Assisted Deaths in Canada.

    PubMed

    Guichon, Juliet; Alakija, Pauline; Doig, Christopher; Mitchell, Jan; Thibeault, Pascal

    2016-02-01

    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

  20. Physician- and nurse-assisted smoking cessation in Harlem.

    PubMed Central

    Royce, J. M.; Ashford, A.; Resnicow, K.; Freeman, H. P.; Caesar, A. A.; Orlandi, M. A.

    1995-01-01

    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

  1. Physician-assisted suicide, euthanasia, and Christian bioethics: moral controversy in Germany.

    PubMed

    May, Arnd T

    2003-01-01

    Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus supporting the hospice movement and condemning physician-assisted suicide and euthanasia. The German Supreme Court has held that treatment decisions should, in absence of known patients' wishes, be made in light of commonly shared values, unless these violate the principle of "in dubio pro vita". The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life.

  2. Attitudes towards euthanasia and assisted suicide: a comparison between psychiatrists and other physicians.

    PubMed

    Levy, Tal Bergman; Azar, Shlomi; Huberfeld, Ronen; Siegel, Andrew M; Strous, Rael D

    2013-09-01

    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.

  3. Supporting assisted suicide. How do the public and physicians feel about aiding in death?

    PubMed

    Bachman, J G; Brody, H; Alcser, K H; Lichtenstein, R L; Doukas, D J; Corning, A D

    1997-04-01

    In January 1997, the Michigan State Medical Society began a series of interdisciplinary forums to discuss guidelines and safeguards for physician-assisted suicide as part of its ongoing analysis of that vexing issue. The forums derive from the minority statement in the MSMS official position, from physicians who would approve of assisting suicide in a limited number of cases, but only upon the patient's voluntary request and as a last resort. Is it possible to develop guidelines which would succeed in limiting the practice of physician-assisted suicide to that small group of patients? Or, as opponents charge, would guidelines predictably fail to contain the practice and lead to the feared slippery slope?

  4. Sports physicians, ethics and antidoping governance: between assistance and negligence.

    PubMed

    Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan

    2013-07-01

    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. PMID:23322892

  5. Sports physicians, ethics and antidoping governance: between assistance and negligence.

    PubMed

    Dikic, Nenad; McNamee, Michael; Günter, Heinz; Markovic, Snezana Samardzic; Vajgic, Bojan

    2013-07-01

    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.

  6. The euthanasia and physician-assisted suicide debate: issues for nursing.

    PubMed

    Coyle, N

    1992-08-01

    The role of nursing has yet to be defined in relationship to the controversial issue of euthanasia and physician-assisted suicide. This may be one of the most important issues facing oncology nurses during the next five years. With recent advances in medical technology, patients are fearful that suffering and death will be prolonged. The option of euthanasia and physician-assisted suicide is seen by some to be a right. Oncology nurses, as patient advocates, need to understand the basic issues surrounding this controversy.

  7. Physician-assisted suicide and the Supreme Court: the Washington and Vacco verdicts.

    PubMed

    Candilis, P J; Appelbaum, K L

    1997-01-01

    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. PMID:9460047

  8. Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

    PubMed

    Campbell, Courtney S; Black, Margaret A

    2014-01-01

    The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.

  9. [Physician-assisted suicide of a patient suffering from a psycho-organic disorder].

    PubMed

    van der Meer, S; de Veen, R C; Noorthoorn, E O; Kraan, H F

    1999-04-24

    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. PMID:10347661

  10. Establishing a framework for a physician assistant/bioethics dual degree program.

    PubMed

    Carr, Mark F; Bergman, Brett A

    2014-01-01

    : 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.

  11. Establishing a framework for a physician assistant/bioethics dual degree program.

    PubMed

    Carr, Mark F; Bergman, Brett A

    2014-01-01

    : 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. PMID:25650878

  12. Voluntary euthanasia, physician-assisted suicide, and the goals of medicine.

    PubMed

    Varelius, Jukka

    2006-04-01

    It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted suicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot provide a clear answer to the question of whether or not voluntary euthanasia and physician-assisted suicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value.

  13. The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes

    ERIC Educational Resources Information Center

    Intrator, Orna; Feng, Zhanlian; Mor, Vince; Gifford, David; Bourbonniere, Meg; Zinn, Jacqueline

    2005-01-01

    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…

  14. Physician Assistants and Nurse Practitioners as a Usual Source of Care

    ERIC Educational Resources Information Center

    Everett, Christine M.; Schumacher, Jessica R.; Wright, Alexandra; Smith, Maureen A.

    2009-01-01

    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…

  15. The Relationship between Self-Efficacy and Student Physician Assistant Clinical Performance.

    ERIC Educational Resources Information Center

    Opacic, Deborah A.

    2003-01-01

    Multivariate analysis of data from measures of self-efficacy, values, outcomes expectation, health care experience, and grade point average for 300 physician assistant students revealed that self-efficacy is a significant predictor of clinical performance. The importance of considering noncognitive variables in addition to academic ones was…

  16. Development and Validation of a Measure of Intention to Stay in Academia for Physician Assistant Faculty

    ERIC Educational Resources Information Center

    Graham, Karen

    2012-01-01

    This study attempted development and validation of a measure of "intention to stay in academia" for physician assistant (PA) faculty in order to determine if the construct could be measured in way that had both quantitative and qualitative meaning. Adopting both the methodologic framework of the Rasch model and the theoretical framework…

  17. Advanced Practice Nursing: Is the Physician's Assistant an Accident of History or a Failure to Act?

    ERIC Educational Resources Information Center

    Christman, Luther

    1998-01-01

    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)

  18. One Hospital's Successful 20-Year Experience with Physician Assistants in Graduate Medical Education.

    ERIC Educational Resources Information Center

    Russell, John C.; Kaplowe, Joseph; Heinrich, Jeffrey

    1999-01-01

    Describes a New Britain General Hospital (Connecticut) program that uses mid-level practitioners, including physician assistants (PAs), to augment diminished staffs of residents in surgical residencies. Topics discussed include program structure, efforts to reduce the potential for PA/resident conflict, protection of residency program integrity,…

  19. Effectiveness of a Shortened, Clinically Engaged Anatomy Course for Physician Assistant Students

    ERIC Educational Resources Information Center

    Rizzolo, Lawrence J.; Rando, William C.; O'Brien, Michael K.; Garino, Alexandria; Stewart, William B.

    2011-01-01

    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…

  20. Wichita State University Physician's Assistant Program. BHME Contract #72-4199. Final Report.

    ERIC Educational Resources Information Center

    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 the…

  1. An Evaluation of Physician Assistants in Diagnostic Radiology. Research Digest Series.

    ERIC Educational Resources Information Center

    Kiernan, Brian; Rosenbaum, H. D.

    Based on a followup study of graduates from a two-year training program for Physician Assistants in Diagnostic Radiology (PA-DR) at the University of Kentucky Medical Center, results are presented of an evaluation of the first year of postgraduate work activities of the initial two classes (twelve students) in nine different radiological work…

  2. Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide.

    ERIC Educational Resources Information Center

    Manetta, Ameda A.; Wells, Janice G.

    2001-01-01

    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)

  3. Narratives and Values: The Rhetoric of the Physician Assisted Suicide Debate.

    ERIC Educational Resources Information Center

    Dysart, Deborah

    2000-01-01

    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)

  4. Physician-Assisted Dying: Are Education and Religious Beliefs Related to Nursing Students' Attitudes?

    ERIC Educational Resources Information Center

    Margalith, Ilana; Musgrave, Catherine F.; Goldschmidt, Lydia

    2003-01-01

    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…

  5. Physician-assisted suicide: compassionate liberation or murder?

    PubMed

    Lachman, Vicki

    2010-01-01

    PAS is legal only in Oregon, Washington, and Montana. Studies show nurses receive requests for aid in dying from patients (Asch, 1996; Ferrell et al., 2000: Kuhse & Singer, 1993; Schwarz, 2003; Volker, 2003; Wurzbach, 2000). The simple answer to these requests is that the nurse is prohibited in participating in assisted suicide or euthanasia by the Code of Ethics for Nurses and by the ANA position statements (ANA, 1994). In this article, the author attempted to present a balanced view of the ethical issues on both sides of the question of PAS. Honoring the autonomy of a patient does not require participation in PAS. However, nurses who support PAS speak of the patient's autonomous choice and their choice to assist in ending suffering of terminally ill patients. As more states pass ballot initiatives or laws supporting PAS, nurses will be faced with the legal choice to participate in the process of PAS by providing information on the option and attending to the patient who has taken the lethal drug. Nurses need to consider their comfort with the idea that patients may choose to accelerate dying.

  6. Common Intra-Cluster Competencies Needed in Selected Occupational Clusters. Final Report. Supplemental Volume XIV: Orthopaedic Physician's Assistant.

    ERIC Educational Resources Information Center

    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…

  7. The Rivalry between Simulation and Problem-Based Learning: A Study of Learning Transfer in Physician Assistant Students

    ERIC Educational Resources Information Center

    Meyer, Kimberly E.

    2010-01-01

    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…

  8. Assisted suicide and voluntary euthanasia: role contradictions for physicians.

    PubMed

    Randall, Fiona; Downie, Robin

    2010-08-01

    It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents.

  9. On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients.

    PubMed

    Varelius, Jukka

    2016-05-01

    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'. PMID:26449985

  10. To die, to sleep: US physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support.

    PubMed

    Curlin, Farr A; Nwodim, Chinyere; Vance, Jennifer L; Chin, Marshall H; Lantos, John D

    2008-01-01

    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.

  11. Twenty Years of Growth and Innovation: A Reflection on PACKRAT's Impact on Physician Assistant Education.

    PubMed

    Cavanagh, Kim; Lessard, Donovan; Britt, Zach

    2015-12-01

    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. PMID:26599313

  12. Twenty Years of Growth and Innovation: A Reflection on PACKRAT's Impact on Physician Assistant Education.

    PubMed

    Cavanagh, Kim; Lessard, Donovan; Britt, Zach

    2015-12-01

    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.

  13. Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada.

    PubMed

    Landry, Joshua T; Foreman, Thomas; Kekewich, Michael

    2015-11-01

    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.]. PMID:26518907

  14. Euthanasia and physician-assisted suicide: knowledge, attitudes and experiences of nurses in Andalusia (Spain).

    PubMed

    Tamayo-Velázquez, María-Isabel; Simón-Lorda, Pablo; Cruz-Piqueras, Maite

    2012-09-01

    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. PMID:22990427

  15. Euthanasia and physician-assisted suicide: knowledge, attitudes and experiences of nurses in Andalusia (Spain).

    PubMed

    Tamayo-Velázquez, María-Isabel; Simón-Lorda, Pablo; Cruz-Piqueras, Maite

    2012-09-01

    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.

  16. Health Policy in Physician Assistant Education: Teaching Considerations and a Model Curriculum.

    PubMed

    Kidd, Vasco Deon; Cawley, James F; Kayingo, Gerald

    2016-03-01

    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.

  17. Physician-assisted dying and psychiatry: recent developments in The Netherlands.

    PubMed

    Pols, Hans; Oak, Stephanie

    2013-01-01

    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. PMID:23816378

  18. Physician-assisted dying and two senses of an incurable condition.

    PubMed

    Varelius, Jukka

    2016-09-01

    It is commonly accepted that voluntary active euthanasia and physician-assisted suicide can be allowed, if at all, only in the cases of patients whose conditions are incurable. Yet, there are different understandings of when a patient's condition is incurable. In this article, I consider two understandings of the notion of an incurable condition that can be found in the recent debate on physician-assisted dying. According to one of them, a condition is incurable when it is known that there is no cure for it. According to the other, a condition is incurable when no cure is known to exist for it. I propose two criteria for assessing the conceptions and maintain that, in light of the criteria, the latter is more plausible than the former. PMID:27178533

  19. Physician-assisted suicide and euthanasia: German Protestantism, conscience, and the limits of purely ethical reflection.

    PubMed

    Bartmann, Peter

    2003-01-01

    In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to "organize" a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. Behind this joint service to society the lines of the theological debate have to be ree-discovered. First it will be argued that a Protestant reading of the joint memoranda has to be based on the concept of individual conscience. The crucial questions are then: Whose conscience has the authority to decide? and: Can the physician assisted suicide be desired faithfully? Prominent in the current debate are Ulrich Eibach as a strict defender of the sanctity of life, and on the other side Walter Jens and Hans Kung, who argue for a right to physician assisted suicide under extreme conditions. I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.

  20. Should we rethink how we teach cultural competency in physician assistant education?

    PubMed

    Kelly, Patricia J

    2012-01-01

    Cultural competency training has traditionally been viewed as addressing race and ethnicity and its influence on health care disparity. There are many aspects of culture or diversity that have been overshadowed in physician assistant education but are equally as important. These cultural elements include socioeconomic status, religion, sexual orientation, and disability. This article will briefly discuss the importance of these elements and how each can affect the medical care of patients in these diverse populations.

  1. A "suicide pill" for older people: attitudes of physicians, the general population, and relatives of patients who died after euthanasia or physician-assisted suicide in The Netherlands.

    PubMed

    Rurup, Mette L; Onwuteaka-Philipsen, Bregje D; Van Der Wal, Gerrit

    2005-01-01

    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.

  2. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    PubMed Central

    Anneser, Johanna; Jox, Ralf J.; Thurn, Tamara; Borasio, Gian Domenico

    2016-01-01

    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

  3. Survey of doctors' opinions of the legalisation of physician assisted suicide

    PubMed Central

    Lee, William; Price, Annabel; Rayner, Lauren; Hotopf, Matthew

    2009-01-01

    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

  4. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    PubMed Central

    Khan, Farooq; Tadros, George

    2013-01-01

    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

  5. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    PubMed

    Khan, Farooq; Tadros, George

    2013-01-01

    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

  6. Physician-assisted Suicide and Euthanasia in Indian Context: Sooner or Later the Need to Ponder!

    PubMed

    Khan, Farooq; Tadros, George

    2013-01-01

    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.

  7. Continuous sedation until death as physician-assisted suicide/euthanasia: a conceptual analysis.

    PubMed

    Lipuma, Samuel H

    2013-04-01

    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.

  8. Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

    PubMed Central

    Hicks, Madelyn Hsiao-Rei

    2006-01-01

    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

  9. Physician Assistants

    MedlinePlus

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  10. [Terminal sedation: consultation with a second physician as is the case in euthanasia and assisted suicide].

    PubMed

    Ponsioen, B P; Schuurman, W H A Elink; van den Hurk, A J P M; van der Poel, B N M; Runia, E H

    2005-02-26

    In terminally-ill patients in the Netherlands deep sedation by means of a continuous subcutaneous infusion with midazolam occurs more frequently than euthanasia and assisted suicide. Deep terminal sedation is applied to relieve symptoms during the phase of dying, but in contrast to euthanasia and assisted suicide, does not hasten death. In three terminally-ill patients, a 65-year-old man suffering from pulmonary carcinoma, a 94-year-old woman with general malaise, nausea and anorexia, and a 79-year-old woman in the final stage of ovarian carcinoma, a general-practitioner advisor was consulted about an end-of-life decision--deep terminal sedation versus euthanasia or assisted suicide. The first two patients were given deep sedation until death, in both cases a day and a half later. The third patient's request for euthanasia was considered to meet the legal criteria for euthanasia. Compliance with the Dutch statutory criteria for due care in euthanasia and assisted suicide might also be helpful when deciding about terminal deep sedation, but the role and responsibility of the attending physician may differ. However, the radical effects of sedation on the terminally-ill patient and the rapid changes in the clinical situation of the patient when the decision to sedate is taken, both emphasize the need for consultation with another physician.

  11. Legalisation of euthanasia or physician-assisted suicide: survey of doctors' attitudes.

    PubMed

    Seale, C

    2009-04-01

    This study reports UK doctors' opinions about legalisation of medically assisted dying (euthanasia and physician-assisted suicide), comparing this with the UK general public. A postal survey of 3733 UK medical practitioners was done. The majority of UK doctors are opposed to legalisation, contrasting with the UK general public. Palliative medicine specialists are particularly opposed. A strong religious belief is independently associated with opposition to assisted dying. Frequency of treating patients who die is not independently associated with attitudes. Many doctors supporting legalisation also express reservations and advocate safeguards; many doctors opposing legalisation believe and accept that treatment and nontreatment decisions may shorten life. It is hoped that future debates about legalisation can proceed with this evidence in mind.

  12. Depression and suicide are natural kinds: implications for physician-assisted suicide.

    PubMed

    Tsou, Jonathan Y

    2013-01-01

    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.

  13. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.

    PubMed

    Everett, Christine; Thorpe, Carolyn; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A

    2013-11-01

    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.

