Patient perceptions of emergency physicians: the gender gap still exists

This study examines whether female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians. A convenience sample of adult patients seen while a trained observer was on duty in an academic Emergency Department constituted the study population. After the first physician contact, the observer asked the patient if a physician had seen the patient yet. The observer recorded the physician’s sex, the patient’s response, sex, age, and race. The frequencies that male and female physicians were recognized as physicians were compared. For the 184 physician-patient contacts evaluated, 98/105 (93.3%) of males were recognized as physicians and 62/79 (78.5%) of females were recognized as physicians. Females were significantly less likely than males to be recognized as physicians (chi-square, p = 0.003). Female emergency physicians are less likely than male emergency physicians to be recognized by patients as physicians.     

The Role of Dual-trained Conventional/Complementary Physicians as Mediators of Integration in Primary Care

A growing number of physicians study complementary and alternative medicine (CAM). Limited data are available on perspectives of physicians with dual training in conventional medicine and CAM, on issues of communication and collaboration with CAM practitioners (CAMPs). Questionnaires were administered to primary care physicians employed in the largest health maintenance organization (HMO) in Israel and to MD and non-MD CAM practitioners employed by a CAM-related agency of the same HMO. Data for statistical analysis were available from 333 primary care physicians (PCPs) and 241 CAM practitioners. Thirty-one of the 241 CAMPs were dual-trained physicians employed in a CAM-related agency as practitioners and/or triage-consultants. Dual trained physicians and CAMPs shared similar attitudes and supported, more so than PCPs, collaborative physician-CAM practitioner teamwork in clinical practice, medical education and research. Nevertheless, dual trained physicians supported a physician-dominant teamwork model (similar to the PCPs' approach) in contrast to non-MD CAM practitioners who mainly supported a co-directed teamwork model. Compared to PCPs and non-MD CAM practitioners, dual trained physicians supported significantly more a medical/referral letter as the preferred means of doctor-CAM practitioner communication. Dual trained physicians have a unique outlook toward CAM integration and physician-practitioner collaboration, compared to non-MD CAM practitioners and PCPs. More studies are warranted to explore the role of dual trained physicians as mediators of integration.     

Physician's role in home care for children with cancer.

We interviewed 29 physicians who had participated to varying degrees in a home care program for children dying of cancer. All physicians stated that they would use home care again and saw such care as an integral part of their practice. Most physicians felt that home care provides psychological advantages to the family; they viewed assessment of the family's needs by the home care nurses an important factor of home care treatment. Some physicians expressed concern of the nurse's assuming too much responsibility or failing to report significant changes observed in the patient, particularly observations of the side effects of medication. Divergent philosophies of physicians and nurses regarding side effects were seen by some physicians as a potential source of confusion and anxiety for families. The legal ramifications of home care were discussed by only a few physicians; the consensus of opinion among the physicians was that close contact among physician, family, and nurse would assure the absence of legal problems.     

Physician's role in home care for children with cancer

We interviewed 29 physicians who had participated to varying degrees in a home care program for children dying of cancer. All physicians stated that they would use home care again and saw such care as an integral part of their practice. Most physicians felt that home care provides psychological advantages to the family; they viewed assessment of the family's needs by the home care nurses an important factor of home care treatment. Some physicians expressed concern of the nurse's assuming too much responsibility or failing to report significant changes observed in the patient, particularly observations of the side effects of medication. Divergent philosophies of physicians and nurses regarding side effects were seen by some physicians as a potential source of confusion and anxiety for families. The legal ramifications of home care were discussed by only a few physicians; the consensus of opinion among the physicians was that close contact among physician, family, and nurse would assure the absence of legal problems     

Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC)

