Physician professional opinion leadership and physician advertising: a consumer view.

The author reports a study of consumers' attitudes toward information provided by personal physicians versus information provided by physicians' advertising and introduces the concept fo professional opinion leadership. The results provide evidence that the credibility of physicians is related to several attitude measures and that there are important differences in how individuals rate that credibility. Evidence also suggests that advertising by doctors is perceived as less credible than personally communicated information; nonetheless, some of the other findings indicate positive consumer response to such advertising. Comparisons are made with information provided by scientists and chiropractors.     

Physician perspectives on the role of religion in the physician-older patient relationship

A study of 160 family physicians and general practitioners found that the majority of physicians believed that religion has a positive effect on the mental health of older patients, and many believed that religion has a positive effect on physical health. While more than one half reported that patients only rarely, if ever, mentioned religious issues during a medical visit, a significant proportion of the physicians felt they should address religious issues when an older person indicates religion's importance and that religious issues should not be reserved completely for the clergy. Nearly two thirds of the physicians felt that prayer with patients was appropriate under certain circumstances, and over one third reported having prayed with older patients during extreme physical or emotional distress. Older physicians were less likely than younger to have positive attitudes toward addressing religious issues. The strongest predictors of physicians' belief in the appropriateness of addressing religious concerns were two attitudinal variables that indicated an understanding of the importance of religion in the lives of older adults and an awareness that patients might desire to engage in prayer with them. Hence, the beliefs and attitudes of the physician appear to be important factors in determining their receptivity to discussion of religious issues, which in turn may influence whether patients mention such issues in the context of the medical visit.     

A follow-up study of internal medicine residents' and faculty staff physicians' attitudes toward patients.

This study assesses the attitudes of internal medicine residents both before and one year after they began their residency, and of staff internists based at the hospitals where these residents rotate. Attitudes toward a broad range of patients' physical, psychological, social, and health-state characteristics were assessed. Results are compared with those obtained by Johnson and Hoffman in their study of medical students' attitudes toward these same characteristics. The results suggest that attitudes towards patient characteristics viewed as hindering communication in the doctor-patient relationship may become more positive as physicians obtain experience and enhance their clinical skills. The results also suggest that much of the research pertaining to medical students' and physicians' attitudes toward geriatric care and chronic illness may not generalize to the population of physicians who specialize in internal medicine.     

Pharmaceutical promotion in Canada: convince them or confuse them

Currently, drug companies are spending in excess of $200 million annually on promoting their products to Canadian physicians. Although the industry has adopted a voluntary code of advertising practice, this has not prevented gross excesses in all forms of pharmaceutical promotion: drug-company sponsored continuing medical education, and promotion through the public media, detailers, direct mail, sampling, and journal advertising. Not only does advertising add to the cost of drugs, but physicians' reliance on information conveyed through advertising leads to poor prescribing and consequently to significant adverse health effects for patients. Reforms of promotional practices are possible, but the initiative is unlikely to come from either the medical profession or the government. Pressure applied through an emerging grass-roots movement is the best hope for change.     

Life-sustaining treatments: what doctors do, what they want for themselves and what elderly persons want.

In view of the current social dilemmas regarding the use of life-sustaining treatments (LST) at the end of life, the purpose of the study was to reveal sources of interpersonal and intrapersonal conflict among the most involved parties, in a society where open doctor-patient communication about end-of-life treatment is rare. Two comparative analyses were conducted: (a) between physicians' practice and elderly persons' preferences regarding the use of different life-sustaining treatments in different illness conditions, and (b) between physicians' hypothetical practice for an elderly person in a metastatic cancer condition, elderly persons' preferences and physicians' preferences for themselves, should they be in the same illness condition. Data were collected in Israel from 339 physicians working in two medical centers, and from a random sample of 987 elderly persons. Attitudes and practice regarding artificial tube feeding, mechanical ventilation and cardiopulmonary resuscitation (CPR) in three different illness conditions were evaluated by close-ended questions. The findings indicate disagreements between the elderly and the physicians on a number of issues: in general, physicians report that they would use more LST than what the elderly report that they would want. Physicians differentiate among different illness conditions and different LST more than elderly persons do. Physicians are more likely to use artificial feeding than CPR, while elderly persons prefer the use of CPR more than artificial feeding. The comparison of physicians' hypothetical practice, the wishes of the elderly, and physicians' wishes for themselves regarding the use of LST in a metastatic cancer condition, shows that physicians would use LST differently from what the elderly want, and that they want less LST for themselves than they would order for elderly patients. The discrepancies found between the physicians' practice and the elderly persons preferences reflect differences in perceptions of artificial feeding and a lack of public knowledge regarding the effectiveness of CPR. They also reflect differences in attitudes regarding the prolongation of life in various illness conditions. The discrepancy between physicians' practice and their preferences for themselves underscores the personal and professional dilemmas related to these issues, which are faced daily by many physicians, and impede their compassionate behavior toward patients. Increasing the awareness of physicians of such discrepancies, and providing them with appropriate behavioral tools, including communication skills, is a timely need which should be addressed by the medical profession, medical services and medical schools.     