  14. Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey

    PubMed Central

    Chambaere, Kenneth; Bilsen, Johan; Cohen, Joachim; Onwuteaka-Philipsen, Bregje D.; Mortier, Freddy; Deliens, Luc

    2010-01-01

    Background Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries. To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. Methods We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. Results The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient’s explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Interpretation Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and without an explicit request occurred in different patient groups and under different circumstances. Cases without an explicit request often involved patients whose diseases had unpredictable end-of-life trajectories. Although opioids were used in most of these cases

  15. Normatology: a review and commentary with reference to abortion and physician-assisted suicide.

    PubMed

    Brodie, H K; Banner, L

    1997-06-01

    This article opens with a review of the concept of "normatology," which was developed by Sabshin and Offer in four books published over a period of 30 years. Normatology seeks to produce an "operational definition of normality and health" over the life cycle. Such a definition can be used as a guideline in the deliver of health care. The importance of this field of study is highlighted when considering issues such as abortion or physician-assisted suicide. Fortunately, the proclivity of Americans to conduct public opinion polls helps researchers determine what is considered "normal" at any given time. Gallup Polls, which have posed the same question about the legality of abortion from 1975 to 1995, indicate that about half of all Americans continuously occupy the middle ground on this issue despite a somewhat liberalizing trend. In general, public opinion holds that it is normal to want to avoid giving birth to a damaged child, to place the mother's health and safety above that of the fetus, and to terminate a pregnancy resulting from rape. It is less normal to abort a healthy fetus on demand. Thus, abortion will likely continue to be a source of controversy and confusion in our society and among psychiatric patients. In comparison, psychiatrists express attitudes about abortion that are more liberal than normal. In the case of physician-assisted suicide, public approval has increased since 1950 as scientific advancements have facilitated the prolongation of unproductive and painful life. If legalized, physician-assisted suicide may depend upon psychiatric assessment of an absence of mental disease. Such an assessment is required in the Northern Territory of Australia, where voluntary euthanasia is legal, but not in the Netherlands, where it is government-regulated. Psychiatrists must understand public opinion in order to influence it or deal with it competently. PMID:9167540

  16. Normatology: a review and commentary with reference to abortion and physician-assisted suicide.

    PubMed

    Brodie, H K; Banner, L

    1997-06-01

    This article opens with a review of the concept of "normatology," which was developed by Sabshin and Offer in four books published over a period of 30 years. Normatology seeks to produce an "operational definition of normality and health" over the life cycle. Such a definition can be used as a guideline in the deliver of health care. The importance of this field of study is highlighted when considering issues such as abortion or physician-assisted suicide. Fortunately, the proclivity of Americans to conduct public opinion polls helps researchers determine what is considered "normal" at any given time. Gallup Polls, which have posed the same question about the legality of abortion from 1975 to 1995, indicate that about half of all Americans continuously occupy the middle ground on this issue despite a somewhat liberalizing trend. In general, public opinion holds that it is normal to want to avoid giving birth to a damaged child, to place the mother's health and safety above that of the fetus, and to terminate a pregnancy resulting from rape. It is less normal to abort a healthy fetus on demand. Thus, abortion will likely continue to be a source of controversy and confusion in our society and among psychiatric patients. In comparison, psychiatrists express attitudes about abortion that are more liberal than normal. In the case of physician-assisted suicide, public approval has increased since 1950 as scientific advancements have facilitated the prolongation of unproductive and painful life. If legalized, physician-assisted suicide may depend upon psychiatric assessment of an absence of mental disease. Such an assessment is required in the Northern Territory of Australia, where voluntary euthanasia is legal, but not in the Netherlands, where it is government-regulated. Psychiatrists must understand public opinion in order to influence it or deal with it competently.

  17. A Program Module to Supplement the Clinical Psychiatry Rotation for Physician Assistant Students.

    PubMed

    Masters, Kim J

    2015-09-01

    A recent blog article aimed at prospective physician assistants (PAs) identified psychiatry as a series of Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnoses supplemented by empathy and medication. It suggested that there were ample opportunities for PAs to practice psychiatry, although a recent survey showed that only 1% of PA graduates were employed in psychiatric clinical practices. While this is only one perspective, it suggests that PAs' understanding of psychiatric practice is limited by the patient population they see during their clinical rotations as students. A broad systematically organized clinical psychiatry module with clinical preceptor direction could provide a more informed knowledge base and more interest in the field.

  18. The right to die and physician-assisted suicide medical, legal, and ethical aspects (Part I).

    PubMed

    Wecht, C H

    1998-01-01

    Part 1 of this paper examines the issue of the "Right to Die", and its relationship to the discipline of Bioethics and the doctrine of Informed Consent. The discussion underlines the role and rights of the patient. A number of relevant judgments are quoted, with their implications. Part 2, to be published in our next issue, continues the discussion, with emphasis on the subject of physician-assisted suicide and the activities of Dr. Kevorkian. Further legal cases are quoted with relevant analysis, together with proposed legislation under the title "Death with Dignity". Finally, the author points to possible future developments in this controversial issue.

  19. Responding to requests for physician-assisted suicide: "These are uncharted waters for both of us...".

    PubMed

    Bascom, Paul B; Tolle, Susan W

    2002-07-01

    Studies of dying patients have shown that about half would like the option of physician-assisted suicide (PAS) to be available for possible future use. Those percentages decrease significantly with each step patients take toward action. Studies show that although about 10% of patients seriously consider PAS, only 1% of dying patients specifically request it, and 1 in 10 of those patients actually receive and take a lethal prescription. However, most patients' desires for PAS diminish as their underlying concerns are identified and addressed directly. To help identify concerns motivating a patient's request for PAS, physicians should talk with patients about their expectations and fears, options for end-of-life care, goals, family concerns and burdens, suffering or physical symptoms, sense of meaning and quality of life, and symptoms of depression. A patient with advanced amyotrophic lateral sclerosis (ALS) who requested PAS illustrates how a hasty response may adversely affect patient care and the health care team. Although physicians should remain mindful of their personal, moral, and legal concerns, these concerns should not override their willingness to explore what motivates a patient to make this request. When this approach is taken, suffering can be optimally alleviated and, in almost all cases, the patient's wishes can be met without PAS.

  20. A systematic review: The role and impact of the physician assistant in the emergency department.

    PubMed

    Doan, Quynh; Sabhaney, Vikram; Kissoon, Niranjan; Sheps, Sam; Singer, Joel

    2011-02-01

    This systematic review describes the role and impact of physician assistants (PAs) in the ED. It includes reports of surveys, retrospective and prospective studies as well as guidelines and reviews. Seven hundred and twelve studies were identified of which only 66 were included, and many of these studies were limited by methodological quality. Generally the use of PAs in the ED is modest with 13-18% of US EDs having PAs although academic medical centres report PA use in 65-68% of EDs. The evidence indicates that PAs are reliable in assessing certain medical complaints and performing procedures, and are well accepted by ED staff and patients alike. There is limited evidence as to whether PAs improve ED flow or are cost-effective. Future studies on work processes, cost-effectiveness, unfamiliar patients' willingness to be treated by non-physician providers, and ED physicians' acceptability of PAs are needed to inform and guide the integration of PAs into EDs. PMID:21284809

  1. Do family physicians need medical assistants to detect and manage hypertension?

    PubMed

    Bass, M J; McWhinney, I R; Donner, A

    1986-06-01

    To test a new approach to detecting and managing hypertension, 34 family practices in southwestern Ontario that comprised 32 124 patients aged 20 to 65 years were randomly assigned in a 5-year study to either undertake a system of care in which a medical assistant oversaw screening and attended to education, compliance and follow-up (experimental group) or continue their usual practices (control group). The 17 physicians in the experimental practices (15 659 patients) were matched with the 17 in the control practices (16 465 patients) according to size of the community, sex, level of practice activity and length of time in practice. Hypertension was defined as at least two diastolic blood pressure readings over 90 mm Hg. More patients in the experimental group than in the control group were screened at least once (91% v. 80%); the former were more likely to have lower systolic blood pressure (p less than 0.02), to be compliant (p less than 0.05) and to be very satisfied with care (p less than 0.01). There were no significant differences between the two groups in the rates of illness and death due to cardiovascular disease for all patients or for hypertensive patients. The unassisted family physician can provide effective care for hypertensive patients. However, minor modifications in the physician's practices can improve care.

  2. Virtual patient care: an interprofessional education approach for physician assistant, physical therapy and occupational therapy students.

    PubMed

    Shoemaker, Michael J; Platko, Christina M; Cleghorn, Susan M; Booth, Andrew

    2014-07-01

    The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.

  3. Facilitating Research in Physician Assistant Programs: Creating a Student-Level Longitudinal Database.

    PubMed

    Morgan, Perri; Humeniuk, Katherine M; Everett, Christine M

    2015-09-01

    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.

  4. Using CD-ROM technology to increase folic acid knowledge among physician assistant students.

    PubMed

    Morgan, Christine; Klein, Diane Austrin; Selbst, Melissa

    2004-01-01

    The purpose of this study was to examine the effectiveness of incorporating CD-ROM technology to increase the knowledge of folic acid among physician assistant students. Participants included 76 first-year physician assistant students enrolled in a Women's Health course. A pretest and posttest was used to evaluate the knowledge gain after viewing the CD-ROM over a 2-week period. Of the 76 students in the course, 73 completed the pretest and the post-test. Posttest scores were significantly better than pretest scores (t = -11.83; p < or = 0.001), with means 68.63% and 46.18%. Knowledge scores increased by 22.45% from pre-test to posttest. Student evaluation results suggested that the CD-ROM (1) provided folic acid information in a clear and effective manner, (2) adequately covered the folic acid information, (3) increased student awareness and knowledge about folic acid, and (4) may promote early commitment by students to recommend daily folic acid intake to their patients.

  5. Considerations for a Primary Care Physician Assistant in Treating Kidney Transplant Recipients

    PubMed Central

    Aston, Ryan; Durkin, Allison; Harris, Kristen; Mace, Amanda; Moore, Sierra; Smith, Brittany; Soult, Eric; Wright, Mara; Yothers, Dustin; Latos, Derrick L.; Horzempa, Joseph

    2015-01-01

    The escalating amount of kidney transplant recipients (KTRs) represents a significant dilemma for primary care providers. As the number of physician assistants (PAs) has been steadily increasing in primary care in the United States, the utilization of these healthcare professionals presents a solution for the care of post-kidney transplant recipients. A physician assistant (PA) is a state licensed healthcare professional who practices medicine under physician supervision and can alleviate some of the increasing demands for primary patient care. Here we provide an outline of the crucial components and considerations for PAs caring for kidney transplant recipients. These include renal function and routine screenings, drug monitoring (both immunosuppressive and therapeutic), pre-existing and co-existing conditions, immunizations, nutrition, physical activity, infection, cancer, and the patient’s emotional well-being. PAs should routinely monitor renal function and blood chemistry of KTRs. Drug monitoring of KTRs is a crucial responsibility of the PA because of the possible side-effects and potential drug-drug interactions. Therefore, PAs should obtain a careful and detailed patient history from KTRs. PAs should be aware of pre- and co-existing conditions of KTRs as this impacts treatment decisions. Regarding immunization, PAs should avoid administering vaccines containing live or attenuated viruses to KTRs. Because obesity following kidney transplantation is associated with decreased allograft survival, PAs should encourage KTRs to maintain a balanced diet with limited sugar. In addition, KTRs should be urged to gradually increase their levels of physical activity over subsequent years following surgery. PAs should be aware that immunosuppressive medications diminish immune defenses and make KTRs more susceptible to bacterial, viral, and fungal infections. Moreover, KTRs should be screened routinely for cancer due to the higher risk of development from

  6. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique.

    PubMed

    Sjöstrand, Manne; Helgesson, Gert; Eriksson, Stefan; Juth, Niklas

    2013-05-01

    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. PMID:22161026

  7. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique.

    PubMed

    Sjöstrand, Manne; Helgesson, Gert; Eriksson, Stefan; Juth, Niklas

    2013-05-01

    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.

  8. Determinants of Public Attitudes towards Euthanasia in Adults and Physician-Assisted Death in Neonates in Austria: A National Survey

    PubMed Central

    Stolz, Erwin; Burkert, Nathalie; Großschädl, Franziska; Rásky, Éva; Stronegger, Willibald J.; Freidl, Wolfgang

    2015-01-01

    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

  9. The problem of the possible rationality of suicide and the ethics of physician-assisted suicide.

    PubMed

    Wittwer, Héctor

    2013-01-01

    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.

  10. Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry.

    PubMed

    Gopal, Abilash A

    2015-06-01

    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.

  11. A Program Module to Supplement the Clinical Psychiatry Rotation for Physician Assistant Students.

    PubMed

    Masters, Kim J

    2015-09-01

    A recent blog article aimed at prospective physician assistants (PAs) identified psychiatry as a series of Diagnostic and Statistical Manual of Mental Disorders, 5th edition, diagnoses supplemented by empathy and medication. It suggested that there were ample opportunities for PAs to practice psychiatry, although a recent survey showed that only 1% of PA graduates were employed in psychiatric clinical practices. While this is only one perspective, it suggests that PAs' understanding of psychiatric practice is limited by the patient population they see during their clinical rotations as students. A broad systematically organized clinical psychiatry module with clinical preceptor direction could provide a more informed knowledge base and more interest in the field. PMID:26309206

  12. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada.

    PubMed

    Duffy, Olivia Anne

    2015-12-01

    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.

  13. The attitudes of socially marginalized men toward physician-assisted suicide.

    PubMed

    Parks, Louisa A; Zelman, Diane C; Wanlass, Richard L

    Bioethics and public policy literature suggests that socially marginalized populations may be at increased risk for overuse of physician-assisted suicide (PAS) were it to become more accepted. Yet the attitudes of socially marginalized populations toward PAS have not been widely studied. The present study surveyed a sample of men in a substance abuse recovery program. Participants completed a PAS attitude questionnaire and a religiosity measure. Support for PAS was fairly evenly split, with 52.2% indicating general opposition to PAS and 46.9% indicating general support. Greater religiosity was associated with more negative attitudes toward PAS. Higher educational level was associated with more acceptance. Overall attitudes toward PAS were considerably more negative than those of Dr. George Domino's (2003) general population sample.

  14. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada.

    PubMed

    Duffy, Olivia Anne

    2015-12-01

    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. PMID:26720829

  15. The economic effect of a physician assistant or nurse practitioner in rural America.

    PubMed

    Eilrich, Fred C

    2016-10-01

    Revenues generated by physician assistants (PAs) and NPs in clinics and hospitals create employment opportunities and wages, salaries, and benefits for staff, which in turn are circulated throughout the local economy. An input-output model was used to estimate the direct and secondary effects of a rural primary care PA or NP on the community and surrounding area. This type of model explains how input/output from one sector of industry can be the output/input for another sector. Given two example scenarios, a rural PA or NP can have an employment effect of 4.4 local jobs and labor income of $280,476 from the clinic. The total effect to a community with a hospital increases to 18.5 local jobs and $940,892 of labor income. PMID:27685514

  16. Voluntary euthanasia, physician-assisted suicide, and the right to do wrong.

    PubMed

    Varelius, Jukka

    2013-09-01

    It has been argued that voluntary euthanasia (VE) and physician-assisted suicide (PAS) are morally wrong. Yet, a gravely suffering patient might insist that he has a moral right to the procedures even if they were morally wrong. There are also philosophers who maintain that an agent can have a moral right to do something that is morally wrong. In this article, I assess the view that a suffering patient can have a moral right to VE and PAS despite the moral wrongness of the procedures in light of the main argument for a moral right to do wrong found in recent philosophical literature. I maintain that the argument does not provide adequate support for such a right to VE and PAS.

  17. Does the experience of interpersonal predictors of suicidal desire predict positive attitudes toward Physician Assisted Suicide?

    PubMed

    Tucker, Raymond P; Buchanan, Carmen A; O'Keefe, Victoria M; Wingate, Laricka R

    2014-01-01

    The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

  18. A study of Canadian hospice palliative care volunteers' attitudes toward physician-assisted suicide.

    PubMed

    Claxton-Oldfield, Stephen; Miller, Kathryn

    2015-05-01

    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.

  19. Necessity and benefits of physician assistants' participation in international clinical experiences.

    PubMed

    Kibe, Lucy Wachera

    2012-01-01

    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. PMID:23437625

  20. Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants.

    PubMed

    Boiano, James M; Steege, Andrea L

    2016-10-01

    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

  1. The military veteran to physician assistant pathway: building the primary care workforce.

    PubMed

    Brock, Douglas; Bolon, Shannon; Wick, Keren; Harbert, Kenneth; Jacques, Paul; Evans, Timothy; Abdullah, Athena; Gianola, F J

    2013-12-01

    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. PMID:24128629

  2. GPs' views on the practice of physician-assisted suicide and their role in proposed UK legalisation: a qualitative study

    PubMed Central

    Hussain, Tariq; White, Patrick

    2009-01-01

    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

  3. Informed Practice: Students' Clinical Experiences in the Undergraduate Phase of an Accelerated Physician Assistant Program.

    PubMed

    Dereczyk, Amy; DeWitt, Rachel

    2016-06-01

    This qualitative study explored the clinical experiences of students in an accelerated physician assistant (PA) program. The participants were either certified nursing assistants (CNAs) or emergency medical technicians-basic (EMTs-B). The study was designed to elicit (1) how the participants perceived their older patients and (2) how the participants' experiences might affect their own future communications, bedside manner, and clinical preparedness as PAs. This study used a focus group to explore students' clinical experiences before the graduate phase of their accelerated PA program. Five female and 2 male PA students (N = 7) participated in the study. All participants were 23 years old and worked as either a CNA or an EMT-B. Results fell into 2 basic themes: informing practice and forming relationships. Regarding the first theme, participants felt that their experience as entry-level health care providers allowed them to improve their communication skills and bedside manner and to provide greater comfort to patients. Regarding the second theme, participants gained appreciation for older people and began to recognize the knowledge deficits and learning needs of their patients. The results suggested that a student's clinical experience as a CNA or an EMT-B before entering a PA program has a positive effect on the student's personal and professional development. The participants acquired greater appreciation and respect for older patients and members of the health care team. PMID:27123599

  4. An Analysis of Department of Defense Medical Corpsmen Training Programs and Possible Contributions to Civilian Physician's Assistant Programs.

