Sample records for professionals including physicians

  1. Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

    PubMed

    Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

    2015-11-01

    We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

  2. A Conceptual Model for Understanding Academic Physicians' Performances of Identity: Findings From the University of Utah.

    PubMed

    Chow, Candace J; Byington, Carrie L; Olson, Lenora M; Ramirez, Karl Paulo Garcia; Zeng, Shiya; López, Ana María

    2018-05-22

    To explore how academic physicians perform social and professional identities and how their personal experiences inform professional identity formation. Semi-structured interviews and observations were conducted with 25 academic physicians of diverse gender and racial/ethnic backgrounds at the University of Utah School of Medicine from 2015-2016. Interviews explored the domains of social identity, professional identity, and relationships with patients and colleagues. Patient interactions were observed. Interviews and observations were audio-recorded, transcribed, and analyzed using grounded theory. Three major themes emerged: physicians' descriptions of identity differed based on social identities, as women and racially/ethnically minoritized participants linked their gender and racial/ethnic identities, respectively, to their professional roles more than men and White, non-Latino/a participants; physicians' descriptions of professional practice differed based on social identities, as participants who associated professional practices with personal experiences often drew from events connected to their minoritized identities; and physicians' interactions with patients corresponded to their self-described actions. Professional identity formation is an ongoing process and the negotiation of personal experiences is integral to this process. This negotiation may be more complex for physicians with minoritized identities. Implications for medical education include providing students, trainees, and practicing physicians with intentional opportunities for reflection and instruction on connecting personal experiences and professional practice.

  3. Locum physicians' professional ethos: a qualitative interview study from Germany.

    PubMed

    Salloch, Sabine; Apitzsch, Birgit; Wilkesmann, Maximiliane; Ruiner, Caroline

    2018-05-08

    In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. In this first qualitative study on German locum physicians, the locums' own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups' perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians' role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor-patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. Further qualitative and quantitative research on locum physicians' professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.

  4. 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. Copyright © 2013 Mosby, Inc. All rights reserved.

  5. Self-care as a professional imperative: physician burnout, depression, and suicide.

    PubMed

    Kuhn, Catherine M; Flanagan, Ellen M

    2017-02-01

    Burnout has been identified in approximately half of all practicing physicians, including anesthesiologists. In this narrative review, the relationship between burnout, depression, and suicide is explored, with particular attention to the anesthesiologist. Throughout this review, we highlight our professional imperative regarding this epidemic. The authors searched the existing English language literature via PubMed from 1986 until present using the search terms physician burnout, depression, and suicide, with particular attention to studies regarding anesthesiologists and strategies to address these problems. Burnout and depression have increased among physicians, while the rate of suicide has remained relatively the same. There are many factors associated with burnout and depression as well as many causes. Certain individual factors include sex, amount of social support, and mental health history. Systems factors that play a role in burnout and depression include work compression, demands of electronic health records, production pressure, and lack of control over one's professional life. Medical license applications include questions that reinforce the stigma of psychological stresses and discourage physicians from seeking appropriate care. The concept of physician well-being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Anesthesiologists must actively engage in self-care. Anesthesiology practices and healthcare organizations should evaluate the balance between demands they place on physicians and the resources provided to sustain an engaged, productive, and satisfied physician workforce. National efforts must be rallied to support physicians seeking help for physical and psychological health problems.

  6. Professionalism in the digital age.

    PubMed

    Mostaghimi, Arash; Crotty, Bradley H

    2011-04-19

    The increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in this digital age in order to maintain confidentiality, honesty, and trust in the medical profession. Although the ability of physicians to use online social networks, blogs, and media sites for personal and professional reasons should be preserved, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a "dual-citizenship" approach to online social media that separates public and private personae would allow physicians to both leverage networks for professional connections and maintain privacy in other aspects. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary.

  7. Building physician resilience.

    PubMed

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

    2008-05-01

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

  8. 75 FR 76831 - Publicly Available Consumer Product Safety Information Database

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-09

    ..., health care professionals, and public safety entities, will likely lack firsthand knowledge about an...) would state that the definition of ``health care professionals'' includes, but is not limited to, medical examiners, coroners, physicians, nurses, physician's assistants, hospitals, chiropractors, and...

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  11. Personal and professional profile of mountain medicine physicians.

    PubMed

    Peters, Patrick

    2003-01-01

    The purpose of this study was to define and describe the personal and professional profile of mountain medicine physicians including general physical training information and to include a detailed overview of the practice of mountain sports. A group of physicians participating in a specialized mountain medicine education program filled out a standardized questionnaire. The data obtained from this questionnaire were first analyzed in a descriptive way and then by statistical methods (chi2 test, t test, and analysis of variance). Detailed results have been provided for gender, age, marital status, general training frequency and methods, professional status, additional medical qualifications, memberships in professional societies and alpine clubs, mountain sports practice, and injuries sustained during the practice of mountain sports. This study has provided a detailed overview concerning the personal and professional profile of mountain medicine physicians. Course organizers as well as official commissions regulating the education in mountain medicine will be able to use this information to adapt and optimize the courses and the recommendations/requirements as detailed by the UIAA-ICAR-ISMM (Union Internationale des Associations Alpinistes, International Commission for Alpine Rescue, International Society for Mountain Medicine).

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

    PubMed

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

    2014-04-01

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

  13. Professional service use for a serious personal problem: Comparing older African Americans, Black Caribbeans, and non-Hispanic Whites using the National Survey of American Life

    PubMed Central

    Woodward, Amanda Toler; Chatters, Linda M.; Taylor, Harry Owen; Taylor, Robert Joseph

    2014-01-01

    Objectives Examines combinations of professionals visited for a serious personal problem. Methods The sample includes those aged 55 and older (n=862) from the National Survey of American Life (NSAL). Latent class analysis was used to identify groups of respondents based on types of professionals visited. Multinomial logistic regression was used to identify factors associated with group membership. Results Classes included health provider plus clergy, physician plus mental health provider, and limited provider use. Whites were more likely than African Americans to fall into the health provider plus clergy and physician plus mental health provider classes. Those with physical and emotional problems were more likely to be in the health provider plus clergy and physician plus mental health provider classes, respectively. Discussion Most respondents were in the limited provider use class suggesting that for many of problems, minimal professional help is utilized. Physicians and clergy were important across all three classes. PMID:25552527

  14. [Professional debate on shortage of physicians].

    PubMed

    Gérvas, Juan; Bonis, Julio

    2008-01-01

    We do not know the best answer to problems due to shortage of physicians (absolute number and by specialities) but perhaps what is important is the lack of a professional debate about what means 'to be' a physician. In this paper we address four key professional questions: 1/ the over-training of physicians when health demand now includes minor problems, 2/ predominance of physician-patient direct encounters in a world of telecommunications and indirect encounters, 3/ the need to delegate power and responsibilities to other health professionals as a consequence of new technology developments and changes in role-design, and 4/ too much emphasis in diagnosis with the danger to initiate cascades with its side-effects. Practical answers to these questions require changes in pre and postgraduate education, improvement in health services organization to profit the use of telecommunications and analysis and re-design of the limits in between professions, levels of care, institutions and health and social sectors.

  15. Teaching professionalism in the digital age on the psychiatric consultation-liaison service.

    PubMed

    Baer, Wendy; Schwartz, Ann C

    2011-01-01

    The rapid emergence of social media, including Facebook and YouTube, have added a new dimension to defining, teaching, and role modeling professionalism in the medical field. Explicit and consistent role modeling of professional behaviors are needed to encourage the development of professional physicians. The purpose of this article is to investigate the challenges and opportunities at the interface of professionalism and social media for physicians. The medical literature via PubMed was reviewed with key words including "Facebook," "YouTube," "social media," "digital media," and key issues are discussed. Our residency program was surveyed regarding their experiences with digital media in medical practice and the findings are discussed. Sample topics and relevant, thought provoking questions generated from our practices are outlined. Case vignettes are offered to exemplify issues with regard to professionalism raised by digital and social media in medical practice. Social media sites offer great opportunity to widely distribute valuable health care information as well as provide physicians with a venue to de-stress. In this new digital age, trainees and lifelong learners must learn to be mindful of professionalism while using social media in order to protect their privacy as well as the image of physicians. Copyright © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  16. Administrative skills for academic physicians.

    PubMed

    Aluise, J J; Scmitz, C C; Bland, C J; McArtor, R E

    1989-01-01

    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

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

    PubMed

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

    2018-03-01

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

  18. [Delegation of Medical Treatment to Non-physician Health Care Professionals: The Medical Care Structure agneszwei in Brandenburg - A Qualitative Acceptance Analysis].

    PubMed

    Schmiedhofer, M H; Brandner, S; Kuhlmey, A

    2017-06-01

    Backround: To address the increasing shortage of primary care physicians in rural regions, pilot model projects were tested, where general practitioners delegate certain physician tasks including house calls to qualified physician assistants. Evaluations show a high level of acceptance among participating physicians, medical assistants and patients. This study aims to measure the quality of cooperation among professionals participating in an outpatient health care delegation structure agnes zwei with a focus on case management in Brandenburg. Methods: We conducted 10 qualitative semi-structured expert interviews among 6 physicians and 4 physician's assistants. Results: Physicians and physicians' assistants reported the cooperative action to be successful and as an advantage for patients. The precondition for successful cooperation is that non-physician health care professionals strictly respect the governance of the General Practitioners. Physicians report that the delegation of certain medical tasks reduces their everyday workload. Physician assistants derive professional satisfaction from the confidential relationship they have with the patients. All physician assistants are in favor of medical tasks being delegated to them in regular medical outpatient care, while most physicians are skeptical or reluctant despite their reported positive experience. Conclusion: Despite the high level of acceptance of delegating some medical tasks to physician assistants, the negotiation process of introducing cooperative working structures in the outpatient health care system is still at the beginning. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Challenges to ethics and professionalism facing the contemporary neurologist.

    PubMed

    Bernat, James L

    2014-09-30

    Challenges to ethics and professionalism that can harm neurologists and their patients include the commercialization of medicine, poorly designed Medicare regulations, conflicts of interest, physician employment by hospitals, faulty measurement of medical quality care, electronic health records, electronic communications with patients, and the demotion of the role of physician beneficence. These threats can lead to inaccurate medical record-keeping, unnecessary medical care, a decline in the primacy of patients' interests, and damage to the sanctity of the patient-physician relationship. The increasing frequency of physician burnout can be attributed at least partially to unmitigated stresses on practicing physicians, particularly the growing time pressures for patient visits, the mounting daily requirements of documentation, and the increasing burden of time-consuming but unproductive tasks. Recommended correctives include reforming billing documentation regulations, improving electronic health records, designing proper quality indicators integrating physician wellness, and incorporating reasonable physician workflows in the design of accountable care organizations. © 2014 American Academy of Neurology.

  20. Peer-support writing group in a community family medicine teaching unit

    PubMed Central

    Al-Imari, Lina; Yang, Jaisy; Pimlott, Nicholas

    2016-01-01

    Abstract Problem addressed Aspiring physician writers need an environment that promotes self-reflection and can help them improve their skills and confidence in writing. Objective of program To create a peer-support writing group for physicians in the Markham-Stouffville community in Ontario to promote professional development by encouraging self-reflection and fostering the concept of physician as writer. Program description The program, designed based on a literature review and a needs assessment, was conducted in 3 sessions over 6 months. Participants included an emergency physician, 4 family physicians, and 3 residents. Four to 8 participants per session shared their projects with guest physician authors. Eight pieces of written work were brought to the sessions, 3 of which were edited. A mixed quantitative and qualitative evaluation model was used with preprogram and postprogram questionnaires and a focus group. Conclusion This program promoted professional development by increasing participants’ frequency of self-reflection and improving their proficiency in writing. Successful elements of this program include creating a supportive group environment and having a physician-writer expert facilitate the peer-feedback sessions. Similar programs can be useful in postgraduate education or continuing professional development. PMID:27965348

  1. Administrative skills for academy physicians.

    PubMed

    Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

    To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

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

    PubMed

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

    2001-07-01

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

  3. Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care.

    PubMed

    Kraus, Elena; DuBois, James M

    2017-03-01

    The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate that changes to the laws governing NP practice will engender acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how practicing professionals view NP independence in primary care. The aim of the present study was to explore and describe the attitudes about NP independence among physicians and NPs working in primary care. A qualitative study based on the principles of grounded theory. Thirty primary care professionals in Missouri, USA, including 15 primary care physicians and 15 primary care NPs. Semi-structured, in-depth interviews, with data analysis guided by grounded theory. Participants had perspectives that were not well represented by professional organizations or the media. Physicians were supportive of a wide variety of NP roles and comfortable with high levels of NP independence and autonomy. Physicians and NPs described prerequisites to NP independence that were complementary. Physicians generally believed that NPs needed some association with physicians for patient safety, and NPs preferred having a physician readily accessible as needed. The theme "knowing your limits" was important to both NPs and physicians regarding NP independence, and has not been described previously in the literature. NP and physician views about NP practice in primary care are not as divergent as their representative professional organizations and the news media would suggest. The significant agreement among NPs and physicians, and some of the nuances of their perspectives, supports recommendations that may reduce the perceived acrimony surrounding discussions of NP independent practice in primary care.

  4. Creating a Framework for Medical Professionalism: An Initial Consensus Statement From an Arab Nation.

    PubMed

    Abdel-Razig, Sawsan; Ibrahim, Halah; Alameri, Hatem; Hamdy, Hossam; Haleeqa, Khaled Abu; Qayed, Khalil I; Obaid, Laila O; Al Fahim, Maha; Ezimokhai, Mutairu; Sulaiman, Nabil D; Fares, Saleh; Al Darei, Maitha Mohammed; Shahin, Nhayan Qassim; Al Shamsi, Noora Abdulla Omran; Alnooryani, Rashed Arif; Al Falahi, Salama Zayed

    2016-05-01

    Background Medical professionalism has received increased worldwide attention, yet there is limited information on the applicability and utility of established Western professionalism frameworks in non-Western nations. Objective We developed a locally derived consensus definition of medical professionalism for the United Arab Emirates (UAE), which reflects the cultural and social constructs of the UAE and the Middle East. Methods We used a purposive sample of 14 physicians working in the UAE as clinical and education leaders. This expert panel used qualitative methods, including the world café, nominal group technique, the Delphi method, and an interpretive thematic analysis to develop the consensus statement. Results The expert panel defined 9 attributes of medical professionalism. There was considerable overlap with accepted Western definitions, along with important differences in 3 aspects: (1) the primacy of social justice and societal rights; (2) the role of the physician's personal faith and spirituality in guiding professional practices; and (3) societal expectations for professional attributes of physicians that extend beyond the practice of medicine. Conclusions Professionalism is a social construct influenced by cultural and religious contexts. It is imperative that definitions of professionalism used in the education of physicians in training and in the assessment of practicing physicians be formulated locally and encompass specific competencies relevant to the local, social, and cultural context for medical practice. Our goal was to develop a secular consensus statement that encompasses culture and values relevant to professionalism for the UAE and the Arab region.

  5. Creating a Framework for Medical Professionalism: An Initial Consensus Statement From an Arab Nation

    PubMed Central

    Abdel-Razig, Sawsan; Ibrahim, Halah; Alameri, Hatem; Hamdy, Hossam; Haleeqa, Khaled Abu; Qayed, Khalil I.; Obaid, Laila O.; Al Fahim, Maha; Ezimokhai, Mutairu; Sulaiman, Nabil D.; Fares, Saleh; Al Darei, Maitha Mohammed; Shahin, Nhayan Qassim; Al Shamsi, Noora Abdulla Omran; Alnooryani, Rashed Arif; Al Falahi, Salama Zayed

    2016-01-01

    Background Medical professionalism has received increased worldwide attention, yet there is limited information on the applicability and utility of established Western professionalism frameworks in non-Western nations. Objective We developed a locally derived consensus definition of medical professionalism for the United Arab Emirates (UAE), which reflects the cultural and social constructs of the UAE and the Middle East. Methods We used a purposive sample of 14 physicians working in the UAE as clinical and education leaders. This expert panel used qualitative methods, including the world café, nominal group technique, the Delphi method, and an interpretive thematic analysis to develop the consensus statement. Results The expert panel defined 9 attributes of medical professionalism. There was considerable overlap with accepted Western definitions, along with important differences in 3 aspects: (1) the primacy of social justice and societal rights; (2) the role of the physician's personal faith and spirituality in guiding professional practices; and (3) societal expectations for professional attributes of physicians that extend beyond the practice of medicine. Conclusions Professionalism is a social construct influenced by cultural and religious contexts. It is imperative that definitions of professionalism used in the education of physicians in training and in the assessment of practicing physicians be formulated locally and encompass specific competencies relevant to the local, social, and cultural context for medical practice. Our goal was to develop a secular consensus statement that encompasses culture and values relevant to professionalism for the UAE and the Arab region. PMID:27168882

  6. The effect of continuing professional development on public complaints: a case-control study.

    PubMed

    Wenghofer, Elizabeth F; Campbell, Craig; Marlow, Bernard; Kam, Sophia M; Carter, Lorraine; McCauley, William

    2015-03-01

    This study aimed to investigate the relationship between participation in different types of continuing professional development (CPD), and incidences and types of public complaint against physicians. Cases included physicians against whom complaints were made by members of the public to the medical regulatory body in Ontario, Canada, the College of Physicians and Surgeons of Ontario (CPSO), during 2008 and 2009. The control cohort included physicians against whom no complaints were documented during the same period. We focused on complaints related to physician communication, quality of care and professionalism. The CPD data included all Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC) CPD programme activities reported by the case and control physicians. Multivariate logistic regression models were used to determine if the independent variable, reported participation in CPD, was associated with the dependent variable, the complaints-related status of the physician in the year following reported CPD activities. A total of 2792 physicians were included in the study. There was a significant relationship between participation in CPD, type of CPD and type of complaint received. Analysis indicated that physicians who reported overall participation in CPD activities were significantly less likely (odds ratio 0.604; p = 0.028) to receive quality of care-related complaints than those who did not report participating in CPD. Additionally, participation in group-based CPD was less likely (OR 0.681; p = 0.041) to result in quality of care-related complaints. The findings demonstrate a positive relationship between participation in the national CPD programmes of the CFPC and RCPSC, and lower numbers of public complaints received by the CPSO. As certification bodies and regulators alike are increasingly mandating CPD, they are encouraged to continually evaluate the effectiveness of their programmes to maximise programme impact on physician performance at the population level. © 2015 John Wiley & Sons Ltd.

  7. A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan

    PubMed Central

    2011-01-01

    Background The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns. Methods Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered. Results Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value <0.001). Significant misunderstandings of some of the salient features of autism were present in both professional groups. Conclusion Results suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan. PMID:22107951

  8. A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan.

    PubMed

    Imran, Nazish; Chaudry, Mansoor R; Azeem, Muhammad W; Bhatti, Muhammad R; Choudhary, Zaidan I; Cheema, Mohsin A

    2011-11-22

    The diagnosis and treatment of Autism in Pakistan occurs in multiple settings and is provided by variety of health professionals. Unfortunately, knowledge and awareness about Autism is low among Pakistani healthcare professionals & the presence of inaccurate and outdated beliefs regarding this disorder may compromise early detection and timely referral for interventions. The study assessed the baseline knowledge and misconceptions regarding autism among healthcare professionals in Pakistan which can impact future awareness campaigns. Physicians (psychiatrists, pediatricians, neurologists and family physicians) and non-physicians (psychologists and speech therapists) participated in this study. Knowledge of DSM-IV TR criteria for Autistic Disorder, beliefs about social, emotional, cognitive, treatment and prognosis of the disorder were assessed. Demographic information regarding the participants of the survey was also gathered. Two hundred and forty seven respondents (154 Physicians & 93 Non-physicians) participated in the study. Mean age of respondents was 33.2 years (S.D 11.63) with 53% being females. Reasonably accurate familiarity with the DSM IV-TR diagnostic criteria of Autistic Disorder was observed. However, within the professional groups, differences were found regarding the utilization of the DSM-IV-TR criteria when diagnosing Autistic Disorder. Non-Physicians were comparatively more likely to correctly identify diagnostic features of autism compared with Physicians (P-value<0.001). Significant misunderstandings of some of the salient features of autism were present in both professional groups. Results suggests that current professionals in the field have an unbalanced understanding of autism due to presence of several misconceptions regarding many of the salient features of autism including developmental, cognitive and emotional features. The study has clinical implications and calls for continued education for healthcare professionals across disciplines with regards to Autism in Pakistan.

  9. Development of the First Guideline for Professional Conduct in Medical Practice in Iran.

    PubMed

    Saeedi Tehrani, Saeedeh; Nayeri, Fatemeh; Parsapoor, Alireza; Jafarian, Ali; Labaf, Ali; Mirzazadeh, Azim; Emadi Kouchak, Hamid; Shahi, Farhad; Ghasemzadeh, Nazafarin; Asghari, Fariba

    2017-01-01

    Professional behavior is first learned at the university. One of the necessary considerations in maintaining the professional environment of the university is establishing a set of codes for the behavior of physicians and medical students. This paper describes the process of developing the professional code of conduct in Tehran University of Medical Sciences, Tehran, Iran. A review of Iranian and international literature was performed to develop the first draft of the guideline. In sessions of group discussion by the authors, the articles of the draft were evaluated for relevancy, clarity, and lack of repetition. The draft was sent for evaluation to all participants, including the medical faculty members, residents, and medical students, four times and necessary corrections were made according to the comments received. The final guideline included 76 behavior codes in 6 categories, including altruism, honor and integrity, responsibility, respect, justice, and excellence. The codes of the guideline cover the physicians' commitments in the physician-patient, physician-colleague, and instructor-student relationships in order to improve the quality of the services. The Islamic and Iranian culture were taken into consideration in developing the guideline. Accordance with the administrative and educational conditions of the universities was ensured in developing the guideline and its acceptance was ensured through extensive surveys. Thus, it is expected that this guideline will be very effective in enhancing professional commitment in medical universities.

  10. Do doctors vote?

    PubMed

    Grande, David; Asch, David A; Armstrong, Katrina

    2007-05-01

    Organizational leaders and scholars have issued calls for the medical profession to refocus its efforts on fulfilling the core tenets of professionalism. A key element of professionalism is participation in community affairs. To measure physician voting rates as an indicator of civic participation. Cross-sectional survey of a subgroup of physicians from a nationally representative household survey of civilian, noninstitutionalized adult citizens. A total of 350,870 participants in the Current Population Survey (CPS) November Voter Supplement from 1996-2002, including 1,274 physicians and 1,886 lawyers; 414,989 participants in the CPS survey from 1976-1982, including 2,033 health professionals. Multivariate logistic regression models were used to compare adjusted physician voting rates in the 1996-2002 congressional and presidential elections with those of lawyers and the general population and to compare voting rates of health professionals in 1996-2002 with those in 1976-1992. After multivariate adjustment for characteristics known to be associated with voting rates, physicians were less likely to vote than the general population in 1998 (odds ratio 0.76; 95% confidence interval [CI] 0.59-0.99), 2000 (odds ratio 0.64; 95% CI 0.44-0.93), and 2002 (odds ratio 0.62; 95% CI 0.48-0.80) but not 1996 (odds ratio 0.83; 95% CI 0.59-1.17). Lawyers voted at higher rates than the general population and doctors in all four elections (P < .001). The pooled adjusted odds ratio for physician voting across the four elections was 0.70 (CI 0.61-0.81). No substantial changes in voting rates for health professionals were observed between 1976-1982 and 1996-2002. Physicians have lower adjusted voting rates than lawyers and the general population, suggesting reduced civic participation.

  11. [The role of the physician in expert testimony leading to an arrest].

    PubMed

    Marek, Z; Baran, E

    1989-01-01

    The authors have offered several problems related to a topic of medical professional activities of physicians being in contact with the administration of justice. There are presented opinions based on existent regulations and experiences associated with juridical expert activities of the authors. These opinions are about two problems that, according to obtained data, are made of controversies which stand between first-aid or ambulance doctors and law officers. The first problem deals with differences of opinion on obligations of physicians to examine drunk patients and to meet the requirements to put them into a sober room or--if there are any for a temporary stay into a prison. There has been also stated an opinion that this activity of physicians is included in a normal range of their professional duties. The second matter is concerned with the correctness of physicians' proceedings dealing with individuals arrested by militia and giving medical evidences that faces a problem whether stay in prison can or cannot constitute a threat for their life or health. It's been also founded that--in those cases--a physician has to be called a medicolegal opinion. The professional obligations of physicians still don't include this function and therefore it has to be granted separately.

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

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

    2016-01-01

    Background  The Physician Charter on medical professionalism has been endorsed by professional organizations worldwide, yet it is unclear if this Western framework of professionalism is applicable in non-Western countries. Objective  This study examines how physicians practicing in a Middle Eastern context perceive the terms, principles, and commitments outlined in the charter. Methods  In May 2013, the authors conducted 6 focus groups with 43 clinician-educators practicing at Hamad Medical Corporation in Doha, Qatar, to discuss the applicability of the Physician Charter in a local context. The research team coded and analyzed transcripts to identify sociocultural influences on professionalism. Results  Participants generally expressed agreement with the applicability of the charter's principles to physician professionalism in Qatar. However, 3 contextual factors (religious beliefs and practices, family-centered decision making, and multinationality) complicated the application of the core principles of patient autonomy and social justice. Islamic beliefs reinforced the importance of professional values such as altruism, but presented a barrier to the principle of self-determination for female patients. The family-centered culture in Qatar called for enlarging the scope of patient-centered decision making to include the patient's family. Qatar's multinational population prompted debate over equal treatment and how to conceptualize and implement the principle of social justice. Conclusions  Several sociocultural contexts influence the conceptualization of the principles of medical professionalism in Qatar. The findings suggest that contextual factors should be considered when developing or adopting a professionalism framework in an international setting and context. PMID:28018537

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

    PubMed

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

    2016-12-01

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

  15. Cooperation within physician-nurse team in occupational medicine service in Poland - Knowledge about professional activities performed by the team-partner.

    PubMed

    Sakowski, Piotr

    2015-01-01

    The goal of the study has been to learn about physicians' and nurses' awareness of the professional activities that are being performed by their colleague in the physician-nurse team. Postal questionnaires were sent out to occupational physicians and nurses in Poland. The analysis includes responses from 232 pairs of physician-nurse teams. The knowledge among occupational professionals about tasks performed by their colleagues in the physician-nurse team seems to be poor. Respondents were asked about who performs tasks from each of 21 groups mentioned in the Occupational Medicine Service Act. In the case of only 3 out of 21 groups of tasks, the rate of non-consistence in answers was lower than 30%. A specified number of professionals performed their tasks on the individual basis. Although in many cases their team colleagues knew about those activities, there was a major proportion of those who had no awareness of such actions. Polish occupational physicians and nurses perform a variety of tasks. Occupational nurses, besides medical role, also play important organizational roles in their units. The cooperation between the two professional groups is, however, slightly disturbed by the deficits in communication. This issue needs to be improved for the betterment of operations within the whole system. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  16. 45 CFR 60.2 - Applicability of these regulations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... authorities; professional societies of physicians, dentists or other health care practitioners which take... health care practitioners, physicians, dentists, or entities; and entities (including insurance companies...

  17. 45 CFR 60.2 - Applicability of these regulations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... authorities; professional societies of physicians, dentists or other health care practitioners which take... health care practitioners, physicians, dentists, or entities; and entities (including insurance companies...

  18. 45 CFR 60.2 - Applicability of these regulations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... authorities; professional societies of physicians, dentists or other health care practitioners which take... health care practitioners, physicians, dentists, or entities; and entities (including insurance companies...

  19. Balancing the professional and personal.

    PubMed

    Armstrong, Alicia Y; Alvero, Ruben J; Dunlow, Susan; Nace, Mary Catherine; Baker, Valerie; Stewart, Elizabeth A

    2009-01-01

    To review the common roles that physicians pursue away from work and identify related challenges and potential solutions, so that individuals can develop a personalized plan for success in each of the areas. Literature review. University-based and university-affiliated medical centers. No subjects were involved in this literature review. Literature searches in Entrez PubMed and the following Websites: http://www.apgo.org, http://www.psychiatrictimes.com, as well as other data sources. Results of physician surveys and summaries of strategies for achieving work-personal life balance. According to surveys of physicians in various specialties, a majority of physicians have high levels of job, marital, and parental satisfaction. However, professional and personal challenges faced by physicians include struggle with time management, lack of mentorship, and difficulty maintaining intimate relationships. Multiple potentially effective strategies have been described in the literature, including exerting control over hours worked, taking a long view of life that acknowledges the need for changing priorities over time, developing communication skills, seeking counseling services if needed that focus on physician relationships, and simplifying home life whenever possible. Although there are unique challenges in being a physician, partner, and parent, many of the professional challenges faced by physicians are common to many adults in the United States. Self-assessment may help individuals to clarify priorities and develop strategies that can lead to improved personal satisfaction.

  20. The sunshine act and medical publications: Guidance from professional medical associations.

    PubMed

    Toroser, Dikran; DeTora, Lisa; Cairns, Angela; Juneja, Renu; Georgieva, Anna; Weigel, Al; Pepitone, Kim

    2015-01-01

    To review guidance from professional medical associations to physicians on the Sunshine Act, with a focus on industry support for medical publications. Using 'Sunshine Act' as a search term, we searched PubMed (dates February 2013 to November 2014) and the 'grey literature' using Google and Google Scholar. Online information was extracted from websites of pre-identified professional medical associations. Some professional medical associations have published peer-reviewed recommendations, position statements or general advice on their websites and in journals around the Sunshine Act. Associations also provided broad online educational resources for physicians. There was universal agreement between peer-reviewed publications, including guidelines, for the need for full transparency and disclosure of industry support. Surveys by some professional associations showed variance in opinion on the forecasted impact of the Sunshine Act on physician-industry relationships. There was scarce information specifically related to reporting requirements for industry-supported medical publications. There is a shortage of information for physicians from professional associations regarding the Sunshine Act and support for medical publications. Due to the lack of clear guidance regarding support for publications, there are presently varying interpretations of the Sunshine Act. The literature debates the potential impact of the Sunshine Act and expresses some concerns that physician-enabled innovation in drug development may be hindered.

  1. Tiny Moments Matter: Promoting Professionalism in Everyday Practice.

    PubMed

    Bernabeo, Elizabeth C; Chesluk, Benjamin; Lynn, Lorna

    2018-01-01

    Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior. In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach. Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning. Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.

  2. Veterinary professional associates: does the profession's foresight include a mid-tier professional similar to physician assistants?

    PubMed

    Kogan, Lori R; Stewart, Sherry M

    2009-01-01

    The projected shortage of veterinarians has created a need to explore alternatives designed to meet society's future demands. A veterinary professional health care provider, similar to the human medical profession's physician assistant (PA), is one such alternative. To explore this option, this paper provides background information on the development of PAs, including the motivations behind the initiative and the history of the role's development. Rather than aiming for a persuasive appeal, the authors have written this article with the intent of fostering discussion. It is suggested that perhaps veterinary professional associates, modeled after PAs, could be employed to handle routine veterinary care and thereby allow veterinarians additional time to focus on the more demanding and challenging aspects of veterinary medicine. Perhaps a team approach, similar to the physician/PA team, could help the field of veterinary medicine to better serve both clients and patients. As veterinary medicine directs its attention toward the new challenges on the horizon, creative solutions will be needed. Perhaps some variation of a veterinary professional associate is worthy of future discussion.

  3. Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout.

    PubMed

    Schrijver, Iris

    2016-09-01

    -In the past decades, physician wellness has diminished in every aspect of professional life. Burnout symptoms in the United States affect 30% to 68% of physicians overall-exceeding the levels of any other professional group. The ramifications of burnout present an underrecognized crisis in the health care system that carries the consequences of personal, professional, institutional, and societal costs. -To bring to light the elements of current medical practice that contribute to physician professional fulfillment and burnout. Intervention measures, steps toward burnout prevention, and the present limitations thereof are also addressed. -This narrative literature review was performed by using studies in PubMed (National Center for Biotechnology Information) and large online physician surveys, published through December 2015. Because of geographic differences, the review is primarily concentrated on physicians across specialties in the United States. Small studies and those of single disciplines were excluded. -Many physicians learn to tolerate burnout symptoms despite negative personal consequences. Long-term work-related stress, however, may lead to the potential for negative effects on the quality of patient care, and to attrition. Interestingly, the factors that enhance physician fulfillment and those that may precipitate burnout symptoms are distinct. Optimization of physician well-being, therefore, requires tailored approaches in each of these 2 dimensions and is most likely to succeed if it includes approaches that are customized to career phase, physician specialty, and practice setting. Importantly, organization leaders must prioritize this issue and provide sustained support for wellness initiatives, to foster a culture that is conducive to physician well-being.

  4. Professional e-mail communication among health care providers: proposing evidence-based guidelines.

    PubMed

    Malka, S Terez; Kessler, Chad S; Abraham, John; Emmet, Thomas W; Wilbur, Lee

    2015-01-01

    E-mail is now a primary method of correspondence in health care, and proficiency with professional e-mail use is a vital skill for physicians. Fundamentals of e-mail courtesy can be derived from lay literature, but there is a dearth of scientific literature that addresses the use of e-mail between physicians. E-mail communication between providers is generally more familiar and casual than other professional interactions, which can promote unprofessional behavior or misunderstanding. Not only e-mail content but also wording, format, and tone may influence clinical recommendations and perceptions of the e-mail sender. In addition, there are serious legal and ethical implications when unprofessional or unsecured e-mails related to patient-identifying information are exchanged or included within an electronic medical record. The authors believe that the appropriate use of e-mail is a vital skill for physicians, with serious legal and ethical ramifications and the potential to affect professional development and patient care. In this article, the authors analyze a comprehensive literature search, explore several facets of e-mail use between physicians, and offer specific recommendations for professional e-mail use.

  5. [Physicians in 19th century Mexico: between State control and professional autonomy].

    PubMed

    Carrillo, Ana María

    2002-01-01

    This article analyses the struggles of 19th century Mexican physicians to gain professional autonomy versus the state. Medical practitioners sought to resist the imposition of a series of state measures, including directives to attend all patients and provide free care to the poor, forced adherence to political ideologies, state control of medical education, penal action in cases of professional liability, violation of medical confidentiality, and challenges to professional freedom. The article shows the reach of political power over medical practice in the 19th century, and explains the range and limits of the power of the medical profession.

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

    PubMed Central

    Ly, Dan P; Seabury, Seth A

    2015-01-01

    Objectives To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. Design Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. Setting United States. Participants 48 881 physicians, 10 086 dentists, 13 883 pharmacists, 159 044 nurses, 18 920 healthcare executives, 59 284 lawyers, and 6 339 310 other non-healthcare professionals. Main outcome measures Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). Results After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. Conclusions Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce. PMID:25694110

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

    PubMed

    Ly, Dan P; Seabury, Seth A; Jena, Anupam B

    2015-02-18

    To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. United States. 48,881 physicians, 10,086 dentists, 13,883 pharmacists, 159,044 nurses, 18,920 healthcare executives, 59,284 lawyers, and 6,339,310 other non-healthcare professionals. Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce. © Ly et al 2015.

  8. Physicians, social media, and conflict of interest.

    PubMed

    Decamp, Matthew

    2013-02-01

    Physicians and patients increasingly use social media technologies, such as Facebook, Twitter, and weblogs (blogs), both professionally and personally. Amidst recent reports of physician misbehavior online, as well as concerns about social media's potential negative effect on trust in the medical profession, several national-level physician organizations have created professional guidelines on social media use by physicians. Missing from these guidelines is adequate attention to conflict of interest. Some guidelines do not explicitly mention conflict of interest; others recommend only disclosure. Recommending disclosure fails to appreciate the unique features of social media that make adequate disclosure difficult to accomplish. Moreover, in emphasizing disclosure alone, current guidelines are inconsistent with medicine's general trend toward management or elimination, not just disclosure, of potential conflicts. Because social media sites typically rely on physicians' voluntary compliance with professional norms, physicians necessarily play a major role in shaping these norms' content and scope. To achieve the benefits of social media and ensure the veracity of social media content while preserving trust in the profession, physicians must reaffirm their commitment to disclose potential conflicts; advocate for better electronic disclosure mechanisms; and develop concrete management strategies-including, where necessary, the elimination of conflicts altogether.

  9. A View from the Professional Schools: Public Health.

    ERIC Educational Resources Information Center

    Gemmell, Michael K.

    1987-01-01

    Issues and trends affecting professional education for public health careers are examined, including specialization shortages, physician faculty shortages, declining federal support, and changing student demographics. (MSE)

  10. The advanced practice professionals' perspective: keys to a good working relationship between advanced practice professions and physicians.

    PubMed

    Polansky, Maura

    2013-01-01

    A strong working relationship between advanced practice professionals (APPs) and supervising oncologists is essential for reducing medical errors, retaining employees, and improving work environments. Although there is rather limited data on the unique relationship of the APP and physician, fundamental communication skills-including open communication, mutual respect, establishing expectations, and working with mutual purpose-should be the foundation of these relationships. This paper addresses various aspects of relationship building between APPs and physicians with suggestions for establishing successful working relationships.

  11. 78 FR 59427 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.13, Fiscal Year 2014 Update

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-26

    ...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

  12. 76 FR 60136 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.8, 2012 Fiscal Year Update

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-28

    ...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

  13. 77 FR 55269 - Reasonable Charges for Inpatient MS-DRGs and SNF Medical Services; V3.11, 2013; Fiscal Year Update

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-07

    ...; physician and other professional charges, including professional charges for anesthesia services and dental... professional charges for anesthesia services and dental services; pathology and laboratory charges; observation...

  14. Tobacco use among adolescents. Strategies for prevention.

    PubMed

    Epps, R P; Manley, M W; Glynn, T J

    1995-04-01

    Tobacco use is a major public health problem that has its onset during childhood and adolescence. To prevent the onset, physicians can reach children and their parents in their offices beginning in the prenatal period and continuing through adulthood. For pediatricians and other physicians who care for children, NCI recommends five office-based activities that begin with the letter A. The 5 As include anticipatory guidance, ask, advise, assist, and arrange follow-up visits. Elimination of tobacco use requires a comprehensive strategy that includes health professional interventions, policy changes, advertising restrictions, comprehensive school-based programs, community activities, and advocacy approaches. Physicians and health professionals have major roles to play in each of these interventions.

  15. Do Doctors Vote?

    PubMed Central

    Asch, David A.; Armstrong, Katrina

    2007-01-01

    BACKGROUND Organizational leaders and scholars have issued calls for the medical profession to refocus its efforts on fulfilling the core tenets of professionalism. A key element of professionalism is participation in community affairs. OBJECTIVE To measure physician voting rates as an indicator of civic participation. DESIGN Cross-sectional survey of a subgroup of physicians from a nationally representative household survey of civilian, noninstitutionalized adult citizens. PARTICIPANTS A total of 350,870 participants in the Current Population Survey (CPS) November Voter Supplement from 1996–2002, including 1,274 physicians and 1,886 lawyers; 414,989 participants in the CPS survey from 1976–1982, including 2,033 health professionals. MEASUREMENTS Multivariate logistic regression models were used to compare adjusted physician voting rates in the 1996–2002 congressional and presidential elections with those of lawyers and the general population and to compare voting rates of health professionals in 1996–2002 with those in 1976–1992. RESULTS After multivariate adjustment for characteristics known to be associated with voting rates, physicians were less likely to vote than the general population in 1998 (odds ratio 0.76; 95% confidence interval [CI] 0.59–0.99), 2000 (odds ratio 0.64; 95% CI 0.44–0.93), and 2002 (odds ratio 0.62; 95% CI 0.48–0.80) but not 1996 (odds ratio 0.83; 95% CI 0.59–1.17). Lawyers voted at higher rates than the general population and doctors in all four elections (P < .001). The pooled adjusted odds ratio for physician voting across the four elections was 0.70 (CI 0.61–0.81). No substantial changes in voting rates for health professionals were observed between 1976–1982 and 1996–2002. CONCLUSIONS Physicians have lower adjusted voting rates than lawyers and the general population, suggesting reduced civic participation. PMID:17443365

  16. International workshop on "professionalism in the practice of medicine- where are we now?"

    PubMed

    Paltiel, Ora; Lowenstein, Lior; Demma, Jonathan; Manor, Orly

    2017-04-03

    Medical professionalism refers to attributes, values, behaviors, responsibilities and commitments of physicians that are congruent with the public's expectations. An international workshop on medical professionalism took place at the Dead Sea, Israel, on December 11-12, 2016. The meeting brought together local medical professionals, physicians and others, as well as international experts, to discuss definitions of professionalism and wrestle with current challenges facing the profession including its perceived status and physician satisfaction, unprofessional behavior and its relation to health care quality and patient safety, and professionalism as a learned competence. Individual medical schools reported on educational efforts to promote professionalism in their curricula. Patient complaints as an improvement mechanism were explored on a national and health plan level. I was found that complaints regarding physician behavior are rare in the Israeli context and need to be dealt with expeditiously at a local level in order to be effective tools for change. The meeting provided a venue to understand local and international strategies and mechanism for regulation and self-regulation, highlighting the role of the Israel Medical Association. A major focus of the meeting was on intergenerational differences in attitude and practice and the necessary adaptation of medicine to the digital age. We provide an overview of the topics addressed, synopsis, evaluation and lessons learned in this first-ever national meeting on medical professionalism in Israel.

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

    PubMed

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

    2018-03-28

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

  18. How do doctors choose where they want to work? - motives for choice of current workplace among physicians registered in Finland 1977-2006.

    PubMed

    Heikkilä, Teppo Juhani; Hyppölä, Harri; Aine, Tiina; Halila, Hannu; Vänskä, Jukka; Kujala, Santero; Virjo, Irma; Mattila, Kari

    2014-02-01

    Though there are a number of studies investigating the career choices of physicians, there are only few concerning doctors' choices of workplace. A random sample (N=7758) of physicians licensed in Finland during the years 1977-2006 was surveyed. Respondents were asked: "To what extent did the following motives affect your choice of your current workplace?" Respondents were grouped based on several background variables. The groups were used as independent variables in univariate analysis of covariance (ANCOVA). The factors Good workplace, Career and professional development, Non-work related issues, Personal contacts and Salary were formed and used as dependent variables. There were significant differences between groups of physicians, especially in terms of gender, working sector and specialties. The association of Good workplace, Career and professional development, and Non-work related issues with the choice of a workplace significantly decreased with age. Female physicians were more concerned with Career and professional development and Non-work related issues. Since more females are entering the medical profession and there is an ongoing change of generations, health care organizations and policy makers need to develop a new philosophy in order to attract physicians. This will need to include more human-centric management and leadership, better possibilities for continuous professional development, and more personalized working arrangements depending on physician's personal motives. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Licensed physicians who work in prisons: a profile.

    PubMed Central

    Lichtenstein, R L; Rykwalder, A

    1983-01-01

    A profile of the personal and professional characteristics of the physicians who work in America's prisons was obtained by analyzing data from a larger study of all licensed physicians in the United States who worked in a prison at least 12 hours a month during the fall of 1979. Psychiatrists were not included, nor were physicians working in jails. The population of 382 prison physicians comprised two major groups--those who worked in prisons full time and those who worked in them part time. Part-time physicians, who represented the majority of physicians involved in prison work (58 percent), were found to resemble closely the typical physician in the United States; they were predominantly trained in America, specialized, and board certified. In contrast, full-time prison physicians, who accounted for 73 percent of the total hours physicians spent working in prisons, differed significantly from the typical U.S. physician. They were older, less specialized, less likely to be board certified, and more likely to be graduates of non-U.S. medical schools. The professional characteristics of the full-time prison physicians raise serious questions about the quality of medical care they are likely to provide. It would seem, based on their professional attributes, that the part-time physicians are able to provide better quality care than their full-time colleagues. Prison health system could thus assure higher quality care to inmates by relying primarily on part-time rather than full-time practitioners. PMID:6419274

  20. Good physicians from the perspective of their patients

    PubMed Central

    Schattner, Ami; Rudin, Dan; Jellin, Navah

    2004-01-01

    Background It is not currently known what is the patient's viewpoint of a "good" physician. We set out to define patient's priorities regarding different physician's attributes in 3 domains important in medical care. Methods Patients hospitalized or attending clinics at a large teaching hospital selected the 4 attributes that they considered most important out of 21 listed arbitrarily in a questionnaire. The questionnaire included 7 items each in the domains of patient autonomy, professional expertise and humanism. Results Participating patients (n = 445, mean age 57.5 ± 16 years) selected professional expertise (50%), physician's patience and attentiveness (38% and 30%, respectively), and informing the patient, representing the patient's interests, being truthful and respecting patient's preferences (25–36% each) as the most essential attributes. Patient's selections were not significantly influenced by different demographic or clinical background. Selections of attributes in the domain of patient's autonomy were significantly more frequent and this was the preferred domain for 31% and as important as another domain for 16% – significantly more than the domain of professional expertise (P = 0.008), and much more than the domain of humanism and support (P < 0.0005). Conclusions Patients studied want their physicians to be highly professional and expert clinicians and show humaneness and support, but their first priority is for the physician to respect their autonomy. PMID:15361255

  1. Physician Manpower in Georgia: Report of the Task Force for Physician Manpower to the Georgia Comprehensive Health Planning Council.

    ERIC Educational Resources Information Center

    Georgia State Dept. of Public Health, Atlanta. Office of Comprehensive Health Planning.

    This report is a result of a study of the state's physician manpower by representatives of the fields of medical education and professional practice in Georgia. Contents include introduction and principal findings, recommendations, and analysis of present supply of physicians and other data. Recommendations suggest improvement of the utilization…

  2. The Professionalism Assessment of Clinical Teachers (PACT): The Reliability and Validity of a Novel Tool to Evaluate Professional and Clinical Teaching Behaviors

    ERIC Educational Resources Information Center

    Young, Meredith E.; Cruess, Sylvia R.; Cruess, Richard L.; Steinert, Yvonne

    2014-01-01

    Physicians function as clinicians, teachers, and role models within the clinical environment. Negative learning environments have been shown to be due to many factors, including the presence of unprofessional behaviors among clinical teachers. Reliable and valid assessments of clinical teacher performance, including professional behaviors, may…

  3. Breaking the glass ceiling.

    PubMed

    Lazarus, A

    1997-03-01

    The glass ceiling is a form of organizational bias and discrimination that prevents qualified professionals from achieving positions of top governance and leadership. This article examines glass ceiling barriers that keep physicians from the upper reaches of management. While these factors apply mainly to women and minority physicians in academia, and are attributable to sexual harassment and discrimination, physicians as a class are frequently denied executive management positions. Such denial results from inadequate preparation for a career in health care administration. Important issues in the professional development of physician executives include mentoring, training and education, administrative experience, and cultural and personality factors. All of those must be considered when making the transition from medicine to management.

  4. A qualitative thematic content analysis of medical students' essays on professionalism.

    PubMed

    Park, So-Youn; Shon, Changwoo; Kwon, Oh Young; Yoon, Tai Young; Kwon, Ivo

    2017-05-03

    Physicians in both Western and Eastern countries are being confronted by changes in health care delivery systems and medical professionalism values. The traditional concept of "In-Sul" (benevolent art) and the modern history of South Korea have led to cultural differences between South Korea and other countries in conceptualizing medical professionalism; thus, we studied medical students' perceptions of professionalism as described in essays written on this topic. In 2014, we asked 109 first-year medical students who were enrolled in a compulsory ethics course to anonymously write a description of an instance of medical professionalism that they had witnessed, as well as reflecting on their own professional context. We then processed 105 valid essays using thematic content analysis with computer-assisted qualitative data analysis software. Thematic analysis of the students' essays revealed two core aspects of professionalism in South Korea, one focused on respect for patients and the other on physicians' accountability. The most common theme regarding physician-patient relationships was trust. By contrast, distributive justice was thought to be a non-essential aspect of professionalism. In Western countries, physicians tend to promote justice in the health care system, including fair distribution of medical resources; however, we found that medical students in South Korea were more inclined to emphasize doctors' relationships with patients. Medical educators should develop curricular interventions regarding medical professionalism to meet the legitimate needs of patients in their own culture. Because professionalism is a dynamic construct of culture, medical educators should reaffirm cultural context-specific definitions of professionalism for development of associated curricula.

  5. "Once when i was on call...," theory versus reality in training for professionalism.

    PubMed

    Eggly, Susan; Brennan, Simone; Wiese-Rometsch, Wilhelmine

    2005-04-01

    To identify the degree to which interns' reported experiences with professional and unprofessional behavior converge and/or diverge with ideal professional behavior proposed by the physician community. Interns at Wayne State University's residency programs in internal medicine, family medicine, and transitional medicine responded to essay questions about their experience with professional and unprofessional behavior as part of a curriculum on professionalism. Responses were coded for whether they reflected each of the principles and responsibilities outlined in a major publication on physician professionalism. Content analysis included the frequencies with which the interns' essays reflected each principle or responsibility. Additionally, a thematic analysis revealed themes of professional behavior that emerged from the essays. Interns' experiences with professional and unprofessional behavior most frequently converged with ideal behavior proposed by the physician community in categories involving interpersonal interactions with patients. Interns infrequently reported experiences involving behavior related to systems or sociopolitical issues. Interns' essays reflect their concern with interpersonal interactions with patients, but they are either less exposed to or less interested in describing behavior regarding systems or sociopolitical issues. This may be due to their stage of training or to the emphasis placed on interpersonal rather than systems or sociopolitical issues during training. The authors recommend future proposals of ideal professional behavior be revised periodically to reflect current experiences of practicing physicians, trainees, other health care providers and patients. Greater educational emphasis should be placed on the systems and sociopolitical environment in which trainees practice.

  6. Prevalence of and Attitudes towards Smoking among Spanish Health Professionals.

    PubMed

    Jiménez-Ruiz, Carlos A; Riesco Miranda, Juan Antonio; Ramos Pinedo, Angela; de Higes Martinez, Eva; Marquez, Francisca Lourdes; Palomo Cobos, Luis; Solano Reina, Segismundo; de Granda Orive, Jose Ignacio; de Lucas Ramos, Pilar

    2015-01-01

    The MPOWER strategy encourages suitable monitoring of the tobacco epidemic among health professionals in all countries. To analyse the prevalence of and attitudes towards tobacco use among Spanish health professionals. A study was conducted based on an online survey. The study population consisted of health professionals (primary care physicians, specialist physicians and nurses). The questionnaire used included questions about tobacco consumption, knowledge of and attitudes towards smoking. The sample size was calculated according to a database with 9,500 e-mail addresses and listings of health centres and hospitals all over Spain. Statistical analysis was done using the SPSS software programme. The study group comprised a total of 612 health professionals: 322 were women (52.6%), 196 were nurses and 416 were physicians. 11.7% of health professionals were smokers (9.6% regular smokers and 2.1% occasional smokers) and 41.3% were ex-smokers. Within the group of daily smokers, differences were observed between the nurses and the physicians: 11.2 versus 8.9% (p = 0.009). Smoking was recognized as a chronic disorder by 58.2% of health professionals, and 54.6% knew that the most effective intervention to help quit is a combination of psychological and pharmacological treatment. 56% of health professionals always asked their patients about their tobacco consumption. 11.7% of Spanish health professionals are smokers. We found that they have low knowledge about strategies to quit smoking and that there is a low level of therapeutic intervention on smokers. © 2015 S. Karger AG, Basel.

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

    PubMed

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

    2003-07-01

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

  8. Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997.

    PubMed

    Murray, A; Montgomery, J E; Chang, H; Rogers, W H; Inui, T; Safran, D G

    2001-07-01

    To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). Primary care practices in Massachusetts. General internists and family practitioners in Massachusetts. Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P < or =.05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P < or =.01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P < or =.01). This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices.

  9. Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations.

    PubMed

    Zuger, A; Miles, S H

    1987-10-09

    The profound reluctance of some physicians to care for patients with acquired immunodeficiency syndrome prompted us to review medical responses to other historic plagues. No consistent professional tradition emerged. Many physicians, including Galen and Sydenham, fled from patients with contagious epidemic diseases. Many of their colleagues, at considerable personal risk, remained behind to care for plague victims. This inconsistency suggests that an ethic stressing traditional professional duties may not be ideal for defining the optimal relation of the medical profession to patients with acquired immunodeficiency syndrome. A new professional ethic to guide physicians in the acquired immunodeficiency syndrome pandemic is needed. This ethic cannot be entirely derived from these patients' right to health care, which is primarily a claim against society rather than individual practitioners. Civil and professional proscriptions against negligence or abandonment apply only to therapeutic relationships after they are contracted. However, a professional duty to treat human immunodeficiency virus-infected persons could be based on the understanding of medicine as a moral enterprise. In this context, treating human immunodeficiency virus-infected persons is a virtuous act, which meets both patients' and society's health needs and affirms the moral mission of health care.

  10. [Attitudes of physicians and nurses towards health prevention and promotion activities in Primary Care].