Office staff savvy: quality staff-patient communications as a loss prevention strategy

Based on the prevalence of medical error that continues to make headlines, you would think that physicians are so busy defending medical malpractice lawsuits that they don't have time to practice medicine. Although many physicians may feel like this, in fact, it is not the case. Contrary to what the media would have you believing, it is not "the conspiracy of silence" that's keeping physicians out of court. It's good, old-fashioned effective communication: courtesy, empathy, friendliness, and professionalism. Because the complexity of health care delivery imposes ever-greater demands on physicians' time, medical office staff play a larger-than-ever role in defining the tenor of physician-patient relationships. It has become incumbent on staff to become the physicians' partners in effectuating patient relationships built on quality communications. This article will discuss ways in which office staff can utilize effective communications to improve physician-patient relationships, thereby reducing professional liability exposures.     

Confidentiality in medical practice

To assess physicians' attitudes toward confidentiality, a questionnaire was mailed to general practitioners and family physicians in New Jersey. The questionnaire was designed to measure their attitudes regarding confidentiality as well as what course of action they believed should be pursued in specific situations involving confidentiality. Data regarding personal and practice characteristics were also collected. One hundred twenty (50%) of the physicians responded. A particularly strong reluctance was found among physicians to divulge information to other physicians. More physicians appeared willing to disclose information to relatives of the patient without their consent. The argument for disclosure among physicians to family members may flow from their belief that they should care for the health of the whole family, and not only that of the patient.     

Physicians' and patients' attitudes toward manual medicine: implications for continuing medical education

INTRODUCTION: Manual medicine (MM) is a physical modality infrequently used in primary care clinics. This study examines primary care physicians' experience with and attitudes toward the use of MM in the primary care setting, as well as patients' experience with and attitudes toward MM. METHODS: Surveys were distributed to a convenience sample of physicians (54.3% response rate) attending a 1-week primary care continuing medical education (CME) conference in Kentucky. Similar surveys were also mailed to a random sample of primary care patients (35.3% response rate) living in a service region in which most conference attendees practiced. RESULTS: Similar responses were obtained from physicians and patients. A majority (81% and 76%, respectively) of physicians and patients felt that MM was safe, and over half (56% of physicians and 59% of patients) felt that MM should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM. The majority of those seeking additional educational exposure (56%) were willing to pay for MM training that included CME credit. DISCUSSION: This survey suggests that primary care physicians feel that there is currently insufficient education in MM. The majority of physicians and patients feel that MM is beneficial, safe, and appropriate for use in a primary care setting. Thus, there may be a rising demand for quality instruction in MM from physical medicine doctors and other licensed therapists who currently practice MM.     

Nurses’ and physicians’ attitudes about women abuse: The effects of gender and professional role

The apathy encountered by battered women when they seek help from medical and other professions has been attributed to patriarchal norms and victim‐blaming. Because of their place in the medical hierarchy this study hypothesized that: a) nurses would have more sympathetic attitudes toward battered women than physicians; and b) professional roles and not gender would explain the differences. The findings supported the first but not the second hypothesis. Nurses were less likely to believe that wife‐beating is justified and that victims are responsible for the abuse. Women, regardless of profession, were more sympathetic than men. Nurses and physicians with the most liberal attitudes about women's roles were least likely to blame victims. Those with the most intensive training on the topic held victims less responsible and were more willing to help them.     