    ERIC Educational Resources Information Center

    Cabral, William R.; Stewart, Wendell L.

    The general Medical Corpsmen Training Programs of the Army, Navy, and Air Force are presented and analyzed. These programs are compared with the Civilian Physician's Assistant Programs at Duke University and the University of Washington Medex Program. The purpose was to determine whether additional academic credit could be granted for Military…

  5. Nurse Practitioners, Physician Assistants, and Certified Nurse-Midwives: A Policy Analysis. Health Technology Case Study 37.

    ERIC Educational Resources Information Center

    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…

  6. Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated with "Physician-Assisted Suicide"

    ERIC Educational Resources Information Center

    Werth, James L., Jr.; Gordon, Judith R.

    2002-01-01

    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…

  7. Just How Important Is the Messenger versus the Message? The Case of Framing Physician-Assisted Suicide

    ERIC Educational Resources Information Center

    Haider-Markel, Donald P.; Joslyn, Mark R.

    2004-01-01

    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…

  8. A Comparison of Osteopathic, Pharmacy, Physical Therapy, Physician Assistant and Occupational Therapy Students' Personality Styles: Implications for Education and Practice.

    ERIC Educational Resources Information Center

    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…

  9. Institutional sponsorship, student debt, and specialty choice in physician assistant education.

    PubMed

    Cawley, James F; Jones, P Eugene

    2013-01-01

    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. PMID:24616952

  10. Institutional sponsorship, student debt, and specialty choice in physician assistant education.

    PubMed

    Cawley, James F; Jones, P Eugene

    2013-01-01

    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.

  11. Factors associated with the use of advanced practice nurses/physician assistants in a fee-for-service nursing home practice: a comparison with primary care physicians.

    PubMed

    Bakerjian, Debra; Harrington, Charlene

    2012-07-01

    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.

  12. Attitudes of people with disabilities toward physician-assisted suicide legislation: broadening the dialogue.

    PubMed

    Fadem, Pamela; Minkler, Meredith; Perry, Martha; Blum, Klaus; Moore, Leroy F; Rogers, Judi; Williams, Lee

    2003-12-01

    This article presents the methods, findings, and implications of a participatory action research project that attempted to shed additional light on the debate over death with dignity (DWD) or physician-assisted suicide (PAS) legislation. In-depth, qualitative interviews with forty-five physically disabled residents of the San Francisco Bay Area, conducted by others with disabilities, revealed a wide breadth of opinions about and attitudes toward such legislation. For close to half of the participants, the desire for autonomy in making end-of-life decisions was a primary concern, yet fear that PAS legislation could violate this autonomy in various ways was a deep concern as well. Also reported were widespread accounts of disability-based discrimination and frequent expressions of fear about openly discussing positions that diverge from the official, publicly held opinions of disability leaders who oppose such legislation. The findings support those of a recent Harris poll demonstrating considerable diversity of opinion about PAS legislation among people with disabilities. The findings further suggest the need for additional research on the apparent disjunction between the diversity of attitudes held by those interviewed and the more unified position taken by many disability activists. Use of the study findings to promote greater dialogue within the community and to better position people with disabilities to take their place at the policy table also is discussed. In addition, the findings are seen as reinforcing the need for the public health community to become more engaged in this central ethical debate. PMID:14756497

  13. Imperfect physician assistant and physical therapist admissions processes in the United States

    PubMed Central

    2014-01-01

    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

  14. Nurse practitioner and physician assistant students' knowledge, attitudes, and perspectives of chiropractic

    PubMed Central

    Bowden, Briana S.; Ball, Lisa

    2016-01-01

    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

  15. A protocol for consultation of another physician in cases of euthanasia and assisted suicide

    PubMed Central

    van der

    2001-01-01

    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

  16. Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings

    PubMed Central

    Kannampallil, Thomas G; Jones, Laura K; Patel, Vimla L; Buchman, Timothy G; Franklin, Amy

    2014-01-01

    Objective Critical care environments are information-intensive environments where effective decisions are predicated on successfully finding and using the ‘right information at the right time’. We characterize the differences in processes and strategies of information seeking between residents, nurse practitioners (NPs), and physician assistants (PAs). Method We conducted an exploratory study in the cardiothoracic intensive care units of two large academic hospitals within the same healthcare system. Clinicians (residents (n=5), NPs (n=5), and PAs (n=5)) were shadowed as they gathered information on patients in preparation for clinical rounds. Information seeking activities on 96 patients were collected over a period of 3 months (NRes=37, NNP=24, NPA=35 patients). The sources of information and time spent gathering the information at each source were recorded. Exploratory data analysis using probabilistic sequential approaches was used to analyze the data. Results Residents predominantly used a patient-based information seeking strategy in which all relevant information was aggregated for one patient at a time. In contrast, NPs and PAs primarily utilized a source-based information seeking strategy in which similar (or equivalent) information was aggregated for multiple patients at a time (eg, X-rays for all patients). Conclusions The differences in the information seeking strategies are potentially a result of the differences in clinical training, strategies of managing cognitive load, and the nature of the use of available health IT tools. Further research is needed to investigate the effects of these differences on clinical and process outcomes. PMID:24619926

  17. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    PubMed

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    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.

  18. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    PubMed Central

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    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

  19. The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

    PubMed Central

    Duffy, Olivia Anne

    2015-01-01

    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

  20. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    PubMed

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    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

  1. Physician-Assisted Suicide and Other Forms of Euthanasia in Islamic Spiritual Care.

    PubMed

    Isgandarova, Nazila

    2015-12-01

    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?' PMID:26631521

  2. Physician-Assisted Suicide and Other Forms of Euthanasia in Islamic Spiritual Care.

    PubMed

    Isgandarova, Nazila

    2015-12-01

    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?'

  3. Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

    PubMed

    Maessen, Maud; Veldink, Jan H; Onwuteaka-Philipsen, Bregje D; Hendricks, Henk T; Schelhaas, Helenius J; Grupstra, Hepke F; van der Wal, Gerrit; van den Berg, Leonard H

    2014-10-01

    The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86% considered the health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity and 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS.

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

    PubMed

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2013-01-01

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

  5. Pilot Survey of Physician Assistants Regarding Lesbian, Gay, Bisexual, and Transgender Providers Suggests Role for Workplace Nondiscrimination Policies.

    PubMed

    Ewton, Tiffany A; Lingas, Elena O

    2015-12-01

    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.

  6. Pilot Survey of Physician Assistants Regarding Lesbian, Gay, Bisexual, and Transgender Providers Suggests Role for Workplace Nondiscrimination Policies.

    PubMed

    Ewton, Tiffany A; Lingas, Elena O

    2015-12-01

    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. PMID:26788777

  7. [Legal issues of physician-assisted euthanasia part I--terminology and historical overview].

    PubMed

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2012-01-01

    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.

  8. [Legal issues of physician-assisted euthanasia part I--terminology and historical overview].

    PubMed

    Laux, Johannes; Röbel, Andreas; Parzeller, Markus

    2012-01-01

    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. PMID:23367790

  9. Are Dutch patients willing to be seen by a physician assistant instead of a medical doctor?

    PubMed Central

    2012-01-01

    Background The employment of physician assistants (PAs) is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD) under various time constraints and semi-urgent medical scenarios. Methods A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively. Results Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario). No differences emerged when analysed by gender, age, or parenthood status. Conclusion Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population. PMID:22947130

  10. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications.

    PubMed

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    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

  11. Full Intelligent Cancer Classification of Thermal Breast Images to Assist Physician in Clinical Diagnostic Applications

    PubMed Central

    Lashkari, AmirEhsan; Pak, Fatemeh; Firouzmand, Mohammad

    2016-01-01

    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

  12. 3 CFR 8579 - Proclamation 8579 of October 6, 2010. National Physician Assistants Week, 2010

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... from the Prevention and Public Health Fund under the Affordable Care Act to expand the Physician... tirelessly everyday to care for Americans and fulfill a critical function in our health care system. They... principal care provider in rural or inner-city clinics, and other settings with provider shortages....

  13. 42 CFR 405.2415 - Services and supplies incident to nurse practitioner and physician assistant services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... nurse practitioner or a physician; and (5) In the case of a service, furnished by a member of the clinic... THE AGED AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services § 405.2415... type commonly rendered either without charge or included in the rural health clinic's bill;...

  14. NuTech and non-physician assisted suicide: a reply to Werth.

    PubMed

    Ogden, R D

    2001-01-01

    This article responds to J. Werth's (2001) concerns about lay person involvement in illegal, unregulated assisted death activities. The author disputes the necessity for a spiral of conflict between the NuTech assisted death activists and their opponents. He also challenges the idea that assisted death must be the dominion of medical control. To shed light on the respective arguments, the author proposes that empirical investigation into the use of NuTech death devices is required. PMID:11806411

  15. [Euthanasia and physician-assisted suicide in Argentina and in other countries].

    PubMed

    Przygoda, P

    1999-01-01

    Medical decisions concerning the end of a patient's life have been widely practiced for centuries and there are strong arguments for and against. Advocates typically adduced that terminally ill patients have the right to impose, with physicians' help, their self-determination to avoid extreme suffering and a painful death. Opponents argued that legalizing those practices would not be ethical because it is against the principles of society and the medical profession. During the last years, debates about medical decisions concerning the end of a patient's life have increased in many regions of the planet after these became legal in several countries. In Argentina, those practices are illegal; however, there is evidence that they are frequently practiced. Nevertheless, public discussion on the subject is limited in Argentina. A profound debate on the position of society and physicians concerning terminally ill patients must be initiated. PMID:10413902

  16. Report 59 of the AMA Board of Trustees (A-96). Physician-assisted suicide. Reference Committee on Amendments to Constitution and Bylaws.

    PubMed

    1996-08-01

    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

  17. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    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. PMID:25068685

  18. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    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.

  19. A Digital Health System to Assist Family Physicians to Safely Prescribe NOAC Medications.

    PubMed

    Abidi, Samina Raza; Cox, Jafna; Abusharekh, Ashraf; Hashemian, Nima; Abidi, Syed Sibte Raza

    2016-01-01

    Atrial Fibrillation (AF) is the most common cardiac arrhythmia. Generally, the therapeutic options for managing AF include the use of anticoagulant drugs that prevent the coagulation of blood. New Oral Anticoagulants (NOACs) are not optimally prescribed to patients, despite their efficacy. In Canada, NOAC medications are not directly available to patients who belong to provincial benefits programs, rather a NOAC special authorization process establishes the eligibility of a patient to receive a NOAC and be paid by the provincial Pharmacare program. This special authorization process is tedious and paper-based which inhibits physicians to prescribe NOAC leading to suboptimal AF care to patients. In this paper, we present a computerized NOAC Authorization Decision Support System (NOAC-ADSS), accessible to physicians to help them (a) determine a patient eligibility for NOAC based on Canadian AF clinical guidelines, and (b) complete the special authorization form. We present a semantic web based system to ontologically model the NOAC eligibility criteria and execute the knowledge to determine a patient NOAC eligibility and dosage. PMID:27577437

  20. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales.

    PubMed

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-06-01

    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.

  1. GPs' views on changing the law on physician-assisted suicide and euthanasia, and willingness to prescribe or inject lethal drugs: a survey from Wales

    PubMed Central

    Pasterfield, Diana; Wilkinson, Clare; Finlay, Ilora G; Neal, Richard D; Hulbert, Nicholas J

    2006-01-01

    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

  2. The debate about physician assistance in dying: 40 years of unrivalled progress in medical ethics?

    PubMed

    Holm, Søren

    2015-01-01

    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.

  3. The debate about physician assistance in dying: 40 years of unrivalled progress in medical ethics?

    PubMed

    Holm, Søren

    2015-01-01

    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. PMID:25516932

  4. Physician-assisted suicide of patients with dementia. A medical ethical analysis with a special focus on patient autonomy.

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2013-01-01

    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.

  5. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands

    ERIC Educational Resources Information Center

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.

    2007-01-01

    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…

  6. A "Suicide Pill" for Older People: Attitudes of Physicians, the General Population, and Relatives of Patients Who Died after Euthanasia or Physician-Assisted Suicide in the Netherlands

    ERIC Educational Resources Information Center

    Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.; van der Wal, Gerrit; van der Heide, Agnes; van Der Maas, Paul J.

    2005-01-01

    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…

  7. Effectiveness of educational strategies preparing physician assistants, nurse practitioners, and certified nurse-midwives for underserved areas.

    PubMed Central

    Fowkes, V K; Gamel, N N; Wilson, S R; Garcia, R D

    1994-01-01

    A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies. PMID:7938389

  8. Cultural competency in a physician assistant curriculum in the United States: a longitudinal study with two cohorts

    PubMed Central

    2014-01-01

    Purpose: Many physician assistant (PA) programs have recently integrated cultural competency into their curricula. However, there is little evidence of the longitudinal effectiveness of such curricula on culture competency. This study tested whether the amount of exposure to a cultural competency curriculum affected self-assessments of cultural awareness in two cohorts of students. Methods: Cohort 1 and Cohort 2 students completed a cultural awareness survey at the beginning of the program and retook the survey at three intervals during the first year. Results: Regression analyses confirmed a significant linear relationship (two-tailed 0.05) between the responses and the interval number on all questions for each cohort, with the exception of Question 8, on the ability to identify discrimination, for Cohort 2. Conclusion: Results from Cohort 2 replicated those from Cohort 1, suggesting that cultural awareness among PA students benefits from repeated exposure to lessons on cultural competency. Schools attempting to develop or expand cultural awareness among students should consider integrating cultural competency training throughout the PA curriculum. PMID:24699447

  9. Will the S.C.C.'s Decision on Physician-Assisted Death Apply to Persons Suffering from Severe Mental Illness?

    PubMed

    Walker-Renshaw, Barbara; Finley, Margot

    2016-02-01

    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. PMID:27169201

  10. Will the S.C.C.'s Decision on Physician-Assisted Death Apply to Persons Suffering from Severe Mental Illness?

    PubMed

    Walker-Renshaw, Barbara; Finley, Margot

    2016-02-01

    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.

  11. Contesting the Equivalency of Continuous Sedation until Death and Physician-assisted Suicide/Euthanasia: A Commentary on LiPuma.

    PubMed

    Raho, Joseph A; Miccinesi, Guido

    2015-10-01

    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. PMID:26242447

  12. Contesting the Equivalency of Continuous Sedation until Death and Physician-assisted Suicide/Euthanasia: A Commentary on LiPuma.

    PubMed

    Raho, Joseph A; Miccinesi, Guido

    2015-10-01

    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.

  13. Physician Assistant profession (PA)

    MedlinePlus

    ... primary care areas, including family practice. Other common practice areas are general surgery, surgery specialties, and emergency medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may ...

  14. Office-based physicians are responding to incentives and assistance by adopting and using electronic health records.

    PubMed

    Hsiao, Chun-Ju; Jha, Ashish K; King, Jennifer; Patel, Vaishali; Furukawa, Michael F; Mostashari, Farzad

    2013-08-01

    Expanding the use of interoperable electronic health record (EHR) systems to improve health care delivery is a national policy priority. We used the 2010-12 National Ambulatory Medical Care Survey--Electronic Health Records Survey to examine which physicians in what types of practices are implementing the systems, and how they are using them. We found that 72 percent of physicians had adopted some type of system and that 40 percent had adopted capabilities required for a basic EHR system. The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers. As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty. However, small practices continued to lag behind larger practices. Finally, the majority of physicians who adopted the EHR capabilities required to obtain federal financial incentives used the capabilities routinely, with few differences across physician groups. PMID:23840050

  15. A better approach to care of the dying. Catholic healthcare and the Catholic community can present an alternative to physician-assisted suicide.

    PubMed

    Hamel, R

    1998-01-01

    To combat physician-assisted suicide, Catholic healthcare and the Catholic community cannot solely focus on mounting campaigns and formulating policies. They must also demonstrate an alternative way to approach death and care of the dying, taking a leadership role in improving end-of-life care. To accomplish this, Catholic healthcare must foster a culture that recognizes death as the inevitable outcome of human life and makes care for the dying as important as care for those who may get well. The ministry must acknowledge the limits of human life, human abilities, human ingenuity, and medical technology; and respect decisions to forgo life-sustaining therapies. In addition, physicians must address advance directives with patients before hospitalization and must be willing to offer hospice care as an option to dying patients and their families. More effective pain management must be devised. Catholic facilities must develop palliative care policies and commit to ongoing education to provide such care. It is essential that they pay attention to the environment in which patients die; identify the physical, psychosocial, and spiritual needs of family members; and use prayer and rituals in meaningful ways. With a clear focus on improving end-of-life care, Catholic healthcare--in partnership with other denominations--can eliminate some of the factors that can make physician-assisted suicide seem appealing to suffering people.

  16. End-of-life discontinuation of destination therapy with cardiac and ventilatory support medical devices: physician-assisted death or allowing the patient to die?

    PubMed Central

    2010-01-01

    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

  17. Disaster management and physician preparedness.

    PubMed

    Kumar, Ajoy; Weibley, Eilene

    2013-01-01

    There are an increasing amount and variety of disasters occurring throughout the United States. Many of these disasters require physicians to provide medical assistance. This article provides a brief introduction to disaster preparedness and its recent history and physicians' obligations, role, education, preparation, and response. It is the intent of this article to increase awareness and provide pathways for physician education and involvement.

