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Sample records for physician insights applications

  1. 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

  2. Physician self-awareness: the neglected insight.

    PubMed Central

    Longhurst, M

    1988-01-01

    Self-awareness is vital to a physician's development. Understanding the impact of our internal subjective world on our attitudes and values and on the fantasies we have of reality is important to us as doctors. Some of the means of acquiring this self-knowledge include accurately perceiving the reflection of one's self in patients, understanding one's learning style, studying and enjoying the humanities, expressing one's self creatively, maintaining a sense of humour and examining one's reaction to experiences. When confronted by a person who is ill the physician must take action that is constructive and affirmative and not compromised by behaviour that originates in unexamined personal issues. PMID:3390780

  3. Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making

    PubMed Central

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

    2015-01-01

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

  4. Earthbound applications for NASA's physician workstation

    NASA Technical Reports Server (NTRS)

    Grams, R.; Yu, F. S.; Li, B.; Iddings, E.; Fiorentino, R.; Shao, S.; Wang, L.; Broughton, H.

    1993-01-01

    The dream of a space probe to Mars or an astronaut colony on the moon persists. Despite years of setbacks and delays, NASA continues to lay the foundation for a new frontier in space. The necessity of a self contained health maintenance facility is an integral part of this stellar venture. As a subsystem of this health maintenance facility, the physician or astronaut workstation was envisioned as the vehicle of interface between the computer resources of the space station and the care provider. Our efforts to define and build this interface have resulted in a series of programs which can now be tested and refined using earth-based applications. The modules which have dual-use application from the NASA workstation include: patient scheduling and master patient index, pharmacy, laboratory, medical library, problem list/progress notes, and digital medical records. Our current plan is to develop these tools as objects that can be assembled in a variety of configurations. This will allow the technology to be used by the private sector where each doctor can select the starting point of his outpatient office system and add modules as he makes progress in system integration and training.

  5. Physician practices in response to intimate partner violence in southern India: insights from a qualitative study.

    PubMed

    Chibber, Karuna Sridharan; Krishnan, Suneeta; Minkler, Meredith

    2011-03-01

    Health care providers in India are often the only institutional contact for women experiencing intimate partner violence, a pervasive public health problem with adverse health outcomes. This qualitative study was among the first to examine Indian primary care physicians' intimate partner violence practices. Between July 2007 and January 2008, 30 in-depth interviews were conducted with physicians serving low-to-middle income women aged 18-30 in southern India. A modified grounded theory approach was used for data collection and analysis. Study findings revealed a distinct subset of 'physician champions' who responded to intimate partner violence more consistently, informed women of their rights, and facilitated their utilization of support services. Findings also offered insights into physicians' ability to identify indications of intimate partner violence and use of potentially culturally appropriate practices to respond to intimate partner violence, even without training. However, physician practices were mediated by individual attitudes. Although not generalizable, findings offer some useful lessons which may be transferable for adaptation to other settings. A potential starting point is to study physicians' current practices, focusing on their safety and efficacy, as well as enhancing these practices through appropriate training. Further research is also needed on women's perspectives on the appropriateness of physicians' practices, and women's recommendations for intimate partner violence intervention strategies.

  6. Insights Into the Impact of Online Physician Reviews on Patients’ Decision Making: Randomized Experiment

    PubMed Central

    Waiguny, Martin KJ

    2015-01-01

    .44, SE 0.19), but there was no such effect when the physician received many reviews. Furthermore, we found that review style also affected the perceived expertise of the reviewer. Fact-oriented reviews (mean 3.90, SE 0.13) lead to a higher perception of reviewer expertise compared to emotional reviews (mean 3.19, SE 0.13). However, this did not transfer to the attitude toward the physician. A similar effect of review style and number on the perceived credibility of the review was observed. While no differences between emotional and factual style were found if the physician received many reviews, a low number of reviews received lead to a significant difference in the perceived credibility, indicating that emotional reviews were rated less positively (mean 3.52, SE 0.18) compared to fact-oriented reviews (mean 4.15, SE 0.17). Our analyses also showed that perceived credibility of the review fully mediated the observed interaction effect on attitude toward the physician. Conclusions Physician-rating websites are an interesting new source of information about the quality of health care from the patient’s perspective. This paper makes a unique contribution to an understudied area of research by providing some insights into how people evaluate online reviews of individual doctors. Information attributes, such as review style and review number, have an impact on the evaluation of the review and on the patient’s attitude toward the rated doctor. Further research is necessary to improve our understanding of the influence of such rating sites on the patient's choice of a physician. PMID:25862516

  7. Insights into emergency physicians' minds in the seconds before and into a patient encounter.

    PubMed

    Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Ammirati, Christine; Bertrand, Catherine; Charlin, Bernard; Dory, Valérie

    2015-10-01

    Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an "own-point-of-view-perspective". 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient's position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient's overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.

  8. Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation

    PubMed Central

    Shield, Renée R.; Goldman, Roberta E.; Anthony, David A.; Wang, Nina; Doyle, Richard J.; Borkan, Jeffrey

    2010-01-01

    PURPOSE Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients’ responses. METHODS We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse’s aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses. RESULTS Patient trust in the physician and security in the physician-patient relationship appeared to override most patients’ concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the “third actor” in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room. CONCLUSIONS Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information. PMID:20644186

  9. Social networks and physician adoption of electronic health records: insights from an empirical study

    PubMed Central

    Padman, Rema; Krackhardt, David; Johnson, Michael P; Diamond, Herbert S

    2010-01-01

    Objective To study how social interactions influence physician adoption of an electronic health records (EHR) system. Design A social network survey was used to delineate the structure of social interactions among 40 residents and 15 attending physicians in an ambulatory primary care practice. Social network analysis was then applied to relate the interaction structures to individual physicians' utilization rates of an EHR system. Measurements The social network survey assessed three distinct types of interaction structures: professional network based on consultation on patient care-related matters; friendship network based on personal intimacy; and perceived influence network based on a person's perception of how other people have affected her intention to adopt the EHR system. EHR utilization rates were measured as the proportion of patient visits in which sentinel use events consisting of patient data documentation or retrieval activities were recorded. The usage data were collected over a time period of 14 months from computer-recorded audit trail logs. Results Neither the professional nor the perceived influence network is correlated with EHR usage. The structure of the friendship network significantly influenced individual physicians' adoption of the EHR system. Residents who occupied similar social positions in the friendship network shared similar EHR utilization rates (p<0.05). In other words, residents who had personal friends in common tended to develop comparable levels of EHR adoption. This effect is particularly prominent when the mutual personal friends of these ‘socially similar’ residents were attending physicians (p<0.001). Conclusions Social influence affecting physician adoption of EHR seems to be predominantly conveyed through interactions with personal friends rather than interactions in professional settings. PMID:20442152

  10. Chest physicians' knowledge of appropriate thromboprophylaxis: insights from the PROMOTE study.

    PubMed

    Bikdeli, Behnood; Sharif-Kashani, Babak; Raeissi, Sasan; Ehteshami-Afshar, Solmaz; Behzadnia, Neda; Masjedi, Mohammad-Reza

    2011-12-01

    Venous thromboembolism (VTE) is a major cause of in-hospital mortality. Several international guidelines provide thromboprophylaxis recommendations; however, guidelines adherence is missing worldwide. We evaluated the chest physicians' knowledge regarding VTE prophylaxis, using a systematically developed questionnaire. The Prophylaxis-foR-venOus-throMbOembolism-assessmenT-questionnairE (PROMOTE) questionnaire was developed using an algorithm encompassing the most important VTE prophylaxis topics and included 13 clinical scenarios. Responses were evaluated with reference to the eighth edition of American College of Chest Physicians guidelines for VTE prevention to assess thromboprophylaxis appropriateness. The questionnaires were distributed during the fourth International Congress on Pulmonary Disease, Intensive Care and Tuberculosis. From the 88 received questionnaires (response rate: 39.8%), 82 were acceptable (62 men, 20 women). The most commonly cited VTE risk factors were immobility (79.2%), surgery (68.2%), and cancer (60.9%). The mean correct response ratio to the questions was 67% [95% confidence interval (CI) 64-70%] with highest appropriateness ratios amongst cardiologists (77.1 ± 5.8%) and lowest ratios among thoracic surgeons (59.2 ± 5%). Physicians' specialty had a significant effect on the overall appropriateness (P = 0.04) and most of appropriateness subcategories. Thoracic surgeons had the lowest rate of over-prophylaxis (P = 0.02). Years passed from graduation were inversely associated with overall appropriateness (P = 0.006). Physicians with academic engagements had a higher overall appropriateness (P = 0.04). We found a wide gap between the guideline recommendations and the responses. PROMOTE is the first systematically developed questionnaire that addresses chest physicians' thromboprophylaxis knowledge and could be useful to strategies to improve VTE prophylaxis. Because of the dissimilar prophylaxis pitfalls of

  11. Physician-patient relationship and medical accident victim compensation: some insights into the French regulatory system.

    PubMed

    Ancelot, Lydie; Oros, Cornel

    2015-06-01

    Given the growing amount of medical litigation heard by courts, the 2002 Kouchner law in France has created the Office National d'Indemnisation des Accidents Médicaux (ONIAM), whose main aim is to encourage out-of-court settlements when a conflict between a physician and the victim of a medical accident occurs. More than 10 years after the implementation of this law, the statistics analysing its effectiveness are contradictory, which raises the question of the potential negative effects of the ONIAM on the compensation system. In order to address this question, the article analyses the impact of the ONIAM on the nature of settlement negotiations between the physician and the victim. Using a dynamic game within incomplete information, we develop a comparative analysis of two types of compensation systems in case of medical accidents: socialised financing granted by the ONIAM and private financing provided by the physician. We show that the ONIAM could encourage out-of-court settlements provided that the hypothesis of judicial error is relevant. On the contrary, in the case of a low probability of judicial errors, the ONIAM could be effective only for severe medical accidents.

  12. THE INTERNET AND THE WORLD WIDE WEB: APPLICATIONS FOR FAMILY PHYSICIANS IN SAUDI ARABIA

    PubMed Central

    Sebiany, Abdulaziz M.

    2001-01-01

    The introduction of the World Wide Web has revolutionized the applications of the computer and the Internet in the medical field. The Web provides an easy and cost-effective way of retrieving medical information and a more flexible way of communicating with patients and colleagues. Family practice is a specialty in which care is given to persons as individuals and members of families regardless of their age, gender or specific problems. To provide quality family practice, a family physician should be a good communicator, a critical thinker, a resource and information manager, a life-long learner, a care giver and a community advocate. Providing such high quality care requires that family practice be an information-sensitive specialty. However, the expansion of the new electronic resources on the Internet and the Web poses a real challenge to the family physician. Family physician in Saudi Arabia need to have basic skills and knowledge for easily retrieving and finding reliable Internet information for his professional development and the care of his patients. This article addresses the Web applications for family physicians in Saudi Arabia, giving examples of the most important Websites. PMID:23008644

  13. [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

  14. Job satisfaction and motivation among physicians in academic medical centers: insights from a cross-national study.

    PubMed

    Janus, Katharina; Amelung, Volker E; Baker, Laurence C; Gaitanides, Michael; Schwartz, Friedrich W; Rundall, Thomas G

    2008-12-01

    Our study assesses how work-related monetary and nonmonetary factors affect physicians' job satisfaction at three academic medical centers in Germany and the United States, two countries whose differing health care systems experience similar problems in maintaining their physician workforce. We used descriptive statistics and factor and correlation analyses to evaluate physicians' responses to a self-administered questionnaire. Our study revealed that German physician respondents were less satisfied overall than their U.S. counterparts. In both countries, participation in decision making that may affect physicians' work was an important correlate of satisfaction. In Germany other important factors were opportunities for continuing education, job security, extent of administrative work, collegial relationships, and access to specialized technology. In the U.S. sample, job security, financial incentives, interaction with colleagues, and cooperative working relationships with colleagues and management were important predictors of overall job satisfaction. The implications of these findings for the development of policies and management tactics to increase physician job satisfaction in German and U.S. academic medical centers are discussed. PMID:19038874

  15. Endoglucanases: insights into thermostability for biofuel applications

    PubMed Central

    2013-01-01

    Obtaining bioethanol from cellulosic biomass involves numerous steps, among which the enzymatic conversion of the polymer to individual sugar units has been a main focus of the biotechnology industry. Among the cellulases that break down the polymeric cellulose are endoglucanases that act synergistically for subsequent hydrolytic reactions. The endoglucanases that have garnered relatively more attention are those that can withstand high temperatures, i.e., are thermostable. Although our understanding of thermostability in endoglucanases is incomplete, some molecular features that are responsible for increased thermostability have been recently identified. This review focuses on the investigations of endoglucanases and their implications for biofuel applications. PMID:24070146

  16. Impact of the social networking applications for health information management for patients and physicians.

    PubMed

    Sahama, Tony; Liang, Jian; Iannella, Renato

    2012-01-01

    Most social network users hold more than one social network account and utilize them in different ways depending on the digital context. For example, friendly chat on Facebook, professional discussion on LinkedIn, and health information exchange on PatientsLikeMe. Thus many web users need to manage many disparate profiles across many distributed online sources. Maintaining these profiles is cumbersome, time consuming, inefficient, and leads to lost opportunity. In this paper we propose a framework for multiple profile management of online social networks and showcase a demonstrator utilising an open source platform. The result of the research enables a user to create and manage an integrated profile and share/synchronise their profiles with their social networks. A number of use cases were created to capture the functional requirements and describe the interactions between users and the online services. An innovative application of this project is in public health informatics. We utilize the prototype to examine how the framework can benefit patients and physicians. The framework can greatly enhance health information management for patients and more importantly offer a more comprehensive personal health overview of patients to physicians. PMID:22874303

  17. 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.

  18. Insights into Bacteriophage Application in Controlling Vibrio Species.

    PubMed

    Letchumanan, Vengadesh; Chan, Kok-Gan; Pusparajah, Priyia; Saokaew, Surasak; Duangjai, Acharaporn; Goh, Bey-Hing; Ab Mutalib, Nurul-Syakima; Lee, Learn-Han

    2016-01-01

    Bacterial infections from various organisms including Vibrio sp. pose a serious hazard to humans in many forms from clinical infection to affecting the yield of agriculture and aquaculture via infection of livestock. Vibrio sp. is one of the main foodborne pathogens causing human infection and is also a common cause of losses in the aquaculture industry. Prophylactic and therapeutic usage of antibiotics has become the mainstay of managing this problem, however, this in turn led to the emergence of multidrug resistant strains of bacteria in the environment; which has raised awareness of the critical need for alternative non-antibiotic based methods of preventing and treating bacterial infections. Bacteriophages - viruses that infect and result in the death of bacteria - are currently of great interest as a highly viable alternative to antibiotics. This article provides an insight into bacteriophage application in controlling Vibrio species as well underlining the advantages and drawbacks of phage therapy. PMID:27486446

  19. Insights into Bacteriophage Application in Controlling Vibrio Species

    PubMed Central

    Letchumanan, Vengadesh; Chan, Kok-Gan; Pusparajah, Priyia; Saokaew, Surasak; Duangjai, Acharaporn; Goh, Bey-Hing; Ab Mutalib, Nurul-Syakima; Lee, Learn-Han

    2016-01-01

    Bacterial infections from various organisms including Vibrio sp. pose a serious hazard to humans in many forms from clinical infection to affecting the yield of agriculture and aquaculture via infection of livestock. Vibrio sp. is one of the main foodborne pathogens causing human infection and is also a common cause of losses in the aquaculture industry. Prophylactic and therapeutic usage of antibiotics has become the mainstay of managing this problem, however, this in turn led to the emergence of multidrug resistant strains of bacteria in the environment; which has raised awareness of the critical need for alternative non-antibiotic based methods of preventing and treating bacterial infections. Bacteriophages – viruses that infect and result in the death of bacteria – are currently of great interest as a highly viable alternative to antibiotics. This article provides an insight into bacteriophage application in controlling Vibrio species as well underlining the advantages and drawbacks of phage therapy. PMID:27486446

  20. Physicians for Prevention of Nuclear War prepare to consider applications for clinical research

    SciTech Connect

    Kandela, P.

    1987-08-07

    A report is presented from the International Physicians for the Prevention of Nuclear War, the group's seventh world congress in Moscow this spring. Although nuclear weapons were the main concern of the congress, in the wake of the accident at Chernobyl there was also considerable debate on the risks of nuclear energy.

  1. 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.

  2. A Physician's Practice Profile: Application for a Teaching Hospital Ambulatory Care Setting

    PubMed Central

    Retchin, Sheldon M.; Blish, Christine S.

    1984-01-01

    A computer generated report (Practice Profile) summarizing epidemiologic, demographic and utilization data from a general internal medicine practice, was developed and implemented in a teaching hospital setting. Using a computerized medical record system, the Profile displays individual and group practice data. It is used for enhancing the physicians' understanding of their ambulatory practices and for raising important quality assurance issues. The Practice Profile is also used for improving educational activities in the residency program and for stimulating research opportunities within the practice.

  3. 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.

  4. Visualization of CDA laboratory reports and long term trends as a possible EHR application for patients and physicians.

    PubMed

    Obenaus, Manuel; Burgsteiner, Harald

    2014-01-01

    To increase the patient's acceptance of electronic health records and understanding for their laboratory findings a web application was developed which presents all parameters and possible deviations of standard values in a clear way and visualizes the time based trend of all recorded parameters graphically. Documents corresponding to the Clinical document architecture (CDA) R2 laboratory reports standard and a rapid prototyping framework called Groovy on Grails were used. This work shows, that it is possible to create a useful, standards based tool for patients and physicians with comparatively few resources - an application that could be in similar form a part of an electronic Health Record (EHR) system like the Austrian electronic Health Record (ELGA).

  5. How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection.

    PubMed

    Stockmann, C; Rogatcheva, M; Harrel, B; Vaughn, M; Crisp, R; Poritz, M; Thatcher, S; Korgenski, E K; Barney, T; Daly, J; Pavia, A T

    2015-02-01

    The objective of this study was to compare the aetiologic yield of standard-of-care microbiologic testing ordered by physicians with that of a multiplex PCR platform. Stool specimens obtained from children and young adults with gastrointestinal illness were evaluated by standard laboratory methods and a developmental version of the FilmArray Gastrointestinal (GI) Diagnostic System (FilmArray GI Panel), a rapid multiplex PCR platform that detects 23 bacterial, viral and protozoal agents. Results were classified according to the microbiologic tests requested by the treating physician. A median of three (range 1-10) microbiologic tests were performed by the clinical laboratory during 378 unique diarrhoeal episodes. A potential aetiologic agent was identified in 46% of stool specimens by standard laboratory methods and in 65% of specimens tested using the FilmArray GI Panel (p < 0.001). For those patients who only had Clostridium difficile testing requested, an alternative pathogen was identified in 29% of cases with the FilmArray GI Panel. Notably, 11 (12%) cases of norovirus were identified among children who only had testing for Clostridium difficile ordered. Among those who had C. difficile testing ordered in combination with other tests, an additional pathogen was identified in 57% of stool specimens with the FilmArray GI Panel. For patients who had no C. difficile testing performed, the FilmArray GI Panel identified a pathogen in 63% of cases, including C. difficile in 8%. Physician-specified laboratory testing may miss important diarrhoeal pathogens. Additionally, standard laboratory testing is likely to underestimate co-infections with multiple infectious diarrhoeagenic agents.

  6. Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario.

    PubMed

    Kantarevic, Jasmin; Kralj, Boris

    2016-10-01

    We develop a stylized principal-agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behavior. These features include the following: (i) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contract and a blended capitation contract; (ii) the capitation rate is higher, and the cost-reimbursement rate is lower in the blended capitation contract; (iii) physicians sort selectively into the contracts based on their preferences; and (iv) physicians in the blended capitation model provide fewer services than physicians in the enhanced fee-for-service model. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Physician Payment Contracts in the Presence of Moral Hazard and Adverse Selection: The Theory and Its Application in Ontario.

    PubMed

    Kantarevic, Jasmin; Kralj, Boris

    2016-10-01

    We develop a stylized principal-agent model with moral hazard and adverse selection to provide a unified framework for understanding some of the most salient features of the recent physician payment reform in Ontario and its impact on physician behavior. These features include the following: (i) physicians can choose a payment contract from a menu that includes an enhanced fee-for-service contract and a blended capitation contract; (ii) the capitation rate is higher, and the cost-reimbursement rate is lower in the blended capitation contract; (iii) physicians sort selectively into the contracts based on their preferences; and (iv) physicians in the blended capitation model provide fewer services than physicians in the enhanced fee-for-service model. Copyright © 2015 John Wiley & Sons, Ltd. PMID:26239311

  8. Neural network models: Insights and prescriptions from practical applications

    SciTech Connect

    Samad, T.

    1995-12-31

    Neural networks are no longer just a research topic; numerous applications are now testament to their practical utility. In the course of developing these applications, researchers and practitioners have been faced with a variety of issues. This paper briefly discusses several of these, noting in particular the rich connections between neural networks and other, more conventional technologies. A more comprehensive version of this paper is under preparation that will include illustrations on real examples. Neural networks are being applied in several different ways. Our focus here is on neural networks as modeling technology. However, much of the discussion is also relevant to other types of applications such as classification, control, and optimization.

  9. 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

  10. 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

  11. A physicians' wish list for the clinical application of intestinal metagenomics.

    PubMed

    Klymiuk, Ingeborg; Högenauer, Christoph; Halwachs, Bettina; Thallinger, Gerhard G; Fricke, W Florian; Steininger, Christoph

    2014-04-01

    Christoph Steininger and colleagues explore how multiple infectious, autoimmune, metabolic, and neoplastic diseases have been associated with changes in the intestinal microbiome, although a cause-effect relationship is often difficult to establish. Integration of metagenomics into clinical medicine is a challenge, and the authors highlight clinical approaches that are of high priority for the useful medical application of metagenomics. Please see later in the article for the Editors' Summary.

  12. Ambulatory care groups and the profiling of primary care physician resource use: examining the application of case mix adjustments.

    PubMed

    Greene, B R; Barlow, J; Newman, C

    1996-01-01

    A variety of profiling models and tools is utilized by payers, providers, and regulators to evaluate physician work, performance, and resource utilization. In physician profiling, the provider's pattern of practice is expressed as a rate of service or outcome. The article by Tucker, Weiner, Honigfeld, and Parton (this issue) compares the practice-based norms of primary care physicians by adjusting for case mix using ambulatory care groups (ACGs), a population-based classification method. Once the case mix is adjusted, the actual use of resources, as measured by overall charges, is compared with the expected value of resource use. In the Center for Research in Ambulatory Health Care Administration (CRAHCA) Physician Profiling Project, funded by The Robert Wood Johnson Foundation, physicians learn which services other physicians in their specialties perform. Physicians are able to compare their profiles with state and national level medians. The profiling project is one of the first demonstration projects in the field to profile ambulatory care practice patterns and collect patient demographics. An aspect of the project is to test the ACG classification system to data selected from 130 nonacademic practices representing over 5,000 physicians.

  13. 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.

  14. New insights into perfluorinated adsorbents for analytical and bioanalytical applications.

    PubMed

    Marchetti, Nicola; Guzzinati, Roberta; Catani, Martina; Massi, Alessandro; Pasti, Luisa; Cavazzini, Alberto

    2015-01-01

    Perfluorinated (F-) adsorbents are generally prepared by bonding perfluoro-functionalized silanes to silica gels. They have been employed for a long time essentially as media for solid-phase extraction of F-molecules or F-tagged molecules in organic chemistry and heterogeneous catalysis. More recently, this approach has been extended to proteomics and metabolomics. Owing to their unique physicochemical properties, namely fluorophilicity and proteinophilicity, and a better understanding of some fundamental aspects of their behavior, new applications of F-adsorbents in the field of environmental science and bio-affinity studies can be envisaged. In this article, we revisit the most important features of F-adsorbents by focusing, in particular, on some basic information that has been recently obtained through (nonlinear) chromatographic studies. Finally, we try to envisage new applications and possibilities that F-adsorbents will allow in the near future. PMID:25358910

  15. Proteomics of ovarian cancer: functional insights and clinical applications

    DOE PAGESBeta

    Elzek, Mohamed A.; Rodland, Karin D.

    2015-03-04

    In the past decade, there has been an increasing interest in applying proteomics to assist in understanding the pathogenesis of ovarian cancer, elucidating the mechanism of drug resistance, and in the development of biomarkers for early detection of ovarian cancer. Although ovarian cancer is a spectrum of different diseases, the strategies for diagnosis and treatment with surgery and adjuvant therapy are similar across ovarian cancer types, increasing the general applicability of discoveries made through proteomics research. While proteomic experiments face many difficulties which slow the pace of clinical applications, recent advances in proteomic technology contribute significantly to the identification ofmore » aberrant proteins and networks which can serve as targets for biomarker development and individualized therapies. This review provides a summary of the literature on proteomics’ contributions to ovarian cancer research and highlights the current issues, future directions, and challenges. In conclusion, we propose that protein-level characterization of primary lesion in ovarian cancer can decipher the mystery of this disease, improve diagnostic tools, and lead to more effective screening programs.« less

  16. Proteomics of ovarian cancer: functional insights and clinical applications

    SciTech Connect

    Elzek, Mohamed A.; Rodland, Karin D.

    2015-03-04

    In the past decade, there has been an increasing interest in applying proteomics to assist in understanding the pathogenesis of ovarian cancer, elucidating the mechanism of drug resistance, and in the development of biomarkers for early detection of ovarian cancer. Although ovarian cancer is a spectrum of different diseases, the strategies for diagnosis and treatment with surgery and adjuvant therapy are similar across ovarian cancer types, increasing the general applicability of discoveries made through proteomics research. While proteomic experiments face many difficulties which slow the pace of clinical applications, recent advances in proteomic technology contribute significantly to the identification of aberrant proteins and networks which can serve as targets for biomarker development and individualized therapies. This review provides a summary of the literature on proteomics’ contributions to ovarian cancer research and highlights the current issues, future directions, and challenges. In conclusion, we propose that protein-level characterization of primary lesion in ovarian cancer can decipher the mystery of this disease, improve diagnostic tools, and lead to more effective screening programs.

  17. Recent insights on applications of pullulan in tissue engineering.

    PubMed

    Singh, Ram Sarup; Kaur, Navpreet; Rana, Vikas; Kennedy, John F

    2016-11-20

    Tissue engineering is a recently emerging line of act which assists the regeneration of damaged tissues, unable to self-repair themselves and in turn, enhances the natural healing potential of patients. The repair of injured tissue can be induced with the help of some artificially created polymer scaffolds for successful tissue regeneration. The pullulan composite scaffolds can be used to enhance the proliferation and differentiation of cells for tissue regeneration. The unique pattern of pullulan with α-(1→4) and α-(1→6) linkages along with the presence of nine hydroxyl groups on its surface, endows the polymer with distinctive physical features required for tissue engineering. Pullulan can be used for vascular engineering, bone repair and skin tissue engineering. Pullulan composite scaffolds can also be used for treatment of injured femoral condyle bone, skull bone and full thickness skin wound of murine models, transversal mandibular and tibial osteotomy in goat, etc. This review article highlights the latest developments on applications of pullulan and its derivatives in tissue engineering. PMID:27561517

  18. Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context.

    PubMed

    Kirschbaum, Kristin

    2012-01-01

    Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians.

  19. Physician communication in the operating room: expanding application of face-negotiation theory to the health communication context.

    PubMed

    Kirschbaum, Kristin

    2012-01-01

    Communication variables that are associated with face-negotiation theory were examined in a sample of operating-room physicians. A survey was administered to anesthesiologists and surgeons at a teaching hospital in the southwestern United States to measure three variables commonly associated with face-negotiation theory: conflict-management style, face concern, and self-construal. The survey instrument that was administered to physicians includes items that measured these three variables in previous face-negotiation research with slight modification of item wording for relevance in the medical setting. The physician data were analyzed using confirmatory factor analysis, Pearson's correlations, and t-tests. Results of this initial investigation showed that variables associated with face-negotiation theory were evident in the sample physician population. In addition, the correlations were similar among variables in the medical sample as those found in previous face-negotiation research. Finally, t-tests suggest variance between anesthesiologists and surgeons on specific communication variables. These findings suggest three implications that warrant further investigation with expanded sample size: (1) An intercultural communication theory and instrument can be utilized for health communication research; (2) as applied in a medical context, face-negotiation theory can be expanded beyond traditional intercultural communication boundaries; and (3) theoretically based communication structures applied in a medical context could help explain physician miscommunication in the operating room to assist future design of communication training programs for operating-room physicians. PMID:21899403

  20. Training transfer: scientific background and insights for practical application.

    PubMed

    Issurin, Vladimir B

    2013-08-01

    Training transfer as an enduring, multilateral, and practically important problem encompasses a large body of research findings and experience, which characterize the process by which improving performance in certain exercises/tasks can affect the performance in alternative exercises or motor tasks. This problem is of paramount importance for the theory of training and for all aspects of its application in practice. Ultimately, training transfer determines how useful or useless each given exercise is for the targeted athletic performance. The methodological background of training transfer encompasses basic concepts related to transfer modality, i.e., positive, neutral, and negative; the generalization of training responses and their persistence over time; factors affecting training transfer such as personality, motivation, social environment, etc. Training transfer in sport is clearly differentiated with regard to the enhancement of motor skills and the development of motor abilities. The studies of bilateral skill transfer have shown cross-transfer effects following one-limb training associated with neural adaptations at cortical, subcortical, spinal, and segmental levels. Implementation of advanced sport technologies such as motor imagery, biofeedback, and exercising in artificial environments can facilitate and reinforce training transfer from appropriate motor tasks to targeted athletic performance. Training transfer of motor abilities has been studied with regard to contralateral effects following one limb training, cross-transfer induced by arm or leg training, the impact of strength/power training on the preparedness of endurance athletes, and the impact of endurance workloads on strength/power performance. The extensive research findings characterizing the interactions of these workloads have shown positive transfer, or its absence, depending on whether the combinations conform to sport-specific demands and physiological adaptations. Finally, cross

  1. Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

    PubMed

    Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

    2016-01-19

    Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

  2. Acceptability of Physician Directed Academic Detailing to Increase Colorectal Cancer Screening: an Application of the RESPECT Approach

    PubMed Central

    Lawson, Gwen; Basch, Corey H.; Zybert, Patricia; Wolf, Randi L.; Basch, Charles E.

    2015-01-01

    Background: In developing effective interventions to increase colorectal cancer (CRC) screening in at risk populations, a necessary first requirement is feasibility. This paper describes how the RESPECT approach to health education guided the conceptualization and implementation of physician-directed academic detailing (AD) to increase practice-wide CRC screening uptake. Methods: Physician-directed AD was one intervention component in a large educational randomized controlled trial to increase CRC screening uptake. Study participants, primarily urban minority, were aged 50 or older, insured for CRC screening with no out-of-pocket expense and out of compliance with current screening recommendations. The trial was conducted in the New York City metropolitan area. Participants identified their primary care physician; 564 individuals were recruited, representing 459 physician practices. Two-thirds of the physician practices were randomized to receive AD. The RESPECT approach, modified for AD, comprises: 1) Rapport, 2) Educate, but don’t overwhelm, 3) Start with physicians where they are, 4) Philosophical orientation based on a humanistic approach to education, 5) Engagement of the physician and his/her office staff, 6) Care and show empathy, and 7) Trust. Feasibility was assessed as rate of AD delivery. Results: The AD was delivered to 283 (92.5%) of the 306 practices assigned to receive it; 222/283 (78.4%) delivered to the doctor. Conclusion: The AD was feasible and acceptable to implement across a range of clinical settings. The RESPECT approach offers a framework for tailoring educational efforts, allowing flexibility, as opposed to strict adherence to a highly structured script or a universal approach. PMID:26634194

  3. 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.