    PubMed

    Ramos-Morcillo, Antonio Jesús; Ruzafa-Martínez, María; Fernández-Salazar, Serafín; del-Pino-Casado, Rafael; Armero Barranco, David

    2014-11-01

    To determine the attitudes of physicians and registered nurses in the Andalusian Public Health System towards preventive and health promotion (PHP) interventions in the context of Primary Health Care and the relationship with occupational variables and self-reported competence in PHP. Multicenter, observational, descriptive study. Primary Health Care (PHC), Andalusia, Spain. A total of 282 professionals (physicians and nurses) from 22 Healthcare centers of the Andalusian public health system and who participated in the validation of CAPPAP were included. The attitude of physicians and registered nurses towards PHP activities consisted of five dimensions: improvements necessary, perception of peers attitude, importance, obstacles, and improvement opportunities. The validated CAPPAP questionnaire was used. Occupational variables and questions about self-reported competence in PHP were also included. All dimensions of CAPPAP exceeded the midpoint of the scale (2.5), with their values varying between 3.06 (SD: 0.76) in "improvement necessary", and 4.39 (SD: 0.49) in "importance". The self-declared social, occupational, and competences variables have a statistically significant relationship with the dimensions of the attitude of the professionals except: job experience in PHC, training and implementation of scheduled PHP activities. The attitudes of physicians and registered nurses towards PHP activities are acceptable, and work must be done to sustain it. Healthcare organizations should implement interventions adapted to different professional profiles. They should also increase activities to improve professional skills in order to provide the appropriate care. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  11. Career Paths of First-Year Resident Physicians: A Seven-Year Study.

    ERIC Educational Resources Information Center

    Langwell, Kathryn M.

    1980-01-01

    Information taken from the American Medical Association's Physician Masterfile on career paths of all physicians who began an initial U.S. residency in 1968 is presented. Data, presented separately for men and women residents, are included for licensure and certification, major professional activities, specialty choices, and location decisions.…

  12. Development of an inter-professional educational program for home care professionals: Evaluation of short-term effects in suburban areas.

    PubMed

    Tsuchiya, Rumiko; Yoshie, Satoru; Kawagoe, Shohei; Hirahara, Satoshi; Onishi, Hirotaka; Murayama, Hiroshi; Nishinaga, Masanori; Iijima, Katsuya; Tsuji, Tetsuo

    2017-01-01

    Objective　To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods　From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results　The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion　Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.

  13. Doctor Discontent

    PubMed Central

    Murray, Alison; Montgomery, Jana E; Chang, Hong; Rogers, William H; Inui, Thomas; Safran, Dana Gelb

    2001-01-01

    OBJECTIVE To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). DESIGN Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). SETTING Primary care practices in Massachusetts. PARTICIPANTS General internists and family practitioners in Massachusetts. MEASUREMENTS Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. RESULTS Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P ≤ .05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P ≤ .01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P ≤ .01). CONCLUSIONS This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices.

  14. Tutorship process in health care professions: a survey investigation in Emilia Romagna.

    PubMed

    Priami, Diletta; Sollami, Alfonso; Vivoli, Vanessa; Artioli, Giovanna

    2015-09-09

    The areas that we wanted to investigate include: tasks performed, tools used, formalization of the assignment, workload, empowerment and satisfaction of the function performed, and training. The results clearly show that the processes of tutoring are different for physicians and non-physician healthcare professionals. The first interesting difference is the method of assignment of mentoring. While among medical professions the function is assigned by others, tutors are often non-medical volunteers. This evidence leads to two unanswered questions: what are the criteria by which they are chosen as tutors? Do volunteers really possess the skills and ability to carry out this role? Future research should be directed towards clearly defining the profile of the "tutor" among both doctors and non-medical professionals. Another difference is the way the work of the mentor is formalized. If they are doctors, the task is assigned to them; this is not the case for non-medical professions. Despite this difference, a high percentage of both medical professionals and doctors said they did not feel valued for their role of tutor. However, differences emerge: physicians see their role as a paid tutor and / or recognized in their curriculum vitae. For non-medical professions, however, the only reward is a recognition of ECM (Educazione Continua in Medicina)credits. A common feature among professionals is that for both physicians and non-physician healthcare tutors, a system of evaluation is rarely reported. Another common feature is the skills that professionals would like to see improved. Both groups of professionals, in fact, would like to see improved teaching methods, communication strategies and reporting and evaluation systems. Finally, non-physician tutors report the same level of satisfaction, although the non-physician professionals are more satisfied in their relationship with colleagues. The degree of empowerment reveals perceived differences and similarities among the professionals. In fact, both professional groups reported the same levels of competence and impact, but differ in meaning and self-determination. More specifically, the non-medical professionals show high scores, while doctors get a higher score for self-determination. These results suggest that for increased attention to the system of evaluation and enhancement of the function tutorial we need not only to increase the satisfaction of those who act as tutors, but also to improve the tutorial process itself. Furthermore, the results suggest the carrying out of training projects for teaching and assessment methods that represent the issues that are most in demand by tutors. The training should include the use of tools for the governance process that project tutorial and apprenticeships. The responses indicate that these tools are already in use, although not as widespread and continuous.

  15. Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards.

    PubMed

    Farnan, Jeanne M; Snyder Sulmasy, Lois; Worster, Brooke K; Chaudhry, Humayun J; Rhyne, Janelle A; Arora, Vineet M

    2013-04-16

    User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient-physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient-physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician-physician communication that preserve confidentiality while best using these technologies.

  16. Social Media and Web Presence for Patients and Professionals: Evolving Trends and Implications for Practice.

    PubMed

    Barreto, Jose E; Whitehair, Curtis L

    2017-05-01

    The use of social media has become very instinctive to many. It has become part of a daily routine. Enhanced communication, liberated expressions of self, becoming updated with all the trends and news, and marketing promotion are only some of the reasons why most people use social media. Health care providers including physicians should take advantage of these platforms for professional purposes. Social media extends far beyond the famous platforms such as Facebook, Twitter, Pinterest, and Instagram, used mostly for social connections. There are sites dedicated to serve professionals, for example, LinkedIn, or even physician-specific forums such as Sermo. The physical medicine and rehabilitation community has a forum (Phyzforum) created by the American Academy of Physical Medicine and Rehabilitation to share questions, comments, and ideas. Moreover, there are broadcast media (Podcast) and blogging sites (WordPress) used by many physiatrists. Surveys show that physicians actively use an average of 2-4 hours of professional-leaning networking sites per week; for example, 44% of physicians use Sermo and 42% use LinkedIn. The participation also extends to more popular sites, with 40%, 25%, and 20% physician participation in YouTube, Blogging, and Twitter, respectively. There are numerous guidelines available for medical practitioners pertaining to professional use of social media. Strategies such as timing of postings and posting content as well as methods to maintain your online reputation are discussed. Various benefits and potential pitfalls with regards to social media use are also analyzed, including how to engage followers and addressing negative comments and reviews. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  17. Effects of Resident Work Hour Limitations on Faculty Professional Lives

    PubMed Central

    Shanafelt, Tait D.; Nathens, Avery B.; Curtis, J. Randall

    2008-01-01

    Background The Accreditation Council for Graduate Medical Education resident work hour limitations were implemented in July, 2003. Effects on faculty are not well understood. Objective The objective of this study was to determine the effects of the resident work hour limitations on the professional lives of faculty physicians. Design and Participants Survey of faculty physicians at three teaching hospitals associated with university-based internal medicine and surgery residency programs in Seattle, Washington. Physicians who attended on Internal Medicine and Surgery in-patient services during the 10 mo after implementation of work hour limitations were eligible for participation (N = 366); 282 physicians (77%) returned surveys. Measurements Participants were asked about the effects of resident work hour limitations on aspects of their professional lives, including clinical work, research, teaching, and professional satisfaction. Results Most attending physicians reported that, because of work hour limitations, they spent more time on clinical work (52%), felt more responsibility for supervising patient care (65%), and spent less time on research or other academic pursuits (51%) and teaching residents (72%). Reported changes in work content were independently associated with the self-reported probability of leaving academic medicine in the next 3 y. Conclusions Resident work hour limitations have had large effects on the professional lives of faculty. These findings may have important implications for recruiting and retaining faculty at academic medical centers. PMID:18612748

  18. Visualizing knowledge and attitude factors related to influenza vaccination of physicians.

    PubMed

    Antón-Ladislao, Ane; García-Gutiérrez, Susana; Soldevila, Núria; González-Candelas, Fernando; Godoy, Pere; Castilla, Jesús; Mayoral, José María; Astray, Jenaro; Martín, Vicente; Tamames, Sonia; Toledo, Diana; Aguirre, Urko; Domínguez, Angela

    2015-02-11

    To characterize groups of primary healthcare physicians according to sociodemographic data, years of professional experience and knowledge of and attitudes to influenza, and to evaluate differences between groups with respect to influenza vaccination in the 2011-2012 season. We carried out an anonymous web survey of Spanish primary healthcare physicians in 2012. Information on vaccination, and knowledge of and attitudes to influenza was collected. Multiple correspondence analysis and cluster analysis were used to define groups of physicians. We included 835 physicians and identified three types. Type B were physicians with low professional experience of influenza. Types A and C were physicians with high professional experience with influenza, type A also had a high awareness of influenza and seasonal vaccination. Types A and C were older and more often male than type B (p<0.0001). Knowledge of influenza was greatest in type A and lowest in type B. Awareness of influenza was greatest in type A and lowest in type C. In type A, 71.0% of physicians were vaccinated in the 2011-2012 season, compared with 48.1% and 33.6% from types B and C, respectively (p<0.001). Additional efforts should be made to increase interest and concerns about preventing the transmission of influenza in physicians who do not believe influenza is a severe disease and are not concerned about its transmission. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. From Nuremberg to Guantanamo Bay: Uses of Physicians in the War on Terror.

    PubMed

    Crosby, Sondra S; Benavidez, Gilbert

    2018-01-01

    Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.

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

    PubMed

    Risberg, Gunilla; Hamberg, Katarina; Johansson, Eva E

    2003-10-27

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

  1. 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

  2. Food for thought: an exploratory study of how physicians experience poor workplace nutrition

    PubMed Central

    2011-01-01

    Background Nutrition is often a casualty of the busy work day for physicians. We aimed to explore physicians' views of their nutrition in the workplace including their perceptions of the impact of inadequate nutrition upon their personal wellness and their professional performance. Methods This is a qualitative study of a sample of 20 physicians practicing in a large urban teaching hospital. Semi-structured open ended interviews were conducted to explore physicians' views of workplace nutrition. The same physicians had agreed to participate in a related nutrition based wellness intervention study that compared nutritional intake and cognitive function during a day of usual nutrition patterns against another day with scheduled nutrition breaks. A second set of interviews was conducted after the intervention study to explore how participation in the intervention impacted these views. Detailed interview content notes were transcribed and analyzed independently with differences reconciled by discussion. Results At initial interview, participants reported difficulty accessing adequate nutrition at work, linking this deficit with emotional (irritable and frustrated), physical (tired and hungry), and cognitive (difficulty concentrating and poor decision making) symptoms. In addition to identifying practical barriers such as lack of time to stop and eat, inconvenient access to food and poor food choices, the physicians described how their sense of professionalism and work ethic also hinder their work nutrition practices. After participating in the intervention, most physicians reported heightened awareness of their nutrition patterns and intentions to improve their workplace nutrition. Conclusions Physicians report that inadequate workplace nutrition has a significant negative impact on their personal wellness and professional performance. Given this threat to health care delivery, health care organizations and the medical profession need to address both the practical and professional barriers identified. PMID:21333008

  3. Computers in medicine: liability issues for physicians.

    PubMed

    Hafner, A W; Filipowicz, A B; Whitely, W P

    1989-07-01

    Physicians routinely use computers to store, access, and retrieve medical information. As computer use becomes even more widespread in medicine, failure to utilize information systems may be seen as a violation of professional custom and lead to findings of professional liability. Even when a technology is not widespread, failure to incorporate it into medical practice may give rise to liability if the technology is accessible to the physician and reduces risk to the patient. Improvement in the availability of medical information sources imposes a greater burden on the physician to keep current and to obtain informed consent from patients. To routinely perform computer-assisted literature searches for informed consent and diagnosis is 'good medicine'. Clinical and diagnostic applications of computer technology now include computer-assisted decision making with the aid of sophisticated databases. Although such systems will expand the knowledge base and competence of physicians, malfunctioning software raises a major liability question. Also, complex computer-driven technology is used in direct patient care. Defective or improperly used hardware or software can lead to patient injury, thus raising additional complicated questions of professional liability and product liability.

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

    PubMed

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

    2016-07-01

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

  5. Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them.

    PubMed

    El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

    2016-12-01

    The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians' choice of workplace, and policy interventions for retaining physicians in the public sector. Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Nineteen articles met the inclusion criteria. Six major themes that affected physicians' choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. While factors affecting physicians' choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross-country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

  6. Exploring dual commitment among physician executives in managed care.

    PubMed

    Hoff, T J

    2001-01-01

    The growth of a medical management specialty is a significant event associated with managed care. Physician executives are lauded for their potential in bridging the clinical and managerial realms. They also serve as a countervailing force to help the medical profession and patients maintain a strong voice in healthcare decision making at the strategic level. However, little is known about their work loyalties. These attitudes are important to explore because they speak to whose interests physician executives consider and represent in their everyday management roles. If physician executives are to maximize their effectiveness in the healthcare workplace, both physicians and organizations must view them as credible sources of authority. This study examines organizational and professional commitment among a national sample of physician executives employed in managed care settings. Data used for the analysis come from a national survey conducted through the American College of Physician Executives in 1996. The findings support the notion that physician executives can and do express simultaneous loyalty to organizational and professional interests. This dual commitment is related to other work attitudes that contribute to success in the management role. In addition, it appears that situational factors increase the chances for dual commitment. These factors derive from a favorable work environment that includes both organizational and professional socialization in the management role. The results of the study are useful in specifying the training and socialization needs of physicians who wish to do management work. They also provide a rationale for collaboration between healthcare organizations and rank-and-file physicians aimed at cultivating physician executives who are credible leaders within the healthcare system.

  7. Primary Care Sports Medicine: A Part-Timer's Perspective.

    ERIC Educational Resources Information Center

    Howe, Warren B.

    1988-01-01

    A family practice physician describes his part-time sports medicine experience, including the multiple roles he plays as team physician, the way sports medicine is integrated into his family practice, and how it affects his professional life and peer relationships. (Author/MT)

  8. Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis.

    PubMed

    Keurhorst, Myrna; van de Glind, Irene; Bitarello do Amaral-Sabadini, Michaela; Anderson, Peter; Kaner, Eileen; Newbury-Birch, Dorothy; Braspenning, Jozé; Wensing, Michel; Heinen, Maud; Laurant, Miranda

    2015-12-01

    Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians. © 2015 Society for the Study of Addiction.

  9. Teaching and Assessing Professionalism in Medical Learners and Practicing Physicians*

    PubMed Central

    Mueller, Paul S.

    2015-01-01

    Professionalism is a core competency of physicians. Clinical knowledge and skills (and their maintenance and improvement), good communication skills, and sound understanding of ethics constitute the foundation of professionalism. Rising from this foundation are behaviors and attributes of professionalism: accountability, altruism, excellence, and humanism, the capstone of which is professionalism. Patients, medical societies, and accrediting organizations expect physicians to be professional. Furthermore, professionalism is associated with better clinical outcomes. Hence, medical learners and practicing physicians should be taught and assessed for professionalism. A number of methods can be used to teach professionalism (e.g. didactic lectures, web-based modules, role modeling, reflection, interactive methods, etc.). Because of the nature of professionalism, no single tool for assessing it among medical learners and practicing physicians exists. Instead, multiple assessment tools must be used (e.g. multi-source feedback using 360-degree reviews, patient feedback, critical incident reports, etc.). Data should be gathered continuously throughout an individual’s career. For the individual learner or practicing physician, data generated by these tools can be used to create a “professionalism portfolio,” the totality of which represents a picture of the individual’s professionalism. This portfolio in turn can be used for formative and summative feedback. Data from professionalism assessments can also be used for developing professionalism curricula and generating research hypotheses. Health care leaders should support teaching and assessing professionalism at all levels of learning and practice and promote learning environments and institutional cultures that are consistent with professionalism precepts. PMID:25973263

  10. Factors associated with professional satisfaction in primary care: Results from EUprimecare project.

    PubMed

    Sanchez-Piedra, Carlos Alberto; Jaruseviciene, Lina; Prado-Galbarro, Francisco Javier; Liseckiene, Ida; Sánchez-Alonso, Fernando; García-Pérez, Sonia; Sarria Santamera, Antonio

    2017-12-01

    Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine. This study explored factors associated with professional satisfaction in seven European countries. A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians. A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8). Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.

  11. Professionalism and maintenance of certification: using vignettes describing interpersonal dilemmas to stimulate reflection and learning.

    PubMed

    Bernabeo, Elizabeth C; Reddy, Siddharta G; Ginsburg, Shiphra; Holmboe, Eric S

    2014-01-01

    Physicians do not always agree on "rules" governing behavior in professionally challenging situations. Little is known about contextual factors that influence physician approaches in these situations. We explored the individual-, social-, and societal-level factors that physicians consider when responding to 2 common professional dilemmas. We were particularly interested in knowing the extent to which physicians engage in self-reflection as a result of responding to the vignettes. A cross-sectional Web-based survey was sent to a random sample of 396 physicians, prompting them to respond to scripted professional dilemmas. A total of 120 physicians responded, yielding a response rate of 32.6%. Physicians responded to these dilemmas in highly variable ways, negotiating a complex array of contextual factors in their decisions. Interacting factors involving individual-level physician (eg, worry, guilt), patient (eg, nature of medical condition or relationship with patient), and social/societal (eg, policy, what peers or colleagues do) were important drivers in physician responses. Qualitative analysis revealed that several interacting themes guide physician approaches to professional dilemmas: patient welfare; types of patients; political, ethical, or legal issues; guiding principles; values; rules; and habits. Physicians negotiate a complex set of individual-, social-, and societal-level factors in response to professional dilemmas. This finding has important implications for the promotion and assessment of professional behavior in practicing physicians. Reflecting on scenarios may be an opportunity for physicians to learn about how and why they make decisions in difficult situations. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  12. Regulatory Organizations for Physicians’ Status and Administrative Sanctions on Physicians

    PubMed Central

    MORIOKA, Yasuhiko; HIGUCHI, Norio; KUROYANAGI, Tatsuo; NUDESHIMA, Jiro

    2014-01-01

    Society bestows professional privilege on physicians. At the same time, it expects physicians to strive constantly to improve their ethics and quality in medical expertise. In every nation, some level of government is responsible for certifying or licensing physicians and imposes strict management, including revoking licenses from inappropriate physicians or providing severe sanctions for misconduct or conduct unbecoming of a physician. In reality, however, it is difficult to reduce the number of inappropriate or indiscreet physicians, and each nation faces its own challenges. We conducted a questionnaire survey of 13 national medical associations, including some major Western countries, regarding the licensing of physicians, the organizations managing their medical practice status, and the data and grounds for administrative sanctioning of physicians. We then examined the circumstances in Japan based on the survey results and pointed out the domestic issues. PMID:25784827

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

    PubMed

    Papic, Ognjen; Malak, Ziad; Rosenberg, Ellen

    2012-02-01

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

  14. 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.

  15. Is conscientious objection incompatible with a physician's professional obligations?

    PubMed

    Wicclair, Mark R

    2008-01-01

    In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician's professional obligations (the "incompatibility thesis"). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician's professional obligations unequivocally supports the incompatibility thesis.

  16. Professionalism of physicians at a major teaching hospital during the Fukushima nuclear disaster.

    PubMed

    Narita, M; Tokuda, Y; Barnett, P

    2016-07-01

    It poses a serious problem if physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Counterpoint: physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed.

    PubMed

    White, Andrew P; Vaccaro, Alexander R; Zdeblick, Thomas

    2007-05-15

    Review of the nature of conflicts of interest in physician-industry relationships, with a focus on the efforts to ethically manage physician-industry relationships. To illustrate the perspective that physician-industry relationships can be ethically established, and conflicts of interest can be ethically managed. The interest in considering the appropriateness of physician-industry relationships has recently become focused on spine surgery. Many of the conflicts of interest inherent to these relationships have been interpreted as problematic, and have been scrutinized by the media, industry, medical and legal professions, and Federal government. The basis for conflicts of interest, manner in which bias may be introduced, and methods to reduce bias are presented. The potential risks and benefits to patients that are inherent to physician-industry relationships are considered. A framework, developed by medical ethicists, is provided to guide analysis of conflicts of interest in physician-industry relationships. Collaboration between spine surgeons and industry is necessary to improve patient care. The conflicts of interest that often arise in physician-industry relationships must be recognized, and keenly managed in order to eliminate the risk and maximize the benefit to the patient. Ethical management of conflicts must include disclosure. To preserve patient autonomy, management should also include a discussion of the quality of the medical evidence on which treatment recommendations are made. Guidelines from industry and medical professional organizations, including the "Standards of Professionalism" currently under development by the American Academy of Orthopedic Surgery, are also expected to aid in the ethical establishment and management of conflicts of interest. Careful consideration of conflicts of interest in physician-industry relationships has provided an opportunity to review our goals as physicians in society, and to continue collaborative advancement of our field for the benefit of our patients.

  18. "Us and them": a social network analysis of physicians' professional networks and their attitudes towards EBM.

    PubMed

    Mascia, Daniele; Cicchetti, Americo; Damiani, Gianfranco

    2013-10-22

    Extant research suggests that there is a strong social component to Evidence-Based Medicine (EBM) adoption since professional networks amongst physicians are strongly associated with their attitudes towards EBM. Despite this evidence, it is still unknown whether individual attitudes to use scientific evidence in clinical decision-making influence the position that physicians hold in their professional network. This paper explores how physicians' attitudes towards EBM is related to the network position they occupy within healthcare organizations. Data pertain to a sample of Italian physicians, whose professional network relationships, demographics and work-profile characteristics were collected. A social network analysis was performed to capture the structural importance of physicians in the collaboration network by the means of a core-periphery analysis and the computation of network centrality indicators. Then, regression analysis was used to test the association between the network position of individual clinicians and their attitudes towards EBM. Findings documented that the overall network structure is made up of a dense cohesive core of physicians and of less connected clinicians who occupy the periphery. A negative association between the physicians' attitudes towards EBM and the coreness they exhibited in the professional network was also found. Network centrality indicators confirmed these results documenting a negative association between physicians' propensity to use EBM and their structural importance in the professional network. Attitudes that physicians show towards EBM are related to the part (core or periphery) of the professional networks to which they belong as well as to their structural importance. By identifying virtuous attitudes and behaviors of professionals within their organizations, policymakers and executives may avoid marginalization and stimulate integration and continuity of care, both within and across the boundaries of healthcare providers.

  19. [Shaare Zedek Medical Center's model of an integrated division of internal medicine].

    PubMed

    Yinnon, Amos M; Munter, Gabriel; Friedmann, Reuven; Katz, David; Nesher, Gideon; Tichler, Thomas; Zevin, Shoshana

    2014-01-01

    The specialty and practice of internal medicine have been subject to serious challenges in the last two decades. We describe the integrative model of internal medicine as developed in our hospital, providing solutions to some major challenges. Major components include: (1) Senior physicians and residents are employed by the Division rather than individual Departments of Medicine, allowing for balanced distribution of professional capabilities. (2) Two medical departments specialize in geriatric medicine, while the other departments take care of younger, more intellectually challenging patients. Senior and junior staff members rotate through these departments, allowing for exposure to different patient populations and professional expertise. (3) The backbone of senior physicians is rewarded by a set of incentives, including dedicated time for research. (4) Senior staff from the subspecialties contributes annually 1-2 months as senior physicians in the departments and receive academic and other compensation for their efforts. (5) In cases where medical departments elsewhere are flooded with corridor admissions (a source of frustration and burnout), a short admission unit in the emergency department relieves internal medicine pressures and shortens evaluation and therapy for many patients. Our integrative model of internal medicine allows for improved patient and staff distribution, greater satisfaction among patients and family members, greater professional satisfaction among physicians, while resident vacancies are filled with competent residents.

  20. [Position paper from the Department of Ethics of the Chilean College of Physicians about conscientious objection].

    PubMed

    Salas, Sofía P; Besio, Mauricio; Bórquez Estefó, Gladys; Salinas, Rodrigo A; Valenzuela, Carlos Y; Micolich, Constanza; Novoa Sotta, Fernando; Bernier Villarroel, Lioniel; Montt M, Julio; Misseroni Raddatz, Adelio

    2016-03-01

    The Chilean bill that regulates abortion for three cases (Bulletin Nº 9895-11) includes the possibility that health professionals may manifest their conscientious objection (CO) to perform this procedure. Due to the broad impact that the issue of C O had, the Ethics Department of the Chilean College of Physicians considered important to review this concept and its ethical and legal basis, especially in the field of sexual and reproductive health. In the present document, we define the practical limit s of CO, both for the proper fulfillment of the medical profession obligations, and for the due respect and non-discrimination that the professional objector deserves. We analyze the denial of some health institutions to perform abortions if it is legalize d, and we end with recommendations adjusted to the Chilean reality. Specifically, we recognize the right to conscientious objection that all physicians who directly participate in a professional act have. But we a lso recognize that physicians have ineludib le obligations towards their patients, including the obligation to inform about the existence of this service, how to access to it and -as set out in our code of ethics- to ensure that another colleague will continue attending the patient.

  1. Gender and the professional career of primary care physicians in Andalusia (Spain)

    PubMed Central

    2011-01-01

    Background Although the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities. Methods Descriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS), patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses. Results Response: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p < 0.001). Female physicians with FMS: 44.2%, male physicians with FMS: 33.3% (p < 0.001). Female physicians dedicated more hours to housework and more frequently lived alone versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked. Conclusions There are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study. PMID:21356111

  2. Health care provider confidence and exercise prescription practices of Exercise is Medicine Canada workshop attendees.

    PubMed

    O'Brien, Myles W; Shields, Christopher A; Oh, Paul I; Fowles, Jonathon R

    2017-04-01

    The Exercise is Medicine Canada (EIMC) initiative promotes physical activity counselling and exercise prescription within health care. The purpose of this study was to evaluate perceptions and practices around physical activity counselling and exercise prescription in health care professionals before and after EIMC training. Prior to and directly following EIMC workshops, 209 participants (physicians (n = 113); allied health professionals (AHPs) (n = 54), including primarily nurses (n = 36) and others; and exercise professionals (EPs) (n = 23), including kinesiologists (n = 16), physiotherapists (n = 5), and personal trainers (n = 2)) from 7 provinces completed self-reflection questionnaires. Compared with AHPs, physicians saw more patients (78% > 15 patients/day vs 93% < 15 patients/day; p < 0.001) and reported lower frequencies of exercise counselling during routine client encounters (48% vs 72% in most sessions; p < 0.001). EPs had higher confidence providing physical activity information (92 ± 11%) compared with both physicians (52 ± 25%; p < 0.001) and AHPs (56 ± 24%; p < 0.001). Physicians indicated that they experienced greater difficulty including physical activity and exercise counselling into sessions (2.74 ± 0.71, out of 5) compared with AHPs (2.17 ± 0.94; p = 0.001) and EPs (1.43 ± 0.66; p < 0.001). Physicians rated the most impactful barriers to exercise prescription as lack of patient interest (2.77 ± 0.85 out of 4), resources (2.65 ± 0.82 out of 4), and time (2.62 ± 0.71 out of 4). The majority of physicians (85%) provided a written prescription for exercise in <10% of appointments. Following the workshop, 87% of physician attendees proposed at least one change to practice; 47% intended on changing their practice by prescribing exercise routinely, and 33% planned on increasing physical activity and exercise counselling, measured through open-ended responses.

  3. Measuring Professionalism in Medicine and Nursing: Results of a European Survey

    PubMed Central

    Lombarts, Kiki M. J. M. H.; Plochg, Thomas; Thompson, Caroline A.; Arah, Onyebuchi A.

    2014-01-01

    Background Leveraging professionalism has been put forward as a strategy to drive improvement of patient care. We investigate professionalism as a factor influencing the uptake of quality improvement activities by physicians and nurses working in European hospitals. Objective To (i) investigate the reliability and validity of data yielded by using the self-developed professionalism measurement tool for physicians and nurses, (ii) describe their levels of professionalism displayed, and (iii) quantify the extent to which professional attitudes would predict professional behaviors. Methods and Materials We designed and deployed survey instruments amongst 5920 physicians and nurses working in European hospitals. This was conducted under the cross-sectional multilevel study “Deepening Our Understanding of Quality Improvement in Europe” (DUQuE). We used psychometric and generalized linear mixed modelling techniques to address the aforementioned objectives. Results In all, 2067 (response rate 69.8%) physicians and 2805 nurses (94.8%) representing 74 hospitals in 7 European countries participated. The professionalism instrument revealed five subscales of professional attitude and one scale for professional behaviour with moderate to high internal consistency and reliability. Physicians and nurses display equally high professional attitude sum scores (11.8 and 11.9 respectively out of 16) but seem to have different perceptions towards separate professionalism aspects. Lastly, professionals displaying higher levels of professional attitudes were more involved in quality improvement actions (physicians: b = 0.019, P<0.0001; nurses: b = 0.016, P<0.0001) and more inclined to report colleagues’ underperformance (physicians – odds ratio (OR) 1.12, 95% CI 1.01–1.24; nurses – OR 1.11, 95% CI 1.01–1.23) or medical errors (physicians – OR 1.14, 95% CI 1.01–1.23; nurses – OR 1.43, 95% CI 1.22–1.67). Involvement in QI actions was found to increase the odds of reporting incompetence or medical errors. Conclusion A tool that reliably and validly measures European physicians’ and nurses’ commitment to professionalism is now available. Collectively leveraging professionalism as a quality improvement strategy may be beneficial to patient care quality. PMID:24849320

  4. 17 CFR 200.305 - Special procedure: Medical records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... (a) Statement of physician or mental health professional. When an individual requests access to... request a signed statement by his physician or a mental health professional indicating that, in their... adverse effect on the individual. (b) Designation of physician or mental health professional to receive...

  5. 17 CFR 200.305 - Special procedure: Medical records.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... (a) Statement of physician or mental health professional. When an individual requests access to... request a signed statement by his physician or a mental health professional indicating that, in their... adverse effect on the individual. (b) Designation of physician or mental health professional to receive...

  6. 17 CFR 200.305 - Special procedure: Medical records.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... (a) Statement of physician or mental health professional. When an individual requests access to... request a signed statement by his physician or a mental health professional indicating that, in their... adverse effect on the individual. (b) Designation of physician or mental health professional to receive...

  7. 17 CFR 200.305 - Special procedure: Medical records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... (a) Statement of physician or mental health professional. When an individual requests access to... request a signed statement by his physician or a mental health professional indicating that, in their... adverse effect on the individual. (b) Designation of physician or mental health professional to receive...

  8. 17 CFR 200.305 - Special procedure: Medical records.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... (a) Statement of physician or mental health professional. When an individual requests access to... request a signed statement by his physician or a mental health professional indicating that, in their... adverse effect on the individual. (b) Designation of physician or mental health professional to receive...

  9. Teaching Medicine as a Profession in the Service of Healing.

    ERIC Educational Resources Information Center

    Cruess, Richard L.; Cruess, Sylvia R.

    1997-01-01

    The relationship between professions and society is changing rapidly. However, society still values the physician as healer and professional. Medicine's professional associations and academic institutions must ensure that all physicians understand professionalism and accept its obligations. They should encourage physicians' moral and intellectual…

  10. Physician views on practicing professionalism in the corporate age.

    PubMed

    Castellani, B; Wear, D

    2000-07-01

    Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman's thesis and education for both students and physicians requires a major overhaul.

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

    PubMed

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

    2018-03-01

    In a previous randomized crossover study, patients perceived a physician delivering a more optimistic message (MO) as more compassionate and professional. However, the impact of the clinical outcome of the patient on patient's perception of physician's level of compassion and professionalism has not been previously studied. Our aim was to determine if the reported clinical outcome modified the patient's perception of physician compassion, professionalism, impression, and preference for physician. One hundred twenty-eight advanced cancer patients in an outpatient Supportive Care Center were randomized to complete validated questionnaires about patients' perception of physician's level of compassion, professionalism, impression, and preference of physician for themselves and their family after watching scripted videos depicting a physician delivering an MO versus a less optimistic (LO) message followed by a clinical vignette depicting a worse outcome. Median age was 61 years and 55% were female. There was no difference in compassion score after the vignette in the MO and LO groups. However, there were significantly worse overall impression and professionalism scores in both the MO and LO groups after the vignette. In the MO group, preference for the physician for themselves and their family significantly decreased after the vignette. Seeing a worse clinical outcome did not change the patients' appraisal of an inappropriately optimistic physician. However, it reduced the overall impression of both physicians that conveyed an MO or an LO message and it also resulted in less likelihood of choosing the MO physician for themselves and their family. The study found that a patient's perception of a physician's compassion did not change after reading a vignette describing a negative clinical outcome, regardless of whether the physician had given a more or a less optimistic message to the patient. However, the results suggested that patients perceived worse professionalism and overall physician impression scores for both more and less optimistic physicians and lower likelihood to choose the more optimistic physician for themselves and their family. © AlphaMed Press 2017.

  12. Rise of Health Consumerism in China and Its Effects on Physicians' Professional Identity and the Physician-Patient Relationship and Communication.

    PubMed

    Tang, Lu; Guan, Mengfei

    2018-05-01

    The physician-patient relationship in China is highly strained. This study examined the professional identity of physicians and their perceptions of the physician-patient relationship against the backdrop of the rise of health consumerism in China. Structured interviews with 29 physicians found that the marketization of medical care and the rise of health consumerism caused physicians to have a conflicted professional identity. The traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm's length relationship characterized by self-interest, opportunism, and mistrust. In addition, the transition from physician-centered communication to patient-centered communication in China was tenacious. Theoretical and practical implications of the current study are discussed.

  13. 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.

  14. Nurses' professional values and attitudes toward collaboration with physicians.

    PubMed

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

    2015-03-01

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

  15. Physician Internet Medical Information Seeking and On-line Continuing Education Use Patterns.

    ERIC Educational Resources Information Center

    Casebeer, Linda; Bennett, Nancy; Kristofco, Robert; Carillo, Anna; Centor, Robert

    2002-01-01

    Responses from 2,200 physicians indicated that nearly all have Internet access and use it primarily for medical information and professional development, not for communicating with patients. Credibility of source, speed, accessibility, and searching ease were most important. Barriers included information overload and too little information…

  16. Professional profile of pediatric intensivists in Rio de Janeiro, southeastern Brazil.

    PubMed

    Lacerda, Jandra Corrêa de; Barbosa, Arnaldo Prata; Cunha, Antonio José Ledo Alves da

    2011-12-01

    This study described the sociodemographic profile and professional qualifications of pediatric intensive care physicians in the State of Rio de Janeiro (RJ), southeastern Brazil. This investigation was an observational, cross-sectional and descriptive study that was conducted in neonatal, pediatric and mixed intensive care units in the State of Rio de Janeiro. Physicians working in the participating intensive care units voluntarily completed a semistructured and anonymous questionnaire. Questionnaires that were not returned within 30 days were considered lost, and questionnaires with less than 75% questions completed were excluded. The differences in neonatal and pediatric intensive care physicians' medical training were compared using the Chi-squared test with a 5% significance level. A total of 410 physicians were included in this study: 84% female, 48% between 30 and 39 years old and 45% with monthly incomes between US $1,700 to 2,700. Forty percent of these physicians worked exclusively in this specialty, and 72% worked in more than one intensive care unit. Only 50% of the participants had received specific training (either medical residency or specialization) in neonatology, and only 33% were board-certified specialists in this area. Only 27% of the physicians had received specific training in pediatric intensive care medicine, and only 17% were board-certified specialists (p < 0.0005 for both comparisons). Most (87%) physicians had participated in scientific events within the past 5 years, and 55% used the internet for continued medical education. However, only 25% had participated in any research. Most (63%) physicians were dissatisfied with their professional activity; 49% were dissatisfied due to working conditions, 23% due to low incomes and 18% due to training-related issues. These results suggested that the medical qualifications of neonatal and pediatric intensive care physicians in the State of Rio de Janeiro, Brazil are inadequate, especially in pediatric intensive care medicine. A high level of dissatisfaction was reported, which may jeopardize the quality of medical assistance that is provided by these professionals.

  17. The use of Spanish language skills by physicians and nurses: policy implications for teaching and testing.

    PubMed

    Diamond, Lisa C; Tuot, Delphine S; Karliner, Leah S

    2012-01-01

    Language barriers present a substantial communication challenge in the hospital setting. To describe how clinicians with various levels of Spanish language proficiency work with interpreters or their own Spanish skills in common clinical scenarios. Survey of physicians and nurses who report ever speaking Spanish with patients on a general medicine hospital floor. Spanish proficiency rated on a 5-point scale, self-reported use of specific strategies (own Spanish skills, professional or ad-hoc interpreters) to overcome the language barrier. Sixty-eight physicians and 65 nurses participated. Physicians with low-level Spanish proficiency reported frequent use of ad-hoc interpreters for all information-based scenarios, except pre-rounding in the morning when most reported using their own Spanish skills. For difficult conversations and procedural consent, most used professional interpreters. Comparatively, physicians with medium proficiency reported higher rates of using their own Spanish skills for information-based scenarios, lower rates of professional interpreter use, and little use of ad-hoc interpreters. They rarely used their own Spanish skills or ad-hoc interpreters for difficult conversations. Physicians with high-level Spanish proficiency almost uniformly reported using their own Spanish skills. The majority (82%) of nurses had low-level Spanish proficiency, and frequently worked with professional interpreters for educating patients, but more often used ad hoc interpreters and their own Spanish skills for information-based scenarios, including medication administration. Physicians and nurses with limited Spanish proficiency use these skills, even in important clinical circumstances in the hospital. Health-care organizations should evaluate clinicians' non-English language proficiency and set policies about use of language skills in clinical care.

  18. Stimulating and Enhancing Partnerships Between Transplant Professionals and Law Enforcement: Recommendations.

    PubMed

    Capron, Alexander Morgan; Muller, Elmi; Erlich, Gilad; John, Manoj; Bienstock, Ric Esther; McCarren, Mark; Palmer, Robin; Scheper-Hughes, Nancy; Siegel, Dina; Yankov, Jordan

    2016-02-01

    To help combat trafficking in human beings for organ removal (THBOR), transplant professionals need to do more than carry out careful, multidisciplinary screening of potential living donors; they also need to communicate and collaborate with law enforcement professionals. This will involve transplant professionals educating investigators and prosecutors about transplant practices and in turn learning about THBOR and how it is prosecuted. Cases of illegal organ transplantation need to be detected at different levels. First, the victims of the crime itself need to be identified, especially when they present themselves for screening. Physicians have a collective responsibility to prevent exploitation of people, including THBOR victims. The second level involves the more difficult matter of making reports that involve transplant tourists who have returned home after receipt of an organ and need follow-up care. Besides counseling patients prospectively about the legal as well as medical risks in receiving a vended organ in a foreign transplant center, physicians treating such patients could have an obligation to report what has happened, if the government has established a mechanism that either allows reporting THBOR that does not include the identity of the patient or that treats patients as victims provided they cooperate in investigation and prosecution of the persons responsible for obtaining or implanting the organs. The third level of cooperation involves transplant professionals who participate in THBOR. Professional societies need to undertake programs to make physicians and nurses aware that their responsibility to protect their professions' reputation includes identifying members of their professions who depart from professional ethics. Doing so allows the local professional societies and state boards to discipline such violators. All 3 of these functions would be facilitated by the creation by an international body such as World Health Organization of a registry of patients who travel internationally to receive a legitimate organ transplant.

  19. Stimulating and Enhancing Partnerships Between Transplant Professionals and Law Enforcement: Recommendations

    PubMed Central

    Capron, Alexander Morgan; Muller, Elmi; Erlich, Gilad; John, Manoj; Bienstock, Ric Esther; McCarren, Mark; Palmer, Robin; Scheper-Hughes, Nancy; Siegel, Dina; Yankov, Jordan

    2016-01-01

    Abstract To help combat trafficking in human beings for organ removal (THBOR), transplant professionals need to do more than carry out careful, multidisciplinary screening of potential living donors; they also need to communicate and collaborate with law enforcement professionals. This will involve transplant professionals educating investigators and prosecutors about transplant practices and in turn learning about THBOR and how it is prosecuted. Cases of illegal organ transplantation need to be detected at different levels. First, the victims of the crime itself need to be identified, especially when they present themselves for screening. Physicians have a collective responsibility to prevent exploitation of people, including THBOR victims. The second level involves the more difficult matter of making reports that involve transplant tourists who have returned home after receipt of an organ and need follow-up care. Besides counseling patients prospectively about the legal as well as medical risks in receiving a vended organ in a foreign transplant center, physicians treating such patients could have an obligation to report what has happened, if the government has established a mechanism that either allows reporting THBOR that does not include the identity of the patient or that treats patients as victims provided they cooperate in investigation and prosecution of the persons responsible for obtaining or implanting the organs. The third level of cooperation involves transplant professionals who participate in THBOR. Professional societies need to undertake programs to make physicians and nurses aware that their responsibility to protect their professions' reputation includes identifying members of their professions who depart from professional ethics. Doing so allows the local professional societies and state boards to discipline such violators. All 3 of these functions would be facilitated by the creation by an international body such as World Health Organization of a registry of patients who travel internationally to receive a legitimate organ transplant. PMID:27500250

  20. Social Media and the Practicing Hematologist: Twitter 101 for the Busy Healthcare Provider.

    PubMed

    Thompson, Michael A; Majhail, Navneet S; Wood, William A; Perales, Miguel-Angel; Chaboissier, Mélanie

    2015-12-01

    Social media is a relatively new form of media that includes social networks for communication dissemination and interaction. Patients, physicians, and other users are active on social media including the microblogging platform Twitter. Many online resources are available to facilitate joining and adding to online conversations. Social media can be used for professional uses, therefore, we include anecdotes of physicians starting on and implementing social media successfully despite the limits of time in busy practices. Various applications demonstrating the utility of social media are explored. These include case discussions, patient groups, research collaborations, medical education, and crowdsourcing/crowdfunding. Social media is integrating into the professional workflow for some individuals and hematology/oncology societies. The potential for improving hematology care and research is just starting to be explored.

  1. Social Media and the Practicing Hematologist: Twitter 101 for the Busy Healthcare Provider

    PubMed Central

    Thompson, Michael A.; Majhail, Navneet S.; Wood, William A.; Perales, Miguel-Angel; Chaboissier, Mélanie

    2015-01-01

    Social media is a relatively new form of media that includes social networks for communication dissemination and interaction. Patients, physicians, and other users are active on social media including the microblogging platform Twitter. Many online resources are available to facilitate joining and adding to online conversations. Social media can be used for professional uses, therefore we include anecdotes of physicians starting on and implementing social media successfully despite the limits of time in busy practices. Various applications demonstrating the utility of social media are explored. These include case discussions, patient groups, research collaborations, medical education and crowdsourcing/crowdfunding. Social media is integrating into the professional workflow for some individuals and hematology/oncology societies. The potential for improving hematology care and research is just starting to be explored. PMID:26449718

  2. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews.

    PubMed

    Chauhan, Bhupendrasinh F; Jeyaraman, Maya M; Mann, Amrinder Singh; Lys, Justin; Skidmore, Becky; Sibley, Kathryn M; Abou-Setta, Ahmed M; Zarychanski, Ryan

    2017-01-05

    There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. Study design: overview of reviews. MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.

  3. Physicians’ Outlook on ICD-10-CM/PCS and Its Effect on Their Practice

    PubMed Central

    Watzlaf, Valerie; Alkarwi, Zahraa; Meyers, Sandy; Sheridan, Patty

    2015-01-01

    Background The United States is one of the last countries to change from ICD-9-CM to ICD-10-CM/PCS. The compliance date for implementation of ICD-10-CM/PCS is expected to fall on October 1, 2015. Objectives Evaluate physicians’ perceptions on the change from ICD-9-CM to ICD-10-CM/PCS and its effect on their practice, determine how HIM professionals can assist in this transition, and assess what resources are needed to aid in the transition. Results Twenty physicians were asked to participate in one of three focus groups. Twelve physicians (60 percent) agreed to participate. Top concerns included electronic health record software readiness, increase in documentation specificity and time, ability of healthcare professionals to learn a new language, and inadequacy of current training methods and content. Conclusion Physicians expressed that advantages of ICD-10-CM/PCS were effective data analytics and complexity of patient cases with more specific codes. Health information management professionals were touted as needed during the transition to create simple, clear specialty guides and crosswalks as well as education and training tools specific for physicians. PMID:26807074

  4. [Gender differences in the perception of professional achievement in family medicine, Spain].

    PubMed

    Saletti-Cuesta, Lorena; Delgado, Ana; Ortiz-Gómez, Teresa; López-Fernández, Luis Andrés

    2013-01-01

    The concept of achievement is important to study the professional development. In medicine there are gender inequalities in career. The purpose was to know and compare the professional achievement's perceptions and attributions of female and male primary care physicians in Andalusia. Qualitative study with 12 focus groups (October 2009 to November 2010). primary care physicians. intentionally segmented by age, sex and health care management. Were conducted by sex: two groups with young physicians, two groups with middle aged and two with health care management. TOTAL: 32 female physician and 33 male physicians. Qualitative content analysis with Nuddist Vivo. Female and male physicians agree to perceive internal achievements and to consider aspects inherent to the profession as external achievements. The most important difference is that female physician related professional achievement with affective bond and male physician with institutional merit. Internal attributions are more important for female physician who also highlight the importance of family, the organization of working time and work-family balance. Patients, continuing education, institutional resources and computer system are the most important attributions for male physician. There are similarities and differences between female and male physicians both in the understanding and the attributions of achievement. The differences are explained by the gender system. The perception of achievement of the female physicians questions the dominant professional culture and incorporates new values in defining achievement. The attributions reflect the unequal impact of family and organizational variables and suggest that the female physicians would be changing gender socialization.

  5. The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy.

    PubMed

    Robinson, J J; Wharrad, H

    2001-05-01

    The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations' data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (Wharrad & Robinson 1999). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (Robinson & Wharrad 2000). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as "attendance at birth by trained personnel" (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

  6. 42 CFR 417.1 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... osteopathy), dentists, nurses, podiatrists, optometrists, physicians' assistants, clinical psychologists... osteopathy and of such other licensed health professionals (including dentists, optometrists, and podiatrists...

  7. 42 CFR 417.1 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... osteopathy), dentists, nurses, podiatrists, optometrists, physicians' assistants, clinical psychologists... osteopathy and of such other licensed health professionals (including dentists, optometrists, and podiatrists...

  8. "If you cannot tolerate that risk, you should never become a physician": a qualitative study about existential experiences among physicians.

    PubMed

    Aase, M; Nordrehaug, J E; Malterud, K

    2008-11-01

    Physicians are exposed to matters of existential character at work, but little is known about the personal impact of such issues. To explore how physicians experience and cope with existential aspects of their clinical work and how such experiences affect their professional identities, a qualitative study using individual semistructured interviews has analysed accounts of their experiences related to coping with such challenges. Analysis was by systematic text condensation. The purposeful sample comprised 10 physicians (including three women), aged 33-66 years, residents or specialists in cardiology or cardiothoracic surgery, working in a university hospital with 24-hour emergency service and one general practitioner. Participants described a process by which they were able to develop a capacity for coping with the existential challenges at work. After episodes perceived as shocking or horrible earlier in their career, they at present said that they could deal with death and mostly keep it at a distance. Vulnerability was closely linked to professional responsibility and identity, perceived as a burden to be handled. These demands were balanced by an experience of meaning related to their job, connected to making a difference in their patients' lives. Belonging to a community of their fellows was a presupposition for coping with the loneliness and powerlessness related to their vulnerable professional position. Physicians' vulnerability facing life and death has been underestimated. Belonging to caring communities may assist growth and coping on exposure to existential aspects of clinical work and developing a professional identity.

  9. Physician satisfaction and burnout at different career stages.

    PubMed

    Dyrbye, Liselotte N; Varkey, Prathibha; Boone, Sonja L; Satele, Daniel V; Sloan, Jeff A; Shanafelt, Tait D

    2013-12-01

    To explore the work lives, professional satisfaction, and burnout of US physicians by career stage and differences across sexes, specialties, and practice setting. We conducted a cross-sectional study that involved a large sample of US physicians from all specialty disciplines in June 2011. The survey included the Maslach Burnout Inventory and items that explored professional life and career satisfaction. Physicians who had been in practice 10 years or less, 11 to 20 years, and 21 years or more were considered to be in early, middle, and late career, respectively. Early career physicians had the lowest satisfaction with overall career choice (being a physician), the highest frequency of work-home conflicts, and the highest rates of depersonalization (all P<.001). Physicians in middle career worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and their work-life balance, and had the highest rates of emotional exhaustion and burnout (all P<.001). Middle career physicians were most likely to plan to leave the practice of medicine for reasons other than retirement in the next 24 months (4.8%, 12.5%, and 5.2% for early, middle, and late career, respectively). The challenges of middle career were observed in both men and women and across specialties and practice types. Burnout, satisfaction, and other professional challenges for physicians vary by career stage. Middle career appears to be a particularly challenging time for physicians. Efforts to promote career satisfaction, reduce burnout, and facilitate retention need to be expanded beyond early career interventions and may need to be tailored by career stage. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  10. Medical Students and Staff Physicians: The Question of Social Media.

    PubMed

    Noller, Michael; Mai, Johnny P; Zapanta, Philip E; Camacho, Macario

    2017-07-01

    Social media's prevalence among the professional world is rapidly increasing. Its use among medical personnel-specifically, medical students, resident physicians, and staff physicians-could compromise personal-professional boundaries. Could the acceptance or lack of acceptance of a friend request bias the medical student application process? If friend requests are accepted, then medical students, resident physicians, and staff physicians are provided access to very personal aspects of one another's lives, which may not have been the intent. The question remains whether the separation of one's personal life from work is necessary. Should medical students restrict social media relationships with residents and staff physicians to professional social media networks? The suitability and opportunities of social media among medical professionals is an ongoing issue for research that needs continued evaluation.

  11. Uncovering paradoxes from physicians' experiences of patient-centered ward-round.

    PubMed

    Bååthe, Fredrik; Ahlborg, Gunnar; Edgren, Lars; Lagström, Annica; Nilsson, Kerstin

    2016-05-03

    Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.

  12. American College of Physicians

    MedlinePlus

    ... Journals & Publications Clinical Resources & Products High Value Care Ethics & Professionalism Practice Resources Physician and Practice Timeline Upcoming ... Journals & Publications Clinical Resources & Products High Value Care Ethics & Professionalism Practice Resources Physician and Practice Timeline Upcoming ...

  13. Narrative reflective practice in medical education for residents: composing shifting identities

    PubMed Central

    Clandinin, Jean; Cave, Marie Thérèse; Cave, Andrew

    2011-01-01

    As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students’ professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called “parallel charts”. They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher). Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making. PMID:23745070

  14. Narrative reflective practice in medical education for residents: composing shifting identities.

    PubMed

    Clandinin, Jean; Cave, Marie Thérèse; Cave, Andrew

    2011-01-01

    As researchers note, medical educators need to create situations to work with physicians in training to help them attend to the development of their professional identities. While there is a call for such changes to be included in medical education, educational approaches that facilitate attention to the development of medical students' professional identities, that is, who they are and who they are becoming as physicians, are still under development. One pedagogical strategy involves narrative reflective practice as a way to develop physician identity. Using this approach, medical residents first write narrative accounts of their experiences with patients in what are called "parallel charts". They then engage in a collaborative narrative inquiry within a sustained inquiry group of other residents and two researcher/facilitators (one physician, one narrative researcher). Preliminary studies of this approach are underway. Drawing on the experiences of one medical resident in one such inquiry group, we show how this pedagogical strategy enables attending to physician identity making.

  15. Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings

    PubMed Central

    2013-01-01

    Background Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel. Methods A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. Questionnaires were mailed to all healthcare workers of 11 randomly selected hospitals. Linear and logistic regression models were used to examine predictors for implementing EBP. Results In total, 6,160 returned questionnaires, including 645 from physicians, 4,206 from nurses, 430 from pharmacists, 179 from physical therapists, 537 from technicians, and 163 from other allied healthcare professionals, were valid for the analysis. Physicians and pharmacists were more aware of EBP than were the other professional groups (p < 0.001). Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups (p < 0.001). Physicians had more sufficient knowledge and skills of EBP than did the other professionals (p < 0.001); in addition, they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP (p < 0.001). Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants: EBP training, having a faculty position, academic degree, one's profession, and perceptions (beliefs, attitudes, knowledge, skills and barriers). Conclusions This study depicts various levels of EBP implementation among medical, nursing, pharmacological, and allied healthcare personnel. There were significant differences in their implementation of EBP. We observed that certain factors were associated with EBP implementation, including personal backgrounds and perceptions toward EBP. The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals. PMID:24063756

  16. Physicians' perceptions on the impact of telemedicine on recruitment and retention in underserved areas: a descriptive study in Senegal.