The number of patients with acquired immunodeficiency syndrome (AIDS) continues to increase. These patients require medical care from physicians who are well trained and who are willing to provide that care. In 1985, we undertook a survey of 314 heterosexual and homosexual physicians in Los Angeles County to determine their willingness and perceived ability to care for patients with AIDS. This survey indicates that most physicians believe that special clinics staffed by physicians who have a particular expertise in caring for AIDS patients should be established. Many of the physicians surveyed indicated that concerns about the risk of contagion with AIDS is a deterrent to treating AIDS patients. Current evidence indicates this concern is unfounded. Both heterosexual and homosexual physicians indicated a lack of medical knowledge and experience regarding the opportunistic infections and cancers that are associated with AIDS, although many physicians in both groups expressed a desire to receive more training in this regard. Our survey indicates that there is a definite need for more clinically based training opportunities for physicians who would like to provide care for AIDS patients. If such training were to become available, it is likely that sufficient numbers of physicians would be willing to care for AIDS patients.     

Empowered patient or empowered physician: an analysis of the importance of the empowered patient in the health delivery system

This paper develops a simple theoretical model which compares resource allocation in the health care system when physicians are empowered with the decisions taken when patients are empowered. We show that even when there is no asymmetry of information, the institutional arrangement (empowered patient or empowered physician) matter. Ceteris paribus, we find that patients demand more time with physicians when they are empowered (relative to the situation when physicians are empowered), whereas physicians want to spend more time developing their expertise when they are empowered. The reaction of physicians and patients to changes in policy instruments also differs across institutional arrangements. The analysis draws attention to the design of the compensation scheme for physicians, and shows that a non-linear scheme is generally optimal for access to resources if physicians are empowered.     

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

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

Malpractice occurrence in emergency medicine: does residency training make a difference?

We evaluated the effects of Emergency Medicine (EM) residency training, EM board certification, and physician experience on the occurrence of malpractice claims and indemnity payments. This was a retrospective review of closed malpractice claims from a single insurer. Outcome measures included the occurrence of claims resulting in indemnity, indemnity amounts, and defense costs. Differences in the outcome measures were compared based on: EM residency training, EM board certification, EM residency training versus other residency training, and physician experience using both univariate and multivariate analyses. There were 428 closed EM claims with indemnity paid in 81 (18.9%). Indemnity was paid in 22. 4% of closed claims against non-EM residency-trained physicians, and in only 13.3% against EM residency-trained physicians (p = 0.04). The total indemnity was $6,214,475. Non-EM trained physicians accounted for $4,440,951 (71.5%), EM residency-trained physicians accounted for $1,773,524 (28.5%). The average indemnity was $76,721 and the average defense cost was $17,775. There were no significant differences in the mean indemnity paid per closed claim or the mean cost to defend a closed claim when comparing EM-trained and non-EM residency-trained physicians. The total cost (indemnity + defense costs) per physician-year of malpractice coverage was $4,905 for non-EM residency-trained physicians and $2,212 for EM residency-trained physicians. EM residency-trained physicians account for significantly less malpractice indemnity than non-EM residency-trained physicians. This difference is not due to differences in the average indemnity but is due to significantly fewer closed claims against EM residency-trained physicians with indemnity paid. This results in a cost per physician-year of malpractice coverage for non-EM residency-trained physicians that is over twice that of EM residency-trained physicians.     

The dogma of identifying occult bacterial infections in young febrile children: a survey of primary-care physicians

Management of undifferentiated febrile illness in young children continues to be a controversial issue among primary-care physicians. A self-administered questionnaire was mailed to 600 randomly selected physicians regarding their management of children with high fever and no focus of infection at various ages: 3 weeks, 7 weeks, 4 months and 20 months. Completed questionnaires were returned by 419 (70%) physicians. Nearly 77% of physicians would hospitalize a 3-week old infant with fever and 70% would treat these infants empirically with antibiotics. Sixty-one per cent of physicians would hospitalize a 7-week-old infant with fever and 46% would treat empirically with antibiotics. Approximately 80% and 93% of physicians, respectively, would not hospitalize 4- and 20-month-old infants with high fever and no focus of infection, but 72% and 59%, respectively, would treat such infants with antibiotics. There was considerable variation in the way physicians managed young febrile children with no focus of infection and the clinical approach of some physicians was remarkably different from current knowledge and recommendations.     