  4. 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.…

  5. Physician Perceptions of Magnet Nurses and Magnet Designation.

    PubMed

    Vila, Linda L

    2016-01-01

    This exploratory study uses focus group methodology to examine physician perceptions of Magnet nurses and Magnet designation. No studies have explored physicians' insights, which are becoming increasingly important to implementing and sustaining a Magnet culture. Qualitative content analysis demonstrated that physicians highly regard Magnet nurses and benefit from Magnet status. Key themes emerged related to Magnet nurse characteristics, relationships with physicians, nursing leadership, shared governance, and Magnet as a marketing tool. "Magnet marginalization" emerged as a new concept. PMID:27144678

  6. Measuring physician attitudes of service quality.

    PubMed

    Walbridge, S W; Delene, L M

    1993-01-01

    The quality of physician services is not yet included in the current Medicare Resource-Based Relative Value Scale (RBRVS) formula. Future RBRVS reimbursement calculations may incorporate a quality index. The authors' research sought to explore the applicability of SERVQUAL determinants when measuring physician perceptions of service quality. Process quality determinants, such as "Reliability," "Assurance," and "Empathy," were rated higher in relative importance by physicians than outcome quality determinants, such as "Core Medical Services," and six of the seven service quality determinants were rated higher by older physicians. Further analyses indicated that physicians' perceptions of health care service quality varied because of factors such as number of years in practice and gender.

  7. 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.

  8. [Neurolinguistic programming in physician-patient communication. Basic principles of the procedure--examples for application in surgery].

    PubMed

    Graf, U

    1995-09-20

    Neurolinguistic programming (NLP) is a means of improving physician-patient communication that can be learned by any doctor. The present article first describes some of the fundamentals of NLP and then provides examples taken from the field of surgery-in the first instance dealing with the treatment of painful conditions by means of trance or dissociation and, secondly, on the influencing of expectations and the restructuring (reframing) of doctrines in a patient with malignant disease. PMID:7498856

  9. 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.

  10. 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

  11. Physician communication in the operating room.

    PubMed

    Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew

    2015-01-01

    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

  12. Physician communication in the operating room.

    PubMed

    Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew

    2015-01-01

    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education. PMID:24885399

  13. 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…

  14. 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 ...

  15. 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.

  16. Current market trends in hospital/physician integration.

    PubMed

    Bauman, Randy R

    2009-01-01

    This article explores recent trends that are dramatically changing the landscape of typical hospital/physician integration models and provides the reader with useful insights to better evaluate this dynamically changing marketplace.

  17. The algebra of managed care. Creating physician and hospital partnerships.

    PubMed

    Goodroe, J H; Murphy, D A

    1994-01-01

    As healthcare faces an economic reengineering, hospitals and physicians are faced with new challenges. It is the first time that they have had joint economic interests, and survival for both is dependent on designing new economic models. This article describes the economic interrelationship between hospitals and physicians and provides insight into opportunities to encourage new levels of collaboration between them.

  18. 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.

  19. 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

  20. Canadian news. Physicians dislike new medical marijuana regulations.

    PubMed

    Garmaise, David

    2002-03-01

    Associations representing physicians are concerned about the medical declaration physicians are required to complete under new Health Canada regulations relating to applications for the use of marijuana for medical purposes. Some physicians are refusing to complete parts of the declaration. PMID:14979235

  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. [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

  3. Measuring physician attitudes of service quality.

    PubMed

    Walbridge, S W; Delene, L M

    1993-01-01

    The quality of physician services is not yet included in the current Medicare Resource-Based Relative Value Scale (RBRVS) formula. Future RBRVS reimbursement calculations may incorporate a quality index. The authors' research sought to explore the applicability of SERVQUAL determinants when measuring physician perceptions of service quality. Process quality determinants, such as "Reliability," "Assurance," and "Empathy," were rated higher in relative importance by physicians than outcome quality determinants, such as "Core Medical Services," and six of the seven service quality determinants were rated higher by older physicians. Further analyses indicated that physicians' perceptions of health care service quality varied because of factors such as number of years in practice and gender. PMID:10126032

  4. 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

  5. Tips for a physician in getting the right job, part XII: general questions for the applicant to ask.

    PubMed

    Harolds, Jay A

    2014-07-01

    The type and caliber of the questions asked by a job hunter is one of the ways an interviewer will evaluate the candidate. Questions that show poor preparation should not be asked, such as failure to read what the employer sent to the job seeker or not doing elementary research on the practice, the organization, or the community. Asking about insignificant details also is not helpful. Not having any good questions to ask is a negative in an interview. This article discusses many possible important questions for the applicant to ask during an interview. PMID:24873801

  6. Tips for a physician in getting the right job, part XIII: applicant questions about remuneration, call, and time off.

    PubMed

    Harolds, Jay A

    2014-08-01

    Part of how an applicant is judged is by the quality of questions he/she asks. If the answers to the questions could be readily found with minimal research, that does not give a good impression. Failure to ask good questions can be viewed as a lack of knowledge, preparation, or interest. If the candidate asks many questions about finances and vacations during the opening minutes of an interview, without inquiring about the practice, that also does not give a good impression. On the other hand, during the later phases of an interview day(s), questions regarding remuneration, call, and time off should be asked.

  7. Factors shaping physicians' willingness to accommodate medication requests.

    PubMed

    Arney, Jennifer; Street, Richard L; Naik, Aanand D

    2014-09-01

    Medical decisions, including physicians' prescribing behaviors, are shaped by a complex interplay of clinical and nonclinical factors. We aim to determine how physician, patient, and relationship characteristics influence physicians' decisions to accommodate brand-name prescription drug requests. We applied multivariate logistic regression to data from the Attitudinal and Behavioral Effects of Direct-to-Consumer Promotion of Prescription Drugs physician survey. We used a national probability sample of 500 primary care and specialty physicians reporting on a clinical encounter that involved a prescription drug request. Independent variables include physician's assessment of the patient's understanding of risks and benefits of a requested medication, whether the patient had the condition the drug treats, duration of the clinical relationship, and physician's age, area of practice, years of experience, and gender. These variables were used to predict whether the physician prescribed the requested drug. Physicians were more willing to accommodate requests when they believed that patients had a clear understanding of the drug's risks and when patients had the condition the drug treats. Primary care practitioners, compared to specialists, had higher odds of prescribing a requested drug. We conclude that clinical and communicative factors shape physicians' decisions to prescribe requested brand-name drugs. Findings offer insight into the influence that direct-to-consumer advertising can have in medical encounters, and may guide efforts to enhance physician-patient communication and shared decision making. PMID:23232050

  8. Time clock requirements for hospital physicians.

    PubMed

    Shapira, Chen; Vilnai-Yavetz, Iris; Rafaeli, Anat; Zemel, Moran

    2016-06-01

    An agreement negotiated following a doctors' strike in 2011 introduced a requirement that physicians in Israel's public hospitals clock in and out when starting and leaving work. The press reported strong negative reactions to this policy and predicted doctors deserting hospitals en masse. This study examines physicians' reactions toward the clock-in/clock-out policy 6 months after its implementation, and assesses the relationship between these reactions and aspects of their employment context. 676 physicians in 42 hospitals responded to a survey assessing doctor's reactions toward the clock, hospital policy makers, and aspects of their work. Reactions to the clock were generally negative. Sense of calling correlated positively with negative reactions to the clock, and the latter correlated positively with quit intentions. However, overall, respondents reported a high sense of calling and low quit intentions. We suggest that sense of calling buffers and protects physicians from quit intentions. Differences in reactions to the clock were associated with different employment characteristics, but sense of calling did not vary by hospital size or type or by physicians' specialty. The findings offer insights into how physicians' working environment affects their reactions to regulatory interventions, and highlight medical professionalism as buffering reactions to unpopular regulatory policies. PMID:27142179

  9. Time clock requirements for hospital physicians.

    PubMed

    Shapira, Chen; Vilnai-Yavetz, Iris; Rafaeli, Anat; Zemel, Moran

    2016-06-01

    An agreement negotiated following a doctors' strike in 2011 introduced a requirement that physicians in Israel's public hospitals clock in and out when starting and leaving work. The press reported strong negative reactions to this policy and predicted doctors deserting hospitals en masse. This study examines physicians' reactions toward the clock-in/clock-out policy 6 months after its implementation, and assesses the relationship between these reactions and aspects of their employment context. 676 physicians in 42 hospitals responded to a survey assessing doctor's reactions toward the clock, hospital policy makers, and aspects of their work. Reactions to the clock were generally negative. Sense of calling correlated positively with negative reactions to the clock, and the latter correlated positively with quit intentions. However, overall, respondents reported a high sense of calling and low quit intentions. We suggest that sense of calling buffers and protects physicians from quit intentions. Differences in reactions to the clock were associated with different employment characteristics, but sense of calling did not vary by hospital size or type or by physicians' specialty. The findings offer insights into how physicians' working environment affects their reactions to regulatory interventions, and highlight medical professionalism as buffering reactions to unpopular regulatory policies.

  10. 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.

  11. Can complexity science inform physician leadership development?

    PubMed

    Grady, Colleen Marie

    2016-07-01

    applications for physician leadership development and emphasizes that it is incumbent upon physicians and organizations to focus attention on this to achieve improved patient and organizational outcomes. Originality/value This study pairing complexity science and physician leadership represents a unique way to view the development of physician leaders within the context of the complex system that is health care. PMID:27397748

  12. First Principles Studies of Tapered Silicon Nanowires: Fundamental Insights and Practical Applications

    NASA Astrophysics Data System (ADS)

    Wu, Zhigang

    2008-03-01

    Nanowires (NWs) are often observed experimentally to be tapered rather than straight-edged, with diameters (d) shrinking by as much as 1 nm per 10 nm of vertical growth. Previous theoretical studies have examined the electronic properties of straight-edged nanowires (SNWs), although the effects of tapering on quantum confinement may be of both fundamental and practical importance. We have employed ab initio calculations to study the structural and electronic properties of tapered Si NWs. As one may expect, tapered nanowires (TNWs) possess axially-dependent electronic properties; their local energy gaps vary along the wire axis, with the largest gap occurring at the narrowest point of the wire. In contrast to SNWs, where confinement tends to shift valence bands more than conduction bands away from the bulk gap, the unoccupied states in TNWs are much more sensitive to d than the occupied states. In addition, tapering causes the band-edge states to be spatially separated along the wire axis, a consequence of the interplay between a strong variation in quantum confinement strength with diameter and the tapering-induced charge transfer. This property may be exploited in electronic and optical applications, for example, in photovoltaic devices where the separation of the valence and conduction band states could be used to transport excited charges during the thermalization process. In order to gain insight into TNW photovoltaic properties, we have also carried out calculations of the dipole matrix elements near the band edges as well as the role of metal contacts on TNW electronic properties. Finally, a combination of ab initio total energy calculations and classical molecular dynamics (MD) simulations are employed to suggest a new technique for bringing nanoscale objects together to form ordered, ultra high-aspect ratio nanowires. This work was supported in part by the U.S. Department of Energy under Contract No. DE-AC02-05CH11231.

  13. 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

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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).

  19. 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

  20. Treating a physician patient with psychosis.

    PubMed

    Freedman, Jacob L; Crow, Fredrick F; Gutheil, Thomas G; Sanchez, Luis T; Suzuki, Joji

    2012-06-01

    The authors present a case of a psychotic female patient who is a former graduate of a locally prestigious medical school and has subsequently been diagnosed with schizophrenia. The patient entered treatment in an outpatient clinic following discharge from her 11th hospitalization. This hospitalization was initiated after the patient's physician friend had called the police and notified them that the patient was significantly disorganized to warrant further evaluation. Treatment was characterized by significant transference and counter-transference reactions amongst her clinicians - both treatment-promoting and treatment-interfering - based on her status as a physician. The problem of insight was a significant hurdle in the treatment of the patient as her medical knowledge of mental illness was substantially greater than her insight into her own mental illness. Throughout treatment, a number of medical-legal and ethical issues arose. Initially, the question was raised as to the legality of the actions by the patient's friend-having made a clinical assessment without having a clinical role in the patient's care. As the patient's clinical status improved and she sought to re-enter the medical field as a resident, new medical legal issues surfaced. What were the roles of the patient's treaters in maintaining confidentiality and simultaneously ensuring the safety of patients that the psychotic physician might care for? This case highlights the universality of psychiatric vulnerability. Insight in psychosis as well as the transference and counter-transference issues involved in caring for a psychotic physician are discussed. Additionally, a thorough medical-legal discussion addresses the various complexities of caring for a psychotic physician. PMID:22813669

  1. Physicians' evaluations of patients' decisions to refuse oncological treatment

    PubMed Central

    van Kleffens, T; van Leeuwen, E

    2005-01-01

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

  2. Analysis of the integration of the physician rostering problem and the surgery scheduling problem.

    PubMed

    Van Huele, Christophe; Vanhoucke, Mario

    2014-06-01

    In this paper, we present the Integrated Physician and Surgery Scheduling Problem (IPSSP) as a new approach for solving operating room scheduling problems where staff rosters for the physicians are integrated in the optimization. A mixed integer linear programming formulation is created based on the most frequently observed objective and restrictions of the surgery scheduling and the physician rostering problem in the literature. We analyze schedules by relaxing both surgery and physician related constraints. We then measure the implications of setting these physician preferences on the surgery schedule. Our experiments show two main interesting insights for physician roster schedulers as well as operating theatre scheduling managers.

  3. 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.

  4. Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices

    PubMed Central

    Casebeer, Linda L; Spettell, Claire M; Wall, Terry C; Weissman, Norman; Ray, Midge N; Allison, Jeroan J

    2003-01-01

    Background The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important. Objective Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. Methods We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials. Results In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group. Conclusions The application of theory in the development and

  5. 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.

  6. The Federal Trade Commission and physician practice.

    PubMed

    Graham, Jon

    2005-01-01

    Obtaining the best possible managed care contracts is important to physicians. Banding together with other practices to obtain more favorable payment could seem a legitimate business prac tice. Physicians competing in the same specialty in a market area must be acutely aware of federal antitrust rules to avoid improper collusion. The Federal Trade Commission is reviewing collaborative activities and seeking settlement agreements with physician organizations it determines have violated antitrust laws and regulations. Physicians and administrators should be aware of these actions, know what triggers a review, and understand what collaborative activities they may participate in to further their business interests. This article reviews Federal Trade Commission application of federal antitrust rules and recent advisory opinions, and their implications for practice.

  7. 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

  8. An open systems architecture for development of a physician's workstation.

    PubMed Central

    Young, C. Y.; Tang, P. C.; Annevelink, J.

    1991-01-01

    We are developing a physician's workstation consisting of highly integrated information management tools for use by physicians in patient care. We have designed and implemented an open systems, client/server architecture as a development platform which allows new applications to be easily added to the system. Applications cooperate by exchanging messages via a broadcast message server. PMID:1807649

  9. Insights into Participants' Behaviours in Educational Games, Simulations and Workshops: A Catastrophe Theory Application to Motivation.

    ERIC Educational Resources Information Center

    Cryer, Patricia

    1988-01-01

    Develops models for participants' behaviors in games, simulations, and workshops based on Catastrophe Theory and Herzberg's two-factor theory of motivation. Examples are given of how these models can be used, both for describing and understanding the behaviors of individuals, and for eliciting insights into why participants behave as they do. (11…

  10. A physician and a man of science: patients, physicians, and diseases in Marcello Malpighi's medical practice.

    PubMed

    Bresadola, Marco

    2011-01-01

    Marcello Malpighi (1628-94), the celebrated Italian anatomist, was also a very successful physician and, as his correspondence indicates, medical consultant by post. This article focuses on the professional and social network that developed around Malpighi's medical activity. The network played a major role in promoting Malpighi's professional career and in disseminating his scientific ideas. Malpighi's medical practice was indeed fully integrated within his views of the structure and functioning of the human body in health and disease. A fresh look into Malpighi's medical practice allows us to get new insights into early modern relations among medicine, the new science, and the identity of physicians.

  11. 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.

  12. 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

  13. 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.

  14. [The "dialogic principle" as the force of the physician-patient relationship].

    PubMed

    Ritschl, D

    1992-01-01

    The discussion is opened with an analysis of the inherent problems of the concept of quality of life. Why must it be pressed into the straight jacket of a quantitative scheme? The second theme, the thesis that verbal contact and interviews in the doctor's office are an application of the philosophical programme of personalism and "dialogism", is also critically analyzed. Why must the physician (and the psychotherapist) aim so high? Is not the lack of symmetry between the physician and the patient typical of the verbal contact between the two? These factors are discussed, not-withstanding the valid insight that intense personal concern and contact are highly desirable in patient-oriented medicine. PMID:1296400

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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

  20. [The role of occupational physician in the application of the 2006 "agreement on workers' health protection through the good handling and use of crystalline silica and products containing it": the experience in mining sector].

    PubMed

    Coggiola, M; Baracco, A; Perrelli, F; Bosio, D; Gullino, A; Pira, E

    2007-01-01

    The 2006 "Agreement on Workers' Health Protection Through the Good Handling and Use of Crystalline Silica and Products Containing it" between social parts defines a standardization of exposition control methods and medical surveillance. The Occupational Physician is integral part in exposition evaluation process and risk stratification in which derives the medical surveillance program. This study presents a first application of the European agreement in mining sector and the role of Occupational Physician in the evaluation of the risk to define methods of prevention. In particular it will be precised the choice of homogenous groups, the classification of exposed workers from results of workplace monitoring, the choice of technical prevention and individual protection equipments, and then the strategy of medical surveillance. PMID:18409742

  1. Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application

    PubMed Central

    2016-01-01

    Background Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as “facilitated access”). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients’ perception of their physician’s endorsement of a website could facilitate the development of an effective alliance between the patient and the app. Objective We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module. Methods The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences. Results Nearly three-quarters (23/32, 72%) of the physicians interviewed chose

  2. Insight into the SEA amide thioester equilibrium. Application to the synthesis of thioesters at neutral pH.

    PubMed

    Pira, S L; El Mahdi, O; Raibaut, L; Drobecq, H; Dheur, J; Boll, E; Melnyk, O

    2016-07-26

    The bis(2-sulfanylethyl)amide (SEA) N,S-acyl shift thioester surrogate has found a variety of useful applications in the field of protein total synthesis. Here we present novel insights into the SEA amide/thioester equilibrium in water which is an essential step in any reaction involving the thioester surrogate properties of the SEA group. We also show that the SEA amide thioester equilibrium can be efficiently displaced at neutral pH for accessing peptide alkylthioesters, i.e. the key components of the native chemical ligation (NCL) reaction.

  3. 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.

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. 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…

  12. 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.

  13. 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.

  14. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of... physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist,...

  15. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of... physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist,...

  16. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of... physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist,...

  17. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of... physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist,...

  18. 42 CFR 483.40 - Physician services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (d) Availability..., nurse practitioner, or clinical nurse specialist who— (i) Meets the applicable definition in § 491.2 of... physician) may also be satisfied when performed by a nurse practitioner, clinical nurse specialist,...

  19. Women physicians as healthcare leaders: a qualitative study.

    PubMed

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

    2016-06-20

    Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent. PMID:27296884

  20. Selected Insights from Application of Whole Genome Sequencing for Outbreak Investigations

    PubMed Central

    Le, Vien Thi Minh; Diep, Binh An

    2014-01-01

    Purpose of review The advent of high-throughput whole genome sequencing has the potential to revolutionize the conduct of outbreak investigation. Because of its ultimate pathogen strain resolution, whole genome sequencing could augment traditional epidemiologic investigations of infectious disease outbreaks. Recent findings The combination of whole genome sequencing and intensive epidemiologic analysis provided new insights on the sources and transmission dynamics of large-scale epidemics caused by Escherichia coli and Vibrio cholerae, nosocomial outbreaks caused by methicillin-resistant Staphylococcus aureus, Klebsiella pneumonia, and Mycobacterium abscessus, community-centered outbreaks caused by Mycobacterium tuberculosis, and natural disaster-associated outbreak caused by environmentally acquired molds. Summary When combined with traditional epidemiologic investigation, whole genome sequencing has proven useful for elucidating sources and transmission dynamics of disease outbreaks. Development of a fully automated bioinformatics pipeline for analysis of whole genome sequence data is much needed to make this powerful tool more widely accessible. PMID:23856896

  1. 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…

  2. 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)

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. Thermodynamic metrics for aggregation of natural resources in life cycle analysis: insight via application to some transportation fuels.

    PubMed

    Baral, Anil; Bakshi, Bhavik R

    2010-01-15

    While methods for aggregating emissions are widely used and standardized in life cycle assessment (LCA), there is little agreement about methods for aggregating natural resources for obtaining interpretable metrics. Thermodynamic methods have been suggested including energy, exergy, and emergy analyses. This work provides insight into the nature of thermodynamic aggregation, including assumptions about substitutability between resources and loss of detailed information about the data being combined. Methods considered include calorific value or energy, industrial cumulative exergy consumption (ICEC) and its variations, and ecological cumulative exergy consumption (ECEC) or emergy. A hierarchy of metrics is proposed that spans the range from detailed data to aggregate metrics. At the fine scale, detailed data can help identify resources to whose depletion the selected product is most vulnerable. At the coarse scale, new insight is provided about thermodynamic aggregation methods. Among these, energy analysis is appropriate only for products that rely primarily on fossil fuels, and it cannot provide a useful indication of renewability. Exergy-based methods can provide results similar to energy analysis by including only nonrenewable fuels but can also account for materials use and provide a renewability index. However, ICEC and its variations do not address substitutability between resources, causing its results to be dominated by dilute and low-quality resources such as sunlight. The use of monetary values to account for substitutability does not consider many ecological resources and may not be appropriate for the analysis of emerging products. ECEC or emergy explicitly considers substitutability and resource quality and provides more intuitive results but is plagued by data gaps and uncertainties. This insight is illustrated via application to the life cycles of gasoline, diesel, corn ethanol, and soybean biodiesel. Here, aggregate metrics reveal the dilemma

  8. 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

  9. 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

  10. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

    PubMed Central

    2010-01-01

    Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices. PMID:20509903

  11. Insights From Laboratory Experiments On Simulated Faults With Application To Fracture Evolution In Geothermal Systems

    SciTech Connect

    Stephen L. Karner, Ph.D

    2006-06-01

    Laboratory experiments provide a wealth of information related to mechanics of fracture initiation, fracture propagation processes, factors influencing fault strength, and spatio-temporal evolution of fracture properties. Much of the existing literature reports on laboratory studies involving a coupling of thermal, hydraulic, mechanical, and/or chemical processes. As these processes operate within subsurface environments exploited for their energy resource, laboratory results provide insights into factors influencing the mechanical and hydraulic properties of geothermal systems. I report on laboratory observations of strength and fluid transport properties during deformation of simulated faults. The results show systematic trends that vary with stress state, deformation rate, thermal conditions, fluid content, and rock composition. When related to geophysical and geologic measurements obtained from engineered geothermal systems (e.g. microseismicity, wellbore studies, tracer analysis), laboratory results provide a means by which the evolving thermal reservoir can be interpreted in terms of physico-chemical processes. For example, estimates of energy release and microearthquake locations from seismic moment tensor analysis can be related to strength variations observed from friction experiments. Such correlations between laboratory and field data allow for better interpretations about the evolving mechanical and fluid transport properties in the geothermal reservoir – ultimately leading to improvements in managing the resource.

  12. Elements of a flexible approach for conceptual hydrological modeling: 2. Application and experimental insights

    NASA Astrophysics Data System (ADS)

    Kavetski, Dmitri; Fenicia, Fabrizio

    2011-11-01

    In this article's companion paper, flexible approaches for conceptual hydrological modeling at the catchment scale were motivated, and the SUPERFLEX framework, based on generic model components, was introduced. In this article, the SUPERFLEX framework and the "fixed structure" GR4H model (an hourly version of the popular GR4J model) are applied to four hydrologically distinct experimental catchments in Europe and New Zealand. The estimated models are scrutinized using several diagnostic measures, ranging from statistical metrics, such as the statistical reliability and precision of the predictive distribution of streamflow, to more process-oriented diagnostics based on flow-duration curves and the correspondence between model states and groundwater piezometers. Model performance was clearly catchment specific, with a single fixed structure unable to accommodate intercatchment differences in hydrological behavior, including seasonality and thresholds. This highlights an important limitation of any "fixed" model structure. In the experimental catchments, the ability of competing model hypotheses to reproduce hydrological signatures of interest could be interpreted on the basis of independent fieldwork insights. The potential of flexible frameworks such as SUPERFLEX is then examined with respect to systematic and stringent hypothesis-testing in hydrological modeling, for characterizing catchment diversity, and, more generally, for aiding progress toward a more unified formulation of hydrological theory at the catchment scale. When interpreted in physical process-oriented terms, the flexible approach can also serve as a language for dialogue between modeler and experimentalist, facilitating the understanding, representation, and interpretation of catchment behavior.

  13. RNAi in Arthropods: Insight into the Machinery and Applications for Understanding the Pathogen-Vector Interface

    PubMed Central

    Barnard, Annette-Christi; Nijhof, Ard M.; Fick, Wilma; Stutzer, Christian; Maritz-Olivier, Christine

    2012-01-01

    The availability of genome sequencing data in combination with knowledge of expressed genes via transcriptome and proteome data has greatly advanced our understanding of arthropod vectors of disease. Not only have we gained insight into vector biology, but also into their respective vector-pathogen interactions. By combining the strengths of postgenomic databases and reverse genetic approaches such as RNAi, the numbers of available drug and vaccine targets, as well as number of transgenes for subsequent transgenic or paratransgenic approaches, have expanded. These are now paving the way for in-field control strategies of vectors and their pathogens. Basic scientific questions, such as understanding the basic components of the vector RNAi machinery, is vital, as this allows for the transfer of basic RNAi machinery components into RNAi-deficient vectors, thereby expanding the genetic toolbox of these RNAi-deficient vectors and pathogens. In this review, we focus on the current knowledge of arthropod vector RNAi machinery and the impact of RNAi on understanding vector biology and vector-pathogen interactions for which vector genomic data is available on VectorBase. PMID:24705082

  14. Insights into the Biology and Therapeutic Applications of Neural Stem Cells

    PubMed Central

    Harris, Lachlan; Zalucki, Oressia; Piper, Michael; Heng, Julian Ik-Tsen

    2016-01-01

    The cerebral cortex is essential for our higher cognitive functions and emotional reasoning. Arguably, this brain structure is the distinguishing feature of our species, and yet our remarkable cognitive capacity has seemingly come at a cost to the regenerative capacity of the human brain. Indeed, the capacity for regeneration and neurogenesis of the brains of vertebrates has declined over the course of evolution, from fish to rodents to primates. Nevertheless, recent evidence supporting the existence of neural stem cells (NSCs) in the adult human brain raises new questions about the biological significance of adult neurogenesis in relation to ageing and the possibility that such endogenous sources of NSCs might provide therapeutic options for the treatment of brain injury and disease. Here, we highlight recent insights and perspectives on NSCs within both the developing and adult cerebral cortex. Our review of NSCs during development focuses upon the diversity and therapeutic potential of these cells for use in cellular transplantation and in the modeling of neurodevelopmental disorders. Finally, we describe the cellular and molecular characteristics of NSCs within the adult brain and strategies to harness the therapeutic potential of these cell populations in the treatment of brain injury and disease. PMID:27069486

  15. Antimicrobial Peptides: Insights into Membrane Permeabilization, Lipopolysaccharide Fragmentation and Application in Plant Disease Control

    PubMed Central

    Datta, Aritreyee; Ghosh, Anirban; Airoldi, Cristina; Sperandeo, Paola; Mroue, Kamal H.; Jiménez-Barbero, Jesús; Kundu, Pallob; Ramamoorthy, Ayyalusamy; Bhunia, Anirban

    2015-01-01

    The recent increase in multidrug resistance against bacterial infections has become a major concern to human health and global food security. Synthetic antimicrobial peptides (AMPs) have recently received substantial attention as potential alternatives to conventional antibiotics because of their potent broad-spectrum antimicrobial activity. These peptides have also been implicated in plant disease control for replacing conventional treatment methods that are polluting and hazardous to the environment and to human health. Here, we report de novo design and antimicrobial studies of VG16, a 16-residue active fragment of Dengue virus fusion peptide. Our results reveal that VG16KRKP, a non-toxic and non-hemolytic analogue of VG16, shows significant antimicrobial activity against Gram-negative E. coli and plant pathogens X. oryzae and X. campestris, as well as against human fungal pathogens C. albicans and C. grubii. VG16KRKP is also capable of inhibiting bacterial disease progression in plants. The solution-NMR structure of VG16KRKP in lipopolysaccharide features a folded conformation with a centrally located turn-type structure stabilized by aromatic-aromatic packing interactions with extended N- and C-termini. The de novo design of VG16KRKP provides valuable insights into the development of more potent antibacterial and antiendotoxic peptides for the treatment of human and plant infections. PMID:26144972

  16. Manager-physician relationships: an organizational theory perspective.

    PubMed

    Kaissi, Amer

    2005-01-01

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

  17. 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.

  18. Assessing the Health of Future Physicians: An Opportunity for Preventive Education

    ERIC Educational Resources Information Center

    Clair, Jennifer H.; Wilson, Diane B.; Clore, John N.

    2004-01-01

    Introduction: Research shows that physicians who model prevention are more likely to encourage preventive behaviors in their patients. Therefore, understanding the health of medical students ought to provide insight into the development of health promotion programs that influence the way these future physicians practice medicine. A…

  19. Developing Canadian physician: the quest for leadership effectiveness.

    PubMed

    Comber, Scott; Wilson, Lisette; Crawford, Kyle C

    2016-07-01

    Purpose The purpose of this study is to discern the physicians' perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels. Design/methodology/approach A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity. Findings Physicians in clinical roles' PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities. Practical implications More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective. Originality/value Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum.