    PubMed

    Ly, Birama Apho; Bourgeault, Ivy Lynn; Labonté, Ronald; Niang, Mbayang Ndiaye

    2017-09-18

    Similar to many places, physicians in Senegal are unevenly distributed. Telemedicine is considered a potential solution to this problem. This study investigated the perceptions of Senegal's physicians of the impact of telemedicine on their recruitment to and retention in underserved areas. We conducted individual interviews with a random sample of 60 physicians in Senegal, including 30 physicians working in public hospitals and 30 physicians working in district health centres between January and June 2014, as part of a mixed methods study. Data were collected using a semi-structured interview guide comprising both open- and close-ended questions. Interviews were recorded, transcribed and coded thematically using NVivo 10 software using a priori and emergent codes. Participants' characteristics were analyzed descriptively using SPSS 23. The impact of telemedicine on physicians' recruitment and retention in underserved areas was perceived with some variability. Among the physicians who were interviewed, most (36) thought that telemedicine could have a positive impact on their recruitment and retention but many (24) believed the opposite. The advantages noted by the first included telemedicine's ability to break their professional isolation and reduce the stress related to this, facilitate their distance learning and improve their working conditions. They did acknowledge that it is not sufficient in itself, an opinion also shared by physicians who did not believe that telemedicine could affect their recruitment and retention. Both identified contextual, economic, educational, family, individual, organizational and professional factors as influential. Based on these opinions of physicians, telemedicine promotion is one intervention that, alongside others, could be promoted to assist in addressing the multiple factors that influence physicians' recruitment and retention in underserved areas.

  17. Whose job? The staffing of advance care planning support in twelve international healthcare organizations: a qualitative interview study.

    PubMed

    Dixon, Josie; Knapp, Martin

    2018-05-24

    ACP involving a facilitated conversation with a health or care professional is more effective than document completion alone. In policy, there is an expectation that health and care professionals will provide ACP support, commonly within their existing roles. However, the potential contributions of different professionals are outlined only broadly in policy and guidance. Research on opportunities and barriers for involving different professionals in providing ACP support, and feasible models for doing so, is currently lacking. We identified twelve healthcare organizations aiming to offer system-wide ACP support in the United States, Canada, Australia and New Zealand. In each, we conducted an average 13 in-depth interviews with senior managers, ACP leads, dedicated ACP facilitators, physicians, nurses, social workers and other clinical and non-clinical staff. Interviews were analyzed thematically using NVivo software. Organizations emphasized leadership for ACP support, including strategic support from senior managers and intensive day-to-day support from ACP leads, to support staff to deliver ACP support within their existing roles. Over-reliance on dedicated facilitators was not considered sustainable or scalable. We found many professionals, from all backgrounds, providing ACP support. However, there remained barriers, particularly for facilitating ACP conversations. A significant barrier for all professionals was lack of time. Physicians sometimes had poor communication skills, misunderstood medico-legal aspects and tended to have conversations of limited scope late in the disease trajectory. However, they could also have concerns about the appropriateness of ACP conversations conducted by others. Social workers had good facilitation skills and understood legal aspects but needed more clinical support than nurses. While ACP support provided alongside and as part of other care was common, ACP conversations in this context could easily get squeezed out or become fragmented. Referrals to other professionals could be insecure. Team-based models involving a physician and a nurse or social worker were considered cost-effective and supportive of good quality care but could require some additional resource. Effective staffing of ACP support is likely to require intensive local leadership, attention to physician concerns while avoiding an entirely physician-led approach, some additional resource and team-based frameworks, including in evolving models of care for chronic illness and end of life.

  18. Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner

    PubMed Central

    de Bruijn, Matthijs C; Kollen, Boudewijn J; Baarveld, Frank

    2013-01-01

    Background In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred. Methods This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared. Results A total of 234 patients were included (mean age 33.7 years, 59.1% male). Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred. Conclusion In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further. PMID:24379706

  19. Effect of Peer-to-Peer Nurse-Physician Collaboration on Attitudes Toward the Nurse-Physician Relationship.

    PubMed

    Edwards, Pamela B; Rea, Jean B; Oermann, Marilyn H; Hegarty, Ellen J; Prewitt, Judy R; Rudd, Mariah; Silva, Susan; Nagler, Alisa; Turner, David A; DeMeo, Stephen D

    The goal of this study was to pilot a novel peer-to-peer nurse-physician collaboration program and assess for changes in attitudes toward collaboration among a group of newly licensed nurses and resident physicians (n = 39). The program included large group meetings, with discussion of key concepts related to interprofessional collaboration. In unit-based teams, the registered nurses and physicians developed a quality improvement project to meet a need on their unit. Creating learning activities like this program enable nursing professional development specialists to promote interprofessional collaboration and learning.

  20. The characteristics of physicians disciplined by professional colleges in Canada.

    PubMed

    Alam, Asim; Klemensberg, Jason; Griesman, Joshua; Bell, Chaim M

    2011-01-01

    The identification of health care professionals who are incompetent, impaired, uncaring or have criminal intent has received increasing attention in recent years. These individuals are often subject to disciplinary action by professional licensing authorities. To date, no national data exist for Canadian physicians disciplined for professional misconduct. We sought to describe the characteristics of physicians disciplined by Canadian professional licensing authorities. We constructed a database of physicians disciplined by provincial licensing authorities during the years 2000 to 2009. Comparisons were made with the general population of physicians licensed in Canada. Data on demographic characteristics, type of misconduct and penalty imposed were collected for each disciplined physician. A total of 606 identifiable physicians were disciplined by their professional college during the years 2000 to 2009. The proportion of licensed physicians who were disciplined in a given year ranged from 0.06% to 0.11%. Fifty-one of the disciplined physicians committed 64 repeat offences, accounting for a total of 113 (19%) offences. Most of the disciplined physicians were independent practitioners (99%), male (92%) and trained in Canada (67%). The most common specialties of physicians subject to disciplinary action were family medicine (62%), psychiatry (14%) and surgery (9%). For disciplined physicians, the average number of years from medical school graduation to disciplinary action was 28.9 (standard deviation [SD] = 11.3). The 3 most frequent violations were sexual misconduct (20%), failure to meet a standard of care (19%) and unprofessional conduct (16%). The 3 most frequently imposed penalties were fines (27%), suspensions (19%) and formal reprimands (18%). A small proportion of registered physicians in Canada were disciplined by their medical licensing authorities. Sexual misconduct was the most common disciplined offence. The standardization of provincial reporting along with the creation of a national database of physician offenders would facilitate more comparable public reporting as well as further research and educational initiatives.

  1. The characteristics of physicians disciplined by professional colleges in Canada

    PubMed Central

    Alam, Asim; Klemensberg, Jason; Griesman, Joshua; Bell, Chaim M

    2011-01-01

    Background The identification of health care professionals who are incompetent, impaired, uncaring or have criminal intent has received increasing attention in recent years. These individuals are often subject to disciplinary action by professional licensing authorities. To date, no national data exist for Canadian physicians disciplined for professional misconduct. We sought to describe the characteristics of physicians disciplined by Canadian professional licensing authorities. Methods We constructed a database of physicians disciplined by provincial licensing authorities during the years 2000 to 2009. Comparisons were made with the general population of physicians licensed in Canada. Data on demographic characteristics, type of misconduct and penalty imposed were collected for each disciplined physician. Results A total of 606 identifiable physicians were disciplined by their professional college during the years 2000 to 2009. The proportion of licensed physicians who were disciplined in a given year ranged from 0.06% to 0.11%. Fifty-one of the disciplined physicians committed 64 repeat offences, accounting for a total of 113 (19%) offences. Most of the disciplined physicians were independent practitioners (99%), male (92%) and trained in Canada (67%). The most common specialties of physicians subject to disciplinary action were family medicine (62%), psychiatry (14%) and surgery (9%). For disciplined physicians, the average number of years from medical school graduation to disciplinary action was 28.9 (standard deviation [SD] = 11.3). The 3 most frequent violations were sexual misconduct (20%), failure to meet a standard of care (19%) and unprofessional conduct (16%). The 3 most frequently imposed penalties were fines (27%), suspensions (19%) and formal reprimands (18%). Interpretation A small proportion of registered physicians in Canada were disciplined by their medical licensing authorities. Sexual misconduct was the most common disciplined offence. The standardization of provincial reporting along with the creation of a national database of physician offenders would facilitate more comparable public reporting as well as further research and educational initiatives. PMID:22567070

  2. The utility of vignettes to stimulate reflection on professionalism: theory and practice.

    PubMed

    Bernabeo, E C; Holmboe, E S; Ross, K; Chesluk, B; Ginsburg, S

    2013-08-01

    Professionalism remains a substantive theme in medical literature. There is an emerging emphasis on sociological and complex adaptive systems perspectives that refocuses attention from just the individual role to working within one's system to enact professionalism in practice. Reflecting on responses to professional dilemmas may be one method to help practicing physicians identify both internal and external factors contributing to (un) professional behavior. We present a rationale and theoretical framework that supports and guides a reflective approach to the self assessment of professionalism. Guided by principles grounded in this theoretical framework, we developed and piloted a set of vignettes on professionally challenging situations, designed to stimulate reflection in practicing physicians. Findings show that participants found the vignettes to be authentic and typical, and reported the group experience as facilitative around discussions of professional ambiguity. Providing an opportunity for physicians to reflect on professional behavior in an open and safe forum may be a practical way to guide physicians to assess themselves on professional behavior and engage with the complexities of their work. The finding that the focus groups led to reflection at a group level suggests that effective reflection on professional behavior may require a socially interactive process. Emphasizing both the behaviors and the internal and external context in which they occur can thus be viewed as critically important for understanding professionalism in practicing physicians.

  3. Let's Have a Tweetup: The Case for Using Twitter Professionally.

    PubMed

    Fuller, Maren Y; Allen, Timothy Craig

    2016-09-01

    Social media use is very common and can be an effective way for professionals to discuss information and interact with colleagues. Twitter (Twitter, Inc, San Francisco, California) is a social media network where posts, termed tweets, are limited to 140 characters. Professional use of Twitter is ideal for physicians interested in both networking and education and is optimally used to facilitate in-person networking. Live-tweeting (posting real-time reactions to events) at professional meetings is also a popular and highly successful use of Twitter. Physicians report patient privacy as the top concern preventing use of social media for professional reasons, and although generally social media use is safe, it is essential to understand how to protect patient confidentially. Other social media platforms with potential for professional use include Facebook (Facebook, Inc, Menlo Park, California), Instagram (Facebook, Inc), YouTube (YouTube, LLC, San Bruno, California), and Periscope (Twitter, Inc). With Twitter and other social media options, now is the time for pathologists to increase our visibility on social media and worldwide.

  4. Viewpoint: professionalism and humanism beyond the academic health center.

    PubMed

    Swick, Herbert M

    2007-11-01

    Medical professionalism and humanism have long been integral to the practice of medicine, and they will continue to shape practice in the 21st century. In recent years, many advances have been made in understanding the nature of medical professionalism and in efforts to teach and assess professional values and behaviors. As more and more teaching of both medical students and residents occurs in settings outside of academic medical centers, it is critically important that community physicians demonstrate behaviors that resonate professionalism and humanism. As teachers, they must be committed to being role models for what physicians should be. Activities that are designed to promote and advance professionalism, then, must take place not only in academic settings but also in clinical practice sites that are beyond the academic health center. The author argues that professionalism and humanism share common values and that each can enrich the other. Because the cauldron of practice threatens to erode traditional values of professionalism, not only for individual physicians but also for the medical profession, practicing physicians must incorporate into practice settings activities that are explicitly designed to exemplify those values, not only with students and patients, but also within their communities. The author cites a number of examples of ways in which professionalism and humanism can be fostered by individual physicians as well as professional organizations.

  5. Factors influencing physicians’ choice of workplace: systematic review of drivers of attrition and policy interventions to address them

    PubMed Central

    El Koussa, Maria; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

    2016-01-01

    Objectives The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians’ choice of workplace, and policy interventions for retaining physicians in the public sector. Methods Five literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings. Results Nineteen articles met the inclusion criteria. Six major themes that affected physicians’ choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions. Conclusion While factors affecting physicians’ choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross–country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector. PMID:27648254

  6. Rehabilitation-specific challenges and advantages in the integration of migrant physicians in Germany: a multiperspective qualitative interview study in rehabilitative settings.

    PubMed

    Jansen, E; Hänel, P; Klingler, C

    2018-07-01

    In Germany, rehabilitative healthcare institutions increasingly rely on migrant physicians to meet their staffing needs. Yet until now, research on the integration of migrant physicians has focussed entirely on the acute care setting. This study is the first to address the specific advantages and challenges to integration in the field of rehabilitative medicine where a high number of migrant physicians work. From the experiences of migrant physicians and their colleagues, we provide actionable suggestions to counteract potential sources of conflict and thereby improve the integration of migrant physicians in the German workforce. We conducted a qualitative interview study. We conducted 23 interviews with a total of 26 participants occupying a variety of roles in two different rehabilitation centres (maximum variation sampling). Interviews were recorded, transcribed verbatim and parsed through thematic analysis. Our research revealed advantages and challenges to integration in three distinct areas: rehabilitative care institutions, competencies of migrant professionals and interpersonal relations. The first set of issues hinges on the work processes within rehabilitative hospitals, professional prospects there and the location of the institutions themselves. Second, migrant physicians may encounter difficulties because of limited linguistic skills and country-specific knowledge. And finally, aspects of their interactions with care teams and patients may constitute barriers to integration. Some of the factors influencing the integration of migrant physicians are the same in both rehabilitative and acute medicine, but the rehabilitative setting presents distinct advantages and challenges that are worthy of study in their own right. We outline several measures which could help overcome challenges to the integration of migrant physicians, including those associated with professional relationships. Further research is needed to develop concrete support programmes. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  7. 45 CFR 60.8 - Reporting licensure actions taken by Boards of Medical Examiners.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... based on reasons relating to a physician's or dentist's professional competence or professional conduct: (1) Which revokes or suspends (or otherwise restricts) a physician's or dentist's license, (2) Which censures, reprimands, or places on probation a physician or dentist, or (3) Under which a physician's or...

  8. 45 CFR 60.8 - Reporting licensure actions taken by Boards of Medical Examiners.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... based on reasons relating to a physician's or dentist's professional competence or professional conduct: (1) Which revokes or suspends (or otherwise restricts) a physician's or dentist's license, (2) Which censures, reprimands, or places on probation a physician or dentist, or (3) Under which a physician's or...

  9. 45 CFR 60.8 - Reporting licensure actions taken by Boards of Medical Examiners.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... based on reasons relating to a physician's or dentist's professional competence or professional conduct: (1) Which revokes or suspends (or otherwise restricts) a physician's or dentist's license, (2) Which censures, reprimands, or places on probation a physician or dentist, or (3) Under which a physician's or...

  10. Joint analyses of open comments and quantitative data: Added value in a job satisfaction survey of hospital professionals.

    PubMed

    Gilles, Ingrid; Mayer, Mauro; Courvoisier, Nelly; Peytremann-Bridevaux, Isabelle

    2017-01-01

    To obtain a comprehensive understanding of the job opinions of hospital professionals by conducting qualitative analyses of the open comments included in a job satisfaction survey and combining these results with the quantitative results. A cross-sectional survey targeting all Lausanne University Hospital professionals was performed in the fall of 2013. The survey considered ten job satisfaction dimensions (e.g. self-fulfilment, workload, management, work-related burnout, organisational commitment, intent to stay) and included an open comment section. Computer-assisted qualitative analyses were conducted on these comments. Satisfaction rates on the included dimensions and professional groups were entered as predictive variables in the qualitative analyses. Of 10 838 hospital professionals, 4978 participated in the survey and 1067 provided open comments. Data from 1045 respondents with usable comments constituted the analytic sample (133 physicians, 393 nurses, 135 laboratory technicians, 247 administrative staff, including researchers, 67 logistic staff, 44 psycho-social workers, and 26 unspecified). Almost a third of the comments addressed scheduling issues, mostly related to problems and exhaustion linked to shifts, work-life balance, and difficulties with colleagues' absences and the consequences for quality of care and patient safety. The other two-thirds related to classic themes included in job satisfaction surveys. Although some comments were provided equally by all professional groups, others were group specific: work and hierarchy pressures for physicians, healthcare quality and patient safety for nurses, skill recognition for administrative staff. Overall, respondents' comments were consistent with their job satisfaction ratings. Open comment analysis provides a comprehensive understanding of hospital professionals' job experiences, allowing better consideration of quality initiatives that match the needs of professionals with reality.

  11. The Relationship between Social Capital in Hospitals and Physician Job Satisfaction

    PubMed Central

    Ommen, Oliver; Driller, Elke; Köhler, Thorsten; Kowalski, Christoph; Ernstmann, Nicole; Neumann, Melanie; Steffen, Petra; Pfaff, Holger

    2009-01-01

    Background Job satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals. Methods The results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables. Results The first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors. Conclusion This analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively. PMID:19445692

  12. A call to include medical humanities in the curriculum of colleges of osteopathic medicine and in applicant selection.

    PubMed

    Hoff, Gary; Hirsch, Norma J; Means, J Jeffrey; Streyffeler, Lisa

    2014-10-01

    Medicine stands at a crossroad. Disruptive physician behavior has increased, and patient satisfaction has decreased. A growing body of knowledge demonstrates that the medical humanities assist in the creation of compassionate, resilient physicians. Incorporating medical humanities into the medical school curriculum promotes the development of compassionate, culturally sensitive physicians, and also encourages the development of resilience in health care professionals at a time when internal and external pressures on physicians are increasing. © 2014 The American Osteopathic Association.

  13. Is current training in basic and advanced cardiac life support (BLS & ACLS) effective? A study of BLS & ACLS knowledge amongst healthcare professionals of North-Kerala.

    PubMed

    Nambiar, Madavan; Nedungalaparambil, Nisanth Menon; Aslesh, Ottapura Prabhakaran

    2016-01-01

    Healthcare professionals are expected to have knowledge of current basic and advanced cardiac life support (BLS/ACLS) guidelines to revive unresponsive patients. A cross-sectional study was conducted to evaluate the current practices and knowledge of BLS/ACLS principles among healthcare professionals of North-Kerala using pretested self-administered structured questionnaire. Answers were validated in accordance with American Heart Association's BLS/ACLS teaching manual and the results were analysed. Among 461 healthcare professionals, 141 (30.6%) were practicing physicians, 268 (58.1%) were nurses and 52 (11.3%) supporting staff. The maximum achievable score was 20 (BLS 15/ACLS 5). The mean score amongst all healthcare professionals was 8.9±4.7. The mean score among physicians, nurses and support staff were 8.6±3.4, 9±3.6 and 9±3.3 respectively. The majority of healthcare professionals scored ≤50% (237, 51.4%); 204 (44.3%) scored 51%-80% and 20 (4.34%) scored >80%. Mean scores decreased with age, male sex and across occupation. Nurses who underwent BLS/ACLS training previously had significantly higher mean scores (10.2±3.4) than untrained (8.2±3.6, P =0.001). Physicians with <5 years experience ( P =0.002) and nurses in the private sector ( P =0.003) had significantly higher scores. One hundred and sixty three (35.3%) healthcare professionals knew the correct airway opening manoeuvres like head tilt, chin lift and jaw thrust. Only 54 (11.7%) respondents were aware that atropine is not used in ACLS for cardiac arrest resuscitation and 79 (17.1%) correctly opted ventricular fibrillation and pulseless ventricular tachycardia as shockable rhythms. The majority of healthcare professionals (356, 77.2%) suggested that BLS/ACLS be included in academic curriculum. Inadequate knowledge of BLS/ACLS principles amongst healthcare professionals, especially physicians, illuminate lacunae in existing training systems and merit urgent redressal.

  14. Pediatric advanced life support and sedation of pediatric dental patients.

    PubMed

    Kim, Jongbin

    2016-03-01

    Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.

  15. Beyond likes and tweets: an in-depth look at the physician social media landscape.

    PubMed

    Fogelson, Nicholas S; Rubin, Zarya A; Ault, Kevin A

    2013-09-01

    Social networking sites are a popular way for physicians to communicate about clinical, professional, and social topics. These sites can be used for educational purposes, professional interaction, and for general discussion. There are many popular sites oriented toward health care professionals, each with their own functionality and style. We reviewed the top physician-oriented networking sites, as well as popular general social networking sites that can be used for physician communication. We also provide background on social media communication, as well as specific advice for online physician communication and a discussion of confidentiality.

  16. The affect of vision and compassion upon role factors in physician leadership.

    PubMed

    Quinn, Joann F

    2015-01-01

    The career path for many professionals is often into a leadership role, yet many professionals do not have the competencies or inclination to lead. This study explores physician leaders as a representative group of professionals. While there have been many efforts at understanding the characteristics of effective physician leaders, a greater understanding is needed on the nature of physician leadership. The largest healthcare organization for physician leaders in the United States was surveyed to gain a greater understanding of the nature of leadership. Partial Lease Squares (PLS) was used to analyze results from 677 online surveys to understand the causal relationship of role conflict and role endorsement to participation. The findings reveal the mediating influence that positivity exerts upon participation, and offers health care leaders an opportunity to increase understanding of the social identification process that leads a higher level of professional participation, which may increase effectiveness for physicians in leadership.

  17. Physicians' professional performance: an occupational health psychology perspective.

    PubMed

    Scheepers, Renée A

    2017-12-01

    Physician work engagement is considered to benefit physicians' professional performance in clinical teaching practice. Following an occupational health psychology perspective, this PhD report presents research on how physicians' professional performance in both doctor and teacher roles can be facilitated by work engagement and how work engagement is facilitated by job resources and personality traits. First, we conducted a systematic review on the impact of physician work engagement and related constructs (e. g. job satisfaction) on physicians' performance in patient care. We additionally investigated physician work engagement and job resources in relation to patient care experience with physicians' performance at ten outpatient clinics covering two hospitals. In a following multicentre survey involving 61 residency training programs of 18 hospitals, we studied associations between physician work engagement and personality traits with resident evaluations of physicians' teaching performance. The findings showed that physician work engagement was associated with fewer reported medical errors and that job satisfaction was associated with better communication and patient satisfaction. Autonomy and learning opportunities were positively associated with physician work engagement. Work engagement was positively associated with teaching performance. In addition, physician work engagement was most likely supported by personality trait conscientiousness (e. g. responsibility). Given the reported associations of physician work engagement with aspects of their professional performance, hospitals could support physician work engagement in service of optimal performance in residency training and patient care. This could be facilitated by worker health surveillance, peer support or promoting job crafting at the individual or team level.

  18. Female family physicians in obstetrics: achieving personal balance.

    PubMed Central

    Carroll, J C; Brown, J B; Reid, A J

    1995-01-01

    OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice. PMID:7497390

  19. Why do they care? Narratives of physician volunteers on motivations for participation in short-term medical missions abroad.

    PubMed

    Caldron, Paul H; Impens, Ann; Pavlova, Milena; Groot, Wim

    2018-01-01

    Short-term medical missions (STMMs) refer to the provision of direct pro bono medical services in lower and middle income countries for periods ranging from days to a few weeks by physicians from rich countries. Survey data have provided limited information on demographic and professional profiles of physicians as well as monetary and manpower inputs. Understanding why physicians participate, however, remains incomplete. The study's objective was to elicit physicians' motivations directly. Semi-structured interviews of physicians identified through snowball recruiting were conducted to explore motivational themes and then analyzed using narrative software employing directed content analysis methodology. Twenty physicians from varying backgrounds and specialties were interviewed. Responses identified aspects of the decision to participate and the relative influence of economic, diplomatic, value-related, and emotive constructs. Personality traits may be more influential to participation than demographic, professional, or socioeconomic determinants. Word-of-mouth recruitment appears to underlie the increase in STMM activity, facilitated by information technology. Reported key motivators for physician participation in STMMs tend to parallel schools of thought regarding philanthropy and volunteering and include satisfaction from helping in challenging conditions of limited resources, learning experiences, appreciation from patients, sense of renewal, and the legacy effect of teaching. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Fostering Professional Communication Skills of Future Physicians and Teachers: Effects of E-Learning with Video Cases and Role-Play

    ERIC Educational Resources Information Center

    Gartmeier, Martin; Bauer, Johannes; Fischer, Martin R.; Hoppe-Seyler, Tobias; Karsten, Gudrun; Kiessling, Claudia; Möller, Grit E.; Wiesbeck, Anne; Prenzel, Manfred

    2015-01-01

    This study investigated the effectiveness of three different versions of a training programme on physician-patient and teacher-parent conversations for medical students and student teachers. The research questions concerned the differential effects of e-learning featuring contrastive video cases, role-play including video feedback and their…

  1. Ethical issues in sports medicine: a review and justification for ethical decision making and reasoning.

    PubMed

    Greenfield, Bruce H; West, Charles Robert

    2012-11-01

    Ethical issues present a challenge for health care professionals working with athletes of sports teams. Health care professionals-including the team physician, the physical therapist, and the athletic trainer-are faced with the challenge of returning an athlete to competition as quickly as possible but as safely as possible. Conflicts of interest arise due to conflicting obligations of the team physician to the athlete and other members of the sports organization, including coaches and the team owner. The multiple stakeholders involved in sports teams challenge the traditional notion of confidentiality and autonomy. The aims of this article are to explicate the ethics of sports medicine, highlight the ethical issues, and provide some strategies and suggestions for ethical decision making.

  2. Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists

    PubMed Central

    Dresden, Graham M.; Baldwin, Laura-Mae; Andrilla, C. Holly A.; Skillman, Susan M.; Benedetti, Thomas J.

    2008-01-01

    PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline—the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics. PMID:18195307

  3. Medical professionalism of foreign-born and foreign-trained physicians under close scrutiny: A qualitative study with stakeholders in Germany.

    PubMed

    Klingler, Corinna; Ismail, Fatiha; Marckmann, Georg; Kuehlmeyer, Katja

    2018-01-01

    Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders' opinions and attitudes towards FB&FT physicians-which likely influence how these physicians settle in-and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians' work performance. Participants criticized FB&FT physicians' work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.

  4. Fostering professional formation in residency: development and evaluation of the "forum" seminar series.

    PubMed

    Nothnagle, Melissa; Reis, Shmuel; Goldman, Roberta E; Anandarajah, Gowri

    2014-01-01

    Residency training is a critical time for physicians' professional formation. However, few structured interventions exist to support residents in this transformative process of integrating personal and professional values, a process that is essential to physician identity formation and preservation of core values such as service and compassion. The authors created a seminar series, the "Forum," to support resident professional formation and address the hidden curriculum as part of a larger intervention to support self-directed learning skills such as goal setting and reflection. Ninety-minute sessions with senior residents and faculty held every other month include opportunities for individual reflection, small- and large-group discussion, and brief didactic components focused on skills such as teaching and leadership. The qualitative program evaluation included analyses of individual semistructured interviews with resident and faculty participants from 2008 to 2011 and of notes recorded by an observer during the 1st year's sessions. Residents appreciated the focus on relevant issues, presence of faculty, opportunities for reflection and interactivity, and inclusion of practical skills. Effects attributed to the Forum included gaining practical skills, feeling a deeper connection to one another and a sense of community, and recognizing progress in their own professional development and growth. Elements described in the literature as essential to professional formation, including encouraging reflection, use of narrative, role modeling, addressing the hidden curriculum, and fostering an authentic community, were recognized by participants as integral to the Forum's success. A group forum for reflection and discussion with peers and role models, tailored to local needs, offers an effective structure to foster professional formation in residency.

  5. [An evaluation of the clinical competence of a population of specialist physicians educated by the medical internship and residency system].

    PubMed

    Pujol, R; Busquet, J; Feliu, E; Castellsague, J; Gómez Sáez, J M; Martínez Carretero, J M; Rozman, C

    1995-10-21

    The quality of physicians who have undergone resident official training (MIR) should logically be better than that of the remaining physicians who were not able to enter into this official training. The present study was designed with the aim of verifying this hypothesis. A sample of physicians who underwent the MIR examination in 1982 and who upon passing the same were permitted to initiate the MIR training in 1983 was selected. The group was subdivided into MIR and no MIR and according to the specialty followed. When the physicians were practicing as specialists two types of surveys were carried out with one being by telephone and the other personal in which the personal characteristics, preparation for the MIR test, professional satisfaction and personal motivation were analyzed. The pharmaceutic prescriptions of both groups were analyzed according to indicators of the Servei Català de la Salut (Catalonian Health Service) and the opinion of colleagues of each of the members of each group was evaluated with another questionnaire. The written resolution of hypothetical clinical cases were given to each of the individuals included. A level of global competence defined as a percentage for the following components was identified using: curricular evaluation (10%), professional satisfaction (20%), personal motivation (10%), hypothetical case resolution (35%) and peer opinion (25%). The global competence of the physicians trained under the MIR system was greater than that of the no MIR group (p < 0.01). On analysis by sections the differences of greatest note were observed in the resolution of hypothetical cases (p < 0.0001), curricular evaluation (p < 0.0001) and the quality of pharmaceutical prescription (p < 0.0001). The differences were less of note in comparison of personal motivation (p < 0.02) and professional satisfaction (p < 0.02). No differences were observed in peer opinion. The professional quality of physicians trained by MIR who presented for the 1982 examination in Catalonia and practiced in medical specialties is greater than that of a comparable group with regard to professional practice.

  6. An exploratory study of mother-daughter physicians: an intergenerational comparison of professional and personal experiences.

    PubMed

    Shrier, Diane K; Shrier, Lydia A

    2005-12-01

    Physician daughters of physician mothers may experience unique advantages in their career development and in combining career and family. The objective of this exploratory study, the first on mother-daughter physicians, was to compare the professional and personal characteristics of physician mothers and their physician daughters. Two hundred fourteen families with at least one mother-daughter physician pair were identified through a nationwide search; 84% of the mothers and 87% of the daughters contacted returned a 56-item questionnaire. Data were analyzed to compare professional and personal characteristics of the subset of mothers and daughters who had both responded (n = 136 pairs). Compared to their physician mothers, physician daughters were less satisfied with their career, less likely to feel in control of their work environment, more likely to report moderate or severe daily stress at work, and less likely to want their children to become physicians or to want to become physicians again if they were to relieve their lives. They were also less likely to want to change specialties. Physician daughters were more likely than their physician mothers to be 30 years or older when they had their first child, to have taken parental leave, and to have a spouse who took parental leave and less likely to experience their caregiving as a hindrance to their professional work and advancement. Despite the availability of a physician mother role model, physician daughters reported less career satisfaction and more work-related stress than their physician mothers. These findings warrant further exploration and support the need for new work-family paradigms in medicine.

  7. [Aggression as the cause of stress among physicians].

    PubMed

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

    2009-01-01

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

  8. Nurse-physician leadership: insights into interprofessional collaboration.

    PubMed

    Clark, Rebecca Culver; Greenawald, Mark

    2013-12-01

    The objective of this qualitative research study was to identify themes characterizing collaboration from the perspectives of nurses and physicians serving in complementary leadership roles in intensive and progressive care hospital units. Failures of communication are reported as a major cause of sentinel events. Most frequently, communication breakdown occurs between physicians and nurses. In this qualitative research study, taped interviews with nursing and medical unit directors (physicians) were analyzed for themes regarding factors influencing collaboration. Themes identified included the impact of organizational support, shared expectations, relationships, and communication. Findings of this study support the need for organizations and professionals to facilitate deliberate, structured interprofessional communication to advance collaboration between nurses and physicians.

  9. Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States.

    PubMed

    Gonsalves, Catherine; Zaidi, Zareen

    2016-01-01

    There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity. Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency. Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

  10. Joint analyses of open comments and quantitative data: Added value in a job satisfaction survey of hospital professionals

    PubMed Central

    Gilles, Ingrid; Mayer, Mauro; Courvoisier, Nelly; Peytremann-Bridevaux, Isabelle

    2017-01-01

    Objective To obtain a comprehensive understanding of the job opinions of hospital professionals by conducting qualitative analyses of the open comments included in a job satisfaction survey and combining these results with the quantitative results. Design A cross-sectional survey targeting all Lausanne University Hospital professionals was performed in the fall of 2013. Material and methods The survey considered ten job satisfaction dimensions (e.g. self-fulfilment, workload, management, work-related burnout, organisational commitment, intent to stay) and included an open comment section. Computer-assisted qualitative analyses were conducted on these comments. Satisfaction rates on the included dimensions and professional groups were entered as predictive variables in the qualitative analyses. Participants Of 10 838 hospital professionals, 4978 participated in the survey and 1067 provided open comments. Data from 1045 respondents with usable comments constituted the analytic sample (133 physicians, 393 nurses, 135 laboratory technicians, 247 administrative staff, including researchers, 67 logistic staff, 44 psycho-social workers, and 26 unspecified). Results Almost a third of the comments addressed scheduling issues, mostly related to problems and exhaustion linked to shifts, work-life balance, and difficulties with colleagues’ absences and the consequences for quality of care and patient safety. The other two-thirds related to classic themes included in job satisfaction surveys. Although some comments were provided equally by all professional groups, others were group specific: work and hierarchy pressures for physicians, healthcare quality and patient safety for nurses, skill recognition for administrative staff. Overall, respondents’ comments were consistent with their job satisfaction ratings. Conclusion Open comment analysis provides a comprehensive understanding of hospital professionals’ job experiences, allowing better consideration of quality initiatives that match the needs of professionals with reality. PMID:28296974

  11. Cooperation between mental health professionals and doctors in a Balint-oriented supervision group.

    PubMed

    Keinänen, M

    2001-01-01

    A Balint-oriented supervision group for physicians is described concentrating on the study of the patient-doctor relationship, the recognition and diagnosis of psychiatric problems, and the planning of psychiatric treatment. The group includes five general practitioners, a gynecologist, a dermatologist, a psychiatrist and a psychologist, who have met once a month for an hour over a period of 12 years. Interaction between the physicians and the mental health professionals is illustrated by two clinical examples. The group helps the physician recognize, tolerate and use his countertransference feelings, and facilitates the examination and treatment of patients suffering from psychiatric problems. In Balint-oriented group work, the focus can be moved from physical symptoms to include observation of the patient's emotional life and significant object relations, to the factors that are crucial for his psychological balance. This kind of holistic observation in the examination and treatment of psychiatric problems is as important as appropriate laboratory investigations in the diagnosis and care of physical diseases.

  12. The relationship between physician participation in continuing professional development programs and physician in-practice peer assessments.

    PubMed

    Wenghofer, Elizabeth F; Marlow, Bernard; Campbell, Craig; Carter, Lorraine; Kam, Sophia; McCauley, William; Hill, Lori

    2014-06-01

    To investigate the relationship between physicians' performance, as evaluated through in-practice peer assessments, and their participation in continuing professional development (CPD). The authors examined the predictive effects of participating in the CPD programs of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada one year before in-practice peer assessments conducted by the medical regulatory authority in Ontario, Canada, in 2008-2009. Two multivariate logistic regression models were used to determine whether physicians who reported participating in any CPD and group-based, assessment-based, and/or self-directed CPD activities were more or less likely to receive satisfactory assessments than physicians who had not. All models were adjusted for the effects of sex, age, specialty certification, practice location, number of patient visits per week, hours worked per week, and international medical graduate status. A total of 617 physicians were included in the study. Analysis revealed that physicians who reported participating in any CPD activities were significantly more likely (odds ratio [OR] = 2.5; P = .021) to have satisfactory assessments than those who had not. In addition, physicians participating in group-based CPD activities were more likely to have satisfactory assessments than those who did not (OR = 2.4; P = .016). There is encouraging evidence supporting a positive predictive association between participating in CPD and performance on in-practice peer assessments. The findings have potential implications for policies which require physicians to participate in programs of lifelong learning.

  13. 76 FR 7860 - Proposed Data Collections Submitted for Public Comment and Recommendations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... professionals......... CBIT pre-post 500 2 3/60 50 test. Health professionals......... Physician Retreat 50 2 3/60 5 pre-post test. Health professionals......... Physician 30 1 2/60 1 Training Retreat follow up...

  14. Moral distress in intensive care unit professionals is associated with profession, age, and years of experience.

    PubMed

    Dodek, Peter M; Wong, Hubert; Norena, Monica; Ayas, Najib; Reynolds, Steven C; Keenan, Sean P; Hamric, Ann; Rodney, Patricia; Stewart, Miriam; Alden, Lynn

    2016-02-01

    To determine which demographic characteristics are associated with moral distress in intensive care unit (ICU) professionals. We distributed a self-administered, validated survey to measure moral distress to all clinical personnel in 13 ICUs in British Columbia, Canada. Each respondent to the survey also reported their age, sex, and years of experience in the ICU where they were working. We used multivariate, hierarchical regression to analyze relationships between demographic characteristics and moral distress scores, and to analyze the relationship between moral distress and tendency to leave the workplace. Response rates to the surveys were the following: nurses--428/870 (49%); other health professionals (not nurses or physicians)--211/452 (47%); physicians--30/68 (44%). Nurses and other health professionals had higher moral distress scores than physicians. Highest ranked items associated with moral distress were related to cost constraints and end-of-life controversies. Multivariate analyses showed that age is inversely associated with moral distress, but only in other health professionals (rate ratio [95% confidence interval]: -7.3 [-13.4, -1.2]); years of experience is directly associated with moral distress, but only in nurses (rate ratio (95% confidence interval):10.8 [2.6, 18.9]). The moral distress score is directly related to the tendency to leave the ICU job, in both the past and present, but only for nurses and other non-physician health professionals. Moral distress is higher in ICU nurses and other non-physician professionals than in physicians, is lower with older age for other non-physician professionals but greater with more years of experience in nurses, and is associated with tendency to leave the job. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed

    Weiss, R

    1989-05-01

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

  16. The medical marriage: a national survey of the spouses/partners of US physicians.

    PubMed

    Shanafelt, Tait D; Boone, Sonja L; Dyrbye, Lotte N; Oreskovich, Michael R; Tan, Litjen; West, Colin P; Satele, Daniel V; Sloan, Jeff A; Sotile, Wayne M

    2013-03-01

    To evaluate physician relationships from the perspective of their spouses/partners. Nearly all data on satisfaction with physician relationships come from the perspective of the physician rather than their spouse/partner. We conducted a national study of the spouses/partners of US physicians from August 17, 2011, through September 12, 2011. Responding spouses/partners provided information on demographic characteristics, their own work life, and the work life of their physician partners. Spouses/partners also rated relationship satisfaction and the effect of the work life of their physician partner on the relationship. Of the 1644 spouses/partners of physicians surveyed, 891 (54.2%) responded. Most spouses/partners (86.8%) reported that they were satisfied with their relationship with their physician partner. Satisfaction strongly related to the amount of time spent awake with their physician partners each day. Despite their overall satisfaction, spouses/partners reported their physician partners frequently came home irritable, too tired to engage in home activities, or preoccupied with work. On multivariate analysis, minutes spent awake with their physician partners each day was the strongest predictor of relationship satisfaction, exhibiting a dose-response effect. No professional characteristic of the physician partners (eg, hours worked per week, specialty area, and practice setting) other than the number of nights on call per week correlated with relationship satisfaction on adjusted analysis. The spouses/partners of US physicians report generally high satisfaction with their relationships. The mean time spent with their physician partners each day appears to be a dominant factor associated with relationship satisfaction and overshadows any specific professional characteristic of the physicians' practice, including specialty area, practice setting, and work hours. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  17. Use of medicinal plants by health professionals in Mexico.

    PubMed

    Alonso-Castro, Angel Josabad; Domínguez, Fabiola; Maldonado-Miranda, Juan José; Castillo-Pérez, Luis Jesús; Carranza-Álvarez, Candy; Solano, Eloy; Isiordia-Espinoza, Mario Alberto; Del Carmen Juárez-Vázquez, María; Zapata-Morales, Juan Ramón; Argueta-Fuertes, Marco Antonio; Ruiz-Padilla, Alan Joel; Solorio-Alvarado, César Rogelio; Rangel-Velázquez, Joceline Estefanía; Ortiz-Andrade, Rolffy; González-Sánchez, Ignacio; Cruz-Jiménez, Gustavo; Orozco-Castellanos, Luis Manuel

    2017-02-23

    The use of medicinal plants in Mexico has been documented since pre-Hispanic times. Nevertheless, the level of use of medicinal plants by health professionals in Mexico remains to be explored. To evaluate the use, acceptance and prescription of medicinal plants by health professionals in 9 of the states of Mexico. Direct and indirect interviews, regarding the use and acceptance of medicinal plants, with health professionals (n=1614), including nurses, physicians, pharmacists, and odontologists from nine states in Mexico were performed from January 2015 to July 2016. The interviews were analyzed with the factor the informant consensus (FIC). The information obtained indicated that 46% of those interviewed feel patients should not use medicinal plants as an alternative therapy. Moreover, 54% of health professionals, and 49% of the physicians have used medicinal plants as an alternative therapy for several diseases. Twenty eight percent of health professionals, and 26% of the physicians, have recommended or prescribed medicinal plants to their patients, whereas 73% of health professionals were in agreement with receiving academic information regarding the use and prescription of medicinal plants. A total of 77 plant species used for medicinal purposes, belonging to 40 botanical families were reported by the interviewed. The results of the FIC showed that the categories of diseases of the digestive system (FIC=0.901) and diseases of the respiratory system (FIC=0.898) had the greatest agreement. This study shows that medicinal plants are used for primary health care in Mexico by health professionals. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  18. ["Something humane has been lost". Re-evaluation of the attitudes of senior physicians towards the G-DRG System - a qualitative normative analysis].

    PubMed

    Knoll, Marco; Otte, Ina; Salloch, Sabine; Ruiner, Caroline; Kruppa, Esta; Vollmann, Jochen

    2018-04-01

    Only a few years after the implementation of the G-DRG (German Diagnosis Related Group) system physicians already began to complain of its negative effects on the quality of inpatient healthcare. The present study examines the recent experiences senior physicians have made with regard to the impact of the G-DRG system on the quality of healthcare and medical professionalism. Nine qualitative guided expert interviews were conducted focusing on the experiences of physicians in leading positions dealing with the G-DRG system in their everyday work. The interviewees report an intensification of work attributable to an increasing number of inpatient cases, a more lenient definition of medical indications and a reduction in patient retention time. The physicians interviewed have felt increasingly constrained by economic conditions. Additionally, they stated that the G-DRG system's incentive structure encourages the discrimination of older, care-dependent and multimorbid patients. Possible countermeasures include a political revision of incentive regulation as well as a strengthening of up-to-date professional ethical education and teaching. Copyright © 2018. Published by Elsevier GmbH.

  19. Patient satisfaction and referral intention: effect of patient-physician match on ethnic origin and cultural similarity.

    PubMed

    Lin, Xiaohua; Guan, Jian

    2002-01-01

    The study brought a cultural perspective into the mainstream model of health service quality by taking into account minorities' unique experience, patient-physician match on ethnic origin and cultural similarity. Survey data from Asian-American respondents supported a three-dimensional humaneness-professionalism-competence model of physician attributes. Physician humaneness and professionalism, patient-physician match on ethnic origin and cultural similarity predicted patient overall satisfaction and referral intention among Asian-Americans. Interestingly, the 3-dimensional model of physician attributes was also revealed in a Caucasian-American sample. However, Caucasian-Americans differ from Asian-Americans in several ways: physician competence was a significant predictor of overall satisfaction; professionalism was the only determinant of referral intention; and cultural similarity was not a significant factor with regards to either overall satisfaction or referral intention.

  20. [The notion of decision making capacity in medical and legal practice].

    PubMed

    Bórquez E, Gladys; Raineri B, Gina; Horwitz C, Nina; Huepe O, Gabriela

    2007-09-01

    The relationship between patients and health professionals emphasizes deliberation and joint decision making, that derives in the informed consent. To evaluate decision making of patients in health care and to identify the notion of capacity for decision making, according to lawyers and physicians. A semi-structured interview about procedures to assess decision making capacity was applied to 27 selected physicians and lawyers, considering their experience in this area. A qualitative analysis of answers was performed. Several differences were observed between physicians and lawyers, probably originated in their respective disciplines as well as the context of their professional practice. For physicians the notion of capacity is associated to comprehension of the information, it is not absolute, and it must consider the intellectual maturity of the teenager and the autonomy of the elderly. This evaluation is frequently performed in the clinical interview and standardized protocols do not exist. For lawyers, capacity is established by age and is associated to rights and obligations, as determined by law. When it is assessed by experts, including physicians, it becomes evidence. These professionals assume that experts will use standardized assessment instruments. Capacity has significance in the legal system. Since there are substantial consequences when a person is deemed incompetent, it is necessary to distinguish between health capacity and legal capacity, and to inverted exclamation markink the informed consent with the fundamental rights of citizens, such as taking decisions about our own health.

  1. The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism.

    PubMed

    Nie, Jing-Bao; Cheng, Yu; Zou, Xiang; Gong, Ni; Tucker, Joseph D; Wong, Bonnie; Kleinman, Arthur

    2018-03-01

    To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. © 2017 John Wiley & Sons Ltd.

  2. How much do physicians in Latin America know about behavioral variant frontotemporal dementia?

    PubMed

    Gleichgerrcht, Ezequiel; Flichtentrei, Daniel; Manes, Facundo

    2011-11-01

    Diagnosis of behavioral variant frontotemporal dementia (bvFTD) can be especially challenging during the early stages for several reasons, including the fact that (a) behavioral disturbances in bvFTD can mimic the symptomatic profile of psychiatric disorders; (b) neuropsychological performance may be relatively spared; and (c) changes in structural neuroimaging may go undetected. Most frequently, bvFTD is not included as part of medical or residency training outside the field of cognitive neurology. The present study aimed at examining bvFTD-related practices concerning academic and professional training, diagnosis, and treatment across Latin America. We surveyed the academic and professional aspects of clinical practice related to bvFTD of 596 physicians from different fields throughout the continent. We discuss several aspects concerning Latin American physicians' training on dementia and bvFTD, the way in which they approach the differential diagnosis of bvFTD, and their most frequent strategies for the treatment of this condition. We conclude that information about bvFTD deserves more attention in both undergraduate and postgraduate medical education in Latin America, and that understanding clinical practices related to FTD can help design more efficient training programs for physicians in this and other world regions.

  3. The influence factors of medical professionalism: A stratified-random sampling study based on the physicians and patients in ambulatory care clinics of Chengdu, China.

    PubMed

    Lin, Yifei; Yin, Senlin; Lai, Sike; Tang, Ji; Huang, Jin; Du, Liang

    2016-10-01

    As the relationship between physicians and patients deteriorated in China recently, medical conflicts occurred more frequently now. Physicians, to a certain extent, also take some responsibilities. Awareness of medical professionalism and its influence factors can be helpful to take targeted measures and alleviate the contradiction. Through a combination of physicians' self-assessment and patients' assessment in ambulatory care clinics in Chengdu, this research aims to evaluate the importance of medical professionalism in hospitals and explore the influence factors, hoping to provide decision-making references to improve this grim situation. From February to March, 2013, a cross-sectional study was conducted in 2 tier 3 hospitals, 5 tier 2 hospitals, and 10 community hospitals through a stratified-random sampling method on physicians and patients, at a ratio of 1/5. Questionnaires are adopted from a pilot study. A total of 382 physicians and 1910 patients were matched and surveyed. Regarding the medical professionalism, the scores of the self-assessment for physicians were 85.18 ± 7.267 out of 100 and the scores of patient-assessment were 57.66 ± 7.043 out of 70. The influence factors of self-assessment were physicians' working years (P = 0.003) and patients' complaints (P = 0.006), whereas the influence factors of patient-assessment were patients' ages (P = 0.001) and their physicians' working years (P < 0.01) and satisfaction on the payment mode (P = 0.006). Higher self-assessment on the medical professionalism was in accordance with physicians of more working years and no complaint history. Higher patient-assessment was in line with elder patients, the physicians' more working years, and higher satisfaction on the payment mode. Elder patients, encountering with physicians who worked more years in health care services or with higher satisfaction on the payment mode, contribute to higher scores in patient assessment part. The government should strengthen the medical professionalism for young physicians and improve the payment mode.

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

    PubMed

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

    2014-09-06

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

  5. Managerial orientation and career success of physicians in hospitals.

    PubMed

    Vera, Antonio; Hucke, Desdemona

    2009-01-01

    This article aims to investigate the impact of managerial orientation on the career success of physicians employed in hospitals. The authors collected data between August and October 2006 using a written questionnaire that was sent to all 278 physicians employed in two German hospitals. The data was analyzed using a multinomial logistic regression. The data indicate that a pronounced managerial orientation has indeed a positive impact on the career success of physicians in hospitals. But the results vary with respect to the different dimensions of managerial orientation. Some aspects of managerial orientation are more compatible with physicians' professional values and, consequently, more relevant for career success than others. The acquisition and improvement of management skills seems to be a crucial factor. The impact of managerial orientation on the career success of physicians has been unclear so far. Physicians are trained and socialized according to professional values and norms that are considered to be the antithesis of a managerial orientation. Furthermore, the typical career paths of professionals are different from careers of other occupational groups. However, this paper shows that physicians employed in hospitals need a certain degree of managerial orientation to have a successful and satisfying professional career.

  6. An Evolving Identity: How Chronic Care Is Transforming What it Means to Be a Physician.

    PubMed

    Bogetz, Alyssa L; Bogetz, Jori F

    2015-12-01

    Physician identity and the professional role physicians play in health care is rapidly evolving. Over 130 million adults and children in the USA have complex and chronic diseases, each of which is shaped by aspects of the patient's social, psychological, and economic status. These patients have lifelong health care needs that require the ongoing care of multiple health care providers, access to community services, and the involvement of patients' family support networks. To date, physician professional identity formation has centered on autonomy, authority, and the ability to "heal." These notions of identity may be counterproductive in chronic disease care, which demands interdependency between physicians, their patients, and teams of multidisciplinary health care providers. Medical educators can prepare trainees for practice in the current health care environment by providing training that legitimizes and reinforces a professional identity that emphasizes this interdependency. This commentary outlines the important challenges related to this change and suggests potential strategies to reframe professional identity to better match the evolving role of physicians today.

  7. The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

    PubMed

    Karmali, Shazia

    2012-01-01

    This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

  8. Physicians' perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States.

    PubMed

    Tyssen, Reidar; Palmer, Karen S; Solberg, Ingunn B; Voltmer, Edgar; Frank, Erica

    2013-12-15

    We lack national and cross-national studies of physicians' perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,213), the U.S. (n = 6,628), and Norway (n = 657), examining demographics, job satisfaction, and professional autonomy. Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians' perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians.

  9. How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

    PubMed

    Solé, Meritxell; Panteli, Dimitra; Risso-Gill, Isabelle; Döring, Nora; Busse, Reinhard; McKee, Martin; Legido-Quigley, Helena

    2014-12-01

    This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape. © 2014 Royal College of Physicians.

  10. The assessment of pathologists/laboratory medicine physicians through a multisource feedback tool.

    PubMed

    Lockyer, Jocelyn M; Violato, Claudio; Fidler, Herta; Alakija, Pauline

    2009-08-01

    There is increasing interest in ensuring that physicians demonstrate the full range of Accreditation Council for Graduate Medical Education competencies. To determine whether it is possible to develop a feasible and reliable multisource feedback instrument for pathologists and laboratory medicine physicians. Surveys with 39, 30, and 22 items were developed to assess individual physicians by 8 peers, 8 referring physicians, and 8 coworkers (eg, technologists, secretaries), respectively, using 5-point scales and an unable-to-assess category. Physicians completed a self-assessment survey. Items addressed key competencies related to clinical competence, collaboration, professionalism, and communication. Data from 101 pathologists and laboratory medicine physicians were analyzed. The mean number of respondents per physician was 7.6, 7.4, and 7.6 for peers, referring physicians, and coworkers, respectively. The reliability of the internal consistency, measured by Cronbach alpha, was > or = .95 for the full scale of all instruments. Analysis indicated that the medical peer, referring physician, and coworker instruments achieved a generalizability coefficient of .78, .81, and .81, respectively. Factor analysis showed 4 factors on the peer questionnaire accounted for 68.8% of the total variance: reports and clinical competency, collaboration, educational leadership, and professional behavior. For the referring physician survey, 3 factors accounted for 66.9% of the variance: professionalism, reports, and clinical competency. Two factors on the coworker questionnaire accounted for 59.9% of the total variance: communication and professionalism. It is feasible to assess this group of physicians using multisource feedback with instruments that are reliable.

  11. A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. Part 1: content.

    PubMed Central

    Robinson, G E; Stewart, D E

    1996-01-01

    Although health care professionals, licensing bodies, governments and the community are paying increasing attention to the negative consequences of sexual misconduct by physicians, education for professionals about this subject is rare and limited. Even less attention has been paid to the adverse effects of violations of boundaries between teachers and learners (students, residents, interns and other trainees). A curriculum now being used at the University of Toronto to teach faculty and students about these topics includes a didactic portion and a workshop component. The didactic portion consists of lectures on the definitions, causes and consequences of physician-patient sexual misconduct and teacher-learner mistreatment and harassment. Relationships after termination of treatment and the complaint and discipline procedures of the College of Physicians and Surgeons of Ontario are also discussed. This article reviews the topics covered in this portion of the curriculum. A subsequent article will discuss the workshop component of the course. PMID:8603320

  12. Report of the AMA Council on Ethical and Judicial Affairs: professionalism in the use of social media.

    PubMed

    Shore, Rebecca; Halsey, Julia; Shah, Kavita; Crigger, Bette-Jane; Douglas, Sharon P

    2011-01-01

    Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians' nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA's Code of Medical Ethics).