  18. CONVERTING THE 'RIGHT TO LIFE' TO THE 'RIGHT TO PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA': AN ANALYSIS OF CARTER V CANADA (ATTORNEY GENERAL), SUPREME COURT OF CANADA.

    PubMed

    Chan, Benny; Somerville, Margaret

    2016-01-01

    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. PMID:27099364

  19. CONVERTING THE 'RIGHT TO LIFE' TO THE 'RIGHT TO PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA': AN ANALYSIS OF CARTER V CANADA (ATTORNEY GENERAL), SUPREME COURT OF CANADA.

    PubMed

    Chan, Benny; Somerville, Margaret

    2016-01-01

    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.

  20. Preparation for Medical, Dental, Pharmacy, Physical Therapy, and Physician Assistant Careers: Helping Students Gain a Competitive Edge

    ERIC Educational Resources Information Center

    Elam, Carol L.; Seaver, Daniel C.; Berres, Peter N.; Brandt, Barbara F.

    2002-01-01

    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…

  1. Do guidelines on euthanasia and physician-assisted suicide in Dutch hospitals and nursing homes reflect the law? A content analysis.

    PubMed

    Hesselink, B A M; Onwuteaka-Philipsen, B D; Janssen, A J G M; Buiting, H M; Kollau, M; Rietjens, J A C; Pasman, H R W

    2012-01-01

    To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process.

  2. 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.

    ERIC Educational Resources Information Center

    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)

  3. Wartime toxicology: evaluation of a military medical toxicology telemedicine consults service to assist physicians serving overseas and in combat (2005-2012).

    PubMed

    Maddry, Joseph K; Sessions, Daniel; Heard, Kennon; Lappan, Charles; McManus, John; Bebarta, Vikhyat S

    2014-09-01

    Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most

  4. Wartime toxicology: evaluation of a military medical toxicology telemedicine consults service to assist physicians serving overseas and in combat (2005-2012).

    PubMed

    Maddry, Joseph K; Sessions, Daniel; Heard, Kennon; Lappan, Charles; McManus, John; Bebarta, Vikhyat S

    2014-09-01

    Those medical providers deployed to remote countries and tasked with caring for military personnel must diagnose and treat diseases and nonbattle injuries that result from exposures rarely seen in developed countries. Military providers must also function with limited resources and a lack of access to physician specialists, to include medical toxicologists. There have been limited published approaches to addressing this clinical gap for medical toxicology. To address this void, the US Army Medical Department deployed an electronic mail telemedicine system to provide teleconsultations for remote health-care providers worldwide, including Iraq and Afghanistan. This study aimed to describe the types and the frequency of toxicology teleconsultation and consultant responses using electronic mail to assist physicians serving in resource-limited locations. This was a retrospective observational study in which an unblinded data extractor independently reviewed all medical toxicology email consultations. Using a previously developed data collection worksheet, the extractor recorded the type of question asked by the consultant (overdose case, envenomation, occupational exposure, etc.) and the duration of time from when the teleconsultation was placed until the consultant replied. The extractor also recorded if the patient was adult or pediatric and if the patient was US military, US contractor, or local national. The extractor also recorded how often the toxicologist provided the consulting physician with information, resources, or protocols to aid in the management of future cases. In addition, for clinical teleconsultations, the extractor documented the frequency that the consulted toxicologist (i) provided a differential diagnosis or specific diagnosis, (ii) provided specific management guidelines for a patient, and (iii) recommended to evacuate or not evacuate a patient. The results were analyzed using descriptive statistics. Of the 99 consultations evaluated, the most

  5. Using PCR-based detection and genotyping to trace Streptococcus salivarius meningitis outbreak strain to oral flora of radiology physician assistant.

    PubMed

    Srinivasan, Velusamy; Gertz, Robert E; Shewmaker, Patricia L; Patrick, Sarah; Chitnis, Amit S; O'Connell, Heather; Benowitz, Isaac; Patel, Priti; Guh, Alice Y; Noble-Wang, Judith; Turabelidze, George; Beall, Bernard

    2012-01-01

    We recently investigated three cases of bacterial meningitis that were reported from a midwestern radiology clinic where facemasks were not worn during spinal injection of contrast agent during myelography procedures. Using pulsed field gel electrophoresis we linked a case strain of S. salivarius to an oral specimen of a radiology physician assistant (RPA). We also used a real-time PCR assay to detect S. salivarius DNA within a culture-negative cerebrospinal fluid (CSF) specimen. Here we extend this investigation through using a nested PCR/sequencing strategy to link the culture-negative CSF specimen to the case strain. We also provide validation of the real-time PCR assay used, demonstrating that it is not solely specific for Streptococcus salivarius, but is also highly sensitive for detection of the closely related oral species Streptococcus vestibularis. Through using multilocus sequence typing and 16S rDNA sequencing we further strengthen the link between the CSF case isolate and the RPA carriage isolate. We also demonstrate that the newly characterized strains from this study are distinct from previously characterized S. salivarius strains associated with carriage and meningitis. PMID:22384169

  6. Using PCR-Based Detection and Genotyping to Trace Streptococcus salivarius Meningitis Outbreak Strain to Oral Flora of Radiology Physician Assistant

    PubMed Central

    Srinivasan, Velusamy; Gertz Jr., Robert E.; Shewmaker, Patricia L.; Patrick, Sarah; Chitnis, Amit S.; O'Connell, Heather; Benowitz, Isaac; Patel, Priti; Guh, Alice Y.; Noble-Wang, Judith; Turabelidze, George; Beall, Bernard

    2012-01-01

    We recently investigated three cases of bacterial meningitis that were reported from a midwestern radiology clinic where facemasks were not worn during spinal injection of contrast agent during myelography procedures. Using pulsed field gel electrophoresis we linked a case strain of S. salivarius to an oral specimen of a radiology physician assistant (RPA). We also used a real-time PCR assay to detect S. salivarius DNA within a culture-negative cerebrospinal fluid (CSF) specimen. Here we extend this investigation through using a nested PCR/sequencing strategy to link the culture-negative CSF specimen to the case strain. We also provide validation of the real-time PCR assay used, demonstrating that it is not solely specific for Streptococcus salivarius, but is also highly sensitive for detection of the closely related oral species Streptococcus vestibularis. Through using multilocus sequence typing and 16S rDNA sequencing we further strengthen the link between the CSF case isolate and the RPA carriage isolate. We also demonstrate that the newly characterized strains from this study are distinct from previously characterized S. salivarius strains associated with carriage and meningitis. PMID:22384169

  7. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups--another perspective on Oregon's data.

    PubMed

    Finlay, I G; George, R

    2011-03-01

    Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it-namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

  8. Physician Requirements-1990. For Cardiology.

    ERIC Educational Resources Information Center

    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…

  9. Today's Physicians Seek Career Direction.

    ERIC Educational Resources Information Center

    Morgan-Haker, Veronica R.

    1998-01-01

    Changes in the role of the physician in today's society have made their career choices risky. Career specialists have an opportunity to assist those who do not normally seek career advice outside their own profession. (JOW)

  10. Physician strikes.

    PubMed

    Thompson, Stephen L; Salmon, J Warren

    2014-11-01

    Throughout medical history, physicians have rarely formed unions and/or carried out strikes. In a profession faced with the turmoil of health reform and increasing pressure to change their practices and lifestyles, will physicians resort to unionization for collective bargaining, and will a strike weapon be used to fight back against the array of corporate and government powers involved in the transformation of the American health-care system? This article examines the question of whether there could be such a thing as an ethical physician strike. Although physicians have not historically used collective bargaining or the strike weapon, the rapidly changing practice environment in the United States might push physicians and other health-care professionals toward unionization. This article considers the ethical questions that would arise if physicians started taking advantage of labor laws, and it lays out criteria for an ethical strike.

  11. Attitudes toward euthanasia and physician-assisted suicide: a study of the multivariate effects of healthcare training, patient characteristics, religion and locus of control.

    PubMed

    Hains, Carrie-Anne Marie; Hulbert-Williams, Nicholas J

    2013-11-01

    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.

  12. Physician unionization.

    PubMed

    Lebowitz, P H

    1997-01-01

    Typically, doctors have seemed unsuited for and uncomfortable with the idea of unions but with the current changes in practices and referral patterns, doctors are looking--at least warily--at unions. Two sets of laws apply to possible unionization of physicians; one, federal antitrust laws, the other, both federal and state labor laws as they apply to changes in the medical profession. Antitrust laws are designed to protect competition by prohibiting price fixing. Another typical antitrust issue that applies to healthcare is that of a group boycott or refusal to deal, where competitors try to coerce a third party to set prices where competitors want them set. Congress' earliest legislation to aide the labor movement involved exceptions to the antitrust laws. Some provisions of the laws are limited to workers who are employees, defined as someone who is employed by any person. Doctors are searching for solutions that provide the collective power of the labor laws without offending the antitrust laws. The question is whether doctors can form unions under these two conflicting forces. The first main issue is whether the doctor is or is not an employee. Although radiologic technologists, typically employees of hospitals or provider groups, have been unionized for years, doctors are usually not employees, at least not if they have their own practices. Although not employees, physicians may affiliate with a larger union to use that broader bargaining power, a purpose that is permissible under current law. Membership in a union does have its responsibilities and disadvantages. Some have suggested that the definition of employee be broadened to cover physician duties under managed care payer agreements, for example. Meanwhile, the Federal Trade Commission and the Justice Department are watching that non-employee physicians not use the union label to mask price fixing, boycotts or refusals to deal.

  13. Assisted suicide and euthanasia.

    PubMed

    van der Heide, Agnes

    2013-01-01

    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.

  14. 38 CFR 51.150 - Physician services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with... case of an emergency. (e) Physician delegation of tasks. (1) Except as specified in paragraph (e)(2) of... certified nurse practitioner, or (ii) a clinical nurse specialist who— (A) Is acting within the scope...

  15. Existential suffering and the extent of the right to physician-assisted suicide in Switzerland: Gross v Switzerland [2013] ECHR 67810/10.

    PubMed

    Black, Isra

    2014-01-01

    In Gross v Switzerland, the European Court of Human Rights held by 4-3 majority that Switzerland had violated the right to decide when and how to die included in the right to respect for private and family life under Article 8 of the European Convention on Human Rights. To comply with the ruling, Switzerland must issue guidance detailing the circumstances (if any) under which physicians may lawfully prescribe lethal medication to competent individuals who have a voluntary and settled wish to die, yet whose suffering is not the product of a medical condition likely to result in death in the near future.

  16. 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.

    PubMed

    Watanabe, Fumiyuki; Shinohara, Kuniko; Dobashi, Akira; Amagai, Kenji; Hara, Kazuo; Kurata, Kaori; Iizima, Hideo; Shimakawa, Kiyoshi; Shimada, Masahiko; Abe, Sakurako; Takei, Keiji; Kamei, Miwako

    2016-01-01

    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.

  17. 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.

    PubMed

    Watanabe, Fumiyuki; Shinohara, Kuniko; Dobashi, Akira; Amagai, Kenji; Hara, Kazuo; Kurata, Kaori; Iizima, Hideo; Shimakawa, Kiyoshi; Shimada, Masahiko; Abe, Sakurako; Takei, Keiji; Kamei, Miwako

    2016-01-01

    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. PMID:27592827

  18. 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.

    PubMed

    Rys, Sam; Deschepper, Reginald; Mortier, Freddy; Deliens, Luc; Atkinson, Douglas; Bilsen, Johan

    2012-06-01

    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.

  19. Tailoring hospital marketing efforts to physicians' needs.

    PubMed

    Mackay, J M; Lamb, C W

    1988-12-01

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

  20. Physician reimbursement reform and family physicians.

    PubMed

    Higgins, C W

    1991-02-01

    In the final hours of the 1989 session, Congress passed the Omnibus Budget Reconciliation Act (OBRA) of 1989, which included the most important change in physician reimbursement policy since the introduction of Medicare. The new payment system will base physician Medicare reimbursement on a fee schedule, establish uniform percentage limits on balance billing, and set targets for total Part B physician expenditures. Medicare payments to family physicians will increase substantially under the new system. This will enhance the status and attractiveness of the specialty. The new system will decrease physician autonomy in some respects, and it is not clear that it will successfully control spending. However, on balance it offers significant advantages for family physicians.

  1. Why not Commercial Assistance for Suicide? On the Question of Argumentative Coherence of Endorsing Assisted Suicide.

    PubMed

    Kipke, Roland

    2015-09-01

    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.

  2. PERFORMANCE MEASURES OF PHYSICIANS.

    ERIC Educational Resources Information Center

    PRICE, PHILIP B.; AND OTHERS

    CRITERION MEASURES DEVELOPED FOR ON-THE-JOB PERFORMANCE OF PHYSICIANS WILL BE USED IN A SUBSEQUENT STUDY TO DETERMINE HOW MUCH THE PERFORMANCE OF PHYSICIANS CAN BE PREDICTED BY THEIR INDIVIDUAL ACHIEVEMENTS IN MEDICAL AND PREMEDICAL SCHOOL. APPROXIMATELY 29 MEASURES OF THE UNIVERSITY OF UTAH COLLEGE OF MEDICINE AND OTHER PHYSICIANS IN THE UTAH…

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

    PubMed

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

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

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

    PubMed

    Quinn, Joann Farrell; Perelli, Sheri

    2016-06-20

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

  5. Physicians: Requirements for Becoming a Physician

    MedlinePlus

    ... Us Contact Us A | A Text size Email Requirements for Becoming a Physician Note: We are not ... the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by ...

  6. Physician leadership. Physician executives share insights.

    PubMed

    Kirschman, D

    1996-09-01

    Senior physician executives were asked to share their insights about how the medical management field has evolved. The Physician Executive Management Center, a Tampa, Florida-based search firm, has been surveying senior physician executives each year for the past decade. This year's report on physician executive compensation and duties in hospitals, managed care organizations, and group practices provides an excellent picture of the growth of the profession, as well as a broad perspective of anticipated changes for the future of medical management. The respondents addressed the following questions: What are the skills necessary for success? How have their jobs changed over the years? Have they made the right choice in pursuing medical management careers? PMID:10161950

  7. Doc Medich: A Physician on Team Physicians.

    PubMed

    Lincoln, E

    1981-06-01

    George F. Medich, MD, is in his ninth season as a professional baseball pitcher. He draws on his experience as a player and orthopedic surgeon to shed some light on the problems inherent in the team physician's position.

  8. Barriers to Primary Care Physicians Prescribing Buprenorphine

    PubMed Central

    Hutchinson, Eliza; Catlin, Mary; Andrilla, C. Holly A.; Baldwin, Laura-Mae; Rosenblatt, Roger A.

    2014-01-01

    PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010–2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODS We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents. RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine. CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. PMID:24615308

  9. Medicare and participating physicians: physician election of "participation" status under Medicare.

    PubMed

    Blehart, B

    1985-07-01

    The purpose of this paper is to assist physicians in making Medicare participation decisions for the coming period of October 1, 1985, to September 30, 1986. This paper will describe the participation program, its operation, and the potential advantages and disadvantages of a participation election. The paper concludes that, while it may be advantageous for some physicians to be identified as "participating" in Medicare, this is an individual decision that should only be made upon a careful examination of many factors.

  10. Serving in haiti: perspective of a physician.

    PubMed

    Vinroot, Richard

    2011-01-01

    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.

  11. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section... acute care when it is indicated. (d) Availability of physicians for emergency care. In case of an... clinical nurse specialist who— (A) Is acting within the scope of practice as defined by State law; and...

  12. Physicians, unions, and antitrust.

    PubMed

    Hirshfeld, E B

    1999-01-01

    The increasing consolidation of our healthcare delivery systems and the concomitant push for perceived efficiencies, speed, and profits has laid the foundation for a renewed interest in unionization by many physicians. This Article analyzes the barriers to such unionization that are posed by the antitrust laws, and provides an analysis of how to proceed with unionization without violating those laws. The Article also analyzes the current status of physician ability to unionize, and surveys the present status of physician unions.

  13. Cancer Incidence in Physicians

    PubMed Central

    Lee, Yu-Sung; Hsu, Chien-Chin; Weng, Shih-Feng; Lin, Hung-Jung; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Guo, How-Ran

    2015-01-01

    Abstract Cancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwan's National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76–0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73–0.94); and female physicians did not (HR 1.29, 95% CI 0.88–1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12–2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11–3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms. PMID:26632715

  14. 42 CFR 456.604 - Physician team member inspecting care of recipients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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...

  15. 42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HEALTH 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...

  16. 42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HEALTH 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...

  17. 42 CFR 456.604 - Physician team member inspecting care of recipients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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...

  18. [The relevance of occupational physician for physicians].

    PubMed

    Hosaka, Takashi

    2012-01-01

    The Japan Medical Association launched a project team to examine health conditions of physicians working at hospitals in 2008. First, cross-sectional study was conducted among total number of 10,000 physicians, who were randomly selected from the Japan Medical Association (JMA). They were asked to fill in a basic questionnaire that was used to collect demographic data and to complete the Japanese version of Quick Inventory of Depressive Symptomatology (QIDS-SR-16). As a result, an adjusted response rate was 40.5%. Fifty-three % of the respondents did not consult with the colleagues about their unhealthy conditions, 46% had less than 4 holidays in a month, and 41% slept for less than 6 hours. More importantly, from a psychiatric point of view, 6% thought of committing suicide several times a week, 9% showed lack of interest, and 6% felt lack of energy. The QIDS-SR-16 also indicated 8.7% were in a moderately depressed state and 1.9% suffered from severe depression. Secondly, the project team provided a consulation service through E-mail and telephone to listen and advice to JMA members who had the needs. However, there were only few consultations that took place. Thirdly, the project team held several workshops in 12 different locations targeting occupational physicians working in hospitals. The workshops included case conferences and lectures on mental health. From 2010 to 2011, there were total of 450 participants. Finally, in addition to these attempts, the author has been working as an occupational physician for a major department of a University hospital. The author thinks from these experiences that the location of an external occupational physician would be most effective for prevention and early detection of mental problems among physicians working in hospitals. PMID:22712204

  19. [The humble physician].