Physician's role in home care for children with cancer

Abstract

We interviewed 29 physicians who had participated to varying degrees in a home care program for children dying of cancer. All physicians stated that they would use home care again and saw such care as an integral part of their practice. Most physicians felt that home care provides psychological advantages to the family; they viewed assessment of the family's needs by the home care nurses an important factor of home care treatment. Some physicians expressed concern of the nurse's assuming too much responsibility or failing to report significant changes observed in the patient, particularly observations of the side effects of medication. Divergent philosophies of physicians and nurses regarding side effects were seen by some physicians as a potential source of confusion and anxiety for families. The legal ramifications of home care were discussed by only a few physicians; the consensus of opinion among the physicians was that close contact among physician, family, and nurse would assure the absence of legal problems     

The importance of foreign-trained physicians to Canada

PURPOSE: To examine the proportion of Canada's physicians who are foreign-trained (non-Canada, non-US), and to determine if there was a relationship between this number and the net change in physicians of each province as affected by inter-provincial migration. METHODS: Data were obtained from the Canadian Medical Association, based on information contained within the Southam Medical Database of the Canadian Institute for Health Information (1987-2003). Information on the net change in the number of physicians lost or gained due to inter-provincial migration was obtained for each province, as well as the percentage of physicians that are foreign-trained (non-Canada, non-US). A correlation between the net change in physician supply and the proportion of foreign-trained physicians was explored. RESULTS: Foreign-trained physicians comprised from 19% (Prince Edward Island) to 55% (Saskatchewan) of the provincial physician supply. There was a strong linear correlation between the net change in physician supply due to inter-provincial migration and the proportion of foreign-trained physicians (r2 0.546; P=0.0146). DISCUSSION: Canada continued to rely heavily on foreign-trained physicians. This was particularly true for provinces which lost the greatest number of physicians to inter-provincial migration. Such 'poaching' of physicians may have important ramifications for the source countries.     

Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians

BACKGROUND: Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients. OBJECTIVES: To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians. METHODS: A longitudinal, practice-based observational study was undertaken in 14 general practice and 51 DC community-based clinics. A total of 2945 consecutive patients with ambulatory low back pain of mechanical origin were enrolled; 835 patients were in the chronic subgroup. Patients were followed for 12 months. Data were obtained on all of the following: patient demographics, health status, and psychosocial characteristics; history, duration, and severity of low back pain and disability; physicians' practice activities; and low back complaint status at 1 year. RESULTS: Patients treated by MD physicians were younger and had lower incomes; their care was more often paid for by a third party; their baseline pain and disability were slightly greater. In addition, patients treated by MD physicians had one fourth as many visits as patients treated by DC physicians. Utilization of imaging procedures by enrolling physicians was equivalent for the two provider groups. Medications were prescribed for 80% of the patients enrolled by MD physicians; spinal manipulation was administered to 84% of patients enrolled by DC physicians. Physical modalities, self-care education, exercise, and postural advice characterized low back pain management in both provider groups. Patients' care-seeking was not exclusive to one provider type. Most patients experienced recurrences (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%); 34.1% of patients treated by MD physicians and 12.7% of patients treated by DC physicians reported 12 months of continuous pain. Only 6.7% of patients treated by MD physicians and 10.9% of patients treated by DC physicians reported 1 resolved episode during the year. CONCLUSIONS: Differences in sociodemographics, present pain intensity, and functional disability may distinguish patients with chronic low back pain seeking care from primary care medical physicians from those seeking care from DC physicians. Although the primary treatment modality differs, the practice activities of MD physicians and DC physicians have much in common. Long-term evaluation suggests that chronic back pain is persistent and difficult to treat for both provider types.     