  13. Impact of non-physician health professionals' BMI on obesity care and beliefs.

    PubMed

    Bleich, Sara N; Bandara, Sachini; Bennett, Wendy L; Cooper, Lisa A; Gudzune, Kimberly A

    2014-12-01

    Examine the impact of non-physician health professional body mass index (BMI) on obesity care, self-efficacy, and perceptions of patient trust in weight loss advice. A national cross-sectional Internet-based survey of 500 US non-physician health professionals specializing in nutrition, nursing, behavioral/mental health, exercise, and pharmacy collected between January 20 and February 5, 2014 was analyzed. Normal-BMI professionals were more likely than overweight/obese professionals to report success in helping patients achieve clinically significant weight loss (52% vs. 29%, P = 0.01). No differences by health professional BMI about the appropriate patient body weight for weight-related care (initiate weight loss discussions and success in helping patients lose weight), confidence in ability to help patients lose weight, or in perceived patient trust in their advice were observed. Most health professionals (71%) do not feel successful in helping patients lose weight until they are morbidly obese, regardless of BMI. Normal-BMI non-physician health professionals report being more successful than overweight and obese health professionals at helping obese patients lose weight. More research is needed to understand how to improve self-efficacy for delivering obesity care, particularly among overweight and class I obese patients. © 2014 The Obesity Society.

  14. [Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes].

    PubMed

    San-Martín, Montserrat; Roig-Carrera, Helena; Villalonga-Vadell, Rosa M; Benito-Sevillano, Carmen; Torres-Salinas, Miquel; Claret-Teruel, Gemma; Robles, Bernabé; Sans-Boix, Antonia; Alcorta-Garza, Adelina; Vivanco, Luis

    2017-01-01

    To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. Observational study using self-administered questionnaires. Five teaching hospitals in the province of Barcelona, Spain. Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (p<.05). On the other hand, Latin-American physicians had the highest scores in lifelong learning abilities (p<.001). A positive relationship was found between empathy and inter-professional collaboration for the whole sample (r=+0.34; p<.05). These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  15. Professional Ethics, Personal Conscience, and Public Expectations.

    PubMed

    Haupt, Claudia E

    2016-01-01

    Examining to what extent physicians are, or ought to be, defined by the profession when giving advice to patients, this commentary seeks to offer a better understanding of the potential conflicts that the American Medical Association's (AMA's) "Opinion 1.1.7, Physician Exercise of Conscience," addresses. This commentary conceptualizes the professions as knowledge communities, and situates the physician-patient relationship within this larger conceptual framework. So doing, it sheds light on how and when specialized knowledge is operationalized in professional advice-giving. Physicians communicate the knowledge community's insights to the patient. Thus, departures from professional knowledge as a matter of the professional's personal conscience are appropriately circumscribed by the knowledge community. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

  16. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center.

    PubMed

    Schrijver, Iris; Brady, Keri J S; Trockel, Mickey

    2016-01-01

    Background. Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians' perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of? Methods. A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life. Results. Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction. Discussion. Our findings indicate that the factors that enhance professional fulfillment and those that precipitate burnout are distinct: motivation and quality of work performed were supported by domains intrinsic to the work itself, whereas external dysfunctional work aspects resulted in frustration. Thus, it can be anticipated that optimization of physician wellness would require tailored approaches in each of these dimensions with sustained funding and support for wellness initiatives. Physicians identified the availability of resources to enable them to thrive and provide excellent patient care as their most important wellness-enhancing factor.

  17. Professional Competence and Intuitive Decision Making: A Simulation Study in the Domain of Emergency Medicine

    ERIC Educational Resources Information Center

    Harteis, Christian; Morgenthaler, Barbara; Kugler, Christine; Ittner, Karl-Peter; Roth, Gabriel; Graf, Bernhard

    2012-01-01

    Intuition presents as a crucial component of professional competence for many occupations, including emergency physicians because many of their decisions have to be made quickly. When arriving at the scene of an accident, they promptly have to assess the circumstances and initiate immediate life-saving measures without opportunities for deep…

  18. Academic achievement, depression and anxiety during medical education predict the styles of success in a medical career: a 10-year longitudinal study.

    PubMed

    Walkiewicz, Maciej; Tartas, Malgorzata; Majkowicz, Mikolaj; Budzinski, Waldemar

    2012-01-01

    Our study investigated the styles of success in the medical career in young physicians, in comparison with the same subjects examined 4-10 years earlier. The participants were first studied when they applied to the medical university (1999). Questionnaires were sent to all students each year (2000-2005). Fifty-four medical doctors participated in the first phase of the study completed a questionnaire four years after graduation. The current questionnaire included measures of burnout, satisfaction with medicine as a career, quality of life (QOL) and postgraduate examination results. Previous questionnaires had included measures of academic achievement, depression and anxiety. We can describe three different styles of success, which can be predicted during medical education. Physicians with the best professional competence have the lowest income. However, physicians with the lowest professional competence gain the highest income. Those with the highest QOL (general well-being and life satisfaction) have the lowest professional stress and vulnerability to burnout. Anxiety and academic achievement (during the second and fourth year of study) are the significant predictors of specific style belonging. Our results may be useful to medical school admissions and resident selection committees to identify candidates at risk for less satisfaction or less competence.

  19. Family caregivers, patients and physicians: ethical guidance to optimize relationships.

    PubMed

    Mitnick, Sheryl; Leffler, Cathy; Hood, Virginia L

    2010-03-01

    Family caregivers play a major role in maximizing the health and quality of life of more than 30 million individuals with acute and chronic illness. Patients depend on family caregivers for assistance with daily activities, managing complex care, navigating the health care system, and communicating with health care professionals. Physical, emotional and financial stress may increase caregiver vulnerability to injury and illness. Geographically distant family caregivers and health professionals in the role of family caregivers may suffer additional burdens. Physician recognition of the value of the caregiver role may contribute to a positive caregiving experience and decrease rates of patient hospitalization and institutionalization. However, physicians may face ethical challenges in partnering with patients and family caregivers while preserving the primacy of the patient-physician relationship. The American College of Physicians in conjunction with ten other professional societies offers ethical guidance to physicians in developing mutually supportive patient-physician-caregiver relationships.

  20. An empirical analysis of ethical and professional issues in physicians' advertising: A comparative cross-sectional study.

    PubMed

    Moser, H Ronald; Stevens, Robert; Loudon, David

    2016-01-01

    The purpose of this study is to investigate current attitudes and opinions of physicians' advertising and to compare them to the attitudes expressed 10 years previously. This study was designed to determine (a) consumers' attitudes toward advertising by physicians, and (b) whether age, occupation, income, education, or sex of consumer accounted for any significant difference in attitudes toward physicians who advertise. The study seems to confirm the belief of many marketing professionals that advertising and marketing do not have a place in the management and operation of professional services.

  1. Impact of race on the professional lives of physicians of African descent.

    PubMed

    Nunez-Smith, Marcella; Curry, Leslie A; Bigby, JudyAnn; Berg, David; Krumholz, Harlan M; Bradley, Elizabeth H

    2007-01-02

    Increasing the racial and ethnic diversity of the physician workforce is a national priority. However, insight into the professional experiences of minority physicians is limited. This knowledge is fundamental to developing effective strategies to recruit, retain, and support a diverse physician workforce. To characterize how physicians of African descent experience race in the workplace. Qualitative study based on in-person and in-depth racially concordant interviews using a standard discussion guide. The 6 New England states in the United States. 25 practicing physicians of African descent representing a diverse range of primary practice settings, specialties, and ages. Professional experiences of physicians of African descent. 1) Awareness of race permeates the experience of physicians of African descent in the health care workplace; 2) race-related experiences shape interpersonal interactions and define the institutional climate; 3) responses to perceived racism at work vary along a spectrum from minimization to confrontation; 4) the health care workplace is often silent on issues of race; and 5) collective race-related experiences can result in "racial fatigue," with personal and professional consequences for physicians. The study was restricted to New England and may not reflect the experiences of physicians in other geographic regions. The findings are meant to be hypothesis-generating and require additional follow-up studies. The issue of race remains a pervasive influence in the work lives of physicians of African descent. Without sufficient attention to the specific ways in which race shapes physicians' work experiences, health care organizations are unlikely to create environments that successfully foster and sustain a diverse physician workforce.

  2. [Communication training MultiTANDEMplus – A contribution to improve communication between professional caregivers and physicians].

    PubMed

    Meyer-Kühling, Inga; Wendelstein, Britta; Pantel, Johannes; Specht-Leible, Norbert; Zenthöfer, Andreas; Schröder, Johannes

    2015-10-01

    Failures of communication between professional caregivers and physicians affect the quality of supply of nursing home residents. As part of a model project it was aimed to develop a training for caregivers to improve communication and promote cooperation with physicians. For the needs assessment as a basis to develop the training 56 professional caregivers and 40 physicians engaged in nursing home care answered questionnaires regarding their cooperation. Based on these results a module for communication between professional caregivers and physicians was developed and adapted the TANDEM communication training for caregivers by Haberstroh and Pantel (2011). 25 professional caregivers in leading positions have been trained as multipliers in order to provide their colleagues the communication training with the additional element (TANDEMplus). TANDEMplus was evaluated in forms of reflection rounds and feedback questionnaires. 254 professional caregivers, housekeeping staff and daytime companions participated in a complete TANDEMplus training by the multipliers until July 2014. The implementation of their developed communication strategies into practice was experienced positively by the participants. The module “communication with physicians” is relevant for professional caregivers to raise awareness of their own competence and facilitate a structured information exchange at eye level. The training of multipliers was executed in order to ensure transfer effects and sustainability.

  3. Descriptions of euthanasia as social representations: comparing the views of Finnish physicians and religious professionals.

    PubMed

    Jylhänkangas, Leila; Smets, Tinne; Cohen, Joachim; Utriainen, Terhi; Deliens, Luc

    2014-03-01

    In many western societies health professionals play a powerful role in people's experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death-related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world-view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals - the freethinker with an atheist world-view - accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  4. Dealing with suicidal patients – a challenging task: a qualitative study of young physicians' experiences

    PubMed Central

    Høifødt, Tordis Sørensen; Talseth, Anne-Grethe

    2006-01-01

    Background Suicide is a major public health problem and treating suicidal patients represents one of the most challenging and complex clinical situations for young physicians. Education of physicians is considered an important strategy in suicide prevention. Young physicians often meet suicidal patients early in their career. Limited information is available about how newly educated physicians experience treating suicidal patients. The aim of the study was to shed light on the meaning of newly educated physicians' lived experiences in treating patients at risk of committing suicide. Methods Thirteen newly educated physicians narrated their experiences with suicidal patients. The interview text was transcribed and interpreted using a phenomenological-hermeneutical method inspired by Ricoeur's philosophy. Results Three main themes and ten themes were noted: Striving for relatedness: relating with the patient; not being able to relate with the patient; Intervening competently: having adequate professional knowledge; performing professionally; having professional values; evaluating one's own competence; and Being emotionally involved: accepting one's own vulnerability; feeling morally indignant; feeling powerless and accepting one's own fallibility. The recently educated physicians clearly described the variety of emotional and ethical dilemmas that arose in meeting suicidal patients and the professional challenge facing this clinical situation. The findings were interpreted in the perspective of communication, clinical decision-making and attention to the professional's emotional reactions. Conclusion An examination of the experiences of young physicians treating suicidal patients reveals three main themes that were a professional challenge for them: Striving for relatedness, Intervening competently and Being emotionally involved. Support for young practitioners that are treating these patients is likely important both to facilitate learning and also for their own well-being. This increased understanding can open up for the patient's suffering and affirm the patient's sense of life. The study provides additional background for educators designing training programs for physicians who will be treating suicidal patients. PMID:16928281

  5. Intentional partnering: a grounded theory study on developing effective partnerships among nurse and physician managers as they co-lead in an evolving healthcare system.

    PubMed

    Clausen, Christina; Lavoie-Tremblay, Melanie; Purden, Margaret; Lamothe, Lise; Ezer, Héléne; McVey, Lynne

    2017-09-01

    The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting. Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is known about how this management dyad functions in the healthcare setting. A constructivist grounded theory approach was used to investigate the process of how nurse and physician managers work together in formalized dyads in an urban Canadian university affiliated teaching hospital. Data collection occurred from September 2013-August 2014. Data included participant observation (n = 142 hours) and intensive interviews (n = 36) with nurse-physician manager dyads (12 nurses, 9 physicians) collected in a surgical department. Theoretical sampling was used to elaborate on properties of emerging concepts and categories. A substantive theory on 'intentional partnering' was generated. Nurses' and physicians' professional agendas, which included their interests and purposes for working with each other served as the starting point of 'intentional partnering'. The theory explains how nurse and physician managers align their professional agendas through the processes of 'accepting mutual necessity', 'daring to risk (together)' and 'constructing a shared responsibility'. Being credible, earning trust and safeguarding respect were fundamental to communicating effectively. Intentional partnering elucidates the relational components of working together and the strategizing that occurs as each partner deliberates on what he or she is willing to accept, risk and put into place to reap the benefits of collaborating. © 2017 John Wiley & Sons Ltd.

  6. Searching for consensus among physicians involved in the management of sick-listed workers in the Belgian health care sector: a qualitative study among practitioners and stakeholders.

    PubMed

    Vanmeerbeek, Marc; Govers, Patrick; Schippers, Nathalie; Rieppi, Stéphane; Mortelmans, Katrien; Mairiaux, Philippe

    2016-02-17

    In Belgium, the management of sick leave involves general practitioners (GPs), occupational health physicians (OPs) and social insurance physicians (SIPs). A dysfunctional relationship among these physicians can impede a patient's ability to return to work. The objective of this study was to identify ways to improve these physicians' mutual collaboration. Two consensus techniques were successively performed among the three professional groups. Eight nominal groups (NGs) gathered 74 field practitioners, and a two-round Delphi process involved 32 stakeholders. From the results, it appears that two areas (reciprocal knowledge and evolution of the legal and regulatory framework) are objects of consensus among the three medical group that were surveyed. Information transfer, particularly electronic transfer, was stressed as an important way to improve. The consensual proposals regarding interdisciplinary collaboration indicate specific and practical changes to be implemented when professionals are managing workers who are on sick leave. The collaboration process appeared to be currently more problematic, but the participants correctly identified the need for common training. The three physician groups all agree regarding several inter-physician collaboration proposals. The study also revealed a latent conflict situation among the analysed professionals that can arise from a lack of mutual recognition. Practical changes or improvements must be included in an extended framework that involves the different determinants of interdisciplinary collaboration that are shown by theoretical models. Collaboration is a product of the actions and behaviours of various partners, which requires reciprocal knowledge and trust; collaboration also implies political and economic structures that are led by public health authorities.

  7. Bushido and Medical Professionalism in Japan

    PubMed Central

    Harrison, Rebecca; Busari, Jamiu; Dornan, Tim

    2014-01-01

    Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido. Cultural scholars have demonstrated Bushido’s continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics. The authors suggest that for those who are teaching and practicing in Japan today, Bushido’s virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today’s health care practice. PMID:24556758

  8. Professional midwifery in Guatemala: A qualitative exploration of perceptions, attitudes and expectations among stakeholders.

    PubMed

    Summer, Anna; Guendelman, Sylvia; Kestler, Edgar; Walker, Dilys

    2017-07-01

    Despite recommendations that women give birth with a skilled birth attendant (SBA), 70% of births in Guatemala occur outside health facilities with informally trained traditional birth attendants (TBAs). To increase SBA in rural, indigenous communities, a professional midwifery school accredited by the government is scheduled to open in 2017. Drawing from Filby's model on barriers to the successful integration of professional midwifery into health systems, this paper aims to identify threats - and facilitators-toward professional midwifery's re-introduction in Guatemala. To elucidate perceptions, attitudes and expectations towards professional midwifery, qualitative, in-depth interviews were conducted with 32 physicians, nurses, and TBAs in six health centers and with key decision makers and professional midwives (PMs) in Guatemala City. We conducted open and axial coding in Atlas.ti and performed normative comparisons of participants' attitudes, perceptions, and expectations with the National Vision for professional midwifery and relative comparisons within and across disciplinary subgroups. Unprompted, physicians, nurses and TBAs were unable to correctly define professional midwifery. Yet, when professional midwifery was defined for them, they expressed willingness to work with PMs, seeing them as a needed human resource, instrumental in providing intercultural care and strengthening facility relationships with TBAs. Some stakeholders anticipated resistance toward PMs due to provider turf issues. Notable differences in expectations among all groups included ideas for supervision of and by the PMs and the PM's role in monitoring women and conducting births in communities alongside TBAs. Facilitators to professional midwifery's success include national political will, stakeholders' uniformity of vision, and the potential for improved intercultural care. Barriers are mostly professional in nature, including impediments to autonomous practice by PMs, hierarchical challenges, and turf issues. A specific road map addressing the identified barriers is needed for professional midwifery to succeed in reducing maternal health disparities in Guatemala. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. A Tale of Two Countries: Innovation and Collaboration Aimed at Changing the Culture of Medicine in Uruguay.

    PubMed

    Dapueto, Juan J; Viera, Mercedes; Samenow, Charles; Swiggart, William H; Steiger, Jeffrey

    2018-05-11

    This is a case study of a program to address professionalism at the Universidad de la República in Uruguay. We describe a five-year ongoing international collaboration. Relevant characteristics of the context, the program components, activities, and results were analyzed. The expected outcomes were to introduce standards of professional practices in the curricula of medical students and residents and the implementation of a program that might lead to a significant change in the culture of medicine in the University. Traditional didactics, interactive theater, and professional development workshops, issues such as teamwork and communication, professional behavior, and the culture of medicine, and physician wellness were addressed. A total of 359 faculty members, general practitioners, stakeholders, and other healthcare professionals (nurses, psychologists, social workers) participated in the intervention. The process led to specific achievements including new content in the curricula, the use of educational innovations to address issues of professionalism, a growing institutional culture of accountability, and the establishment of new rules and regulations. The strategies and interventions followed in the case of Uruguay can serve as a model to other developing countries to promote physician professionalism, wellness, and joy.

  10. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship.

    PubMed

    Konkin, Jill; Suddards, Carol

    2012-10-01

    Building on other models of longitudinal integrated clerkships (LIC), the University of Alberta developed its Integrated Community Clerkship with guiding principles of continuity of care, preceptor and learning environment. Professionalism is an important theme in medical education. Caring is important in professional identity formation and an ethic of caring is a moral framework for caring. This study explored the development of an ethic of caring in an LIC using empathy, compassion and taking responsibility as descriptors of caring. Through a hermeneutic phenomenological study, the authors focused on students' accounts of being with patients. Following an iterative process of successive analyses and explorations of the relevant literature, sensitizing concepts related to physician identity, and an ethic of caring were used to make sense of these accounts following the principles of constructivist grounded theory methodology. Continuity afforded by the LIC results in a safe environment in which students can meaningfully engage with patients and take responsibility for their care under the supervision of a physician teacher. Together these attributes foster an emerging physician identity born at the site of patient-student interaction and grounded in an ethic of caring. A medical student's evolving professional identity in the clerkship includes the emergence of an ethic of caring. Student accounts of being with patients demonstrate that the LIC at the University of Alberta affords opportunities for students be receptive to and responsible for their patients. This ethic of caring is part of an emerging physician identity for the study participants.

  11. Suicide In Doctors And Wives Of Doctors

    PubMed Central

    Sakinofsky, Isaac

    1980-01-01

    This paper re-examines the widespread belief that doctors have a proneness for suicide greater than the general population. The Standardized Mortality Ratio for male physicians is 335 and for single women doctors 257. Doctors' wives have an even greater risk: their SMR is 458. These rates for doctors are higher than for most other professional groups (except pharmacists) and the rate for doctors' wives far exceeds that for wives of other professionals. The intrinsic causes of the physician's high occupational mortality include his knowledge of toxicology and ready access to lethal drugs, so that impulsive suicide is more often successful. Professional stress and overwork, particularly the unrelenting responsibility for decisions upon which the lives of others may depend, have been inculpated. These stresses interact with the decline in the doctors' self-respect and with a personality that is prestige-oriented and independent. Some physicians turn in their frustration to alcohol/and or drugs, accelerating the process of deterioration. The high suicide rate in doctors' wives appears to be the result of unrequited needs for caring and dependency which the doctors' career demands and personality deny them. PMID:21293651

  12. Suicide in doctors and wives of doctors.

    PubMed

    Sakinofsky, I

    1980-06-01

    This paper re-examines the widespread belief that doctors have a proneness for suicide greater than the general population. The Standardized Mortality Ratio for male physicians is 335 and for single women doctors 257. Doctors' wives have an even greater risk: their SMR is 458. These rates for doctors are higher than for most other professional groups (except pharmacists) and the rate for doctors' wives far exceeds that for wives of other professionals. The intrinsic causes of the physician's high occupational mortality include his knowledge of toxicology and ready access to lethal drugs, so that impulsive suicide is more often successful. Professional stress and overwork, particularly the unrelenting responsibility for decisions upon which the lives of others may depend, have been inculpated. These stresses interact with the decline in the doctors' self-respect and with a personality that is prestige-oriented and independent. Some physicians turn in their frustration to alcohol/and or drugs, accelerating the process of deterioration. The high suicide rate in doctors' wives appears to be the result of unrequited needs for caring and dependency which the doctors' career demands and personality deny them.

  13. Trust, Satisfaction, and Confidence in Health Care Providers Among Student and Professional Dancers in France.

    PubMed

    Alimena, Stephanie; Air, Mary E

    2016-09-01

    Patients who trust their physicians are more likely to communicate about medical problems, adhere to medical advice, and be satisfied with care. Dancers have demonstrated low utilization of physician services for both preventive care and dance injuries. The purpose of this cross-sectional study was to examine trust in physicians as a variable influencing dancers' health care-seeking behavior. The validated Trust in Physician Scale was administered to 45 professional and 34 student ballet/contemporary dancers in France (36.7% male, 63.3% female) to evaluate their trust in medical doctors (MDs) vs physical therapists (PTs). Dancers were also asked about satisfaction and confidence in medical treatment for dance injuries. Dancers indicated greater trust in PTs than MDs (70.61±10.57 vs 65.38±10.79, t=-3.499, p=0.001). Students exhibited significantly less trust in MDs than professional dancers (62.04±9.96 vs 67.65±10.42, t=-2.381, p=0.020). Trust scale scores for PTs did not differ between students and professionals (69.53±8.30 vs 71.68±12.09, t=-0.866, p=0.389). Students were less confident than professional dancers in their physician's ability to treat their most severe injury (6.7% of students vs 35.7% of professionals "very confident, " X2=9.402, p=0.052). Dancer patients exhibit lower trust in physicians compared to previously studied non-dancer populations. Our results suggest that reduced trust in physicians and factors related to professional status may influence dancers' health care-seeking behavior. Student dancers may comprise a unique subpopulation of dancers with distinctive health care needs.

  14. Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician.

    PubMed

    Abbott, Richard L; Weber, Paul; Kelley, Betsy

    2005-12-01

    To review the history and current issues surrounding medical professional liability insurance and its relationship to medical error and healthcare risk management. Focused literature review and authors' experience. Medical professional liability insurance issues are reviewed in association with the occurrence of medical error and the role of healthcare risk management. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have dramatically increased over the past several years and have resulted in accelerated efforts to reduce medical errors and control practice risk for physicians. Medical error reduction and improved patient outcomes are closely linked to the goals of the medical risk manager by reducing exposure to adverse medical events. Management of professional liability risk by the physician-led malpractice insurance company not only protects the economic viability of physicians, but also addresses patient safety concerns. Physician-owned malpractice liability insurance companies will continue to be the dominant providers of insurance for practicing physicians and will serve as the primary source for loss prevention and risk management services. To succeed in the marketplace, the emergence and importance of the risk manager and incorporation of risk management principles throughout the professional liability company has become crucial to the financial stability and success of the insurance company. The risk manager provides the necessary advice and support requested by physicians to minimize medical liability risk in their daily practice.

  15. Fight or flight: the ethics of emergency physician disaster response.

    PubMed

    Iserson, Kenneth V; Heine, Carlton E; Larkin, Gregory Luke; Moskop, John C; Baruch, Jay; Aswegan, Andrew L

    2008-04-01

    Most disaster plans depend on using emergency physicians, nurses, emergency department support staff, and out-of-hospital personnel to maintain the health care system's front line during crises that involve personal risk to themselves or their families. Planners automatically assume that emergency health care workers will respond. However, we need to ask: Should they, and will they, work rather than flee? The answer involves basic moral and personal issues. This article identifies and examines the factors that influence health care workers' decisions in these situations. After reviewing physicians' response to past disasters and epidemics, we evaluate how much danger they actually faced. Next, we examine guidelines from medical professional organizations about physicians' duty to provide care despite personal risks, although we acknowledge that individuals will interpret and apply professional expectations and norms according to their own situation and values. The article goes on to articulate moral arguments for a duty to treat during disasters and social crises, as well as moral reasons that may limit or override such a duty. How fear influences behavior is examined, as are the institutional and social measures that can be taken to control fear and to encourage health professionals to provide treatment in crisis situations. Finally, the article emphasizes the importance of effective risk communication in enabling health care professionals and the public to make informed and defensible decisions during disasters. We conclude that the decision to stay or leave will ultimately depend on individuals' risk assessment and their value systems. Preparations for the next pandemic or disaster should include policies that encourage emergency physicians, who are inevitably among those at highest risk, to "stay and fight."

  16. 42 CFR 410.26 - Services and supplies incident to a physician's professional services: Conditions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) Services and supplies must be commonly furnished without charge or included in the bill of a physician (or... the Act. (c) Limitations. (1) Drugs and biologicals are also subject to the limitations specified in...)(iii), 410.60(a)(3)(iii), and 410.62(a)(3)(ii). [51 FR 41339, Nov. 14, 1986, as amended at 66 FR 55328...

  17. 42 CFR 410.26 - Services and supplies incident to a physician's professional services: Conditions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... charge or included in the bill of a physician (or other practitioner). (4) Services and supplies must be... independent contractor. (c) Limitations. (1) Drugs and biologicals are also subject to the limitations... §§ 410.59(a)(3)(iii), 410.60(a)(3)(iii), and 410.62(a)(3)(ii). [51 FR 41339, Nov. 14, 1986, as amended at...

  18. 42 CFR 410.26 - Services and supplies incident to a physician's professional services: Conditions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... charge or included in the bill of a physician (or other practitioner). (4) Services and supplies must be... payable to a pharmacy/supplier as DME under section 1861(s)(6) of the Act. (c) Limitations. (1) Drugs and...)(ii). [51 FR 41339, Nov. 14, 1986, as amended at 66 FR 55328, Nov. 1, 2001; 67 FR 20684, Apr. 26, 2002...

  19. Analysis of Your Professional Liability Insurance Policy

    PubMed Central

    Sadusk, Joseph F.; Hassard, Howard; Waterson, Rollen

    1958-01-01

    The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following: 1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field. 2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances. 3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage. 4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for “latent liability” claims as the years go along—certainly for his lifetime. 5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000. 6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service. 7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage. 8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice. 9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors. PMID:13489519

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

    PubMed

    Sidat, Mohsin M

    2016-07-02

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

  1. Physician' entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics.

    PubMed

    Koelewijn, Wout T; de Rover, Matthijs; Ehrenhard, Michel L; van Harten, Wim H

    2014-05-19

    Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians' groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are 'glued' to the central medical logic.

  2. Professionalism and Occupational Well-Being: Similarities and Differences Among Latin American Health Professionals

    PubMed Central

    San-Martín, Montserrat; Delgado-Bolton, Roberto; Vivanco, Luis

    2017-01-01

    Context: Empathy, teamwork, and lifelong learning are described as key elements of professionalism. The first recipients of their benefits are professionals themselves. Paradoxically, scarce studies have reported association between professionalism and occupational well-being. The main purpose of this study was to characterize the influence that empathy, teamwork, and lifelong learning, play in the occupational well-being of physicians and nurses working in Latin American healthcare institutions. Materials and Methods: The Jefferson Scale of Empathy, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, the Jefferson Scale of Physicians Lifelong Learning, and the Scale of Collateral Effects (somatization, exhaustion, and work alienation), were administered to 522 physicians and nurses working in institutions of Mexico, Colombia, Ecuador, and Argentina. Internal reliability was calculated. Gender and discipline were used as explanatory variables in comparison analysis. Two-way analysis of variance was performed to examine differences due to the main effects of the gender, and discipline, and to determine possible combined effects. Correlation analysis was performed to measure associations between collateral effects and age, and between collateral effects and professionalism. Results: A total of 353 (68%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. No differences were found among countries for collateral effects. Correlation analysis confirmed in physicians an inverse association between empathy and collateral effects (P = -0.16; p < 0.05), and between collateral effects and lifelong learning (P = -0.18; p < 0.01). In nurses, this association was confirmed only for empathy (P = -0.19; p < 0.05). Important differences in the development of professionalism and in its effects on occupational well-being appeared associated to inter-professional collaboration and work roles. An inverse correlation between age and collateral effects was confirmed in physicians (P = -0.22; p < 0.001) and in nurses (P = -28; p < 0.001). Comparison by gender confirmed higher somatization in women physicians and nurses than in men groups (p < 0.001). On the other hand, comparison by discipline confirmed higher exhaustion and alienation in physicians than in nurses (p < 0.01). Conclusion: The findings support the importance that empathy, teamwork, and lifelong learning have in practitioners’ health and welfare, and the role that cultural behaviors, associated to work professional models and social stereotypes, play in the interaction between professionalism and occupational well-being. PMID:28179893

  3. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... internees per year to the number of FTE primary care physicians serving the institution is at least 1,000:1... year). (The number of FTE primary care physicians is computed as in part I, section B, paragraph 3... care physicians, as follows: Group 1—Institutions with 500 or more inmates and no physicians. Group 2...

  4. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... internees per year to the number of FTE primary care physicians serving the institution is at least 1,000:1... year). (The number of FTE primary care physicians is computed as in part I, section B, paragraph 3... care physicians, as follows: Group 1—Institutions with 500 or more inmates and no physicians. Group 2...

  5. 42 CFR Appendix A to Part 5 - Criteria for Designation of Areas Having Shortages of Primary Medical Care Professional(s)

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... internees per year to the number of FTE primary care physicians serving the institution is at least 1,000:1... year). (The number of FTE primary care physicians is computed as in part I, section B, paragraph 3... care physicians, as follows: Group 1—Institutions with 500 or more inmates and no physicians. Group 2...

  6. [Not enough help for themselves--the risk of physicians to commit suicide].

    PubMed

    Püschel, Klaus; Schalinski, Sarah

    2006-01-01

    Physicians seem unwilling to deal with their own suicidal problems professionally. Suicide is a repressed topic. According to international studies, medical students and physicians are clearly over-represented among suicide victims. Committing suicide stands in sharp contrast to the positive image physicians enjoy as competent, strong helpers transmitting positive energy. Various studies and meta-analyses show that physicians use knowledge specific to their profession and are therefore "more successful" than the general population in committing suicide. Moreover, the data reveal a number of risk factors specifically correlating with medical practice. This is confirmed by an increased number of suicides during medical training and professional life in comparison with the general population. Gender-specific analyses show an even higher suicide risk for female physicians. In this context it cannot be excluded that out of "professional respect" cardiovascular causes of death are sometimes falsely documented in death certificates instead of suicide. Despite their special education, physicians are not very good at diagnosing their own emotional disorders and asking colleagues for adequate professional help. They rather tend to camouflage their own psychological problems also because they are afraid of occupational and personal discrimination.

  7. The patient-physician relationship and the sexual abuse of patients.

    PubMed Central

    1994-01-01

    The CMA's policy on the patient-physician relationship and the sexual abuse of patients follows a review of policies and initiatives of its provincial and territorial divisions and other professional associations. The CMA's approach to this policy has been to consider the overall patient-physician relationship in order to understand factors associated with functional and dysfunctional relationships, including those involving sexual abuse. In addition to defining abuse of patients by physicians in general and sexual abuse in particular this document gives guidelines on such issues as sexual or romantic relationships with current or former patients and provides educational and preventive strategies. PMID:8199968

  8. Views of West African surgeons on how well their educational and professional backgrounds may have prepared them for health leadership roles.

    PubMed

    Mahmoud, Abdulraheem O; Nkanga, Dennis; Onakoya, Adeola

    2010-12-01

    Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents' bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians' involvement in health managerial roles, probable influence of some physicians' characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role "strongly important" (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

  9. [Adolescents ask physicians on the Internet: a one-year survey of adolescents' questions on health issues in an Internet forum].

    PubMed

    Hardoff, Daniel; Friedman, Rina; Pilo, Nurit; Friedman, Fernando; Greilsammer, Daniel; Rigler, Shmuel

    2012-06-01

    During the past decade, the internet has become a major information resource in various domains of life and a communication venue among young people and adolescents who seek health information via the internet. Until now, the contents of Israeli adolescents' questions regarding health issues on internet sites have not been published. (1) A survey of the characteristics of adolescents who seek health information and their questions presented to the Ynet forum "The body during adolescence". In this forum physicians experienced in adolescent medicine respond to these questions and to comments of other forum participants. (2) Presentation of problematic issues in professionals' responses to health questions in the internet. Survey of a representative sample of contacts to the Ynet forum "The body during adolescence" during 2009 gathering information on gender and age of contacting person, parents' contacts, contacts' contents and physicians responses. A total of 412 contacts were surveyed, 210 (51%) females, aged 14-17 years--60%, 10-13 years--17% and 18-21 years 15%. Parents' questions appeared in 39 (9%) of contacts. Of all contacts, 44% related to sexuality issues and 17% related to self image and body composition. The physicians provided complete responses to 60% of the contacts, while in 40% the physician's responses included referral to clinical medical consultation. An internet health forum enables adolescents and parents to ask questions and raise doubts and anxieties regarding various health issues without the fear of being exposed and enables them to express their concerns face-to-face with a healthcare provider Sensitive issues regarding sexuality and self-image, which are not raised frequently during clinical encounters, are expressed and receive professional responses in the forum. Notwithstanding the significance of a rapid professional contribution, physicians responding to contacts in internet forums need to recognize the barrier related to professional communication with persons whom they have not met and for whom follow-up is impossible.

  10. Smoking habits, knowledge about and attitudes toward smoking among employees in health institutions in Serbia.

    PubMed

    Stojanović, Miodrag; Musović, Dijana; Petrović, Branislav; Milosević, Zoran; Milosavljević, Ivica; Visnjić, Aleksandar; Sokolović, Dusan

    2013-05-01

    According to the number of active smokers, Serbia occupies a high position in Europe, as well as worldwide. More than 47% of adults are smokers according to WHO data, and 33.6% according to the National Health Survey Serbia in 2006. Smoking physicians are setting a bad example to patients, they are uncritical to this habit, rarely ask patients whether they smoke and rarely advise them not to smoke. These facts contribute to the battle for reducing the number of medical workers who smoke, as well as the number of smokers among general population. The aim of the study was to determine the smoking behavior, knowledge and attitudes and cessation advice given to patients by healthcare professionals in Serbia. A stratified random cluster sample of 1,383 participants included all types of health institutions in Serbia excluding Kosovo. The self administrated questionnaire was used to collect data about smoking habits, knowledge, attitudes and cessation advice to patients given by health professionals in Serbia. Out of 1,383 participants, 45.60% were smokers, of whom 34.13% were physicians and 51.87% nurses. There were 46.4% male and 45.4% female smokers. The differences in agreement with the statements related to the responsibilities of health care professionals and smoking policy are significant between the "ever" and "never" smokers, and also between physicians and nurses. Twenty-five percent of nurses and 22% of doctors claimed they had received formal training. However, only 35.7% of the healthcare professionals felt very prepared to counsel patients, while 52.7% felt somewhat prepared and 11.6% were not prepared at all. According to the result of this survey, there are needs for more aggressive nationwide non-smoking campaigns for physicians and medical students. Experiences from countries where physicians smoke less and more effectively carry out smoking cessation practices need to be shared with Serbian physicians in order to improve their smoking behavior and smoking cessation practices.

  11. Commentary: What Are the Benefits of Training Deaf and Hard-of-Hearing Doctors?

    PubMed Central

    McKee, Michael M.; Smith, Scott; Barnett, Steven; Pearson, Thomas A.

    2013-01-01

    Deaf and hard-of-hearing (DHoH) individuals are underrepresented among physicians and physicians-in-training, yet this group is frequently overlooked in the diversity efforts of many medical training programs. The inclusion of DHoH individuals, with their diverse backgrounds, experiences, and struggles contributes to medical education and health care systems in a variety of ways, including: (1) a richer medical education experience for students and faculty resulting in greater disability awareness and knowledge about how to interact with and care for DHoH individuals and their families; (2) the provision of empathetic care desired by many patients and their families, including individuals who have a disability or chronic condition; and (3) the promotion of a more supportive and accessible professional environment for physicians, including older physicians in practice and as educators, who are experiencing age-associated decreased hearing acuity or other acquired disabilities. PMID:23361028

  12. The need to incorporate health information technology into physicians' education and professional development.

    PubMed

    Graham-Jones, Pierce; Jain, Sachin H; Friedman, Charles P; Marcotte, Leah; Blumenthal, David

    2012-03-01

    Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.

  13. A pragmatic guide on how physicians can take over financial control of their clinical practice.

    PubMed

    Jacobs, Volker R; Fischer, Thorsten

    2012-01-01

    Control of clinical cost is becoming increasingly important in health care worldwide. Physicians should accept the limitation of resources and take responsibility to improve their clinical cost-reimbursement ratio. To achieve this, they will need basic education in clinic management to control and adjust costs and reimbursement, without impacting professional quality of care. Rational use of diagnostics and therapy should be implemented and frequently verified. Physicians are the only professionals that are able to integrate economics with health care. This is in the best interest of patients and will improve a physician's position, influence, and professional freedom levels within our hospitals.

  14. The impact of patients' gender, race, and age on health care professionals' pain management decisions: an online survey using virtual human technology.

    PubMed

    Wandner, Laura D; Heft, Marc W; Lok, Benjamin C; Hirsh, Adam T; George, Steven Z; Horgas, Anne L; Atchison, James W; Torres, Calia A; Robinson, Michael E

    2014-05-01

    Previous literature indicates that biases exist in pain ratings. Healthcare professionals have been found to use patient demographic cues such as sex, race, and age when making decisions about pain treatment. However, there has been little research comparing healthcare professionals' (i.e., physicians and nurses) pain decision policies based on patient demographic cues. The current study used virtual human technology to examine the impact of patients' sex, race, and age on healthcare professionals' pain ratings. One hundred and ninety-three healthcare professionals (nurses and physicians) participated in this online study. Healthcare professionals assessed virtual human patients who were male and African American to be experiencing greater pain intensity and were more willing to administer opioid analgesics to them than to their demographic counterparts. Similarly, nurses were more willing to administer opioids make treatment decisions than physicians. There was also a significant virtual human-sex by healthcare professional interaction for pain assessment and treatment decisions. The sex difference (male>female) was greater for nurses than physicians. Results replicated findings of previous studies using virtual human patients to assess the effect of sex, race, and age in pain decision-making. In addition, healthcare professionals' pain ratings differed depending on healthcare profession. Nurses were more likely to rate pain higher and be more willing to administer opioid analgesics than were physicians. Healthcare professionals rated male and African American virtual human patients as having higher pain in most pain assessment and treatment domains compared to their demographic counterparts. Similarly the virtual human-sex difference ratings were more pronounced for nurses than physicians. Given the large number of patients seen throughout the healthcare professionals' careers, these pain practice biases have important public health implications. This study suggests attention to the influence of patient demographic cues in pain management education is needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship — systematic review and expert survey

    PubMed Central

    2000-01-01

    Background Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails. Objective To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction. Methods Systematic review of the literature, professional, and ethical codes; and consultation with experts. Results Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures. Conclusions Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient. PMID:11720920

  16. Physician nurse care: A new use of UMLS to measure professional contribution: Are we talking about the same patient a new graph matching algorithm?

    PubMed

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

    2018-05-01

    Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted "physician terms" from free-text physician summaries. The nursing plans of care were constructed using the HANDS © nursing documentation software. HANDS © utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create "nursing terms". The physician's and nurse's terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions' documentation. On average, physicians' discharge summaries contain 27 terms and nurses' documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. Our hypothesis that physician's and nurse's practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

  17. From Burnout to Wellness: A Professional Imperative.

    PubMed

    Golub, Justin S; Johns, Michael M

    2018-03-01

    Professional burnout is a barrier to physician wellness. Burnout is prevalent across medicine, and otolaryngology as a specialty ranks near the mean. We review burnout levels in various subgroups of otolaryngology, including academic chairs, faculty, and residents. Risk factors of burnout are discussed, which differ by subgroup. Finally, we propose measures that could help minimize burnout and promote healthy and satisfying careers.

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

    PubMed

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

    2003-01-03

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

  19. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center

    PubMed Central

    Brady, Keri J.S.; Trockel, Mickey

    2016-01-01

    Background. Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians’ perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of? Methods. A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life. Results. Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction. Discussion. Our findings indicate that the factors that enhance professional fulfillment and those that precipitate burnout are distinct: motivation and quality of work performed were supported by domains intrinsic to the work itself, whereas external dysfunctional work aspects resulted in frustration. Thus, it can be anticipated that optimization of physician wellness would require tailored approaches in each of these dimensions with sustained funding and support for wellness initiatives. Physicians identified the availability of resources to enable them to thrive and provide excellent patient care as their most important wellness-enhancing factor. PMID:26989621

  20. A Cross-site Qualitative Study of Physician Order Entry

    PubMed Central

    Ash, Joan S.; Gorman, Paul N.; Lavelle, Mary; Payne, Thomas H.; Massaro, Thomas A.; Frantz, Gerri L.; Lyman, Jason A.

    2003-01-01

    Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. Measurements: Patterns and themes concerning perceptions of POE were identified. Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied. PMID:12595408

  1. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.

    PubMed

    Shanafelt, Tait D; Mungo, Michelle; Schmitgen, Jaime; Storz, Kristin A; Reeves, David; Hayes, Sharonne N; Sloan, Jeff A; Swensen, Stephen J; Buskirk, Steven J

    2016-04-01

    To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort. Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction. Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months. Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  2. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians.

    PubMed

    Gleichgerrcht, Ezequiel; Decety, Jean

    2014-01-01

    Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine.

  3. Health care professionals' and students' attitude toward collaboration between pharmacists and physicians in Croatia.

    PubMed

    Seselja-Perisin, Ana; Mestrovic, Arijana; Klinar, Ivana; Modun, Darko

    2016-02-01

    As traditional roles of pharmacists and physicians seem nowadays insufficient to ensure patient safety and therapy effectiveness, interprofessional collaboration has been suggested to improve health outcomes. To assess and compare the attitudes of physicians and pharmacists, as well as medical and pharmacy students in Croatia, toward interprofessional collaboration in primary health care. The study included 513 pharmacists and physicians, and 365 students of pharmacy and medicine from Croatia. The validated questionnaire, Scale of Attitudes Toward Physician–Pharmacist Collaboration, was translated in Croatian and completed, anonymously and voluntarily, by all participants. Results Pharmacists showed a more positive attitude toward collaboration than physicians (53.8 ± 4.8 vs. 50.7 ± 5.0). Pharmacy students expressed the most positive attitude (56.2 ± 4.9), while medical students showed the remarkably lowest attitude toward collaboration (44.6 ± 6.2). Pharmacists and physicians in Croatia expressed a relatively positive attitude toward their collaboration, comparable with their colleges in the USA. On the other hand, medical students expressed a 21 % less positive attitude than pharmacy students which could have an effect on interprofessional collaboration in the future when those students start working as health care professionals. Future studies, focusing on the promotion of this collaboration, on both under-graduated and post-graduated level, are warranted.

  4. Inquiring into our past: when the doctor is a survivor of abuse.

    PubMed

    Candib, Lucy M; Savageau, Judith A; Weinreb, Linda; Reed, George

    2012-06-01

    Health care professionals like other adults have a substantial exposure to childhood and adult victimization, but the prevalence of abuse experiences among practicing family physicians has not been examined. Also unclear is the impact of such personal experiences of abuse on physicians' screening practices for childhood abuse among their patients and the personal and professional barriers to such screening. We surveyed Massachusetts family physicians about their screening practices of adult patients for a history of childhood abuse and found that 33.6% had some experience of personal trauma, with 42.4% of women and 24.3% of men reporting some kind of lifetime personal abuse, including witnessing violence between their parents. These rates are comparable to or higher than those reported in prior studies of physicians' histories of abuse. Physicians with a past history of trauma were more likely to feel confident in screening and less likely to perceive time as a barrier to screening. Given the high prevalence of prior childhood and victimization of both men and women physicians with the associated effects on their clinical work, we recommend that educational and training settings adopt specific competencies to provide safe and confidential environments where trainees can safely explore these issues and the potential impact on their clinical practice and well-being.

  5. Physicians' lack of knowledge - a possible reason for red blood cell transfusion overuse?

    PubMed

    Rahav Koren, Roni; Suriu, Celia; Yakir, Orly; Akria, Luiza; Barhoum, Masad; Braester, Andrei

    2017-12-12

    A significant percentage of red blood cell transfusions are inappropriately overused. This study investigated physicians from the western Galilee in terms of their knowledge of transfusion medicine as a potential reason for red blood cell overuse, and assessed the influence of personal background characteristics on their knowledge. Data were collected via anonymous questionnaires. The questionnaires included a personal background section and a professional section. Study participants were grouped according to field of specialty, seniority, and location of medical school graduation, in order to correlate participant characteristics with knowledge. Scores were calculated on a 0-100 scale. The overall knowledge of the study population was low (mean score 47.8 ± 18.6). Knowledge regarding basic physiology of red blood cell transfusion was also low. Internal medicine physicians and senior physicians had significantly greater overall knowledge scores and were more familiar with a restrictive blood management policy than were surgeons and residents, respectively. Comparing knowledge scores, no difference was found regarding indications for transfusion. General and fundamental knowledge in transfusion medicine is lacking among physicians in the non-operating room setting, which may play a role in red blood cell transfusion overuse. Field of specialty and professional status influenced knowledge of transfusion medicine. Educational programs and increased physicians' awareness might help decrease unnecessary transfusions. Not applicable.

  6. Patient–physician communication about work-related asthma: what we do and do not know

    PubMed Central

    Mazurek, Jacek M.; White, Gretchen E.; Moorman, Jeanne E.; Storey, Eileen

    2015-01-01

    Background Effective patient–physician communication is the key component of the patient–physician relationship. Objective To assess the proportion of ever-employed adults with current asthma who talked about asthma associated with work with their physician or other health professional and to identify factors associated with this communication. Methods The 2006 to 2010 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey data from 40 states and the District of Columbia for ever-employed adults (≥18 years old) with current asthma (N = 50,433) were examined. Multivariable logistic regression analyses were conducted to identify factors associated with communication with a health professional about asthma and work. Results Among ever-employed adults with current asthma, 9.1% were ever told by a physician that their asthma was related to any job they ever had and 11.7% ever told a physician or other health professional that this was the case. When responses to the 2 questions were combined, the proportion of those who communicated with a health professional about asthma and work was 14.7%. Communication with a health professional about asthma and work was associated with age, race or ethnicity, employment, education, income, insurance, and urgent treatment for worsening asthma. Conclusion A small proportion of patients with asthma might communicate with a health professional about asthma associated with work. Future studies should examine whether patients with asthma ever discussed with a health professional the possibility that their asthma might be related to work to provide information on the frequency of patient–clinician communication about asthma related to work. PMID:25492097

  7. Influence of physician factors on the effectiveness of a continuing medical education intervention.

    PubMed

    Flores, Sergio; Reyes, Hortensia; Perez-Cuevas, Ricardo

    2006-01-01

    Continuing medical education (CME) is essential for improving the quality of care in primary health care settings. This study's objective was to determine how the characteristics of family physicians influenced the effectiveness of a multifaceted CME intervention to improve the management of acute respiratory infection (ARI) or type 2 diabetes (DM2). A secondary analysis was conducted based on data from 121 family physicians, who participated in the educational intervention study. The outcome variable was positive change in physician's performance for treatment of ARI or DM2. The exposure variable was multifaceted CME intervention. Independent variables were professional physicians and organizational characteristics. Analysis included log binomial regression modeling. Factors influencing positive change included, for ARI, participation in the CME intervention and medical director interested in that condition and for DM2, participation in the CME intervention, medical director interested in DM2, and being a teacher. Physicians' characteristics and organizational environment influence the effectiveness of educational intervention and are therefore relevant to the implementation of CME strategies.

  8. Sense of meaning as a predictor of burnout in emergency physicians in Israel: a national survey.

    PubMed

    Ben-Itzhak, Shulamit; Dvash, Jonathan; Maor, Maya; Rosenberg, Noa; Halpern, Pinchas

    2015-12-01

    Burnout is common in physicians and particularly acute in emergency physicians. Physician burnout may adversely affect physicians' lives and the quality of care they provide, but much remains unknown about its main contributing factors. The present study evaluated burnout rates and contributing factors in emergency physicians in Israel, specifically focusing on the role of a sense of meaning, which has received little attention in the literature concerning burnout in emergency physicians. A multicenter study, involving a convenience sample of physicians working full-time in the emergency departments of 16 general hospitals in Israel, was conducted. Questionnaires were used to assess burnout, demographic characteristics, professional stress, emotional distress, satisfaction, and quality of professional life, and open-ended questions were used to evaluate subjective perception of job satisfaction. Seventy physicians completed the questionnaires; 71.4% reported significant burnout levels in at least one of the burnout measures, while 82% also reported medium or high levels of competency. Burnout levels were associated with work-life balance, work satisfaction, social support, depressive symptoms, stress, and preoccupying thoughts. Regression analysis yielded two significant factors associated with burnout: worry and a sense of existential meaning derived from work. In addition, 61%, 51%, and 17% of participants exhibited high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment, respectively. These results indicate a high burnout rate in emergency physicians in Israel and highlight relevant positive and negative factors including the importance of addressing existential meaning in designing specific intervention programs to counter burnout.

  9. Nuclear medicine training and practice in Turkey.

    PubMed

    Ozcan, Zehra; Bozkurt, M Fani; Erbas, Belkıs; Durak, Hatice

    2017-05-01

    Nuclear medicine applications in Turkey started in the early 1950s, grew as an independent medical discipline and finally were recognized by the Ministry of Health in 1973. Later on, the professional organization of nuclear medicine physicians and other related professionals including radiopharmacists and technologists under the Turkish Society of Nuclear Medicine were established in 1975. Recently after completing more than a half century in Turkey, nuclear medicine has proved to be a strong and evolving medical field with more than 600 physicians serving for the changing needs of clinical practice throughout these years. This article describes past and present facts in this field and attempts to provide insights into the future which hopefully will be brighter than before.

  10. Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants.

    PubMed

    Betts, Kevin R; O'Donoghue, Amie C; Aikin, Kathryn J; Kelly, Bridget J; Boudewyns, Vanessa

    2016-12-01

    Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups. Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so. Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites. Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic. ©2016 American Association of Nurse Practitioners.

  11. Credentialing of Physicians in the Army.

    DTIC Science & Technology

    1984-05-21

    unqualified , inexperienced or reckless."l2 There are many other legal decisions which have impacted on medical credentials, but their impact is clear...of a physician in good standing. The professional qualifications require: (1) a medical degree (either a Doctor of Medicine (MD) or a Doctor of...is a process to specifically define areas of medical practice to include specific modalities of care which a medical treat- ment facility (WI?) grants

  12. Future Physicians' Professional Communication Skills Training at US Universities: Structure and Content

    ERIC Educational Resources Information Center

    Manyuk, Lubov

    2016-01-01

    Professional training of physicians able to apply their skills in order to reflect the patients' needs related to care, prevention and treatment of the diseases is one of the most common current trends in higher medical education. Due to the development of patient-centered relationships of physicians the attention of medical educators and…

  13. 10 CFR 1008.8 - Action in response to a request for access: disclosure of requested information to subject...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... individual, the individual may be asked: (1) To designate in writing a physician or mental health... physician or a mental health professional indicating that, in his view, disclosure of the requested records... individual refuses to designate a physician or mental health professional, or to submit a signed statement...

  14. Exploring the components of physician volunteer engagement: a qualitative investigation of a national Canadian simulation-based training programme

    PubMed Central

    Sarti, Aimee J; Sutherland, Stephanie; Landriault, Angele; DesRosier, Kirk; Brien, Susan; Cardinal, Pierre

    2017-01-01

    Objectives Conceptual clarity on physician volunteer engagement is lacking in the medical literature. The aim of this study was to present a conceptual framework to describe the elements which influence physician volunteer engagement and to explore volunteer engagement within a national educational programme. Setting The context for this study was the Acute Critical Events Simulation (ACES) programme in Canada, which has successfully evolved into a national educational programme, driven by physician volunteers. From 2010 to 2014, the programme recruited 73 volunteer healthcare professionals who contributed to the creation of educational materials and/or served as instructors. Method A conceptual framework was constructed based on an extensive literature review and expert consultation. Secondary qualitative analysis was undertaken on 15 semistructured interviews conducted from 2012 to 2013 with programme directors and healthcare professionals across Canada. An additional 15 interviews were conducted in 2015 with physician volunteers to achieve thematic saturation. Data were analysed iteratively and inductive coding techniques applied. Results From the physician volunteer data, 11 themes emerged. The most prominent themes included volunteer recruitment, retention, exchange, recognition, educator network and quasi-volunteerism. Captured within these interrelated themes were the framework elements, including the synergistic effects of emotional, cognitive and reciprocal engagement. Behavioural engagement was driven by these factors along with a cue to action, which led to contributions to the ACES programme. Conclusion This investigation provides a preliminary framework and supportive evidence towards understanding the complex construct of physician volunteer engagement. The need for this research is particularly important in present day, where growing fiscal constraints create challenges for medical education to do more with less. PMID:28645956

  15. Exploring the components of physician volunteer engagement: a qualitative investigation of a national Canadian simulation-based training programme.