    PubMed

    Barnhoorn, P C

    2016-01-01

    A good physician is a humble physician. Humility can be defined as the middle ground between meekness and vanity, or the insight that what we know and what we are capable of is incomplete. This insight is needed to develop a realistic self-image and to prevent unprofessional behaviour among doctors. PMID:27650023

  20. The Role of Physicians in State-Sponsored Corporal Punishment.

    PubMed

    Muaygil, Ruaim

    2016-07-01

    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.

  1. Physicians, patients, and Facebook: Could you? Would you? Should you?

    PubMed

    Peluchette, Joy V; Karl, Katherine A; Coustasse, Alberto

    2016-01-01

    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. PMID:27295007

  2. Physicians, patients, and Facebook: Could you? Would you? Should you?

    PubMed

    Peluchette, Joy V; Karl, Katherine A; Coustasse, Alberto

    2016-01-01

    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.

  3. The Role of Physicians in State-Sponsored Corporal Punishment.

    PubMed

    Muaygil, Ruaim

    2016-07-01

    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. PMID:27348832

  4. Physician collective bargaining.

    PubMed

    Schiff, Anthony Hunter

    2009-11-01

    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

  5. LEGAL DUTIES OF PHYSICIANS

    PubMed Central

    Sandor, Andrew A.

    1951-01-01

    The history of the physician's legal duties has been traced from the first recorded writings of the Babylonian era to the present day. There has been a transition from the days of absolute liability to the modern idea of liability based on culpability. The doctrine of stare decisis developed in early English law forms the very backbone of our own jurisprudence. Broadly, if a physician renders reasonable care and skill, he is absolved from liability. Some of the more important legal duties and proscriptions applying to physicians are discussed in particular in this presentation. PMID:14848696

  6. Involve physicians in marketing.

    PubMed

    Randolph, G T; Baker, K M; Laubach, C A

    1984-01-01

    Many everyday problems in medical group practice can be attacked by a marketing approach. To be successful, however, this kind of approach must have the full support of those involved, especially the physicians, since they are the principal providers of healthcare services. When marketing is presented in a broad context, including elements such as patient mix, population distribution, and research, physicians are more likely to be interested and supportive. The members of Geisinger Medical Center's Department of Cardiovascular Medicine addressed their patient appointment backlog problem with a marketing approach. Their method is chronicled here and serves as a fine example of how physician involvement in marketing can lead to a positive outcome.

  7. Remembering More Jewish Physicians

    PubMed Central

    Weisz, George M.; Grzybowski, Andrzej

    2016-01-01

    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

  8. Remembering More Jewish Physicians.

    PubMed

    Weisz, George M; Grzybowski, Andrzej

    2016-01-01

    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

  9. Remembering More Jewish Physicians.

    PubMed

    Weisz, George M; Grzybowski, Andrzej

    2016-07-28

    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).

  10. Physician medical malpractice

    PubMed Central

    LeMasurier, Jean

    1985-01-01

    Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher than health care cost inflation and the increase in physician costs. Trends indicate that malpractice related costs, both liability insurance and defensive medicine costs, will continue to increase for the near future. Pressures to limit physician costs under Medicare raise a concern about how malpractice costs can be controlled. This paper presents an overview of the problem, reviews options that are available to policymakers, and discusses State and legislative efforts to address the issue. PMID:10311396

  11. A Model for Physician Leadership Development and Succession Planning.

    PubMed

    Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

    2015-01-01

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

  12. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... practitioner'” means a clinical psychologist, licensed clinical social worker, physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. ... supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section...

  13. House physicians. Accountabilities and possibilities.

    PubMed

    La Puma, J

    Current house physicians' practice, responsibilities, and earnings are reviewed. House physicians are licensed, ordinarily institutionally based, typically salaried physician employees of 1 or more hospitals or systems. Many are hourly workers, often foreign medical graduates or physicians in training, with little professional status and less visibility. Yet managed care sees a new, creative role for house physicians that makes them masters of quality and models of service. No longer dependent beings shielded by an institution's coverage, house physicians can emerge as efficient, educated champions of inpatient medicine. To produce hospital generalist physicians for the patient's good, physician availability, institutional financial incentives, and patient values must align.

  14. Does educational indebtedness affect physician specialty choice?

    PubMed

    Bazzoli, G J

    1985-03-01

    There has been much debate over the effect of educational indebtedness on the specialty choices of new physicians, especially in light of the perceived shortage of primary care physicians. This paper explores the theoretical foundations on which this debate is based. In addition, the paper estimates the effects of various types of debt on specialty choice. The results suggest that an increase in debt from subsidized loan sources (i.e., Guaranteed Student Loans, National Direct Student Loans, or Health Professions Student Loans) has mixed effects while an increase in debt from Health Education Assistance Loans reduces the likelihood of becoming a primary care physician. Though these effects are significant, they are very small in magnitude. Economic returns to certain specialties and personal background appear to play a more important role in specialty choice.

  15. Hitler's Jewish Physicians.

    PubMed

    Weisz, George M

    2014-07-01

    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.

  16. Environmental market factors associated with physician career satisfaction.

    PubMed

    Mazurenko, Olena; Menachemi, Nir

    2012-01-01

    Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization's environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction. PMID:23087994

  17. Physician, heal thyself

    PubMed Central

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

    2010-01-01

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

  18. Exploring the case for assisted dying in the UK.

    PubMed

    Haigh, Carol

    This article discusses the concepts of euthanasia, assisted suicide and physician-assisted suicide, under the umbrella term of assisted dying, from a pro-assisted dying perspective. It outlines the key principles underpinning the debate around assisted dying and refutes the main arguments put forward by those opposing legalisation of assisted dying in the UK.

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

    PubMed

    Weiss, R

    1989-05-01

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

  20. Instrumentation problems for physicians.

    PubMed

    Turner, G O

    1980-01-01

    The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.

  1. Dismembering the ethical physician

    PubMed Central

    Genuis, S J

    2006-01-01

    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

  2. Marital stability among physicians.

    PubMed

    Rose, K D; Rosow, I

    1972-03-01

    Analysis of 57,514 initial complaints for divorce, separate maintenance, and annulment filed in California during the first six months of 1968 reveals that physicians are considerably less prone to marital failure than men of comparable age in the general population. Furthermore, when compared to professionals in general, doctors also appear less prone to marital collapse. For physicians, marriages break down in the greatest numbers and at the greatest rate between the ages of 35 and 44. Women doctors are at least 40% more prone to marital instability than men, and black physicians are nearly 70% more prone to divorce than their white colleagues. Of the individual specialists, orthopedists and psychiatrists possibly have the highest rates of marital demise.

  3. Nurse-physician collaboration.

    PubMed

    Taylor-Seehafer, M

    1998-09-01

    The literature indicates that collaboration between nurses and physicians has become more sophisticated as these relationships have become collegial in nature and as nurses have become assertive, autonomous, and accountable. On an individual level, physicians and nurses now entering collaborative relationships are successful at minimizing the obstacles of turf and territoriality as well as at managing practice boundaries. However, both need to consciously examine their patterns of communication in order to effect clinical interaction styles that maintain unequal or hierarchical relationships. Studies of interprofessional communication, including style of clinical interaction, conflict resolution, use of humor, and negotiation, contribute support for nurses and physicians in collaborative relationships (Balzer, 1993; Campbell, Mauksch, Neikirk, & Hosokawa, 1990; Feiger & Schmitt, 1979; Lenkman & Gribbins, 1994; Pike, 1991). Research on differences in health outcomes of patients cared for in the traditional and collaborative models of health care delivery, identification of the unique product of collaborative practice models, and further identification of the type of attitudinal climate in which collaborative relationships can be nurtured should be undertaken if the elusive nature of collaboration is to be captured (Siegler, Whitney, & Schmitt, 1994). Providing collaborative, interdisciplinary clinical experiences for students, as well as role modeling of collaborative relationships in nurse-physician faculty practice, can contribute to a greater understanding and acceptance of each professional's role in health care delivery (Campbell, 1993; Forbes & Fitzsimons, 1993; Larson, 1995). Tradition and professionalism and progressive concern about practice boundaries continue to be obstacles to collaborative practice. These need to be addressed by medical and nursing professionals on the institutional level and in the political arena. Collaboration between nurses and

  4. Burnout among physicians.

    PubMed

    Romani, Maya; Ashkar, Khalil

    2014-01-01

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

  5. Forensic physicians and written evidence: witness statements v. expert reports.

    PubMed

    Choong, Kartina A; Barrett, Martin

    2014-02-01

    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. PMID:24485431

  6. Forensic physicians and written evidence: witness statements v. expert reports.

    PubMed

    Choong, Kartina A; Barrett, Martin

    2014-02-01

    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.

  7. Leasing physician office space.

    PubMed

    Murray, Charles

    2009-01-01

    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. PMID:19743715

  8. Leasing physician office space.

    PubMed

    Murray, Charles

    2009-01-01

    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.

  9. Physicians as Patient Teachers

    PubMed Central

    Brunton, Stephen A.

    1984-01-01

    Physicians have a central role in educating patients and the public in the elements of personal health maintenance. To be an effective teacher, one must recognize the learning needs of each patient and use methods of information transfer that will result in comprehension and compliance. To bring about a change in life-style, one must also have an understanding of a patient's health beliefs and the determinants of human behavior. Using this information together with behavior modification strategies, physicians can forge an effective partnership with patients working toward the goal of optimum health. PMID:6395500

  10. As good as physicians: patient perceptions of physicians and non-physician clinicians in rural primary health centers in India

    PubMed Central

    Rao, Krishna D; Stierman, Elizabeth; Bhatnagar, Aarushi; Gupta, Garima; Gaffar, Abdul

    2013-01-01

    ABSTRACT Background: Attracting physicians to rural areas has been a long-standing challenge in India. Government efforts to address the shortage of rural physicians include posting non-physician clinicians (NPCs) at primary health centers (PHCs) in select areas. Performance assessments of NPCs have typically focused on the technical quality of their care with little attention to the perspectives of patients. This study investigates patient views of physicians (Medical Officers) and NPCs in terms of patient satisfaction, perceived quality, and provider trust. NPCs include: Indian system of medicine physicians (AYUSH Medical Officers) and clinicians with 3 years of training, such as Rural Medical Assistants (RMAs). At PHCs without clinicians, paramedics provide clinical care, although they are not trained for this. Methods: PHCs in the state of Chhattisgarh were stratified by provider type: Medical Officer, AYUSH Medical Officer, RMA, or paramedic. PHCs were randomly sampled in each group. A total of 1,082 exiting patients were sampled from138 PHCs. Factor analysis was used to identify perceived quality domains. Multiple regression analysis was used to test for group differences. Results: Patients of Medical Officers and NPCs reported similar levels of satisfaction, trust, and perceived quality, with scores of 84% for Medical Officers, 80% for AYUSH Medical Officers, and 85% for RMAs. While there were no significant differences in these outcomes between these groups, scores for paramedical staff were significantly lower, at 73%. Conclusions: Physicians and NPCs performed similarly in terms of patient satisfaction, trust, and perceived quality. From a patient's perspective, this supports the use and scale up of NPCs in primary care settings in India. Leaving clinician posts vacant undermines public trust and quality perceptions of government health services. PMID:25276553

  11. Have Non-physician Clinicians Come to Stay?

    PubMed Central

    Monekosso, Gottlieb Lobe

    2016-01-01

    A decade ago, sub-Saharan Africa accounted for 24% of the global disease burden but was served by only 4% of the global health workforce. The chronic shortage of medical doctors has led other health professionals especially nurses to perform the role of healthcare providers. These health workers have been variously named clinical officers, health officers, physician assistants, nurse practitioners, physician associates and non-physician clinicians (NPCs) defined as "health workers who have fewer clinical skills than physicians but more than nurses." Although born out of exigencies, NPCs, like previous initiatives, seem to have come to stay and many more medical doctors are being trained to care for the sick and to supervise other health team members. Physicians also have to assume new roles in the healthcare system with consequent changes in medical education PMID:27801363

  12. Medication counselling: physicians' perspective.

    PubMed

    Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Eskildsen, Anette Gjetrup; Saedder, Eva Aggerholm; Nielsen, Lars Peter

    2013-12-01

    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.

  13. Physician Challenges in 2015.

    PubMed

    Cascardo, Debra

    2015-01-01

    While the influx of new patients resulting from the ACA will increase the number of people receiving healthcare, the regulations associated with it will add to physicians' administrative duties, as will government regulations associated with HIPAA and Meaningful Use. Further stress will come from the demands of both payers and patients, requiring doctors to walk a fine line to protect themselves from litigation. Technology also will play an increasing role. The continuing move toward EHRs and the new ICD-10 coding standard will require investments in software, testing, and training staff, and may also require an investment in new computer hardware. Physicians and staff will have to teach patients how to use EHR portals and how to follow the record-keeping requirements of their insurance providers. The regulatory changes and increased costs of time and money associated with them may drive many physicians out of private practice and into hospital system-based team practices, which will face a greater challenge in recruiting and retaining top talent. Other physicians, in contrast, may continue to seek the independence of private practice; some of them may decide to stop accepting insurance because of their need for autonomy in their practices. Regardless of what decisions doctors choose to make within the changing nature of healthcare, it is important to keep abreast of the changes and develop a plan for dealing with them, in 2015 and beyond. PMID:26182706

  14. Physicians and Insider Trading.

    PubMed

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

    2015-12-01

    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information. PMID:26457747

  15. Physicians and Insider Trading.

    PubMed

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

    2015-12-01

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

  16. The ideal physician entrepreneur.

    PubMed

    Bottles, K

    2000-01-01

    How does the sometimes elusive and high-stakes world of venture capital really work? How can physician executives with innovative ideas or new technologies approach venture capitalists to help them raise capital to form a start-up company? These important questions are explored in this new column on the physician as entrepreneur. The ideal physician executive is described as: (1) an expert in an area that Wall Street perceives as hot; (2) a public speaker who can enthusiastically communicate scientific and business plans to a variety of audiences; (3) a team leader who is willing to share equity in the company with other employees; (4) a recruiter and a motivator; (5) an implementer who can achieve milestones quickly that allow the company to go public as soon as possible; and (6) a realist who does not resent the terms of the typical deal. The lucrative world of the venture capitalists is foreign territory for physician executives and requires a great idea, charisma, risk-taking, connections, patience, and perseverance to navigate it successfully.

  17. Hitler's Jewish Physicians.

    PubMed

    Weisz, George M

    2014-07-01

    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

  18. Physician mentoring and evaluation.

    PubMed

    Bauman, Randy R

    2007-01-01

    Maintaining a cohesive medical group requires more than partners who get along with one another. Physicians must share the same values and be willing to give (and graciously receive) honest feedback on issues such as quality of care, technical competence, patient- and staff relations, behavior, work ethic, and productivity. This article shows group leaders how to start this process by mentoring new physicians and how to then extend the process to include all physicians in the group. Medical practices that have evaluation systems in place enjoy benefits that include better communication, accountability, increased retention rates, and a more unified group. Many physician groups avoid the evaluation process because they are not comfortable "judging" their peers, they don't know how to approach the process, or they don't want to invest the time. This article presents alternative approaches to establishing a mentoring and evaluation process, shows group leaders how to identify which is right for them, and provides do's and don'ts for a smooth implementation ofthe process.