Gatekeeping: a challenge in the management of primary care physicians.

Assesses the degree of self-reported implementation of gatekeeping in clinical practice, and gains insight into primary care physicians' attitudes toward gatekeeping and their perceptions of necessary conditions for implementation of gatekeeping in daily practice. A self-administered questionnaire was mailed to a national sample of 800 primary care physicians in Israel, with a response rate of 86 per cent. Multivariate analysis indicated that sick fund affiliation was the main predictor of self-reported implementation of gatekeeping, while specialty training predicted primary care physicians' attitude toward this role. Close communication with specialists, continuous medical education, and management support of physician decisions were identified by respondents as being important conditions for gatekeeping. Discusses strategies to gain the cooperation of primary care physicians, which is necessary for implementing an effective gatekeeping system.     

Physicians' capability in home health practice: home health nurses' perceptions.

OBJECTIVES: To examine home health nurses' attitudes towards physician capabilities in home health care, and whether nurses' attitudes are associated with their experience, practice setting, degree of physician interaction, or use of home health guidelines. DESIGN: A multiple regression analysis of a 90 item survey on agency characteristics, degree of interaction with physicians, and ratings of physicians capabilities across multiple dimensions of home health practice. SETTING/PARTICIPANTS: 86 registered visiting nurses from seven Chicago-area home health agencies, who averaged 25 home visits and over one hour of direct contact with physicians weekly. MEASUREMENTS: Nurses' ratings of physician capability in home health practice were scaled from 18 survey items with high internal consistency reliability and correlated with nurses' practice characteristics. RESULTS: While most nurses (72%) felt that physicians responded adequately in emergencies and respected them as colleagues (70%), over 70% of respondents did not agree that physicians were adequately trained in home health. A majority of respondents rated physicians negatively on patient education, cross-coverage and availability, discharge planning, support and medical supply services, and insurance issues. Respondents' years of home health experience correlated negatively (p = .004) and degree of contact with physicians correlated positively (p = .05) with ratings of physician capabilities. CONCLUSION: Nurses' attitudes about physicians' performance can provide important insights for improving the effectiveness of specialized disease and outcomes management programs which rely on care in the home setting.     

The professional image of medical record practitioners: perceptions from administrative officers, financial officers, and chiefs of medical staffs

The study's findings provide insights into the relationship between medical record practitioners and the disciplines whose members were surveyed. This relationship is an important one. Much has been written about the team concept in the provision of care. Teamwork and maintaining a mutually respectful relationship is just as important to the administrative aspects of health care. A positive professional image is a prerequisite for gaining respect. Nurturing a positive professional image is the responsibility of individual practitioners as well as the medical record profession as a collective entity. One way in which these findings can be utilized is for self analysis of MRPs: how would they evaluate themselves and how they perceive others would evaluate them. Answers to these questions may suggest areas where improvement in necessary. A second way in which findings can be used is in the recruitment arena. Positive findings can be used as recruiting and marketing tools to attract potential members into the medical record profession. Efforts in the recruitment area are necessary to meet predicted manpower shortages in the profession. While the study assisted in the understanding of the relationship of MRPs and other professionals with whom they must work closely, further study is necessary. This study's response rate and limitations to the parameters may preclude generalization; therefore, replication of the study is needed before findings can be universally applied. Additional study is necessary to determine others' perceptions of not only the image of MRPs but the identity as well. Are MRPs perceived as safekeepers of medical records or as health information leaders?     

Disciplined doctors: the electronic medical record and physicians' changing relationship to medical knowledge

This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, U.S. integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors' interactions with the EMR reconcile these perspectives by making physicians' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners' professional identities are reconciled with bureaucratic subordination across the different departments studies.     

Location patterns of recent physician settlers in rural America

The location patterns of young physicians who settled in the most rural communities of America between 1973 and 1976 are analyzed. The majority of these recent rural settlers were primary care practitioners. They tended to be the alumni of state university medical schools in states with large rural populations. Foreign medical graduates were heavily represented. The principal finding—a tendency toward further concentration of rural physicians within existing medical communities—suggests that those rural communities with the greatest needs may remain underserved without the assistance of organized external programs.     