    PubMed

    Sarti, Aimee J; Sutherland, Stephanie; Landriault, Angele; DesRosier, Kirk; Brien, Susan; Cardinal, Pierre

    2017-06-23

    Conceptual clarity on physician volunteer engagement is lacking in the medical literature. The aim of this study was to present a conceptual framework to describe the elements which influence physician volunteer engagement and to explore volunteer engagement within a national educational programme. The context for this study was the Acute Critical Events Simulation (ACES) programme in Canada, which has successfully evolved into a national educational programme, driven by physician volunteers. From 2010 to 2014, the programme recruited 73 volunteer healthcare professionals who contributed to the creation of educational materials and/or served as instructors. A conceptual framework was constructed based on an extensive literature review and expert consultation. Secondary qualitative analysis was undertaken on 15 semistructured interviews conducted from 2012 to 2013 with programme directors and healthcare professionals across Canada. An additional 15 interviews were conducted in 2015 with physician volunteers to achieve thematic saturation. Data were analysed iteratively and inductive coding techniques applied. From the physician volunteer data, 11 themes emerged. The most prominent themes included volunteer recruitment, retention, exchange, recognition, educator network and quasi-volunteerism. Captured within these interrelated themes were the framework elements, including the synergistic effects of emotional, cognitive and reciprocal engagement. Behavioural engagement was driven by these factors along with a cue to action, which led to contributions to the ACES programme. This investigation provides a preliminary framework and supportive evidence towards understanding the complex construct of physician volunteer engagement. The need for this research is particularly important in present day, where growing fiscal constraints create challenges for medical education to do more with less. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Theodore E. Woodward Award. HIV/AIDS, ethics, and medical professionalism: where went the debate?

    PubMed Central

    Bryan, Charles S.

    2003-01-01

    The recent surge of dialogue about medical professionalism has largely ignored HIV/AIDS, perhaps because the ethical issues that abounded during the 1980s and early 1990s have become largely passé. Prior to the introduction of highly active antiretroviral therapy (HAART) in 1996, the care ethic for patients with HIV/AIDS depended heavily on compassion since effective treatment was unavailable. Moreover, physicians and other health care workers often assumed physical risks on behalf of patients. HAART transformed the care ethic for HIV/AIDS to one dependent mainly on medical competence. Reflecting on the epidemic, I propose a distinction between "basic" and "higher" professionalism. Basic professionalism requires discipline-specific competence, facilitated by adherence to the four cardinal virtues (prudence, temperance, justice, and courage). Higher professionalism brings into play the transcendent virtues: faith, hope, and--especially--love (compassion). Specific examples of "compassion" in the strict sense of "suffering with" include caring without adequate reimbursement, caring when one would rather be doing something else, and assuming emotional or physical risks on behalf of patients. The physicians and other health care workers who displayed such compassion in abundance between 1981 and 1996 deserve our remembrance as exemplars of a higher professionalism. PMID:12813930

  17. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.

    PubMed

    Wald, Hedy S; Anthony, David; Hutchinson, Tom A; Liben, Stephen; Smilovitch, Mark; Donato, Anthony A

    2015-06-01

    Recent calls for an expanded perspective on medical education and training include focusing on complexities of professional identity formation (PIF). Medical educators are challenged to facilitate the active constructive, integrative developmental process of PIF within standardized and personalized and/or formal and informal curricular approaches. How can we best support the complex iterative PIF process for a humanistic, resilient health care professional? How can we effectively scaffold the necessary critical reflective learning and practice skill set for our learners to support the shaping of a professional identity?The authors present three pedagogic innovations contributing to the PIF process within undergraduate and graduate medical education (GME) at their institutions. These are (1) interactive reflective writing fostering reflective capacity, emotional awareness, and resiliency (as complexities within physician-patient interactions are explored) for personal and professional development; (2) synergistic teaching modules about mindful clinical practice and resilient responses to difficult interactions, to foster clinician resilience and enhanced well-being for effective professional functioning; and (3) strategies for effective use of a professional development e-portfolio and faculty development of reflective coaching skills in GME.These strategies as "bridges from theory to practice" embody and integrate key elements of promoting and enriching PIF, including guided reflection, the significant role of relationships (faculty and peers), mindfulness, adequate feedback, and creating collaborative learning environments. Ideally, such pedagogic innovations can make a significant contribution toward enhancing quality of care and caring with resilience for the being, relating, and doing of a humanistic health care professional.

  18. Toward accommodating physicians' conscientious objections: an argument for public disclosure.

    PubMed

    Harter, Thomas D

    2015-03-01

    This paper aims to demonstrate how public disclosure can be used to balance physicians' conscientious objections with their professional obligations to patients--specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians' conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians' conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians' conscientious objections are briefly addressed--potential harassment of physicians, workplace discrimination, and mischaracterising physicians' professional aptitude--concluding that each of these concerns requires further deliberation in the realm of business ethics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Disenfranchised Grief and Physician Burnout.

    PubMed

    Lathrop, Deborah

    2017-07-01

    Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential. © 2017 Annals of Family Medicine, Inc.

  20. Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings.

    PubMed

    Yamada, Janet; Potestio, Melissa L; Cave, Andrew J; Sharpe, Heather; Johnson, David W; Patey, Andrea M; Presseau, Justin; Grimshaw, Jeremy M

    2017-12-20

    This study aimed to apply a theory-based approach to identify barriers and enablers to implementing the Alberta Primary Care Asthma Pediatric Pathway (PCAPP) into clinical practice. Phase 1 included an assessment of assumptions underlying the intervention from the perspectives of the developers. Phase 2 determined the perceived barriers and enablers for: 1) primary care physicians' prescribing practices, 2) allied health care professionals' provision of asthma education to parents, and 3) children and parents' adherence to their treatment plans. Interviews were conducted with 35 individuals who reside in Alberta, Canada. Phase 1 included three developers. Phase 2 included 11 primary care physicians, 10 allied health care professionals, and 11 parents of children with asthma. Phase 2 interviews were based on the 14 domains of the Theoretical Domains Framework (TDF). Transcribed interviews were analyzed using a directed content analysis. Key assumptions by the developers about the intervention, and beliefs by others about the barriers and enablers of the targeted behaviors were identified. Eight TDF domains mapped onto the assumptions of the pathway as described by the intervention developers. Interviews with health care professionals and parents identified nine TDF domains that influenced the targeted behaviors: knowledge, skills, beliefs about capabilities, social/professional role and identity, beliefs about consequences, environmental context and resources, behavioral regulation, social influences, and emotions. Barriers and enablers perceived by health care professionals and parents that influenced asthma management will inform the optimization of the PCAPP prior to its evaluation.

  1. Virtual reality skills training for health care professionals in alcohol screening and brief intervention.

    PubMed

    Fleming, Michael; Olsen, Dale; Stathes, Hilary; Boteler, Laura; Grossberg, Paul; Pfeifer, Judie; Schiro, Stephanie; Banning, Jane; Skochelak, Susan

    2009-01-01

    Educating physicians and other health care professionals about the identification and treatment of patients who drink more than recommended limits is an ongoing challenge. An educational randomized controlled trial was conducted to test the ability of a stand-alone training simulation to improve the clinical skills of health care professionals in alcohol screening and intervention. The "virtual reality simulation" combined video, voice recognition, and nonbranching logic to create an interactive environment that allowed trainees to encounter complex social cues and realistic interpersonal exchanges. The simulation included 707 questions and statements and 1207 simulated patient responses. A sample of 102 health care professionals (10 physicians; 30 physician assistants or nurse practitioners; 36 medical students; 26 pharmacy, physican assistant, or nurse practitioner students) were randomly assigned to a no training group (n = 51) or a computer-based virtual reality intervention (n = 51). Professionals in both groups had similar pretest standardized patient alcohol screening skill scores: 53.2 (experimental) vs 54.4 (controls), 52.2 vs 53.7 alcohol brief intervention skills, and 42.9 vs 43.5 alcohol referral skills. After repeated practice with the simulation there were significant increases in the scores of the experimental group at 6 months after randomization compared with the control group for the screening (67.7 vs 58.1; P < .001) and brief intervention (58.3 vs 51.6; P < .04) scenarios. The technology tested in this trial is the first virtual reality simulation to demonstrate an increase in the alcohol screening and brief intervention skills of health care professionals.

  2. Physician revalidation in Europe.

    PubMed

    Merkur, Sherry; Mossialos, Elias; Long, Morgan; McKee, Martin

    2008-08-01

    Despite the increasing attention on patient mobility, there remains a lack of European-level interest in assuring the sustained competence of health professionals. Specifically, the existing European legal framework fails to recognise the introduction of periodic revalidation and requirements to participate in continuing professional development in some countries. This study shows that the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should explore the implications for professional mobility of the diversity in the regulation of the medical profession.

  3. Wisconsin Emergency Assistance Volunteer Registry (WEAVR): how physicians can help and why they are needed.

    PubMed

    Katcher, Murray L; Bayou, Billee; Anderson, Henry A; Davis, Jeffrey P

    2005-09-01

    The Wisconsin Division of Public Health (DPH) and its partners have developed the necessary public health infrastructure and core expertise to prepare for, and respond to, public health threats and emergencies. The infrastructure includes 12 public health preparedness consortia that have been established across the state. An important part of the response plan is to assure that the responder workforce is adequate to meet the need at the local, regional, and statewide levels. The responder workforce includes health professional volunteers who, if called on, will take on a variety of assigned roles relevant to a defined incident. In order to facilitate an organized system for volunteers to indicate their skills and availability, DPH has developed a secure and confidential database--the Wisconsin Emergency Assistance Volunteer Registry (WEAVR)--to collect and organize contact information on health professional volunteers and to make contact with volunteers when needed. Physicians, as well as other health professional volunteers, are critical to protect the health and safety of the community, especially if the need to dispense prophylactic medications or to vaccinate the entire population of Wisconsin arises. At the time of an event, volunteers will receive "just-in-time" training after reporting to their assigned location. In other states, physicians have found this emergency training to be of value to their overall practice of medicine. Information about how to sign on to WEAVR is provided.

  4. 42 CFR 410.26 - Services and supplies incident to a physician's professional services: Conditions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... supplies means any services or supplies (including drugs or biologicals that are not usually self... independent contractor. (c) Limitations. (1) Drugs and biologicals are also subject to the limitations...

  5. 42 CFR 410.26 - Services and supplies incident to a physician's professional services: Conditions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... supplies means any services or supplies (including drugs or biologicals that are not usually self... independent contractor. (c) Limitations. (1) Drugs and biologicals are also subject to the limitations...

  6. What Schooling Could Be Like: Analogies for Learning

    ERIC Educational Resources Information Center

    Engel, Martin

    1974-01-01

    A survey of alternative models of education is presented metaphorically. Alternatives suggested include schools more like mobile homes, teaching hospital complexes, summer camps, art classrooms, professional practice, a physician's practice, and libraries and museums. (SDH)

  7. Terminating the Doctor-Patient Relationship

    ERIC Educational Resources Information Center

    Kay, Jarald

    1978-01-01

    Emotional aspects of ending the physician-patient relationship should be illustrated in clinical teaching courses. Teaching opportunities include examination of this relationship and professional development, unresolved doctor-patient conflicts, role underevaluation, patient gifts, and referral procedures. (Author/LBH)

  8. A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit.

    PubMed

    Shoham, David A; Harris, Jenine K; Mundt, Marlon; McGaghie, William

    2016-09-01

    Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01-2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.

  9. Professionalism for Medicine: Opportunities and Obligations*

    PubMed Central

    Cruess, Sylvia R; Cruess, Richard L; Johnston, Sharon

    2004-01-01

    Physicians' dual roles-as healer and professional-are linked by codes of ethics governing behaviour and are empowered by science.Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service.Societal attitudes to professionalism have changed from supportive to increasingly critical-with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence.Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector.For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values. PMID:15296199

  10. Professionalism for medicine: opportunities and obligations.

    PubMed

    Cruess, Sylvia R; Johnston, Sharon; Cruess, Richard L

    2002-08-19

    Physicians' dual roles - as healer and professional - are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical - with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values.

  11. Professionalism for medicine: opportunities and obligations.

    PubMed

    Cruess, Sylvia R; Johnston, Sharon; Cruess, Richard L

    2004-01-01

    Physicians' dual roles--as healer and professional--are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical--with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values.

  12. [The path of creating TCM female periodicals in the Republican period].

    PubMed

    Ji, Zhenghan; Yan, Jilan; Zu, Na

    2014-03-01

    A"special issue of female physicians" was included in the 1934 Kunghwa Medical Journal. In 1939, Qian Bao-hua, together with a batch of female TCM professional medical workers, inaugurated a "Chinese Feminine Physicians" included in the "Journal of Column of Traditional Chinese Medicine". The former one was published independently in 1941, only for 8 issues and was suspended in the same year. In the Republican period, the 7 years of running the TCM periodicals by the female physicians was the miniature of the campaign of feminine rights in the TCM field from heat to cold, from foolish through confidence to self-realization. As the only extant TCM periodical, the Chinese Feminine Physicians run by females in the upper half of the 20th century, the basic cause of its failure may lie on the wrong evaluation of its audiences.

  13. Differential effects of professional leaders on health care teams in chronic disease management groups.

    PubMed

    Wholey, Douglas R; Disch, Joanne; White, Katie M; Powell, Adam; Rector, Thomas S; Sahay, Anju; Heidenreich, Paul A

    2014-01-01

    Leadership by health care professionals is likely to vary because of differences in the social contexts within which they are situated, socialization processes and societal expectations, education and training, and the way their professions define and operationalize key concepts such as teamwork, collaboration, and partnership. This research examines the effect of the nurse and physician leaders on interdependence and encounter preparedness in chronic disease management practice groups. The aim of this study was to examine the effect of complementary leadership by nurses and physicians involved in jointly producing a health care service on care team functioning. The design is a retrospective observational study based on survey data. The unit of analysis is heart failure care groups in U.S. Veterans Health Administration medical centers. Survey and administrative data were collected in 2009 from 68 Veterans Health Administration medical centers. Key variables include nurse and physician leadership, interdependence, psychological safety, coordination, and encounter preparedness. Reliability and validity of survey measures were assessed with exploratory factor analysis and Cronbach alphas. Multivariate analyses tested hypotheses. Professional leadership by nurses and physicians is related to encounter preparedness by different paths. Nurse leadership is associated with greater team interdependence, and interdependence is positively associated with respect. Physician leadership is positively associated with greater psychological safety, respect, and shared goals but is not associated with interdependence. Respect is associated with involvement in learning activities, and shared goals are associated with coordination. Coordination and involvement in learning activities are positively associated with encounter preparedness. By focusing on increasing interdependence and a constructive climate, nurse and physician leaders have the opportunity to increase care coordination and involvement in learning activities.

  14. Physician-Rating Web Sites: Ethical Implications.

    PubMed

    Samora, Julie Balch; Lifchez, Scott D; Blazar, Philip E

    2016-01-01

    To understand the ethical and professional implications of physician behavior changes secondary to online physician-rating Web sites (PRWs). The American Society for Surgery of the Hand (ASSH) Ethics and Professionalism Committee surveyed the ASSH membership regarding PRWs. We sent a 14-item questionnaire to 2,664 active ASSH members who practice in both private and academic settings in the United States. We received 312 responses, a 12% response incidence. More than 65% of the respondents had a slightly or highly unfavorable impression of these Web sites. Only 34% of respondents had ever updated or created a profile for PRWs, although 62% had observed inaccuracies in their profile. Almost 90% of respondents had not made any changes in their practice owing to comments or reviews. One-third of respondents had solicited favorable reviews from patients, and 3% of respondents have paid to improve their ratings. PRWs are going to become more prevalent, and more research is needed to fully understand the implications. There are several ethical implications that PRWs pose to practicing physicians. We contend that it is morally unsound to pay for good reviews. The recourse for physicians when an inaccurate and potentially libelous review has been written is unclear. Some physicians have required patients to sign a waiver preventing them from posting negative comments online. We propose the development of a task force to assess the professional, ethical, and legal implications of PRWs, including working with companies to improve accuracy of information, oversight, and feedback opportunities. It is expected that PRWs will play an increasing role in the future; it is unclear whether there will be a uniform reporting system, or whether these online ratings will influence referral patterns and/or quality improvement. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. The perception and experience of gender-based discrimination related to professional advancement among Japanese physicians.

    PubMed

    Yasukawa, Kosuke; Nomura, Kyoko

    2014-01-01

    Previous studies from the US have found that female physicians often experience gender-based discrimination related to professional advancement. In Japan, female physicians are underrepresented in leadership positions but little is known about the prevalence of gender discrimination. We investigated the perception and prevalence of gender-based career obstacles and discrimination among Japanese physicians. The study was based on surveys of alumnae from 13 medical schools and alumni from 3 medical schools. In total, 1,684 female and 808 male physicians completed a self-administered questionnaire (response rate 83% and 58%). More women than men had the perception of gender-based career obstacles for women (77% vs. 55%; p < 0.0001). Women with part-time positions were more likely to have the perception of gender-based career obstacles than women working full-time (OR 1.32, 95% CI: 1.01-1.73). More women than men reported experience of gender discrimination related to professional advancement (21% vs. 3%; p < 0.0001). Factors associated with experience of gender discrimination included age (p < 0.0001), marital status (p < 0.0001), academic positions (p < 0.0001), subspecialty board certification (p = 0.0011), and PhD status (p < 0.0001). Women older than 40 years were more likely to experience gender discrimination compared with younger women (OR 5.77, 95% CI: 1.83-18.24 for women above 50, and OR 3.2, 95% CI: 1.48-7.28 for women between 40 and 49) and women with PhD were more likely to experience gender discrimination (OR 4.23, 95% CI: 1.81-9.89). Our study demonstrated that a significant proportion of Japanese women experienced gender-based discrimination and perceived gender-based career obstacles compared with male physicians.

  16. Resigned professionalism? Non-acute inpatients and resident education.

    PubMed

    Vanstone, Meredith; Watling, Christopher; Goldszmidt, Mark; Weijer, Charles; Lingard, Lorelei

    2014-10-01

    A growing group of inpatients on acute clinical teaching units have non-acute needs, yet require attention by the team. While anecdotally, these patients have inspired frustration and resource pressures in clinical settings, little is known about the ways in which they influence physician perceptions of the learning environment. This qualitative study explored residents' and attending physicians' perceptions of caring for these patients, including their educational value. Using constructivist grounded theory, we conducted seven homogeneous focus groups and three interviews with residents and attending physicians from neurology and general internal medicine. A constant comparative analytical approach was employed alongside data collection, using theoretical sampling to explore emergent themes. Residents consistently described non-acute patients as non-educational, uninteresting, but still in need of care. Some attending physicians echoed this view, while others described multiple learning opportunities presented by non-acute patients. Both groups described residents as engaging with non-acute patients in a professional capacity, but not as learners. This engagement in a professional capacity could be considered diligent disinterest, or resigned professionalism. A constructivist understanding of the dynamics which influence learning in the workplace was used to explore the reasons why the residents in our study did not recognize the learning opportunities presented by non-acute patients. Our results resonate with Billett's theory of workplace affordances, which offers an explanation as to why learners may not identify or take advantage of potential learning opportunities. Overall, our study assists our understanding of the sociocultural factors that influence learners' choices to engage with particular clinical learning opportunities.

  17. Burnout in Rural Physician Assistants: An Initial Study.

    PubMed

    Benson, Marc A; Peterson, Teri; Salazar, Lisa; Morris, Wesley; Hall, Rebecca; Howlett, Bernadette; Phelps, Paula

    2016-06-01

    To assess the prevalence and causes of burnout in rural physician assistants. (PA in this article refers to personal accomplishment. To avoid confusion, we will spell out physician assistant throughout the article, instead of using PA to refer to both physician assistant and personal accomplishment.) Physician assistants who practice in rural communities were asked to complete the Maslach Burnout Inventory. A preliminary assessment of burnout was determined using the 3 Maslach Burnout Inventory subscale scores: emotional exhaustion, depersonalization, and personal accomplishment, as well as causes of burnout assessed for a correlation to personal and professional factors. Burnout within the rural physician assistant population responding to this survey (response rate = 11.3%) was measured to have high to moderate emotional exhaustion and depersonalization subscores (64% each) and a low to moderate personal accomplishment subscore (46%). The rural physician assistant population who responded to this survey exhibited burnout correlating to feelings of professional isolation and various workplace conditions such as the adequacy of administrative support and control over workload. To begin addressing burnout within this community, we suggest adjusting rural physician assistant workload and support, enhancing professional communications, and addressing burnout prevention techniques within physician assistant training programs.

  18. SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

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

    Dieterich, S; Perks, J; Fragoso, R

    Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlapmore » and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social support system has developed, embedding physics residents into a larger peer group.« less

  19. Sense of meaning as a predictor of burnout in emergency physicians in Israel: a national survey

    PubMed Central

    Ben-Itzhak, Shulamit; Dvash, Jonathan; Maor, Maya; Rosenberg, Noa; Halpern, Pinchas

    2015-01-01

    Objective Burnout is common in physicians and particularly acute in emergency physicians. Physician burnout may adversely affect physicians’ lives and the quality of care they provide, but much remains unknown about its main contributing factors. The present study evaluated burnout rates and contributing factors in emergency physicians in Israel, specifically focusing on the role of a sense of meaning, which has received little attention in the literature concerning burnout in emergency physicians. Methods A multicenter study, involving a convenience sample of physicians working full-time in the emergency departments of 16 general hospitals in Israel, was conducted. Questionnaires were used to assess burnout, demographic characteristics, professional stress, emotional distress, satisfaction, and quality of professional life, and open-ended questions were used to evaluate subjective perception of job satisfaction. Results Seventy physicians completed the questionnaires; 71.4% reported significant burnout levels in at least one of the burnout measures, while 82% also reported medium or high levels of competency. Burnout levels were associated with work-life balance, work satisfaction, social support, depressive symptoms, stress, and preoccupying thoughts. Regression analysis yielded two significant factors associated with burnout: worry and a sense of existential meaning derived from work. In addition, 61%, 51%, and 17% of participants exhibited high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment, respectively. Conclusion These results indicate a high burnout rate in emergency physicians in Israel and highlight relevant positive and negative factors including the importance of addressing existential meaning in designing specific intervention programs to counter burnout. PMID:27752601

  20. Core competencies for pharmaceutical physicians and drug development scientists

    PubMed Central

    Silva, Honorio; Stonier, Peter; Buhler, Fritz; Deslypere, Jean-Paul; Criscuolo, Domenico; Nell, Gerfried; Massud, Joao; Geary, Stewart; Schenk, Johanna; Kerpel-Fronius, Sandor; Koski, Greg; Clemens, Norbert; Klingmann, Ingrid; Kesselring, Gustavo; van Olden, Rudolf; Dubois, Dominique

    2013-01-01

    Professional groups, such as IFAPP (International Federation of Pharmaceutical Physicians and Pharmaceutical Medicine), are expected to produce the defined core competencies to orient the discipline and the academic programs for the development of future competent professionals and to advance the profession. On the other hand, PharmaTrain, an Innovative Medicines Initiative project, has become the largest public-private partnership in biomedicine in the European Continent and aims to provide postgraduate courses that are designed to meet the needs of professionals working in medicines development. A working group was formed within IFAPP including representatives from PharmaTrain, academic institutions and national member associations, with special interest and experience on Quality Improvement through education. The objectives were: to define a set of core competencies for pharmaceutical physicians and drug development scientists, to be summarized in a Statement of Competence and to benchmark and align these identified core competencies with the Learning Outcomes (LO) of the PharmaTrain Base Course. The objectives were successfully achieved. Seven domains and 60 core competencies were identified and aligned accordingly. The effective implementation of training programs using the competencies or the PharmaTrain LO anywhere in the world may transform the drug development process to an efficient and integrated process for better and safer medicines. The PharmaTrain Base Course might provide the cognitive framework to achieve the desired Statement of Competence for Pharmaceutical Physicians and Drug Development Scientists worldwide. PMID:23986704

  1. Dietary and physical activity counselling on type 2 diabetes and impaired glucose tolerance by physicians and nurses in primary healthcare in Finland.

    PubMed

    Poskiparta, Marita; Kasila, Kirsti; Kiuru, Päivi

    2006-12-01

    To investigate the initiation of dietary and physical activity counselling and the arguments used when discussing physical activity and the type and consumption of dietary fats, during nurse-patient and physician-patient diabetic lifestyle counselling. This study is a part of a larger follow-up research project focusing on diabetes counselling. The data include 129 videotaped counselling sessions between 17 patients and their physicians and nurses. Content analysis was carried out by identifying the verbal comments and reactions of participants concerning both physical activity and the type and consumption of dietary fats. The physicians and nurses spent little time on dietary and physical activity counselling. The counselling sessions consisted mainly of short questions with minimal feedback from either party. The beginning of the sessions concentrated on blood cholesterol levels and the extent of physical activity. The health professionals failed to emphasize the roles of reduced dietary fats and increased physical activity in substituting for or supplementing diabetes care. Although the patients communicated the factors that encouraged or discouraged physical activity the subject was generally not pursued by the health professionals. Within primary care there is a need for methods that would facilitate the discussion of health behaviour changes. In healthcare settings, education and training are required to develop the communication skills of health professionals in all aspects of preventive medicine.

  2. Medical professionalism of foreign-born and foreign-trained physicians under close scrutiny: A qualitative study with stakeholders in Germany

    PubMed Central

    Ismail, Fatiha; Marckmann, Georg; Kuehlmeyer, Katja

    2018-01-01

    Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration. PMID:29447259

  3. Essential professional duties for the sub-Saharan medical/dental graduate: An Association of Medical Schools of Africa initiative.

    PubMed

    Olapade-Olaopa, E O; Sewankambo, N; Iputo, J E; Rugarabamu, P; Amlak, A H; Mipando, M; Monekosso G L

    2016-09-01

    BACKGROUND - Globally, human resources for health are being optimized to address the increasing health burden and concomitant increased demands on health professionals. These demands are even more exacting in Sub-SaharanAfrica considering the shortage of health care workers, especially physicians. The noteworthy efforts at deploying task-shifting to address this situation not-withstanding, the situation also signals the need to re-define the objectives of medical instruction to ensure effective and contemporary medical practice in a mostly physician-led health workforce across the sub-continent. In this regard, medical and dental graduates must be educated to perform certain minimum essential professional duties competently. Essential Professional Duties are locally relevant professional activities of international standard that represent identifiable outcomes against which the effectiveness of physicians in a specific community can be measured to ensure social accountability. PROCEDURE AND PRODUCT - The Association of Medical Schools of Africa has developed the 'Essential Professional Duties for sub-Saharan medical and dental graduates' to ensure these physicians provide safe and effective contemporary medical/dental practice on the sub-continent. The duties have been grouped into those required for basic patient care, basic administrative skills, basic emergency care, communication, inter-professional relationships, self-directed learning and social responsibilities. Their relevance and suitability have been evaluated prior to their adoption by the Association. CONCLUSION; These Essential Physician Duties have been developed to serve as targets for health professionals training instruments and thus give direction to health system strategies. It is hoped that they will be adopted by medical and dental schools across sub-,. Saharan Africa.

  4. [Profesionalismo en médicos de un hospital de segundo nivel].

    PubMed

    Prieto-Miranda, Sergio Emilio; Jiménez-Bernardino, Carlos Alberto; Monjaraz-Guzmán, Elizabeth Guadalupe; Esparza-Pérez, Ramiro Israel

    2017-01-01

    It takes many years to acquire abilities and technical skills necessary to do a good work as a doctor and even more years, for being "good professionals". Much of this training is based on old teaching schemes, but medicine has changed. So far no studies in our medium addressing the problem are known. The aim of this paper was to determine the level of professionalism in physicians that work in a second-level hospital. Descriptive cross-sectional study. We apply a survey to physicians, residents and medical interns in a second-level hospital. We developed and implemented a questionnaire on professionalism, which contained 18 items, 3 demographic questions and 15 questions with a Likert scale, which identified four dimensions: specialized knowledge, autonomy in decision-making, self-regulation and social commitment. Descriptive and inferential statistics were used, considering significant a p-value <0.05. We surveyed 228 physicians, 57.5% demonstrated competence in professionalism. 93.3% of the participants were competent in specialized knowledge and 60.5% in social commitment. The physicians and residents got the higher scores, and these differences were significant between autonomy in decision-making and specialized knowledge (p < 0.001). The medical interns obtained lower scores in all dimensions compared with residents and physicians. More than a half of physicians surveyed had a competent level of professionalism but only in some dimensions. We observed higher scores with a higher academic grade.

  5. Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective.

    PubMed

    Sprung, Charles L; Somerville, Margaret A; Radbruch, Lukas; Collet, Nathalie Steiner; Duttge, Gunnar; Piva, Jefferson P; Antonelli, Massimo; Sulmasy, Daniel P; Lemmens, Willem; Ely, E Wesley

    2018-01-01

    Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn't be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don't want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient's death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable. Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.

  6. Transforming Medical Education is the Key to Meeting North Carolina's Physician Workforce Needs.

    PubMed

    Cunningham, Paul R G; Baxley, Elizabeth G; Garrison, Herbert G

    2016-01-01

    To meet the needs of the population of North Carolina, an epic transformation is under way in health care. This transformation requires that we find new ways to educate and train physicians and other health care professionals. In this commentary, we propose that the success of the Brody School of Medicine in preparing a primary care physician workforce can serve as a model for meeting the state's future physician workforce needs. Other considerations include increasing graduate medical education positions through state funding and providing incentives for medical students who stay in North Carolina. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

  7. Race-Conscious Professionalism and African American Representation in Academic Medicine.

    PubMed

    Powers, Brian W; White, Augustus A; Oriol, Nancy E; Jain, Sachin H

    2016-07-01

    African Americans remain substantially less likely than other physicians to hold academic appointments. The roots of these disparities stem from different extrinsic and intrinsic forces that guide career development. Efforts to ameliorate African American underrepresentation in academic medicine have traditionally focused on modifying structural and extrinsic barriers through undergraduate and graduate outreach, diversity and inclusion initiatives at medical schools, and faculty development programs. Although essential, these initiatives fail to confront the unique intrinsic forces that shape career development. America's ignoble history of violence, racism, and exclusion exposes African American physicians to distinct personal pressures and motivations that shape professional development and career goals. This article explores these intrinsic pressures with a focus on their historical roots; reviews evidence of their effect on physician development; and considers the implications of these trends for improving African American representation in academic medicine. The paradigm of "race-conscious professionalism" is used to understand the dual obligation encountered by many minority physicians not only to pursue excellence in their field but also to leverage their professional stature to improve the well-being of their communities. Intrinsic motivations introduced by race-conscious professionalism complicate efforts to increase the representation of minorities in academic medicine. For many African American physicians, a desire to have their work focused on the community will be at odds with traditional paths to professional advancement. Specific policy options are discussed that would leverage race-conscious professionalism as a draw to a career in academic medicine, rather than a force that diverts commitment elsewhere.

  8. Muslim physicians and palliative care: attitudes towards the use of palliative sedation.

    PubMed

    Muishout, George; van Laarhoven, Hanneke W M; Wiegers, Gerard; Popp-Baier, Ulrike

    2018-05-08

    Muslim norms concerning palliative sedation can differ from secular and non-Muslim perceptions. Muslim physicians working in a Western environment are expected to administer palliative sedation when medically indicated. Therefore, they can experience tension between religious and medical norms. To gain insight into the professional experiences of Muslim physicians with palliative sedation in terms of religious and professional norms. Interpretative phenomenological study using semi-structured interviews to take a closer look at the experiences of Muslim physicians with palliative sedation. Data were recorded, transcribed and analysed by means of interpretative phenomenological analysis (IPA). Ten Muslim physicians, working in the Netherlands, with professional experience of palliative sedation. Two main themes were identified: professional self-concept and attitudes towards death and dying. Participants emphasized their professional responsibility when making treatment decisions, even when these contravened the prevalent views of Islamic scholars. Almost all of them expressed the moral obligation to fight their patients' pain in the final stage of life. Absence of acceleration of death was considered a prerequisite for using palliative sedation by most participants. Although the application of palliative sedation caused friction with their personal religious conceptions on a good death, participants followed a comfort-oriented care approach corresponding to professional medical standards. All of them adopted efficient strategies for handling of palliative sedation morally and professionally. The results of this research can contribute to and provide a basis for the emergence of new, applied Islamic ethics regarding palliative sedation.

  9. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.

    PubMed

    Davis, David A; Mazmanian, Paul E; Fordis, Michael; Van Harrison, R; Thorpe, Kevin E; Perrier, Laure

    2006-09-06

    Core physician activities of lifelong learning, continuing medical education credit, relicensure, specialty recertification, and clinical competence are linked to the abilities of physicians to assess their own learning needs and choose educational activities that meet these needs. To determine how accurately physicians self-assess compared with external observations of their competence. The electronic databases MEDLINE (1966-July 2006), EMBASE (1980-July 2006), CINAHL (1982-July 2006), PsycINFO (1967-July 2006), the Research and Development Resource Base in CME (1978-July 2006), and proprietary search engines were searched using terms related to self-directed learning, self-assessment, and self-reflection. Studies were included if they compared physicians' self-rated assessments with external observations, used quantifiable and replicable measures, included a study population of at least 50% practicing physicians, residents, or similar health professionals, and were conducted in the United Kingdom, Canada, United States, Australia, or New Zealand. Studies were excluded if they were comparisons of self-reports, studies of medical students, assessed physician beliefs about patient status, described the development of self-assessment measures, or were self-assessment programs of specialty societies. Studies conducted in the context of an educational or quality improvement intervention were included only if comparative data were obtained before the intervention. Study population, content area and self-assessment domain of the study, methods used to measure the self-assessment of study participants and those used to measure their competence or performance, existence and use of statistical tests, study outcomes, and explanatory comparative data were extracted. The search yielded 725 articles, of which 17 met all inclusion criteria. The studies included a wide range of domains, comparisons, measures, and methodological rigor. Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations. A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions. While suboptimal in quality, the preponderance of evidence suggests that physicians have a limited ability to accurately self-assess. The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.

  10. Physicians’ perceptions of quality of care, professional autonomy, and job satisfaction in Canada, Norway, and the United States

    PubMed Central

    2013-01-01

    Background We lack national and cross-national studies of physicians’ perceptions of quality of patient care, professional autonomy, and job satisfaction to inform clinicians and policymakers. This study aims to compare such perceptions in Canada, the United States (U.S.), and Norway. Methods We analyzed data from large, nationwide, representative samples of physicians in Canada (n = 3,083), the U.S. (n = 6,628), and Norway (n = 638), examining demographics, job satisfaction, and professional autonomy. Results Among U.S. physicians, 79% strongly agreed/agreed they could provide high quality patient care vs. only 46% of Canadian and 59% of Norwegian physicians. U.S. physicians also perceived more clinical autonomy and time with their patients, with differences remaining significant even after controlling for age, gender, and clinical hours. Women reported less adequate time, clinical freedom, and ability to provide high-quality care. Country differences were the strongest predictors for the professional autonomy variables. In all three countries, physicians’ perceptions of quality of care, clinical freedom, and time with patients influenced their overall job satisfaction. Fewer U.S. physicians reported their overall job satisfaction to be at-least-somewhat satisfied than did Norwegian and Canadian physicians. Conclusions U.S. physicians perceived higher quality of patient care and greater professional autonomy, but somewhat lower job satisfaction than their colleagues in Norway and Canada. Differences in health care system financing and delivery might help explain this difference; Canada and Norway have more publicly-financed, not-for-profit health care delivery systems, vs. a more-privately-financed and profit-driven system in the U.S. None of these three highly-resourced countries, however, seem to have achieved an ideal health care system from the perspective of their physicians. PMID:24330820

  11. Attitudes toward expanding nurses' authority.

    PubMed

    Kerzman, Hana; Van Dijk, Dina; Eizenberg, Limor; Khaikin, Rut; Phridman, Shoshi; Siman-Tov, Maya; Goldberg, Shoshi

    2015-01-01

    In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics. A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work. Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority. In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.

  12. A Medical Student Perspective on Physician-Assisted Suicide.

    PubMed

    Rhee, John Y; Callaghan, Katharine A; Allen, Philip; Stahl, Amanda; Brown, Martin T; Tsoi, Alexandra; McInerney, Grace; Dumitru, Ana-Maria G

    2017-09-01

    Physician-assisted suicide and euthanasia (PAS/E) has been increasingly discussed and debated in the public arena, including in professional medical organizations. However, the medical student perspective on the debate has essentially been absent. We present a medical student perspective on the PAS/E debate as future doctors and those about to enter the profession. We argue that PAS/E is not in line with the core principles of medicine and that the focus should be rather on providing high-quality end-of-life and palliative care. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  13. Qualitative study of employment of physician assistants by physicians: benefits and barriers in the Ontario health care system.

    PubMed

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

    2013-11-01

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

  14. Building a workforce of physicians to care for underserved patients.

    PubMed

    Anthony, David; El Rayess, Fadya; Esquibel, Angela Y; George, Paul; Taylor, Julie

    2014-09-02

    There is a shortage of physicians to care for underserved populations. Medical educators at The Warren Alpert Medical School of Brown University have used five years of Health Resources and Services Administration funding to train medical students to provide outstanding primary care for underserved populations. The grant has two major goals: 1) to increase the number of graduating medical students who practice primary care in underserved communities ("Professional Development"); and 2) to prepare all medical school graduates to care for underserved patients, regardless of specialty choice ("Curriculum Development"). Professional Development, including a new scholarly concentration and an eight-year primary care pipeline, has been achieved in partnership with the Program in Liberal Medical Education, the medical school's Admissions Committee, and an Area Health Education Center. Curriculum Development has involved systematic recruitment of clinical training sites and disease-specific curricula including tools for providing care to vulnerable populations. A comprehensive, longitudinal evaluation is ongoing.

  15. Consolidation of medical groups into physician practice management organizations.

    PubMed

    Robinson, J C

    1998-01-14

    Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

  16. Validation of the Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) Questionnaire: A Prospective Analysis of Facial Plastic and Reconstructive Surgery Procedures.

    PubMed

    Oliver, Jeremie D; Menapace, Deanna; Younes, Ahmed; Recker, Chelsey; Hamilton, Grant; Friedman, Oren

    2018-02-01

    Although periorbital edema and ecchymosis are commonly encountered after facial plastic and reconstructive surgery procedures, there is currently no validated grading scale to qualify these findings. In this study, the modified "Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE)" questionnaire is used as a grading scale for patients undergoing facial plastic surgery procedures. This article aims to validate a uniform grading scale for periorbital edema and ecchymosis using the modified SPREE questionnaire in the postoperative period. This is a prospective study including 82 patients at two different routine postoperative visits (second and seventh postoperative days), wherein the staff and resident physicians, physician assistants (PAs), patients, and any accompanying adults were asked to use the modified SPREE questionnaire to score edema and ecchymosis of each eye of the patient who had undergone a plastic surgery procedure. Interrater and intrarater agreements were then examined. Cohen's kappa coefficient was calculated to measure intrarater and interrater agreement between health care professionals (staff physicians and resident physicians); staff physicians and PAs; and staff physicians, patients, and accompanying adults. Good to excellent agreement was identified between staff physicians and resident physicians as well as between staff physicians and PAs. There was, however, poor agreement between staff physicians, patients, and accompanying adults. In addition, excellent agreement was found for intraobserver reliability during same-day visits. The modified SPREE questionnaire is a validated grading system for use by health care professionals to reliably rate periorbital edema and ecchymosis in the postoperative period. Validation of the modified SPREE questionnaire may improve ubiquity in medical literature reporting and related outcomes reporting in future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. The effects of fatigue and dissatisfaction on how physicians perceive their social responsibilities.

    PubMed

    O'Donnell, Erin P; Humeniuk, Katherine M; West, Colin P; Tilburt, Jon C

    2015-02-01

    To examine how fatigue and dissatisfaction with practicing medicine relate to US physicians' perceptions of their professional responsibilities in a time of upheaval in health care. From May 30, 2012, through September 1, 2012, we mailed an 8-page paper survey, including measures of perceived social responsibility, fatigue, and satisfaction, to a random sample of 3897 physicians selected from the American Medical Association Physician Masterfile. We performed bivariate tests and multivariable logistic regression to examine associations between key predictors (fatigue and satisfaction) and 3 dependent variables: obligations to care for the uninsured and underinsured, obligations to address policy issues, and agreement with cost-containment. A total of 2556 physicians (65.6%) responded to the survey. Nearly half of physicians (1160 [45.4%]) reported high levels of fatigue, whereas most (1810 [70.8%]) expressed satisfaction with practicing medicine. Dissatisfaction in practicing medicine proved to be a significant predictor in how physicians perceive their professional responsibilities and in medical decision-making. Overall, physicians who rated themselves as very dissatisfied had a significantly reduced likelihood of favoring limiting reimbursement to expand basic coverage (odds ratio, 0.5; 95% CI, 0.3-0.7), recognizing an obligation to care for the uninsured (odds ratio, 0.5; 95% CI, 0.3-0.7), and addressing societal health policy issues (OR, 0.7; 95% CI, 0.5-0.9). Although fatigue and satisfaction are strongly associated, only satisfaction appears to correlate with physicians' perceived social responsibilities. Physicians who are dissatisfied with their profession may be less inclined to address health policy issues, embrace charity care, or practice cost containment. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  18. Mississippi burnout part II: satisfaction, autonomy and work/family balance.

    PubMed

    Cossman, Jeralynn S; Street, Debra

    2009-10-01

    Documented Mississippi physician shortages' make evidence about factors shaping physicians' career choices especially important if Mississippi policymakers are to devise workable strategies to maximize the physician workforce. Work-life interactions influence physicians' choices about how they manage their careers and professional burnout is one documented cause of physicians' decisions to change work hours or to choose early retirement. We find that women and mid-career physicians are more likely than men or later career physicians to experience stress and burnout. Additionally, physicians who experience burnout are less likely to report being satisfied with nearly every aspect of their professional life and work-life balance indicating that burnout permeates several dimensions of physicians' lives. The associations in our findings are suggestive; however, to minimize deleterious effects of burnout on the Mississippi physician workforce, future research should examine the causal factors underlying stress and burnout.

  19. Useful but Different: Resident Physician Perceptions of Interprofessional Feedback.

    PubMed

    Vesel, Travis P; O'Brien, Bridget C; Henry, Duncan M; van Schaik, Sandrijn M

    2016-01-01

    Phenomenon: Based on recently formulated interprofessional core competencies, physicians are expected to incorporate feedback from other healthcare professionals. Based on social identity theory, physicians likely differentiate between feedback from members of their own profession and others. The current study examined residents' experiences with, and perceptions of, interprofessional feedback. In 2013, Anesthesia, Obstetrics-Gynecology, Pediatrics, and Psychiatry residents completed a survey including questions about frequency of feedback from different professionals and its perceived value (5-point scale). The authors performed an analysis of variance to examine interactions between residency program and profession of feedback provider. They conducted follow-up interviews with a subset of residents to explore reasons for residents' survey ratings. Fifty-two percent (131/254) of residents completed the survey, and 15 participated in interviews. Eighty percent of residents reported receiving written feedback from physicians, 26% from nurses, and less than 10% from other professions. There was a significant interaction between residency program and feedback provider profession, F(21, 847) = 3.82, p < .001, and a significant main effect of feedback provider profession, F(7, 847) = 73.7, p < .001. On post hoc analyses, residents from all programs valued feedback from attending physicians higher than feedback from others, and anesthesia residents rated feedback from other professionals significantly lower than other residents. Ten major themes arose from qualitative data analysis, which revealed an overall positive attitude toward interprofessional feedback and clarified reasons behind residents' perceptions and identified barriers. Insights: Residents in our study reported limited exposure to interprofessional feedback and valued such feedback less than intraprofessional feedback. However, our data suggest opportunities exist for effective utilization of interprofessional feedback.

  20. Self- and rater-assessed effectiveness of "thinking-aloud" and "regular" morning report to intensify young physicians' clinical skills.

    PubMed

    Hsu, Hui-Chi; Lee, Fa-Yauh; Yang, Ying-Ying; Tsao, Yen-Po; Lee, Wen-Shin; Chuang, Chiao-Lin; Chang, Ching-Chih; Huang, Chia-Chang; Huang, Chin-Chou; Ho, Shung-Tai

    2015-09-01

    This study compared the effects of the "thinking aloud" (TA) morning report (MR), which is characterized by sequential and interactive case discussion by all participants, with "regular" MR for clinical skill training of young physicians. Between February 2011 and February 2014, young physicians [including postgraduate year-1 (PGY1) residents, interns, and clerks) from our hospital were sequentially enrolled and followed for 3 months. The self- and rater-assessed educational values of two MR models for building up clinical skills of young physicians were compared. The junior (intern and clerk) attendees had higher self-assessed educational values scores and reported post-training application frequency of skills trained by TA MR compared with the senior (PGY1 resident) attendees. Higher average and percentage of increased overall rater-assessed OSCE scores were noted among the regular MR senior attendees and TA MR junior attendees than in their corresponding control groups (regular MR junior attendees and TA MR senior attendees). Interestingly, regular MRs provided additional beneficial effects for establishing the "professionalism, consulting skills and organization efficiency" aspects of clinical skills of senior/junior attendees. Moreover, senior and junior attendees benefited the most by participating in seven sessions of regular MR and TA MR each month, respectively. TA MR effectively trains junior attendees in basic clinical skills, whereas regular MR enhances senior attendees' "work reports, professionalism, organizational efficiency, skills in dealing with controversial and professional issues." Undoubtedly, all elements of the two MR models should be integrated together to ensure patient safety and good discipline among young physicians. Copyright © 2015. Published by Elsevier Taiwan.

  1. Emergency Medical Treatment and Labor Act: what every physician should know about the federal antidumping law.

    PubMed

    Hyman, David A; Studdert, David M

    2015-06-01

    Since 1986, the Emergency Medical Treatment and Labor Act (EMTALA) has imposed an obligation on hospitals and physicians to evaluate and stabilize patients who present to a hospital ED seeking care. Available sanctions for noncompliance include fines, damages awarded in civil litigation, and exclusion from Medicare. EMTALA uses several terms that are familiar to physicians (eg, "emergency medical condition," "stabilize," and "transfer"), but the statutory definitions do not map neatly onto the way in which these terms are used and understood in clinical settings. Thus, there is potential for a mismatch between a physician's on-the-spot professional judgment and what the statute demands. We review what every physician should know about EMTALA and answer six common questions about the law.

  2. The relationship between different facets of empathy, pain perception and compassion fatigue among physicians

    PubMed Central

    Gleichgerrcht, Ezequiel; Decety, Jean

    2014-01-01

    Background: Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. Methods: A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. Results: Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. Conclusions: Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine. PMID:25071495

  3. Professionalism and clinical autonomy in the practice of medicine.

    PubMed

    Morreim, E Haavi

    2002-11-01

    Professionalism in medicine requires a reasonable measure of freedom for physicians to determine patients needs based on their own judgment. However, because virtually every medical decision is also a spending decision, third-party payers concerned about rising health care costs have introduced cost-containment tactics that significantly limit physicians accustomed autonomy. In response, groups of physicians have filed class-action lawsuits against managed care plans, alleging causes of action such as fraud, breach of contract, extortion, and violations of federal RICO (Racketeer-Influenced and Corrupt Organizations) law. Such litigation may have merits, but it also faces significant obstacles, in part because the contracts involved may not actually have promised the broad measure of clinical autonomy that the physicians allege was promised, then denied. As physicians seek to restore and retain their professional autonomy, it will be important for them to be increasingly proactive in structuring or modifying the contracts under whose terms they practice as some physicians have successfully done.

  4. Female Physicians and the Work-Family Conflict.

    PubMed

    Treister-Goltzman, Yulia; Peleg, Roni

    2016-05-01

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

  5. Why physicians and nurses ask (or don't) about partner violence: a qualitative analysis.

    PubMed

    Beynon, Charlene E; Gutmanis, Iris A; Tutty, Leslie M; Wathen, C Nadine; MacMillan, Harriet L

    2012-06-21

    Intimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians' and nurses' experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development. Physicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher's Exact Test was performed to determine statistical significance when examining nurse/physician differences. Of the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments. This research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues.

  6. What Does Professionalism Mean to the Physician?

    PubMed Central

    Kanter, Michael H; Nguyen, Miki; Klau, Marc H; Spiegel, Nancy H; Ambrosini, Virginia L

    2013-01-01

    Professionalism, which is a core competency for physicians, can be described as a spectrum of behaviors and may have a significant impact on the problems in today’s changing health care climate. In this article, we discuss the meaning of professionalism and its role in the Southern California Permanente Medical Group (SCPMG) and consider how it may be applied to integrated care delivery systems such as Kaiser Permanente. To understand professionalism, one must consider Stern’s definition, which consists of four principles: excellence, humanism, accountability, and altruism. SCPMG has taken three of these principles—excellence, accountability, and altruism—and divided the fourth, humanism, into another three principles similar to those identified by the University of California Los Angeles Task Force on Professionalism: humanitarianism, respect for others, and honor and integrity. SCPMG has a rich history and culture of promoting clinical excellence and professionalism, as evidenced by the programs and initiatives described throughout this article. Indeed, the SCPMG experience validates professionalism as a core physician competency comprising a set of behaviors that are continually refined. PMID:24355895

  7. Predictors of Depression Stigma in Medical Students: Potential Targets for Prevention and Education.

    PubMed

    Wimsatt, Leslie A; Schwenk, Thomas L; Sen, Ananda

    2015-11-01

    Suicide rates are higher among U.S. physicians than the general population. Untreated depression is a major risk factor, yet depression stigma presents a barrier to treatment. This study aims to identify early career indications of stigma among physicians-in-training and to inform the design of stigma-reduction programs. A cross-sectional student survey administered at a large, Midwestern medical school in fall 2009 included measures of depression symptoms, attitudes toward mental health, and potential sources of depression stigma. Principal components factor analysis and linear regression were used to examine stigma factors associated with depression in medical students. The response rate was 65.7%, with 14.7% students reporting a previous depression diagnosis. Most students indicated that, if depressed, they would feel embarrassed if classmates knew. Many believed that revealing depression could negatively affect professional advancement. Factor analyses revealed three underlying stigma constructs: personal weakness, public devaluation, and social/professional discrimination. Students associating personal weakness with depression perceived medication as less efficacious and the academic environment as more competitive. Those endorsing public stigma viewed medication and counseling as less efficacious and associated depression with an inability to cope. Race, gender, and diagnosis of past/current depression also related to beliefs about stigma. Depression measures most strongly predicted stigma associated with personal weakness and social/professional discrimination. Recommendations for decreasing stigma among physicians-in-training include consideration of workplace perceptions, depression etiology, treatment efficacy, and personal attributes in the design of stigma reduction programs that could facilitate help-seeking behavior among physicians throughout their career. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Professional activity, information demands, training and updating needs of occupational medicine physicians in Italy: National survey.

    PubMed

    Persechino, Benedetta; Fontana, Luca; Buresti, Giuliana; Rondinone, Bruna Maria; Laurano, Patrizia; Imbriani, Marcello; Iavicoli, Sergio

    2016-01-01

    Occupational medicine is a discipline continually evolving in response to technological advances, changes in workplaces and production processes, emergence of new occupational risks and diseases and modifications in regulatory framework for occupational health and safety. Therefore, the recurrent revaluation of professional activity, information demands and education and training needs of occupational physicians is essential in order to identify methodologies and tools that may contribute to improvement of their professional knowledge and competency. In this regard, we conducted the first large-scale national survey of Italian occupational medicine physicians to define their demographic and professional activity and to assess their information demands, training and updating needs. A random sample of occupational physicians, listed in the national register of the Italian Ministry of Health, was selected to complete a voluntary survey. Subjects recruited in this study were asked to complete 3 different sections (personal and professional information, training and updating needs, professional activity and practice characteristics) of a questionnaire for a total of 35 questions. Most of participants were specialized in occupational medicine, worked for a large number of companies and carried out health surveillance on a total number of workers that exceeds 1500. Occupational physicians would like to have a higher training offer towards practical aspects of health surveillance, risks assessment, manual handling of loads, chemical substances and upper limb biomechanical overload. Interestingly, statistically significant differences were observed subdividing the sample into different groups according to the legal requirements to perform the professional activity of occupational physicians in Italy or according to particular aspects of their professional activity. This study has provided interesting findings that may help to guide future discussion on alternative and additional instruments and/or methodologies that may be adopted to implement the quality and effectiveness of occupational medicine practice. Int J Occup Med Environ Health 2016;29(5):837-858. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  9. Lay obligations in professional relations.