  19. Longevity of Thai physicians.

    PubMed

    Sithisarankul, Pornchai; Piyasing, Veera; Boontheaim, Benjaporn; Ratanamongkolgul, Suthee; Wattanasirichaigoon, Somkiat

    2004-10-01

    The objectives of this study were to explore characteristics of the long-lived Thai physicians. We sent 983 posted questionnaires to 840 male and 143 female physicians. We obtained 327 of them back after 2 rounds of mailing, yielding a response rate of 33.3 percents. The response rate of male physicians was 32.4 percents and that of female physicians was 38.5 percents. Their ages were between 68-93 years (75.1 +/- 4.86 years on average). The majority were married, implying that their spouses were also long-lived. Around half of them still did some clinical work, one-fourth did some charity work, one-fourth did various voluntary works, one-fifth did some business, one-fifth did some academic work, and some did more than one type of work. Most long-lived physicians were not obese, with BMI of 16.53-34.16 (average 23.97 +/- 2.80). Only 8 had BMI higher than 30. BMIs were not different between male and female physicians. However, four-fifths of them had diseases that required treatment, and some of them had more than one disease. The five most frequent diseases were hypertension, diabetes, ischemic heart disease, dyslipidemia, and benign prostate hypertrophy, respectively. Most long-lived physicians did exercise (87.8%), and some did more than one method. The most frequent one was walking (52.3%). Most did not drink alcohol or drank occasionally, only 9.0% drank regularly. Most of them slept 3-9 hours per night (average 6.75 +/- 1.06). Most (78.3%) took some medication regularly; of most were medicine for their diseases. Most did not eat macrobiotic food, vegetarian food, or fast food regularly. Most long-lived physicians practiced some religious activities by praying, paying respect to Buddha, giving food to monks, practicing meditation, and listening to monks' teaching. They also used Buddhist practice and guidelines for their daily living and work, and also recommended these to their younger colleagues. Their recreational activities were playing musical instruments

  20. First responder and physician liability during an emergency.

    PubMed

    Eddy, Amanda

    2013-01-01

    First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

  1. Physician Information Seeking Behaviors: Are Physicians Successful Searchers?

    ERIC Educational Resources Information Center

    Swiatek-Kelley, Janice

    2010-01-01

    In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to…

  2. Ideal teleradiology configuration from a physician's perspective

    NASA Astrophysics Data System (ADS)

    Leckie, Robert G.; de Treville, Robert E.; Lyche, David K.; Norton, Gary S.; Goeringer, Fred; Willis, Charles E.; Cawthon, Michael A.; Smith, Donald V.; Hansen, Mark

    1993-09-01

    Teleradiology systems are being developed and implemented around the world. The ultimate success of these systems depends on the acceptance by the end users -- the physicians. From a physician's perspective, several major areas need to be addressed in the ideal situation. The areas include (1) image quality and ease of manipulation of images on a workstation; (2) expert interpretation by a specialist or sub-specialist; (3) good communication between the radiologist, radiology technologist, primary care physician, and the patient; (4) accessibility to images; (5) system reliability; (6) costs and assistance in balancing workloads; and (7) education and research. The Medical Diagnostic Imaging Support (MDIS) System is a large tri-service project to install picture archive and communication systems (PACS) and teleradiology at military medical treatment facilities across the United States and abroad. The first sites primarily involved with teleradiology will be installed in the summer of 1993. Ways in which the MDIS teleradiology system address the physicians' ideal configuration as well as possible future improvements are discussed.

  3. Using financial ratios to assess physician practices.

    PubMed

    Doelling, P M

    1996-01-01

    Purchasing physician practices has become commonplace in the health care environment today. The most commonly used method to evaluate a physician's practice is the medical practice assessment. Although assessments include examining revenues, expenses, staffing ratios, collection ratios and other pertinent statistics, one of the often overlooked financial areas is the balance sheet. Evaluating a business, such as a medical practice, requires a thorough examination of the total financial picture including assets, liabilities, owner's equity or net worth, and the relationship of all the variables to each other. Ratios put the numbers into perspective by creating relationships between the balance sheet variables of assets, liabilities and owner's equity, and key income statement components of revenues, expenses and net income. As a result, ratios provide a unique perspective to the assessment process and enable a more complete analysis. This article examines the types and uses of ratios to assist physicians, managers, and hospital executives to better evaluate the financial viability of a physician's solo or group practice.

  4. How to fire a physician.

    PubMed

    Rock, W

    1995-09-01

    How does one fire a physician? In a word, carefully! Most of the legal protections for other employees apply just as well to physicians. And physicians have access to an expanded realm of protections because of the nature of their profession and because of its role in the health care delivery system. The ordinary employee cannot raise antitrust; the fired physician may very well raise just that issue. And yet the need to terminate a physician will sometimes, even though rarely, occur. How can the organization be certain that it has treated the physician fairly, has documented any and all offenses in a defensible fashion, and has generally followed accepted practices in all aspects of dealing with the physician? The author provides some guidelines for dealing with the problem or the incompetent physician.

  5. Robotically assisted ultrasound interventions

    NASA Astrophysics Data System (ADS)

    Ding, Jienan; Swerdlow, Dan; Wang, Shuxin; Wilson, Emmanuel; Tang, Jonathan; Cleary, Kevin

    2008-03-01

    The goal of this project is to develop a robotic system to assist the physician in minimally invasive ultrasound interventions. In current practice, the physician must manually hold the ultrasound probe in one hand and manipulate the needle with the other hand, which can be challenging, particularly when trying to target small lesions. To assist the physician, the robot should not only be capable of providing the spatial movement needed, but also be able to control the contact force between the ultrasound probe and patient. To meet these requirements, we are developing a prototype system based on a six degree of freedom parallel robot. The system will provide high bandwidth, precision motion, and force control. In this paper we report on our progress to date, including the development of a PC-based control system and the results of our initial experiments.

  6. 42 CFR 410.27 - Outpatient hospital or CAH services and supplies incident to a physician or nonphysician...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... worker, physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. ... incident to a physician or nonphysician practitioner service: Conditions. 410.27 Section 410.27 Public... CAH services and supplies incident to a physician or nonphysician practitioner service: Conditions....

  7. Family Physician attitudes about prescribing using a drug formulary

    PubMed Central

    Suggs, L Suzanne; Raina, Parminder; Gafni, Amiram; Grant, Susan; Skilton, Kevin; Fan, Aimei; Szala-Meneok, Karen

    2009-01-01

    Background Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers. Methods Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis. Results Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions. Conclusion Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms. PMID:19835601

  8. Medical Services Assistant Curriculum.

    ERIC Educational Resources Information Center

    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…

  9. Task Analysis for Health Occupations. Cluster: Medical Assisting. Occupation: Medical Assistant. Education for Employment Task Lists.

    ERIC Educational Resources Information Center

    Lathrop, Janice

    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 ointment. The…

  10. The Future Supply of Physicians.

    ERIC Educational Resources Information Center

    Ginzberg, Eli

    1996-01-01

    Reviews policy positions regarding the supply of physicians in the United States, from the 1910 Flexner Report to the present, and evaluates current policy alternatives that address the problem of physician oversupply. Maintains that, if future health care outlays increase as predicted, the demand for physicians should continue to grow. (MDM)

  11. Physicians in literature: three portrayals.

    PubMed

    Cameron, I A

    1986-02-01

    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.

  12. Physician nutrition education.

    PubMed

    Kiraly, Laszlo N; McClave, Stephen A; Neel, Dustin; Evans, David C; Martindale, Robert G; Hurt, Ryan T

    2014-06-01

    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.

  13. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-01

    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. PMID:11874314

  14. Physician practice management companies: should physicians be scared?

    PubMed

    Scott-Rotter, A E; Brown, J A

    1999-01-01

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

  15. Assessment of physician performance in Alberta: the Physician Achievement Review

    PubMed Central

    Hall, W; Violato, C; Lewkonia, R; Lockyer, J; Fidler, H; Toews, J; Jennett, P; Donoff, M; Moores, D

    1999-01-01

    The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years. PMID:10420867

  16. Managing margins through physician engagement.

    PubMed

    Sears, Nicholas J

    2012-07-01

    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication. PMID:22788036

  17. The Contribution of Non-Physician Health Workers to the Delivery of Primary Care.

    ERIC Educational Resources Information Center

    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;…

  18. Patients' and physicians' attitudes regarding the physician's professional appearance.

    PubMed

    Gjerdingen, D K; Simpson, D E; Titus, S L

    1987-07-01

    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.

  19. Negotiation skills for physicians.

    PubMed

    Anastakis, Dimitri J

    2003-01-01

    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.

  20. Issues in physician contracting.

    PubMed

    Fanburg, John D; Leone, Alyson M

    2005-09-01

    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. PMID:16202950

  1. Physician Support Personnel in the 70's: New Concepts.

    ERIC Educational Resources Information Center

    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…

  2. Social media and physicians: Exploring the benefits and challenges.

    PubMed

    Panahi, Sirous; Watson, Jason; Partridge, Helen

    2016-06-01

    Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community. PMID:25038200

  3. Social media and physicians: Exploring the benefits and challenges.

    PubMed

    Panahi, Sirous; Watson, Jason; Partridge, Helen

    2016-06-01

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

  4. The liberal arts physician.

    PubMed

    Burrow, G N

    1999-10-01

    The United States is in the midst of the second revolution in American health care to occur during this century, as Kenneth Ludmerer makes clear in his book Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. The "Flexnerian revolution" eventually led to the closing of a third of the medical schools. Although such closures are not likely this time, familiar arrangements are collapsing, without a clear picture of the shape of things to come. Whatever the outcome of the current revolution, well-trained physicians will be needed to care for the sick. Academic medical centers truly are at risk and increasingly require public support to flourish or even to survive, but medical schools and their teaching hospitals must demonstrate that they deserve this support. These institutions have responded by focusing on the business aspects of medicine, perhaps to the detriment of medical education. Lost in this focus is teaching time, and perhaps even more important, the time for mentoring. Often lacking too is a clear vision of the preparation needed by the student to practice medicine successfully in the future: different specialty mixes, interdisciplinary group practice; vastly increased use of information technologies, and overwhelming amounts of relevant and interrelated information. Yet the answer is the same as it was 75 years ago when Yale introduced the first radical medical curricular reform--the "liberal arts physician," trained in science, the values of medicine, and particularly for uncertainly and with the capacity to adapt.

  5. [Self-education in the system of postgraduate training of physicians].

    PubMed

    Chizhikov, V A

    1990-01-01

    A brief analysis is made of the importance of physician self-training in the process of upgrading their skills and maintaining the professional competence at the proper level. Emphasis is being placed on the necessity of creating corresponding organizational structures for the control of effectiveness and providing assistance to physicians engaged in self-training.

  6. Primary-care physician compensation.

    PubMed

    Olson, Arik

    2012-01-01

    This article reviews existing models of physician compensation and presents information about current compensation patterns for primary-care physicians in the United States. Theories of work motivation are reviewed where they have relevance to the desired outcome of satisfied, productive physicians whose skills and expertise are retained in the workforce. Healthcare reforms that purport to bring accountability for healthcare quality and value-rather than simply volume-bring opportunities to redesign primary-care physician compensation and may allow for new compensation methodologies that increase job satisfaction. Physicians are increasingly shunning the responsibility of private practice and choosing to work as employees of a larger organization, often a hospital. Employers of physicians are seeking compensation models that reward both productivity and value. PMID:22786738

  7. The physician leader as logotherapist.

    PubMed

    Washburn, E R

    1998-01-01

    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.

  8. Blue Shield Plan Physician Participation

    PubMed Central

    Yett, Donald E.; Der, William; Ernst, Richard L.; Hay, Joel W.

    1981-01-01

    Many Blue Shield Plans offer participation agreements to physicians that are structurally similar to the participation provisions of Medicaid programs. This paper examines physicians' participation decisions in two such Blue Shield Plans where the participation agreements were on an all-or-nothing basis. The major results show that increases in the Plans' reasonable fees or fee schedules significantly raise the probability of participation, and that physicians with characteristics associated with “low quality” are significantly more likely to participate than are physicians with characteristics associated with “high quality.” In this sense the results highlight the tradeoff that must be faced in administering governmental health insurance policy. On the one hand, restricting reasonable and scheduled fees is the principal current tool for containing expenditures on physicians' services. Yet these restrictions tend to depress physicians' willingness to participate in government programs, thereby reducing access to high quality care by the populations those programs were designed to serve. PMID:10309468

  9. Family Violence and Family Physicians

    PubMed Central

    Herbert, Carol P.

    1991-01-01

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

  10. Physician ownership of medical equipment.

    PubMed

    Reschovsky, James; Cassil, Alwyn; Pham, Hoangmai H

    2010-12-01

    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.

  11. The making of a physician.

    PubMed

    Balakrishnan, V

    2009-01-01

    Medicine is a science, and healing, an art. The right mix of a scientist and an artist is essential in a good physician. Clinical detachment is the balance between the scientist and the human. Good physicians are born; however, it is possible to cultivate the qualities. Gaining the patient's confidence is an art; a sense of humor can greatly help. Give a child respect and he becomes your friend. Death is inevitable, but a physician can help make it less agonizing. A good physician is a philosopher, aware of the beauty of life, of his limitations and conscious of the power that controls us.

  12. The physician exodus from hospitals.

    PubMed

    Royce, P C

    1997-04-01

    Physicians are spending increasingly less of their work week in the hospital. This is true of surgeons because they are performing more ambulatory surgery, often off the hospital premises, and for primary care physicians because they are delegating hospital care of their patients to others. What are the effects of this physician exodus on hospitals, patients, physicians, and medical education? Some of these consequences are explored, from disruptions in the continuity of care, to increase in practice productivity, to preparing undergraduates for the realities of medical practice.

  13. Fractals for physicians.

    PubMed

    Thamrin, Cindy; Stern, Georgette; Frey, Urs

    2010-06-01

    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.

  14. Computerized Physician Order Entry

    PubMed Central

    Khanna, Raman; Yen, Tony

    2014-01-01

    Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks. PMID:24381708

  15. Writing to Heal Thyself: Physician as Person & Person as Physician

    ERIC Educational Resources Information Center

    Kasman, Deborah L.

    2006-01-01

    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…

  16. Should Physicians Have Facial Piercings?

    PubMed Central

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

    2005-01-01

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

  17. Abortion and compelled physician speech.

    PubMed

    Orentlicher, David

    2015-01-01

    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. PMID:25846035

  18. Abortion and compelled physician speech.

    PubMed

    Orentlicher, David

    2015-01-01

    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.

  19. Physician Labor Market in Croatia

    PubMed Central

    Bagat, Mario; Sekelj Kauzlarić, Katarina

    2006-01-01

    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

  20. The chaotic physician work world.

    PubMed

    Paterick, Timothy E

    2014-01-01

    Physicians are immersed in a work environment where daily challenges seem to represent a condition or place of increasing disorder and confusion. The degree of "entropy" in the physician workplace is increasing exponentially. Healthcare systems are in a state of chaos and are dynamic--meaning the behavior at one time influences its behavior in the future. The initial changes have future exponential fluctuations that have created a state of healthcare crisis. These systems are nonlinear; the metaphor to describe the unruly nature of the physician work world is that in which the flap of a butterfly wing in Brazil can set off a tornado in Texas. The tornado affecting physician work life must be understood to be rectified. Physicians must slow down and pay attention. PMID:25807614

  1. [The changing role of physicians].

    PubMed

    Siegrist, J

    2012-09-01

    Despite a very successful process of professionalisation during the past 150 years, today's physicians face several challenges urging them to adapt their traditional professional role and the patient-physician relationship inherent in this role. Among these challenges, a growing economic influence on physicians' practices, new demands from particular groups of patients (consumerism, role of the Internet etc.), and increasing inter-professional competition deserve special attention. New evidence of an association between a stressful work environment and physician's increased health risks provides additional support in favour of this notion. This contribution suggests potential directions of change of the physician's role by pointing to (a) a growing 'feminisation' of medicine, (b) an even stronger emphasis on patient needs and (c) extended teamwork and inter-professional cooperation.

  2. When questions arise, physician advisors are there with the answers.

    PubMed

    2016-06-01

    DCH Health System's seven part-time physician advisors perform a variety of tasks to help ensure that the hospitals are appropriately reimbursed and that patients move smoothly through the continuum of care. They work with care managers on patient status and also assist with documentation, writing medical necessity appeals, resource utilization, and patient throughput. They attend daily transition rounds with the nurses, care managers, and social workers, and participate in weekly long-stay rounds and capacity rounds in the ICU and acute cardiac care. The health system brought in experts to educate the physician advisors, sent them to educational symposia, and pays for membership in professional organizations. PMID:27323508

  3. Physicians beware: revisiting the physician practice acquisition frenzy.

    PubMed

    Eichmiller, Judith Riley

    2014-01-01

    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future.

  4. Physicians' strikes and the competing bases of physicians' moral obligations.

    PubMed

    MacDougall, D Robert

    2013-09-01

    Many authors have addressed the morality of physicians' strikes on the assumption that medical practice is morally different from other kinds of occupations. This article analyzes three prominent theoretical accounts that attempt to ground such special moral obligations for physicians--practice-based accounts, utilitarian accounts, and social contract accounts--and assesses their applicability to the problem of the morality of strikes. After critiquing these views, it offers a fourth view grounding special moral obligations in voluntary commitments, and explains why this is a preferable basis for understanding physicians' moral obligations in general and especially as pertaining to strikes.

  5. Developing physician referrals for the new physician: techniques to market your physician's practice.

    PubMed

    Schwarz, Chad; Baum, Neil

    2011-01-01

    New physicians will need to be proactive to market and promote their practices. Generating referrals from colleagues is one of the best ways to attract new patients to a start-up practice. This article will provide techniques that will help new physicians enhance their relationships with their colleagues in the community.

  6. Developing physician referrals for the new physician: techniques to market your physician's practice.

    PubMed

    Schwarz, Chad; Baum, Neil

    2011-01-01

    New physicians will need to be proactive to market and promote their practices. Generating referrals from colleagues is one of the best ways to attract new patients to a start-up practice. This article will provide techniques that will help new physicians enhance their relationships with their colleagues in the community. PMID:21815560

  7. Effect of Physician Tutorials on Prescribing Patterns of Graduate Physicians.

    ERIC Educational Resources Information Center

    Klein, Lawrence E.; And Others

    1981-01-01

    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)

  8. Can physicians lead other physicians into the future?

    PubMed

    Bujak, J S

    1998-01-01

    This article reflects upon some of the dynamics that prevent physicians from successfully engaging change. Physicians are enculturated to the competitive and hierarchical, and to value personal autonomy. These traits promote distrust and inhibit the formation of collaborative relationships. At this time of growing complexity, when most other industries are developing styles of work based on teamwork, worker empowerment, cross training, and information sharing, physicians cling to the metaphor of the ship's captain, a lone decision-marker and authoritarian possessor of grand knowledge. And yet, in order to lead, physicians need to learn to work differently and nurture a more collaborative approach. The author's blueprint for change includes: Stop trying to manage consensus; commit to measured accountability; think systemically; don't make the mistake of thinking that people will follow because you are right; and, most importantly, create relationships based on shared purpose and principles.