Herbal medicines: predictors of recommendation by physicians

BACKGROUND: We hypothesized that as the use of herbal medicines increases in the general population, so do patients' requests to physicians for recommendations. However, why some physicians recommend herbal medicines while others do not is not well understood. OBJECTIVE: To identify factors, which predict recommendation of herbal medicines by physicians. DESIGN, LOCATION, SUBJECTS: Face-to-face interview using a structured questionnaire of 206 physicians working at the University of Malaya Medical Centre, Malaysia. RESULTS: About a third (206 of 626) of the physicians in the Centre participated. Only nine of the 215 approached refused to participate. Forty physicians (19%) recommended herbal medicines to patients. Logistic regression modelling identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of physicians recommending herbal medicines. CONCLUSIONS: Physicians' personal attributes and training influence their likelihood of recommending herbal medicines.     

本科毕业护士与医生合作态度的调查分析

目的 调查某三甲医院住院部本科毕业护士与医生的合作态度,分析二者差异,为营造良好的医护合作氛围提供参考依据.方法 采用Jefferson医护合作态度量表对某三甲医院住院部96名护理本科毕业护士及52名医生进行现场调查.结果 本科毕业护士与住院医生的医护合作态度得分均较高,医护合作态度积极.本科毕业护士在条目“医护之间有很多重叠的职责”得分低于医生,差异有统计学意义;在“医生的权利”维度,护士得分较高,差异有统计学意义;2组在“医疗与护理工作内容”及“护士的自主权”总分上表现出较高一致性.结论 护士和医生之间的医护合作态度总体是积极的,多数护士认为医护工作中有很多的职责是共同的,但是彼此在工作中的沟通还不够理想.可通过医护整体查房、病案讨论等方式增加医护间沟通,加强医护人员团队合作精神,营造良好的医护合作氛围.     

Social Security disability determinations. Knowledge and attitudes of consultative physicians

Social Security spends $135 million yearly, contracting with physicians to provide consultative examinations for disability applicants. However, little is known about who these physicians are or how they view the determination of impairment. We surveyed a random sample of 153 physicians from North Carolina who performed consultative examinations for the North Carolina Disability Determinations Agency in 1983 (the consultative group), and a randomly selected group of 165 physicians of similar medical specialties (the comparison group). Response rates were 75% for the consultative group and 66% for the comparison group. Most consultative physicians (63%) performed fewer than 6 examinations per month. Characteristics of the consultative physicians were similar to the comparison group. Both groups were skeptical of the claims of disability applicants; 48% of the consultative and 55% of the comparison group thought that a majority of applicants could be employed. Of the consultative physicians, 53% indicated that they had learned little about disability programs from any source. Most consultative physicians (58%) judged it "almost impossible" to determine impairment on the basis of a single office examination. However, consultative physicians were less likely than the comparison group to view Social Security as difficult to work with (25% vs. 54%; P less than 0.01). Agencies that determine disability ask physicians to perform a task for which they feel ill prepared and have little special knowledge.     

A Canadian survey of issues in cancer pain management

We report the analysis of a cancer management survey mailed to a representative group of health professionals in 1994. The goals of the study were to gather information on cancer pain treatment practices, and to obtain health professional views on obstacles to ideal pain management. The survey, designed by a working party of pharmacists, nurses and physicians, was distributed to 14,628 physicians. A total of 2,686 physicians responded to the survey, including 39% of medical or radiation oncologists, and 18.19% of physicians who listed their primary interest as Family Medicine. Reflecting the modest emphasis placed on palliative care and cancer pain management in the current Canadian milieu, 67% of physicians rated their past teaching experience as only “fair” or “poor.” Lack of exposure to pain education was reflected in the response to a series of hypothetical case scenarios exploring physician choices in managing severe cancer pain. For example, in the initial management of a cancer patient with severe pain, 50% of physicians would not use a strong opioid in the absence of other contraindications to opioid use. A wide variety of analgesics and non-pharmacologic techniques is available to Canadian physicians to assist patients with pain. Few physicians identified the unavailability of analgesics or analgesic techniques as limiting factors in pain management. We condude that greater emphasis should be placed on pain education in our training programmes. We suggest that further surveys of this type, sponsored by our provincial colleges and medical organizations, can provide feedback which will enhance the adherence by Canadian physicians to published guidelines for pain management.     