    PubMed

    Benjamin, M

    1985-02-01

    Little has been written recently about the obligations of lay people in professional relationships. Yet the Code of Medical Ethics adopted by the American Medical Association in 1847 included an extensive statement on "Obligations of patients to their physicians'. After critically examining the philosophical foundations of this statement, I provide an alternative account of lay obligations in professional relationships. Based on a hypothetical social contract and included in a full specification of professional as well as lay obligations, this account requires lay people to honor commitments and disclose relevant information. Ethically, the account assumes that all parties in lay-professional relationships should be given equal consideration and respect in determining rights and obligations. Factually, it assumes that the treatment of many illnesses and injuries required collaboration and cooperation among lay persons and health professionals, that medical resources and personnel are limited, and that medicine, nursing, and related health professions, are, in MacIntyre's sense, practices.

  10. Medical professionalism: a tale of two doctors.

    PubMed

    Gorrindo, Tristan; Groves, James E

    2011-01-01

    The AMA's social media guidelines provide physicians with some basic rules for maintaining professional boundaries when engaging in online activities. Left unanswered are questions about how these guidelines are to be implemented by physicians of different generations. By examining the issues of privacy and technological skill through the eyes of digital natives and digital immigrants, the challenges associated with medical e-professionalism become clear.

  11. Codes of professional conduct for Australian Defence Force military physicians: evenomating the serpent?

    PubMed

    O'Connor, Mike

    2010-09-01

    The scandal of health professionals' involvement in recent human rights abuses in United States military detention centres has prompted concern that Australian military physicians should be well protected against similar pressures to participate in harsh interrogations. A framework of military health ethics has been proposed. Would a code of professional conduct be a partial solution? This article examines the utility of professional codes: can they transform unethical behaviour or are they only of value to those who already behave ethically? How should such codes be designed, what support mechanisms should be in place and how should complaints be managed? A key recommendation is that codes of professional conduct should be accompanied by publicly transparent procedures for the investigation of serious infractions and appropriate disciplinary action when proven. The training of military physicians should also aim to develop a sound understanding of both humanitarian and human rights law. At present, both civil and military education of physicians generally lacks any component of human rights law. The Australian Defence Force (ADF) seems well placed to add codes of professional conduct to its existing ethical framework because of strong support at the highest executive levels.

  12. Job satisfaction among emergency department staff.

    PubMed

    Suárez, M; Asenjo, M; Sánchez, M

    2017-02-01

    To compare job satisfaction among nurses, physicians and administrative staff in an emergency department (ED). To analyse the relationship of job satisfaction with demographic and professional characteristics of these personnel. We performed a descriptive, cross-sectional study in an ED in Barcelona (Spain). Job satisfaction was evaluated by means of the Font-Roja questionnaire. Multivariate analysis determined relationship between the overall job satisfaction and the variables collected. Fifty-two nurses, 22 physicians and 30 administrative staff were included. Administrative staff were significantly more satisfied than physicians and nurses: 3.42±0.32 vs. 2.87±0.42 and 3.06±0.36, respectively. Multivariate analysis showed the following variables to be associated with job satisfaction: rotation among the different ED acuity levels (OR: 2.34; 95%CI: 0.93-5.89) and being an administrative staff (OR: 0.27; 95%CI: 0.09-0.80). Nurses and physicians reported greater stress and work pressure than administrative staff and described a worse physical working environment. Interpersonal relationships obtained the highest score among the three groups of professionals. Job satisfaction of nurses and physicians in an ED is lower than that of administrative staff with the former perceiving greater stress and work pressure. Conversely, interpersonal relationships are identified as strength. Being nurse or physician and not rotating among the different ED acuity levels increase dissatisfaction. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  13. Legal abortion in Peru: knowledge, attitudes and practices among a group of physician leaders.

    PubMed

    Pace, Lydia; Grossman, Daniel; Chávez, Susana; Távara, Luis; Lara, Diana; Guerrero-Vásquez, Rossina

    2006-01-01

    We sought to examine knowledge, attitudes and practices regarding legal abortion among a group of Peruvian physicians. A pre-conference survey was mailed to Peruvian physicians invited to a workshop on legal abortion. A post-conference survey was distributed following the event. Eighty-six percent of 35 respondents correctly indicated that abortion is legal in Peru when a pregnancy endangers a woman's life while less than 50% knew it is also legal when necessary to protect a woman's health. Knowledge about abortion techniques was lower for induced abortion than for management of incomplete abortions. Dilation and curettage was used more frequently than manual vacuum aspiration and medications. Half of physicians reported having performed a legal abortion. The vast majority of physicians surveyed thought legal indications for abortion should be expanded to include cases of rape or fetal malformations. Most considered their abortion training to be inadequate. They identified lack of training and administrative and professional support as barriers to legal abortion provision. Physicians surveyed were willing to provide legal abortions but lacked the knowledge, skills, and support to do so. Improved training of health professionals, increasing institutional support, and developing administrative and legal procedures to guide management of women seeking abortions could increase women's access to legal abortion services and diminish the occurrence of unsafe abortion in Peru.

  14. Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings.

    PubMed

    Sidani, Souraya; Reeves, Scott; Hurlock-Chorostecki, Christina; van Soeren, Mary; Fox, Mary; Collins, Laura

    2018-06-01

    There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals' characteristics (gender, work experience) and a contextual factor (caseload), with the professionals' PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada. Consenting professionals (n = 382) completed a self-report instrument assessing the three PCC components and responded to standard questions inquiring about their characteristics and workload. Small differences were found in the PCC practices across professional groups: (1) physicians reported higher levels of enacting the holistic care component; (2) physicians, other healthcare providers, and social workers reported implementing higher levels of the collaborative care component; and (3) physicians, nurses, and other healthcare providers reported higher levels of providing responsive care. Caseload influenced holistic care practices. Interprofessional education and training strategies are needed to clarify and address professional differences in valuing and practicing PCC components. Clinical guidelines can be revised to enable professionals to engage patients in care-related decisions, customize patient care, and promote interprofessional collaboration in planning and implementing PCC. Additional research is warranted to determine the influence of professional, patient, and other contextual factors on professionals' PCC practices in acute care hospitals.

  15. Analysis of the Role of Physicians in the Cessation of Cigarette Smoking Based on Medical Specialization.

    PubMed

    Dülger, Seyhan; Doğan, Canan; Dikiş, Özlem Şengören; Yıldırım, Eylem; Tapan, Utku; Özmen, İpek; Satılmış, Birsen Şahin; İntepe, Yavuz Selim; Ocaklı, Birsen; Kaçan, Cevriye Yüksel; Budak, Ersin; Yıldız, Tekin

    2018-01-01

    Physicians do not adequately use their unique professional privilege to prevent patients from smoking. The aim of this study was to investigate the type and extent of advice given to patients by physicians of different medical specialties regarding smoking cessation. In total, 317 volunteer physicians were included in this study. The participants rated their attitudes toward the smoking habits of their patients by completing a questionnaire. The approaches used to address the smoking habits of patients significantly differed among physicians working at polyclinics, clinics and emergency service departments (p<0.001). Physicians working at clinics exhibited the highest frequency of inquiring about the smoking habits of their patients, while physicians working at emergency service departments exhibited the lowest frequency. Physicians from different medical specialties significantly differed in their responses. Physicians specializing in lung diseases, thoracic surgery, and cardiology were more committed to preventing their patients from cigarette smoking. The role of physicians, particularly pulmonologists and thoracic surgeons, is critical in the fight against cigarette smoking. Promoting physician awareness of this subject is highly important in all other branches of medicine.

  16. In defense of industry-physician relationships.

    PubMed

    Nakayama, Don K

    2010-09-01

    The objective was to examine the economic, ethical, and legal foundations for conflict of interest restrictions between physicians and pharmaceutical and medical device industries ("industry"). Recently academic medical centers and professional organizations have adopted policies that restrict permissible interactions between industry and physicians. The motive is to avoid financial conflicts of interest that compromise core values of altruism and fiduciary relationships. Productive relationships between industry and physicians provide novel drugs and devices of immense benefit to society. The issues are opposing views of medical economics, profit motives, medical professionalism, and extent to which interactions should be lawfully restricted. Industry goals are congruent with those of physicians: patient welfare, safety, and running a profitable business. Profits are necessary to develop drugs and devices. Physician collaborators invent products, refine them, and provide feedback and so are appropriately paid. Marketing is necessary to bring approved products to patients. Economic realities limit the extent to which physicians treat their patients altruistically and as fiduciaries. Providing excellent service to patients may be a more realistic standard. Statements from industry and the American College of Surgeons appropriately guide professional behavior. Preservation of industry-physician relationships is vital to maintain medical innovation and progress.

  17. Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

    PubMed Central

    2014-01-01

    Background Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. Methods For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. Results We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. Conclusions These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic. PMID:24885912

  18. Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics.

    PubMed

    Carvalho, Milton Jorge de; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

    2016-07-01

    Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.

  19. Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics

    PubMed Central

    de Carvalho, Milton Jorge; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

    2016-01-01

    OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks. PMID:27464295

  20. Perceptions of Unprofessional Social Media Behavior Among Emergency Medicine Physicians.

    PubMed

    Soares, William; Shenvi, Christina; Waller, Nikki; Johnson, Reuben; Hodgson, Carol S

    2017-02-01

    Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action?" (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P  < .05); alcohol intoxication (41%, 95% CI 32-51 versus 73%, P  < .05); and holding alcohol without intoxication (7%, 95% CI 3-13 versus 40%, P  < .05). There were no significant associations with position, hospital site, years since medical school, or prior SM professionalism training. Physicians reported a lower likelihood of investigation for themes that intersect with social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.

  1. Becoming a Doctor in Different Cultures: Toward a Cross-Cultural Approach to Supporting Professional Identity Formation in Medicine.

    PubMed

    Helmich, Esther; Yeh, Huei-Ming; Kalet, Adina; Al-Eraky, Mohamed

    2017-01-01

    Becoming a doctor is fundamentally about developing a new, professional identity as a physician, which in and of itself may evoke many emotions. Additionally, medical trainees are increasingly moving from one cultural context to another and are challenged with navigating the resulting shifts in their professional identify. In this Article, the authors aim to address medical professional identity formation from a polyvocal, multidisciplinary, cross-cultural perspective. They delineate the cultural approaches to medical professionalism, reflect on professional identity formation in different cultures and on different theories of identity development, and advocate for a context-specific approach to professional identity formation. In doing so, the authors aim to broaden the developing professional identity formation discourse to include non-Western approaches and notions.

  2. Descriptive study of interprofessional collaboration between physicians and osteopaths for the pediatric population in Quebec, Canada.

    PubMed

    Morin, Chantal; Desrosiers, Johanne; Gaboury, Isabelle

    2017-11-14

    Osteopathy is an increasingly popular healthcare approach that uses a wide variety of therapeutic manual techniques to address pain and somatic dysfunction. In Quebec, Canada, osteopathy is the complementary medicine most often recommended by family physicians. However, factors fostering the development of interprofessional collaboration (IPC) between physicians and osteopaths are unknown. This study aimed to describe the current situation in terms of IPC among practitioners working with pediatric patients. A self-administered questionnaire was sent to osteopaths, family physicians, and pediatricians involved with pediatric patients in the province of Quebec. The postal questionnaire captured general knowledge about osteopathy and its practice parameters and role, sources of information, communication aspects including having a professional relationship and referrals, and influence of the upcoming government regulation. Quantitative data from the questionnaires were analyzed using descriptive statistics. Logistic regression model for factors associated with osteopathic referrals and multiple linear regression analyses for the number of correct answers about general osteopathic practice parameters were performed. A total of 274 physicians (155 family physicians (response rate 13%) and 119 pediatricians (17%)) and 297 osteopaths (42%) completed the survey. According to physicians, osteopathy was most appropriate for musculoskeletal pain (241; 91%) and plagiocephaly (235; 88%). Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and belief in the active role of osteopathy for pediatric conditions (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). The majority of physicians (72%) and osteopaths (62%) considered the upcoming government regulation of osteopathy a positive factor for collaboration. Some collaboration already exists among these practitioners, including mutual referrals, but optimizing this collaboration still poses some challenges.

  3. Medical leaders or masters?—A systematic review of medical leadership in hospital settings

    PubMed Central

    Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

  4. Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

    PubMed

    Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

  5. Exploring family physician stress

    PubMed Central

    Lee, F. Joseph; Brown, Judith Belle; Stewart, Moira

    2009-01-01

    ABSTRACT OBJECTIVE To explore the nature of professional stress and the strategies used by family physicians to deal with this stress. DESIGN Qualitative study. SETTING Kitchener-Waterloo, Ont. PARTICIPANTS Ten key-informant family physicians. METHODS In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used. MAIN FINDINGS The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns. CONCLUSION Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels. PMID:19282541

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

    PubMed Central

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

    2018-01-01

    Background Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. Objective The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. Methods 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted “physician terms” from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create “nursing terms”. The physician’s and nurse’s terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. Results We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions’ documentation. On average, physicians’ discharge summaries contain 27 terms and nurses’ documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. Conclusion Our hypothesis that physician’s and nurse’s practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession. PMID:29602435

  7. Job and life satisfaction and preference of future practice locations of physicians on remote islands in Japan.

    PubMed

    Nojima, Yoshiaki; Kumakura, Shunichi; Onoda, Keiichi; Hamano, Tsuyoshi; Kimura, Kiyoshi

    2015-05-26

    The objective of this research is to investigate job and life satisfaction and preference of future practice locations of physicians in rural and remote islands in Japan. A cross-sectional study was conducted for physicians who reside or resided on the Oki islands: isolated islands situated in the Sea of Japan between the Eurasian continent and the mainland of Japan. A questionnaire was sent to physicians on the Oki islands to evaluate physician satisfaction regarding job environment, career development, living conditions, salary, and support by local government. Data was analysed for 49 physicians; 47 were male and 2 were female, and the mean ± SD age was 44.3 ± 10.9 years. Among the variables related to physicians' satisfaction, most of the physicians (>90%) were satisfied with "team work" and "salary". On the other hand, the majority of physicians (approximately 70%) were not satisfied with the "opportunity to continue professional development". Age ≥ 50 years, graduates of medical schools other than Jichi Medical University (established in 1972 with the aim to produce rural physicians), self-selected the Oki islands as a practice location, and satisfaction in "work as a doctor", "opportunity to consult with peers about patients", "relationship with people in the community", and "acceptance by community" were found to be significant factors influencing the choice of the Oki islands as a future practice location. Factors influencing future practice locations on the remote islands were included in a self-reported questionnaire which illustrated the importance of factors that impact both the spouses and children of physicians. Improving work satisfaction, providing outreach support programmes for career development and professional support in rural practice, and building appropriate relationships between physicians and people in the community, which can in turn improve work satisfaction, may contribute to physicians' choices of practising medicine on rural and remote islands in Japan. Addressing family issues is also crucial in encouraging the choice of a rural medical practice location.

  8. Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness.

    PubMed

    Trybou, Jeroen; Gemmel, Paul; Van Vaerenbergh, Yves; Annemans, Lieven

    2014-05-21

    Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

  9. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers.

    PubMed

    Carameli, Kelley A; Eisenman, David P; Blevins, Joy; d'Angona, Brian; Glik, Deborah C

    2013-06-01

    Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves. A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers. Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster. To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.

  10. Effects of continuing professional development on clinical performance

    PubMed Central

    Goulet, François; Hudon, Eveline; Gagnon, Robert; Gauvin, Eliane; Lemire, Francine; Arsenault, Isabelle

    2013-01-01

    Abstract Objective To evaluate the link between the quantity and quality of continuing professional development (CPD) activities completed by family physicians in Quebec and the quality of their practice. Design Retrospective analysis of data collected during professional inspection visits (PIVs). Setting Quebec. Participants Three groups were created from among Quebec family physicians who had been subject to PIVs (peer evaluation) by the Collège des médecins du Québec between 1998 and 2005. Group 1 was composed of physicians who were members of the College of Family Physicians of Canada, which requires participation in 250 hours of CPD in every 5-year cycle. Group 2 was composed of family physicians who were not members of the College of Family Physicians of Canada but who had declared at least 50 hours a year of CPD on their Collège des médecins du Québec annual notice of assessment for the same period. Group 3 was composed of family physicians who had declared fewer than 10 hours of CPD a year. Main outcome measures During the PIV, the following characteristics were examined: record keeping, quality and number of hours of CPD activities, and quality of professional practice based on 3 components— clinical investigation, accuracy of diagnosis, and appropriateness of treatment plan and follow-up. Results The factors associated with a high quality of practice were privileges in a hospital or local community health centre (institution) and a substantial number of accredited CPD hours (Mainpro-M1, Credit I, or Mainpro-C). The factors associated with a poor quality of practice were advanced age of the physician, absence of privileges in an institution (hospital or local community health centre), and participation in CPD activities that were more informal, such as reading and non-accredited activities (Mainpro-M2). Conclusion This study supports earlier research showing that CPD activities of sufficient quality and quantity are correlated with a high quality of professional practice by family physicians. PMID:23673591

  11. Paediatric approaches to child maltreatment are subject to wide organisational variations across Europe.

    PubMed

    Otterman, Gabriel; Jalsenius, Marie; Maguire, Sabine; Sarkadi, Anna; Janson, Staffan

    2017-07-01

    Little is known about the organisation of child maltreatment practice in Europe. We therefore explored medical child protection systems and training across Europe. An online survey was completed by physicians working in child maltreatment, identified through professional organisations in 28 member countries of the European Union, Iceland, Norway and Switzerland in 2012-2013. Respondents were questioned regarding management of suspected child maltreatment, mandatory reporting, professional training, patient referral and physician roles in multidisciplinary investigations. Responses underwent a narrative synthesis and descriptive enumerations. The survey was completed by 88 individuals, unevenly distributed in 22 of 31 countries. Physicians were mandated to report child maltreatment in 16 of 22 countries. All of 88 responding physicians described multidisciplinary involvement in the clinical and forensic management of suspected child maltreatment. Practitioners involved in physical examinations included general physicians, paediatricians, forensic medical examiners, gynaecologists and paediatric surgeons. Paediatricians were required to undergo child protection training according to 30 of 86 respondents in 14 of 22 countries. This survey demonstrates that there were wide variations in the organisation of child maltreatment paediatrics in Europe. The differing legislative frameworks and models of care are pertinent to consider when comparing epidemiology of maltreatment reported from across European countries. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  12. The rural health care workforce implications of practice guideline implementation.

    PubMed

    Yawn, B P; Casey, M; Hebert, P

    1999-03-01

    Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce. The current care of a cohort of rural Medicare recipients with diabetes mellitus was compared with the care recommended by a diabetes practice guideline. The additional tests and visits that were needed to comply with the guideline were translated into additional hours of physician services and total physician full-time equivalents. The implementation of a practice guideline for Medicare recipients with diabetes in rural Minnesota would require over 30,000 additional hours of primary care physician services and over 5,000 additional hours of eye care professionals' time per year. This additional need represents a 1.3% to 2.4% increase in the number of primary care physicians and a 1.0% to 6.6% increase in the number of eye-care clinicians in a state in which the rural medical provider to population ratios already meet some recommended workforce projections. The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.

  13. Mentorship for newly appointed physicians: a strategy for enhancing patient safety?

    PubMed

    Harrison, Reema; McClean, Serwaa; Lawton, Rebecca; Wright, John; Kay, Clive

    2014-09-01

    Mentorship is an increasingly popular innovation from business and industry that is being applied in health-care contexts. This paper explores the concept of mentorship for newly appointed physicians in their first substantive senior post, and specifically its utilization to enhance patient safety. Semi-structured face to face and telephone interviews with Medical Directors (n = 5), Deputy Medical Directors (n = 4), and Clinical Directors (n = 6) from 9 acute NHS Trusts in the Yorkshire and Humber region in the north of England. A focused thematic analysis was used. A number of beneficial outcomes were associated with mentorship for newly appointed physicians including greater personal and professional support, organizational commitment, and general well-being. Providing newly appointed senior physicians with support through mentorship was considered to enhance the safety of patient care. Mentorship may prevent or reduce active failures, be used to identify threats in the local working environment, and in the longer term, address latent threats to safety within the organization by encouraging a healthier safety culture. Offering mentorship to all newly appointed physicians in their first substantive post in health care may be a useful strategy to support the development of their clinical, professional, and personal skills in this transitional period that may also enhance the safety of patient care.

  14. Burnout among physicians in palliative care: Impact of clinical settings.

    PubMed

    Dréano-Hartz, Soazic; Rhondali, Wadih; Ledoux, Mathilde; Ruer, Murielle; Berthiller, Julien; Schott, Anne-Marie; Monsarrat, Léa; Filbet, Marilène

    2016-08-01

    Burnout syndrome is a work-related professional distress. Palliative care physicians often have to deal with complex end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. Our study aims to identify the impact of clinical settings (in a palliative care unit (PCU) or on a palliative care mobile team (PCMT)) on palliative care physicians. We undertook a cross-sectional study using a questionnaire that included the Maslach Burnout Inventory (MBI), and we gathered sociodemographic and professional data. The questionnaire was sent to all 590 physicians working in palliative care in France between July of 2012 and February of 2013. The response rate was 61, 8% after three reminders. Some 27 (9%) participants showed high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalization, and 71 (18%) had feelings of low personal accomplishment. Physicians working on a PCMT tended (p = 0.051) to be more likely to suffer from emotional exhaustion than their colleagues. Physicians working on a PCMT worked on smaller teams (fewer physicians, p < 0.001; fewer nonphysicians, p < 0.001). They spent less time doing research (p = 0.019), had fewer resources (p = 0.004), and their expertise seemed to be underrecognized by their colleagues (p = 0.023). The prevalence of burnout in palliative care physicians was low and in fact lower than that reported in other populations (e.g., oncologists). Working on a palliative care mobile team can be a more risky situation, associated with a lack of medical and paramedical staff.

  15. The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

    PubMed

    Parlier, Anna Beth; Galvin, Shelley L; Thach, Sarah; Kruidenier, David; Fagan, Ernest Blake

    2018-01-01

    To examine the literature documenting successes in recruiting and retaining rural primary care physicians. The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

  16. Teaching professionalism to first year medical students using video clips.

    PubMed

    Shevell, Allison Haley; Thomas, Aliki; Fuks, Abraham

    2015-01-01

    Medical schools are confronted with the challenge of teaching professionalism during medical training. The aim of this study was to examine medical students' perceptions of using video clips as a beneficial teaching tool to learn professionalism and other aspects of physicianship. As part of the longitudinal Physician Apprenticeship course at McGill University, first year medical students viewed video clips from the television series ER. The study used qualitative description and thematic analysis to interpret responses to questionnaires, which explored the educational merits of this exercise. Completed questionnaires were submitted by 112 students from 21 small groups. A major theme concerned the students' perceptions of the utility of video clips as a teaching tool, and consisted of comments organized into 10 categories: "authenticity and believability", "thought provoking", "skills and approaches", "setting", "medium", "level of training", "mentorship", "experiential learning", "effectiveness" and "relevance to practice". Another major theme reflected the qualities of physicianship portrayed in video clips, and included seven categories: "patient-centeredness", "communication", "physician-patient relationship", "professionalism", "ethical behavior", "interprofessional practice" and "mentorship". This study demonstrated that students perceived the value of using video clips from a television series as a means of teaching professionalism and other aspects of physicianship.

  17. The shield of professional status: Comparing internationally educated nurses' and international medical graduates' experiences of discrimination.

    PubMed

    Neiterman, Elena; Bourgeault, Ivy Lynn

    2015-11-01

    This article examines the intersecting roles of gender, ethnicity, and professional status in shaping the experiences of internationally educated health professionals in Canada. The article is based on 140 semi-structured qualitative interviews with internationally trained nurses and physicians who came to Canada within past 10 years with the intention to practice their profession. Describing the challenging process of professional integration in Canada, our participants highlighted incidents of discrimination they experienced along the way. Although some of the participants from both professional groups experienced racial discrimination, the context of those experiences differed. Physicians rarely reported instances of discrimination in communication with patients or nurses. Instead, they were concerned with instances of discrimination within their own professional group. Nurses, on the other hand, reported discrimination at the hands of patients and their families as well as racialization by physicians, management, and other nurses. We conclude our article with a reflection on the role that gender and professional status play in shaping the experiences of ethnic discrimination of internationally educated health professionals. © The Author(s) 2015.

  18. Performance during internal medicine residency training and subsequent disciplinary action by state licensing boards.

    PubMed

    Papadakis, Maxine A; Arnold, Gerald K; Blank, Linda L; Holmboe, Eric S; Lipner, Rebecca S

    2008-06-03

    Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

  19. Electronic conferencing for continuing medical education: a resource survey.

    PubMed

    Sternberg, R J

    1986-10-01

    The use of electronic technologies to link participants for education conferences is an option for providers of Continuing Medical Education. In order to profile the kinds of electronic networks currently offering audio- or videoteleconferences for physician audiences, a survey was done during late 1985. The information collected included range of services, fees, and geographic areas served. The results show a broad diversity of providers providing both interactive and didactic programming to both physicians and other health care professionals.

  20. Rethinking medical professionalism: the role of information technology and practice innovations.

    PubMed

    Mechanic, David

    2008-06-01

    Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system.

  1. Satisfaction of health care professionals managing patients with inflammatory bowel disease.

    PubMed

    Casellas, Francesc; Ginard, Daniel; Vera, Isabel; Torrejón, Antonio

    2013-08-01

    The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction. Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care. A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p<0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations. The level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  2. Rethinking Medical Professionalism: The Role of Information Technology and Practice Innovations

    PubMed Central

    Mechanic, David

    2008-01-01

    Context Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. Methods The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. Findings IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. Conclusions IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system. PMID:18522615

  3. An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action.

    PubMed

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  4. Experiences of healthcare professionals of having their significant other admitted to an acute care facility: a qualitative systematic review.

    PubMed

    Sabyani, Hussamaldeen; Wiechula, Richard; Magarey, Judy; Donnelly, Frank

    2017-05-01

    Most healthcare professionals at some time will experience having a significant other admitted to an acute care hospital. The knowledge and understanding that these individuals possess because of their professional practice can potentially alter this experience. Expectations of staff and other family members (FMs) can potentially increase the burden on these health professionals. All FMs of patients should have their needs and expectations considered; however, this review specifically addresses what may be unique for healthcare professionals. To synthesize the qualitative evidence on the experiences of healthcare professionals when their significant others are admitted to an acute care hospital. The current review considered studies reporting the experiences of healthcare professionals, specifically registered nurses (RNs) and physicians. The experiences of RNs and physicians when a significant other is admitted to an acute care facility. Qualitative studies that have examined the phenomenon of interest including, but not limited to, designs such as phenomenology and grounded theory. The search strategy aimed to find both published and unpublished studies with no date restrictions. Only studies published in English were considered for inclusion in this review. Qualitative papers selected for retrieval were assessed using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data were extracted from the seven included papers using the standardized data extraction tool from JBI-QARI. The data were synthesized using the JBI approach to meta-synthesis by meta-aggregation using the JBI-QARI software and methods. Seven studies of moderate quality were included in the review. Forty findings were extracted and aggregated to create 10 categories, from which five synthesized findings were derived: CONCLUSION: In contrast to "lay" FMs, health professionals possess additional knowledge and understanding that alter their perceptions and expectations, and the expectations others have of them. This knowledge and understanding can be an advantage in navigating a complex health system but may also result in an additional burden such as role conflict.

  5. 36 CFR 1202.42 - How are requests for access to medical records handled?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... writing a physician or mental health professional to whom you would like the records to be disclosed, and disclosure that otherwise would be made to you will instead be made to the designated physician or mental health professional. ...

  6. 36 CFR 1202.42 - How are requests for access to medical records handled?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... writing a physician or mental health professional to whom you would like the records to be disclosed, and disclosure that otherwise would be made to you will instead be made to the designated physician or mental health professional. ...

  7. 36 CFR 1202.42 - How are requests for access to medical records handled?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... writing a physician or mental health professional to whom you would like the records to be disclosed, and disclosure that otherwise would be made to you will instead be made to the designated physician or mental health professional. ...

  8. 36 CFR 1202.42 - How are requests for access to medical records handled?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... writing a physician or mental health professional to whom you would like the records to be disclosed, and disclosure that otherwise would be made to you will instead be made to the designated physician or mental health professional. ...

  9. [Discussion on knowledge structural system of modern acupuncture professionals].

    PubMed

    Wang, Qin-Yu; Li, Su-He

    2012-02-01

    To explore the knowledge structural system that the modern acupuncture professionals should have. The current situation of personnel training for modern acupuncture professionals was multi-dimensionally and comprehensively analyzed from course offering of higher education, laws of famous physicians growth, and discipline development features of the acupuncture and moxibustion subject, and suggestions were made to the shortages. The reasonable knowledge structural system that the modern acupuncture professionals should have included establishment of good Chinese medicine thoughts, mastery of complete Chinese medicine therapy, and ability of followup of dynamic development of subject. The reformation of course design is imperative in order to promote the reasonable knowledge structural system formation of modern acupuncture professionals.

  10. An Organization Model to Assist Individual Physicians, Scientists, and Senior Health Care Administrators With Personal and Professional Needs.

    PubMed

    Shanafelt, Tait D; Lightner, Deborah J; Conley, Christopher R; Petrou, Steven P; Richardson, Jarrett W; Schroeder, Pamela J; Brown, William A

    2017-11-01

    Working as a physician, scientist, or senior health care administrator is a demanding career. Studies have demonstrated that burnout and other forms of distress are common among individuals in these professions, with potentially substantive personal and professional consequences. In addition to system-level interventions to promote well-being globally, health care organizations must provide robust support systems to assist individuals in distress. Here, we describe the 15-year experience of the Mayo Clinic Office of Staff Services (OSS) providing peer support to physicians, scientists, and senior administrators at one center. Resources for financial planning (retirement, tax services, college savings for children) and peer support to assist those experiencing distress are intentionally combined in the OSS to normalize the use of the Office and reduce the stigma associated with accessing peer support. The Office is heavily used, with approximately 75% of physicians, scientists, and senior administrators accessing the financial counseling and 5% to 7% accessing the peer support resources annually. Several critical structural characteristics of the OSS are specifically designed to minimize potential stigma and reduce barriers to seeking help. These aspects are described here with the hope that they may be informative to other medical practices considering how to create low-barrier access to help individuals deal with personal and professional challenges. We also detail the results of a recent pilot study designed to extend the activity of the OSS beyond the reactive provision of peer support to those seeking help by including regular, proactive check-ups for staff covering a range of topics intended to promote personal and professional well-being. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. Opinions and practices of medical rehabilitation professionals regarding prayer and meditation.

    PubMed

    Schoenberger, Nancy E; Matheis, Robert J; Shiflett, Samuel C; Cotter, Ann C

    2002-02-01

    To assess the attitudes and practices of professionals in the field of physical medicine and rehabilitation (PM&R) regarding prayer and meditation. A national mail survey that included questions about the use of a number of complementary and alternative therapies. The survey was mailed to 7,479 physicians, nurses, physical therapists, and occupational therapists who specialize in PM&R, and 1221 (17%) returned completed surveys. Although the majority of respondents endorsed prayer as a legitimate health care practice, there was greater belief in the benefits of meditation. Older respondents were more likely to recommend meditation to their patients and more likely to meditate themselves. Gender differences that were observed in opinions and practices are better interpreted as differences in professional specialty. In general, nurses and occupational therapists responded more positively toward meditation and prayer than did physicians and physical therapists. Personal use of a technique was the strongest predictor of professional behaviors. Attitude was a stronger predictor of professional use or referral for prayer than meditation, but correlations between attitude and behavior were generally weak for both techniques. Despite their acceptance of these techniques, the vast majority of rehabilitation professionals did not refer their patients for meditation or religious consultation. Although there were significant relationships among beliefs, and personal and professional behaviors regarding these techniques, a large part of the variance in professional behaviors was not accounted for by age, gender, opinion, or personal behavior, indicating that other influences exert a stronger effect on professional practice decisions.

  12. The legal liability of the occupational health professional.

    PubMed

    Billauer, B P

    1985-03-01

    Workers' compensation laws originally provided the exclusive remedy for an injured worker. Under the workers' compensation system, an injured worker received a limited monetary recovery, while the employer and the employees (i.e., the co-employees of the injured worker, including company physicians and nurses) received immunity from negligence actions, including those for medical malpractice. Recent trends in workers' compensation law indicate tha company physicians and nurses now may well be subject to malpractice suits. However, carefully-drawn company health care protocols, appropriate employment requirements, and attention to the handling of cases, may reduce the number of these claims.

  13. Patient aggression towards different professional groups of healthcare workers.

    PubMed

    Kowalczuk, Krystyna; Krajewska-Kułak, Elżbieta

    2017-03-31

    Patient aggression affects healthcare quality and, in extreme situations, may even lead to medical malpractice. Little is known, however, about the specific distribution of health care professionals' exposure to patient aggression in various countries. The aim of this study was to assess the exposure of various professional groups of healthcare personnel to patient aggression, and to identify potential determinants (medical profession, age, gender, professional experience and employment at outpatient/inpatient healthcare units) of this exposure. The study was performed between January 2008 - December 2009 in northeastern Poland, and included 1,624 healthcare workers (493 nurses, 504 midwives, 501 physicians and 126 medical rescue workers). Exposure to eight forms of patient aggression was assessed using the MDM Mobbing Questionnaire. Using a raised voice was the most frequently observed form of aggression in all groups, whereas the least frequent form of aggression encountered was the use of direct physical violence. In inpatient healthcare units, the intensity of patient aggression was encountered most by nurses and medical rescue workers, followed by physicians and midwives. In outpatient healthcare units, medical rescue workers experienced significantly higher levels of aggression when compared to other professional groups. Significant differences in mean aggression intensity experienced in inpatient and outpatient healthcare units were observed only in nurses and physicians. Furthermore, no significant effects of gender were observed on the intensity of patient aggression. Nurses are most exposed to different forms of patient aggression, with verbal attacks being most prevalent. Nurses employed at inpatient healthcare units experienced aggression more frequently than those working in outpatient healthcare units.

  14. Virtual Reality Skills Training for Health Care Professionals in Alcohol Screening and Brief Intervention

    PubMed Central

    Fleming, Michael; Olsen, Dale; Stathes, Hilary; Boteler, Laura; Grossberg, Paul; Pfeifer, Judie; Schiro, Stephanie; Banning, Jane; Skochelak, Susan

    2009-01-01

    Background Educating physicians and other health care professionals to identify and treat patients who drink above recommended limits is an ongoing challenge. Methods An educational Randomized Control Trial (RCT) was conducted to test the ability of a stand alone training simulation to improve the clinical skills of health care professionals in alcohol screening and intervention. The “virtual reality simulation” combines video, voice recognition and non branching logic to create an interactive environment that allows trainees to encounter complex social cues and realistic interpersonal exchanges. The simulation includes 707 questions and statements and 1207 simulated patient responses. Results A sample of 102 health care professionals (10 physicians; 30 physician assistants [PAs] or nurse practitioners [NPs]; 36 medical students; 26 pharmacy, PA or NP students) were randomly assigned to no training (n=51) or a computer based virtual reality intervention (n=51). Subjects in both groups had similar pre-test standardized patient alcohol screening skill scores – 53.2 (experimental) vs. 54.4 (controls), 52.2 vs. 53.7 alcohol brief intervention skills, and 42.9 vs. 43.5 alcohol referral skills. Following repeated practice with the simulation there were significant increases in the scores of the experimental group at 6 months post-randomization compared to the control group for the screening (67.7 vs. 58.1, p<.001) and brief intervention (58.3 vs. 51.6, p<.04) scenarios. Conclusions The technology tested in this trial is the first virtual reality simulation to demonstrate an increase in the alcohol screening and brief intervention skills of health care professionals. PMID:19587253

  15. 77 FR 16244 - Request for Comments on the Update of the Scholarships for Disadvantaged Students Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-20

    ... backgrounds, including students who are members of racial and ethnic minority groups. (PHS Act, Sec. 737(d)(1... social work, professional counseling, marriage and family therapy); and physician assistant training..., including students who are members of racial and ethnic minority groups. Also, the primary care weights are...

  16. Pediatric Residents' Perceptions of Potential Professionalism Violations on Social Media: A US National Survey.

    PubMed

    Dawkins, Rachel; King, William D; Boateng, Beatrice; Nichols, Michele; Desselle, Bonnie C

    2017-01-31

    The ubiquitous use of social media by physicians poses professionalism challenges. Regulatory bodies have disseminated guidelines related to physicians' use of social media. This study had 2 objectives: (1) to understand what pediatric residents view as appropriate social media postings, and (2) to recognize the degree to which these residents are exposed to postings that violate social media professionalism guidelines. We distributed an electronic survey to pediatric residents across the United States. The survey consisted of 5 postings from a hypothetical resident's personal Facebook page. The vignettes highlighted common scenarios that challenge published social media professionalism guidelines. We asked 2 questions for each vignette regarding (1) the resident's opinion of the posting's appropriateness, and (2) their frequency of viewing similar posts. We also elicited demographic data (age, sex, postgraduate year level), frequency of Facebook use, awareness of their institutional policies, and prior social media training. Of 1628 respondents, 1498 (92.01%) of the pediatric residents acknowledged having a Facebook account, of whom 888/1628 (54.55%) reported daily use and 346/1628 (21.25%) reported using Facebook a few times a week. Residents frequently viewed posts that violated professionalism standards, including use of derogatory remarks about patients (1756/3256, 53.93%) and, much less frequently, about attending physicians (114/1628, 7.00%). The majority of the residents properly identified these postings as inappropriate. Residents had frequently viewed a post similar to one showing physicians drinking alcoholic beverages while in professional attire or scrubs and were neutral on this post's appropriateness. Residents also reported a lack of knowledge about institutional policies on social media (651/1628, or 40.00%, were unaware of a policy; 204/1628, or 12.53%, said that no policy existed). A total of 372/1628 respondents (22.85%) stated that they had never received any structured training on social media professionalism. Today's residents, like others of their generation, use social media sites to converse with peers without considering the implications for the profession. The frequent use of social media by learners needs to change the emphasis educators and regulatory bodies place on social media guidelines and teaching professionalism in the digital age. ©Rachel Dawkins, William D King, Beatrice Boateng, Michele Nichols, Bonnie C Desselle. Originally published in JMIR Medical Education (http://mededu.jmir.org), 31.01.2017.

  17. Online professional networks for physicians: risk management.

    PubMed

    Hyman, Jon L; Luks, Howard J; Sechrest, Randale

    2012-05-01

    The rapidly developing array of online physician-only communities represents a potential extraordinary advance in the availability of educational and informational resources to physicians. These online communities provide physicians with a new range of controls over the information they process, but use of this social media technology carries some risk. The purpose of this review was to help physicians manage the risks of online professional networking and discuss the potential benefits that may come with such networks. This article explores the risks and benefits of physicians engaging in online professional networking with peers and provides suggestions on risk management. Through an Internet search and literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct from professional organizations and consultants. We reviewed the OrthoMind.com site as a case example because it is currently the only online social network exclusively for orthopaedic surgeons. Existing case law suggests potential liability for orthopaedic surgeons who engage with patients on openly accessible social network platforms. Current society guidelines in both the United States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a strong body of legal opinions, government regulations as well as practical experience for most surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with one another both as clinicians and practice owners. Educating surgeons about the pros and cons of participating in these networking platforms is helping them more astutely manage risks and optimize benefits. This evolving online environment of professional interaction is one of few precedents, but the application of risk management strategies that physicians use in daily practice carries over into the online community. This participation should foster ongoing dialogue as new guidelines emerge. This will allow today's orthopaedic surgeon to feel more comfortable with online professional networks and better understand how to make an informed decision regarding their proper use.

  18. Caution required when relying on a colleague's advice; a comparison between professional advice and evidence from the literature

    PubMed Central

    Schaafsma, Frederieke; Verbeek, Jos; Hulshof, Carel; van Dijk, Frank

    2005-01-01

    Background Occupational Physicians rely especially on advice from colleagues when answering their information demands. On the other hand, Evidence-based Medicine (EBM) promotes the use of up-to-date research literature instead of experts. To find out if there was a difference between expert-based practice and EBM we compared professional advice on occupational health topics with best evidence from the literature. Methods We asked 14 occupational physicians to consult their usual information sources on 12 pre-conceived occupational health problems. The problems were presented in the form of case vignettes which contained sufficient clinical information to be used by the occupational physicians for the consultation of their experts. We had searched the literature for the best available evidence on the 12 problems, which made it possible to answer the clinical questions with a clear yes or no. Results The cases could be used by the occupational physicians as arising from their own practice. All together the occupational physicians consulted 75 different experts. Almost half of the consulted experts were near colleagues, 10% were industrial hygienists, 8% medical specialists and the rest had a varied background. Fifty three percent (95% confidence interval 42% to 65%) of all professional advice was not in line with the research literature. In 18 cases (24%) professional advice explicitly referred to up-to-date research literature as their used source. These cases were substantially less incorrect (17%) than advice that had not mentioned the literature as a source (65%) (difference 48%, 95% Confidence Interval from 27% to 69%). Conclusion Advice that occupational physicians routinely get in their daily practice differs substantially from best evidence from the literature. Occupational physicians who ask professional advice should always ask about the evidence of this advice. PMID:16131405

  19. 42 CFR 483.120 - Specialized services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... team, which includes a physician, qualified mental health professionals and, as appropriate, other... acute episode of serious mental illness, which necessitates supervision by trained mental health... functioning level that permits reduction in the intensity of mental health services to below the level of...

  20. 42 CFR 483.120 - Specialized services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... team, which includes a physician, qualified mental health professionals and, as appropriate, other... acute episode of serious mental illness, which necessitates supervision by trained mental health... functioning level that permits reduction in the intensity of mental health services to below the level of...

  1. 42 CFR 483.120 - Specialized services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... team, which includes a physician, qualified mental health professionals and, as appropriate, other... acute episode of serious mental illness, which necessitates supervision by trained mental health... functioning level that permits reduction in the intensity of mental health services to below the level of...

  2. 42 CFR 483.120 - Specialized services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... team, which includes a physician, qualified mental health professionals and, as appropriate, other... acute episode of serious mental illness, which necessitates supervision by trained mental health... functioning level that permits reduction in the intensity of mental health services to below the level of...

  3. 42 CFR 483.120 - Specialized services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... team, which includes a physician, qualified mental health professionals and, as appropriate, other... acute episode of serious mental illness, which necessitates supervision by trained mental health... functioning level that permits reduction in the intensity of mental health services to below the level of...

  4. 46 CFR 10.227 - Requirements for renewal.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the applicant. (v) An applicant for renewal of an endorsement as medical doctor or professional nurse... currently valid, appropriate license as physician, surgeon, or registered nurse issued under the authority.... There are no professional requirements for renewal of an endorsement as marine physician assistant or...

  5. 46 CFR 10.227 - Requirements for renewal.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the applicant. (v) An applicant for renewal of an endorsement as medical doctor or professional nurse... currently valid, appropriate license as physician, surgeon, or registered nurse issued under the authority.... There are no professional requirements for renewal of an endorsement as marine physician assistant or...

  6. 46 CFR 10.227 - Requirements for renewal.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the applicant. (v) An applicant for renewal of an endorsement as medical doctor or professional nurse... currently valid, appropriate license as physician, surgeon, or registered nurse issued under the authority.... There are no professional requirements for renewal of an endorsement as marine physician assistant or...

  7. Physicians' Values and Their Career Stage.

    ERIC Educational Resources Information Center

    Blackburn, Robert T.; Fox, Thomas G.

    1983-01-01

    Professional values of 241 physicians were determined from analyzing responses to 25 questionnaire items about an ideal medical school. Few differences were found for the seven factors (values), academic, professional, separatism, support, social welfare, research/specialization, status/prestige, and convenience. When values were analyzed by age…

  8. 36 CFR § 1202.42 - How are requests for access to medical records handled?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... writing a physician or mental health professional to whom you would like the records to be disclosed, and disclosure that otherwise would be made to you will instead be made to the designated physician or mental health professional. ...

  9. Competency-based medical education and continuing professional development: A conceptualization for change.

    PubMed

    Lockyer, Jocelyn; Bursey, Ford; Richardson, Denyse; Frank, Jason R; Snell, Linda; Campbell, Craig

    2017-06-01

    Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.

  10. Dyshormonia Iatrogenica: crossroads of medicine, malpractice law, and professional ethics in clinical endocrinology.

    PubMed

    Goldberg, Philip A; Varriale, David J; Mercurio, Mark R

    2012-01-01

    To present 2 challenging cases of patients who request endocrine therapies that their physician considers to be outside of the standard of care. With these complex cases as a backdrop, we explore the constructs of medicine, malpractice law, and professional ethics that guide physicians' medical decision-making processes. These cases illustrate a common conundrum for clinical endocrinologists, who often find themselves struggling to balance patient satisfaction and well-being with generally accepted standards of medical care. From the perspective of a malpractice lawyer, we review the keys to limiting medicolegal liability, with emphasis on thorough documentation, informed consent, and effective doctor-patient communication. We then review the constructs of professional ethics that guide patient care, with emphasis on virtues of the "good physician," patients' right to self-determination, and paternalism. Finally, we explore some justifications for a compassionate physician to refuse a patient's desired treatment plan. In the end, we hope that this manuscript helps to facilitate best medical, legal, professional, and ethical practices of clinical endocrinology.

  11. [Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration].

    PubMed

    Díaz-Portillo, Sandra P; Idrovo, Álvaro J; Dreser, Anahí; Bonilla, Federico R; Matías-Juan, Bonifacia; Wirtz, Veronika J

    2015-01-01

    To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

  12. Graduate Medical Education in Tactical Medicine and the Impact of ACGME Accreditation of EMS Fellowships.

    PubMed

    Tang, Nelson; Levy, Matthew J; Margolis, Asa M; Woltman, Nathan

    Physician interest in tactical medicine as an area of professional practice has grown significantly over the past decade. The prevalence of physician involvement in terms of medical oversight and operational support of civilian tactical medicine has experienced tremendous growth during this timeframe. Factors contributing to this trend are multifactorial and include enhanced law enforcement agency understanding of the role of the tactical physician, support for the engagement of qualified medical oversight, increasing numbers of physicians formally trained in tactical medicine, and the ongoing escalation of intentional mass-casualty incidents worldwide. Continued vigilance for the sustenance of adequate and appropriate graduate medical education resources for physicians seeking training in the comprehensive aspects of tactical medicine is essential to ensure continued advancement of the quality of casualty care in the civilian high-threat environment. 2017.

  13. [Burnout syndrome in medical and obstetric perception of violence].

    PubMed

    Pintado-Cucarella, Sheila; Penagos-Corzo, Julio C; Casas-Arellano, Marco Antonio

    2015-03-01

    Obstetric violence involves a violation of reproductive rights of women during pregnancy, childbirth and postpartum. It has been associated with lack of empathy and emotional discomfort of physicians. To identify the perceptions of obstetric violence and to determine the possible relationship with burnout syndrome. We evaluated 29 physicians whose scope of work relates to obstetrics and gynecology. The evaluation instruments were: a) questionnaire on professional perception that collects demographic information, situations of perceived obstetric violence, major concerns of physicians in their professional work, and includes an scale about level of job satisfaction, b) the Maslach Burnout inventory, and c) Jefferson Scale of Physician Empathy. The most prevalent obstetric violence situations perceived were: medical malpractice and harmful practices (10/29), discrimination (10/29), rude treatment and verbal attacks (11/29). Seventeen participants reported lack of information on obstetric violence and not have tools to cope with this problem. Regarding the burnout syndrome, it was associated with several items of the scale of empathy and with the scale of job satisfaction. This study shows the importance of providing knowledge and tools to deal with obstetric violence and stress management to prevent such situations on medical practices.

  14. Compassion fatigue, burnout and compassion satisfaction among family physicians in the Negev area - a cross-sectional study.

    PubMed

    El-Bar, Nurit; Levy, Amalia; Wald, Hedy S; Biderman, Aya

    2013-08-15

    Compassion fatigue among health care professionals has gained interest over the past decade. Compassion fatigue, as well as burnout, has been associated with depersonalization and suboptimal patient care. Professional caregivers in general are exposed to the risk of compassion fatigue (CF), burnout (BO) and low levels of compassion satisfaction (CS). While CF has been studied in health care professionals, few publications address its incidence among family physicians, specifically. The objectives of this study were to assess the prevalence and severity of CF among family practitioners (FPs) in the Negev (Israel's southern region), evaluating the correlations between CF, BO and CS and their relations with socio-demographic variables and work related characteristics. Self-report anonymous Compassion Satisfaction and Fatigue Test questionnaires (CSFT) measuring CF, BO, and CS were distributed among 194 family physicians at Clalit Health Services clinics in the Negev between July 2007 and April 2008. Correlations between CF, BO and CS were assessed. Multivariable logistic regression models with backward elimination were constructed. 128 (66%) physicians responded. 46.1% of respondents scored extremely high and high for CF, 21.1% scored low for CS and 9.4% scored high for BO. Strong correlations were found between BO and CF (r = 0.769, p < 0.001), and between BO and CS (r = -0.241, p = 0.006), but no correlation was found between CS and CF. The logistic regression model showed that the only factor associated with a significantly increased risk for CF was former immigration to Israel. Increased risk for BO was associated with female gender, history of personal trauma and lack of academic affiliation. Higher CS was associated with holding management positions and teaching residents. Family physicians in the Negev are at high risk for CF, with the potential for CF- associated patient dissatisfaction, compromised patient safety and increased medical error. We propose creation of a CF educational and early intervention treatment program for family physicians and other health care professionals. Such programs would train facilitators of physician well-being and resiliency building. We also recommend analyzing contributing variables and organizational factors related to higher CF. Policy recommendations include integrating such programs within required risk management continuing medical education.

  15. Compassion fatigue, burnout and compassion satisfaction among family physicians in the Negev area - a cross-sectional study

    PubMed Central

    2013-01-01

    Background Compassion fatigue among health care professionals has gained interest over the past decade. Compassion fatigue, as well as burnout, has been associated with depersonalization and suboptimal patient care. Professional caregivers in general are exposed to the risk of compassion fatigue (CF), burnout (BO) and low levels of compassion satisfaction (CS). While CF has been studied in health care professionals, few publications address its incidence among family physicians, specifically. The objectives of this study were to assess the prevalence and severity of CF among family practitioners (FPs) in the Negev (Israel’s southern region), evaluating the correlations between CF, BO and CS and their relations with socio-demographic variables and work related characteristics. Methods Self-report anonymous Compassion Satisfaction and Fatigue Test questionnaires (CSFT) measuring CF, BO, and CS were distributed among 194 family physicians at Clalit Health Services clinics in the Negev between July 2007 and April 2008. Correlations between CF, BO and CS were assessed. Multivariable logistic regression models with backward elimination were constructed. Results 128 (66%) physicians responded. 46.1% of respondents scored extremely high and high for CF, 21.1% scored low for CS and 9.4% scored high for BO. Strong correlations were found between BO and CF (r = 0.769, p < 0.001), and between BO and CS (r = −0.241, p = 0.006), but no correlation was found between CS and CF. The logistic regression model showed that the only factor associated with a significantly increased risk for CF was former immigration to Israel. Increased risk for BO was associated with female gender, history of personal trauma and lack of academic affiliation. Higher CS was associated with holding management positions and teaching residents. Conclusions and policy recommendations Family physicians in the Negev are at high risk for CF, with the potential for CF- associated patient dissatisfaction, compromised patient safety and increased medical error. We propose creation of a CF educational and early intervention treatment program for family physicians and other health care professionals. Such programs would train facilitators of physician well-being and resiliency building. We also recommend analyzing contributing variables and organizational factors related to higher CF. Policy recommendations include integrating such programs within required risk management continuing medical education. PMID:23947591

  16. The assessment of emergency physicians by a regulatory authority.

    PubMed

    Lockyer, Jocelyn M; Violato, Claudio; Fidler, Herta

    2006-12-01

    To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program (360 degree evaluation) for emergency physicians. Surveys with 16, 20, 30, and 31 items were developed to assess emergency physicians by 25 patients, eight coworkers, eight medical colleagues, and self, respectively, using five-point scales along with an "unable to assess" category. Items addressed key competencies related to communication skills, professionalism, collegiality, and self-management. Data from 187 physicians who identified themselves as emergency physicians were available. The mean number of respondents per physician was 21.6 (SD +/- 3.87) (93%) for patients, 7.6 (SD +/- 0.89) (96%) for coworkers, and 7.7 (SD +/- 0.61) (95%) for medical colleagues, suggesting it was a feasible tool. Only the patient survey had four items with "unable to assess" percentages > or = 15%. The factor analysis indicated there were two factors on the patient questionnaire (communication/professionalism and patient education), two on the coworker survey (communication/collegiality and professionalism), and four on the medical colleague questionnaire (clinical performance, professionalism, self-management, and record management) that accounted for 80.0%, 62.5%, and 71.9% of the variance on the surveys, respectively. The factors were consistent with the intent of the instruments, providing empirical evidence of validity for the instruments. Reliability was established for the instruments (Cronbach's alpha > 0.94) and for each physician (generalizability coefficients were 0.68 for patients, 0.85 for coworkers, and 0.84 for medical colleagues). The psychometric examination of the data suggests that the instruments developed to assess emergency physicians were feasible and provide evidence for validity and reliability.

  17. Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis

    PubMed Central

    2012-01-01

    Background Intimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians’ and nurses’ experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development. Methods Physicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher’s Exact Test was performed to determine statistical significance when examining nurse/physician differences. Results Of the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments. Conclusions This research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues. PMID:22721371

  18. The influence of managed care on supply of certified nurse-midwives: an evaluation of the physician dominance thesis.