Physician acceptance of a computerized health maintenance prompting program

Computer prompting systems remind physicians to perform health promotion/disease prevention (HP/DP) procedures on their patients, but it is unclear how willingly physicians accept these systems. Because acceptance is critical to long-term system success, we assessed attitudes toward a computerized health maintenance program (HMP) prompting system. We surveyed 23 faculty and 52 residents in a general medicine teaching hospital group practice after the HMP had been in use for three years. Sixty-four physicians (85 percent) responded. Almost all (91 percent) agreed that all ongoing-care patients should receive periodic screening--a significant (p less than .001) increase compared to 1979, when prior to the HMP 56 percent agreed. On average, the physicians believed that 87 percent of their ongoing-care patients over 50 years of age should be enrolled in the HMP. About half (55 percent) felt that losing the HMP would limit their ability to care for their patients, and almost all (97 percent) said they would include a prompting system in any future private practice, with most (87 percent) preferring a computer-based system. A majority (65 percent) said that they liked being reminded. Prompting systems improve physician performance of HP/DP procedures. The HMP received a high level of acceptance and was associated with improved attitudes toward HP/PD activities, suggesting that computerized prompting systems should be more widespread.     

"The doctors' choice is America's choice": the physician in US cigarette advertisements, 1930-1953

In the 1930s and 1940s, smoking became the norm for both men and women in the United States, and a majority of physicians smoked. At the same time, there was rising public anxiety about the health risks of cigarette smoking. One strategic response of tobacco companies was to devise advertising referring directly to physicians. As ad campaigns featuring physicians developed through the early 1950s, tobacco executives used the doctor image to assure the consumer that their respective brands were safe. These advertisements also suggested that the individual physicians' clinical judgment should continue to be the arbiter of the harms of cigarette smoking even as systematic health evidence accumulated. However, by 1954, industry strategists deemed physician images in advertisements no longer credible in the face of growing public concern about the health evidence implicating cigarettes.     

Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians

OBJECTIVES: This study aimed to explore Kuwaiti family physicians' attitudes and knowledge about HIV/AIDS. METHODS: One hundred and sixty-two Kuwaiti family physicians (95 females and 67 males) from all four health catchment areas have completed a 30-item self-administered questionnaire to measure HIV/AIDS-related attitudes and knowledge. RESULTS: Knowledge was lacking in areas dealing with HIV-related neuropsychiatric complications and other issues concerning HIV/AIDS, special populations and range of normal sexuality. The majority of physicians expressed negative attitudes toward homosexuality and about AIDS patients in general. Eighty-three per cent of Kuwaiti family physicians would opt out of treating AIDS patients. More than half of the physicians would avoid coming into social contact with HIV-seropositive persons. No significant difference was found for the total knowledge and attitude scores for gender. CONCLUSION: The results of this survey revealed that even in the second decade of the AIDS epidemic, some Kuwaiti family physicians continue to have a lack of proper knowledge about HIV and harbour negative attitudes toward AIDS patients. There is a need to promote an AIDS education early in the medical internship training years which addresses many underlying socio-cultural factors.     

Chinese physicians' cigarette smoking habits and their anti-smoking counselling practices

A survey of Chinese physicians' cigarette smoking habits andtheir counselling of patients to quit smoking was carried outin two provincial hospitals in Wuhan, capital city of Hubeiprovince, People's Republic of China. All 559 physicians inthe two hospitals were given the questionnaire, of which 86%(480) returned their completed questionnaires. Of the 480 physicians,50.9% of the males, and 4.8% of the females were current cigarettesmokers. The majority of physicians (85.6%) had counselled theirpatients about cigarette smoking in the past year, althoughfew physicians (2.9%) felt that they were very successful inhelping patients to quit smoking. The frequency of physicians'anti-smoking counselling was significantly correlated with anumber of variables: physicians' own smoking status; whetherthey perceived themselves as the most influential people inhelping patients to quit smoking; whether physicians thoughtthat they were successful in their past counselling practices;and physicians' age.