  20. Developing Canadian physician: the quest for leadership effectiveness.

    PubMed

    Comber, Scott; Wilson, Lisette; Crawford, Kyle C

    2016-07-01

    Purpose The purpose of this study is to discern the physicians' perception of leadership effectiveness in their clinical and non-clinical roles (leadership) by identifying their political skill levels. Design/methodology/approach A sample of 209 Canadian physicians was surveyed using the Political Skills Inventory (PSI) during the period 2012-2014. The PSI was chosen because it assesses leadership effectiveness on four dimensions: social astuteness, interpersonal influence, networking ability and apparent authenticity. Findings Physicians in clinical roles' PSI scores were significantly lower in all four PSI dimensions when compared to all other physicians in non-clinical roles, with the principal difference being in their networking abilities. Practical implications More emphasis is needed on educating and training physicians, specifically in the areas of political skills, in current clinical roles if they are to assume leadership roles and be effective. Originality/value Although this study is located in Canada, the study design and associated findings may have implications to other areas and countries wanting to increase physician leadership effectiveness. Further, replication of this study in other settings may provide insight into the future design of physician leadership training curriculum. PMID:27397750

  1. Choosing and using diversity indices: insights for ecological applications from the German Biodiversity Exploratories

    PubMed Central

    Morris, E Kathryn; Caruso, Tancredi; Buscot, François; Fischer, Markus; Hancock, Christine; Maier, Tanja S; Meiners, Torsten; Müller, Caroline; Obermaier, Elisabeth; Prati, Daniel; Socher, Stephanie A; Sonnemann, Ilja; Wäschke, Nicole; Wubet, Tesfaye; Wurst, Susanne; Rillig, Matthias C

    2014-01-01

    considering analyses using multiple indices can provide greater insight into the interactions in a system. PMID:25478144

  2. Choosing and using diversity indices: insights for ecological applications from the German Biodiversity Exploratories.

    PubMed

    Morris, E Kathryn; Caruso, Tancredi; Buscot, François; Fischer, Markus; Hancock, Christine; Maier, Tanja S; Meiners, Torsten; Müller, Caroline; Obermaier, Elisabeth; Prati, Daniel; Socher, Stephanie A; Sonnemann, Ilja; Wäschke, Nicole; Wubet, Tesfaye; Wurst, Susanne; Rillig, Matthias C

    2014-09-01

    using multiple indices can provide greater insight into the interactions in a system.

  3. 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.

  4. 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

  5. Trigeminal neuralgia: An insight into the current treatment modalities

    PubMed Central

    Punyani, Silky Rajesh; Jasuja, Vishal Ramesh

    2012-01-01

    Trigeminal neuralgia (TN) is one of the most excruciating pain syndromes afflicting the orofacial region. Trigeminal neuralgia may be primary i.e. idiopathic or secondary, resulting from trauma or a CNS lesion. Considering the agonizing nature of the disease and TN being the commonest of the neural maladies affecting the orofacial region it is important for the oral physician to be aware of all available treatment options. This article makes an attempt to present a brief insight into the current treatment modalities that are on hand to treat this condition. From the perspective of the oral physician the pharmacotherapy constitutes the cornerstone in the management of TN. At the same time, it is also important to be aware and updated of the role of the oral surgeon and radiologist in the application of the array of interventional procedures available for treating TN. PMID:25737864

  6. Validity and reliability of the Vietnamese Physician Professional Values Scale.

    PubMed

    Sang, Nguyen Minh; Hall, Alix; Huong, Tran Thi Thanh; Giang, Le Minh; Hinh, Nguyen Duc

    2015-01-01

    Physician values influence a physician's clinical practice and level of medical professionalism. Currently, there is no psychometrically valid scale to assess physician values in Vietnam. This study assessed the initial validity and reliability of the Vietnamese Physician Professional Values Scale (VPPVS). Hartung's original Physician Values in Practice Scale (PVIPS) was translated from English into Vietnamese and adapted to reflect the cultural values of Vietnamese physicians. A sample of clinical experts reviewed the VPPVS to ensure face and content validity of the scale, resulting in a draft 37-item measure. A cross-sectional survey of 1086 physicians from Hanoi, Hue and Ho Chi Minh City completed a self-report survey, which included the draft of the VPPVS. Exploratory Factor Analysis was used to assess construct validity, resulting in 35 items assessing physician's professional values across five main factors: lifestyle, professionalism, prestige, management and finance. The final five-factor scale illustrated acceptable internal consistency, with Cronbach's alpha coefficients ranging from 0.73 to 0.86 and all item-total correlations >0.2. Limited floor or ceiling effects were found. This study supports the application of the VPPVS to measure medical professional values of Vietnamese physicians. Future studies should further assess the psychometric properties of the VPPVS using large samples. PMID:25465039

  7. Polymer-Based Nitric Oxide Therapies: Recent Insights for Biomedical Applications

    PubMed Central

    Jen, Michele C.; Serrano, María C.; van Lith, Robert

    2014-01-01

    Since the discovery of nitric oxide (NO) in the 1980s, this cellular messenger has been shown to participate in diverse biological processes such as cardiovascular homeostasis, immune response, wound healing, bone metabolism, and neurotransmission. Its beneficial effects have prompted increased research in the past two decades, with a focus on the development of materials that can locally release NO. However, significant limitations arise when applying these materials to biomedical applications. This Feature Article focuses on the development of NO-releasing and NO-generating polymeric materials (2006–2011) with emphasis on recent in vivo applications. Results are compared and discussed in terms of NO dose, release kinetics, and biological effects, in order to provide a foundation to design and evaluate new NO therapies. PMID:25067935

  8. How physician/administrator teams work in small groups. Six steps to make it happen.

    PubMed

    Stearns, T H

    1999-01-01

    The physician/administrator team is frequently supported as the preferred model for physician group governance. Perhaps an obvious model for large groups, it remains true that the largest percentage of physicians are practicing in groups of 10 or fewer. This article explores the applicability of the physician/administrator team concept for small group practices. The article covers the significance of the physician/administrator team in managed care settings, difference in governance structures between large and small groups, the need for physicians to be willing to share leadership in organizations they own, understanding empowerment in small groups, the manager's need to assume more responsibility and how to form the team.

  9. 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.

  10. 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)

  11. Assessing physician job satisfaction and mental workload.

    PubMed

    Boultinghouse, Oscar W; Hammack, Glenn G; Vo, Alexander H; Dittmar, Mary Lynne

    2007-12-01

    Physician job satisfaction and mental workload were evaluated in a pilot study of five physicians engaged in a telemedicine practice at The University of Texas Medical Branch at Galveston Electronic Health Network. Several previous studies have examined physician satisfaction with specific telemedicine applications; however, few have attempted to identify the underlying factors that contribute to physician satisfaction or lack thereof. One factor that has been found to affect well-being and functionality in the workplace-particularly with regard to human interaction with complex systems and tasks as seen in telemedicine-is mental workload. Workload is generally defined as the "cost" to a person for performing a complex task or tasks; however, prior to this study, it was unexplored as a variable that influences physician satisfaction. Two measures of job satisfaction were used: The Job Descriptive Index and the Job In General scales. Mental workload was evaluated by means of the National Aeronautics and Space Administration Task Load Index. The measures were administered by means of Web-based surveys and were given twice over a 6-month period. Nonparametric statistical analyses revealed that physician job satisfaction was generally high relative to that of the general population and other professionals. Mental workload scores associated with the practice of telemedicine in this environment are also high, and appeared stable over time. In addition, they are commensurate with scores found in individuals practicing tasks with elevated information-processing demands, such as quality control engineers and air traffic controllers. No relationship was found between the measures of job satisfaction and mental workload. PMID:18047420

  12. Gut Microbiota and Nonalcoholic Fatty Liver Disease: Insights on Mechanism and Application of Metabolomics.

    PubMed

    He, Xuyun; Ji, Guang; Jia, Wei; Li, Houkai

    2016-01-01

    Gut microbiota are intricately involved in the development of obesity-related metabolic diseases such as nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, and insulin resistance. In the current review, we discuss the role of gut microbiota in the development of NAFLD by focusing on the mechanisms of gut microbiota-mediated host energy metabolism, insulin resistance, regulation of bile acids and choline metabolism, as well as gut microbiota-targeted therapy. We also discuss the application of a metabolomic approach to characterize gut microbial metabotypes in NAFLD. PMID:26999104

  13. Gut Microbiota and Nonalcoholic Fatty Liver Disease: Insights on Mechanism and Application of Metabolomics

    PubMed Central

    He, Xuyun; Ji, Guang; Jia, Wei; Li, Houkai

    2016-01-01

    Gut microbiota are intricately involved in the development of obesity-related metabolic diseases such as nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, and insulin resistance. In the current review, we discuss the role of gut microbiota in the development of NAFLD by focusing on the mechanisms of gut microbiota-mediated host energy metabolism, insulin resistance, regulation of bile acids and choline metabolism, as well as gut microbiota-targeted therapy. We also discuss the application of a metabolomic approach to characterize gut microbial metabotypes in NAFLD. PMID:26999104

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

    PubMed

    Weber, J Michael

    2013-01-01

    The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making. PMID:23924222

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

    PubMed

    Weber, J Michael

    2013-01-01

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

  16. Oncolytic Adenovirus: Strategies and Insights for Vector Design and Immuno-Oncolytic Applications

    PubMed Central

    Uusi-Kerttula, Hanni; Hulin-Curtis, Sarah; Davies, James; Parker, Alan L.

    2015-01-01

    Adenoviruses (Ad) are commonly used both experimentally and clinically, including oncolytic virotherapy applications. In the clinical area, efficacy is frequently hampered by the high rates of neutralizing immunity, estimated as high as 90% in some populations that promote vector clearance and limit bioavailability for tumor targeting following systemic delivery. Active tumor targeting is also hampered by the ubiquitous nature of the Ad5 receptor, hCAR, as well as the lack of highly tumor-selective targeting ligands and suitable targeting strategies. Furthermore, significant off-target interactions between the viral vector and cellular and proteinaceous components of the bloodstream have been documented that promote uptake into non-target cells and determine dose-limiting toxicities. Novel strategies are therefore needed to overcome the obstacles that prevent efficacious Ad deployment for wider clinical applications. The use of less seroprevalent Ad serotypes, non-human serotypes, capsid pseudotyping, chemical shielding and genetic masking by heterologous peptide incorporation are all potential strategies to achieve efficient vector escape from humoral immune recognition. Conversely, selective vector arming with immunostimulatory agents can be utilized to enhance their oncolytic potential by activation of cancer-specific immune responses against the malignant tissues. This review presents recent advantages and pitfalls occurring in the field of adenoviral oncolytic therapies. PMID:26610547

  17. 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

  18. 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

  19. The Successful Application of a National Peer Advisory Committee for Physicians Who Provide Salvage Regimens to Heavily Antiretroviral-Experienced Patients in Mexican Human Immunodeficiency Virus Clinics

    PubMed Central

    Calva, Juan J.; Sierra-Madero, Juan; Soto-Ramírez, Luis E.; Aguilar-Salinas, Pedro

    2014-01-01

    Background  Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients. Methods  We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22–43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of <200 copies per mL, followed by levels above this threshold) during the follow-up assessment using an observed-failure competing risks regression analysis. Results  A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4). The probabilities of virologic failure were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively. Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4+ T-cell count was 162 cells per mL (IQR = 45–304 cells per mL). Conclusions  In routine practice, a high rate of patients with extensive ARV experience, who received an optimized salvage regimen recommended by a peer advisory committee, achieved a long-term sustained virologic response and immune reconstitution. PMID:25734149

  20. 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

  1. ISMRM Workshop on Fat–Water Separation: Insights, Applications and Progress in MRI

    PubMed Central

    Hu, Houchun Harry; Börnert, Peter; Hernando, Diego; Kellman, Peter; Ma, Jingfei; Reeder, Scott; Sirlin, Claude

    2013-01-01

    Approximately 130 attendees convened on February 19–22, 2012 for the first ISMRM-sponsored workshop on water–fat imaging. The motivation to host this meeting was driven by the increasing number of research publications on this topic over the past decade. The scientific program included an historical perspective and a discussion of the clinical relevance of water–fat MRI, a technical description of multiecho pulse sequences, a review of data acquisition and reconstruction algorithms, a summary of the confounding factors that influence quantitative fat measurements and the importance of MRI-based biomarkers, a description of applications in the heart, liver, pancreas, abdomen, spine, pelvis, and muscles, an overview of the implications of fat in diabetes and obesity, a discussion on MR spectroscopy, a review of childhood obesity, the efficacy of lifestyle interventional studies, and the role of brown adipose tissue, and an outlook on federal funding opportunities from the National Institutes of Health. PMID:22693111

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. Promote potential applications of nanoparticles as respiratory drug carrier: insights from molecular dynamics simulations

    NASA Astrophysics Data System (ADS)

    Lin, Xubo; Bai, Tingting; Zuo, Yi Y.; Gu, Ning

    2014-02-01

    Nanoparticles (NPs) show great promises in biomedical applications as the respiratory drug carrier system. Once reaching the alveolar region, NPs first interact with the pulmonary surfactant (PS) film, which serves as the first biological barrier and plays an important role in maintaining the normal respiratory mechanics. Therefore, understanding the interactions between NPs and PS can help promote the NP-based respiratory drug carrier systems. Using coarse-grained molecular dynamics simulations, we studied the effect of rigid spherical NPs with different hydrophobicity and sizes on a dipalmitoylphosphatidylcholine (DPPC) monolayer at the air-water interface. Four different NPs were considered, including hydrophilic and hydrophobic NPs, each with two diameters of 3 nm and 5 nm (the sizes are comparable to that of generation 3 and 5 PAMAM dendrimers, which have been widely used for nanoscale drug carrier systems). Our simulations showed that hydrophilic NPs can readily penetrate into the aqueous phase with little or no disturbance on the DPPC monolayer. However, hydrophobic NPs tend to induce large structural disruptions, thus inhibiting the normal phase transition of the DPPC monolayer upon film compression. Our simulations also showed that this inhibitory effect of hydrophobic NPs can be mitigated through PEGylation. Our results provide useful guidelines for molecular design of NPs as carrier systems for pulmonary drug delivery.Nanoparticles (NPs) show great promises in biomedical applications as the respiratory drug carrier system. Once reaching the alveolar region, NPs first interact with the pulmonary surfactant (PS) film, which serves as the first biological barrier and plays an important role in maintaining the normal respiratory mechanics. Therefore, understanding the interactions between NPs and PS can help promote the NP-based respiratory drug carrier systems. Using coarse-grained molecular dynamics simulations, we studied the effect of rigid spherical NPs

  7. 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…

  8. 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)

  9. Functional body composition: insights into the regulation of energy metabolism and some clinical applications.

    PubMed

    Müller, M J; Bosy-Westphal, A; Later, W; Haas, V; Heller, M

    2009-09-01

    The application of advanced methods and techniques and their continuous development enable detailed body composition analyses (BCAs) and modeling of body composition at different levels (e.g., at atomic, molecular, organ-tissue and whole body level). Functional body composition integrates body components into regulatory systems (e.g., on energy balance). Regulation of body weight is closely linked to the mass and function of individual body components. Fat mass is part of the energy intake regulatory feedback system. In addition, fat-free mass (FFM) and fat mass are both determinants of resting energy expenditure (REE). Up to 80% of the variance in energy intake and energy expenditure is explained by body composition. A deviation from normal associations between body components and function suggests a metabolic disequilibrium (e.g., in the REE-FFM relationship or in the plasma leptin-fat mass association) that may occur in response to weight changes and diseases. The concept of functional body composition adds to a more sophisticated view on nutritional status and diseases, as well as to a characterization of biomedical traits that will provide functional evidence relating genetic variants.

  10. Super-resolution fluorescent materials: an insight into design and bioimaging applications.

    PubMed

    Yang, Zhigang; Sharma, Amit; Qi, Jing; Peng, Xiao; Lee, Dong Yeop; Hu, Rui; Lin, Danying; Qu, Junle; Kim, Jong Seung

    2016-08-22

    Living organisms are generally composed of complex cellular processes which persist only within their native environments. To enhance our understanding of the biological processes lying within complex milieus, various techniques have been developed. Specifically, the emergence of super-resolution microscopy has generated a renaissance in cell biology by redefining the existing dogma towards nanoscale cell dynamics, single synaptic vesicles, and other complex bioprocesses by overcoming the diffraction-imposed resolution barrier that is associated with conventional microscopy techniques. Besides the typical technical reliance on the optical framework and computational algorithm, super-resolution imaging microscopy resorts largely to fluorescent materials with special photophysical properties, including fluorescent proteins, organic fluorophores and nanomaterials. In this tutorial review article, with the emphasis on cell biology, we summarize the recent developments in fluorescent materials being utilized in various super-resolution techniques with successful integration into bio-imaging applications. Fluorescent proteins (FP) applied in super-resolution microscopy will not be covered herein as it has already been well summarized; additionally, we demonstrate the breadth of opportunities offered from a future perspective. PMID:27296269

  11. Insights into the biology of Borrelia burgdorferi gained through the application of molecular genetics.

    PubMed

    Groshong, Ashley M; Blevins, Jon S

    2014-01-01

    Borrelia burgdorferi, the vector-borne bacterium that causes Lyme disease, was first identified in 1982. It is known that much of the pathology associated with Lyme borreliosis is due to the spirochete's ability to infect, colonize, disseminate, and survive within the vertebrate host. Early studies aimed at defining the biological contributions of individual genes during infection and transmission were hindered by the lack of adequate tools and techniques for molecular genetic analysis of the spirochete. The development of genetic manipulation techniques, paired with elucidation and annotation of the B. burgdorferi genome sequence, has led to major advancements in our understanding of the virulence factors and the molecular events associated with Lyme disease. Since the dawn of this genetic era of Lyme research, genes required for vector or host adaptation have garnered significant attention and highlighted the central role that these components play in the enzootic cycle of this pathogen. This chapter covers the progress made in the Borrelia field since the application of mutagenesis techniques and how they have allowed researchers to begin ascribing roles to individual genes. Understanding the complex process of adaptation and survival as the spirochete cycles between the tick vector and vertebrate host will lead to the development of more effective diagnostic tools as well as identification of novel therapeutic and vaccine targets. In this chapter, the Borrelia genes are presented in the context of their general biological roles in global gene regulation, motility, cell processes, immune evasion, and colonization/dissemination.

  12. Super-resolution fluorescent materials: an insight into design and bioimaging applications.

    PubMed

    Yang, Zhigang; Sharma, Amit; Qi, Jing; Peng, Xiao; Lee, Dong Yeop; Hu, Rui; Lin, Danying; Qu, Junle; Kim, Jong Seung

    2016-08-22

    Living organisms are generally composed of complex cellular processes which persist only within their native environments. To enhance our understanding of the biological processes lying within complex milieus, various techniques have been developed. Specifically, the emergence of super-resolution microscopy has generated a renaissance in cell biology by redefining the existing dogma towards nanoscale cell dynamics, single synaptic vesicles, and other complex bioprocesses by overcoming the diffraction-imposed resolution barrier that is associated with conventional microscopy techniques. Besides the typical technical reliance on the optical framework and computational algorithm, super-resolution imaging microscopy resorts largely to fluorescent materials with special photophysical properties, including fluorescent proteins, organic fluorophores and nanomaterials. In this tutorial review article, with the emphasis on cell biology, we summarize the recent developments in fluorescent materials being utilized in various super-resolution techniques with successful integration into bio-imaging applications. Fluorescent proteins (FP) applied in super-resolution microscopy will not be covered herein as it has already been well summarized; additionally, we demonstrate the breadth of opportunities offered from a future perspective.

  13. 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

  14. Pathogenic Mechanisms Underlying Iron Deficiency and Iron Overload: New Insights for Clinical Application

    PubMed Central

    van Velden, DP; van Rensburg, SJ; Erasmus, R

    2009-01-01

    Iron uptake, utilisation, release and storage occur at the gene level. Individuals with variant forms of genes involved in iron metabolism may have different requirements for iron and are likely to respond differently to the same amount of iron in the diet, a concept termed nutrigenetics. Iron deficiency, iron overload and the anemia of inflammation are the commonest iron-related disorders. While at least four types of hereditary iron overload have been identified to date, our knowledge of the genetic basis and consequences of inherited iron deficiency remain limited. The importance of genetic risk factors in relation to iron overload was highlighted with the identification of the HFE gene in 1996. Deleterious mutations in this gene account for 80-90% of inherited iron overload and are associated with loss of iron homeostasis, alterations in inflammatory responses, oxidative stress and in its most severe form, the disorder hereditary haemochromatosis (HH). Elucidation of the genetic basis of HH has led to rapid clinical benefit through drastic reduction in liver biopsies performed as part of the diagnostic work-up of affected patients. Today, detection of a genetic predisposition in the presence of high serum ferritin and transferrin saturation levels is usually sufficient to diagnose HH, thereby addressing the potential danger of inherited iron overload which starts with the same symptoms as iron deficiency, namely chronic fatigue. This review provides the scientific back-up for application of pathology supported genetic testing, a new test concept that is well placed for optimizing clinical benefit to patients with regard to iron status.

  15. Molecular insights into cold active polygalacturonase enzyme for its potential application in food processing.

    PubMed

    Ramya, L N; Pulicherla, K K

    2015-09-01

    Pectin is a complex structural heteropolysaccharide that require numerous pectinolytic enzymes for its complete degradation. Polygalacturonase from mesophilic or thermophilic origin are being widely used in fruit and vegetable processing in the recent decades to degrade pectic substances. Recently cold active pectinases are finding added advantages over meso and thermophilic counterparts, to use in industrial scale particularly in food processing industry. They facilitate in conservation of several properties of foods so that the end product retains its naturality and also generates economic benefits. In the present study, Pseudoalteromonas haloplanktis, a well reported marine psychrophile is taken as a model organism for cold active polygalacturonase and is evaluated in comparision to the routinely used mesophilic and thermophilic enzymes by insicio approach. Polygalacturonase sequences from industrially important microbial sources were subjected to MEME and Pfam wherein motifs and domains involved in the conservation were analyzed. Dendrogram revealed sequence level similarity and motifs showed uniform distribution of conserved regions that are involved in important functions. It was also observed through clustalW analysis that the amount of arginine content of psychrophiles is less when compared with thermophiles. Finally, all the modeled enzyme structures were subjected to docking studies using Autodock 4.2 with the substrate polygalacturonic acid and binding energies were found to be -5.73, -6.22 and -7.27 KCals/mole for meso, thermo and psychrophiles respectively which indicates the efficiency of psychrophilic enzymes when compared with its counterparts giving scope for further experimentation to find their better usage in various food industry applications. PMID:26344963

  16. PET Neuroimaging: Insights on Dystonia and Tourette Syndrome and Potential Applications

    PubMed Central

    Alongi, Pierpaolo; Iaccarino, Leonardo; Perani, Daniela

    2014-01-01

    Primary dystonia (pD) is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric developmental disorder characterized by motor and phonic tics, which could progress to behavioral changes. GTS and obsessive–compulsive disorders are often seen in comorbidity, also suggesting that a possible overlap in the pathophysiological bases of these two conditions. PET techniques are of considerable value in detecting functional and molecular abnormalities in vivo, according to the adopted radioligands. For example, PET is the unique technique that allows in vivo investigation of neurotransmitter systems, providing evidence of changes in GTS or pD. For example, presynaptic and post-synaptic dopaminergic studies with PET have shown alterations compatible with dysfunction or loss of D2-receptors bearing neurons, increased synaptic dopamine levels, or both. Measures of cerebral glucose metabolism with 18F-fluorodeoxyglucose PET (18F-FDG PET) are very sensitive in showing brain functional alterations as well. 18F-FDG PET data have shown metabolic changes within the cortico-striato-pallido-thalamo-cortical and cerebello-thalamo-cortical networks, revealing possible involvement of brain circuits not limited to basal ganglia in pD and GTS. The aim of this work is to overview PET consistent neuroimaging literature on pD and GTS that has provided functional and molecular knowledge of the underlying neural dysfunction. Furthermore, we suggest potential applications of these techniques in monitoring treatments. PMID:25295029

  17. Theory of Current Transients in Planar Semiconductor Devices: Insights and Applications to Organic Solar Cells

    NASA Astrophysics Data System (ADS)

    Hawks, Steven A.; Finck, Benjamin Y.; Schwartz, Benjamin J.

    2015-04-01

    Time-domain current measurements are widely used to characterize semiconductor material properties, such as carrier mobility, doping concentration, carrier lifetime, and the static dielectric constant. It is therefore critical that these measurements be theoretically understood if they are to be successfully applied to assess the properties of materials and devices. In this paper, we derive generalized relations for describing current-density transients in planar semiconductor devices at uniform temperature. By spatially averaging the charge densities inside the semiconductor, we are able to provide a rigorous, straightforward, and experimentally relevant way to interpret these measurements. The formalism details several subtle aspects of current transients, including how the electrode charge relates to applied bias and internal space charge, how the displacement current can alter the apparent free-carrier current, and how to understand the integral of a charge-extraction transient. We also demonstrate how the formalism can be employed to derive the current transients arising from simple physical models, like those used to describe charge extraction by linearly increasing voltage (CELIV) and time-of-flight experiments. In doing so, we find that there is a nonintuitive factor-of-2 reduction in the apparent free-carrier concentration that can be easily missed, for example, in the application of charge-extraction models. Finally, to validate our theory and better understand the different current contributions, we perform a full time-domain drift-diffusion simulation of a CELIV trace and compare the results to our formalism. As expected, our analytic equations match precisely with the numerical solutions to the drift-diffusion, Poisson, and continuity equations. Thus, overall, our formalism provides a straightforward and general way to think about how the internal space-charge distribution, the electrode charge, and the externally applied bias translate into a measured

  18. Making it work: characteristics of high-performing hospital-physician networks.

    PubMed

    Bauman, Randy

    2011-01-01

    Physician practice is in the midst of another historic change--from solo and small groups to large, hospital-sponsored employed-physician networks. The question remains as to whether these large, hospital-centric physician organizations are sustainable. This article examines the stress points that physicians and practice managers face as they find themselves thrust into new but often ill-defined business models. It offers insights and pathways to help them navigate the changes that will be necessary for these business models to survive, evolve, and thrive. PMID:22111274

  19. Making it work: characteristics of high-performing hospital-physician networks.

    PubMed

    Bauman, Randy

    2011-01-01

    Physician practice is in the midst of another historic change--from solo and small groups to large, hospital-sponsored employed-physician networks. The question remains as to whether these large, hospital-centric physician organizations are sustainable. This article examines the stress points that physicians and practice managers face as they find themselves thrust into new but often ill-defined business models. It offers insights and pathways to help them navigate the changes that will be necessary for these business models to survive, evolve, and thrive.

  20. What Explains Usage of Mobile Physician-Rating Apps? Results From a Web-Based Questionnaire

    PubMed Central

    Terlutter, Ralf; Röttl, Johanna

    2014-01-01

    Background Consumers are increasingly accessing health-related information via mobile devices. Recently, several apps to rate and locate physicians have been released in the United States and Germany. However, knowledge about what kinds of variables explain usage of mobile physician-rating apps is still lacking. Objective This study analyzes factors influencing the adoption of and willingness to pay for mobile physician-rating apps. A structural equation model was developed based on the Technology Acceptance Model and the literature on health-related information searches and usage of mobile apps. Relationships in the model were analyzed for moderating effects of physician-rating website (PRW) usage. Methods A total of 1006 randomly selected German patients who had visited a general practitioner at least once in the 3 months before the beginning of the survey were randomly selected and surveyed. A total of 958 usable questionnaires were analyzed by partial least squares path modeling and moderator analyses. Results The suggested model yielded a high model fit. We found that perceived ease of use (PEOU) of the Internet to gain health-related information, the sociodemographic variables age and gender, and the psychographic variables digital literacy, feelings about the Internet and other Web-based applications in general, patients’ value of health-related knowledgeability, as well as the information-seeking behavior variables regarding the amount of daily private Internet use for health-related information, frequency of using apps for health-related information in the past, and attitude toward PRWs significantly affected the adoption of mobile physician-rating apps. The sociodemographic variable age, but not gender, and the psychographic variables feelings about the Internet and other Web-based applications in general and patients’ value of health-related knowledgeability, but not digital literacy, were significant predictors of willingness to pay. Frequency of

  1. Emerging Roles of Exosomes in Normal and Pathological Conditions: New Insights for Diagnosis and Therapeutic Applications

    PubMed Central

    De Toro, Julieta; Herschlik, Leticia; Waldner, Claudia; Mongini, Claudia

    2015-01-01

    infectious diseases such as tuberculosis, diphtheria, and toxoplasmosis as well as infections caused by prions or viruses such as HIV. The aim of this review is to disclose the emerging roles of exosomes in normal and pathological conditions and to discuss their potential therapeutic applications. PMID:25999947

  2. Physician handoffs: opportunities and limitations for supportive technologies

    PubMed Central

    Blondon, Katherine S.; Wipfli, Rolf; Nendaz, Mathieu R.; Lovis, Christian

    2015-01-01

    Shift-to-shift handoffs refer to the process of transferring role and responsibility for providing care from one person to another, thus insuring continuity of care. Through focus groups of residents and supervising physicians, we studied how physicians select patient cases to discuss during handoffs. We also compared the selection across level of experience. Understanding the patient selection criteria can give us insight into how to improve handoffs, in particular using supportive technologies that are integrated into the clinical information system. Studying the actual handoff process and note-taking also generated suggestions for handoff improvement. PMID:26958165

  3. Collaborating internationally on physician leadership development: why now?

    PubMed

    Chan, Ming-Ka; de Camps Meschino, Diane; Dath, Deepak; Busari, Jamiu; Bohnen, Jordan David; Samson, Lindy Michelle; Matlow, Anne; Sánchez-Mendiola, Melchor

    2016-07-01

    Purpose This paper aims to highlight the importance of leadership development for all physicians within a competency-based medical education (CBME) framework. It describes the importance of timely international collaboration as a key strategy in promoting physician leadership development. Design/methodology/approach The paper explores published and Grey literature around physician leadership development and proposes that international collaboration will meet the expanding call for development of leadership competencies in postgraduate medical learners. Two grounding frameworks were used: complexity science supports adding physician leadership training to the current momentum of CBME adoption, and relational cultural theory supports the engagement of diverse stakeholders in multiple jurisdictions around the world to ensure inclusivity in leadership education development. Findings An international collaborative identified key insights regarding the need to frame physician leadership education within a competency-based model. Practical implications International collaboration can be a vehicle for developing a globally relevant, generalizable physician leadership curriculum. This model can be expanded to encourage innovation, scholarship and program evaluation. Originality/value A competency-based leadership development curriculum is being designed by an international collaborative. The curriculum is based on established leadership and education frameworks. The international collaboration model provides opportunities for ongoing sharing, networking and diversification. PMID:27397746

  4. 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…

  5. 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

  6. 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.

  7. 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

  8. 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

  9. [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.

  10. Risk perception & strategic decision making :general insights, a framework, and specific application to electricity generation using nuclear energy.

    SciTech Connect

    Brewer, Jeffrey D.

    2005-11-01

    The objective of this report is to promote increased understanding of decision making processes and hopefully to enable improved decision making regarding high-consequence, highly sophisticated technological systems. This report brings together insights regarding risk perception and decision making across domains ranging from nuclear power technology safety, cognitive psychology, economics, science education, public policy, and neural science (to name a few). It forms them into a unique, coherent, concise framework, and list of strategies to aid in decision making. It is suggested that all decision makers, whether ordinary citizens, academics, or political leaders, ought to cultivate their abilities to separate the wheat from the chaff in these types of decision making instances. The wheat includes proper data sources and helpful human decision making heuristics; these should be sought. The chaff includes ''unhelpful biases'' that hinder proper interpretation of available data and lead people unwittingly toward inappropriate decision making ''strategies''; obviously, these should be avoided. It is further proposed that successfully accomplishing the wheat vs. chaff separation is very difficult, yet tenable. This report hopes to expose and facilitate navigation away from decision-making traps which often ensnare the unwary. Furthermore, it is emphasized that one's personal decision making biases can be examined, and tools can be provided allowing better means to generate, evaluate, and select among decision options. Many examples in this report are tailored to the energy domain (esp. nuclear power for electricity generation). The decision making framework and approach presented here are applicable to any high-consequence, highly sophisticated technological system.