    PubMed

    Hartley, H

    1999-03-01

    A key debate over the nature of professional power centers on the maintenance of physician dominance within the system of professions in health care. The changes in health care delivery and financing brought by managed care present a new context for evaluating the physician dominance thesis. I propose that increases in the supply of certified nurse-midwives, a "contending" health care professional group, are related to the expansion of managed care and may signal a decline in physician dominance. I analyze state-level data compiled from governmental, health professional, and industry sources to determine the influence of managed care market penetration, physician supply, state policy context, and demographic factors on the state-level supply of nurse-midwives. Results indicate that, despite high physician supply, nurse-midwife supply is higher in states with higher managed care penetration, as well as in those with more favorable state policy environments and a more educated demographic base. Outcomes from a series of hypothesis tests support my assertion that the expansion of managed care is altering the jurisdictional boundaries in the system of professions in health care, eroding the dominance of physicians while creating new openings for nurse-midwives.

  19. From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems.

    PubMed

    Kitchener, Martin; Caronna, Carol A; Shortell, Stephen M

    2005-03-01

    As national health systems pursue the common goals of containing expenditure growth and improving quality, many have sought to replace autonomous modes (systems) of physician control that rely on initial professional training and subsequent peer review. A common approach has involved extending bureaucratic modes of physician control that employ techniques such as hierarchical coordination and salaried positions. This paper applies concepts from studies of professional work to frame an empirical analysis of emergent bureaucratic modes of physician control in US hospital-based systems. Conceptually, we draw from recent studies to update Scott's (Health Services Res. 17(3) (1982) 213) typology to specify three bureaucratic modes of physician control: heteronomous, conjoint, and custodial. Empirically, we use case study evidence from eight US hospital-based systems to illustrate the heterogeneity of bureaucratic modes of physician control that span each of the ideal types. The findings indicate that some influential analysts perpetuate a caricature of bureaucratic organization which underplays its capacity to provide multiple modes of physician control that maintain professional autonomy over the content of work, and present opportunities for aligning practice with social goals.

  20. Professionally responsible malpractice reform.

    PubMed

    Brody, Howard; Hermer, Laura D

    2011-07-01

    Medical malpractice reform is both necessary and desirable, yet certain types of reform are clearly preferable to others. We argue that "traditional" tort reform remedies such as stringent damage caps not only fail to address the root causes of negligence and the adverse effects that fear of suit can have on physicians, but also fail to address the needs of patients. Physicians ought to view themselves as professionals who are dedicated to putting patients' interests ahead of their own. Professionally responsible malpractice reform should therefore be at least as patient-centered as it is physician-centered. Examples of more professionally responsible malpractice reform exist where institutions take a pro-active approach to identification, investigation, and remediation of possible malpractice. Such programs should be implemented more generally, and state laws enacted to facilitate them.

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

    PubMed

    Domenighetti, G; Casabianca, A

    1995-10-21

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

  2. Social support in the workplace for physicians in specialization training.

    PubMed

    Mikkola, Leena; Suutala, Elina; Parviainen, Heli

    2018-12-01

    When becoming a specialist, learning-through-service plays a significant role. The workplace affords good opportunities for learning, but the service-learning period may also impose stress on phycisians in specialization training. In medical work, social support has proved to be a very important factor in managing stress. Social support may afford advantages also for learning and professional identity building. However, little was known about how social support is perceived by doctors in specialization training. This study aimed to understand the perceptions of physicians in specialization training regarding social support communication in their workplace during their learning-through-service period. The study was conducted qualitatively by inductively analyzing the physicians' descriptions of workplace communication. The dataset included 120 essays, 60 each from hospitals and primary healthcare centres. Physicians in specialization training explained the need of social support with the responsibilities and demands of their clinical work and the inability to control and manage their workloads. They perceived that social support works well for managing stress, but also for strengthening relational ties and one's professional identity. A leader's support was perceived as being effective, and both senior and junior colleagues were described as an important source of social support. Also co-workers, such as the individual nurse partner with whom one works, was mentioned as an important source of social support. The results of this study indicate that social support works at the relational and identity levels, which is due to the multi-functional nature of workplace communication. For example, consultation functions as situational problem-solving, but also the tone of social interaction is meaningful. Thus, strengthening one's professional identity or collegial relationships requires further attention to workplace communication. Abbreviations PiST: Physician in specialization training.

  3. Risks and benefits of Twitter use by hematologists/oncologists in the era of digital medicine.

    PubMed

    Attai, Deanna J; Anderson, Patricia F; Fisch, Michael J; Graham, David L; Katz, Matthew S; Kesselheim, Jennifer; Markham, Merry Jennifer; Pennell, Nathan A; Sedrak, Mina S; Thompson, Michael A; Utengen, Audun; Dizon, Don S

    2017-10-01

    Twitter use by physicians, including those in the hematology-oncology field, is increasing. This microblogging platform provides a means to communicate and collaborate on a global scale. For the oncology professional, an active Twitter presence provides opportunities for continuing medical education, patient engagement and education, personal branding, and reputation management. However, because Twitter is an open, public forum, potential risks such as patient privacy violations, personal information disclosures, professionalism lapses, and time management need to be considered and managed. The authors have summarized the benefits and risks of Twitter use by the hematology-oncology physician. In addition, strategies to maximize benefit and minimize risk are discussed, and resources for additional learning are provided. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. [Suicide postvention: what mental health professionals need to know].

    PubMed

    Becker, Katja; Manthey, Thomas; Kaess, Michael; Brockmann, Elisabeth; Zimmermann, Frank; Plener, Paul L

    2017-11-01

    Postvention is the term used to describe a package of interventions designed for people affected by suicide. Inpatient suicides in Departments of Child and Adolescent Psychiatry are rare, but nevertheless constitute an immense burden to family members, friends, and fellow patients, as well as to medical staff members. Besides including an effective management of the acute crisis situation with well-defined communication rules, appropriate interaction with the bereaved, and prevention of copycat suicides in other patients, reliable guidelines for dealing with inpatient suicide must also contain a precise procedure on how to handle mental stress in physicians, psychotherapists, and other staff members. Furthermore, postvention should be an important part of the professional training of physicians as well as psychotherapists who work in child and adolescent psychiatry departments or outpatient clinics.

  5. Effective physician-nurse communication: a patient safety essential for labor and delivery.

    PubMed

    Lyndon, Audrey; Zlatnik, Marya G; Wachter, Robert M

    2011-08-01

    Effective communication is a hallmark of safe patient care. Challenges to effective interprofessional communication in maternity care include differing professional perspectives on clinical management, steep hierarchies, and lack of administrative support for change. We review principles of high reliability as they apply to communication in clinical care and discuss principles of effective communication and conflict management in maternity care. Effective clinical communication is respectful, clear, direct, and explicit. We use a clinical scenario to illustrate an historic style of nurse-physician communication and demonstrate how communication can be improved to promote trust and patient safety. Consistent execution of successful communication requires excellent listening skills, superb administrative support, and collective commitment to move past traditional hierarchy and professional stereotyping. Copyright © 2011 Mosby, Inc. All rights reserved.

  6. Physicians' early perspectives on Oregon's Coordinated Care Organizations.

    PubMed

    Stock, Ronald; Hall, Jennifer; Chang, Anna Marie; Cohen, Deborah

    2016-06-01

    Through development of Coordinated Care Organizations (CCOs), Oregon's version of the Accountable Care Organization (ACO) for Medicaid beneficiaries, Oregon is redesigning the healthcare system delivering care to some of its most vulnerable citizens. While clinicians are central to healthcare transformation, little is known about the impact on their role. The aim of this study was to understand the current and perceived effect CCO-related changes have on Oregon physicians' professional and personal lives. This qualitative observational study involved semi-structured interviews, conducted between March and October, 2013, of twenty-two purposively selected physicians who varied in years of practice, gender, employment status, specialty, and geographic location from three different CCOs. A grounded theory approach was used to analyze data. Physicians expressed uncertainty and ambiguity about the CCO model, reporting minor financial changes in the first year, but anticipating future reimbursement changes; new team-based care roles and responsibilities, accountability for quality incentive measures; and effects of CCO implementation on their personal lives. To meet CCO model changes and requirements, physicians requested collegial networking, team-based care training, and data system and information technology support for undergoing health system transformation. Although perhaps not immediate, healthcare reform can have a real and perceived impact on physicians' professional and personal lives. Attention to the impact of healthcare reform on physicians' personal and professional lives is important to ensure strategies are implemented to maintain a viable workforce, professional satisfaction, financial sustainability, and quality of care. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. 46 CFR 10.227 - Requirements for renewal.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., marine physician assistant, medical doctor, or professional nurse that have been expired for more than 12...) An applicant for renewal of an endorsement as medical doctor or professional nurse must, in addition..., appropriate license as physician, surgeon, or registered nurse issued under the authority of a State or...

  8. Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual?

    PubMed

    Jacobson, Peter D; Jazowski, Shelley A

    2011-08-01

    The Patient Protection and Affordable Care Act 1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation's primary care needs. In this commentary, we argue that physicians should take the lead in developing policies to address the primary care shortage. First, physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers. Second, physicians should re-imagine how primary care is delivered, including shifting routine care to NPPs while retaining responsibility for complex patients and oversight of the new primary care arrangements. Third, the ACA's focus on wellness and prevention creates opportunities for physicians to integrate population health into primary care practice.

  9. Qualitative study of employment of physician assistants by physicians

    PubMed Central

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

    2013-01-01

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

  10. ED physicians group ousted, sues--power struggle with CEO blamed.

    PubMed

    2007-07-01

    Serious contract problems with administration should never come as a surprise. The ED manager who is part of a physicians group should communicate regularly with key audiences within the hospital, and keep an ear to the ground for potential issues. Have routine meetings with senior administration, and work to gain a seat on the hospital's executive committee. Participate in community activities with hospital leadership, including family activities. Work to develop a professional working relationship with the nurse manager.

  11. Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique--a discrete choice experiment for eliciting job preferences.

    PubMed

    Honda, Ayako; Vio, Ferruccio

    2015-04-26

    Successfully motivating and retaining health workers is critical for the effective performance of health systems. In Mozambique, a shortage of health care professionals and low levels of staff motivation in rural and remote areas pose challenges to the provision of equitable health care delivery. This study provides quantitative information on the job preferences of non-physician health professionals in Mozambique, examining how different aspects of jobs are valued and how health professionals might respond to policy options that would post them to district hospitals in rural areas. The study used a discrete choice experiment (DCE) to elicit the job preferences of non-physician health professionals. Data collection took place in four Mozambique provinces: Maputo City, Maputo Province, Sofala and Nampula. DCE questionnaires were administered to 334 non-physician health professionals with specialized or university training ('mid-level specialists' and N1 and N2 categories). In addition, questionnaires were administered to 123 N1 and N2 students to enable comparison of the results for those with work experience with those without and determine how new N1 and N2 graduates can be attracted to rural posts. The results indicate that the provision of basic government housing has the greatest impact on the probability of choosing a job at a public health facility, followed by the provision of formal education opportunities and the availability of equipment and medicine at a health facility. The sub-group analysis suggests that job preferences vary according to stage of life and that incentive packages should vary accordingly. Recruitment strategies to encourage non-clinical professionals to work in rural/remote areas should also consider birthplace, as those born in rural/remote areas are more willing to work remotely. The study was undertaken within an overarching project that aimed to develop incentive packages for non-physician health professionals assigned to work in remote/rural areas. Based on the DCE results, the project team, together with the Mozambique Ministry of Health, has developed a range of health workforce retention strategies focusing on the provision of housing benefits and professional development opportunities to be utilized when assigning non-physician health professionals to rural/remote areas.

  12. Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

    PubMed

    Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

    2016-01-01

    State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

  13. 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…

  14. Relationship between burnout and professional conduct and attitudes among US medical students.

    PubMed

    Dyrbye, Liselotte N; Massie, F Stanford; Eacker, Anne; Harper, William; Power, David; Durning, Steven J; Thomas, Matthew R; Moutier, Christine; Satele, Daniel; Sloan, Jeff; Shanafelt, Tait D

    2010-09-15

    The relationship between professionalism and distress among medical students is unknown. To determine the relationship between measures of professionalism and burnout among US medical students. Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01). Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.

  15. [The professional and family characteristics, difficulties, contentment and resources of physicians working at level 3 neonatal intensive care centres. General overview in Hungary].

    PubMed

    Soósné Kiss, Zsuzsanna; Feith, Helga Judit; Szabó, Miklós; Gradvohl, Edina

    2018-04-01

    A survey that investigates the situation of physicians working at neonatal intensive care (NIC) centres has not been made since 1997. To give an overview of the sociodemographic characteristics; personal and professional problems; the satisfaction with their job and family roles; their levels of healthy lifestyle; resources in the families of physicians working at NIC. We have made an examination in Hungary at NIC among physicians from April 2015 till January 2016, with an anonym self-fill-in questionnaire. The physicians involved in the research (n = 111) are representatively middle-aged people. They are well-qualified and hold a subordinate post. Most of them have second jobs. The manager and deputy-manager positions are characteristic for the men. Most of them live in family. The main problems for them are financial and professional difficulties, not the family or personal problems. They have conflicts in families because of finding partners and having children as well as job problems. They are satisfied with their parenting, partnership and professional roles but they are not contented with their family role as a financial safety provider person and as a person living a healthy life. In difficult situations in their life, they can count on friends and family members, furthermore they can rely on their workmates and superiors. It is the first research that focuses on the general situation of physicians working at level 3 NIC centres. This is the first time when a survey investigates their professional-personal-family life. Orv Hetil. 2018; 159(16): 628-635.

  16. Online Professionalism and the Mirror of Social Media

    PubMed Central

    Kind, Terry; Chretien, Katherine C.

    2010-01-01

    The rise of social media—content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs—has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they “tread” through the World Wide Web, they leave behind a “footprint” that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for “online professionalism.” Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see. PMID:20632121

  17. [Medical empathy of physicians-in-training who are enrolled in professional training programs. A comparative intercultural study in Spain].

    PubMed

    Delgado-Bolton, Roberto; San-Martín, Montserrat; Alcorta-Garza, Adelina; Vivanco, Luis

    2016-11-01

    To characterise some of the environmental factors that are sensitive to cultural influence, and are involved in the development of medical empathy in Spanish and Latin American physicians-in-training. Cross-sectional study using questionnaires. Primary care and specialized medicine centres of the Healthcare System of La Rioja, Logroño, Spain. Physicians-in-training MAIN MEASUREMENTS: : Empathy was measured using the Jefferson Scale of Physician Empathy, version for healthcare professionals (JSE-HP). Socio-demographic, academic, and professional background information was collected. A total of 104 residents (67 from Spain and 32 from Latin America) answered and returned the questionnairess. The JSE-HP showed adequate psychometric properties. The empathy mean score of Spanish group was higher than that of the Latin American group (P=.01). Differences in the development of empathy were associated with: the development of professional models (P<.001), the positive encounter with other professionals (P=.001), and with a continuing medical education (P=.008). Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  18. Online professionalism and the mirror of social media.

    PubMed

    Greysen, S Ryan; Kind, Terry; Chretien, Katherine C

    2010-11-01

    The rise of social media--content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs--has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they "tread" through the World Wide Web, they leave behind a "footprint" that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for "online professionalism." Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.

  19. Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment.

    PubMed

    Petrič, Gregor; Atanasova, Sara; Kamin, Tanja

    2017-03-13

    Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs. The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician's paternalism. An email list-based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses. The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=-.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=-.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=-.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=-.17, P=.01). Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians. ©Gregor Petrič, Sara Atanasova, Tanja Kamin. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.03.2017.

  20. Educational outreach visits: effects on professional practice and health care outcomes.

    PubMed

    Thomson O'Brien, M A; Oxman, A D; Davis, D A; Haynes, R B; Freemantle, N; Harvey, E L

    2000-01-01

    Outreach visits have been identified as an intervention that may improve the practice of health care professionals, in particular prescribing. This type of 'face to face' visit has been referred to as university-based educational detailing, public interest detailing, and academic detailing. To assess the effects of outreach visits on improving health professional practice or patient outcomes. We searched MEDLINE up to March 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles. Randomised trials of outreach visits (defined as a personal visit by a trained person to a health care provider in his or her own setting). The participants were health care professionals. Two reviewers independently extracted data and assessed study quality. Eighteen studies were included involving more than 1896 physicians. All of the outreach visit interventions consisted of several components, including written materials and conferences. Reminders or audit and feedback complemented some visits. In 13 studies, the targeted behaviours were prescribing practices. In three studies, the behaviours were preventive services, including counselling for smoking cessation. In two studies, the outreach visits were directed toward improving the general management of common problems encountered in general practice, including asthma, diabetes, otitis media, hypertension, anxiety, and acute bronchitis. All studies examined physician behaviour and in three studies other health professionals such as nurses, nursing home attendants or health care workers were targeted. Positive effects on practice were observed in all studies. Only one study measured a patient outcome. Few studies examined the cost effectiveness of outreach. Educational outreach visits, particularly when combined with social marketing, appear to be a promising approach to modifying health professional behaviour, especially prescribing. Further research is needed to assess the effects of outreach visits for other aspects of practice and to identify key characteristics of outreach visits that are important to its success. The cost-effectiveness of outreach visits is not well evaluated.

  1. Pharmacist and physician perspectives on diabetes service delivery within community pharmacies in Indonesia: a qualitative study.

    PubMed

    Wibowo, Yosi; Sunderland, Bruce; Hughes, Jeffery

    2016-05-01

    To explore perspectives of physicians and pharmacists on diabetes service delivery within community pharmacies in Indonesia. In depth interviews were conducted with 10 physicians and 10 community pharmacists in Surabaya, Indonesia, using a semi-structured interview guide. Nvivo version 9 was used to facilitate thematic content analysis to identify barriers/facilitators for community pharmacists to provide diabetes services. The identified themes indicating barriers/facilitators for diabetes service delivery within Indonesian community pharmacies included: (1) pharmacist factors - i.e. positive views (facilitator) and perceived lack of competence (barrier); (2) pharmacist-physician relationships - i.e. physicians' lack of support and accessibility (barriers); (3) pharmacist-patient relationships - i.e. perceived patients' lack of support and accessibility (barriers); (4) pharmacy environment - i.e. business orientation (barrier), lack of staff and poor pharmacist availability (barriers), and availability of supporting resources, such as counselling areas/rooms, procedures/protocols and IT systems for labelling and patient records (facilitators); and (5) external environment - i.e. a health system to support pharmacist roles, remuneration, marketing and professional assistance (facilitators). Issues related to the pharmacist-physician-patient relationships, pharmacy environment and external environment need to be addressed before Indonesian community pharmacists can provide additional pharmacy services for type 2 diabetes patients. Collaboration between the Government, Ikatan Apoteker Indonesia (Indonesian Pharmacists Association) and Ikatan Dokter Indonesia (Indonesian Medical Association) is required to improve the pharmacy professional environment and facilities. © 2015 Royal Pharmaceutical Society.

  2. Physician-Assisted Suicide and Euthanasia: Can You Even Imagine Teaching Medical Students How to End Their Patients' Lives?

    PubMed Central

    Boudreau, J Donald

    2011-01-01

    The peer-reviewed literature includes numerous well-informed opinions on the topics of euthanasia and physician-assisted suicide. However, there is a paucity of commentary on the interface of these issues with medical education. This is surprising, given the universal assumption that in the event of the legalization of euthanasia, the individuals on whom society expects to confer the primary responsibility for carrying out these acts are members of the medical profession. Medical students and residents would inevitably and necessarily be implicated. It is my perspective that everyone in the profession, including those charged with educating future generations of physicians, has a critical interest in participating in this ongoing debate. I explore potential implications for medical education of a widespread sanctioning of physician-inflicted and physician-assisted death. My analysis, which uses a consequential-basis approach, leads me to conclude that euthanasia, when understood to include physician aid in hastening death, is incommensurate with humanism and the practice of medicine that considers healing as its overriding mandate. I ask readers to imagine the consequences of being required to teach students how to end their patients' lives and urge medical educators to remain cognizant of their responsibility in upholding long-entrenched and foundational professional values. PMID:22319424

  3. Interpreting Rape: Differences Among Professionals and Non-Professional Resources.

    ERIC Educational Resources Information Center

    Calhoun, Lawrence G.

    Physicians and rape crisis counselors may play important roles in assisting a rape victim; their beliefs and perceptions about rape may influence their treatment of the victim. Physicians (N=10) and volunteer rape counselors (N=44) completed questionnaires focused on demographic characteristics, their experiences with rape victims, and personal…

  4. Medical education and the physician workforce of Iraq.

    PubMed

    Al Mosawi, Aamir Jalal

    2008-01-01

    The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the continuing professional development of physicians.

  5. 12 CFR 1102.104 - Special procedure: Medical records.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good faith...

  6. 12 CFR 1102.104 - Special procedure: Medical records.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good faith...

  7. 12 CFR 1102.104 - Special procedure: Medical records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good faith...

  8. 12 CFR 1102.104 - Special procedure: Medical records.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good faith...

  9. 12 CFR 1102.104 - Special procedure: Medical records.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good faith...

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

    PubMed

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

    2014-01-01

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

  11. Physicians' propensity to collaborate and their attitude towards EBM: A cross-sectional study

    PubMed Central

    2011-01-01

    Background The healthcare management literature states that physicians often coordinate their activities within and between organizations through social networks. Previous studies have also documented the relationship between professional networks and physicians' attitudes toward evidence-based medicine (EBM). The present study sought associations between physicians' self-reported attitudes toward EBM and the formation of inter-physician collaborative network ties. Methods Primary data were collected from 297 clinicians at six hospitals belonging to one of the largest local health units of the Italian National Health Service. Data collection used a survey questionnaire that inquired about professional networks and physicians' characteristics. Social network analysis was performed to describe inter-physician professional networks. Multiple regression quadratic assignment procedures were performed to assess the relationship between self-reported attitudes toward EBM and clinicians' propensity to collaborate. Results Physicians who reported similar attitudes toward EBM were more likely to exchange information and advice through collaborative relationships (β = 0.0198; p < 0.05). Similarities in other characteristics, such as field of specialization (β = 0.1988; p < 0.01), individual affiliations with hospital sites (β = 0.0845; p < 0.01), and organizational clinical directorates (β = 0.0459; p < 0.01), were also significantly related to physicians' propensity to collaborate. Conclusions Communities of practice within healthcare organizations are likely to contain separate clusters of physicians whose members are highly similar. Organizational interventions are needed to foster heterophily whenever multidisciplinary cooperation is required to provide effective health care. PMID:21787395

  12. Physicians must honor refusal of treatment to restore competency by non-dangerous inmates on death row.

    PubMed

    Zonana, Howard

    2010-01-01

    The role of physicians in death penalty cases has provoked discussion in both the legal system as well as in professional organizations. Professional groups have responded by developing ethical guidelines advising physicians as to current ethical standards. Psychiatric dilemmas as a subspecialty with unique roles have required more specific guidelines. A clinical vignette provides a focus to explicate the conflicts. © 2010 American Society of Law, Medicine & Ethics, Inc.

  13. Hospital-physician relations: the relative importance of economic, relational and professional attributes to organizational attractiveness

    PubMed Central

    2014-01-01

    Background Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. Methods Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. Results The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. Conclusions This study shows that initiatives aimed at strengthening physicians’ positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians. PMID:24884491

  14. Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals.

    PubMed

    Peicius, Eimantas; Blazeviciene, Aurelija; Kaminskas, Raimondas

    2017-06-05

    This paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals' understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania. A cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods. The analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents' profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice. Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives. The study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD's improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

  15. 42 CFR 410.150 - To whom payment is made.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... charges or is paid any amount for services furnished by a physician assistant. (16) To a nurse... employer of a physician assistant for professional services furnished by the physician assistant and for... physician assistant regardless of whether the physician assistant furnishes services under a W-2, employer...

  16. 42 CFR 410.150 - To whom payment is made.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... charges or is paid any amount for services furnished by a physician assistant. (16) To a nurse... employer of a physician assistant for professional services furnished by the physician assistant and for... physician assistant regardless of whether the physician assistant furnishes services under a W-2, employer...

  17. 42 CFR 410.150 - To whom payment is made.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... charges or is paid any amount for services furnished by a physician assistant. (16) To a nurse... employer of a physician assistant for professional services furnished by the physician assistant and for... physician assistant regardless of whether the physician assistant furnishes services under a W-2, employer...

  18. 42 CFR 410.150 - To whom payment is made.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... charges or is paid any amount for services furnished by a physician assistant. (16) To a nurse... employer of a physician assistant for professional services furnished by the physician assistant and for... physician assistant regardless of whether the physician assistant furnishes services under a W-2, employer...

  19. Moral distress in physicians and nurses: Impact on professional quality of life and turnover.

    PubMed

    Austin, Cindy L; Saylor, Robert; Finley, Phillip J

    2017-07-01

    The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital. Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale-Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one's professional quality of life. Relationships between these constructs and clinicians' years in health care, critical care patient load, and professional discipline were explored. The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%. The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

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

    PubMed

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

    2008-01-24

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

  1. Physician health and wellness.

    PubMed

    Taub, Sara; Morin, Karine; Goldrich, Michael S; Ray, Priscilla; Benjamin, Regina

    2006-03-01

    Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. To develop ethical guidelines regarding physician health and wellness. The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.

  2. Physicians as well as nonphysician health care professionals in Taiwan have higher risk for lumbar herniated intervertebral disc than general population

    PubMed Central

    Chan, Feng-Kai; Hsu, Chien-Chin; Lin, Hung-Jung; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Weng, Shih-Feng

    2018-01-01

    Abstract Physicians in Taiwan have long working hours and are at risk for inappropriate posture when handling patients, which may contribute to lumbar herniated intervertebral disc (L-HIVD). This study was conducted to delineate this issue, which is still unknown. This nationwide population-based cohort study was based on Taiwan National Health Insurance Research Database. We identified 25,428 physicians, 32,316 nonphysician health care professionals (HCPs), and an identical number of age- and sex-matched individuals from the general population. All individuals who had L-HIVD before 2007 were excluded. We compared the L-HIVD risk between physicians and general population, nonphysician HCPs and general population, and physicians and nonphysician HCPs by tracing their medical histories between 2007 and 2011. A comparison among physician specialties was also performed. Physicians and nonphysician HCPs had higher L-HIVD risk than the general population [odds ratio (OR): 1.149; 95% confidence interval (CI): 1.011–1.307 and OR: 1.220; 95% CI: 1.080–1.378, respectively]. Physicians did not have higher L-HIVD risk than nonphysician HCPs [adjusted OR (AOR): 0.912; 95% CI: 0.795–1.046]. Physician specialties of orthopedics and obstetrics and gynecology had a trend of higher L-HIVD risk than other specialties (AOR: 1.538; 95% CI: 0.805–2.939, and AOR: 1.306; 95% CI: 0.967–1.764, respectively). Physicians as well as nonphysician health care professionals in Taiwan have higher L-HIVD risk than the general population, which could be attributed to a probable role of long working hours. This result provides an important reference for the government to promote occupational health in health care professionals; however, further studies are warranted for the underlying mechanisms. PMID:29505537

  3. Physicians as well as nonphysician health care professionals in Taiwan have higher risk for lumbar herniated intervertebral disc than general population.

    PubMed

    Chan, Feng-Kai; Hsu, Chien-Chin; Lin, Hung-Jung; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Weng, Shih-Feng

    2018-01-01

    Physicians in Taiwan have long working hours and are at risk for inappropriate posture when handling patients, which may contribute to lumbar herniated intervertebral disc (L-HIVD). This study was conducted to delineate this issue, which is still unknown. This nationwide population-based cohort study was based on Taiwan National Health Insurance Research Database. We identified 25,428 physicians, 32,316 nonphysician health care professionals (HCPs), and an identical number of age- and sex-matched individuals from the general population. All individuals who had L-HIVD before 2007 were excluded. We compared the L-HIVD risk between physicians and general population, nonphysician HCPs and general population, and physicians and nonphysician HCPs by tracing their medical histories between 2007 and 2011. A comparison among physician specialties was also performed. Physicians and nonphysician HCPs had higher L-HIVD risk than the general population [odds ratio (OR): 1.149; 95% confidence interval (CI): 1.011-1.307 and OR: 1.220; 95% CI: 1.080-1.378, respectively]. Physicians did not have higher L-HIVD risk than nonphysician HCPs [adjusted OR (AOR): 0.912; 95% CI: 0.795-1.046]. Physician specialties of orthopedics and obstetrics and gynecology had a trend of higher L-HIVD risk than other specialties (AOR: 1.538; 95% CI: 0.805-2.939, and AOR: 1.306; 95% CI: 0.967-1.764, respectively). Physicians as well as nonphysician health care professionals in Taiwan have higher L-HIVD risk than the general population, which could be attributed to a probable role of long working hours. This result provides an important reference for the government to promote occupational health in health care professionals; however, further studies are warranted for the underlying mechanisms. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  4. Generation to generation: discrimination and harassment experiences of physician mothers and their physician daughters.

    PubMed

    Shrier, Diane K; Zucker, Alyssa N; Mercurio, Andrea E; Landry, Laura J; Rich, Michael; Shrier, Lydia A

    2007-01-01

    To examine bias and sexual harassment experiences of physician mothers and their physician daughters; correlations of these experiences with career satisfaction, stress at work, stress at home, and percentage of women in specialty; and influences of the mother on her daughter's experiences. A convenience sample of 214 families with mother and daughter physicians was sent a 56-item survey that included questions on bias and sexual harassment experiences. Statistical comparisons were made within 136 dyads where both mother and daughter returned the questionnaire. Eighty-four percent of mothers and 87% of daughters responded. Mothers and daughters reported similarly high rates and severity of sexual harassment before medical school, while in residency/fellowship, while in practice/work setting, and by teachers and supervisors. Daughters reported higher rates of harassment during medical school and by patients, mothers by colleagues. Gender and racial/ethnic discrimination was lower for daughters compared with their mothers, but gender discrimination was still substantial. Compared with other daughters, daughters who experienced discrimination or sexual harassment reported lower career satisfaction and more stress at work and at home and worked in specialties with fewer women. Gender discrimination and sexual harassment remain entrenched in medical education and professional workplaces. Maternal role models and mentors were not as protective as anticipated. Leadership of medical institutions and professional associations must deal more effectively with persistent discrimination and harassment or risk the loss of future leaders.

  5. Specialist Physicians' Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors.

    PubMed

    Dossett, Lesly A; Kauffmann, Rondi M; Lee, Jay S; Singh, Harkamal; Lee, M Catherine; Morris, Arden M; Jagsi, Reshma; Quinn, Gwendolyn P; Dimick, Justin B

    2018-06-01

    Our objective was to determine specialist physicians' attitudes and practices regarding disclosure of pre-referral errors. Physicians are encouraged to disclose their own errors to patients. However, no clear professional norms exist regarding disclosure when physicians discover errors in diagnosis or treatment that occurred at other institutions before referral. We conducted semistructured interviews of cancer specialists from 2 National Cancer Institute-designated Cancer Centers. We purposively sampled specialists by discipline, sex, and experience-level who self-described a >50% reliance on external referrals (n = 30). Thematic analysis of verbatim interview transcripts was performed to determine physician attitudes regarding disclosure of pre-referral medical errors; whether and how physicians disclose these errors; and barriers to providing full disclosure. Participants described their experiences identifying different types of pre-referral errors including errors of diagnosis, staging and treatment resulting in adverse events ranging from decreased quality of life to premature death. The majority of specialists expressed the belief that disclosure provided no benefit to patients, and might unnecessarily add to their anxiety about their diagnoses or prognoses. Specialists had varying practices of disclosure including none, non-verbal, partial, event-dependent, and full disclosure. They identified a number of barriers to disclosure, including medicolegal implications and damage to referral relationships, the profession's reputation, and to patient-physician relationships. Specialist physicians identify pre-referral errors but struggle with whether and how to provide disclosure, even when clinical circumstances force disclosure. Education- or communication-based interventions that overcome barriers to disclosing pre-referral errors warrant development.

  6. Adopting electronic medical records: what do the new federal incentives mean to your individual physician practice?

    PubMed

    Neclerio, John M; Cheney, Kathleen; Goldman, C Mitchell; Clark, Lisa W

    2009-01-01

    Under President Obama's American Recovery and Reinvestment Act of 2009, the federal government is offering incentives to physicians to adopt electronic health records. The goal is to improve quality of care and constrain costs. Higher incentive payments are available for those physicians who act quickly to meet the government's standards. Physicians who practice in "health professional shortage areas" and who serve mainly Medicaid recipients may qualify for additional incentives. Although compliance is "voluntary, "physicians who have not met the standards by 2015 will face reductions in their Medicare reimbursements unless they can show a significant hardship. Physicians can get started by contacting hospitals with which they are affiliated and professional associations to find out what vendors are being used in their service area. Agreements for electronic health records should be reviewed carefully to ensure that physicians' interests are protected.

  7. Perspective: Can emotional intelligence training serve as an alternative approach to teaching professionalism to residents?

    PubMed

    Taylor, Christine; Farver, Carol; Stoller, James K

    2011-12-01

    Of the Accreditation Council for Graduate Medical Education's six general competencies, professionalism has posed the greatest challenges for medical educators to define and teach. Currently, professionalism is largely taught experientially through role modeling, which has many shortcomings as a sole teaching strategy. Namely, role modeling does not involve an explicit curriculum, the skill is difficult to teach or develop, and physicians may be reluctant to talk about lapses in their own behaviors regarding professionalism.In this article, the authors propose instead using the model of emotional intelligence (EI) to define key elements of professionalism and as the basis for their proposed curriculum for teaching professionalism. EI is a well-developed construct and consists of four types of abilities: emotional self-awareness, self-management, social awareness, and relationship management. EI is grounded in effective performance and leadership success rather than in moral right or wrong. The authors propose that the EI abilities suggest specific curricula which, when successfully taught by faculty and learned by physicians-in-training, would allow trainees' professionalism to be recognized and measured in ways that are not currently possible with existing hidden curricula. The authors hope that those who develop policies regarding professionalism and those who train physicians will find this construct a useful way of developing curricula for the critical professionalism competency.

  8. 42 CFR 410.43 - Partial hospitalization services: Conditions and exclusions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Include any of the following: (i) Individual and group therapy with physicians or psychologists or other mental health professionals to the extent authorized under State law. (ii) Occupational therapy requiring... appropriate supervision of a qualified occupational therapist by an occupational therapy assistant as...

  9. Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

    PubMed

    Kawamoto, Kensaku; Lobach, David F

    2003-01-01

    Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.

  10. The differing perspectives of workers and occupational medicine physicians on the ethical, legal and social issues of genetic testing in the workplace.

    PubMed

    Brandt-Rauf, Sherry I; Brandt-Rauf, Elka; Gershon, Robyn; Brandt-Rauf, Paul W

    2011-01-01

    Genetic testing in the workplace holds the promise of improving worker health but also raises ethical, legal, and social issues. In considering such testing, it is critical to understand the perspectives of workers, who are most directly affected by it, and occupational health professionals, who are often directly involved in its implementation. Therefore, a series of focus groups of unionized workers (n=25) and occupational medicine physicians (n=23) was conducted. The results demonstrated strikingly different perspectives of workers and physicians in several key areas, including the goals and appropriateness of genetic testing, and methods to minimize its risks. In general, workers were guided by a profound mistrust of the employer, physician, and government, while physicians were guided primarily by scientific and medical concerns, and, in many cases, by the business concerns distrusted by the workers.

  11. Results from using a new dyadic-dependence model to analyze sociocentric physician networks.

    PubMed

    Paul, Sudeshna; Keating, Nancy L; Landon, Bruce E; O'Malley, A James

    2014-09-01

    Professional physician networks can potentially influence clinical practices and quality of care. With the current focus on coordinated care, discerning influences of naturally occurring clusters and other forms of dependence among physicians' relationships based on their attributes and care patterns is an important area of research. In this paper, two directed physician networks: a physician influential conversation network (N = 33) and a physician network obtained from patient visit data (N = 135) are analyzed using a new model that accounts for effect modification of the within-dyad effect of reciprocity and inter-dyad effects involving three (or more) actors. The results from this model include more nuanced effects involving reciprocity and triadic dependence than under incumbent models and more flexible control for these effects in the extraction of other network phenomena, including the relationship between similarity of individuals' attributes (e.g., same-gender, same residency location) and tie-status. In both cases we find extensive evidence of clustering and triadic dependence that if not accounted for confounds the effect of reciprocity and attribute homophily. Findings from our analysis suggest alternative conclusions to those from incumbent models. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Principles to promote physician satisfaction and work-life balance.

    PubMed

    Shanafelt, Tait D; West, Colin P; Poland, Gregory A; LaRusso, Nicolas F; Menaker, Ronald; Bahn, Rebecca S

    2008-12-01

    Substantial evidence suggests that difficulty balancing their personal and professional life is a major contributor to physician distress. Limited evidence suggests that the mission and policies of health care organizations may relate to physician satisfaction. In this article, we describe principles to promote professional satisfaction and work-life integration developed by the Mayo Clinic department of medicine. These principles can be used to measure and align policies. It is hoped they will serve as a model that can be used by other health care organizations.

  13. Medical professionalism in China and the United States: a transcultural interpretation.

    PubMed

    Nie, Jing-Bao; Smith, Kirk L; Cong, Yali; Hu, Linying; Tucker, Joseph D

    2015-01-01

    As in other societies, medical professionalism in the Peoples' Republic of China has been rapidly evolving. One of the major events in this process was the endorsement in 2005 of the document, "Medical Professionalism in the New Millennium: A Physician Charter," by the Chinese Medical Doctor Association (hereafter, the Charter)(1). More recently, a national survey, the first on such a large scale, was conducted on Chinese physicians' attitudes toward the fundamental principles and core commitments put forward in the Charter. Based on empirical findings from that study and comparing them to the published results of a similar American survey, the authors offer an in-depth interpretation of significant cross-cultural differences and important transcultural commonalities. The broader historical, socio-economic, and ethical issues relating to salient Chinese cultural practices such as family consent, familism (the custom of deferring decisions to family members), and the withholding of medical information, as well as controversial topics such as not respecting patients' autonomy, are examined. The Chinese Survey found that Chinese physicians supported the principles of the Charter in general. Here we argue that Chinese culture and traditional medical ethics are broadly compatible with the moral commitments demanded by modern medical professionalism. Methodologically and theoretically-recognizing the problems inherent in the hoary but still popular habit of dichotomizing cultures and in relativism-a transcultural approach is adopted that gives greater (due) weight to the internal moral diversity present within every culture, the common ground shared by different cultures, and the primacy of morality. Genuine cross-cultural dialogue, including a constructive Chinese-American dialogue in the area of medical professionalism, is not only possible, but necessary. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  14. Relevance of the Rationalist-Intuitionist Debate for Ethics and Professionalism in Medical Education

    ERIC Educational Resources Information Center

    Leffel, G. Michael; Mueller, Ross A. Oakes; Curlin, Farr A.; Yoon, John D.

    2015-01-01

    Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no…

  15. Professional Interactions: Negotiation and Expression for Future Physicians and Healthcare Providers

    ERIC Educational Resources Information Center

    Pan, Andrew J.; Pan, Aaron J.; Leary, Kimberlyn R.

    2017-01-01

    The rapid pace of change in medicine requires doctors to be effective conflict mediators and negotiators in the clinical workplace, and a multitude of research connects strong physician-patient communication to improved patient outcomes. Disparities in such skills exist among medical students and professionals, and are neither taught nor evaluated…

  16. Cosmetic surgery on children - professional and legal obligations in Australia.

    PubMed

    Kitipornchai, Leon; Then, Shih-Ning

    2011-07-01

    Public awareness and concern about cosmetic surgery on children is increasing. Nationally and internationally questions have been raised by the media and government bodies about the appropriateness of children undergoing cosmetic surgery. Considering the rates of cosmetic surgery in comparable Western societies, it seems likely that the number of physicians in Australia who will deal with a request for cosmetic surgery for a child will continue to increase. This is a sensitive issue and it is essential that physicians understand the professional and legal obligations that arise when cosmetic surgery is proposed for a child. This article reviews the current professional and legal obligations that physicians have to competent and incompetent children for whom cosmetic surgery has been requested. A case study is used to highlight the factors that Australian primary care physicians must consider before referring and conducting cosmetic surgery on children.

  17. [Gender and career paths of female primary care physicians in Andalusia, Spain, at the beginning of 21st century].

    PubMed

    Saletti-Cuesta, Lorena; Delgado, Ana; Ortiz-Gómez, Teresa

    2014-12-01

    The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in the study. The discourse analysis revealed that most of the female physicians did not plan for professional goals and, when they did plan for them, the goals were intertwined with family needs. Consequently, their career paths were discontinuous. In contrast, career paths oriented towards professional development and the conscious planning of goals were more common among the female doctors acting as directors of health care centers.

  18. Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain

    PubMed Central

    Peña-Sánchez, Juan Nicolás; Lepnurm, Rein; Morales-Asencio, José Miguel; Delgado, Ana; Domagała, Alicja; Górkiewicz, Maciej

    2014-01-01

    The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians. PMID:26973935

  19. [Draft guideline regarding appropriate use of 131I-MIBG radiotherapy for neuroendocrine tumors Drafting Committee for Guideline of Radiotherapy with 131I-MIBG, Committee for Nuclear Oncology and Immunology, The Japanese Society of Nuclear Medicine].

    PubMed

    Kinuya, Seigo; Yoshinaga, Keiichiro; Higuchi, Tetsuya; Jinguji, Megumi; Kawamoto, Hiroshi; Kurihara, Hiroaki

    2015-02-01

    131I-MIBG radiotherapy has been used for unresectable nueroendocrine tumors including malignant pheochromocytomas and neuroblastomas in foreign countries since the '80s when clinical therapeutic trials were initiated. In Japan, 131I-MIBG radiotherapy has not been approved by Ministry of Health, Labor and Welfare, however, personally imported 131I-MIBG is now available in limited institutions for therapeutic purpose. This updated guideline draft aims to provide useful information concerning 131I-MIBG radiotherapy, to prevent side effects, and to protect physicians, nurses, other health care professionals, patients and their families from radiation exposure. The committee also provides appendices including practical guidance for attending physicians, patient management and referring physicians for their conveniences.

  20. Social Media for Networking, Professional Development, and Patient Engagement.

    PubMed

    Markham, Merry Jennifer; Gentile, Danielle; Graham, David L

    2017-01-01

    Social media has become an established method of communication, and many physicians are finding these interactive tools and platforms to be useful for both personal and professional use. Risks of social media, or barriers to its use, include perceived lack of time, privacy concerns, and the risk of damage to one's reputation by unprofessional behavior. Of the social media platforms, Twitter has become favored by physicians and other health care professionals. Although one of the most obvious uses of social media is for rapid dissemination and receipt of information, oncologists are finding that social media is important for networking through blogs, Facebook, and Twitter. These platforms also have potential for providing opportunities for professional development, such as finding collaborators through networking, participation in Twitter journal clubs, and participating in online case-based tumor boards. Social media can also be used for patient engagement, such as through participation in tweet chats. There is emerging data that patient engagement through these platforms may lead to improvement in some health-related outcomes; however, data are sparse for oncology-specific outcomes. Efforts are underway to determine how to assess how social media engagement impacts health outcomes in oncology patients.

  1. When Guild Interests and Professional Obligations Collide.

    PubMed

    Minkoff, Howard; Ecker, Jeffrey

    2017-08-01

    Physicians who work in medical organizations are called on to fulfill two roles: guild members who work to advance physician interests (eg, lobbying for tort reform) and professional society members who work to advance patient interests (eg, developing clinical guidelines). Most often, physicians' self-interest and their interest in patient well-being align. When they do not, members of a guild or profession may justify the prioritization of self-interest with a form of motivated reasoning (a process wherein physicians weigh data differently depending on whether it supports their a priori beliefs). This allows physicians to frame self-interest as being in the best interests of their patients (eg, tort reform makes malpractice insurance affordable and allows physicians to continue to serve their patients). When interests conflict, physicians must be cognizant of the forces at play, that is, self-interest or in-group interest on the one hand and obligations to patients on the other. This entails recognition and negation of motivated reasoning. Often the most difficult calculus is evaluating proposed actions that would disadvantage physicians but advantage patients. In such cases, the health care provider must be aware not only of the temptation to oppose the action for financial reasons, but also the equally natural temptation to frame the proposal as a threat to patient well-being. Ultimately recognizing that a central tenet of professionalism is the primacy of patient welfare should help physicians both to maintain their fidelity to patient good and to uphold their reputation for altruism.

  2. A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study.

    PubMed

    Luckett, Tim; Chenoweth, Lynnette; Phillips, Jane; Brooks, Deborah; Cook, Janet; Mitchell, Geoffrey; Pond, Dimity; Davidson, Patricia M; Beattie, Elizabeth; Luscombe, Georgina; Goodall, Stephen; Fischer, Thomas; Agar, Meera

    2017-10-01

    Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.

  3. Law Enforcement and Emergency Medicine: An Ethical Analysis.

    PubMed

    Baker, Eileen F; Moskop, John C; Geiderman, Joel M; Iserson, Kenneth V; Marco, Catherine A; Derse, Arthur R

    2016-11-01

    Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Occupational physicians' perceived value of evidence-based medicine intervention in enhancing their professional performance.

    PubMed

    Hugenholtz, Nathalie I R; Schaafsma, Frederieke G; Schreinemakers, Jos F; van Dijk, Frank J H; Nieuwenhuijsen, Karen

    2008-06-01

    This study evaluated how physicians in a nonclinical setting perceive the value of an intervention with multifaceted evidence-based medicine with regard to enhancing their professional performance. A qualitative study was conducted using focus groups and face-to-face interviews with 14 of the 48 Dutch occupational physicians who participated in the intervention. The intervention combined a didactic course in evidence-based medicine with recurrent case-method learning sessions. During the sessions, the participants were challenged to discuss their cases and to give one another feedback on how to find information on cases. Five main themes and four subthemes were identified: professional behavior and quality of care (subtheme: transparency): occupational physicians associated being up-to-date with quality of care, and evidence-based medicine was associated with improvements in professional standards; critical attitude and improved recommendations: occupational physicians asked themselves more-profound questions and searched more for information; sharing knowledge: the peer-group sessions facilitated the sharing of knowledge; communication (subthemes: colleagues, clients and other specialists): the more soundly based recommendations enhanced self-confidence positively and therefore altered interaction with medical specialists in particular; and satisfaction and barriers: the occupational physicians were especially content with the structured discussion in the peer-group sessions. However, the intervention was very time consuming. The participants regarded the intervention as a useful method for enhancing their professional performance. They stated that they became more up-to-date and more self-confident by searching for and sharing knowledge. These actions resulted in more scientifically based recommendations and improved interaction with clients and other specialists. However, time constraints remain an important barrier.

  5. Recapturing time: a practical approach to time management for physicians.

    PubMed

    Gordon, Craig E; Borkan, Steven C

    2014-05-01

    Increasing pressures on physicians demand effective time management and jeopardise professional satisfaction. Effective time management potentially increases productivity, promotes advancement, limits burnout and improves both professional and personal satisfaction. However, strategies for improving time management are lacking in the current medical literature. Adapting time management techniques from the medical and non-medical literature may improve physician time management habits. These techniques can be divided into four categories: (1) setting short and long-term goals; (2) setting priorities among competing responsibilities; (3) planning and organising activities; and (4) minimising 'time wasters'. Efforts to improve time management can increase physician productivity and enhance career satisfaction.

  6. Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses

    PubMed Central

    Gutmanis, Iris; Beynon, Charlene; Tutty, Leslie; Wathen, C Nadine; MacMillan, Harriet L

    2007-01-01

    Background Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors. Methods A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse. Results In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV. Conclusion The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice. PMID:17250771

  7. Health Care Professionals' Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency.

    PubMed

    Braverman, Derek W; Marcus, Brian S; Wakim, Paul G; Mercurio, Mark R; Kopf, Gary S

    2017-10-01

    Health care professionals (HCPs) are crucial to physician-assisted death (PAD) provision. To quantitatively assess the favorability of justifications for or against PAD legalization among HCPs, the effect of the terms "suicide" and "euthanasia" on their views and their support for three forms of PAD. Our questionnaire presented three cases: physician-assisted suicide, euthanasia for a competent patient, and euthanasia for an incompetent patient with an advance directive for euthanasia. Respondents judged whether each case was ethical and should be legal and selected their justifications from commonly cited reasons. The sample included physician clinicians, researchers, nonphysician clinicians, and other nonclinical staff at a major academic medical center. Of 221 HCPs, the majority thought that each case was ethical and should be legal. In order of declining favorability, justifications supporting PAD legalization were relief of suffering, right to die, mercy, acceptance of death, nonabandonment, and saving money for the health care system; opposing justifications were the slippery slope argument, unnecessary due to palliative care, killing patients is wrong, religious views, and suicide is wrong. The use of suicide and euthanasia terminology did not affect responses. Participants preferred physician-assisted suicide to euthanasia for a competent patient (P < 0.0001) and euthanasia for an incompetent patient to euthanasia for a competent patient (P < 0.005). HCPs endorsed patient-centered justifications over other reasons, including role-specific duties. Suicide and euthanasia language did not bias HCPs against PAD, challenging claims that such value-laden terms hinder dialogue. More research is required to understand the significance of competency in shaping attitudes toward PAD. Published by Elsevier Inc.

  8. Psychosocial Care Provided by Physicians and Nurses in Palliative Care: A Mixed Methods Study.

    PubMed

    Fan, Sheng-Yu; Lin, I-Mei; Hsieh, Jyh-Gang; Chang, Chih-Jung

    2017-02-01

    Psychosocial care is an important component of palliative care, which is also provided by physicians and nurses. The aim of this study was to explore the experiences of physicians and nurses in palliative care regarding the process of psychosocial care, the difficulties, and the support needs from "psychosocial care professionals." A two-phase mixed methods study was conducted. In the first phase, 16 physicians and nurses with palliative care experience were recruited. A semi-structured interview was used to collect data about their experience of providing psychosocial care, and these were analyzed using thematic analysis. In the second phase, 88 physicians and nurses completed an online survey that was developed from the qualitative results. Qualitative results revealed three themes: 1) the contents of psychosocial care included not only disease-related events but also emotional and family support, 2) providing psychosocial care was a dynamic process including assessment, interventions, and evaluation, and 3) there were difficulties from the participants themselves, patients and families, and the system. Participants also reflected on what they did and the influences of providing care on themselves. Quantitative results showed that the most common psychosocial care was discussion about the progress of the disease and future care plan; the difficulty was the long-term problems in families; and the psychosocial care professionals most needed were social workers and clinical/counseling psychologists. Understanding the process of psychosocial care and integrating it with specialized mental health care in a team could improve the quality of psychosocial care in palliative care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Euthanasia.

    PubMed

    Brock, D W

    1992-01-01

    The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release the dying patient from otherwise prolonged suffering and agony. Potentially bad consequences of permitting euthanasia include the undermining of the "moral center" of medicine by allowing physicians to kill, the weakening of society's commitment to provide optimal care for dying patients, and, of greatest concern, the "slippery slope" argument. The evaluation of the arguments leads to support for euthanasia, with its performance not incompatible with a physician's professional commitment.

  10. Euthanasia.

    PubMed Central

    Brock, D. W.

    1992-01-01

    The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release the dying patient from otherwise prolonged suffering and agony. Potentially bad consequences of permitting euthanasia include the undermining of the "moral center" of medicine by allowing physicians to kill, the weakening of society's commitment to provide optimal care for dying patients, and, of greatest concern, the "slippery slope" argument. The evaluation of the arguments leads to support for euthanasia, with its performance not incompatible with a physician's professional commitment. PMID:1519375

  11. Factors influencing physicians' knowledge sharing on web medical forums.

    PubMed

    Lin, Tung Cheng; Lai, Ming Cheng; Yang, Shu Wen

    2016-09-01

    Web medical forums are relatively unique as knowledge-sharing platforms because physicians participate exclusively as knowledge contributors and not as knowledge recipients. Using the perspective of social exchange theory and considering both extrinsic and intrinsic motivations, this study aims to elicit the factors that significantly influence the willingness of physicians to share professional knowledge on web medical forums and develops a research model to explore the motivations that underlie physicians' knowledge-sharing attitudes. This model hypothesizes that constructs, including shared vision, reputation, altruism, and self-efficacy, positively influence these attitudes and, by extension, positively impact knowledge-sharing intention. A conventional sampling method and the direct recruitment of physicians at their outpatient clinic gathered valid data from a total of 164 physicians for analysis in the model. The empirical results support the validity of the proposed model and identified shared vision as the most significant factor of influence on knowledge-sharing attitudes, followed in descending order by knowledge-sharing self-efficacy, reputation, and altruism. © The Author(s) 2015.