  9. Organizational complements to electronic health records in ambulatory physician performance: the role of support staff

    PubMed Central

    Jha, Ashish K

    2012-01-01

    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

  10. Can we close the income and wealth gap between specialists and primary care physicians?

    PubMed

    Vaughn, Bryan T; DeVrieze, Steven R; Reed, Shelby D; Schulman, Kevin A

    2010-05-01

    Over their lifetimes, primary care physicians earn lower incomes--and accumulate considerably less wealth--than their specialist counterparts. This gap influences medical students, who are choosing careers in primary care in declining numbers. We estimated career wealth accumulation across specialists, primary care physicians, physician assistants, business school graduates, and college graduates. We then compared specialists, represented by cardiologists, to primary care physicians in four scenarios. The wealth gap is substantial; narrowing it would require substantial reductions in specialists' practice income or increases in primary care physicians' practice income, or both, of more than $100,000 a year. Current proposals for increasing primary care physician supply would do little to lessen these differences.

  11. Physician Enabling Skills Questionnaire

    PubMed Central

    Hudon, Catherine; Lambert, Mireille; Almirall, José

    2015-01-01

    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

  12. Infected physicians and invasive procedures: national policy and legal reality.

    PubMed

    Tereskerz, P M; Pearson, R D; Jagger, J

    1999-01-01

    Recent reports of the transmission of hepatitis B, hepatitis C, and HIV from physicians to patients during invasive procedures have again raised the question of whether physicians infected with bloodborne pathogens should perform invasive procedures that place patients at risk, and if so, under what conditions. Attempts to formulate a national policy on this subject must consider the competing interests of the patient's welfare versus the physician's livelihood. A review of the legal aspects of this topic is provided to assist policy makers and to serve as a foundation for the recommended establishment of a multidisciplinary committee to develop a uniform national policy. Both legal and medical realities call for the formulation of a clear policy to guide those who must make the decisions on this issue.

  13. Role of the Physician Anesthesiologist

    MedlinePlus

    ... an anesthesia plan, taking into consideration the patient’s medical history and physical condition. During surgery : Physician anesthesiologists use advanced technology to monitor the body’s functions and determine how ...

  14. Working with Generation X physicians.

    PubMed

    Shields, Mark C; Shields, Margaux T

    2003-01-01

    Learn ways to integrate Generation X physicians into your hospital or practice. Discover how their career goals differ from the earlier generation's and find out how health care organizations can help meet those goals.

  15. Family Homeostasis and the Physician

    PubMed Central

    Jackson, Don D.

    1965-01-01

    Physical illness, including psychosomatic disorders, often play an unexpected role in maintaining emotional balances within the family. The outbreak of such disorders, conversely, can be utilized by the physician as a barometer of family emotional difficulties. PMID:5828172

  16. ERISA litigation and physician autonomy.

    PubMed

    Jacobson, P D; Pomfret, S D

    2000-02-16

    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.

  17. Physician discontent: challenges and opportunities.

    PubMed

    Mechanic, David

    2003-08-20

    Most physicians continue to report overall career satisfaction, but increased public and patient expectations and administrative and regulatory controls contribute to perceptions of increased time pressures and erosion of autonomy. Increasingly, knowledgeable patients armed with information from the media, as well as guidelines developed by health plans, government, specialty societies, professional organizations, and advocacy groups, confront physicians with a bewildering array of new expectations and demands. Although physicians are spending more time with patients than in earlier periods they feel themselves on a treadmill. Strategies to ease pressures include increased use and enhanced scope of nonphysician clinicians, adoption of information technology and disease management programs to reduce errors and to increase efficiency and quality, and thoughtful practice design. Use of such strategies, combined with leadership and a clear sense of direction, can empower physicians, provide them with expanded knowledge and expert systems, and relieve some practice burdens and frustrations.

  18. [Collaboration between occupational physicians and other specialists including insurance physicians].

    PubMed

    Rijkenberg, A M; van Sprundel, M; Stassijns, G

    2013-09-01

    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

  19. Resource allocation and physician liability

    PubMed Central

    Capen, K

    1997-01-01

    Lawyer Karen Capen says funding cutbacks that have affected the services physicians can provide may cause legal problems for Canada's doctors. If cutbacks affect the care that is being provided, they should be discussed with the patient and noted on the chart. She says physicians have "good reason to be concerned" about increasing pressures that create an imbalance between health care resources and the demand and need for services. For some doctors, these have resulted in court cases. PMID:9033422

  20. Physician motivation, satisfaction and survival.

    PubMed

    Zimberg, S E; Clement, D G

    1997-01-01

    Physicians are working harder today and enjoying it less. What has happened to create such dissatisfaction among those in one of the most autonomous professions? What can be done to address the anger, fear and unhappiness? This article is an analysis of the factors influencing human motivation. Maslow's hierarchy of needs--physiological, safety/security, social/affiliation, esteem and self-actualization--is used to suggest ways physicians can satisfy their needs in turbulent financial and professional times.

  1. Marketing a physician referral service.

    PubMed

    Wiggins, C

    1988-01-01

    A recent survey of 670 CEOs revealed that 51 percent had already established physician referral services and 65.2 percent were involved in various activities geared towards strengthening physician relations, one of which was increasing staff personnel to perform these functions (Hospitals March 20, 1987). It is apparent that PRPs have gained wide acceptance and have proved helpful in bettering relations between hospitals and physicians and, at the same time, helped both of them to offer better health care to the public. These programs can be very beneficial to patients and help make the referral system more organized and formal, based on relevant data and knowledge of patients' needs and physicians' needs, qualifications and specialties. Current literature on PRPs is appearing more frequently. Enough hospitals have begun such programs that a new PRP director should be able to research the subject quite thoroughly and become familiar with the possible strengths and weaknesses. Software for PRPs has been developed by various companies which should make the program more useful in terms of data collection, follow-up and provision of feedback. In my opinion PRPs are needed, and if they are marketed correctly, to the physicians initially and then to patients, such programs will prove extremely advantageous to all involved: hospitals, physicians and patients.

  2. Clinical trials and physicians as double agents.

    PubMed Central

    Levine, R. J.

    1992-01-01

    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

  3. Laboratory Procedures for Medical Assistants.

    ERIC Educational Resources Information Center

    Johnson, Pauline

    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…

  4. Physicians and the pharmaceutical industry (update 1994). Canadian Medical Association.

    PubMed Central

    1994-01-01

    The history of health care delivery in Canada has been marked by close collaboration between physicians and the pharmaceutical and health supply industries, this collaboration extending to research as well as to education. Since medicine is a self-governing profession physicians have a responsibility to ensure that their participation in such collaborative efforts is in keeping with their duties toward their patients and society. The following guidelines have been developed by the CMA to assist physicians in determining when a relationship with industry is appropriate. Although directed primarily to individual physicians, including residents and interns as well as medical students, the guidelines also govern the relationships between industry and medical associations. These guidelines focus on the pharmaceutical companies; however, the CMA considers that the same principles apply to the relationship between its members and manufacturers of medical devices, infant formulas and similar products, and health care products and service suppliers in general. These guidelines reflect a national consensus and are meant to serve as an educational resource for physicians throughout Canada. PMID:8287348

  5. New rules for physicians implement sample drug bill.

    PubMed

    1990-06-01

    Record keeping requirements for dangerous drugs, including samples, has been a source of confusion for physicians and often has lead to misinterpretation of the law. To clarify this issue and to assist in implementing Senate Bill 788 (the sample drug bill), the Texas State Board of Medical Examiners recently has adopted rules for record keeping for dangerous drugs and controlled substances. A dangerous drug is any drug or device that is not listed in the Controlled Substances Act and thus is not safe for self-medication, or bears the legend, "Caution: Federal law prohibits dispensing without a prescription." The Dangerous Drugs Act requires a physician to maintain records for 2 years after the date of the acquisition or disposal of the dangerous drug. The new TSBME rules provide a presumption of compliance by a physician for record keeping for dangerous drug samples if he or she (1) retains a copy of the signed request form required by the Prescription Drug Marketing Act of 1987 for 2 years and (2) makes appropriate entries in a patient's medical records when a dangerous drug sample is supplied to the patient. Generally, a drug company representative provides a copy of the request as a receipt at the time the physician receives the samples. For dangerous drugs that the physician acquires other than as samples, the physician needs to retain a copy of the invoice or receiving order or other form of documentation of receipt or acquisition for 2 years. Once again, the physician should make appropriate entries in patients' records.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2371702

  6. Physicians beware: revisiting the physician practice acquisition frenzy.

    PubMed

    Eichmiller, Judith Riley

    2014-01-01

    This commentary compares the current physician practice acquisition frenzy to that of the mid-1990s and reflects on lessons learned. The bottom line: Physicians must understand that there were no "white knights" in the 1990s, and there really aren't any today. This article delineates five main factors that both physicians and hospital executives should thoroughly explore and agree on before an alignment or acquisition. Agreement on these issues is the glue that holds the deal together after the merger. These factors eliminate both buyer and seller remorse and delve into the true cultural alignment that must take place as the healthcare industry addresses the challenges of the future. PMID:25108989

  7. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. ... supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section 410... practitioner's service: Conditions. (a) Medicare Part B pays for therapeutic hospital or CAH services...

  8. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. ... supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section 410... practitioner's service: Conditions. (a) Medicare Part B pays for therapeutic hospital or CAH services...

  9. HMO physicians' use of referrals.

    PubMed

    Bachman, K H; Freeborn, D K

    1999-02-01

    Clinical uncertainty is a source of variation in medical decision-making as well as a source of work-related stress. Increasing enrollment in organized health care systems has intensified interest in understanding referral utilization as well as issues such as physician dissatisfaction and burnout. We examined whether primary care physicians' affective reactions to uncertainty and their job characteristics were associated with use of referrals and burnout. Data came from mail surveys of primary care physicians practicing in two large group model health maintenance organizations (HMOs) in the USA. Consistent with past research, we found that younger physicians had higher referral rates than older physicians, and that general internists had higher rates than either family practitioners or pediatricians. Greater stress from uncertainty increased referrals and referrals were negatively correlated with heavier work demands (patient visits per hour). Greater stress from uncertainty, perceived workload (too high) and a sense of loss of control over the practice environment were associated with higher levels of burnout.

  10. Barriers to physician identification and reporting of child abuse.

    PubMed

    Flaherty, Emalee G; Sege, Robert

    2005-05-01

    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

  11. Barriers to physician identification and reporting of child abuse.

    PubMed

    Flaherty, Emalee G; Sege, Robert

    2005-05-01

    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

  12. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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...

  13. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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...

  14. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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...

  15. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  16. Katrina Kinetics: The Physician Supply.

    PubMed

    Rigby, Perry Gardner; Paragi Gururaja, Ramnaryan

    2016-01-01

    In the aftermath of Hurricane Katrina 10 years ago, acute changes were recognized and reported; acute kinetic destruction and desperation. Physicians performed heroically, but after the flood and the closing of hospitals, most left at least briefly. The chronic recovery began with spirit, but was uncharted and unplanned with the recognition that individual decisions were a necessity. The documentation of physician numbers of practicing doctors, residents and fellows, from the AMA as related to geography, population, and other circumstances tells an additional story of renewal, more objectively without the hype. The fall and rise of the physician population occurred, and was and is remarkable in its consistency, smaller than expected variations. Its effect generated promise for continuous chronic conditions of recovery and positive change. PMID:27598896

  17. William Harvey, physician and scientist.

    PubMed

    Sloan, A W

    1978-08-01

    William Harvey was born in 1578 and died in 1657. He studied arts at the University of Cambridge and medicine at the University of Padua. He was a Fellow of the College of Physicians of London and physician to St Bartholomew's Hospital and to King James I and King Charles I. His discovery of the circulation of the blood was announced in his Lumleian Lectures to the College of Physicians and later published in his book, De Motu Cordis. His other major work was on embryology, published under the title De Generatione Animalium. Harvey was distinguished in many fields of medicine and medical science and is widely regarded as the founder of modern physiology.

  18. Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices

    MedlinePlus

    ... Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard Technical Notes Other Publications Advance Data From Vital and ... Vital Statistics of the United States: 1890-1938 Technical Appendices Miscellaneous Publications National Conference on Health Statistics ...

  19. [Career support systems for female physicians in Tokyo Women's Medical University].

    PubMed

    Kawakami, Yoriko

    2013-01-01

    Tokyo Women's University has career support systems for a female physician. Basic career support is provided for a young female physician who has children. Our University runs the nursery school which takes care of children in day and night. It also helps mothers (female physician) when children are sick. The university also provides short time office hours system for doctors who take care of their children. Both men and women can take advantage of the system. These systems can assist for female physicians to keep their position in hospitals and universities. Then, the next step of a career support is a project for higher-ranking position. Publishing scientific papers and developing good reputation as excellent physicians are essential for promotion. How can we support female physicians for promotion? Our university establishes a scientific research grant and a one-year scholarship for female physicians. We just start the support, therefore, we expect out come in future. We have been developing support systems for female physicians, however effects have not been sufficient yet. We should take more active action to promote female physicians in our society. PMID:24291989

  20. Student-Directed Fresh Tissue Anatomy Course for Physician Assistants

    ERIC Educational Resources Information Center

    McBride, Jennifer M.; Drake, Richard L.

    2011-01-01

    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…

  1. [Suicide and euthanasia : Discourse on physician-assisted suicide].

    PubMed

    Lewitzka, Dr U; Bauer, R

    2016-05-01

    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. PMID:27119531

  2. Physician-assisted suicide in Oregon: a medical perspective.

    PubMed

    Hendin, Herbert; Foley, Kathleen

    2008-06-01

    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.

  3. [Suicide and euthanasia : Discourse on physician-assisted suicide].

    PubMed

    Lewitzka, Dr U; Bauer, R

    2016-05-01

    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.

  4. [The pharmacist-physician collaboration for IPW: from physician's perspective].

    PubMed

    Son, Daisuke; Kawamura, Kazumi; Nakashima, Mitsuko; Utsumi, Miho

    2015-01-01

    Interprofessional work (IPW) is increasingly important in various settings including primary care, in which the role of pharmacists is particularly important. Many studies have shown that in cases of hypertension, diabetes, dyslipidemia, and metabolic syndrome, physician-pharmacist collaboration can improve medication adherence and help to identify drug-related problems. Some surveys and qualitative studies revealed barriers and key factors for effective physician-pharmacist collaboration, including trustworthiness and role clarification. In Japan, some cases of good collaborative work between pharmacists and physicians in hospitals and primary care settings have been reported. Still, community pharmacists in particular have difficulties collaborating with primary care doctors because they have insufficient medical information about patients, they feel hesitant about contacting physicians, and they usually communicate by phone or fax rather than face to face. Essential competencies for good interprofessional collaboration have been proposed by the Canadian Interprofessional Health Collaborative (CIHC): interprofessional communication; patient/client/family/community-centered care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution. Our interprofessional education (IPE) team regularly offers educational programs to help health professionals learn interprofessional collaboration skills. We expect many pharmacists to learn those skills and actively to facilitate interprofessional collaboration. PMID:25743907

  5. [Sherlock Holmes as amateur physician].

    PubMed

    Madsen, S

    1998-03-30

    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.

  6. Costs of Physician-Hospital Integration.

    PubMed

    Cho, Na-Eun

    2015-10-01

    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. PMID:26496300

  7. Attitudes toward physician advertising among rural consumers.

    PubMed

    Kviz, F J

    1984-04-01

    The issue of whether physicians should advertise their services has been the subject of much debate among health policymakers. This study reports data from a survey of rural residents in Illinois regarding attitudes toward physician advertising and reasons for opposition or support of the practice. The results indicate neither strong opposition nor strong support for physician advertising. While those who are opposed are largely nonspecific regarding their reasons, those in favor primarily expect that it will aid in the selection of a physician. However, few respondents indicate a predisposition to shop for a physician. Although the major concern about physician advertising is a danger of false advertising by some physicians, it appears that the respondents are not trusting of advertising in general rather than of advertising by physicians in particular. These findings suggest that regardless of its potential advantages, physician advertising may be relatively ineffective because consumers may be inattentive, unresponsive, or distrusting . PMID:6717113

  8. Costs of Physician-Hospital Integration

    PubMed Central

    Cho, Na-Eun

    2015-01-01

    Abstract 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. PMID:26496300

  9. [Physicians in Mexico, 1970-1990].

    PubMed

    Frenk, J; Durán-Arenas, L; Vázquez-Segovia, A; García, C; Vázquez, D

    1995-01-01

    A study was carried out in 1970 on the distribution of medical personnel in Mexico. At that time an unequal distribution of physicians was detected, but not emphasized given the general shortage of physicians in the country. At the present time, the situation has changed. In this article the analysis of the 1990 census data using traditional indicators of availability of physicians in the country, as well as indirect criteria of physician requirements is presented. In the year of reference there were 157,407 physicians in the country, with a national average of 673 persons per physician. The distribution of physicians by state showed a great deal of variation in the number of persons per physician. For example, the state of Chiapas has 1,642 inhabitants per physician, whereas the Federal District has 292. The relation between trained and employed physicians shows another important phenomenon: there is a high percentage of physicians that do not practice clinical medicine (19.4%). Nevertheless, the number of physicians almost tripled the growth experienced by the general population, and important differences among and within states do persist. Furthermore, a new paradoxical effect has emerged, the presence of underemployment and unemployment of physicians, even in communities with greater needs for medical care. This indicates that the strategy of training more physicians has not solved the problems of accessibility and coverage, but in fact has fostered new problems and perhaps greater inequalities. PMID:7754425

  10. Information Searching Behavior of Physicians.

    ERIC Educational Resources Information Center

    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.…

  11. [The tragic fate of physicians].