  11. Insights into the Rational Design of Multi-Functional Fullerene Systems for Application in Blended Heterojunction Organic Solar Cells

    NASA Astrophysics Data System (ADS)

    Cowart, John S., Jr.

    Elucidating the structure-function relationships of organic semiconductors has been central to the advancement of organic photovoltaics (OPVs). In particular, enhancing the performance of p-type materials in disordered heterojunctions is broadly acknowledged as the principal factor leading to current trends of improved power conversion efficiencies (PCEs). However, two additional factors are crucially important for the next step forward in improving PCEs. First, investigating the influence, design and synthesis of new n-type materials, specifically fullerene acceptors, is of high importance. Second, because fullerene performance is often compromised by the morphological disorder of bulk heterojunctions, developing fullerenes systems that retain fidelity within disordered blends is also of broad interest. In light of these challenges, the field has witnessed a notable shift towards developing a comprehensive understanding of the design rules needed to advance the performance of fullerene acceptors in bulk heterojunctions. This work spotlights two multi-functional fullerene systems designed for blended heterojunctions. First, the synthesis of several novel fullerene-dye adducts with enhanced photon absorption will be presented. The ability of these adducts to absorb visible light in their pure state was evaluated and systematically examined versus their capacity to complement the absorption of low band gap donors and mediate charge transport in bulk heterojunctions. Second, mixed fullerene ternary blends were introduced as a strategy to stabilize the morphology in bulk heterojunctions and prolong operational lifetimes of OPV devices. Combined, these two systems offer unique insight into the rational design of fullerenes for their application in blended systems.

  12. 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.

  13. 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.

  14. 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

  15. 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)

  16. 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.

  17. Medical school tuition and young physicians' indebtedness.

    PubMed

    Jolly, Paul

    2005-01-01

    Medical school tuition and medical student debt have increased dramatically during the past two decades, but loans are available on favorable terms, which makes it possible for students without personal or family means to get a medical education. As an investment, medical education is an excellent choice; its net present value is more than a million dollars. Cost is nevertheless a strong deterrent to potential applicants, especially minority applicants. If tuition and indebtedness continue to increase while physician incomes do not, there may come a time when only the wealthy can finance a medical education, and medical schools may have increasing difficulty recruiting qualified students. PMID:15757940

  18. Medical school tuition and young physicians' indebtedness.

    PubMed

    Jolly, Paul

    2005-01-01

    Medical school tuition and medical student debt have increased dramatically during the past two decades, but loans are available on favorable terms, which makes it possible for students without personal or family means to get a medical education. As an investment, medical education is an excellent choice; its net present value is more than a million dollars. Cost is nevertheless a strong deterrent to potential applicants, especially minority applicants. If tuition and indebtedness continue to increase while physician incomes do not, there may come a time when only the wealthy can finance a medical education, and medical schools may have increasing difficulty recruiting qualified students.

  19. Practice efficiency and physician compensation: a case study.

    PubMed

    Shaw, D V

    2002-01-01

    One of the major challenges facing today's health care executive is that of achieving maximum efficiency. The public also requires an efficient health care system. However, a problem occurs when the health care executive defines "efficiency" in a manner that is diametrically opposed to the public's definition. Maximum efficiency in the physician practice is defined by productivity equal to capacity. Maximum efficiency of the health care system is defined by lower health care costs. If the physician practice is achieving its goal of maximum efficiency, the market economy will likely force a failure in achieving the public's goal of a lower cost health care system! The following case study provides an opportunity to review this health care management conundrum and offers insights into a possible approach for some solution through attention to physician compensation. PMID:12534255

  20. The anatomy of online information for physicians.

    PubMed Central

    Mendelson, D N; Levinson, J; Gaylin, D S

    1996-01-01

    Online medical networked information (OMNI) is one of the newest and fastest growing types of information sources for physicians. The authors present an organizational framework for understanding the range of available OMNI sources and discuss the practical applications, strengths and limitations of online resources. Physicians can now gain access on line to a wealth of information relating to many aspects of clinical medicine and can consult interactively with colleagues on clinical and research questions. The limitations of networked online resources include lack of access, difficulty in navigating online systems and the potential for fraudulent use. Net-worked online systems are growing in popularity and may become integral to medical practice as barriers to efficient use are overcome. PMID:8823212

  1. [PERSONALIZED MEDICINE: NEW CHALLENGES FOR THE PHYSICIAN].

    PubMed

    Scheen, A J

    2015-01-01

    The clinician has to cope with new advances in medicine. Traditional medicine, which is based upon pathophysiological reasoning and clinical experience, has been reinforced by evidence-based medicine, which relies on levels of evidence provided by controlled clinical trials carried out on cohorts of patients. Since a few years, personalized medicine has been put at the forefront. A therapy tailored to every patient, if possible characterized by biomarkers, among which, since the achievement of the whole human genome sequencing, an increasing number of genetic markers. Personalized medicine should be used as a complement of traditional and evidence-based medicine. Physicians should progressively integrate this new strategy in their therapeutic approach. Hence, clinicians have to face new challenges as far as scientific knowledge, practical applications and physician-patient relationship are concerned.

  2. 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

  3. Application of the new GOLD COPD staging system to a US primary care cohort, with comparison to physician and patient impressions of severity

    PubMed Central

    Mapel, Douglas W; Dalal, Anand A; Johnson, Phaedra T; Becker, Laura K; Hunter, Alyssa Goolsby

    2015-01-01

    Background In 2011, the traditional Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD spirometry-based severity classification system was revised to also include exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnea Scale (mMRC) scores. This study examined how COPD patients treated in primary care are reclassified by the new GOLD system compared to the traditional system, and each system’s level of agreement with patient’s or physician’s severity assessments. Methods In this US multicenter cross-sectional study, COPD patients were recruited by 83 primary care practitioners (PCPs) to complete spirometry testing and a survey. Patients were classified by the traditional spirometry-based system (stages 1–4) and under the new system (grades A, B, C, D) using spirometry, exacerbation history, mMRC, and/or CAT results. Concordance between physician and patient-reported severity, spirometry stage, and ABCD grade based on either mMRC or CAT scores was examined. Results Data from 445 patients with spirometry-confirmed COPD were used. As compared to the traditional system, the GOLD mMRC system reclassifies 47% of patients, and GOLD CAT system reclassifies 41%, but the distributions are very different. The GOLD mMRC system resulted in relatively equal distributions by ABCD grade (33%, 22%, 19%, 26%, respectively), but the GOLD CAT system put most into either B or D groups (9%, 45%, 4%, and 42%). The addition of exacerbation history reclassified only 19 additional patients. Agreement between PCPs’ severity rating or their patients’ self-assessment and the new ABCD grade was very poor (κ=0.17 or less). Conclusion As compared to the traditional system, the GOLD 2011 multidimensional system reclassified nearly half of patients, but how they were reclassified varied greatly by whether the mMRC or CAT questionnaire was chosen. Either way, the new system had little correlation with the PCPs or their patients

  4. 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 ...

  5. 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.

  6. 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)

  7. 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

  8. 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.

  9. 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.

  10. [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

  11. 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.

  12. Zygosity Diagnosis: When Physicians and DNA Disagree.

    PubMed

    Segal, Nancy L

    2015-10-01

    Physicians and other medical professionals do not always provide new parents with an accurate diagnosis of their twins' zygosity. An overview of this problem is presented, supplemented by an interview with a mother who recently learned that her 2-year-old 'dizygotic (DZ)' twin girls are actually 'monozygotic (MZ)'. Reviews of two case studies, one of twins with sex-discordance and chimerism and the other of twins with congenital amegakaryotic thrombocytopenia, follow. Two additional studies, one a twin analysis of attractiveness to mosquitoes and the other a study of twins coping with crisis, are also described. Several articles and letters from the popular media, concerning less favored twins, paternity issues surrounding superfecundation, twins with late-onset Tay-Sachs disease, and triplets admitted to MIT are informative and insightful. PMID:26323370

  13. 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

  14. 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.

  15. 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.

  16. Kappa statistic for clustered dichotomous responses from physicians and patients.

    PubMed

    Kang, Chaeryon; Qaqish, Bahjat; Monaco, Jane; Sheridan, Stacey L; Cai, Jianwen

    2013-09-20

    The bootstrap method for estimating the standard error of the kappa statistic in the presence of clustered data is evaluated. Such data arise, for example, in assessing agreement between physicians and their patients regarding their understanding of the physician-patient interaction and discussions. We propose a computationally efficient procedure for generating correlated dichotomous responses for physicians and assigned patients for simulation studies. The simulation result demonstrates that the proposed bootstrap method produces better estimate of the standard error and better coverage performance compared with the asymptotic standard error estimate that ignores dependence among patients within physicians with at least a moderately large number of clusters. We present an example of an application to a coronary heart disease prevention study.

  17. 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…

  18. Prosocial motivation and physicians' work attitudes. Effects of a triple synergy on prosocial orientation in a healthcare organization.

    PubMed

    Kim, Young Shin

    2015-01-01

    Employees work attitudes are key determinants to organizational performance. This article proposes a model integrating servant leadership, prosocial motivation, and corporate social responsibility (CSR) in order to explain a mechanism through which prosocial motivation plays a central role in enhanding physicians' work attitudes. A cross sectional survey from a sample of physicians indicates that (1) prosocial motivation can be shaped from servant leadership when physicians perceive high value fit with their supervisors, (2) prosocial motivation improves physicians' job satisfaction. Its effects is strengthened when physicians perceive high CSR, and (3) job satisfaction improves organizational commitment. The results provide meaningful insights that a triple synergy of prosocial orientation among physicians, supervisors and organization enhances physicians' work attitudes.

  19. Prosocial motivation and physicians' work attitudes. Effects of a triple synergy on prosocial orientation in a healthcare organization.

    PubMed

    Kim, Young Shin

    2015-01-01

    Employees work attitudes are key determinants to organizational performance. This article proposes a model integrating servant leadership, prosocial motivation, and corporate social responsibility (CSR) in order to explain a mechanism through which prosocial motivation plays a central role in enhanding physicians' work attitudes. A cross sectional survey from a sample of physicians indicates that (1) prosocial motivation can be shaped from servant leadership when physicians perceive high value fit with their supervisors, (2) prosocial motivation improves physicians' job satisfaction. Its effects is strengthened when physicians perceive high CSR, and (3) job satisfaction improves organizational commitment. The results provide meaningful insights that a triple synergy of prosocial orientation among physicians, supervisors and organization enhances physicians' work attitudes. PMID:26058287

  20. 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

  1. Physician Beliefs about Physical and Mental Competency of Patients Applying for Concealed Weapon Permits.

    PubMed

    Goldstein, Adam O; Viera, Anthony J; Pierson, John; Barnhouse, Kathy K; Tulsky, James A; Richman, Barak D

    2015-06-01

    Law enforcement officials have asked health care providers to evaluate patient applications for concealed weapon permits. The current study was designed to examine physician beliefs regarding competency to carry a concealed weapon for patients with specific physical and mental conditions. Among 222 North Carolina physicians who participated in this survey (40% response rate), large variation and uncertainty existed for determining competency. Physicians most frequently chose mild dementia, post-traumatic stress disorder, and recent depression as conditions that would render a patient not competent to carry a concealed weapon. Male physicians and those owning a gun were more likely to deem a patient competent. Almost a third of physicians were unsure about competence for most conditions. Physicians asked to assess competency of patients to carry a concealed weapon have quite disparate views on competency and little confidence in their decisions. If physicians are expected to assess patient competence to carry a concealed weapon, more objective criteria and training are needed.

  2. 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.

  3. Burnout Among Primary Care Physicians: A Test of the Areas of Worklife Model.

    PubMed

    Gregory, Sean T; Menser, Terri

    2015-01-01

    Examinations of the current state of the physician workforce, in the United States and globally, indicate a declining overall well-being, and specifically increasing levels of burnout. The consequences of these effects include early retirements or exits from the medical profession, difficulties improving the patient experience, and low levels of provider engagement with clinic-level and system-level initiatives. Such consequences affect physicians, healthcare organizations, and patients. While most research has focused on identifying burnout, cataloging its effects, and creating a case for attending to its impact, relatively few studies have focused on exploring the antecedents of burnout for physicians. The goal of this study was to test an etiological model, the Areas of Worklife Scale (AWS), for practicing primary care physicians. Using the AWS and the Maslach Burnout Inventory, the study used a longitudinal survey research design method to query primary care physicians employed at a large integrated delivery system in the United States. Data collected successfully fit the AWS model for burnout among primary care physicians, supporting our theory that workplace drivers are responsible for burnout. Workload, control, and values congruence are the largest drivers of burnout for practicing primary care physicians. The AWS model provides key insights into the domains of work that cause stress and ultimately burnout for physicians, and these domains can guide physicians and managers to develop interventions to fight the rising incidence of burnout. PMID:26529850

  4. 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...

  5. 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...

  6. 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...

  7. 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....

  8. 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

  9. 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.

  10. [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

  11. [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.

  12. End Results What Happens Next?: Effect of plasticine on falling rods Insights and Conundrums: de Broglie's wavelength has many applications in the study of gases Signing Off: The life and work of Marie Curie

    NASA Astrophysics Data System (ADS)

    2011-07-01

    What Happens Next?: Effect of plasticine on falling rods David Featonby Insights and Conundrums: de Broglie's wavelength has many applications in the study of gases Rick Marshall Signing Off: The life and work of Marie Curie David Smith

  13. Science insights.

    PubMed

    Tanabe, Kazuyuki

    2015-06-01

    "Below is an essay by Prof. Tanabe originally written in Japanese. It gives an insight to Prof. Tanabe's inquiring mind and his approach to science. He also seek, as always, to inspire and nudge the young to scientific discovery".

  14. Physicians' opinions following pharmacogenetic testing for psychotropic medication.

    PubMed

    Walden, Lucas M; Brandl, Eva J; Changasi, Amtul; Sturgess, Jessica E; Soibel, Alexander; Notario, Janna Fe D; Cheema, Sheraz; Braganza, Nicole; Marshe, Victoria S; Freeman, Natalie; Tiwari, Arun K; Kennedy, James L; Müller, Daniel J

    2015-10-30

    Pharmacogenetics seeks to improve patient drug response and decrease side effects by personalizing prescriptions using genetic information. Since 2012, by one estimate, the number of patients who have had pharmacogenetic testing has doubled and this number is expected to double again by 2015. Given the increasing evidence for genetic influences on treatment response, we deemed it important to study physicians' opinions of pharmacogenetic testing. Surveys were completed by 168 Canadian physicians who had ordered at least one pharmacogenetic test (in particular for CYP2D6 or CYP2C19) for the prescription of psychiatric medication. Our results indicated that 80% of respondents believe genetic testing would become common standard in psychiatric drug treatment and 76% of respondents reported satisfactory or higher than satisfactory understanding of the pharmacogenetic report provided. Significantly more male physicians believed they had a higher understanding of the pharmacogenetic report compared to female physicians. To our knowledge, this is the only study that has assessed physicians' opinions of pharmacogenetic testing for psychotropic medication after they had received a pharmacogenetic report. Our results demonstrate a positive opinion of physicians on pharmacogenetics and indicate great potential for future clinical application. PMID:26298505

  15. 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

  16. 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

  17. 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

  18. [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

  19. 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.…

  20. [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

  1. 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)

  2. 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

  3. 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.

  4. 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

  5. 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…

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. The dilemma of physician shortage and international recruitment in Canada.

    PubMed

    Islam, Nazrul

    2014-06-01

    The perception of physician shortage in Canada is widespread. Absolute shortages and relative discrepancies, both specialty-wise and in urban-rural distribution, have been a daunting policy challenge. International Medical Graduates (IMGs) have been at the core of mitigating this problem, especially as long as shortage of physicians in rural areas is concerned. Considering such recruitment as historical reality is naïve annotation, but when it is recommended per se, then the indication of interest overweighs the intent of ethically justified solution. Such a recommendation has not only invited policy debate and disagreement, but has also raised serious ethical concerns. Canadian healthcare policy-makers were put into a series of twisting puzzles-recruiting IMGs in mitigating physician shortage was questioned by lack of vision for Canada's self-sufficiency. In-migration of IMGs was largely attributed to Canada's point-based physician-friendly immigration system without much emphasizing on IMGs' home countries' unfavorable factors and ignoring their basic human rights and choice of livelihood. While policy-makers' excellence in integrating the already-migrated IMGs into the Canadian healthcare is cautiously appraised, its logical consequence in passively drawing more IMGs is loudly criticised. Even the passive recruitment of IMGs raised the ethical concern of source countries' (which are often developing countries with already-compromised healthcare system) vulnerability. The current paper offers critical insights juxtaposing all these seemingly conflicting ideas and interests within the scope of national and transnational instruments.

  14. The dilemma of physician shortage and international recruitment in Canada

    PubMed Central

    Islam, Nazrul

    2014-01-01

    The perception of physician shortage in Canada is widespread. Absolute shortages and relative discrepancies, both specialty-wise and in urban-rural distribution, have been a daunting policy challenge. International Medical Graduates (IMGs) have been at the core of mitigating this problem, especially as long as shortage of physicians in rural areas is concerned. Considering such recruitment as historical reality is naïve annotation, but when it is recommended per se, then the indication of interest overweighs the intent of ethically justified solution. Such a recommendation has not only invited policy debate and disagreement, but has also raised serious ethical concerns. Canadian healthcare policy-makers were put into a series of twisting puzzles—recruiting IMGs in mitigating physician shortage was questioned by lack of vision for Canada’s self-sufficiency. In-migration of IMGs was largely attributed to Canada’s point-based physician-friendly immigration system without much emphasizing on IMGs’ home countries’ unfavorable factors and ignoring their basic human rights and choice of livelihood. While policy-makers’ excellence in integrating the already-migrated IMGs into the Canadian healthcare is cautiously appraised, its logical consequence in passively drawing more IMGs is loudly criticised. Even the passive recruitment of IMGs raised the ethical concern of source countries’ (which are often developing countries with already-compromised healthcare system) vulnerability. The current paper offers critical insights juxtaposing all these seemingly conflicting ideas and interests within the scope of national and transnational instruments. PMID:24987719

  15. Exploring personal interests of physicians in hospitals and specialty clinics.

    PubMed

    Koelewijn, Wout T; Ehrenhard, Michel L; Groen, Aard J; van Harten, Wim H

    2014-01-01

    Physicians' interests substantially influence intra-organizational dynamics in hospitals, though little is known about the actual content and structure of these interests. The objective of this study was to both identify and build a structured model of physicians' interests. Based on literature and 27 semi-structured interviews with physicians, a questionnaire containing 10 interests was developed. Next, 1475 physicians in the Netherlands filled out an online survey. Analyses of the data revealed a distinction between the primary interest of 'helping patients as well as possible' and nine secondary interests. Factor analysis identified the main secondary interest dimensions as work-related, setting-related, and life-related. Value attached to interests differs between specialties and types of hospitals. The influence of hospital type on the value attached to interests is stronger than the influence of specialty group on the value attached to interests. Insight in the relative importance of different interests may help policy-makers make decisions that foster shared interests.

  16. 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.

  17. NIH research funding and early career physician scientists: continuing challenges in the 21st century

    PubMed Central

    Garrison, Howard H.; Deschamps, Anne M.

    2014-01-01

    Physician scientists (researchers with either M.D. or M.D.-Ph.D. degrees) have the unique potential to combine clinical perspectives with scientific insight, and their participation in biomedical research has long been an important topic for policymakers and educators. Given the recent changes in the research environment, an update and extension of earlier studies of this population was needed. Our findings show that physician scientists are less likely to take a major role in biomedical research than they were in the past. The number of physician scientists receiving postdoctoral research training and career development awards is at an all-time low. Physician scientists today, on average, receive their first major research award (R01 equivalent) at a later age than in the 1980s. The number of first-time R01-equivalent awards to physicians is at the same level as it was 30 yr ago, but physicians now represent a smaller percentage of the grant recipients. The long-term decline in the number of physicians entering research careers was temporarily halted during the period of substantial U.S. National Institutes of Health (NIH) budget growth (1998–2003). These gains are lost, however, in the subsequent years when NIH budgets failed to keep pace with rising costs.— Garrison, H. H., Deschamps, A. M. NIH research funding and early career physician scientists: continuing challenges in the 21st century. PMID:24297696

  18. 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

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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

  5. 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.

  6. Development and Validation of a Computer Application to Aid the Physician's Decision-Making Process at the Start of and during Treatment with Insulin in Type 2 Diabetes: A Randomized and Controlled Trial

    PubMed Central

    Sáenz, Antonio; Brito, Miguel; Morón, Ignacio; Torralba, Amalia; García-Sanz, Elena; Redondo, Jesus

    2012-01-01

    Background Achieving optimum blood glucose control in patients with type 2 diabetes mellitus (T2DM) is difficult. Some primary care physicians (PCPs) delay the start of insulin use because of the uncertainty in intensifying insulin therapy. The objective was to develop and validate a computer application (CA) that helps PCPs to make decisions about insulin therapy in order to achieve a significant improvement in glycated hemoglobin (HbA1c). Methods This was a cluster-randomized clinical trial. Fourteen primary care centers (PCCs) in Madrid with 66 PCPs and 697 T2DM patients on insulin therapy were randomly divided into two groups of seven PCCs each. In the intervention group, seven PCCs included 39 PCPs and 365 T2DM patients on insulin therapy. These PCPs were free to use the CA. A further seven PCCs were assigned to the control group with 27 PCPs and 332 T2DM patients on insulin therapy. The control group did not use the CA. The duration of the trial was 18 months to validate the CA. The outcome was a change in HbA1c from baseline. Results In the intervention group, the final HbA1c was 7.19% (standard deviation [SD] ± 0.93), with a difference from the start of -0.69% (p = .001). In the control group, it was 7.71% (SD ± 1.37), with a difference from the start of -0.09% (p not significant). Conclusions This CA helps to improve HbA1c figures of T2DM patients with insulin when it is used by PCPs to make decisions when starting, continuing, or changing insulin and its dosage. PMID:22768889

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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 .

  12. 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.

  13. 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...

  14. 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.

  15. 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

  16. 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…

  17. 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…

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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

  4. Public challenge of physician authority.

    PubMed

    Haug, M R; Lavin, B

    1979-08-01

    A sample survey of the public in a midwestern state substantiates the existence of widespread challenges to the authority of physicians, a phenomenon previously reported only impressionistically in the media. Attitudes tending to reject physicians' right to direct their interaction with patients characterized more than half the sample and were related to younger age, higher educational level, and greater health knowledge, with a consumerist and anti-authority stance also explanatory. Actual challenging behavior occurred at least once for about half the group, but in this instance was related less to age and knowledge than to more extensive experience with the health care system, as well as a lack of trust in people in general and doctors' competence in particular. However, explained variance was modest, arguing that other variables, not identified in this study, are at work. Surprisingly, respondents' health status, race, sex, and pattern of insurance coverage had little impact on either attitude or behavior, while both knowledge and a general tendency to reject authority were influential factors. Implications for physician-patient relations in the future are discussed in light of a number of social changes, including the rising educational level of the American public.

  5. American College of Physicians Ethics Manual: sixth edition.

    PubMed

    Snyder, Lois

    2012-01-01

    Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.

  6. Social media and you: what every physician needs to know.

    PubMed

    Chauhan, Bindiya; George, Ruth; Coffin, Janis

    2012-01-01

    New healthcare models have been developed to keep up with the dynamic changes of the Internet revolution through social media. Physicians are taking this new technology and enhancing their communication with patients as well among the healthcare community including distributing public health information via Twitter and Facebook. However, a physician's freedom of speech via Twitter and blogs can reach millions instantly, causing irreversible harm. U.S. licensing authorities have reported numerous violations of professionalism by physicians resulting in disciplinary actions negatively impacting their careers. Federation of State Medical Boards guidelines advise that patient privacy must be protected at all times on social networking sites. In addition, employers and residency programs are also now searching Facebook and other social networking sites before hiring applicants. There are many benefits of social media; however, professionalism, patient privacy, and boundaries need to be maintained. PMID:23373164

  7. American College of Physicians Ethics Manual: sixth edition.

    PubMed

    Snyder, Lois

    2012-01-01

    Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The sixth edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession. PMID:22213573

  8. Doctors for the world: Indian physician emigration.

    PubMed

    Mullan, Fitzhugh

    2006-01-01

    Almost 60,000 Indian physicians practice in the United States, United Kingdom, Canada, and Australia--a workforce equal to 10 percent of the physicians in India and the largest émigré physician workforce in the world. I traveled to India to interview leaders in medical education, health policy, and public health, to better characterize and understand Indian physician emigration. A changing political and policy environment in India is raising new questions about what might be done to keep more of India's physicians at home. PMID:16610096

  9. Aligning physician compensation with strategic goals.

    PubMed

    Bunkers, Brian; Koch, Mark; McDonough, Becky; Whited, Brian

    2014-07-01

    In 2012, Mayo Clinic Health System (MCHS) had 13 different physician compensation models among its operating units, with most based on productivity metrics. MCHS aimed to transition all physicians to a single compensation model that would facilitate its integration with Mayo Clinic and promote physician engagement with emerging value-based payment models. The new model, which was implemented this past January, incorporates quality metrics, provides physicians with regular reports of their performance, and already has resulted in greater physician attention to outcomes, safety, and patient experience.

  10. Physician specialty societies and the development of physician performance measures.

    PubMed

    Ferris, Timothy G; Vogeli, Christine; Marder, Jessica; Sennett, Cary S; Campbell, Eric G

    2007-01-01

    Efforts to increase accountability in the delivery of care include attempts to measure performance of individual doctors. Although physician specialty societies may be best positioned to define best practices, they have not yet played a major role in the development of measures. We examined specialty society involvement in measure development through interviews and review of Web sites. We found that a minority (35 percent) of societies were engaged in developing performance measures. Key barriers included member reluctance, lack of resources for development, and problems with data collection; facilitators included strong leadership and the perception of increasing pressure for accountability. PMID:17978390

  11. Physician unionization efforts gain momentum, support.

    PubMed

    Keating, G C

    1999-11-01

    Physicians increasingly are assuming the status of employees in healthcare organizations. Physicians also are seeing restrictions imposed on their practices by healthcare organizations seeking to control costs of care delivery. These trends have led a growing number of physicians to attempt to organize into unions. Obstacles to physician unionization efforts have included Federal antitrust laws that prohibit physicians from organizing, as well as physician reluctance to engage in organized activities they see as antithetical to their professional duties (e.g., strikes). In addition, physicians' attempts to unionize frequently have failed due to provisions of the National Labor Relations Act, which authorize collective bargaining only among individuals designated as "employees." Physicians seeking to form unions often are thwarted by the argument that they are not employees, but rather students, independent contractors, or supervisors, and therefore not entitled to protection under the act. Nonetheless, a number of recent developments, such as the American Medical Association's decision to endorse unionization by physicians and the National Labor Relations Board's decision that attending physicians should be regarded as employees, not supervisors, are creating a climate more conducive to physician unionization in the United States.

  12. Review article: burnout in emergency medicine physicians.

    PubMed

    Arora, Manit; Asha, Stephen; Chinnappa, Jason; Diwan, Ashish D

    2013-12-01

    Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.

  13. Physicians' attitudes about their professional appearance.

    PubMed

    Gjerdingen, D K; Simpson, D E

    1989-01-01

    Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.

  14. Physician switching after drug request refusal.

    PubMed

    Lee, Doohee; Begley, Charles E

    2011-10-01

    Physician switching is a barometer of the quality of the relationship between a patient and a physician. Understanding the factors associated with physician switching in the context of direct-to-consumer advertising (DTCA) of prescription drugs has been largely unexamined. A total of 818 of 2,988 participants in a national telephone survey (27.4%) who had received DTCA reported asking their physician for a prescription drug, and 196 (24.0%) reported that their physician refused to prescribe the drug. Of those whose physicians refused, 13.9% (n = 27 of 194 with data) switched doctors. We found that individuals with regular medical-seeking behavior, full prescription drug coverage, with certain chronic conditions, and of African American origin were significantly more likely to switch physicians in this context.

  15. Siren song: physicians, congress, and medicare fees.

    PubMed

    Laugesen, Miriam J

    2009-04-01

    Physicians' fees under Medicare are updated by regulation annually based on a formula called the Sustainable Growth Rate (SGR). Since 2003 Congress has reversed impending cuts to fees in response to physician calls for reform of the SGR, yet physician groups supported the SGR when fee increases outstripped medical inflation. Physician groups are partly culpable for the failure of cost containment because physician groups have resisted efforts to regulate their practice or link effectiveness research to coverage and reimbursement decisions. In the story of Ulysses and the Sirens, Ulysses has himself bound to the mast so that he cannot be seduced by the calls of the Sirens. Physician groups are like sirens because legislators cannot resist their songs. Future policy changes should consider physician needs alongside broader cost-containment goals, including linking reimbursement to comparative effectiveness research. PMID:19276315

  16. Barriers Facing Physicians Practicing Evidence-Based Medicine in Saudi Arabia

    ERIC Educational Resources Information Center

    Al-Almaie, Sameeh M.; Al-Baghli, Nadira

    2004-01-01

    Introduction: Tremendous advances in health care have been made through the development of evidence-based medicine (EBM). Studies show that physicians face barriers in practice, preventing the effective use of the best evidence available. Insight into these barriers should pave the way for an action plan to remove them. The aim of this study was…

  17. Exploring Deliberate Practice in Medicine: How Do Physicians Learn in the Workplace?

    ERIC Educational Resources Information Center

    van de Wiel, Margje W. J.; Van den Bossche, Piet; Janssen, Sandra; Jossberger, Helen

    2011-01-01

    Medical professionals need to keep on learning as part of their everyday work to deliver high-quality health care. Although the importance of physicians' learning is widely recognized, few studies have investigated how they learn in the workplace. Based on insights from deliberate practice research, this study examined the activities physicians…

  18. [Are American physicians more satisfied?--results from an International Study of Physicians in University Hospitals].