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

    PubMed

    Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall

    2004-06-11

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

  13. Experiences of primary care physicians and staff following lean workflow redesign.

    PubMed

    Hung, Dorothy Y; Harrison, Michael I; Truong, Quan; Du, Xue

    2018-04-10

    In response to growing pressures on primary care, leaders have introduced a wide range of workforce and practice innovations, including team redesigns that delegate some physician tasks to nonphysicians. One important question is how such innovations affect care team members, particularly in view of growing dissatisfaction and burnout among healthcare professionals. We examine the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. This included co-locating physician and medical assistant dyads, delegating significant responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members. The redesigns were implemented and scaled in three phases across 46 primary care departments in a large ambulatory care delivery system. We fielded 1164 baseline and 1333 follow-up surveys to physicians and other nonphysician staff (average 73% response rate) to assess workforce engagement (e.g., job satisfaction, motivation), perceptions of the work environment, and job-related burnout. We conducted multivariate regressions to detect changes in experiences after the redesign, adjusting for respondent characteristics and clustering of within-clinic responses. We found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, they also experienced higher levels of burnout and perceptions of the workplace as stressful. Trends were the same for both occupational groups, but the increased reports of stress were greater among physicians. Additionally, members of all clinics, except for the pilot site that developed the new workflows, reported higher burnout, while perceptions of workplace stress increased in all clinics after the redesign. Our findings partially align with expectations of work redesign as a route to improving physician and staff experiences in delivering care. Although teamwork and engagement increased, the redesigns in our study were not enough to moderate long-standing challenges facing primary care. Yet higher levels of empowerment and engagement, as observed in the pilot clinic, may be particularly effective in facilitating improvements while combating fatigue. To help practices cope with increasing burdens, interventions must directly benefit healthcare professionals without overtaxing an already overstretched workforce.

  14. Nonmedical influences on medical decision making: an experimental technique using videotapes, factorial design, and survey sampling.

    PubMed Central

    Feldman, H A; McKinlay, J B; Potter, D A; Freund, K M; Burns, R B; Moskowitz, M A; Kasten, L E

    1997-01-01

    OBJECTIVE: To study nonmedical influences on the doctor-patient interaction. A technique using simulated patients and "real" doctors is described. DATA SOURCES: A random sample of physicians, stratified on such characteristics as demographics, specialty, or experience, and selected from commercial and professional listings. STUDY DESIGN: A medical appointment is depicted on videotape by professional actors. The patient's presenting complaint (e.g., chest pain) allows a range of valid interpretation. Several alternative versions are taped, featuring the same script with patient-actors of different age, sex, race, or other characteristics. Fractional factorial design is used to select a balanced subset of patient characteristics, reducing costs without biasing the outcome. DATA COLLECTION: Each physician is shown one version of the videotape appointment and is asked to describe how he or she would diagnose or treat such a patient. PRINCIPAL FINDINGS: Two studies using this technique have been completed to date, one involving chest pain and dyspnea and the other involving breast cancer. The factorial design provided sufficient power, despite limited sample size, to demonstrate with statistical significance various influences of the experimental and stratification variables, including the patient's gender and age and the physician's experience. Persistent recruitment produced a high response rate, minimizing selection bias and enhancing validity. CONCLUSION: These techniques permit us to determine, with a degree of control unattainable in observational studies, whether medical decisions as described by actual physicians and drawn from a demographic or professional group of interest, are influenced by a prescribed set of nonmedical factors. PMID:9240285

  15. Job satisfaction of occupational physicians in commercial and other delivery settings: a comparative and explorative study.

    PubMed

    Plomp, Harmen Nico; van der Beek, Allard J

    2014-08-01

    Commercialization of occupational health services (OHS) and transition to a supplier market which started in 1995, has affected work and working conditions of occupational physicians (OPs) profoundly. OPs have lost influence on the organization of their work and managers took over control. This study explores the impact of commercialization on job satisfaction of occupational physicians. Data were collected through a questionnaire completed by 797 OPs, members of the Netherlands Association of Occupational Medicine (response: 45%). A range of work satisfiers and dissatisfiers measures was included that, according to the Social Action Approach, could explain the variation in job satisfaction. Stepwise multivariate regression analyses were performed to explore to what extent the differences in job satisfaction can be attributed to the characteristics of the setting, biographical variables, satisfiers and dissatisfiers. Occupational physicians in commercial settings had the lowest average score as regards job satisfaction (6.7) contrasting sharply with their colleagues in private practices (8.7) and in non-commercial settings (7.9). The variation in job satisfaction between delivery settings could largely be attributed to satisfiers and dissatisfiers. Biographical characteristics (age, gender) had no effect. The data suggested that not commercialization as such, but the ability of commercial OHS providers to integrate professional values was the crucial factor to bring about job satisfaction. The challenge for commercial OHS providers is to preserve the professional zeal in OPs by integrating professional values in their organization in order to improve the quality of the services and the attractiveness of the profession.

  16. Medical professional liability risk among US cardiologists.

    PubMed

    Mangalmurti, Sandeep; Seabury, Seth A; Chandra, Amitabh; Lakdawalla, Darius; Oetgen, William J; Jena, Anupam B

    2014-05-01

    Medical professional liability (MPL) remains a significant burden for physicians, in general, and cardiologists, in particular, as recent research has shown that average MPL defense costs are higher in cardiology than other specialties. Knowledge of the clinical characteristics and outcomes of lawsuits against cardiologists may improve quality of care and risk management. We analyzed closed MPL claims of 40,916 physicians and 781 cardiologists insured by a large nationwide insurer for ≥1 policy year between 1991 and 2005. The annual percentage of cardiologists facing an MPL claim was 8.6%, compared with 7.4% among physicians overall (P < .01). Among 530 claims, 72 (13.6%) resulted in an indemnity payment, with a median size of $164,988. Mean defense costs for claims resulting in payment were $83,593 (standard deviation (s.d.) $72,901). The time required to close MPL claims was longer for claims with indemnity payment than claims without (29.6 versus 18.9 months; P < .001). More than half of all claims involved a patient's death (304; 57.4%), were based on inpatient care (379; 71.5%), or involved a primary cardiovascular condition (416; 78.4%). Acute coronary syndrome was the most frequent condition (234; 44.2%). Medical professional liability claims involving noncardiovascular conditions were common (66; 12.5%) and included falls or mechanical injuries had while under a cardiologist's care and a failure to diagnose cancer. Rates of malpractice lawsuits are higher among cardiologists than physicians overall. A substantial portion of claims are noncardiovascular in nature. Copyright © 2014 Mosby, Inc. All rights reserved.

  17. Supply and Characteristics of Selected Health Personnel.

    ERIC Educational Resources Information Center

    Ake, James N.; Johnson, Donald W.

    Detailed statistics on trends in the U.S. supply and geographic distribution of personnel in eight health occupations, along with current data on selected professional characteristics, are presented. Statistical tables include combined data for the eight occupations, and groups of tables for the individual health occupations: physicians (both…

  18. Valuation of Online Continuing Medical Education and Telemedicine in Taiwan

    ERIC Educational Resources Information Center

    Wang, Fuhmei

    2008-01-01

    Physicians have acknowledged information technology (IT) efficiency and now utilize it in their professional practice and patient management. The benefits of IT within the health care environment has received academic attention, however existing literature currently pertains to limited areas, including the financial effects of telemedicine…

  19. Is the Professional Satisfaction of General Internists Associated with Patient Satisfaction?

    PubMed Central

    Haas, Jennifer S; Cook, E Francis; Puopolo, Ann Louise; Burstin, Helen R; Cleary, Paul D; Brennan, Troyen A

    2000-01-01

    BACKGROUND The growth of managed care has raised a number of concerns about patient and physician satisfaction. An association between physicians' professional satisfaction and the satisfaction of their patients could suggest new types of organizational interventions to improve the satisfaction of both. OBJECTIVE To examine the relation between the satisfaction of general internists and their patients. DESIGN Cross-sectional surveys of patients and physicians. SETTING Eleven academically affiliated general internal medicine practices in the greater-Boston area. PARTICIPANTS A random sample of English-speaking and Spanish-speaking patients (n = 2,620) with at least one visit to their physician (n = 166) during the preceding year. MEASUREMENTS Patients' overall satisfaction with their health care, and their satisfaction with their most recent physician visit. MAIN RESULTS After adjustment, the patients of physicians who rated themselves to be very or extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73–3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26–2.21). In addition, younger patients, those with better overall health status, and those cared for by a physician who worked part-time were significantly more likely to report better satisfaction with both measures. Minority patients and those with managed care insurance also reported lower overall satisfaction. CONCLUSIONS The patients of physicians who have higher professional satisfaction may themselves be more satisfied with their care. Further research will need to consider factors that may mediate the relation between patient and physician satisfaction. PMID:10672116

  20. The History of Preconception Care: Evolving Guidelines and Standards

    PubMed Central

    Moos, Merry-K.; Curtis, Michele

    2006-01-01

    This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail. PMID:16710764

  1. Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

    PubMed Central

    Atanasova, Sara; Kamin, Tanja

    2017-01-01

    Background Substantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs. Objective The main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician’s paternalism. Method An email list–based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses. Results The mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=−.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=−.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=−.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=−.17, P=.01). Conclusions Social processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social support in OHCs plays an ambiguous role, often making patients behave in a strategic, uncooperative way toward physicians. PMID:28288953

  2. [The sociological survey of syndrome of professional burnout in physicians of obstetrics department].

    PubMed

    Novgorodova, U R

    2016-01-01

    The syndrome of emotional burnout is a condition of emotional, psychic, physical exhaustion developed as a result of chronic unresolved stress at working place. The development of the given syndrome is specific for altruistic professions where care of people prevails (social workers, physicians, medical nurses, teachers, etc.). In ICD-10 the syndrome of burnout is described under rubric Z.73.0 as “a state of total exhaustion”. Nowadays, physicians and other medical workers found oneself least socially protected in social economic and professional aspects. This is conditioned by low level of salary, significant decreasing of quality of life, increasing of professional responsibility and also by intensification of contradictions between professional and moral duty and possibilities of rendering of medical care to population. The recent studies demonstrate that this condition can be developed in 30-50% of physicians. Also, it is established that age, marital status, had no effect on emotional burnout. The emotional burnout is developing in more degree in females than in males. Also, females are lacking relationship between motivation (satisfaction with remuneration of labor) and development of syndrome in the presence of relationship between significance of work as motivation for activities, satisfaction with professional progression. Those who experience deficiency of autonomy (“super-controlled personalities”) are more subjected to burnout. The study was carried out to determine syndrome of professional burnout in physicians of obstetrics department of large (160 beds) obstetric institution the Yakurskaia municipal clinical hospital with purpose offurther implementation of measures of prevention and correction. The presence of syndrome of burnout effects negatively on both psychophysical general state of particular workers and functioning of medical institution on the whole.

  3. Leadership competencies for medical education and healthcare professions: population-based study

    PubMed Central

    Çitaku, Fadil; Beran, Tanya; Donnon, Tyrone; Hecker, Kent; Cawthorpe, David

    2012-01-01

    Objective To identify and empirically investigate the dimensions of leadership in medical education and healthcare professions. Design A population-based design with a focus group and a survey were used to identify the perceived competencies for effective leadership in medical education. Setting The focus group, consisting of five experts from three countries (Austria n=1; Germany n=2; Switzerland n=2), was conducted (all masters of medical education), and the survey was sent to health professionals from medical schools and teaching hospitals in six countries (Austria, Canada, Germany, Switzerland, the UK and the USA). Participants The participants were educators, physicians, nurses and other health professionals who held academic positions in medical education. A total of 229 completed the survey: 135 (59.0%) women (mean age=50.3 years) and 94 (41.0%) men (mean age=51.0 years). Measures A 63-item survey measuring leadership competencies was developed and administered via electronic mail to participants. Results Exploratory principal component analyses yielded five factors accounting for 51.2% of the variance: (1) social responsibility, (2) innovation, (3) self-management, (4) task management and (5) justice orientation. There were significant differences between physicians and other health professionals on some factors (Wilk's λ=0.93, p<0.01). Social responsibility was rated higher by other health professionals (M=71.09) than by physicians (M=67.12), as was innovation (health professionals M=80.83; physicians M=76.20) and justice orientation (health professionals M=21.27; physicians M=20.46). Conclusions The results of the principal component analyses support the theoretical meaningfulness of these factors, their coherence, internal consistency and parsimony in explaining the variance of the data. Although there are some between-group differences, the competencies appear to be stable and coherent. PMID:22457482

  4. Enhancing the role of nutrition professionals in weight management: A cross sectional survey

    PubMed Central

    Bleich, Sara N.; Bandara, Sachini; Bennett, Wendy; Cooper, Lisa A.; Gudzune, Kimberly A.

    2014-01-01

    Objective 1) To determine the non-physician health profession perceived as best qualified to provide weight management; 2) To examine nutrition professionals’ current practice characteristics and perceived challenges and solutions for obesity care; and 3) To examine the association between nutrition professionals’ quality of training and self-efficacy in weight management. Design and methods We analyzed a 2014 national cross-sectional online survey of 500 U.S. non-physician health professionals (100 from each: nutrition, nursing, behavioral/mental health, exercise, pharmacy). Results Nutrition professionals most commonly self-identified as the most qualified group to help patients lose weight (92%), sentiments supported by other health professionals (57%). The most often cited challenge was lack of patient adherence (87%). Among nutrition professionals, 77% reported receiving high quality training in weight loss counseling. Nutrition professionals who reported high quality training were significantly more likely to report confidence (95% vs. 48%) and success (74% vs. 50%) in helping obese patients lose weight (p<0.05) than those reporting lower quality training. Conclusion Across all non-physician health professionals, nutrition professionals were identified as best suited to provide routine weight management counseling to obese patients. Yet, nutrition professionals’ receipt of high quality weight management training appears critical to their success in helping patients lose weight. PMID:25445319

  5. Hawai'i Island Health Workforce Assessment 2008.

    PubMed

    Withy, Kelley; Andaya, January; Vitousek, Sharon; Sakamoto, David

    2009-12-01

    Anecdotal reports of a doctor shortage on the Big Island have been circulating for years, but a detailed assessment of the health care workforce had not previously been accomplished. The Hawai'i Island Health Workforce Assessment used licensure data, focus groups, telephone follow up to provider offices, national estimates of average provider supply and analysis of insurance claims data to assess the extent of the existing medical and mental health workforce, approximate how many additional providers might be effectively utilized, develop a population-based estimate of future demand and identify causes and potential solutions for the challenges faced. As of February 2008, the researchers were able to locate 310 practicing physicians, 36 nurse practitioners, 6 physician assistants, 51 psychologists, 57 social workers and 42 other mental health providers. Based on national averages, claims analysis and focus groups, the Island could use approximately 45 additional medical professionals to care for the 85% of the population that is medically insured; a larger number to care for the entire population. Ascertaining a complete roster of mental health professionals was not possible using this methodology. The researchers compared the current supply of physicians with the national average of physicians to population and the number of visits to different specialists for the year 2006 and found specific regional shortages of providers. The focus groups concentrated on solutions to the workforce crisis that include the formation of a well-organized, broad collaboration to coordinate recruitment efforts, expand and strengthen retention and renewal activities, and reinvigorate the health profession pipeline and training opportunities. The researchers recommend collaboration between the community, government, business, health center care providers, hospitals and centers to develop a plan before the tenuous state of healthcare on the Big Island worsens. In addition, continued surveillance of the health workforce is vital to tracking the impact of interventions. This could be accomplished through community informants and data collected at the time of professional relicensure to include practice location and practice intensions for future planning estimates.

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

    PubMed

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

    2013-01-01

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

  7. Development of a Canadian deceased donation education program for health professionals: a needs assessment survey.

    PubMed

    Hancock, Jennifer; Shemie, Sam D; Lotherington, Ken; Appleby, Amber; Hall, Richard

    2017-10-01

    The purpose of this survey was to determine how Canadian healthcare professionals perceive their deficiencies and educational requirements related to organ and tissue donation. We surveyed 641 intensive care unit (ICU) physicians, 1,349 ICU nurses, 1,561 emergency room (ER) physicians, and 1,873 ER nurses. The survey was distributed by the national organization for each profession (the Canadian Association of Emergency Physicians, the Canadian Association of Critical Care Nurses, and the National Emergency Nurses Association). Canadian Blood Services developed the critical care physician list in collaboration with the Canadian Critical Care Society. Survey development included questions related to comfort with, and knowledge of, key competencies in organ and tissue donation. Eight hundred thirty-one (15.3%) of a possible 5,424 respondents participated in the survey. Over 50% of respondents rated the following topics as highly important: knowledge of general organ and tissue donation, neurological determination of death, donation after cardiac death, and medical-legal donation issues. High competency comfort levels ranged from 14.7-50.9% for ICU nurses and 8.0-34.6% for ER nurses. Competency comfort levels were higher for ICU physicians (67.5-85.6%) than for ER physicians who rated all competencies lower. Respondents identified a need for a curriculum on national organ donation and preferred e-learning as the method of education. Both ICU nurses and ER practitioners expressed low comfort levels with their competencies regarding organ donation. Intensive care unit physicians had a much higher level of comfort; however, the majority of these respondents were specialty trained and working in academic centres with active donation and transplant programs. A national organ donation curriculum is needed.

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

    PubMed Central

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

    2014-01-01

    Background Mild cognitive impairment (MCI) or mild neurocognitive disorder is a well-established clinical entity included in current diagnostic guidelines for Alzheimer’s disease and in major psychiatric classifications. In all, a loosely defined concern obtained from conceptually different sources (the individual, a knowledgeable informant, or a clinician) regarding a decline in cognition and change in functioning constitutes a sine qua non for initiating diagnostics and providing therapy and support. This concern in practice may translate into complex proactive help-seeking behavior. A better understanding of help-seeking preferences is required in order to promote early detection and management. Objectives To compare help-seeking preferences of family physicians and the lay public in the area of MCI. Methods A structured questionnaire was used to collect data from 197 family physicians (self-administered) and 517 persons aged 45 and over from the lay public (face to face). Information regarding familiarity with MCI and help-seeking preferences was assessed. Results The vast majority in both samples reported that family physician, spouse, and children are the most highly recommended sources of help-seeking. In regard to professional sources of help-seeking, a higher percentage of the physicians than the lay public sample consistently recommended seeking help from nurses and social workers and psychiatrists, but a higher percentage of the lay public recommended turning to a neurologist for help. Discussion There were both similarities and differences between family physicians and the lay public in their preferences regarding help-seeking for a person with MCI. Most prominent is the physicians’ greater tendency to recommend professional sources of help-seeking. Conclusion Understanding of help-seeking preferences of both physicians and lay persons might help overcome barriers for establishing diagnosis, receiving care, and improving communication between doctors and patients. PMID:24748779

  9. Perspective: Teaching and mentoring the history of medicine: an Oslerian perspective.

    PubMed

    Bryan, Charles S; Longo, Lawrence D

    2013-01-01

    Many predict a takeover (seen by some as hostile, and by others as inadvertent) of professional virtues and values by government and capitalism. One source of professional virtues and values consists of lessons from the history of medicine as taught and mentored by Sir William Osler. Some medical schools have required courses in medical history, but proposing a new requirement would probably be a tough sell to most curriculum committees. Osler himself argued against compulsory courses in medical history. The authors propose that exposing medical students to the history of medicine promotes at least two of the seven types of professionalism identified by Hafferty and Castellani. Exposure to the evolution of medical science and to exemplary physicians of bygone eras promotes nostalgic professionalism, which, although in some ways suspect and naïve, fosters a sense of belonging and solidarity as members of a profession, not a trade, whereas exposure to the evolution of medicine as a public service, to the sad history of health care disparities, and to patients' perspectives promotes activist professionalism, fostering a sense of civic responsibility and opposition to excessive commercialism.Steps to promote such exposure include (1) identifying faculty, community physicians, and others interested in the history of medicine, (2) including the history of medicine in faculty development programs, (3) considering a segment in the history of medicine during the introduction to each major course, (4) sponsoring history clubs, and (5) promoting environments favorable for mentor-protégé relationships for faculty and students with further interest.

  10. Americans with Disabilities Act: physician-shareholder practice groups and ADA compliance.

    PubMed

    Odem, Nathan; Blanck, Peter

    2003-02-01

    This article examines the application of Americans with Disabilities Act requirements to professional associations like physician practice groups. In general, employers with 15 or more full-time employees must comply with the Act. However, the definition of an employee is sometimes unclear, especially as applied to business entities commonly used by physician practice groups. A recent case decided by the United States Court of Appeals for the Ninth Circuit held that physician-shareholders of a professional corporation are employees for Americans with Disabilities Act coverage purposes. Analogous cases in other federal circuits have held differently, likening the "owners" of professional corporations to partners in a partnership, who are not considered employees. Similar questions arise for popular business entities, such as Limited Liability Companies and Limited Liability Partnerships. This article discusses the nature of the business forms commonly used by physician practice groups and how their characteristics impact employee status for Americans with Disabilities Act coverage. It then suggests that examination is useful beyond business formation characteristics to the purpose of the Americans with Disabilities Act and other employment antidiscrimination statutes.

  11. [To see oneself in a context--medicine and historia--the two cultures].

    PubMed

    Schiøtz, A

    2000-12-10

    Historians and physicians have different social vantage points and have developed widely different professional cultures. This diversity is a distinct feature of their research, their theoretical approaches, and their scholarly methods. The historian's and the physician's points of view both seem to be necessary parts of medical history. The subject itself as well as the scholars involved may profit from teamwork. The author also asks whether historical knowledge in the field of medicine is useful for today's practitioners. Her answer is yes. Historical insight might contribute to a better understanding of day-to-day problems and the complex structures of which physicians are part. Furthermore, it is suggested that physicians will benefit from insights into why their discipline and their professional position have developed in the ways they have. At its best, historical knowledge can contribute to a deeper understanding of the limitations of medicine, and so may add to physicians' ability to adjust their role in line with the present time. Historical knowledge might even contribute to increased respect for other branches of knowledge and for other people's skills and professional problems.

  12. A professional curriculum vitae will open career doors.

    PubMed

    Harper, D S

    1999-01-01

    In today's challenging healthcare environment, it is essential for nurse practitioners to be able to describe themselves professionally on paper to compete for practice and academic opportunities. Nurse practitioners are competing with physician assistants as well as physicians for primary and acute care positions. A carefully compiled curriculum vitae will present the individual in the best light possible to help open career doors and enhance chances of success. Preparing a curriculum vitae will serve to highlight relevant professional accomplishments, whatever the setting, toward the fulfillment of professional goals. This article reviews the current professional print and electronic literature on preparing a curriculum vitae to assist the nurse practitioner in developing this vital document.

  13. Improving communication on hope in palliative care. A qualitative study of palliative care professionals' metaphors of hope: grip, source, tune, and vision.

    PubMed

    Olsman, Erik; Duggleby, Wendy; Nekolaichuk, Cheryl; Willems, Dick; Gagnon, Judith; Kruizinga, Renske; Leget, Carlo

    2014-11-01

    Hope is important in palliative care. However, palliative care professionals' perspectives on hope are not well understood. Metaphors of hope are a way of better understanding these perspectives. To describe palliative care professionals' perspectives on hope by examining the hope metaphors they spontaneously used to describe their own hope and their perspectives on the hope of patients and their families. Semistructured interviews with palliative care professionals were recorded, transcribed, and analyzed using a narrative approach. Results were discussed until the researchers reached consensus and reinforced by other health-care professionals and by observing several palliative care settings. The 64 participants (mean (SD) age, 48.42 (9.27) years and 72% female) were physicians (41%), nurses (34%), chaplains (20%), or other professionals (5%), working in Canada (19%) or The Netherlands (81%). Participants described the hope of patients, their families, or themselves as a 1) grip, which implied safety; 2) source, which implied strength; 3) tune, which implied harmony; and 4) vision, which implied a positive perspective. Compared with Dutch participants, Canadian participants generally put more emphasis on spirituality and letting go of their own hope as a grip (safety). Compared with other included professionals, physicians used hope as a grip (safety) most often, whereas chaplains used hope as a tune (harmony) most often. Our findings help to increase the understanding of hope and contribute to improving communication skills in palliative care professionals. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  14. [Computers in the consultation: can we stay patient-centered?].

    PubMed

    Lanier, Cédric; Sommer, Johanna; Perron, Noelle Junod

    2015-05-13

    Eletronic health records (EHR) are now part of most medical practices in many countries including Switzerland. Their use facilitates access and exchange of information among health professionals, improves the quality of medical care and decreases the number of medical errors. Even patients express their satisfaction with the use of EHR. However, it has been observed that use of EHR can modify patient-physician communication. The present article describes the different elements linked to EHR which can enhance or inhibit patient-physician communication. It also suggests strategies for improving it.

  15. Physician and nurse supply in Serbia using time-series data

    PubMed Central

    2013-01-01

    Background Unemployment among health professionals in Serbia has risen in the recent past and continues to increase. This highlights the need to understand how to change policies to meet real and projected needs. This study identified variables that were significantly related to physician and nurse employment rates in the public healthcare sector in Serbia from 1961 to 2008 and used these to develop parameters to model physician and nurse supply in the public healthcare sector through to 2015. Methods The relationships among six variables used for planning physician and nurse employment in public healthcare sector in Serbia were identified for two periods: 1961 to 1982 and 1983 to 2008. Those variables included: the annual total national population; gross domestic product adjusted to 1994 prices; inpatient care discharges; outpatient care visits; students enrolled in the first year of medical studies at public universities; and the annual number of graduated physicians. Based on historic trends, physician supply and nurse supply in the public healthcare sector by 2015 (with corresponding 95% confidence level) have been modeled using Autoregressive Integrated Moving Average (ARIMA) / Transfer function (TF) models. Results The ARIMA/TF modeling yielded stable and significant forecasts of physician supply (stationary R2 squared = 0.71) and nurse supply (stationary R2 squared = 0.92) in the public healthcare sector in Serbia through to 2015. The most significant predictors for physician employment were the population and GDP. The supply of nursing staff was, in turn, related to the number of physicians. Physician and nurse rates per 100,000 population increased by 13%. The model predicts a seven-year mismatch between the supply of graduates and vacancies in the public healthcare sector is forecasted at 8,698 physicians - a net surplus. Conclusion The ARIMA model can be used to project trends, especially those that identify significant mismatches between forecasted supply of physicians and vacancies and can be used to guide decision-making for enrollment planning for the medical schools in Serbia. Serbia needs an inter-sectoral strategy for HRH development that is more coherent with healthcare objectives and more accountable in terms of professional mobility. PMID:23773678

  16. Physician and nurse supply in Serbia using time-series data.

    PubMed

    Santric-Milicevic, Milena; Vasic, Vladimir; Marinkovic, Jelena

    2013-06-17

    Unemployment among health professionals in Serbia has risen in the recent past and continues to increase. This highlights the need to understand how to change policies to meet real and projected needs. This study identified variables that were significantly related to physician and nurse employment rates in the public healthcare sector in Serbia from 1961 to 2008 and used these to develop parameters to model physician and nurse supply in the public healthcare sector through to 2015. The relationships among six variables used for planning physician and nurse employment in public healthcare sector in Serbia were identified for two periods: 1961 to 1982 and 1983 to 2008. Those variables included: the annual total national population; gross domestic product adjusted to 1994 prices; inpatient care discharges; outpatient care visits; students enrolled in the first year of medical studies at public universities; and the annual number of graduated physicians. Based on historic trends, physician supply and nurse supply in the public healthcare sector by 2015 (with corresponding 95% confidence level) have been modeled using Autoregressive Integrated Moving Average (ARIMA) / Transfer function (TF) models. The ARIMA/TF modeling yielded stable and significant forecasts of physician supply (stationary R2 squared = 0.71) and nurse supply (stationary R2 squared = 0.92) in the public healthcare sector in Serbia through to 2015. The most significant predictors for physician employment were the population and GDP. The supply of nursing staff was, in turn, related to the number of physicians. Physician and nurse rates per 100,000 population increased by 13%. The model predicts a seven-year mismatch between the supply of graduates and vacancies in the public healthcare sector is forecasted at 8,698 physicians - a net surplus. The ARIMA model can be used to project trends, especially those that identify significant mismatches between forecasted supply of physicians and vacancies and can be used to guide decision-making for enrollment planning for the medical schools in Serbia. Serbia needs an inter-sectoral strategy for HRH development that is more coherent with healthcare objectives and more accountable in terms of professional mobility.

  17. Responding to the professionalism of learners and faculty in orthopaedic surgery.

    PubMed

    Arnold, Louise

    2006-08-01

    Recent developments in assessing professionalism and remediating unprofessional behavior can curtail the inaction that often follows observations of negative as well as positive professionalism of learners and faculty. Developments include: longitudinal assessment models promoting professional behavior, not just penalizing lapses; clarity about the assessment's purpose; methods separating formative from summative assessment; conceptual and behavioral definitions of professionalism; techniques increasing the reliability and validity of quantitative and qualitative approaches to assessment such as 360-degree assessments, performance-based assessments, portfolios, and humanism connoisseurs; and systems-design providing infrastructure support for assessment. Models for remediation have been crafted, including: due process, a warning period and, if necessary, confrontation to initiate remediation of the physician who has acted unprofessionally. Principles for appropriate remediation stress matching the intervention to the cause of the professional lapse. Cognitive behavioral therapy, motivational interviewing, and continuous monitoring linked to behavioral contracts are effective remediation techniques. Mounting and maintaining robust systems for professionalism and remediating professional lapses are not easy tasks. They require a sea change in the fundamental goal of academic health care institutions: medical education must not only be a technical undertaking but also a moral process designed to build and sustain character in all its professional citizens.

  18. Ethics Guide Recommendations for Organ-Donation-Focused Physicians: Endorsed by the Canadian Medical Association.

    PubMed

    Shemie, Sam D; Simpson, Christy; Blackmer, Jeff; MacDonald, Shavaun; Dhanani, Sonny; Torrance, Sylvia; Byrne, Paul

    2017-05-01

    Donation physicians are specialists with expertise in organ and tissue donation and have been recognized internationally as a key contributor to improving organ and tissue donation services. Subsequent to a 2011 Canadian Critical Care Society-Canadian Blood Services consultation, the donation physician role has been gradually implemented in Canada. These professionals are generally intensive care unit physicians with an enhanced focus and expertise in organ/tissue donation. They must manage the dual obligation of caring for dying patients and their families while providing and/or improving organ donation services. In anticipation of actual, potential or perceived ethical challenges with the role, Canadian Blood Services in partnership with the Canadian Medical Association organized the development of an evidence-informed consensus process of donation experts and bioethicists to produce an ethics guide. This guide includes overarching principles and benefits of the DP role, and recommendations in regard to communication with families, role disclosure, consent discussions, interprofessional conflicts, conscientious objection, death determination, donation specific clinical practices in neurological determination of death and donation after circulatory death, end-of-life care, performance metrics, resources and remuneration. Although this report is intended to inform donation physician practices, it is recognized that the recommendations may have applicability to other professionals (eg, physicians in intensive care, emergency medicine, neurology, neurosurgery, pulmonology) who may also participate in the end-of-life care of potential donors in various clinical settings. It is hoped that this guidance will assist practitioners and their sponsoring organizations in preserving their duty of care, protecting the interests of dying patients, and fulfilling best practices for organ and tissue donation.

  19. Developing a modern standard to define and assess professionalism in trainees.

    PubMed

    Schwartz, Ann C; Kotwicki, Raymond J; McDonald, William M

    2009-01-01

    Assessing professionalism in medical education poses many challenges. The authors discuss common themes and principles in managing professionalism in medical education. The authors review the development of standards of professionalism in medical education. They define educational goals for professionalism and also discuss the practical problems with assessing professionalism and addressing it with the trainees. Strategies for remediation of unprofessional conduct are outlined. Given the importance of role models in the development of professional behavior, maintaining an environment that fosters professionalism is an implicit feature of teaching professionalism. Professionalism should be a part of the objectives for each course and clinical rotation, using clearly defined goals and objectives. Assessment of professionalism should begin early and be conducted frequently, giving trainees the opportunity to change. A formal mentoring system can be an effective mechanism to develop role models and teach professionalism. Teaching professionalism through formal curricula is paramount in helping develop new generations of compassionate and responsible physicians. Additional strategies such as consistent role modeling of professional behaviors are also needed to encourage the development of professional physicians.

  20. Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

    PubMed

    Metz, Anneke M

    2017-01-01

    Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating from medical school, choosing primary care specialties, and working in medically underserved areas. MEDPREP may therefore serve as a model for increasing physician diversity and addressing the needs of medically underserved communities.

  1. Trends in Primary Care Provision to Medicare Beneficiaries by Physicians, Nurse Practitioners, or Physician Assistants: 2008-2014

    PubMed Central

    Xue, Ying; Goodwin, James S.; Adhikari, Deepak; Raji, Mukaila A.; Kuo, Yong-Fang

    2017-01-01

    Objectives: To document the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examine the role of these models in serving elders with multiple chronic conditions and those residing in rural and health professional shortage areas (HPSAs). Design: Serial cross-sectional analysis of Medicare claims data for years 2008, 2011, and 2014. Setting: Primary care outpatient setting. Participants: Medicare fee-for-service beneficiaries who had at least 1 primary care office visit in each study year. The sample size is 2 471 498. Measurements: Physician model—Medicare beneficiary’s primary care office visits in a year were conducted exclusively by physicians; shared care model—conducted by a group of professionals that included physicians and either NPs or PAs or both; NP/PA model: conducted either by NPs or PAs or both. Results: There was a decrease in the physician model (85.5% to 70.9%) and an increase in the shared care model (11.9% to 23.3%) and NP/PA model (2.7% to 5.9%) from 2008 to 2014. Compared with the physician model, the adjusted odds ratio (AOR) of receiving NP/PA care was 3.97 (95% CI 3.80-4.14) in rural and 1.26 (95% CI 1.23-1.29) in HPSAs; and the AOR of receiving shared care was 1.66 (95% CI 1.61-1.72) and 1.14 (95% CI 1.13-1.15), respectively. Beneficiaries with 3 or more chronic conditions were most likely to received shared care (AOR = 1.67, 95% CI 1.65-1.70). Conclusion: The increase in shared care practice signifies a shift toward bolstering capacity of the primary care delivery system to serve elderly populations with growing chronic disease burden and to improve access to care in rural and HPSAs. PMID:29047322

  2. Ethics, Cultural Competence, and the Changing Face of America

    PubMed Central

    Chilton, Janice A.

    2012-01-01

    The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation’s examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine—Anne Fadiman’s The Spirit Catches You And You Fall Down. PMID:23794754

  3. 42 CFR 405.2414 - Nurse practitioner, physician assistant, and certified nurse midwife services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Nurse practitioner, physician assistant, and... practitioner, physician assistant, and certified nurse midwife services. (a) Professional services are payable..., physician assistant, or certified nurse midwife who is employed by, or receives compensation from, the RHC...

  4. Defining and assessing professional competence.

    PubMed

    Epstein, Ronald M; Hundert, Edward M

    2002-01-09

    Current assessment formats for physicians and trainees reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice, including interpersonal skills, lifelong learning, professionalism, and integration of core knowledge into clinical practice. To propose a definition of professional competence, to review current means for assessing it, and to suggest new approaches to assessment. We searched the MEDLINE database from 1966 to 2001 and reference lists of relevant articles for English-language studies of reliability or validity of measures of competence of physicians, medical students, and residents. We excluded articles of a purely descriptive nature, duplicate reports, reviews, and opinions and position statements, which yielded 195 relevant citations. Data were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion were broad, given the heterogeneity of interventions, complexity of outcome measures, and paucity of randomized or longitudinal study designs. We generated an inclusive definition of competence: the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served. Aside from protecting the public and limiting access to advanced training, assessments should foster habits of learning and self-reflection and drive institutional change. Subjective, multiple-choice, and standardized patient assessments, although reliable, underemphasize important domains of professional competence: integration of knowledge and skills, context of care, information management, teamwork, health systems, and patient-physician relationships. Few assessments observe trainees in real-life situations, incorporate the perspectives of peers and patients, or use measures that predict clinical outcomes. In addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork promise a multidimensional assessment while maintaining adequate reliability and validity. Institutional support, reflection, and mentoring must accompany the development of assessment programs.

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

    PubMed

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

    2004-09-01

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

  6. Professional oversight of physician expert witnesses: an analysis of complaints to the Professional Conduct Committee of the American Association of Neurological Surgeons, 1992-2006.

    PubMed

    Kesselheim, Aaron S; Studdert, David M

    2009-01-01

    To investigate the role of the professional conduct review program that is operated by the American Association of Neurological Surgeons (AANS). The program adjudicates complaints against AANS members for their work as expert witnesses in medical malpractice litigation. Policymakers worry that physician expert witnesses who espouse unfounded views in malpractice cases may fuel inappropriate litigation. A growing number of professional societies have sought to oversee their members' work as expert witnesses by instituting standards to regulate this conduct and enforcing those standards through formal disciplinary procedures. The AANS runs the longest-established and busiest program of this kind in the country. Plaintiffs' lawyers and consumer advocates have questioned the even-handedness of this form of self-regulation. We reviewed the confidential case summaries of all 59 complaints involving charges of inappropriate expert witness testimony adjudicated by the AANS Professional Conduct Committee from 1992 to 2006. We developed descriptive categories for the characteristics of the complainant and respondent, the types of misconduct alleged, and the outcomes of the review, including penalties imposed. The most common type of allegation was presentation of testimony that misrepresented the standard of care. Nineteen complaints (32%) were dismissed, but 40 (68%) resulted in sanctions ranging from censure to expulsion from membership. Both the frequency of complaints and length of sanctions have increased in the last 4 years. Although the AANS is highly attentive to procedural fairness, the overwhelming majority (57/59, 97%) of complaints related to testimony from witnesses acting for plaintiffs. Professional organizations may play a useful role in oversight of expert witness conduct, provided they maintain procedural fairness and strive for impartiality, as the AANS program seems to have done. However, from a policy perspective, this form of oversight is incomplete and should be complemented by other mechanisms aimed at ensuring the quality of physician testimony.

  7. Unfolding similarity in interphysician networks: the impact of institutional and professional homophily.

    PubMed

    Mascia, Daniele; Di Vincenzo, Fausto; Iacopino, Valentina; Fantini, Maria Pia; Cicchetti, Americo

    2015-03-10

    Modern healthcare is characterized by high complexity due to the proliferation of specialties, professional roles, and priorities within organizations. To perform clinical interventions, knowledge distributed across units, directorates and individuals needs to be integrated. Formal and/or informal mechanisms may be used to coordinate knowledge and tasks within organizations. Although the literature has recently considered the role of physicians' professional networks in the diffusion of knowledge, several concerns remain about the mechanisms through which these networks emerge within healthcare organizations. The aim of the present paper is to explore the impact of institutional and professional homophilies on the formation of interphysician professional networks. We collected data on a community of around 300 physicians working at a local health authority within the Italian National Health Service. We employed multiple regression quadratic assignment procedures to explore the extent to which institutional and professional homophilies influence the formation of interphysician networks. We found that both institutional and professional homophilies matter in explaining interphysician networks. Physicians who had similar fields of interest or belonged to the same organizational structure were more likely to establish professional relationships. In addition, professional homophily was more relevant than institutional affiliation in explaining collaborative ties. Our findings have organizational implications and provide useful information for managers who are responsible for undertaking organizational restructuring. Healthcare executives and administrators may want to consider the structure of advice networks while adopting new organizational structures.

  8. Interweaving Objects, Gestures, and Talk in Context

    ERIC Educational Resources Information Center

    Brassac, Christian; Fixmer, Pierre; Mondada, Lorenza; Vinck, Dominique

    2008-01-01

    In a large French hospital, a group of professional experts (including physicians and software engineers) are working on the computerization of a blood-transfusion traceability device. By focusing on a particular moment in this slow process of design, we analyze their collaborative practices during a work session. The analysis takes a…

  9. A Statewide System To Track Medical Students' Careers: The Pennsylvania Model.

    ERIC Educational Resources Information Center

    Rabinowitz, Howard K.; Veloski, J. Jon; Aber, Robert C.; Adler, Sheldon; Ferretti, Sylvia M.; Kelliher, Gerald J.; Mochen, Eugene; Morrison, Gail; Rattner, Susan L.; Sterling, Gerald; Robeson, Mary R.; Hojat, Mohammadreza; Xu, Gang

    1999-01-01

    Pennsylvania developed a generalist physician initiative, inspired by that of the Robert Wood Johnson Foundation, initiating a longitudinal tracking system at six allopathic and two osteopathic medical schools to follow students from matriculation into professional careers. The statewide database includes information on over 18,000 students,…

  10. The Harvard Medical School Guide to Suicide Assessment and Intervention. First Edition.

    ERIC Educational Resources Information Center

    Jacobs, Douglas G., Ed.

    Written by several experts, this multidimensional compendium of current research and thought provides a hands-on guide for psychiatrists, psychotherapists, primary care physicians, counselors, and other professionals faced with the need to assess risk and relate to potentially suicidal clients. Part 1, "Assessment," includes two…

  11. Physician recruitment and retention in Manitoba: results from a survey of physicians' preferences for rural jobs.

    PubMed

    Witt, Julia

    2017-01-01

    Rural recruitment and retention continues to present challenges to health workforce planners. This paper reports and analyzes the results of a survey sent to physicians in Manitoba, eliciting their opinions regarding rural jobs. A survey was sent to all physicians in Manitoba. Part 1 of the survey included questions about background and demographic information; part 2 was a set of job satisfaction questions regarding respondents' current job; and part 3 included 2 sets of stated-choice questions eliciting preferences for a set of attributes relevant to rural recruitment and retention. Of the 2487 physicians who received surveys, 561 (22.6%) responded. Respondents indicated that income, hours worked and on-call frequency are very important: overall job satisfaction increased with income and decreased with hours worked. Income, hours and on-call frequency were ranked "very important" by the largest proportions of physicians. The estimated compensation for on-call more frequent than 1-in-4 was very high (82% of average income), and additional hours worked were worth $183 per hour. Other attributes that were important included professional interaction, housing availability and community incentives during the first year, which were valued at 11%-31% of annual income. Work-life balance is a key consideration for rural jobs, and there are incentives that can compensate for less desirable attributes.

  12. Effect of colleague and coworker abuse on family physicians in Canada.

    PubMed

    Miedema, Baukje; Tatemichi, Sue; Hamilton, Ryan; Lambert-Lanning, Anita; Lemire, Francine; Manca, Donna P; Ramsden, Vivian R

    2011-12-01

    To assess the effects of physician-colleague and coworker abuse on family physicians in Canada. A mixed-methods, bilingual study that included surveys and telephone interviews. Canada. Family physicians in active practice who were members of the College of Family Physicians of Canada in 2009. Surveys were mailed to a random sample of family physicians (N = 3802), and 37 family physicians who had been abused in the past year participated in telephone interviews. A total of 770 surveys (20%) were completed. A small number of respondents reported having been subjected to abuse by physician colleagues (9%) or coworkers (6%) in the previous month. Many of the respondents reported that the same physician colleagues or coworkers were repeat abusers. More than three-quarters (77%) of the physician-colleague abusers were men, whereas more than three-quarters (77%) of the other coworker abusers were women. Interviewed family physicians described feeling humiliated and unappreciated, and developed symptoms of anxiety or depression. As a result of the abuse, some family physicians terminated their employment or refused to work in certain environments. The most striking effect of this abuse was that respondents reported losing confidence in their professional abilities and skills. Although only a small number of family physicians experience abuse by physician colleagues and other coworkers, the effects can be considerable. Victims reported a loss of confidence in their clinical abilities and some subsequently were faced with mental health issues.

  13. Legal and ethical implications in the evaluation and management of sports-related concussion.

    PubMed

    Kirschen, Matthew P; Tsou, Amy; Nelson, Sarah Bird; Russell, James A; Larriviere, Daniel

    2014-07-22

    To examine the ethical and legal issues physicians face when evaluating and managing athletes with sports-related concussions, and to offer guidance to physicians as they navigate these situations. This position paper reviews and compares the components of sports-related concussion laws, including education, removal from play, and clearance for return to play. It highlights the challenges privacy laws present relevant to providing care to concussed athletes and suggests ways to help physicians overcome these obstacles. The report also explores the ethical considerations physicians should bear in mind as they evaluate and manage concussed athletes, addressing them through a framework that includes considerations of professionalism, informed decision-making, patient autonomy, beneficence, nonmaleficence, conflicts of interest, and distributive justice. Physicians caring for concussed athletes have an ethical obligation to ensure that their primary responsibility is to safeguard the current and future physical and mental health of their patients. Physicians have a duty to provide athletes and their parents with information about concussion risk factors, symptoms, and the risks for postconcussion neurologic impairments. Physicians should facilitate informed and shared decision-making among athletes, parents, and medical teams while protecting athletes from potential harm. Additionally, including concussion evaluation and management training in neurology residency programs, as well as developing a national concussion registry, will benefit patients by the development of policies and clinical guidelines that optimize prevention and treatment of concussive head injury. © 2014 American Academy of Neurology.

  14. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education).

    PubMed

    Holden, Mark D; Buck, Era; Luk, John; Ambriz, Frank; Boisaubin, Eugene V; Clark, Mark A; Mihalic, Angela P; Sadler, John Z; Sapire, Kenneth J; Spike, Jeffrey P; Vince, Alan; Dalrymple, John L

    2015-06-01

    The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.

  15. Essential learning tools for continuing medical education for physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows: the Midwest Reproductive Symposium International.

    PubMed

    Collins, Gretchen G; Jeelani, Roohi; Beltsos, Angeline; Kearns, William G

    2018-04-01

    Essential learning tools for continuing medical education are a challenge in today's rapidly evolving field of reproductive medicine. The Midwest Reproductive Symposium International (MRSi) is a yearly conference held in Chicago, IL. The conference is targeted toward physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows engaged in the practice of reproductive medicine. In addition to the scientific conference agenda, there are specific sessions for nurses, mental health professionals, and REI fellows. Unique to the MRSi conference, there is also a separate "Business Minds" session to provide education on business acumen as it is an important element to running a department, division, or private clinic.

  16. Attitudes, Knowledge, Use, and Recommendation of Complementary and Alternative Medicine by Health Professionals in Western Mexico.

    PubMed

    Brambila-Tapia, Aniel Jessica Leticia; Rios-Gonzalez, Blanca Estela; Lopez-Barragan, Liliana; Saldaña-Cruz, Ana Miriam; Rodriguez-Vazquez, Katya

    2016-01-01

    The use of complementary and alternative medicine (CAM) has increased in many countries, and this has altered the knowledge, attitudes, and treatment recommendations of health professionals in regard to CAM. Considering Mexican health professionals׳ lack of knowledge of CAM, in this report we surveyed 100 biomedical researchers and Ph.D. students and 107 specialized physicians and residents of a medical specialty in Guadalajara, México (Western Mexico) with a questionnaire to address their attitudes, knowledge, use, and recommendation of CAM. We observed that significantly more researchers had ever used CAM than physicians (83% vs. 69.2%, P = .023) and that only 36.4% of physicians had ever recommended CAM. Female researchers tended to have ever used CAM more than male researchers, but CAM use did not differ between genders in the physician group or by age in either group. Homeopathy, herbal medicine, and massage therapy were the most commonly used CAMs in both the groups. Physicians more frequently recommended homeopathy, massage therapy, and yoga to their patients than other forms of CAM, and physicians had the highest perception of safety and had taken the most courses in homeopathy. All CAMs were perceived to have high efficacy (>60%) in both the groups. The attitude questionnaire reported favorable attitudes toward CAM in both the groups. We observed a high rate of Mexican health professionals that had ever used CAM, and they had mainly used homeopathy, massage therapy, and herbal medicine. However, the recommendation rate of CAM by Mexican physicians was significantly lower than that in other countries, which is probably due to the lack of CAM training in most Mexican medical schools. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Demands, values, and burnout

    PubMed Central

    Leiter, Michael P.; Frank, Erica; Matheson, Timothy J.

    2009-01-01

    OBJECTIVE T o explore the interaction between workload and values congruence (personal values with health care system values) in the context of burnout and physician engagement and to explore the relative importance of these factors by sex, given the distinct work patterns of male and female physicians. DESIGN National mailed survey. SETTING Canada. PARTICIPANTS A random sample of 8100 Canadian physicians (response rate 40%, N = 3213); 2536 responses (from physicians working more than 35 hours per week) were analyzed. MAIN OUTCOME MEASURES Levels of burnout, values congruence, and workload, by sex, measured by the Maslach Burnout Inventory—General Scale and the Areas of Worklife Scale. RESULTS Results showed a moderate level of burnout among Canadian physicians, with relatively positive scores on exhaustion, average scores on cynicism, and mildly negative scores on professional efficacy. A series of multiple regression analyses confirmed parallel main effect contributions from manageable workload and values congruence. Both workload and values congruence predicted exhaustion and cynicism for men and women (P = .001). Only values congruence provided a significant prediction of professional efficacy for both men and women (P = .001) These predictors interacted for women on all 3 aspects of burnout (exhaustion, cynicism, and diminished efficacy). Howevever, overall levels of the burnout indicators departed only modestly from normative levels. CONCLUSION W orkload and values congruence make distinct contributions to physician burnout. Work overload contributes to predicting exhaustion and cynicism; professional values crises contribute to predicting exhaustion, cynicism, and low professional efficacy. The interaction of values and workload for women in particular has implications for the distinct work-life patterns of male and female physicians. Specifically, the congruence of individual values with values inherent in the health care system appeared to be of greater consequence for women than for men. PMID:20008605

  18. Assessment of healthcare professionals' knowledge about warfarin-vitamin K drug-nutrient interactions.

    PubMed

    Couris, R R; Tataronis, G R; Dallal, G E; Blumberg, J B; Dwyer, J T

    2000-08-01

    Dietary vitamin K can interact with oral anticoagulant drugs and interfere with their therapeutic safety and efficacy. Therefore, knowledge about drug-nutrient interactions involving vitamin K possessed by physicians, pharmacists, dietitians and nurses practicing anticoagulant therapy was assessed. Healthcare practitioners were surveyed using a 30-question, 98-item questionnaire on the most common and/or important food interactions with warfarin, drug interactions with warfarin and general drug-nutrient interactions involving vitamin K. The study sample included 160 randomly selected healthcare providers (40 physicians, pharmacists, dietitians and nurses) from 10 hospitals with 200 to 1000 beds from six Massachusetts regions. Random selection was conducted from a pool of selected healthcare providers practicing anticoagulant therapy who counsel patients receiving warfarin. All surveys were completed within three months of the start of the study, and all participants provided usable data for statistical analysis. The mean scores (+/- SD) on the overall test were 72.5+/-9.0 for pharmacists, 62.51+/-10.6 for physicians, 56.9+/-8.8 for dietitians and 50.2+/-9.3 for nurses, with 100 being a perfect score. Pharmacists scored significantly higher in the area of drug interactions (75.9+/-11.3, p<0.05). Dietitians scored higher in the area of food interactions (73.0+/-10.3). No significant differences between physicians and pharmacists were evident on general drug-nutrient interactions. While over 87% of the healthcare professionals correctly identified some common foods containing large amounts of vitamin K, such as broccoli and spinach, fewer than 25% were able to identify others such as pea soup, coleslaw and dill pickles. Although the healthcare professionals surveyed in this study appear to have demonstrated some proficiency in their respective areas of expertise, they exhibited less knowledge in others. Therefore, additional training and integration of knowledge and expertise about drug-nutrient interactions among healthcare professionals are essential to provide appropriate patient counseling and optimal therapeutic outcomes.

  19. Are Physicians Obliged to Lead Environmental Sustainability Efforts in Health Care Organizations?

    PubMed

    Macpherson, Cheryl C; Hill, Jonathan

    2017-12-01

    Climate change threatens health, health care, and the industries and resources upon which these depend. The growing prevalence and severity of its health consequences and economic costs are alarming health professionals and organizations as their professional obligations, grounded in the core value of health, include protecting against these harms. One means of fulfilling these obligations is to lead or support sustainability initiatives that are built upon current, reliable, accurate, and unbiased evidence and collaboratively tailored to meet specific needs and respond to specific contexts. We consider why and how health professionals and organizations should lead or support such initiatives. © 2017 American Medical Association. All Rights Reserved.

  20. The career trajectories of health care professionals practicing with permanent disabilities.

    PubMed

    Neal-Boylan, Leslie; Hopkins, Amy; Skeete, Rachel; Hartmann, Sarah B; Iezzoni, Lisa I; Nunez-Smith, Marcella

    2012-02-01

    The authors sought to generate insights and hypotheses about the professional experiences of registered nurses and physicians with self-identified disabilities to inform local and national policy conversations on supporting a diverse health care workforce. In 2009-2010, the authors conducted in-depth interviews in person and over the telephone with a sample of licensed registered nurses and physicians across the country who self-identified as having a permanent disability. They coded the interview transcripts to identify key themes across the participants' responses. The authors interviewed 10 registered nurses and 10 physicians. Five novel and consistent themes emerged from the data analysis: (1) Living and working with a physical/sensory disability narrows the career choices and trajectories of nurses and physicians, (2) nurses and physicians struggle with decisions regarding whether to disclose and discuss their disabilities at work, (3) nurses and physicians rarely seek legally guaranteed workplace accommodations, instead viewing patient safety as a personal responsibility, (4) interpersonal interactions often reflect the institutional climate and set the tone for how welcome nurses and physicians feel at work, and (5) reactions to workplace disability-related challenges run an emotional spectrum from anger and grief to resilience and optimism. The responses revealed several missed opportunities for supporting health care professionals with disabilities in the workplace. These findings should inform the continuing debate regarding what defines "reasonable accommodation" and how to create a workplace that is welcoming for nurses and physicians with disabilities.

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