    PubMed

    Ohry, Avi

    2013-10-01

    Physicians and surgeons were always involved in revolutions, wars and political activities, as well as in various medical humanities. Tragic fate met these doctors, whether in the Russian prisons gulags, German labor or concentration camps, pogroms or at the hands of the Inquisition. PMID:24450039

  12. Training Physicians in Palliative Care.

    ERIC Educational Resources Information Center

    Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

    1999-01-01

    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)

  13. Physician-centered management guidelines.

    PubMed

    Pulde, M F

    1999-01-01

    The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness. PMID:10387270

  14. Incest and the family physician.

    PubMed

    Boekelheide, P D

    1978-01-01

    This paper is a review of incest from epidemiologic, familial, and individual points of view. The incest taboo has characterized almost every culture and society throughout the ages. Respect for the incest barrier is a cultural demand made by society and is not a physiological or biological imperative. Overt incest occurs in a dysfunctional family through tension-reducing "acting out." The family physician is in a unique position to observe and understand the family dynamics which both help maintain defenses against the incestuous wishes as well as, in some families, contribute to the practice of incest. For 2,000 years physicians have taken the Hippocratic oath, with its explicit love relationship clause, as a reminder of their ethical responsibilities towards their patients. Examples of para-incestuous relationships between vulnerable individuals and authoritative helping figures are cited. A psychodynamic rationale is offered as to why sexual relationships between patients and their family physicians are not therapeutically beneficial. Clues for assessment and ten preventive measures are presented to enable physicians to monitor themselves and the families in their practice.

  15. Physician burnout: A neurologic crisis.

    PubMed

    Sigsbee, Bruce; Bernat, James L

    2014-12-01

    The prevalence of burnout is higher in physicians than in other professions and is especially high in neurologists. Physician burnout encompasses 3 domains: (1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalization: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value. Burnout results in reduced work hours, relocation, depression, and suicide. Burned-out physicians harm patients because they lack empathy and make errors. Studies of motivational factors in the workplace suggest several preventive interventions: (1) Provide counseling for physicians either individually or in groups with a goal of improving adaptive skills to the stress and rapid changes in the health care environment. (2) Identify and eliminate meaningless required hassle factors such as electronic health record "clicks" or insurance mandates. (3) Redesign practice to remove pressure to see patients in limited time slots and shift to team-based care. (4) Create a culture that promotes career advancement, mentoring, and recognition of accomplishments. PMID:25378679

  16. The Mindful Physician and Pooh

    ERIC Educational Resources Information Center

    Winter, Robin O.

    2013-01-01

    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  17. Hitler’s Jewish Physicians

    PubMed Central

    Weisz, George M.

    2014-01-01

    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

  18. Medical futility and physician discretion

    PubMed Central

    Wreen, M

    2004-01-01

    Some patients have no chance of surviving if not treated, but very little chance if treated. A number of medical ethicists and physicians have argued that treatment in such cases is medically futile and a matter of physician discretion. This paper critically examines that position. According to Howard Brody and others, a judgment of medical futility is a purely technical matter, which physicians are uniquely qualified to make. Although Brody later retracted these claims, he held to the view that physicians need not consult the patient or his family to determine their values before deciding not to treat. This is because professional integrity dictates that treatment should not be undertaken. The argument for this claim is that medicine is a profession and a social practice, and thus capable of breaches of professional integrity. Underlying professional integrity are two moral principles, one concerning harm, the other fraud. According to Brody both point to the fact that when the odds of survival are very low treatment is a violation of professional integrity. The details of this skeletal argument are exposed and explained, and the full argument is criticised. On a number of counts, it is found wanting. If anything, professional integrity points to the opposite conclusion. PMID:15173362

  19. Early Islamic physicians and thorax.

    PubMed

    Batirel, H F

    1999-02-01

    Modern anatomic knowledge has developed throughout centuries with transfer of knowledge from generations to generations. Ibn-i Sina (980-1037), Razi (850-923), Davud El-Antaki (?-1008), Ali ibn Abbas (?-982), Ahmed bin Mansur (14th century), Semseddin-i Itaki (1570-1640), and Ibn-i Nafis (1210-1288) were Islamic physicians who all contributed to the understanding of anatomy. They benefited from Greek and Roman pioneers, as well as from each other. To show the situation of thoracic anatomy in early Islamic physicians, we analyzed two original manuscripts in the Süleymaniye Library and some contemporary texts. There were original drawings of the trachea, lung, and vascular system in Semseddin-i Itaki's and Ahmed bin Mansur's anatomy texts. Ibn-i Nafis's writings revealed that he was the first person to describe the pulmonary circulation. Also Ali ibn Abbas wrote that the pulmonary artery wall had two layers and these layers may have a role in constriction and relaxation of this vessel. He also stated that pulmonary veins branched together with the bronchial tree. Ahmed bin Mansur, Ali ibn Abbas, and Ibn-i Nafis each wrote that the heart has two cavities. They also added that the wall of the septum is very thick and there are no passages in between. These show that Islamic physicians had important contributions to thoracic anatomy and physiology. European physicians benefited from these contributions till the end of the 16th century. PMID:10197707

  20. Internet resources for family physicians.

    PubMed Central

    Anthes, D. L.; Berry, R. E.; Lanning, A.

    1997-01-01

    PROBLEM BEING ADDRESSED: The internet has experienced tremendous growth over the past few years and has many resources in the field of family medicine. However, many family physicians remain unaware of how the Internet can be used to enhance their practice and of how to gain access to this powerful tool. OBJECTIVE OF PROGRAM: To characterize components of the Internet, to explore how family physicians can use the Internet to enhance practice, and to increase awareness of how to gain access to Internet sites relevant to family medicine. MAIN COMPONENTS OF THE PROGRAM: An on-line search through the World Wide Web was conducted using multiple search engines including Lycos, WebCrawler, OpenText, and Yahoo as well as a conventional MEDLINE search of Internet publications for the past 5 years. A website containing an evolving selection of resources can be found at http:@dfcm 18.med.utoronto.ca/anthes/hpgdfcm1.htm. CONCLUSION: The Internet has useful applications and resources for family physicians including rapid communication between physicians, access to medical literature, continuing medical education programs, and lists of patient support and discussion groups. PMID:9189299

  1. TQM: a paradigm for physicians.

    PubMed

    Snyder, D A

    1993-01-01

    Change, even when for the better, is always accompanied by apprehension and even outright fear. It is therefore not surprising to hear health care workers, especially physicians, expressing their concerns about this "new" management philosophy through a spectrum of reactions that vary from skeptical or grudging acceptance to outright dismissal of all of the new "alphabet soup" associated with TQM.

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

    PubMed Central

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

    2002-01-01

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

  3. Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers.

    PubMed

    McCarthy, G J

    1993-12-01

    The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them.

  4. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

    PubMed

    Foley, Rose-Anna; Johnston, Wendy S; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian D; Beauverd, Michel

    2015-01-01

    In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

  5. The value of the physician executive role to organizational effectiveness and performance.

    PubMed

    Dunham, N C; Kindig, D A; Schulz, R

    1994-01-01

    With the growing importance of medical management as a component of health care delivery, it is important to understand the extent to which physician executives assist their organizations in the provision of health care that is efficient and of high quality. To date, research on the role of physician executives in large health care organizations has been limited. This research attempts to address some of the gaps in our understanding of the value of the role of the physician executive and explores the anticipated opportunities for expansion of that role as health care organizations attempt to respond to a rapidly changing health care environment.

  6. The changing healthcare landscape: physicians embrace disease management and improve outcomes.

    PubMed

    Selecky, Christobel; Peck, Charles A

    2009-01-01

    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.

  7. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

    PubMed

    Foley, Rose-Anna; Johnston, Wendy S; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian D; Beauverd, Michel

    2015-01-01

    In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life. PMID:26107119

  8. Use of Smoking Cessation Interventions by Physicians in Argentina

    PubMed Central

    Schoj, Veronica; Mejia, Raul; Alderete, Mariela; Kaplan, Celia P.; Peña, Lorena; Gregorich, Steven E.; Alderete, Ethel; Pérez-Stable, Eliseo J.

    2015-01-01

    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

  9. Use of Smoking Cessation Interventions by Physicians in Argentina

    PubMed Central

    Schoj, Veronica; Mejia, Raul; Alderete, Mariela; Kaplan, Celia P.; Peña, Lorena; Gregorich, Steven E.; Alderete, Ethel; Pérez-Stable, Eliseo J.

    2015-01-01

    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.

  10. Financial implications of serving as team physician.

    PubMed

    Lemak, Larry

    2007-04-01

    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.

  11. How to develop breakthrough physician-to-physician relationships.

    PubMed

    Ramirez, Lito

    2008-01-01

    In today's highly competitive marketplace, specialty practices must strive to distinguish themselves from the competition. One key strategy is to provide exceptional levels of service based on fundamentals already in play among many non-healthcare service providers. The problem is that too many practices are failing to deliver. This article outlines precautionary principles that will enable specialty practices, and even hospitals, to develop stronger, more positive physician relationships that increase loyalty and keep your patient pipeline filled.

  12. Providing primary health care with non-physicians.

    PubMed

    Chen, P C

    1984-04-01

    The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.

  13. Diagnosis and therapy for the disruptive physician.

    PubMed

    Kissoon, Niranjan; Lapenta, Susan; Armstrong, George

    2002-01-01

    A disruptive physician can alienate staff, drive away patients, and even land your organization in a lawsuit. Consider some practical advice on how to identify and deal with disruptive physicians. PMID:11806231

  14. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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...

  15. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 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...

  16. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 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...

  17. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 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...

  18. 20 CFR 702.404 - Physician defined.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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...

  19. Service and collaboration keys to physician control.

    PubMed

    Bujak, Joseph S

    2002-01-01

    Discover what physicians must do to regain power and half health care's slide from a profession toward a trade. The solutions lie in better customer service and improved physician collaboration. PMID:12055949

  20. Organizational aspects of physician joint ventures.

    PubMed

    Rublee, D A; Rosenfield, R H

    1987-03-01

    This article describes organizational forms of physician joint ventures. Four models are described that typify physician involvement in health care joint ventures: limited partnership syndication, venture capital company, provider network, and alternative delivery system. Important practical issues are discussed.

  1. Simplifying the negotiating process with physicians: critical elements in negotiating from private practice to employed physician.

    PubMed

    Gallucci, Armen; Deutsch, Thomas; Youngquist, Jaymie

    2013-01-01

    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.

  2. Privacy beliefs and the violent family. Extending the ethical argument for physician intervention.

    PubMed

    Jecker, N S

    1993-02-10

    Privacy beliefs associated with the family impede physicians' response to domestic violence. As a private sphere, the family is regarded as sacred, separate, and hidden from public view. Hence, physicians who look for or uncover violence in the family risk defilling a sacred object and violating norms of non-interference. Privacy beliefs also obfuscate the ethical analysis of physicians' duties to intercede on behalf of battered patients. Ethical principles of beneficence and nonmaleficence have been invoked to justify physicians' duties to abused patients; however, the principle of justice has not been invoked. Ethical analysis of physicians' duties in this area must be broadened to include the principle of justice. Justice is at stake because establishing conditions favorable to self-respect is a requirement of justice, and the response physicians make to battered patients carries important ramifications for supporting patients' self-respect and dignity. If justice forms part of the ethical foundation for physician intervention in domestic violence, mandatory steps that do not transgress the confidentiality of the physician-patient relationship or infringe the patient's autonomy should be taken, such as requiring domestic violence training in medical education and following treatment plans and protocols to identify abuse and provide assistance to battered patients. PMID:8423660

  3. Assisted suicide: factors affecting public attitudes.

    PubMed

    Worthen, L T; Yeatts, D E

    Public support for assisted suicide has been growing despite the ethical questions raised by members of the medical profession. Previous research suggests that age, gender, experience, and religiosity are factors affecting individuals' attitudes. This study examines the effect of demographic and ideological factors, as well as individuals' caregiving experiences, on attitudes toward assisted suicide. Random-digit-dialing procedures produced a sample of 156 residents of Denton, Texas, in March 1998. T-tests were conducted to measure significance, while gamma values were used to measure level of association and percent reduction in error. The data indicate that age, gender, and caregiving experience were not significant predictors of attitudes. Situational factors, including whether a physician or friend/family member should assist and whether a child or a terminally ill patient experiencing no pain should receive assistance, all were highly significant and positively associated with attitudes toward assisted suicide. Respondents were most likely to support physician-assisted suicide for individuals experiencing no pain. The data also indicated that the depth of commitment to the beliefs that suffering has meaning, that life belongs to God, and that physician-assisted suicide is murder, were highly significant and negatively associated with attitudes toward assisted suicide.

  4. Are emergency room physicians always employees?

    PubMed

    Tesdahl, D B

    1994-05-01

    The Internal Revenue Service (IRS) has recently increased its scrutiny of the worker classifications used by hospitals in arrangements with physicians for the provision of services (see "Reclassifying physicians as employees for Federal tax purposes," HEALTHCARE FINANCIAL MANAGEMENT, February 1994, pp. 38-44). In particular, emergency room physicians have been singled out by the IRS as a category of physicians who are often treated as independent contractors by hospitals but should, in the view of the IRS, be characterized as employees.

  5. Organizational commitment of military physicians.

    PubMed

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay

    2009-09-01

    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. PMID:19780367

  6. Empowering Physicians with Financial Literacy.

    PubMed

    Bar-Or, Yuval

    2015-01-01

    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.

  7. Physician distribution and access: workforce priorities.

    PubMed

    Zhang, Xingyou; Phillips, Robert L; Bazemore, Andrew W; Dodoo, Martey S; Petterson, Stephen M; Xierali, Imam; Green, Larry A

    2008-05-15

    Most Primary Health Professional Shortage Areas (HPSAs) exceed federal population-to-physician designation criteria, yet struggle to maintain access to primary care physicians. Policy options for recruiting and retaining primary care physicians to HPSAs, and new HPSA criteria that support access to primary care practices, should be considered.

  8. Trends in physician supply and population growth.

    PubMed

    Makaroff, Laura A; Green, Larry A; Petterson, Stephen M; Bazemore, Andrew W

    2013-04-01

    The physician workforce has steadily grown faster than the U.S. population over the past 30 years, context that is often absent in conversations anticipating physician scarcity. Policy makers addressing future physician shortages should also direct resources to ensure specialty and geographic distribution that best serves population health .

  9. Physician executives boost clout, earning power.

    PubMed

    Dister, Lois

    2002-01-01

    Results of the 2001 Physician Executive Compensation Survey are in and they show that physician executives working in practice/hospital management companies or single specialty groups earn the highest pay. Physician executives with advanced degrees appear to earn more, as well.

  10. 42 CFR 405.2412 - Physicians' services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Physicians' services. 405.2412 Section 405.2412 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... Health Center Services § 405.2412 Physicians' services. (a) Physicians' services are...

  11. Understanding the business of employed physician practices.

    PubMed

    Sanford, Kathleen D

    2013-09-01

    Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices.

  12. Opinion and Special Articles: "Physician debtor".

    PubMed

    Scharf, Eugene L; Jones, Lyell K

    2016-01-19

    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. PMID:26783273

  13. Guiding Principles for Physician Reentry Programs

    ERIC Educational Resources Information Center

    Kenagy, Gretchen P.; Schneidman, Barbara S.; Barzansky, Barbara; Dalton, Claudette; Sirio, Carl A.; Skochelak, Susan E.

    2011-01-01

    Physician reentry is defined by the American Medical Association (AMA) as: "A return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment." Physician reentry programs are creating an avenue for physicians who have left…

  14. Revealing a Child's Pathology: Physicians' Experiences

    ERIC Educational Resources Information Center

    Scelles, Regine; Aubert-Godard, Anne; Gargiulo, Marcela; Avant, Monique; Gortais, Jean

    2010-01-01

    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…

  15. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 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...

  16. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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...

  17. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 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...

  18. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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...

  19. 22 CFR 62.27 - Alien physicians.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 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...

  20. The physician and the Internet.

    PubMed

    Wang, K K; Wong Kee Song, L M

    1997-01-01

    The Internet is one of the greatest developments in informational exchange during the past century. It allows almost anyone to access information available throughout the world. Nonetheless, the Internet is often misunderstood by physicians. It can be considered a super computer network that allows users to transfer a wide variety of information at a low cost. The information can be transferred through functions such as electronic mail, file transfer protocols, the Usenet, or the most widely recognized World Wide Web. Electronic mail functions like the usual postal service but is carried through the Internet, and delivery is usually within the hour. It can serve as a method of communication between physicians and patients. File transfer protocols function as a method for transferring large amounts of information such as software through the Internet. The Usenet acts like an international bulletin board service, allowing users anywhere to post messages and to respond to messages from other users. Several patient support groups have Usenet sites for exchanging specific disease information. The World Wide Web has received the greatest attention because most of the information on the Internet is text, sound, or pictures. Numerous medical organizations have established Web sites. This article attempts to describe each of these functions and the benefits to physicians. PMID:9005289