    PubMed

    Janus, K; Amelung, V E; Baker, L C; Gaitanides, M; Rundall, T G; Schwartz, F W

    2009-04-01

    Understanding the factors that affect physicians' job satisfaction is important not only to physicians themselves, but also to patients, health system managers, and policy makers. Physicians represent the crucial resource in health-care delivery. In order to enhance efficiency and quality in health care, it is indispensable to analyse and consider the motivators of physicians. Physician job satisfaction has significant effects on productivity, the quality of care, and the supply of physicians. The purpose of our study was to assess the associations between work-related monetary and non-monetary factors and physicians' work satisfaction as perceived by similar groups of physicians practicing at academic medical centres in Germany and the U.S.A., two countries that, in spite of differing health-care systems, simultaneously experience problems in maintaining their physician workforce. We used descriptive statistics, factor and correlation analyses to evaluate physicians' responses to a self-administered questionnaire. Our study revealed that overall German physicians were less satisfied than U.S. physicians. With respect to particular work-related predictors of job satisfaction we found that similar factors contributed to job satisfaction in both countries. To improve physicians' satisfaction with working conditions, our results call for the implementation of policies that reduce the time burden on physicians to allow more time for interaction with patients and colleagues, increase monetary incentives, and enhance physicians' participation in the development of care management processes and in managerial decisions that affect patient care. PMID:19288428

  19. Wanted: Well-Rounded Physicians.

    PubMed

    Sorrel, Amy Lynn

    2015-10-01

    The Association of American Medical Colleges has revamped the MCAT for the first time in nearly three decades. While the new exam retains the science-based testing historically included, it adds new topics and approaches meant to keep up with a rapidly changing health care delivery system. It aims to test and train aspiring physicians based less on memorizing scientific facts and more on competency: putting that scientific knowledge into practice. Questions on the new MCAT pertain to concepts such as self-identity, social stratification, and multiculturalism and ask students to apply them to certain scenarios. PMID:26457841

  20. December financial checkup for physicians.

    PubMed

    Miller, Rita

    2014-01-01

    December is a busy month for holiday fun, but don't neglect your financial health! Physicians should review their business and personal finances at year end to ensure they are on target both for income generated and taxes paid. Preparing for the April 15 tax filing is aided by a thorough review in December. Payroll items such as W2s, 1099s, and employee benefits need to be reviewed. Retirement savings should be analyzed. Make sure to look at your business profit/loss statement and balance sheet. Personal contributions and other tax planning strategies need to be completed by the end of the year. Your CPA can help!

  1. December financial checkup for physicians.

    PubMed

    Miller, Rita

    2014-01-01

    December is a busy month for holiday fun, but don't neglect your financial health! Physicians should review their business and personal finances at year end to ensure they are on target both for income generated and taxes paid. Preparing for the April 15 tax filing is aided by a thorough review in December. Payroll items such as W2s, 1099s, and employee benefits need to be reviewed. Retirement savings should be analyzed. Make sure to look at your business profit/loss statement and balance sheet. Personal contributions and other tax planning strategies need to be completed by the end of the year. Your CPA can help! PMID:25807615

  2. Wanted: Well-Rounded Physicians.

    PubMed

    Sorrel, Amy Lynn

    2015-10-01

    The Association of American Medical Colleges has revamped the MCAT for the first time in nearly three decades. While the new exam retains the science-based testing historically included, it adds new topics and approaches meant to keep up with a rapidly changing health care delivery system. It aims to test and train aspiring physicians based less on memorizing scientific facts and more on competency: putting that scientific knowledge into practice. Questions on the new MCAT pertain to concepts such as self-identity, social stratification, and multiculturalism and ask students to apply them to certain scenarios.

  3. [Human rights of the physician].

    PubMed

    García-Romero, H

    1995-01-01

    The physician rights may be classified in those related with his quality as a person, and those derived from his relationship with his patients and the institution to which he belongs. Among the first, liberty of expression, legal security, right of free association, the right of a dignified social position and neutral attitude towards the commitment of giving medical attention to whomever the patient may be. He has the right to receive a full and up-to-date training oriented to serve the community, supported by health institutions, and to have the means of utmost quality to give medical attention of the highest standard. PMID:8549918

  4. [Human rights of the physician].

    PubMed

    García-Romero, H

    1995-01-01

    The physician rights may be classified in those related with his quality as a person, and those derived from his relationship with his patients and the institution to which he belongs. Among the first, liberty of expression, legal security, right of free association, the right of a dignified social position and neutral attitude towards the commitment of giving medical attention to whomever the patient may be. He has the right to receive a full and up-to-date training oriented to serve the community, supported by health institutions, and to have the means of utmost quality to give medical attention of the highest standard.

  5. Coronary CT angiography: how should physicians use it wisely and when do physicians request it appropriately?

    PubMed

    Sun, Zhonghua; Aziz, Yang Faridah Abdul; Ng, Kwan-Hoong

    2012-04-01

    Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease due to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with 64- and more slice CT scanners and in selected patients, coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. Although the tremendous contributions of coronary CT angiography to cardiac imaging are acknowledged, appropriate use of cardiac CT as the first line technique by physicians has not been well established. Optimal selection of cardiac CT is essential to ensure acquisition of valuable diagnostic information and avoid unnecessary invasive procedures. This is of paramount importance since cardiac CT not only involves patient risk assessment, prediction of major cardiac events, but also impacts physician decision-making on patient management. Applications of CT in cardiac imaging include coronary artery calcium scoring for predicting the patient risk of developing major cardiac events, followed by coronary CT angiography which is commonly used to determine the diagnostic and prognostic accuracy in the coronary artery disease. This review presents an overview of the applications of CT in cardiac imaging in terms of coronary calcium scoring and coronary CT angiography. Judicious use of both cardiac CT tools will be discussed with regard to their value in different patient risk groups with the aim of identifying the appropriate criteria for choosing a cardiac CT modality. An effective diagnostic pathway is finally recommended to physicians for appropriate selection of cardiac CT in clinical practice.

  6. Physician professionalism for a new century.

    PubMed

    Holsinger, James W; Beaton, Benjamin

    2006-07-01

    During the past 50 years, physicians have become increasingly dissatisfied with certain aspects of their profession. Dissatisfaction has intensified with the advent of managed care in the late 20th century, the medical liability crisis, and the growing divergence between the professional and personal expectations placed upon physicians and their practical ability to meet these expectations. These and other factors have encroached on physician autonomy, the formerly ascendant professional value within medicine. As the underlying values and practical realities of the broader American health care system have changed, the professional values and practices of physicians have failed to adapt correspondingly, resulting in a "professionalism gap" that contributes to physician dissatisfaction. To improve the outlook and efficacy of modern American physicians, the profession must adopt a new values framework that conforms to today's health care system. This means foregoing the 20th century's preferred "independent physician" model in favor of a new professional structure based on teamwork and collaboration. Convincing established physicians to embrace such a model will be difficult, but opportunities exist for significant progress among a new generation of physicians accustomed to the realities of managed care, flexible practice models, and health information technology. The teaching of clinical anatomy, given its incorporation of student collaboration at the earliest stages of medical education, offers a prime opportunity to introduce this generation to a reinvigorated code of professionalism that should reduce physician dissatisfaction and benefit society.

  7. Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience.

    PubMed

    Swensen, Stephen; Kabcenell, Andrea; Shanafelt, Tait

    2016-01-01

    The process of creating healthy organization-physician relationships is critical to organizational success. Partnerships in process improvement can nurture these relationships and mitigate burnout by meeting physicians' psychological needs. To flourish, physicians need some degree of choice (control over their lives), camaraderie (social connectedness), and an opportunity for excellence (being part of something meaningful). Organizations can provide these opportunities by establishing constructive organization-physician relationships and developing physician leaders. We present a case study from the Mayo Clinic that supports the foundational principles of a physician-engagement model. We developed the Listen-Act-Develop model as an integrated strategy to reduce burnout and engage physicians in the mission of the organization. The intent of the model is to maximize physician wellness by fostering engagement and mitigating the drivers of burnout. This model provides a path to increase physician satisfaction and meaning in work and to improve organizational effectiveness.

  8. Application of Sociology of Education on Early Childhood Curriculum and Pedagogic Practices in Hong Kong: Insight from David Riesman

    ERIC Educational Resources Information Center

    Lau, Grace; Ho, Kwok Keung

    2016-01-01

    This paper will present multiple themes that are intermingled with one another, aiming to bring an overview of sociology of education and its application in the Hong Kong situation. One of the themes concerns how sociology of education has intertwined with the socio-political aspect of Hong Kong before and after year 1997 resulting in different…

  9. Difficult physician-patient relationships.

    PubMed

    Reifsteck, S W

    1998-01-01

    Changes in the delivery of health care services in the United States are proceeding so rapidly that many providers are asking how the working relationships between doctors and patients will be effected. Accelerated by cost containment, quality improvement and the growth of managed care, these changes have caused some critics to feel that shorter visits and gatekeeper systems will promote an adversarial relationship between physicians and patients. However, proponents of the changing system feel that better prevention, follow-up care and the attention to customer service these plans can offer will lead to increased patient satisfaction and improved doctor-patient communication. Dedicated to addressing these concerns, the Bayer Institute for Health Care Communication was established in 1987 as a continuing medical education program (CME) focusing on this topic. A half-day workshop on clinician-patient communication to enhance health outcomes was introduced in 1992 and a second workshop, "Difficult' Clinician-Patient Relationships," was developed two years later. The two courses discussed in this article are offered to all physicians, residents, medical students, mid-level providers and other interested staff within the Carle system. PMID:10186308

  10. Finite Difference Simulations of Acoustic and Gravity Wave Propagation in Mars Atmosphere: Applications to INSIGHT NASA Mission and Mars Microphone Experiments

    NASA Astrophysics Data System (ADS)

    Garcia, R.; Brissaud, Q.; Martin, R.; Rolland, L. M.; Komatitsch, D.

    2015-12-01

    A simulation tool of acoustic and gravity wave propagation through finite differences is applied to the case of Mars atmosphere.The details of the code and its validation for Earth atmosphere are presented in session SA003.The simulations include the modeling of both acoustic and gravity waves in the same run, an effects of exponential density decrease, winds and attenuation.The application to Mars requires the inclusion of a specific attenuation effect related to the relaxation induced by vibrational modes of carbon dioxide molecules.Two different applications are presented demonstrating the ability of the simulation tool to work at very different scale length and frequencies.First the propagation of acoustic and gravity waves due to a bolide explosion in the atmosphere of Mars are simulated.This case has a direct application to the atmospheric pressure and seismic measurements that will be performed by INSIGHT NASA discovery mission next year.Then, we also present simulations of sound wave propagation on a scale of meters that can be used to infer the feasability microphone measurements for future Mars missions.

  11. Physician leadership in e-health? A systematic literature review.

    PubMed

    Keijser, Wouter; Smits, Jacco; Penterman, Lisanne; Wilderom, Celeste

    2016-07-01

    Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny. PMID:27397753

  12. Physician leadership in e-health? A systematic literature review.

    PubMed

    Keijser, Wouter; Smits, Jacco; Penterman, Lisanne; Wilderom, Celeste

    2016-07-01

    Purpose This paper aims to systematically review the literature on roles of physicians in virtual teams (VTs) delivering healthcare for effective "physician e-leadership" (PeL) and implementation of e-health. Design/methodology/approach The analyzed studies were retrieved with explicit keywords and criteria, including snowball sampling. They were synthesized with existing theoretical models on VT research, healthcare team competencies and medical leadership. Findings Six domains for further PeL inquiry are delineated: resources, task processes, socio-emotional processes, leadership in VTs, virtual physician-patient relationship and change management. We show that, to date, PeL studies on socio-technical dynamics and their consequences on e-health are found underrepresented in the health literature; i.e. no single empirical, theoretic or conceptual study with a focus on PeL in virtual healthcare work was identified. Research limitations/implications E-health practices could benefit from organization-behavioral type of research for discerning effective physicians' roles and inter-professional relations and their (so far) seemingly modest but potent impact on e-health developments. Practical implications Although best practices in e-health care have already been identified, this paper shows that physicians' roles in e-health initiatives have not yet received any in-depth study. This raises questions such as are physicians not yet sufficiently involved in e-health? If so, what (dis)advantages may this have for current e-health investments and how can they best become involved in (leading) e-health applications' design and implementation in the field? Originality/value If effective medical leadership is being deployed, e-health effectiveness may be enhanced; this new proposition needs urgent empirical scrutiny.

  13. Existential medicine: Martin Buber and physician-patient relationships.

    PubMed

    Cohn, F

    2001-01-01

    Martin Buber's (1878-1965) social existentialist thought offers a unique lens through which physician-patient relationships may be interpreted. Buber develops concepts of relationships and dialogue that provide insight into physician-patient relationships. His notions of I-Thou and I-It relationships have relevance for contemporary medical education and practice. Current medical practice is situated in the It-realm of order, objectivity, detachment, abstraction, and experience. This perspective is necessary for medical education and practice but can result in the progressive decline of the interhuman relationships that define medicine. I-Thou relationships, characterized by spontaneity, subjectivity, reciprocity, and recognition and acceptance of the unique other, are essential for humanhood. However, physicians and patients may be constrained from achieving I-Thou relationships by the very nature of their interactions, which are planned and purposive. Buber describes the possibility of a therapeutic relationship that approaches the I-Thou realm. Buber's thought suggests three conceptual shifts that facilitate the development of therapeutic relationships in medical practice and have implications for medical education: (1) from disease-centered to person-centered care, (2) from crisis to everyday management, and (3) from principles and contracts to relationships. PMID:11563223

  14. Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

    PubMed

    Rosenthal, David A; Layman, Elizabeth J

    2008-02-13

    The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

  15. 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…

  16. [Moses Maimonides, "physician of princes, prince of physicians"].

    PubMed

    Cerda L, Jaime

    2009-08-01

    Moses Maimonides (1135-1204) is considered the most prominent figure of Judaism during the Middle Ages. Born within the Sephardic Jewish community of Cordoba, his rich intellectual education (theological, philosophical and medical) together with a deep spirituality gave birth to the figure of a highly humanitarian, rational and dedicated physician. His medical legacy includes ten treatises, among them 'Medical Aphorisms of Moses', a set of 1,500 aphorisms organized in 25 chapters, each dealing with a different area of medicine. His theological works and the renowned 'Guide for the Perplexed' raised his figure as a theologist and modern philosopher, being the latest his most universal creation. His life and legacy are an invitation to raise the medical vocation and practice beyond a simple occupation.

  17. 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

  18. 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.

  19. Are physicians obligated to provide preventive services?

    PubMed

    Belcher, D W

    1990-01-01

    Preventive care is considered a benefit to the patient. Physicians express a positive attitude towards prevention, but their performance of recommended activities is low, as shown in a five-year trial at the Seattle VA Medical Center. The release of the U.S. Preventive Services Task Force's guide to clinical preventive services has provided physicians with authoritative prevention recommendations. While most physicians are specialists with little interest or skill in preventive care, primary care providers do accept an obligation to provide comprehensive care, including prevention. This paper examines the ethical basis for the idea of obligation. External pressures, legal, economic, and organizational, are affecting the physician-patient relationship in ways that encourage a contract mode of medical practice and limit physicians' ability to provide preventive care. As a profession, medicine needs to speak for the health needs of the public. As practitioners, physicians need to seek the welfare of their patients. PMID:2231049

  20. Overview of physician-hospital ventures.

    PubMed

    Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard

    2005-01-01

    An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors. PMID:15701482

  1. The next step for physician executives?

    PubMed

    Kirschman, D

    1998-01-01

    The next step for career growth for many physician executives will be the top leadership role in a health care organization. The availability of such positions for physicians has been limited in the past but could very well open in the future. As physicians, administrators, and boards begin to trust each other more and form meaningful partnerships, the potential for physician CEOs increases. In 1997, the Physician Executive Management Center conducted surveys of physicians serving in CEO roles in hospitals and group practices throughout the country. We compared the results with earlier surveys we had conducted since 1986. This article reports the significant findings of these surveys on areas such as employment contracts, job duties, skills and talents, and remuneration. PMID:10185641

  2. Overview of physician-hospital ventures.

    PubMed

    Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard

    2005-01-01

    An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

  3. Psychotherapy, a concept for the nonpsychiatric physician.

    PubMed

    KAHN, J P

    1962-05-01

    Patients tend to repeat with their physician, as with other significant people in their lives, their earlier previous patterns of behavior. The physician as well as the patient is involved in the physician-patient relationship. He will tend to respond to his patients in accordance with his earlier life experiences and his characteristic repetitive behavioral pattern. For both physician and patient, the relationship between them extends beyond the immediate reality situation. Psychotherapy is the utilization of psychological measures in the treatment of sick persons and the deliberate utilization by the physician of the physician-patient relationship for the benefit of the patient. The kind of psychotherapy that is practical and utilizable by the nonpsychiatric physician is that which uses education, reassurance, support and the management of the patient's problems either directly or indirectly or through the intermediary of other people or agencies. The symbolic aspect of the physician-patient relationship is based essentially on the fact that a sick person, because of his anxiety and because of the threat to his physical and psychic integrity, is more dependent and more anxious than he would be if he were well, and therefore he has a correspondingly greater need for the authoritative and protective figure he finds in the physician. Psychotherapy is not directed exclusively to the treatment of flagrantly or obviously neurotic or psychotic patients. It should be and is directed to all sick persons. Limitations in psychotherapy are set by various determinants, among which are the nature of the precipitating factor in the illness, the nature of the sick person, the skill, knowledge and abilities of the physician, and the nature of the physician-patient relationship. In psychotherapy, as in all medicine, the physician should not do anything which may disturb the patient if the disturbance is of no value or if it cannot be followed through with special skills.

  4. Service motives and profit incentives among physicians.

    PubMed

    Godager, Geir; Iversen, Tor; Ma, Ching-To Albert

    2009-03-01

    We model physicians as health care professionals who care about their services and monetary rewards. These preferences are heterogeneous. Different physicians trade off the monetary and service motives differently, and therefore respond differently to incentive schemes. Our model is set up for the Norwegian health care system. First, each private practice physician has a patient list, which may have more or less patients than he desires. The physician is paid a fee-for-service reimbursement and a capitation per listed patient. Second, a municipality may obligate the physician to perform 7.5 h/week of community services. Our data are on an unbalanced panel of 435 physicians, with 412 physicians for the year 2002, and 400 for 2004. A physician's amount of gross wealth and gross debt in previous periods are used as proxy for preferences for community service. First, for the current period, accumulated wealth and debt are predetermined. Second, wealth and debt capture lifestyle preferences because they correlate with the planned future income and spending. The main results show that both gross debt and gross wealth have negative effects on physicians' supply of community health services. Gross debt and wealth have no effect on fee-for-service income per listed person in the physician's practice, and positive effects on the total income from fee-for-service. The higher income from fee-for-service is due to a longer patient list. Patient shortage has no significant effect on physicians' supply of community services, a positive effect on the fee-for-service income per listed person, and a negative effect on the total income from fee for service. These results support physician preference heterogeneity.

  5. A Jewish physician amidst the Holocaust.

    PubMed

    Hoenig, L J

    2000-10-23

    On November 27, 1940, in Nazi Germany, a prescription was written by a Jewish physician, Dr Lucie Adelsberger. This article examines that prescription and tells the story of the physician who wrote it. Tracing the fate of Dr Adelsberger throughout the Holocaust, this article describes her ordeal as a prisoner-physician at the Auschwitz concentration camp and her struggles to help sick camp inmates survive under the most brutal of conditions. Arch Intern Med. 2000;160:2891-2894

  6. An experimental insight into the evolution of permeability at high temperatures and applications for shallow conduit and lava dome degassing

    NASA Astrophysics Data System (ADS)

    Chadderton, Amy; Sammonds, Peter; Meredith, Philip; Smith, Rosanna; Tuffen, Hugh; Gaunt, Elizabeth

    2016-04-01

    Two recent eruptions in Chile, at Chaitén Volcano in 2008-10 and Cordón Caulle in 2011-12, allowed the first detailed observations of rhyolitic activity and provided insights into the evolution of highly silicic eruptions. Both events exhibited simultaneous explosive and effusive activity, with both lava and ash plumes emitted from the same vent [1]. The permeability of fracture networks that act as fluid flow pathways is key to understanding such eruptive behaviour. Here, we report results from a systematic experimental investigation of permeability in volcanic rocks at magmatic temperatures and pressures, in the presence of pore fluids using our newly-developed high-temperature permeability facility. Enhancements to the High Temperature Triaxial Deformation Cell at UCL [2] have enabled us to make permeability measurements on 25mm x 50mm cores at both elevated temperature and elevated hydrostatic pressure [3]. We present results from several suites of permeability measurements on samples of dome dacite from the 2004-08 eruption of Mount St Helens, and rhyolite collected from the lava dome formed during the 2008-10 eruption of Chaitén, Chile. Tests were conducted at temperatures up to 900oC and under an effective pressure of 5 MPa, using the steady-state flow technique. Samples were cooled to room temperature between each high temperature test, and the permeability of each sample was re-measured before heating to the next temperature increment in the series. Additional longer duration high temperature tests were also conducted to investigate the development of a permeable network at high temperatures over time. The results show a complex permeability evolution that includes a reduction in permeability by approximately 3 orders of magnitude up to 600oC. Together with thermal cracking tests, AE data and SEM/thin section analysis these new experimental permeability results are applied to enhance our understanding of the complex issue of shallow conduit and lava

  7. [The clinic and the general physician].

    PubMed

    Jinich, Horacio

    2004-01-01

    The clinician's activity consists of in the simple words of Dr. Gonzalo Castañeda "knowledge, good deeds and bread winning ". The respective value that clinicians grant to each of these, is variable, but even those whose priority is the latter of the three are obliged to accomplish the other two. Knowledge requires continuous medical education. Effective education requires the ability to separate the "wheat from the chaff". It is important to know how to study. Knowing the patient requires careful collection of symptoms, signs, and paraclinical data, as well as awareness of the sensitivity, specificity, and positive and negative predictive value of the data, but acknowledgment of the important discrepancies that occur among different observers as well as in the same observer at different times should not be disregarded. Clinical medicine is a scientific art that challenges the reasoning and decision-making abilities of the practitioner, who must apply various diagnostic strategies, the hypothetic-deductive strategy usually being the most important of all. Knowing the disease that the patient bears is not enough: it is equally important to know the patient who bears the disease. In clinical medicine there are no diseases, only diseased people. The biological approach to the patient must be substituted by a biopsycho-social one. The clinician's main objective--to heal, has become enormously fiacilitated by the dramatic progress of modern scientific medicine, which has provided the physician with powerful but dangerous tools. The old Hippocratic aphorism, primum non nocere, should never beforgotten. Equally essential for the clinician is application of evidence-based knowledge applied to diagnostic and therapeutic measures; there should be no room for past attitudes that were supported by empires and the advice of "authorities". A solid and warm patient-physician relationship is a tremendously important aspect of the healer's behavior.

  8. Physician shortage in Kentucky, 1930-1980.

    PubMed Central

    Johnson, T P; Cooper, J K

    1982-01-01

    Changes in the number and locations of Kentucky counties with a shortage of physicians (using current federal definitions of medical underservice) were examined for the decennial years 1930 to 1980. The number of counties with a physician shortage were found to have increased from four per cent in 1930 to 20 per cent in 1970 and 1980. The per cent of population in physician shortage counties was also found to have increased between 1930 and 1970, but to have declined slightly by 1980. Differences in the average population-to-physician ratios of Appalachian and non-Appalachian counties were significant for every year except 1980. PMID:7036762

  9. Physician participation in alternative health plans

    PubMed Central

    Rosenbach, Margo L.; Harrow, Brooke S.; Hurdle, Sylvia

    1988-01-01

    In this article, physician participation in alternative health plans is examined, using cross-sectional data from the Physicians' Practice Costs and Income Survey, 1983-85. Overall, about one-third of physicians participated in one or more plans, ranging from 18 percent of general practitioners to 46 percent of medical subspecialists. Only 19 percent, however, received income from prepaid sources, averaging $5,275 per physician. Reasons for joining or not joining are also examined. Participants joined most often to maintain or increase workload, while nonparticipants most often declined to join because they would be giving up independence. PMID:10312633

  10. 360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: A critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers.

    PubMed

    Kamangar, Faranak; Davari, Parastoo; Parsi, Kory K; Li, Chin-Shang; Wang, Qinlu; Mathis, Stephen; Fazel, Nasim

    2016-01-01

    ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves. PMID:27617720

  11. The Internet for Louisiana physicians.

    PubMed

    Ellis, M S

    2000-09-01

    Fewer than 50% of Louisiana physicians actively use the Internet, and many of them confine their usage to e-mailing among family and friends. The purpose of this article is to acquaint the reader with many of the benefits of exploiting the incredible potential of this technological invention. I provide addresses and information about sites that I believe warrant usage by our colleagues. Of the vast smorgasbord of data available we highlight educational Web sites for professionals and the public, how to determine credibility of information, clinical research of scientific articles, computer security, federal and state government sites, newspapers, political and socioeconomic functions, medical supply shops, e-mail and other computerized communication, electronic medical records, personal or professional Web sites, and future medical internet uses. It is hoped that this process will encourage nonparticipating colleagues to begin using this modality while also supplying sites that current users may not yet have discovered. PMID:11064554

  12. Childhood bullying: implications for physicians.

    PubMed

    Lyznicki, James M; McCaffree, Mary Anne; Robinowitz, Carolyn B

    2004-11-01

    Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities. PMID:15554490

  13. Suicide and the Victorian physicians.

    PubMed

    Gates, B T

    1980-04-01

    From 1830 to 1900, medical opinion of suicide underwent significant changes in Britain. During the 1830s and 1840s physicians, like most of the populace, saw suicide as a legal and moral question. However, major changes in the suicide law had called for increased medical testimony in questions of "temporary insanity" in suicide, and alienists were forced to refine their thinking about what was still termed "self-murder." By the 1850s and 1860s such refinement continued, with emphasis falling on categorization and physiology, while the 1870s and 1880s saw far more attention paid to social factors determining suicide. Statistics became more reliable, and, increasingly, prevention and compassion were urged by a number of prominent practitioners. By the end of the century, earlier attitudes, particularly as to the criminal implications of suicide, were reviewed and mainly discarded. Emphasis was now on diagnosis and on the social significance of suicide.

  14. The physician of the future.

    PubMed

    Thomas, E L

    1966-04-01

    The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.

  15. Spirituality and the physician executive.

    PubMed

    Kaiser, L R

    2000-01-01

    The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.

  16. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints.

    PubMed

    Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang

    2015-01-01

    The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS.

  17. Key success factors for clinical knowledge management systems: Comparing physician and hospital manager viewpoints.

    PubMed

    Chang, Sho-Fang; Hsieh, Ping-Jung; Chen, Hui-Fang

    2015-01-01

    The study explores the perceptions of physicians and hospital managers regarding the key success factors (KSFs) of a clinical knowledge management system (CKMS). It aims to eliminate the perception gap and gain more insights for a successful CKMS.A survey was conducted in four medical centers in Taiwan. A total of 340 questionnaires, including 15 for hospital managers and 70 for physicians in each hospital, were administered. The effective response rates are 78.3% and 56.1% respectively. Partial least square (PLS) were used to analyze the data.The results identified six KSFs of CKMS including system software and hardware, knowledge quality, system quality, organizational factors, user satisfaction, and policy factors. User satisfaction and policy factors have direct effects on perceived CKMS performance. Knowledge quality is regarded as an antecedent to user satisfaction, while system quality is the antecedent to both user satisfaction and policy factors. System software and hardware was supported only by managers, and organizational factors were supported only by physicians.Among the factors, this study highlighted the policy factor. Besides, the study provides hospital managers additional insights into physician requirements for organizational support. Third, more physician participation and involvement are recommended when introducing and developing a CKMS. PMID:26444813

  18. Patient-Physician Web Messaging

    PubMed Central

    Liederman, Eric M; Lee, Jerry C; Baquero, Victor H; Seites, Paul G

    2005-01-01

    BACKGROUND Patients want electronic access to providers. Providers fear being overwhelmed by unreimbursed messages. OBJECTIVE Measure the effects of patient-physician web messaging on primary care practices. DESIGN/SETTING Retrospective analysis of 6 case and 9 control internal medicine (IM) and family practice (FP) physicians' message volume, and a survey of 5,971 patients' web messaging with 267 providers and staff in 16 community primary care clinics in the Sacramento, CA region. MEASUREMENTS AND MAIN RESULTS Case telephone volume was 18.2% lower (P =.002) and fell 6.50 times faster than control. Case total telephone plus web message volume was 13.7% lower (P =.025) and fell 5.84 times faster than control. Surveys were responded to by 40.3% (1,743/4,320) of patients and 61.4% (164/267) of providers and staff. Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use. Patient satisfaction correlated strongly with provider response time (Γ=0.557), and provider/staff satisfaction with computer skills (Γ=0.626) (Goodman-Kruskal Gamma [Γ] measure of ordinal association). CONCLUSIONS Secure web messaging improves on e-mail with encryption, access controls, message templates, customized message and prescription routing, knowledge content, and reimbursement. Further study is needed to determine whether reducing telephone traffic through the use of web messaging decreases provider interruptions and increases clinical efficiency during the workday. Satisfaction with web messaging may increase patient retention. PMID:15693928

  19. [Physicians working part-time].

    PubMed

    Kiechl-Kohlendorfer, Ursula; Hackl, Johann Michael

    2004-04-01

    In order to ensure the best possible medical care and high-quality research, hospital medical staff must be well educated and highly motivated. Part-time work can help to provide good human resources. Moreover, part-time jobs are often necessary as a means of juggling work and family responsibilities. The aim of this study was to illustrate the legal and educational groundwork for part-time work for physicians in Austria and to outline the advantages and drawbacks of part-time work. In March 2003, all medical doctors working part-time at hospitals in the Austrian state of the Tyrol (n = 60) were surveyed by means of a written questionnaire with the aim of finding out their motives for taking a part-time job as well as the positive and negative aspects involved. The response rate was nearly 70% (n = 40). Most of the part-time hospital physicians were female. The vast majority chose part-time employment in order to better balance family and job. Problems involved in part-time work are legal issues (part-time employment does not always qualify for medical training), the comparatively low salary and the fewer career opportunities. All respondents agreed that patient care, teaching and research are not compatible on a part-time basis. Another negative aspect is the generally strong time pressure experienced in part-time jobs. Despite these negative aspects of working part-time, advantages are considered more important, especially the better balancing of job and family and the possibility of an important early professional reintegration. Better acceptance of part-time jobs would help to make part-time work more attractive. An important improvement is associated with the forthcoming changes in the laws governing part-time work and medical training. PMID:15182044

  20. Application of the design of experiments in optimization of drug layering of pellets with an insight into drug polymer interactions.

    PubMed

    Kovacevic, Jovana; Ibric, Svetlana; Djuris, Jelena; Kleinebudde, Peter

    2016-06-15

    This study consists of two experimental designs. Within the first one, suitable technique for application of model drug onto inactive pellets was evaluated and formulation and process parameters with greatest impact to process efficency and useful yield were determined. Results of experiments showed that formulation characteristics were the ones with the greatest impact on coating efficiency and that suspension layering technique was significantly better for drug application onto inactive pellets in comparison to solution layering during which pronounced agglomeration of pellets occurred. Analysis of drug-polymer interactions by differential scanning calorimetry was performed to explain the results of experiments. The reason for agglomeration of pellets during solution layering was formation of low Tg amorphous form of model drug. The second set of experiments was performed according to central composite design experimental plan in order to optimize level of binder and concentration of solids in the coating liquid which were found to have greatest positive impact on process efficiency and useful yield in the screening study. Statistically significant models were obtained by response surface methodology and it was possible to use them to define optimal levels of excipients in the formulation. PMID:27094356

  1. The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

    PubMed Central

    Burns, L R; Andersen, R M; Shortell, S M

    1990-01-01

    This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict. PMID:2380074

  2. Primary care physician supply, physician compensation, and Medicare fees: what is the connection?

    PubMed

    Dummit, Laura A

    2008-11-01

    Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a primary care physician crisis? Why does compensation across physician specialties vary so widely? Can Medicare physician fee changes affect access to primary care? These questions defy simple answers. This issue brief lays out the latest information on physician workforce, compensation differences across physician specialties, and Medicare's physician fee-setting process. PMID:19048687

  3. Education to Return Nonpracticing Physicians to Clinical Activity: A Case Study in Physician Reentry

    ERIC Educational Resources Information Center

    Bower, Elizabeth A.; English, Clea; Choi, Dongseok; Cedfeldt, Andrea S.; Girard, Donald E.