Identifying physicians likely to benefit from depression education: a challenge for health care organizations

BACKGROUND: Few methods exist to identify physicians who might benefit from depression education. OBJECTIVES: To develop a measure of physicians' confidence or self-efficacy in caring for depressed patients and assess it's reliability and validity. RESEARCH DESIGN: A national sample of primary care physicians were surveyed and exploratory factor analysis (EFA) was used to identify factors underlying physicians' responses to 26 items. We named the factors, selected items with factor loadings > or = 0.50 for final scales, and tested a priori hypotheses about self-efficacy. SUBJECTS: 1) Random cross-sectional sample of family physicians, internists, obstetrician-gynecologists, and pediatricians (n = 5,369) and 2) 49 general internists and family physicians participating in a prepost evaluation of a depression workshop. RESULTS: In the national sample, 3,712 physicians were eligible and 2,104 responded. Forty-six percent were female, and 51% were family physicians and general internists. EFA identified 5 factors, the first of which was called Self-Efficacy (4 items, alpha = 0.86). More family physicians (64%) had confidence (self-efficacy) in caring for depressed patients compared with general internists (33%), obstetrician-gynecologists (16%), and pediatricians (6%) (P < 0.001). Few physicians intended to change their care of depressed patients (10%) or take CME on depression (24%). Of the 49 physicians attending a depression workshop, 76% reported high self-efficacy after the workshop versus 50% before it (P = 0.013). CONCLUSIONS: This study supports the reliability and validity of the Self-Efficacy scale as one method to identify physicians who might benefit from interventions. New approaches are needed because physicians are unlikely to change.     

Reported practice behaviors for medical care of patients with diabetes mellitus by primary-care physicians in Pennsylvania

OBJECTIVE: To compare the American Diabetes Association standards for the medical care of diabetic patients with reported care patterns. RESEARCH DESIGN AND METHODS: These standards were compared with reported care patterns obtained from a stratified random telephone survey of general practitioners, family physicians, and general internists in Pennsylvania. A total of 610 physicians completed the survey for a response rate of 73%. RESULTS: All primary-care physicians reported measurement of glycosylated hemoglobin, routine referrals to eye doctors, and patient self-monitoring of blood glucose less than recommended. Nearly all physicians performed foot exams, but the exams were infrequent for many of the physicians. Significant and independent differences (P less than 0.05) were noted between different groups of physicians. Older physicians and general practitioners reported patterns of care most different from the recommended standards for referral to eye doctors, measurement of glycosylated hemoglobin, and use of patient self-monitoring of blood glucose. General practitioners reported the lowest frequency of foot exams. CONCLUSIONS: Educational programs on diabetes for primary-care physicians should focus on reported behaviors most different from recommended standards and may need to target subgroups of physicians to achieve a more uniform level of care for all diabetic patients.     

Profession and gender in relationships between advanced practice nurses and physicians.

Relationships between registered nurses and physicians have often been described in terms of two models: one based on interactions between two health professions and one based on the patriarchy of male physicians and the deference of female nurses. To evaluate nurses' perceptions of the two models, 125 advanced practice nurses at a statewide professional conference completed a closed-ended self-administered questionnaire that asked about their relations with male and female physicians. Nurses rated male and female physicians very similarly; both groups were rated most favorably on their confidence in the nurse's expertise and least favorably on their recognition of the nurse's responsibilities unrelated to the care of individual patients. Nurses rated female physicians under the age of 50 more favorably than older female physicians and rated male physicians of all ages similarly. These findings provide greater support for the professional than for the gender model of nurse-physician relations.