    2010-01-01

    Introduction: Physician shortages in the United States are estimated to reach as high as 85 000 by 2020. One strategy for addressing the shortage is to encourage physicians who left clinical practice to return to work, but few programs exist to prepare physicians to reenter practice. The Divisions of Continuing Medical Education and Graduate…

  4. Computerized Physician Order Entry: Reluctance of Physician Adoption of Technology Linked to Improving Health Care

    ERIC Educational Resources Information Center

    Ulinski, Don

    2013-01-01

    Physicians are the influential force in the complex field of patient care delivery. Physicians determine when and where patient healthcare is delivered and affect 80% of the money spent on it. Computerized systems used in the delivery of healthcare information have become an integral part that physicians use to provide patient care. This study…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  6. Attitudes towards collaboration and servant leadership among nurses, physicians and residents.

    PubMed

    Garber, Jeannie Scruggs; Madigan, Elizabeth A; Click, Elizabeth R; Fitzpatrick, Joyce J

    2009-07-01

    A descriptive, comparative study was conducted to examine the attitudes of nurses, physicians and residents towards collaboration and to assess their self-perception of servant leadership characteristics. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration and the Barbuto-Wheeler Servant Leadership Questionnaire were utilized for data collection. Registered nurses (RNs) (n = 2,660), physicians (n = 447) and residents (n = 171) in a Southeastern United States health system were surveyed via the intranet; there were 497 responses for analysis. The response rate should be considered and generalizations made with caution regarding the study results. RN scores were higher for both total scores and subscales as compared to physician/resident groups for collaboration and servant leadership. There was a weak positive correlation between collaboration and servant leadership in the RN group and no significant correlation between the variables in the physician/resident group. Findings from this study have implications for nursing and physician education and practice and may serve as a framework for future studies. Representative samples are needed to gain further insight and to guide future research.

  7. Physician recruitment in rural Canada: programs in New Brunswick, Newfoundland, and Nova Scotia.

    PubMed

    Reamy, J

    1994-01-01

    This paper examines programs used in the Atlantic provinces of New Brunswick, Newfoundland, and Nova Scotia to recruit and retain physicians in rural areas. The provinces have many similarities but have unique characteristics that have shaped recruitment methods. The total number of physicians in each province has grown at a faster rate than the population. Each has problems attracting physicians to underserved areas, although the magnitude of the problems vary. The data for this paper were gathered from documents available from various agencies in each province and a series of personal interviews conducted in the spring of 1993. The provinces have chosen different avenues in attempting to solve the maldistribution of physician resources, ranging from regulatory methods in New Brunswick to moves in Newfoundland to encourage graduates of the province's medical school to locate in the rural areas and lessen the dependence on foreign medical graduates. Nova Scotia, with fewer areas needing physicians, has been able to focus its efforts on selected locations. Reviewing the methods used in the three provinces provides an insight into the attempts to solve the shortage of physicians in rural areas.

  8. Boosting the bottom line of physician networks.

    PubMed

    Mertz, Greg

    2013-06-01

    To improve the bottom line of owned physician practices, hospitals should: Identify disparities between physician pay and performance, and understand the factors that are creating these disparities. Review fees to make sure they are aligned with insurer and Medicare fee schedules. Analyze the work load and job resposibilities of office staff and modify staffng levels and job descriptions, if needed. PMID:23795381

  9. Physician Performance Assessment: Prevention of Cardiovascular Disease

    ERIC Educational Resources Information Center

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.

    2013-01-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  10. Physician Training for Hospital Information Systems.

    ERIC Educational Resources Information Center

    Shapiro, Jay R.; And Others

    1982-01-01

    Advantages and disadvantages discovered during introduction of computerized patient-care recordkeeping at the National Institute of Health's Clinical Center are discussed, including the needs for physicians to change some behaviors and for better records, changes in the relationship between nurse and physician, and adjustment problems in inputting…

  11. Report of the 1992 Survey of Physicians.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Postsecondary Research and Information Systems.

    A survey of 50,273 practicing physicians in New York State gathered data on demographic characteristics, medical education characteristics, practice setting characteristics, and specialty practice characteristics. Highlights of survey findings include: (1) physicians are distinctively male (78 percent) and white (76 percent); (2) minority…

  12. Physicians' Internet Information-Seeking Behaviors

    ERIC Educational Resources Information Center

    Bennett, Nancy L.; Casebeer, Linda L.; Kristofco, Robert E.; Strasser, Sheryl M.

    2004-01-01

    Introduction: Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they…

  13. Physicians' Knowledge of Genetics and Genetic Tests.

    ERIC Educational Resources Information Center

    Hofman, Karen J.; And Others

    1993-01-01

    A survey of 1,140 primary care physicians and psychiatrists who graduated from medical school from 1950 through 1985 indicated that knowledge of genetics is increasing, especially among more recent graduates, but deficiencies remain. Need is seen for greater emphasis on genetics to reduce chance of physician error as more tests become available.…

  14. 42 CFR 410.20 - Physicians' services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Physicians' services. 410.20 Section 410.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.20 Physicians' services. (a) Included services....

  15. 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.

  16. Urban-Rural Flows of Physicians

    ERIC Educational Resources Information Center

    Ricketts, Thomas C.; Randolph, Randy

    2007-01-01

    Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…

  17. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Physician services. 52.150 Section 52.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician...

  18. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Physician services. 52.150 Section 52.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician...

  19. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Physician services. 52.150 Section 52.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician...

  20. 38 CFR 52.150 - Physician services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Physician services. 52.150 Section 52.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.150 Physician...

  1. [Geographical distribution of physicians in Chile].

    PubMed

    Goic, A

    1995-03-01

    In 1994, Chile had 15,451 active physicians (less than 70 years old) for a population of 14,027,344 with a ratio of 1 physician per 908 inhabitants, a satisfactory figure compared to other countries of similar socio-economical development. Ratios of 1:880 and 1:843 are projected for 1999 and 2004 respectively. The annual rate of physician's population growth (2.2%), that is superior to the general population's growth rate (1.6%), will increase to about 2.5% per annum in 2001 as a consequence of the creation of three new medical schools. However, the distribution of physicians along the country is unsatisfactory. While the capital (Metropolitan Region) has a ratio of 1 physician per 629 inhabitants, the figure for the Region of Maule is 1:2,113. Only two of ten regions, excepting the capital, have a ratio lower than 1:1,000. Sixty percent of physicians live in Santiago while only 40% of the general population does so, illustrating their high concentration. Median ratio in Chile, that better reflects the reality than the mean, is 1:1,280. The heterogeneous distribution of physicians in Chile is a sign of social inequity that must be corrected. In a free society a better physician distribution is achieved with economical and professional incentives given by health institutions.

  2. Genograms. Practical tools for family physicians.

    PubMed Central

    Waters, I.; Watson, W.; Wetzel, W.

    1994-01-01

    A genogram can help a physician integrate a patient's family information into the medical problem-solving process for better patient care. A genogram allows a physician to obtain medical and psychosocial information from a patient easily and, as a result, to have a better understanding of the context of the presenting symptoms. PMID:8130675

  3. 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…

  4. Framing Bias among Expert and Novice Physicians.

    ERIC Educational Resources Information Center

    Christensen, Caryn; And Others

    1991-01-01

    A study explored the responses of medical students, resident physicians, and experienced physicians to 12 vignettes describing hypothetical patients to determine the relationship between clinical experience and susceptibility to bias in treatment decisions resulting from presentation of possible outcomes. Framing bias was most evident in the…

  5. Rural Idaho Family Physicians' Scope of Practice

    ERIC Educational Resources Information Center

    Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat

    2010-01-01

    Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature…

  6. 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…

  7. Construction of a Physician Skills Inventory

    ERIC Educational Resources Information Center

    Richard, George V.; Zarconi, Joseph; Savickas, Mark L.

    2012-01-01

    The current study applied Holland's RIASEC typology to develop a "Physician Skills Inventory". We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced…

  8. 38 CFR 51.150 - Physician services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....

  9. 38 CFR 51.150 - Physician services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....

  10. 38 CFR 51.150 - Physician services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....

  11. 38 CFR 51.150 - Physician services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Physician services. 51.150 Section 51.150 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.150 Physician services....

  12. 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.

  13. The Physician-Scientist: An Endangered Species.

    ERIC Educational Resources Information Center

    Legato, Marianne, J.

    1983-01-01

    The number of physician-scientists in training decreased below the recommended level in 1976. Reasons young doctors are not attracted to research training and why these academic physicians are needed are discussed. The demise of the academic medical community will begin an ice age in American medicine. (SR)

  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. Patient–physician communication regarding electronic cigarettes

    PubMed Central

    Steinberg, Michael B.; Giovenco, Daniel P.; Delnevo, Cristine D.

    2015-01-01

    Introduction Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician–patient communication regarding e-cigarettes. Methods A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient–provider e-cigarette communication, and attitudes towards tobacco harm reduction. Results Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Discussion Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction. PMID:26844056

  16. Winning physician support for your quality initiatives.

    PubMed

    Mattison, J

    2001-03-01

    Joel Mattison, MD, a member of Hospital Peer Review's editorial board, offers practical tips for bringing physicians on board for hospital quality initiatives. He is the physician advisor in the department of clinical resource management and medical director at St. Joseph's Hospital in Tampa, FL.

  17. Physician Knowledge of Child Sexual Abuse.

    ERIC Educational Resources Information Center

    Socolar, Rebecca R. S.

    1996-01-01

    A survey of physicians (n=113) concerning their knowledge about child sexual abuse found several areas of inadequate knowledge, including assessment of chlamydia infection, Tanner staging, and documentation of historical and physical exam findings. Factors associated with better knowledge scores were physician participation in continuing medical…

  18. Sol-gel microspheres doped with glycerol: a structural insight in light of forthcoming applications in the polyurethane foam industry.

    PubMed

    Ciriminna, Rosaria; Fidalgo, Alexandra; Ilharco, Laura M; Pagliaro, Mario

    2015-04-01

    Porous silica-based microspheres encapsulating aqueous glycerol can be potential curing agents for one-component foams (OCFs). Such agents have the advantage of an enhanced sustainability profile on top of being environmentally friendly materials. A synthetically convenient and scalable sol-gel process was used to make silica and organosilica microspheres doped with aqueous glycerol. These methyl-modified silica microspheres, named "GreenCaps", exhibit remarkable physical and chemical stability. The microspheres were characterized by scanning electron microscopy, transmission electron microscopy at reduced pressure, and cryogenic nitrogen adsorption-desorption analysis. The structure of the materials was also analyzed at the molecular level by diffuse reflectance infrared Fourier transform (DRIFT) spectroscopy. As expected, the degree of methylation affects the degree of encapsulation and pore structure. Microspheres similarly methylated, however, can differ considerably in surface area and pore size due to the templating effect of glycerol on the organosilica structure. The results of the structure analysis reveal that glycerol is efficiently encapsulated, acts as a template, barely leaches over time, but is released by depressurization. A proper application of these microspheres can later on enhance both the environmental and health profile, as well as the technical performance (curing speed, foam quality, and froth thixotropy) of spray polyurethane foams.

  19. Reactions of oxygen-containing molecules on transition metal carbides: Surface science insight into potential applications in catalysis and electrocatalysis

    NASA Astrophysics Data System (ADS)

    Stottlemyer, Alan L.; Kelly, Thomas G.; Meng, Qinghe; Chen, Jingguang G.

    2012-09-01

    Historically the interest in the catalytic properties of transition metal carbides (TMC) has been inspired by their "Pt-like" properties in the transformation reactions of hydrocarbon molecules. Recent studies, however, have revealed that the reaction pathways of oxygen-containing molecules are significantly different between TMCs and Pt-group metals. Nonetheless, TMCs demonstrate intriguing catalytic properties toward oxygen-containing molecules, either as the catalyst or as the catalytically active substrate to support metal catalysts, in several important catalytic and electrocatalytic applications, including water electrolysis, alcohol electrooxidation, biomass conversion, and water gas shift reactions. In the current review we provide a summary of theoretical and experimental studies of the interaction of TMC surfaces with oxygen-containing molecules, including both inorganic (O2, H2O, CO and CO2) and organic (alcohols, aldehydes, acids and esters) molecules. We will discuss the general trends in the reaction pathways, as well as future research opportunities in surface science studies that would facilitate the utilization of TMCs as catalysts and electrocatalysts.

  20. Reactions of oxygen-containing molecules on transition metal carbides: Surface science insight into potential applications in catalysis and electrocatalysis

    NASA Astrophysics Data System (ADS)

    Stottlemyer, Alan L.; Kelly, Thomas G.; Meng, Qinghe; Chen, Jingguang G.

    2012-09-01

    Historically the interest in the catalytic properties of transition metal carbides (TMC) has been inspired by their “Pt-like” properties in the transformation reactions of hydrocarbon molecules. Recent studies, however, have revealed that the reaction pathways of oxygen-containing molecules are significantly different between TMCs and Pt-group metals. Nonetheless, TMCs demonstrate intriguing catalytic properties toward oxygen-containing molecules, either as the catalyst or as the catalytically active substrate to support metal catalysts, in several important catalytic and electrocatalytic applications, including water electrolysis, alcohol electrooxidation, biomass conversion, and water gas shift reactions. In the current review we provide a summary of theoretical and experimental studies of the interaction of TMC surfaces with oxygen-containing molecules, including both inorganic (O2, H2O, CO and CO2) and organic (alcohols, aldehydes, acids and esters) molecules. We will discuss the general trends in the reaction pathways, as well as future research opportunities in surface science studies that would facilitate the utilization of TMCs as catalysts and electrocatalysts.

  1. Fluorescence of the Flavin group in choline oxidase. Insights and analytical applications for the determination of choline and betaine aldehyde.

    PubMed

    Ortega, E; de Marcos, S; Sanz-Vicente, I; Ubide, C; Ostra, M; Vidal, M; Galbán, J

    2016-01-15

    Choline oxidase (ChOx) is a flavoenzyme catalysing the oxidation of choline (Ch) to betaine aldehyde (BA) and glycine betaine (GB). In this paper a fundamental study of the intrinsic fluorescence properties of ChOx due to Flavin Adenine Dinucleotide (FAD) is presented and some analytical applications are studied in detail. Firstly, an unusual alteration in the excitation spectra, in comparison with the absorption spectra, has been observed as a function of the pH. This is ascribed to a change of polarity in the excited state. Secondly, the evolution of the fluorescence spectra during the reaction seems to indicate that the reaction takes place in two consecutive, but partially overlapped, steps and each of them follows a different mechanism. Thirdly, the chemical system can be used to determine the Ch concentration in the range from 5×10(-6)M to 5×10(-5)M (univariate and multivariate calibration) in the presence of BA as interference, and the joint Ch+BA concentration in the range 5×10(-6)-5×10(-4)M (multivariate calibration) with mean errors under 10%; a semiquantitative determination of the BA concentration can be deduced by difference. Finally, Ch has been successfully determined in an infant milk sample.

  2. Pharmaceutical marketing research and the prescribing physician.

    PubMed

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

  3. Issues for the Traveling Team Physician.

    PubMed

    Kaeding, Christopher C; Borchers, James

    2016-07-01

    This article outlines the value of having the team physician traveling with athletes to away venues for competitions or training sessions. At present, this travel presents several issues for the team physician who crosses state lines for taking care of the athletes. In this article, these issues and their possible remedies are discussed. A concern for the travelling team physician is practicing medicine while caring for the team in a state where the physician is not licensed. Another issue can be the transportation of controlled substances in the course of providing optimal care for the team athletes. These two issues are regulatory and legislative issues at both the state and federal levels. On the practical side of being a team physician, the issues of emergency action plans, supplies, and when to transport injured or ill patients are also reviewed. PMID:27273409

  4. Stakeholder strategies for the physician executive.

    PubMed

    Whitehead, C J; Stanton, S Y; Buesseler, J A; Blair, J D

    1989-01-01

    If physician executives are to be effective in confronting the environmental turbulence and uncertainty facing their organizations, they must effectively manage their stakeholders. This article extends the stakeholder approach described in the May-June 1989 issue of Physician Executive as a tool for the physician executive in the development of practical strategies to cope with turbulence and uncertainty. We suggest four generic strategies physician executives can use: involve supportive stakeholders, monitor marginal stakeholders, defend against nonsupportive stakeholders, and collaborate with mixed-blessing stakeholders. As an overarching strategy, a physician executive should try to change the organization's relationships with a stakeholder from a less favorable category to a more favorable one. The stakeholder can then be managed using the generic strategy most appropriate for the category.

  5. [Toward the lived experience of the physician].

    PubMed

    Bourquin, Céline; Saraga, Michael; Marion-Veyron, Régis; Stiefel, Friedrich

    2016-02-10

    For manyyears, a major focus of interest has been the patient, in the context of a constantly changing society and increasingly complex medical practices. We propose to shift this focus on the physician, who is entangled in a similar, but less evident way. In these three articles, we explore, in succession, the lived experience of the contemporary physician, the ethos which brings together the medical community, and the education of the future physician, using research projects currently under way within the Service of Liaison Psychiatry at Lausanne University Hospital. In this first article, we particularly raise the question of what is the lived experience of the physician and sketch the outline of <physician-centered> research. PMID:27039439

  6. Improving the appropriateness of physician prescribing.

    PubMed

    Lexchin, J

    1998-01-01

    Appropriate prescribing means that prescribers should try to maximize effectiveness, minimize risks and costs, and respect patients' choices. Evidence from studies on prescribing to individuals and from administrative databases reveals a significant level of inappropriate prescribing by Canadian physicians. Two important reasons for inappropriate prescribing seem to be physicians' level of knowledge and physicians' practice settings. A large number of methods have been tried to improve prescribing behavior, but most are unsuccessful. Academic detailing, and audit and feedback, have both been shown to work but may be difficult to implement in Canada, where most physicians practice in solo fee-for-service settings. Alternative forms of physician payment such as capitation or salary are probably necessary to make prescribing more appropriate.

  7. Liability of physicians supervising nonphysician clinicians.

    PubMed

    Paterick, Barbara B; Waterhouse, Blake E; Paterick, Timothy E; Sanbar, Sandy S

    2014-01-01

    Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored. PMID:24873129

  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. Physician Burnout and Patient-Physician Communication During Primary Care Encounters

    PubMed Central

    Roter, Debra; Beach, Mary Catherine; Laird, Shivonne L.; Larson, Susan M.; Carson, Kathryn A.; Cooper, Lisa A.

    2008-01-01

    Background Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors. Objective To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters. Design Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment. Setting Fifteen urban community-based clinics in Baltimore, MD. Participants Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured. Measurements Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients’ ratings of satisfaction with and trust and confidence in the physician. Results The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6–30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58 – 2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients’ ratings of their satisfaction, confidence, or trust. Conclusions Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication

  10. 42 CFR 483.360 - Consultation with treatment team physician.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Consultation with treatment team physician. 483.360... treatment team physician. If a physician or other licensed practitioner permitted by the state and the... the resident's treatment team physician, unless the ordering physician is in fact the...

  11. The Soil and Water Assessment Tool (SWAT) Ecohydrological Model Circa 2015: Global Application Trends, Insights and Issues

    NASA Astrophysics Data System (ADS)

    Gassman, P. W.; Arnold, J. G.; Srinivasan, R.

    2015-12-01

    The Soil and Water Assessment Tool (SWAT) is one of the most widely used watershed-scale water quality models in the world. Over 2,000 peer-reviewed SWAT-related journal articles have been published and hundreds of other studies have been published in conference proceedings and other formats. The use of SWAT was initially concentrated in North America and Europe but has also expanded dramatically in other countries and regions during the past decade including Brazil, China, India, Iran, South Korea, Southeast Asia and eastern Africa. The SWAT model has proven to be a very flexible tool for investigating a broad range of hydrologic and water quality problems at different watershed scales and environmental conditions, and has proven very adaptable for applications requiring improved hydrologic and other enhanced simulation needs. We investigate here the various technological, networking, and other factors that have supported the expanded use of SWAT, and also highlight current worldwide simulation trends and possible impediments to future increased usage of the model. Examples of technological advances include easy access to web-based documentation, user-support groups, and SWAT literature, a variety of Geographic Information System (GIS) interface tools, pre- and post-processing calibration software and other software, and an open source code which has served as a model development catalyst for multiple user groups. Extensive networking regarding the use of SWAT has further occurred via internet-based user support groups, model training workshops, regional working groups, regional and international conferences, and targeted development workshops. We further highlight several important model development trends that have emerged during the past decade including improved hydrologic, cropping system, best management practice (BMP) and pollutant transport simulation methods. In addition, several current SWAT weaknesses will be addressed and key development needs will be

  12. The process of earthflow propagation: insights from an application of the SPH technique to a case history

    NASA Astrophysics Data System (ADS)

    Lollino, Piernicola; Giordan, Daniele; Allasia, Paolo; Pastor, Manuel

    2016-04-01

    An intense reactivation of a large earthflow (about 6 million m3 of soil debris) took place in Montaguto (Southern Apennines, Italy) between 2005 and 2006 as a consequence of the retrogression of a sliding process in the source area at the top of the slope. The earthflow run-out was approximately 2-2.5 km long, with the landslide mass thickness approximately ranging between 5 m and 30 m. Relevant damages were produced at the toe of the slope, since important infrastructures hereby located were covered by large volumes of landslide detritum. In the transition area, that is just downslope the source area, the landslide soil mass was channelized and transformed into a viscous soil flowing down through a natural depression channel, with an average displacement rate estimated to range between 3 and 7 m/day. In this work an application of the Smoothed Particle Hydrodynamics method has been carried out in order to simulate both the main features of the earthflow propagation, that is the direction and the thickness of the flowing mass, as well as to investigate some factors of the soil mechanical behavior that might have controlled the earthflow mobility. In particular, two different assumptions concerning the soil rheology, i.e. Bingham visco-plasticity and frictional-consolidating soil, the first complying more with the assumption of a flow-like behavior and the latter with a soil-like behavior of the landslide mass, have been made for comparison purposes. Based on the experiences gained from previous authors concerning the in-situ features of similar earthflow soil masses, these landslides are thought to behave more as a viscous fluid during the very first stages of propagation due to phase transition processes and, later on, to recover a soil-like behavior, therefore characterized by sliding mechanism, due to soil consolidation processes. Field evidences of consolidation processes have indeed been observed in situ in recent years based on pore water pressure monitoring

  13. Lipid-based palaeotemperature reconstruction in lakes: New insights on the applicability of branched GDGTs in lacustrine sedimentary archives

    NASA Astrophysics Data System (ADS)

    Weber, Yuki; De Jonge, Cindy; Hopmans, Ellen C.; Sinninghe Damsté, Jaap S.; Gilli, Adrian; Lehmann, Moritz F.; Niemann, Helge

    2014-05-01

    MAAT (derived from the lapse rate model), possibly pointing to different source organisms in soils and lakes. Our results imply that in situ production of brGDGTs plays a mayor role. By further constraining the environmental controls on lake-derived brGDGTs, we aim to improve the future applicability of brGDGT-based proxies in lacustrine climate archives.

  14. Finnish physicians' experiences with computer-supported patient information exchange and communication in clinical work.

    PubMed

    Viitanen, Johanna; Nieminen, Marko; Hypponen, Hannele; Laaveri, Tinja

    2011-01-01

    Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer-supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians? experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange-related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross-organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician?nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.

  15. Do osteopathic physicians differ in patient interaction from allopathic physicians? An empirically derived approach.

    PubMed

    Carey, Timothy S; Motyka, Thomas M; Garrett, Joanne M; Keller, Robert B

    2003-07-01

    Colleges of osteopathic medicine teach osteopathic principles, which provide a different approach to and interaction with patients than principles taught in allopathic medical schools. The authors examined whether osteopathic primary care physicians' interactions with patients reflect the principles of osteopathic medicine when compared with allopathic physicians' interactions. The principles of osteopathic medicine were adapted to elements that could be measured from an audio recording. This 26-item index was refined with two focus groups of practicing osteopathic physicians. Fifty-four patient visits to 11 osteopathic and 7 allopathic primary care physicians in Maine for screening physicals, headache, low back pain, and hypertension were recorded on audiotape and were dual-abstracted. When the 26-item index of osteopathic principles was summed, the osteopathic physicians had consistently higher scores (11 vs. 6.9; P = .01) than allopathic physicians, and visit length was similar (22 minutes vs. 20 minutes, respectively). Twenty-three of the 26 items were used more commonly by the osteopathic physicians. Osteopathic physicians were more likely than allopathic physicians to use patients' first names; explain etiologic factors to patients; and discuss social, family, and emotional impact of illnesses. In this study, osteopathic physicians were easily distinguishable from allopathic physicians by their verbal interactions with patients. Future studies should replicate this finding as well as determine whether it correlates with patient outcomes and satisfaction.

  16. 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.

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

    PubMed Central

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

    2016-01-01

    Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of non-physician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system. PMID:26927585

  18. Maintenance of skills for today's family physician: the SAGE approach to physician learning.

    PubMed

    Oh, Robert C; Junnila, Jennifer L; Seehusen, Dean A; Edwards, John A; Runkle, Guy P

    2005-12-01

    Physicians need practical ways to maintain and augment clinical skills after residency training. The problem is amplified when a physician encounters a new practice environment that requires retraining in particular skills. With their broad scope of practice, family physicians are especially prone to deterioration of infrequently used skills. The SAGE model for lifelong learning provides a simple solution for today's military family physicians. Scan, assess, gather, and experience are four key steps physicians should take when maintaining or upgrading clinical skills. This approach allows physicians to identify available resources and to develop action plans to improve skills. Supervisors must encourage physicians to be honest in self-assessment of patient care skills and should support the acquisition of improved skills. System-based solutions, in keeping with suggestions from the Institute of Medicine, are introduced.

  19. Walter sutton: physician, scientist, inventor.

    PubMed

    Ramirez, Gregory J; Hulston, Nancy J; Kovac, Anthony L

    2015-01-01

    Walter S. Sutton (1877-1916) was a physician, scientist, and inventor. Most of the work on Sutton has focused on his recognition that chromosomes carry genetic material and are the basis for Mendelian inheritance. Perhaps less well known is his work on rectal administration of ether. After Sutton's work on genetics, he completed his medical degree in 1907 and began a 2-year surgical fellowship at Roosevelt Hospital, New York City, NY, where he was introduced to the technique of rectal administration of ether. Sutton modified the work of others and documented 100 cases that were reported in his 1910 landmark paper "Anaesthesia by Colonic Absorption of Ether". Sutton had several deaths in his study, but he did not blame the rectal method. He felt that his use of rectal anesthesia was safe when administered appropriately and believed that it offered a distinct advantage over traditional pulmonary ether administration. His indications for its use included (1) head and neck surgery; (2) operations when ether absorption must be minimized due to heart, lung, or kidney problems; and (3) preoperative pulmonary complications. His contraindications included (1) cases involving alimentary tract or weakened colon; (2) laparotomies, except when the peritoneal cavity was not opened; (3) incompetent sphincter or anal fistula; (4) orthopnea; and (5) emergency cases. Sutton wrote the chapter on "Rectal Anesthesia" in one of the first comprehensive textbooks in anesthesia, James Tayloe Gwathmey's Anesthesia. Walter Sutton died of a ruptured appendix in 1916 at age 39.

  20. Walter sutton: physician, scientist, inventor.

    PubMed

    Ramirez, Gregory J; Hulston, Nancy J; Kovac, Anthony L

    2015-01-01

    Walter S. Sutton (1877-1916) was a physician, scientist, and inventor. Most of the work on Sutton has focused on his recognition that chromosomes carry genetic material and are the basis for Mendelian inheritance. Perhaps less well known is his work on rectal administration of ether. After Sutton's work on genetics, he completed his medical degree in 1907 and began a 2-year surgical fellowship at Roosevelt Hospital, New York City, NY, where he was introduced to the technique of rectal administration of ether. Sutton modified the work of others and documented 100 cases that were reported in his 1910 landmark paper "Anaesthesia by Colonic Absorption of Ether". Sutton had several deaths in his study, but he did not blame the rectal method. He felt that his use of rectal anesthesia was safe when administered appropriately and believed that it offered a distinct advantage over traditional pulmonary ether administration. His indications for its use included (1) head and neck surgery; (2) operations when ether absorption must be minimized due to heart, lung, or kidney problems; and (3) preoperative pulmonary complications. His contraindications included (1) cases involving alimentary tract or weakened colon; (2) laparotomies, except when the peritoneal cavity was not opened; (3) incompetent sphincter or anal fistula; (4) orthopnea; and (5) emergency cases. Sutton wrote the chapter on "Rectal Anesthesia" in one of the first comprehensive textbooks in anesthesia, James Tayloe Gwathmey's Anesthesia. Walter Sutton died of a ruptured appendix in 1916 at age 39. PMID:25748370

  1. Family physicians: importance and relevance.

    PubMed

    Yeravdekar, Rajiv; Yeravdekar, Vidya Rajiv; Tutakne, M A

    2012-07-01

    Due to rapid advancement in medical technology and knowledge patients today prefer treatment from specialists, if they can afford it. Medical treatment has become a purchasable commodity, to be procured as and when required, based on cost and availability.This is unfortunate but true. Specialisation tends to divide the patients into'parts' and increases the cost of treatment. Moreover no single physician is in charge of the patient as a whole to maintain long term continuity and coordinate the treatments given by different specialists. Since long term dependence on 'family doctor' has reduced, trust deficit in the profession has started creeping in. It is essential to rejuvenate the concept of family doctors equipped with skills suitable for modern technology and practice, to restore the faith of patients in medical professionals. Family doctor can provide a 'single window clearance' for all healthcare needs of an individual. Exploitation of gullible patient can be prevented when the family doctor becomes the friend and guide for all treatments being given to the individual. Society should be educated on the benefits of getting the treatment through the family doctor. The family doctor then becomes the Authorised Medical Attendant (AMA), responsible for all treatments beings provided to the patients. The Medical Council of India (MCI) may consider incorporating this in code of medical ethics.

  2. Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study

    PubMed Central

    Tucker, Joseph D; Cheng, Yu; Wong, Bonnie; Gong, Ni; Nie, Jing-Bao; Zhu, Wei; McLaughlin, Megan M; Xie, Ruishi; Deng, Yinghui; Huang, Meijin; Wong, William C W; Lan, Ping; Liu, Huanliang; Miao, Wei; Kleinman, Arthur

    2015-01-01

    Objective To better understand the origins, manifestations and current policy responses to patient–physician mistrust in China. Design Qualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust. Setting Guangdong Province, China. Participants One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships. Results One of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust. Conclusions The blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives

  3. Heuristic estimation of dust devil vortex parameters and trajectories from single-station meteorological observations: Application to InSight at Mars

    NASA Astrophysics Data System (ADS)

    Lorenz, Ralph D.

    2016-06-01

    A physically-realistic migrating vortex model is developed and applied to generate pressure and wind speed and direction histories for dust devil passage. The asymmetric character of wind histories is noted, and we examine how these combined data constrain the solution space of dust devil parameters (migration velocity, diameter and intensity), ambient wind, and miss distance. These histories are compared with a new terrestrial field dataset of high-time resolution pressure and wind measurements of over twenty dust devil encounters in New Mexico. This new dataset is made available electronically and it is found that model fits can be typically achieved with simultaneous root-mean-square errors of ∼0.05 hPa (∼5-10% of the peak pressure signature), ∼20°of wind azimuth, and ∼2 m/s windspeed. The fits are not unique, however, and some heuristic aspects of resolving the intrinsic degeneracies of the problem and nonideal features of real encounters are discussed. The application of this approach to the InSight lander is noted, offering the possibility of defining the context for any possible detections of electromagnetic and seismic signatures of dust devils on Mars.

  4. Factors Associated with the Income Distribution of Full-Time Physicians: A Quantile Regression Approach

    PubMed Central

    Shih, Ya-Chen Tina; Konrad, Thomas R

    2007-01-01

    Objective Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population. Data Sources Full-time physicians (N=10,777) from the restricted version of the 1996–1997 Community Tracking Study Physician Survey (CTS-PS), 1996 Area Resource File, and 1996 health maintenance organization penetration data. Study Design We conducted separate analyses for primary care physicians (PCPs) and specialists. We employed least square and quantile regression models to examine factors associated with physician incomes at the mean and at various points of the income distribution, respectively. We accounted for the complex survey design for the CTS-PS data using appropriate weighted procedures and explored endogeneity using an instrumental variables method. Principal Findings We detected widespread and subtle effects of many variables on physician incomes at different points (10th, 25th, 75th, and 90th percentiles) in the distribution that were undetected when employing regression estimations focusing on only the means or medians. Our findings show that the effects of managed care penetration are demonstrable at the mean of specialist incomes, but are more pronounced at higher levels. Conversely, a gender gap in earnings occurs at all levels of income of both PCPs and specialists, but is more pronounced at lower income levels. Conclusions The quantile regression technique offers an analytical tool to evaluate policy effects beyond the means. A longitudinal application of this approach may enable health policy makers to identify winners and losers among segments of the physician workforce and assess how market dynamics and health policy initiatives affect the overall physician income distribution over various time intervals. PMID:17850525

  5. Medicare payment changes and physicians' incomes.

    PubMed

    Weeks, William B; Wallace, Amy E

    2002-01-01

    An effort to control the physician portion of Medicare expenditures and to narrow the income gap between primary care and procedure-based physicians was effected through t he enactment of the Medicare Fee Schedule (MFS). To determine whether academic and private sector physicians' incomes had demonstrated changes consistent with payment changes, we collected income information from surveys of private sector physicians and academic physicians in six specialties: (1) family practice; (2) general internal medicine; (3) psychiatry; (4) general surgery; (5) radiology; and (6) anesthesiology. With the exception of general internal medicine, the anticipated changes in Medicare revenue were not closely associated with income changes in either the academic or private sector group. Academic physicians were underpaid, relative to their private sector counterparts, but modestly less so at the end of the period examined. Our findings suggest that using changes in payment schedules to change incomes in order to influence the attractiveness of different specialties, even with a very large payer, may be ineffective. Should academic incomes remain uncompetitive with private sector incomes, it may be increasingly difficult to persuade physicians to enter academic careers. PMID:12462656

  6. Physician's error: medical or legal concept?

    PubMed

    Mujovic-Zornic, Hajrija M

    2010-06-01

    This article deals with the common term of different physician's errors that often happen in daily practice of health care. Author begins with the term of medical malpractice, defined broadly as practice of unjustified acts or failures to act upon the part of a physician or other health care professionals, which results in harm to the patient. It is a common term that includes many types of medical errors, especially physician's errors. The author also discusses the concept of physician's error in particular, which is understood no more in traditional way only as classic error in acting something manually wrong without necessary skills (medical concept), but as an error which violates patient's basic rights and which has its final legal consequence (legal concept). In every case the essential element of liability is to establish this error as a breach of the physician's duty. The first point to note is that the standard of procedure and the standard of due care against which the physician will be judged is not going to be that of the ordinary reasonable man who enjoys no medical expertise. The court's decision should give finale answer and legal qualification in each concrete case. The author's conclusion is that higher protection of human rights in the area of health equaly demands broader concept of physician's error with the accent to its legal subject matter.

  7. Ensuring Competent Care by Senior Physicians.

    PubMed

    Hawkins, Richard E; Welcher, Catherine M; Stagg Elliott, Victoria; Pieters, Richard S; Puscas, Liana; Wick, Paul H

    2016-01-01

    The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce. PMID:27584000

  8. Policy implications of physician income homeostasis.

    PubMed

    Bernstein, J

    1998-01-01

    Physicians tend to protect their desired target incomes in the face of declining fees by working more. This homeostatic "volume response" in the name of income protection can have budgetary consequences opposite of those intended: overall spending will probably rise. This is seen because when the physician tries to earn one extra dollar, he or she causes many additional dollars to be spent within the health care economy. The fraction of total costs represented by the physician's fee varies among specialties and procedures. Among certain medical services that are susceptible to doctor-induced demand, the Medicare standard physician payment may represent 10 percent or less of the total cost of that service. Accordingly, even if physicians were very inefficient at finding additional work to compensate for lower fees, cutting physician payments may still lead to increased spending. For example, a 50 percent decrease in the physician payment for a single operation, total hip replacement, may trigger nearly one billion dollars in additional annual Medicare spending, even if surgeons can find only half of the additional work they would need to neutralize the effect of the fee reduction. A sophisticated health care spending policy would recognize that cutting fees induces volume increases. It would recognize that such fee decreases without controls on the volume response will lead to increases in overall costs. Finally, it would recognize that the fiscal effect of the volume response varies between specialties and procedures, and thus flexible guidelines are in order. PMID:9612740

  9. Regulatory focus affects physician risk tolerance.

    PubMed

    Veazie, Peter J; McIntosh, Scott; Chapman, Benjamin P; Dolan, James G

    2014-01-01

    Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention-regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (p = 0.01). The Cohen's d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (p = 0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

  10. Use of mobile learning by resident physicians in Botswana.

    PubMed

    Chang, Aileen Y; Ghose, Sankalpo; Littman-Quinn, Ryan; Anolik, Rachel B; Kyer, Andrea; Mazhani, Loeto; Seymour, Anne K; Kovarik, Carrie L

    2012-01-01

    With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home. PMID:22171597

  11. Use of Mobile Learning by Resident Physicians in Botswana

    PubMed Central

    Chang, Aileen Y.; Ghose, Sankalpo; Littman-Quinn, Ryan; Anolik, Rachel B.; Kyer, Andrea; Mazhani, Loeto; Seymour, Anne K.

    2012-01-01

    Abstract With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home. PMID:22171597

  12. Development of the physician satisfaction survey instrument.

    PubMed

    Soo Hoo, W E; Ramer, L

    1998-01-01

    Continuous quality improvement (CQI) activities depend on valid and reliable instruments to generate data. An evaluation of internal and external customer satisfaction is one of the pillars of the CQI process. This article describes the development of a valid and reliable instrument for measuring physicians' satisfaction with the orthopedic nursing units at a major medical trauma center. The physician satisfaction survey instrument was found to be internally consistent (alpha = .95). Confirmatory factor analysis revealed that 68% of the variance in physician satisfaction scores (eigenvalue = 8.14) was explained by using a single-factor model. PMID:10181899

  13. Development of the physician satisfaction survey instrument.

    PubMed

    Soo Hoo, W E; Ramer, L

    1998-01-01

    Continuous quality improvement (CQI) activities depend on valid and reliable instruments to generate data. An evaluation of internal and external customer satisfaction is one of the pillars of the CQI process. This article describes the development of a valid and reliable instrument for measuring physicians' satisfaction with the orthopedic nursing units at a major medical trauma center. The physician satisfaction survey instrument was found to be internally consistent (alpha = .95). Confirmatory factor analysis revealed that 68% of the variance in physician satisfaction scores (eigenvalue = 8.14) was explained by using a single-factor model.

  14. Physician involvement in torture: an ethical perspective.

    PubMed

    Siddiqui, Norain A; Civaner, Murat; Elci, Omur Cinar

    2013-03-01

    Evidence proves that physician involvement in torture is widely practiced in society. Despite its status as an illegal act as established by multiple international organizations, mandates are routinely unheeded and feebly enforced. Philosophies condemning and condoning torture are examined as well as physicians' professional responsibilities and the manner in which such varying allegiances can be persuasive. Physician involvement in torture has proven detrimental to the core values of medicine and has tainted the field's commitment to individuals' health and well-being. Only when this complex issue is addressed using a multilevel approach will the moral rehabilitation of medicine begin.

  15. Education and the physician's office laboratory.

    PubMed

    Fischer, P M; Addison, L A; Koneman, E W; Crowley, J

    1986-03-21

    The field of physicians' office laboratory testing has witnessed an increase in test volume and advances in technology, but little attention to educational issues. If this field is to continue to grow and to perform high-quality testing, primary care physicians will need to be trained in the role of laboratory director. Office staff will require "in the office" continuing education. Formal technician and technologist training will need to focus some attention on office test procedures. The development of these new educational programs will require the cooperative efforts of primary care physician educators, pathologists, allied health faculty, and the diagnostic equipment industry.

  16. Physician advertising: some reasons for caution.

    PubMed

    Yarborough, M

    1989-12-01

    Physician advertising is a growing trend which, proponents contend, will bring needed reforms to health care. Among these reforms are better informed patients, reduction in the price of health care, improvement in the quality of care, and reduction in the incidence of malpractice litigation and the cost of malpractice insurance. I argue that physician advertising probably will not accomplish these goals. I also discuss problems with the intent, content, monitoring, and costs of advertising, along with how it may adversely affect the way physicians perceive one another.

  17. 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

  18. Medical Expert Systems—Knowledge Tools for Physicians

    PubMed Central

    Shortliffe, Edward H.

    1986-01-01

    Recent advances in the field of artificial intelligence have led to the emergence of expert systems, computational tools designed to capture and make available the knowledge of experts in a field. Although much of the underlying technology available today is derived from basic research on biomedical advice systems during the 1970s, medical application packages are thus far generally unavailable from the young artificial intelligence industry. Medical expert systems will begin to appear, however, as researchers in medical artificial intelligence continue to make progress in key areas such as knowledge acquisition, model-based reasoning and system integration for clinical environments. It is accordingly important for physicians to understand the current state of such research and the theoretic and logistic barriers that remain before useful systems can be made available. One experimental system, ONCOCIN, provides a glimpse of the kinds of knowledge-based tools that will someday be available to physicians. ImagesFigure 1. PMID:3811349

  19. 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

  20. 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

  1. After the "Doc Fix": Implications of Medicare Physician Payment Reform for Academic Medicine.

    PubMed

    Rich, Eugene C; Reschovsky, James D

    2016-07-01

    The Medicare Access and CHIP Reauthorization Act (MACRA) introduces incentives for clinicians serving Medicare patients to move away from traditional "fee-for-service" and into alternative payment models (APMs) such as accountable care organizations and bundled payment arrangements. Thus, MACRA creates strong reasons for various teaching clinical services to participate in APMs, not only for Medicare patients but for other public and private payers as well. Unfortunately, different APMs may be more or less applicable to the diverse teaching physician roles, academic clinical programs, and patient populations served by medical schools and teaching hospitals. Therefore, this time of transition will complicate the work of academic clinical program leaders endeavoring to sustain the tripartite mission of patient care, health professional education, and research. Nonetheless, payment reforms promoted by MACRA can reward efforts to reinvent medical education to better incorporate value into medical decision making, as well as to give clinical learners the tools and insights needed to recognize their personal financial (and other) conflicts and navigate these to meet their patients' needs. This post-MACRA environment may intensify the need for researchers in academic medicine to stay independent of the short-term financial interests of affiliated clinical institutions. Health sciences scholars must be able to study effectively and speak forcefully regarding the actual benefits, risks, and costs of health care services so that educators and clinicians can identify high-value care and deliver it to their patients. PMID:27224297

  2. Microbial metabolomics: innovation, application, insight.

    PubMed

    Aldridge, Bree B; Rhee, Kyu Y

    2014-06-01

    Most textbooks depict metabolism as a well understood housekeeping function of cells. However, organisms vary in their metabolic needs according to the specific niches they reside in and selective pressures encountered therein. Recent advances in analytical chemistry have begun to reveal an unexpected diversity in the composition, structure and regulation of metabolic networks. Here, we review key technological developments in the area of metabolism and their impact on our understanding of the fundamental roles of metabolism in cellular physiology.

  3. Race, Segregation, and Physicians' Participation in Medicaid

    PubMed Central

    Greene, Jessica; Blustein, Jan; Weitzman, Beth C

    2006-01-01

    Many studies have explored the extent to which physicians' characteristics and Medicaid program factors influence physicians' decisions to accept Medicaid patients. In this article, we turn to patient race/ethnicity and residential segregation as potential influences. Using the 2000/2001 Community Tracking Study and other sources we show that physicians are significantly less likely to participate in Medicaid in areas where the poor are nonwhite and in areas that are racially segregated. Surprisingly—and contrary to the prevailing Medicaid participation theory—we find no link between poverty segregation and Medicaid participation when controlling for these racial factors. Accordingly, this study contributes to an accumulating body of circumstantial evidence that patient race influences physicians' choices, which in turn may contribute to racial disparities in access to health care. PMID:16771818

  4. 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

  5. Purchasers look at physician hospital organizations.

    PubMed

    Burns, S P

    1994-01-01

    Business leaders are finally seizing the opportunity to shape the future of this country's health care delivery system. One such system could be new, community-based alliances known as physician hospital organizations.

  6. [Contributions by Austrian physicians to skeletal diseases].

    PubMed

    Ellegast, H H; Strasser, E

    1991-01-01

    We report about Austrian physicians who made major contributions to the scientific research of skeletal disorders. They include pathologists, radiologists, clinicians, pediatricians and surgeons. We present a short biography as well as a brief discussion of their major papers.

  7. How physician stress can hurt your practice.

    PubMed

    1998-08-01

    Physicians are under increasing pressure to see more patients, take on more management responsibilities, and still provide the best care. That is leading to a variety of problems--everything from general malaise and burnout to early retirement and unionization. Stressed-out physicians can have a disastrous effect on the bottom line of practices. Productivity drops, staff become demoralized, turnover increases, and patients become less satisfied with the care they receive--both from the physician and support staff. There are clear warning signs of physicians under too much pressure. There are also some simple steps a practice can take to minimize the occurrence of burnout and deal with it effectively when it occurs.

  8. 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

  9. Ethical decision making by Canadian family physicians.

    PubMed Central

    Christie, R J; Hoffmaster, C B; Stewart, M A

    1987-01-01

    Canadian family physicians were sent questionnaires that asked how they would handle the ethical problems posed by six sample cases and what reasons were relevant to their decisions. The ethical problems concerned how much information to divulge to patients, how extensively a physician should become involved in the lifestyles of patients and how to deal with a possible family problem. The study identified characteristics of family physicians that affect their ethical decision making and tested a theoretical model that regards ethical problems as conflicts between respecting patient autonomy and promoting patient welfare. The varied responses suggested that ethical issues are resolved on a case-by-case, rather than a theoretical, basis. Certification in family medicine was the only characteristic associated with a consistent pattern of responses; certificants were more likely than other physicians to involve patients in decisions. PMID:3676930

  10. Physician-hospital alignment: "employment lite".

    PubMed

    Hunter, Craig; Baum, Neil

    2013-01-01

    The American healthcare delivery system is undergoing a major change that involves independent solo and small groups of doctors becoming employed by hospitals. Some describe this as a paradigm shift; we view it as a tsunami that is engulfing physicians across the nation. This phenomenon is unfamiliar to most physicians and represents huge risks with the shift from private, fee-for-service practices to practicing as an employee of a hospital. This article discusses the pitfalls associated with the transfer to a hospital employee using a concept called "employment lite." It presents the advantages and disadvantages of employment lite and why this might serve as an alternative to a fully employed hospital physician. The employment lite option is similar to employment in that it allows the physician to enjoy most of the nuances of employment, yet maintain a desirable level of independence. PMID:23547505

  11. Marketing to physicians in a digital world.

    PubMed

    Manz, Christopher; Ross, Joseph S; Grande, David

    2014-11-13

    Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made. PMID:25390738

  12. IT challenges in physician practice management.

    PubMed

    Runy, Lee Ann

    2009-11-01

    Policymakers thought after they eased Stark and antikickback statutes that hospitals would be "handing out EMRs like Halloween candy" to physician practices. It didn't happen. What are the barriers to digitizing docs? How can we move forward?

  13. Marketing to physicians in a digital world.

    PubMed

    Manz, Christopher; Ross, Joseph S; Grande, David

    2014-11-13

    Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made.

  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. A Nonparametric Statistical Method That Improves Physician Cost of Care Analysis

    PubMed Central

    Metfessel, Brent A; Greene, Robert A

    2012-01-01

    Objective To develop a compositing method that demonstrates improved performance compared with commonly used tests for statistical analysis of physician cost of care data. Data Source Commercial preferred provider organization (PPO) claims data for internists from a large metropolitan area. Study Design We created a nonparametric composite performance metric that maintains risk adjustment using the Wilcoxon rank-sum (WRS) test. We compared the resulting algorithm to the parametric observed-to-expected ratio, with and without a statistical test, for stability of physician cost ratings among different outlier trimming methods and across two partially overlapping time periods. Principal Findings The WRS algorithm showed significantly greater within-physician stability among several typical outlier trimming and capping methods. The algorithm also showed significantly greater within-physician stability when the same physicians were analyzed across time periods. Conclusions The nonparametric algorithm described is a more robust and more stable methodology for evaluating physician cost of care than commonly used observed-to-expected ratio techniques. Use of such an algorithm can improve physician cost assessment for important current applications such as public reporting, pay for performance, and tiered benefit design. PMID:22524195

  16. Time management: a review for physicians.

    PubMed Central

    Brunicardi, F. C.; Hobson, F. L.

    1996-01-01

    This article reviews the basic concepts and techniques of time management as they relate to a medical lifestyle. Essential tools are described to help the physician reassess and sharpen skills for handling intensifying demands and constraints of juggling patient care, research, teaching, and family responsibilities. The historical background and principles of time management for three popular "best selling" techniques are critiqued. In addition, a fourth technique, or model, of time management is introduced for physician use. PMID:8855650

  17. Ethics and the professional team physician.

    PubMed

    Tucker, Andrew M

    2004-04-01

    The professional team physician may face ethical questions that are unique to the practice of sports medicine. There are numerous pressures that potentially may affect or interfere with ethical medical decision-making. The purpose of this article is to highlight some of these issues and to increase awareness of them for the practicing team physician and trainers and others involved in professional sports. PMID:15183569

  18. Physician performance assessment: prevention of cardiovascular disease.

    PubMed

    Lipner, Rebecca S; Weng, Weifeng; Caverzagie, Kelly J; Hess, Brian J

    2013-12-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight evidence-based clinical measures from 811 physicians that completed the American Board of Internal Medicine's Preventive Cardiology Practice Improvement Module(SM) to form an overall composite score for preventive cardiology care. An expert panel of nine internists/cardiologists skilled in preventive care for cardiovascular disease used an adaptation of the Angoff standard-setting method and the Dunn-Rankin method to create the composite and establish a standard. Physician characteristics were used to examine the validity of the inferences made from the composite scores. The mean composite score was 73.88 % (SD = 11.88 %). Reliability of the composite was high at 0.87. Specialized cardiologists had significantly lower composite scores (P = 0.04), while physicians who reported spending more time in primary, longitudinal, and preventive consultative care had significantly higher scores (P = 0.01), providing some evidence of score validity. The panel established a standard of 47.38 % on the composite measure with high classification accuracy (0.98). Only 2.7 % of the physicians performed below the standard for minimally acceptable preventive cardiovascular disease care. Of those, 64 % (N = 14) were not general cardiologists. Our study presents a psychometrically defensible methodology for assessing physician performance in preventive cardiology while also providing relative feedback with the hope of heightening physician awareness about deficits and improving patient care. PMID:23417594

  19. Modeling solutions to Tanzania's physician workforce challenge

    PubMed Central

    Goodell, Alex J.; Kahn, James G.; Ndeki, Sidney S.; Kaale, Eliangiringa; Kaaya, Ephata E.; Macfarlane, Sarah B. J.

    2016-01-01

    Background There is a great need for physicians in Tanzania. In 2012, there were approximately 0.31 physicians per 10,000 individuals nationwide, with a lower ratio in the rural areas, where the majority of the population resides. In response, universities across Tanzania have greatly increased the enrollment of medical students. Yet evidence suggests high attrition of medical graduates to other professions and emigration from rural areas where they are most needed. Objective To estimate the future number of physicians practicing in Tanzania and the potential impact of interventions to improve retention, we built a model that tracks medical students from enrollment through clinical practice, from 1990 to 2025. Design We designed a Markov process with 92 potential states capturing the movement of 25,000 medical students and physicians from medical training through employment. Work possibilities included clinical practice (divided into rural or urban, public or private), non-clinical work, and emigration. We populated and calibrated the model using a national 2005/2006 physician mapping survey, as well as graduation records, graduate tracking surveys, and other available data. Results The model projects massive losses to clinical practice between 2016 and 2025, especially in rural areas. Approximately 56% of all medical school students enrolled between 2011 and 2020 will not be practicing medicine in Tanzania in 2025. Even with these losses, the model forecasts an increase in the physician-to-population ratio to 1.4 per 10,000 by 2025. Increasing the absorption of recent graduates into the public sector and/or developing a rural training track would ameliorate physician attrition in the most underserved areas. Conclusions Tanzania is making significant investments in the training of physicians. Without linking these doctors to employment and ensuring their retention, the majority of this investment in medical education will be jeopardized. PMID:27357075

  20. Physician attitudes toward computerized practice guidelines.

    PubMed

    Alberti, E; Holt, T J

    1996-01-01

    Computerized information systems are gaining ground in quality improvement, and will become even more important as health plans implement, evaluate, and maintain clinical guidelines. PacifiCare of California explored physicians' attitudes toward applying computerized technologies to direct clinical guidelines. The results indicate not only physician acceptance factors, but illustrate the issues, such as information for medical decision making, that health plans must consider in developing computerized case management systems to manage the care of the chronically ill. PMID:10157264

  1. Physician alignment strategies and real estate.

    PubMed

    Czerniak, Thomas A

    2012-06-01

    When addressing locations of facilities after acquiring physician practices, hospitals should: Acknowledge the hospital's ambulatory plan is the driver rather than real estate assumed with the physician practices, Review the hospital ambulatory service plan for each submarket, Review the location of facilities within the service area and their proximity to one another, Sublease or sell existing facilities that are not appropriate, Ensure that the size and characteristics of each facility in the market are appropriate and consistent with the hospital's image.

  2. Sigmund Freud's physicians and "the monster".

    PubMed

    Tainmont, J

    2007-01-01

    Freud received treatment from several physicians--including rhinologists, oro-facial surgeons or radiotherapists--for a cancer of the palate. Furthermore, as a consequence of his operation, Freud was required to wear a prosthesis that he probably named "the monster". This paper provides some details about the physicians who cured Freud and looks at the prosthesis he was forced to wear until his death.

  3. 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.

  4. Consequences of contextual factors on clinical reasoning in resident physicians.

    PubMed

    McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J

    2015-12-01

    Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. After watching each video recording, participants completed a think-aloud protocol. Transcripts from the think-aloud protocols were analyzed using a constant comparative approach. After iterative coding, utterances were analyzed for emergent themes with utterances grouped into categories, themes and subthemes. Ten residents participated in the study with saturation reached during analysis. Participants universally acknowledged the presence of contextual factors in the video recordings. Four categories emerged as a consequence of the contextual factors: (1) emotional reactions (2) behavioral inferences (3) optimizing the doctor patient relationship and (4) difficulty with closure of the clinical encounter. The presence of contextual factors may impact clinical reasoning performance in resident physicians. When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory.

  5. Ethnic Elders and American Health Care—A Physician's Perspective

    PubMed Central

    Kim, Sundra S.

    1983-01-01

    The aging process is a fugue composed of innumerable themes; the theme of “ethnicity” is by far one of its more dominant. Due to the increasing incidence of chronic, progressive infirmity and acute, catastrophic illness, the elderly are thrust into direct contact with the health care systems of their society. The experiences of ethnic elders in American health care situations are fraught with conflict and mutual dissatisfaction with the physician-patient relationship. Both providers and consumers of health care services harbor differing culture-bound perceptions of health, illness and the healing process; these cultural beliefs define personal and professional needs and expectations and notions of how those needs are to be met by others. Both physicians and patients can enhance their communication and their compassion for one another by acknowledgment of cultural differences and by increased willingness to interpret motives and behavior within native context. It behooves us in medicine to examine the cultural traditions underlying our own attitudes, beliefs and values about the aged in a universal sense, as well as in a culturally specific sense, that we may gain insight that will be helpful in serving elderly persons more effectively, and in solving some of the problems inherent in the aging process. PMID:6666105

  6. Consequences of contextual factors on clinical reasoning in resident physicians.

    PubMed

    McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J

    2015-12-01

    Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. After watching each video recording, participants completed a think-aloud protocol. Transcripts from the think-aloud protocols were analyzed using a constant comparative approach. After iterative coding, utterances were analyzed for emergent themes with utterances grouped into categories, themes and subthemes. Ten residents participated in the study with saturation reached during analysis. Participants universally acknowledged the presence of contextual factors in the video recordings. Four categories emerged as a consequence of the contextual factors: (1) emotional reactions (2) behavioral inferences (3) optimizing the doctor patient relationship and (4) difficulty with closure of the clinical encounter. The presence of contextual factors may impact clinical reasoning performance in resident physicians. When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory. PMID:25753295

  7. Critical care physician cognitive task analysis: an exploratory study

    PubMed Central

    Fackler, James C; Watts, Charles; Grome, Anna; Miller, Thomas; Crandall, Beth; Pronovost, Peter

    2009-01-01

    Introduction For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine. The study objective was to assess the usefulness of CTA as an analytical tool in order that physician cognitive tasks may be understood and redistributed within the work-hour limited medical decision-making teams. Methods After approval from each Institutional Review Board, two intensive care units (ICUs) within major university teaching hospitals served as data collection sites for CTA observations and interviews of critical care providers. Results Five broad categories of cognitive activities were identified: pattern recognition; uncertainty management; strategic vs. tactical thinking; team coordination and maintenance of common ground; and creation and transfer of meaning through stories. Conclusions CTA within the framework of Naturalistic Decision Making is a useful tool to understand the critical care process of decision-making and communication. The separation of strategic and tactical thinking has implications for workflow redesign. Given the global push for work-hour limitations, such workflow redesign is occurring. Further work with CTA techniques will provide important insights toward rational, rather than random, workflow changes. PMID:19265517

  8. [Martin Luther and his physicians. A contribution to Luther year 1983].

    PubMed

    Völker, A

    1983-10-15

    The Luther memorial year 1983 gives rise to describe the reformer's life from the point of view of his diseases as well as of the measures of the physicians treating him. The description of the work of these persons at the same time mediates insights into the level of the therapeutic measures of the 16th century as well as especially into the medico-scientific activities of the University of Wittenberg, where Martin Luther worked for about 35 years.

  9. [The marriage between the physician and philology].

    PubMed

    Gourevitch, D

    1998-01-01

    The day before yesterday: the physician-philologist. The times of the first appearance of printed books and of the re-discovery of ancient texts are also the times of syphilis. The physician, more than a philosopher as Galen suggested, is also a philologist. A very interesting example is fournished by Antonio Benivieni (+1502) and by his book De causis abditis (1506). Yesterday: the philologist-physician. Charles Daremberg (1816-1872) is our example. In 1841, he wrote his medical thesis Exposition des connaissances de Galien sur l'anatomie, la physiologie et la pathologie du systeme nerveux (faculte de medecine de Paris, n 222). Today: a necessary couple, the physician and the philologist. Greek and Latin are no more subjects of teaching in school, and the philologists seem to be strange, dusty and dirty people. Is the physician-philologist still alive or not? To be useful to the daily practice of medicine, history of medicine will be also a philological matter, as philology is the complete study of ancient, modern and contemporary texts. It teaches to read well, to understand all that has been written and, as a consequence, all that the patients tell today to their physicians. The problem is not teaching something more (new facts, new notions...) but teaching to know well; in a word, teaching the famous continuous learning, which is still a difficult reality. PMID:11620532

  10. Family Physician Perspectives on Primary Immunodeficiency Diseases

    PubMed Central

    Orange, Jordan S.; Seeborg, Filiz O.; Boyle, Marcia; Scalchunes, Christopher; Hernandez-Trujillo, Vivian

    2016-01-01

    Primary immunodeficiency diseases (PIDs) include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed) family practice physicians, of whom 44% reported following ≥1 patient with PID. Selective immunoglobulin A deficiency (21%) and chronic granulomatous disease (11%) were most common and were followed by significantly more subspecialist immunologists (P < 0.05). Use of intravenously administered immunoglobulin and live viral vaccinations across PID was significantly different (P < 0.05). Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4 vs. 79% of subspecialist immunologists, P < 0.05). Family practice physicians will likely encounter patients with PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care. PMID:27066486

  11. The professional responsibility model of physician leadership.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L

    2013-02-01

    The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the professional responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the professional medical ethics of Drs John Gregory and Thomas Percival. Four professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical professionalism, and to prevent and respond effectively to organizational dysfunction. The professional responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.

  12. An overlooked source of physician-scientists.

    PubMed

    Puljak, Livia

    2007-12-01

    A shortage of physician-scientists in the United States is an ongoing problem. Various recommendations have been made to address this issue; however, none of them have ameliorated the situation. Foreign medical school graduates with postdoctoral training in the United States are an overlooked and untapped resource for combating the dearth of physician-scientists. Evaluation of the scientific staff at the University of Texas Southwestern Medical Center revealed that 11% of all postdoctoral fellows were international medical graduates. Interestingly, a survey taken by these individuals revealed a lack of institutional and/or mentor support for career development and preparation for becoming physician-scientists. Foreign postdoctoral fellows with medical degrees are not even eligible for physician-scientist grants and awards since they are not US citizens. Although physicians educated in the United States usually matriculate from medical school with high educational debt that prevents most of them from entering into scientific careers, doctors trained outside the United States generally have minimal, if any, debt. Furthermore, many of them have a keen interest in remaining in the United States once they complete their postdoctoral training. Thus, foreign-trained medical professionals who have pursued scientific training in the United States can be one of the solutions for the current dearth of physician-scientists. PMID:18163964

  13. 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

  14. Preparing for the physician payment sunshine act.

    PubMed

    Dickerson, David M; Naidu, Ramana K

    2014-01-01

    In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Centers for Medicare and Medicaid Services any payments or transfers of value to physicians. These reports are not meant to prohibit relationships between physicians and industry, but rather to generate a searchable public database illustrating the purpose of the payment, the entities involved, and the timing of each occurrence. Although the bill is meant to reveal physician-industry relationships, the question of how society at large and the medical field will interpret these data are unknown. The purpose of this article is to inform physicians of the components of the Physician Payment Sunshine Act. We discuss several resultant challenges and suggest a framework for preparing for transparency reporting and its potential effects. PMID:24695000

  15. California physician's professional image of therapists.

    PubMed

    Silva, D M; Clark, S D; Raymond, G

    1981-08-01

    The purpose of this study was to identify the attitudes of California physicians toward the professional image of physical therapists and to determine the influence of several independent variables on that image. A three-part questionnaire was used to survey the sample of physicians. The first two sections contained attitudinal statements based on criteria representing degrees of professionalism; the third section contained questions on demographic variables. The results indicated that, although the majority of responding physicians viewed physical therapists as possessing all of the criteria denoting professionalism, there was relatively less agreement with the two criteria representing the highest degrees of professionalism-evaluative skills and autonomy of judgment. None of the independent variables influenced physicians' professional image of physical therapists except physician specialty area, in which family practitioners held a significantly higher professional image of physical therapists than did neurosurgeons and orthopedists. The authors suggest further study of other factors that may affect physicians' professional image of physical therapists as well as recommend steps that may be taken to improve the professional image of physical therapists. PMID:7267705

  16. Family Physician Perspectives on Primary Immunodeficiency Diseases.

    PubMed

    Orange, Jordan S; Seeborg, Filiz O; Boyle, Marcia; Scalchunes, Christopher; Hernandez-Trujillo, Vivian

    2016-01-01

    Primary immunodeficiency diseases (PIDs) include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed) family practice physicians, of whom 44% reported following ≥1 patient with PID. Selective immunoglobulin A deficiency (21%) and chronic granulomatous disease (11%) were most common and were followed by significantly more subspecialist immunologists (P < 0.05). Use of intravenously administered immunoglobulin and live viral vaccinations across PID was significantly different (P < 0.05). Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4 vs. 79% of subspecialist immunologists, P < 0.05). Family practice physicians will likely encounter patients with PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care. PMID:27066486

  17. Physicians under siege: the Federal Trade Commission versus the physicians of St. Francis Hospital.

    PubMed

    Rosen, B F

    1988-01-01

    This article concerns the Federal Trade Commission's recent consent agreement with Preferred Physicians, Inc. ("PPT"), a corporation formed by physicians for the purpose of negotiating with HMOs and PPOs. The author comments on PPI's agreement not to negotiate on behalf of any PPI member unless and until PPI becomes an "integrated joint venture." and suggests how to insulate a physician joint venture from antitrust liability.

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

    PubMed

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

    2008-01-01

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

  19. Training Future Physicians about Weapons of Mass Destruction: Report of the Expert Panel on Bioterrorism Education for Medical Students.

    ERIC Educational Resources Information Center

    Association of American Medical Colleges, Washington, DC.

    The Association of American Medical Colleges (AAMC) convened a multidisciplinary group of experts to share their insights about the learning objectives and educational experiences that they would recommend for the training of future physicians about bioterrorism. The expert panel broadened the scope of their discussion beyond bioterrorism to…

  20. Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

    PubMed

    Colt, H G; Solot, J A

    1989-02-01

    To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

  1. Patient or physician safety? Physicians' views of informed consent and nurses' roles in an Indonesian setting.

    PubMed

    Susilo, Astrid Pratidina; Nurmala, Ira; van Dalen, Jan; Scherpbier, Albert

    2012-05-01

    Informed consent is a reflection of patients' autonomy in health decision-making. The main responsibility lies with the doctor. In practice, the nurses' contributions matter as well. This paper presents a case study that explored physicians' perceptions of the existing informed consent process, their suggestions for improvement and their views on the nurses' roles in this process. A two-phase approach was conducted. First, six physicians with different expertise were interviewed. Second, after attending presentations about informed consent and physician-patient relationship principles, 32 physicians were asked to complete an open-ended questionnaire. Data were analyzed by two independent coders and emerging themes were compared. The results of the questionnaires and the interviews were triangulated. Of 32 physicians attending the presentations, 24 (75%) completed the questionnaire. The results indicate that physicians perceive patients, physicians and the hospital as main factors influencing the process of informed consent. Physicians' misinterpretation of informed consent principles, (mis)perceptions regarding patients and their family, and deficient hospital policy and support challenge the informed consent process. Physicians value nurses' roles, provided nurses have sufficient clinical knowledge, sound comprehension of informed consent principles and effective communication skills.

  2. [The empowerment of the elderly patient in interaction with the geriatric physician].

    PubMed

    Vissenberg, Marle; de Natris, Dirk

    2016-09-01

    Previous studies have shown that there has been an increase in the empowerment of different groups of patients in their contact with physicians and nurses. However, no research to date has specifically focussed on the empowerment of elderly patients from the geriatrician's perspective . Research in this area is important in view of the rise in the ageing population, as elderly patients more frequently come into contact with physicians and more patient participation is required in care through processess such as 'shared decision making' and 'informed consent'. Through interviews with geriatricians from hospitals, this study attempted to gain insights into empowerment of elderly patients in consultations with geriatric physicians. Results show that there is a large degree of variation in empowerment among patients. The main factors that hinder or promote empowerment are the patients' cognitive state, their medical knowledge and educational level. Family and caregivers also appear to play a large role in the empowerment that elderly patients show in the physician's office. Three forms of active communication (asking questians, giving opinions, and expressing concerns) are the predominant manifestations of empowerment in elderly patients. Geriatricians unanimously agreed that empowerment influences the communication and relationship between the physician and the patient and also impacts decision making. Empowerment usually leads to greater therapy adherence and to more extensive patient examinations. PMID:27372461

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

    PubMed

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

    2016-01-01

    There has been substantial growth in the number of physicians pursing Master of Business Administration (MBA) degrees over the past decade, but there is continuing debate over the utility of these programs and the career outcomes of their graduates. The authors analyzed the clinical and professional activities of a large cohort of physician-MBAs by gathering information on 206 physician graduates from the Harvard Business School MBA program who obtained their degrees between 1941 and 2014. Key outcome measures that were examined include medical specialty, current professional activity, and clinical practice. Chi square tests were used to assess the correlations in the data. Among the careers that were tracked (n = 195), there was significant heterogeneity in current primary employment. The most common sectors were clinical (27.7%), investment banking/finance (27.0%), hospital/provider administration (11.7%), biotech/device/pharmaceutical (10.9%), and entrepreneurship (9.5%). Overall, 84% of physician-MBAs entered residency; approximately half (49.3%) remained clinically active in some capacity and only one-fourth (27.7%) reported clinical medicine as their primary professional role. Among those who pursued residency training, the most common specialties were internal medicine (39.3%), emergency medicine (10.4%), orthopedic surgery (9.2%), and general surgery (8.6%). Physician-MBAs trained in internal medicine were significantly more likely to remain clinically active (63.8% vs 42.4%; P = .01). Clinical activity and primary employment in a clinical role decreased after degree conferment. After completing their education, a majority of physician-MBAs divert their primary professional focus away from clinical activity. These findings reveal new insights into the career outcomes of physician-MBAs. PMID:27355906

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

    PubMed

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

    2016-06-01

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

  5. The Work Lives of Women Physicians

    PubMed Central

    McMurray, Julia E; Linzer, Mark; Konrad, Thomas R; Douglas, Jeffrey; Shugerman, Richard; Nelson, Kathleen

    2000-01-01

    OBJECTIVE To describe gender differences in job satisfaction, work life issues, and burnout of U.S. physicians. DESIGN/PARTICIPANTS The Physician Work life Study, a nationally representative random stratified sample of 5,704 physicians in primary and specialty nonsurgical care (N = 2,326 respondents; 32% female, adjusted response rate = 52%). Survey contained 150 items assessing career satisfaction and multiple aspects of work life. MEASUREMENTS AND MAIN RESULTS Odds of being satisfied with facets of work life and odds of reporting burnout were modeled with survey-weighted logistic regression controlling for demographic variables and practice characteristics. Multiple linear regression was performed to model dependent variables of global, career, and specialty satisfaction with independent variables of income, time pressure, and items measuring control over medical and workplace issues. Compared with male physicians, female physicians were more likely to report satisfaction with their specialty and with patient and colleague relationships (P < .05), but less likely to be satisfied with autonomy, relationships with community, pay, and resources (P < .05). Female physicians reported more female patients and more patients with complex psychosocial problems, but the same numbers of complex medical patients, compared with their male colleagues. Time pressure in ambulatory settings was greater for women, who on average reported needing 36% more time than allotted to provide quality care for new patients or consultations, compared with 21% more time needed by men (P < .01). Female physicians reported significantly less work control than male physicians regarding day-to-day aspects of practice including volume of patient load, selecting physicians for referrals, and details of office scheduling (P < .01). When controlling for multiple factors, mean income for women was approximately $22,000 less than that of men. Women had 1.6 times the odds of reporting burnout compared

  6. Contributions of ancient Indian physicians--implications for modern times.

    PubMed

    Singh, J; Desai, M S; Pandav, C S; Desai, S P

    2012-01-01

    Ayurveda traces its origins to contributions of mythological and real physicians that lived millennia earlier. In many respects, Western medicine also had similar origins and beliefs, however, the introduction of anatomical dissection and progressive application of scientific evidence based practices have resulted in divergent paths taken by these systems. We examined the lives, careers, and contributions made by nine ancient Indian physicians. Ancient texts, translations of these texts, books, and biographical works were consulted to obtain relevant information, both for Indian traditional medicine as well as for Western medicine. Ayurveda has retained principles enunciated by these physicians, with minor conceptual advances over the centuries. Western medicine separated from ancient Indian medicine several hundred years ago, and remains the foundation of modern medicine. Modern medicine is evidence based, and randomized clinical trials (RCTs) are the gold standard by which efficacy of treatment is evaluated. Ayurvedic medicine has not undergone such critical evaluation to any large extent. The few RCTs that have evaluated alternative medical treatment recently have shown that such therapy is no better than placebo; however, placebo treatment is 30% effective. We suggest that foreign domination, initially by Mughals, and later by the British, may have contributed, in part, to this inertia and protracted status quo. PMID:22387655

  7. High-performance teams and the physician leader: an overview.

    PubMed

    Majmudar, Aalap; Jain, Anshu K; Chaudry, Joseph; Schwartz, Richard W

    2010-01-01

    The complexity of health care delivery within the United States continues to escalate in an exponential fashion driven by an explosion of medical technology, an ever-expanding research enterprise, and a growing emphasis on evidence-based practices. The delivery of care occurs on a continuum that spans across multiple disciplines, now requiring complex coordination of care through the use of novel clinical teams. The use of teams permeates the health care industry and has done so for many years, but confusion about the structure and role of teams in many organizations contributes to limited effectiveness and suboptimal outcomes. Teams are an essential component of graduate medical education training programs. The health care industry's relative lack of focus regarding the fundamentals of teamwork theory has contributed to ineffective team leadership at the physician level. As a follow-up to our earlier manuscripts on teamwork, this article clarifies a model of teamwork and discusses its application to high-performance teams in health care organizations. Emphasized in this discussion is the role played by the physician leader in ensuring team effectiveness. By educating health care professionals on the fundamentals of high-performance teamwork, we hope to stimulate the development of future physician leaders who use proven teamwork principles to achieve the goals of trainee education and excellent patient care.

  8. Dual loyalty of physicians in the military and in civilian life.

    PubMed

    Benatar, Solomon R; Upshur, Ross E G

    2008-12-01

    The concept of the dual loyalty physicians may have to both a patient and a third party is important in elucidating the obligations of physicians. The extent to which loyalty may be deflected from a patient to a third party (e.g., an insurance company or a prison commander) is greatly underestimated and has not attracted significant scholarly analysis. We examined dual loyalty in civilian and military contexts and used the principles of public health ethics to construct a framework for determining the legitimacy of physicians' obligations. We illustrate the application of these principles to problems physicians encounter regarding communicable diseases, elder abuse, and driving fitness. In the complex military context, independent ethics tribunals should be created to adjudicate loyalty conflicts. PMID:18923128

  9. Personality Traits Affect Teaching Performance of Attending Physicians: Results of a Multi-Center Observational Study

    PubMed Central

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

    2014-01-01

    openness were evaluated as less adequate feedback-givers. Non-surgical attending physicians who were conscientious seem to be good at evaluating residents. These insights could contribute to future work on development paths of attending physicians in medical education. PMID:24844725

  10. [Physician practice patterns and attitudes to euthanasia in Germany. A representative survey of physicians].

    PubMed

    Kirschner, R; Elkeles, T

    1998-04-01

    Growing life expectancy and increasing pharmaceutical and technical methods in medicine are leading to more and more discussions among the general population and among physicians as to whether methods to shorten the sufferings of mortally ill persons should be legalised further. In Australia 60% of physicians wish to be able to perform active euthanasia if this would be legal. In the Netherlands physicians do not commit an offence if they perform euthanasia on the basis of ethically consented rules. In the FRG the National Board of Physicians (Bundesärztekammer) still rejects any liberalisation concerning active euthanasia. However, little is known of the attitudes and behaviour of physicians concerning the questions of active and passive euthanasia. Sponsored by Gruner and Jahr publishers for a magazine "Stern" publication we conducted a representative study among physicians working in hospitals and their colleagues in free practices concerning this topic. Beginning with qualitative interviews with 50 physicians we tested the questionnaire developed and looked for the data production method best fitting for this difficult matter resulting in telephone interviews or a self-administered questionnaire. In the main study a representative sample of n = 282 physicians in free practices and n = 191 physicians in hospitals were interviewed. The response rates were 94% and 51% respectively. Analysis of non-responses did not indicate any bias. Half of the physicians think that a broader discussion on euthanasia is necessary, 34% disagree and 17% consider even a discussion already dangerous. 6% of the physicians in hospitals and 11% in free practices have already experienced methods of active euthanasia. Half of the physicians have seen patients who strongly wished euthanasia, a situation which happens once in every two years. The majority of physicians feel a deep understanding but only a minority of 4% comply with the wish. The vast majority of physicians advocate

  11. Clinical Criteria for Physician Aid in Dying.

    PubMed

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

    2016-03-01

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

  12. Motivational determinants among physicians in Lahore, Pakistan

    PubMed Central

    2010-01-01

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

  13. 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

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

    PubMed Central

    Beagan, Brenda; Fredericks, Erin; Bryson, Mary

    2015-01-01

    Background Medical students and physicians report feeling under-prepared for working with patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ). Understanding physician perceptions of this area of practice may aid in developing improved education. Method In-depth interviews with 24 general practice physicians in Halifax and Vancouver, Canada, were used to explore whether, when and how the gender identity and sexual orientation of LGBTQ women were relevant to good care. Inductive thematic analysis was conducted using ATLAS.ti data analysis software. Results Three major themes emerged: 1) Some physicians perceived that sexual/gender identity makes little or no difference; treating every patient as an individual while avoiding labels optimises care for everyone. 2) Some physicians perceived sexual/gender identity matters primarily for the provision of holistic care, and in order to address the effects of discrimination. 3) Some physicians perceived that sexual/gender identity both matters and does not matter, as they strove to balance the implications of social group membership with recognition of individual differences. Conclusions Physicians may be ignoring important aspects of social group memberships that affect health and health care. The authors hold that individual and socio-cultural differences are both important to the provision of quality health care. Distinct from stereotypes, generalisations about social group differences can provide valuable starting points, raising useful lines of inquiry. Emphasizing this distinction in medical education may help change physician approaches to the care of LGBTQ women. PMID:26451226

  15. Physicians with the least experience have higher cost profiles than do physicians with the most experience

    PubMed Central

    Mehrotra, Ateev; Reid, Rachel O.; Adams, John L.; Friedberg, Mark W.; McGlynn, Elizabeth A.; Hussey, Peter S.

    2013-01-01

    Health plans and Medicare are using cost profiles to identify high-cost physicians in the hope of lowering total health care spending, but it is unclear which types of physicians will be most affected. Using cost profiles created from health plan claims, we examined which physician characteristics are associated with higher costs. Our strongest association was related to a physician’s year of experience. Compared to the most experienced physicians, the least experienced physicians had 13 percent higher overall costs. We found no association between costs and other factors such as malpractice claims, disciplinary action, board certification status, and the size of the group in which the physician practices. While winners and losers are inevitable in any cost profiling effort, physicians with less experience are more likely to be negatively affected by policies that utilize cost profiles. For example, they could be excluded from high-value networks or receive lower payments under Medicare’s planned value-based payment program. Further, our results raise the possibility that the more costly practice style of newly trained physicians may be a driver of rising health care costs. PMID:23129676

  16. Is there a physician union in your future?

    PubMed

    McGraw, S E; Rodriguez, T A

    1997-01-01

    Physician unions are in the news. Patient management and patient care decisions are increasingly being taken out of the hands of physicians and put into the hands of "The Suits." To take their case for a return to physician-driven patient care to the people, some physicians are joining unions. Some are even collectively bargaining for salary and other issues that are historically more closely associated with unions. The simple fact is that physician unions exist and the number of physicians joining them is expected to increase. What are the pros and cons of unionization? What motivates physicians to join unions, and what potential negative and positive factors are associated with physician unionization? This article reviews the pros and cons and the issues related to physician unions, for physicians attempting to answer the question, "Is there a union in my future?"

  17. The physician's response to climate change.

    PubMed

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being. PMID:19418286

  18. Illness episodes, physician visits, and depressive symptoms.

    PubMed

    Berkanovic, E; Hurwicz, M L

    1992-08-01

    Although there is a large literature examining the effects of distress on the demand for medical care, the data on which this literature is based are equivocal. Nonetheless, this literature is cited frequently by those who advocate a national mental health policy designed to produce a cost-effective "medical offset effect." In this study, longitudinal data on illness episodes, physician visits, and depressive symptoms were collected from 940 Medicare recipients enrolled in a health maintenance organization (HMO) under a Tax Equity and Fiscal Responsibility Act (TEFRA) contract. Seven waves of interviews were conducted over a period of 1 year. This article presents two sets of analyses. In the first, controlling for chronic conditions and demographics reported at baseline, the relationships between depressive symptoms reported at baseline, and all illness episodes and physician visits that occurred over the subsequent year are examined. In the second, controlling for depressive symptoms and demographics reported at baseline, the relationships between illness episodes and physician visits over the study year, and depressive symptoms recorded at the final interview are examined. The data indicate that, whereas depressive symptoms at baseline are virtually unrelated to subsequent illness episodes and physician visits, illness episodes and physician visits are related to subsequent depressive symptoms. These data indicate, therefore, that policies aimed at diverting the distressed from seeking medical care may result in further inequities in the receipt of needed care. PMID:10120227

  19. The physician in the technological age.

    PubMed

    Jaspers, K

    1989-09-01

    Translator's summary and notes: Karl Jaspers (1883-1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments.

  20. Patient attitudes toward emergency physician attire.

    PubMed

    Li, Siu Fai; Haber, Marc

    2005-07-01

    Previous studies have suggested that Emergency Department (ED) patient satisfaction is unaffected by physician attire. We conducted a before-and-after trial to test this hypothesis. A convenience sample of ED patients was surveyed during a 2-week period. In the first week, emergency physicians wore white coats and formal attire. In the second week, the same physicians wore scrubs. Patients were asked to indicate on a 100-mm visual analog scale (VAS) their ratings of physician appearance, satisfaction, and professionalism. The primary outcome was the difference in VAS scores between the two dress styles. There were 111 patients surveyed. There were no significant differences between patients' evaluation of appearance (Delta=-.68 mm VAS, 95% confidence interval [CI] -5.5 to 4.1), satisfaction (Delta=.83 mm VAS, 95% CI -3.0 to 4.6), or professionalism (Delta=-.46 mm VAS, 95% CI -3.6 to 2.6) between the two dress styles. Emergency physician attire does not affect patient satisfaction.

  1. Can price controls induce optimal physician behavior?

    PubMed

    Wedig, G; Mitchell, J B; Cromwell, J

    1989-01-01

    Recently, budget-conscious policymakers have shifted their attention to the physician services market and have begun to consider a wide variety of price regulatory schemes for moderating expenditures in this market. In a recent article in this journal, Feldman and Sloan warned that price controls on physician services may cause undesirable declines in service quality, independent of their budgetary ramifications. Our aim in this article is to reconsider the effects of price controls in the broader context of insurance coverage and moral hazard. Our ultimate goal is to assess the benefits of price controls independent of specific assumptions about the controversial issues of demand inducement and income targeting. Using a simple extension of the Feldman/Sloan model, we find that price controls can be and almost certainly are welfare-improving as long as consumers are sufficiently well insured, regardless of where one stands on the inducement issue. The salutary effects of price controls, on the other hand, can be compromised by income-targeting behavior on the part of physicians. We also introduce evidence from Medicare's recent fee freeze to evaluate the possibility of income-targeting behavior empirically. While formal studies of income targeting suggest that its magnitude is small in cross-section, we warn that its effects may be larger over time; this is what our descriptive evidence suggests. We conclude that more dramatic short-term progress on physician fee inflation will require stronger measures, such as putting physicians at risk for consumer expenditures.

  2. 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.

  3. The physician's response to climate change.

    PubMed

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being.

  4. Emergency physicians' experience with pediatric death.

    PubMed

    Ahrens, W R; Hart, R G

    1997-11-01

    Based on the hypothesis that managing pediatric death--particularly, communicating with survivors--is extremely difficult for most emergency physicians, 122 general emergency physicians at a written board review course were surveyed to assess their attitudes toward pediatric death. Sixty-six percent reported that communicating with the family of a child who had died was the most difficult experience in emergency medicine. Sixty-six percent considered communication with the family of a child who had died to be much more difficult than communication with the family of an adult who had died. Sixty-four percent reported feelings of guilt or inadequacy after unsuccessful pediatric resuscitation, and 47% reported feeling impaired for the remainder of their shift. Only 8% of physicians were aware of published guidelines regarding managing pediatric emergency department (ED) deaths, and only 14% of physicians had ever had any training in death notification. Ninety-two percent of physicians responded that a course directed toward managing the family of a child who had died in the ED would be helpful in dealing with this difficult situation.

  5. 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

  6. [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.

  7. Physician-Hospital Alignment in Orthopedic Surgery.

    PubMed

    Bushnell, Brandon D

    2015-09-01

    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery.

  8. Physician views regarding substance use-related participation in a state physician health program.

    PubMed

    Merlo, Lisa J; Greene, William M

    2010-01-01

    Physician Health Programs (PHPs) safeguard the public by monitoring impaired physicians, but participation is not always voluntary, and many physicians resist referral. In this study, 80 physicians (85.1% male) who were referred to a state PHP for substance use-related problems completed an anonymous online survey regarding their experiences in the program. Results indicated that 78.1% of program completers had a 5-year contract, with 100% including random drug screening. In addition, 84.8% continued participation in 12-step fellowships after the required monitoring period. Participants were generally satisfied with the program, and 92.5% indicated that they would recommend it to others. They provided suggestions to increase the acceptability and efficacy of PHPs for physicians.  PMID:20958849

  9. Using internal communication as a marketing strategy: gaining physician commitment.

    PubMed

    Heine, R P

    1990-01-01

    In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel. PMID:10110694

  10. Physician's acquittal of responsibility in Iranian statutes

    PubMed Central

    Abbasi, Mahmoud; Pirouz, Amir Samavati

    2011-01-01

    The physician's acquittal has obsessed Iranian legislator's mind to a large extent. This is exclusively observed in Iranian statuses and specifically in Shi’ite school of though. Muslim jurists’ opinions play a very important role in enacting legal articles related to it. After reviewing the literature, the authors tried to pick and collect common features of physician's responsibilities and duties to introduce Iranian Acts with respect to the subject. Also, Iranian Acts are analyzed and the challenging medical topics such as emergency situations and infectious diseases are discussed. Iranian legislator didn’t specify a kind of physician's acquittal which received from the patient knowingly and is based on his/her free will. There are also some medical and legal gaps. Patients are not often informed of all exact and scientific information and results of their treatments. Furthermore, the forms prepared to receive the patient's consent do not provide what Iranian legislator meant. PMID:22091234

  11. Lobar pneumonia treated by Musgrave Park physicians

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2009-01-01

    In the decade 1935-45 the treatment of lobar pneumonia in the developed and warring world underwent a series of evolutions—anti-sera, specific anti-sera, refinement of sulpha drugs, sulpha and anti-sera, the introduction of penicillin for bacteriology, then ophthalmology, and then for penicillin-sensitive bacterial infections such as lobar pneumonia with its many Cooper types of Streptococcus pneumoniae. Penicillin for civilian use was essentially banned in World War II, a ban that early in 1941 two Musgrave Park physicians tried to circumvent. Strict secrecy on the details of penicillin production was enforced. The treatment option chosen by the Musgrave Park physicians in 1941, and the non-availability of penicillin led to sequelae affecting the post-Belfast careers of both patient and physicians. PMID:19568449

  12. The work of the American emergency physician.

    PubMed Central

    Wyatt, J P; Weber, J E; Chudnofsky, C

    1998-01-01

    The organisation of the American emergency health care system has changed rapidly during recent years, but it remains very different to the system in the United Kingdom. American emergency departments are organised around an attending physician based service, rather than a consultant led service. As a result, the work of the American emergency physician differs considerably from that of the United Kingdom A&E consultant. The problems associated with working in an attending physician based service include antisocial hours of work, sleep deprivation, decreased job satisfaction, and "burn out," all in the context of a relatively hostile medicolegal climate. Although there appear to be no easy answers to some of these problems, the A&E specialist should be aware of the potential future difficulties for A&E medicine as it develops within the United Kingdom. PMID:9639179

  13. Strategies for selling and consolidating physician practices.

    PubMed

    Mancino, D M

    1997-01-01

    The changing dynamics of healthcare service delivery is forcing many physicians to consider selling their practices to hospitals or health plans or consolidating them with other practices. Besides being subject to the corporate and tax requirements that apply to the sale of any business, the sale of physician practices is also subject to Federal fraud and abuse and self-referral laws. Several sale strategies are available to physicians who desire to sell or consolidate their practices, including asset sales, stock sales, forward mergers, drop down consolidations, spinoffs, and statutory mergers. Each strategy has advantages and disadvantages, but whichever strategy is chosen, both sellers and buyers must ensure that tax issues are addressed and that the transaction complies with the requirements of Federal anti-kickback and self-referral laws.

  14. Physician manpower expansionism: a policy review.

    PubMed

    Bloom, B S; Peterson, O L

    1979-02-01

    A lack of national health goals has allowed physician manpower policy to be dominated by an expansionist philosophy. Scarce resources have been channeled into the production of specialist physicians trained to provide complex and expensive care for uncommon diseases, using other scare and expensive resources and adding to the steep rise in medical care costs. Society seems to want access to primary care--a lack it views with dismay--and simultaneously fears increasing costs of care. Lack of access plus high cost might lead to rash implementation of other inappropriate policies. Success of policy decisions is pure serendipity if made without reliable and relevant information or based on inappropriate data, such as opinions alone. If information is unavailable, then physician manpower decisions should be delayed or, if made, implemented cautiously.

  15. Euthanasia: American attitudes toward the physician's role.

    PubMed

    Caddell, D P; Newton, R R

    1995-06-01

    This is a study of American public opinion toward euthanasia and the physician's role in performing it. The authors examine how these attributes are affected by religious affiliation, religious self-perception, political self-perception and education. The data include 8384 American respondents from years 1977, 1978, 1982, 1985 and 1988 of the General Social Survey conducted by the National Opinion Research Center. The findings suggest that highly educated, politically liberal respondents with a less religious self-perception are most likely to accept active euthanasia or suicide in the case of terminally ill patient. The data also show that Americans tend to draw a distinction between the suicide of a terminally ill patient and active euthanasia under the care of a physician, preferring to have the physician perform this role in the dying process. The tendency to see a distinction between active euthanasia and suicide was clearly affected by religious affiliation and education.

  16. 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.

  17. An Update on Physician Practice Cost Shares

    PubMed Central

    Dayhoff, Debra A.; Cromwell, Jerry; Rosenbach, Margo L.

    1993-01-01

    The 1988 physicians' practice costs and income survey (PPCIS) collected detailed costs, revenues, and incomes data for a sample of 3,086 physicians. These data are utilized to update the Health Care Financing Administration (HCFA) cost shares used in calculating the medicare economic index (MEI) and the geographic practice cost index (GPCI). Cost shares were calculated for the national sample, for 16 specialty groupings, for urban and rural areas, and for 9 census divisions. Although statistical tests reveal that cost shares differ across specialties and geographic areas, sensitivity analysis shows that these differences are small enough to have trivial effects in computing the MEI and GPCI. These results may inform policymakers on one aspect of the larger issue of whether physician payments should vary by geographic location or specialty. PMID:10130573

  18. Physician unionization: a threat to integration?

    PubMed

    1999-08-01

    Physicians, primarily those salaried by hospitals and health systems, are increasingly turning to labor unions to help them in their frustration over what they see as eroding clinical autonomy as well as diminishing compensation. Significantly, non-salaried physicians are also looking to the concept of collective bargaining as a tool in their negotiations with health insurers. The pro-labor doctors may get some of what they're looking for in the coming months and years, with a combination of economic and political forces driving the nascent trend forward regionally and nationwide. But victory won't come without a struggle and some major legal and regulatory hassles. And what will physician unionization mean for integrated health systems and other large healthcare organizations? Plenty, say industry observers and those in the trenches.

  19. Creating a physician-led quality imperative.

    PubMed

    Nelson, Marcia F; Merriman, Charles S; Magnusson, Peter T; Thomassian, Kristapor V; Strawn, Alivia; Martin, Julie

    2014-01-01

    To emerge from a significant quality crisis, hospital administration recognized the need for physician leadership to drive improvements. A framework is presented for a physician-led Quality Summit to select best practice initiatives for implementation over 1 year. Results demonstrated statistically significant reductions in ventilator-associated pneumonia, decreasing from the first quarter 2009 baseline of 8.34 per 1000 ventilator days to 3.32 per 1000 ventilator days in second quarter 2010 (P = .0055). During the same time frame, catheter-associated urinary tract infections decreased from 4.35 per 1000 catheter days to 0.98 per 1000 catheter days (P = .0438), and severe sepsis/septic shock mortality declined from 33% to 13% (P = .0084). The customized World Health Organization Surgical Safety Checklist was used in 93% of surgeries within 1 month of adoption. Venous thromboembolism screening for adults became routine. The annual Quality Summit cycle engages physicians to introduce and spread quality improvement.

  20. Infectious Diseases Physician Compensation: An Improved Perspective

    PubMed Central

    Ritter, Jethro Trees; Lynch, John B.; MacIntyre, Ann T.; Trotman, Robin

    2016-01-01

    Negotiating physician compensation can be complicated because many factors now influence the ways in which physicians can be compensated. Infectious diseases (ID) specialists typically provide a wide array of services, ranging from patient care to administrative leadership. Compensation surveys from national organizations have produced results based on small samples and often are not congruent with ID physicians’ perceptions. In July of 2015, the Infectious Diseases Society of America (IDSA) conducted a compensation survey to assess current compensation earned by the diverse ID specialists within its membership. Members of IDSA's Clinical Affairs Committee report the results from the 2015 IDSA Physician Compensation survey, with a particular focus on the findings from respondents who indicate “patient care” as their primary responsibility and present a discussion that compares and contrasts results against other survey data. PMID:27419159