从《执业医师法》与医学模式的转变谈医疗安全管理

要加强医疗安全管理，首先必须随着生物医学模式向生物－心理－社会医学模式的转化，不断拓宽我们的管理思维，要从生物，心理，社会这三个密切相关的致病环节中全闰地制订医疗安全措施，提高医护质量。同时还要以规章制度，法律法规，特别是《执业医师法》来约束医护人员的医疗行为，最大限度地减少医疗纠纷的发生。     

How social media,training, and demographics influence online reviews across three leading review websites for spine surgeons

Background Context

The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website.

临沂市医护人员心理健康状况调查

目的调查医护人员心理健康状况,为医护人员开展心理健康教育提供理论依据。方法采用自编调查问卷,症状自评量表,艾森克人格问卷,简易应对方式问卷和社会支持问卷,对临沂市140名市级医院的医护人员心理健康相关因素进行分析。结果医护人员大部分有积极的表现,自我感觉良好(54.3%),心情愉快(53.5%),但是也经常有焦虑症状(42.9%);SCL-90测试医护人员的心理健康水平,躯体化、强迫症状、人际关系、抑郁、焦虑、恐怖因子的分值高于常模,两者比较有显著性差异(P<0.01);人格特征测试,精神质和神经质与常摸比较,有显著性差异(P<0.01);多因素分析医护人员健康水平与社会支持、积极应对、消极应对、神经质相关(P<0.01)。结论总体上讲,医护人员的心理健康状况良好,应注意保护他们的心理健康,建立医护支持系统,帮助他们提高心理调适能力,减轻和消除心理压力。     

Does the Race/Ethnicity or Gender of a Physician's Name Impact Patient Selection of the Physician?

This study's objective was to examine the extent to which individuals exhibit a preference for physicians based upon the race/ethnicity and gender of a physician's name. We conducted an online survey of 915 adults, who viewed a comparative display of four physicians' quality performance. We randomized the name of one physician, whose quality performance was equal to that of one physician and better than two other physicians, to be either typically African American male, African American female, white male, white female, or Middle Eastern (gender ambiguous). In regression models, participants more frequently selected the physician with the randomized name when displayed with a white male name, compared to when presented with an African American male, African American female, or Middle Eastern name (ORs ranging from .59 to .64). White and male study participants exhibited this pattern, while racial/ethnic minority participants did not. If the hypothetical choice bias observed here translates to people's actual selection of physicians, it could be a contributing factor for why women and racial/ethnic minority physicians have lower incomes than white male physicians.     

Novel use of an OSCE to assess medical students’ responses to a request for a low value diagnostic imaging test: A mixed methods analysis

ObjectiveEvaluate medical students’ communication skills with a standardized patient (SP) requesting a low value test and describe challenges students identify in addressing the request.MethodsIn this mixed-methods study, third-year students from two medical schools obtained a history, performed a physical examination, and counseled an SP presenting with uncomplicated low back pain who requests an MRI which is not indicated. SP raters evaluated student communication skills using a 14-item checklist. Post-encounter, students reported whether they ordered an MRI and challenges faced.ResultsStudents who discussed practice guidelines and risks of unnecessary testing with the SP were less likely to order an MRI. Students cited several challenges in responding to the SP request including patient characteristics and circumstances, lack of knowledge about MRI indications and alternatives, and lack of communication skills to address the patient request.ConclusionsMost students did not order an MRI for uncomplicated LBP, but only a small number of students educated the patient about the evidence to avoid unnecessary imaging or the harm of unnecessary testing.Practice implicationsKnowledge about unnecessary imaging in uncomplicated LBP may be insufficient to adhere to best practices and longitudinal training in challenging conversations is needed.     

Physicians,emotion, and the clinical encounter: A survey of physicians’ experiences

ObjectivesTraining in emotion management is not a standard part of medical education. This study’s objective was to understand physicians’ challenges navigating emotion (their own and their patients’) and identify areas for intervention to support physician wellness and enhance patient care.MethodsIn 2019, we surveyed 103 physicians in emergency medicine, internal medicine, family medicine, and neurology. Participants quantitatively reported emotion training, emotions that were challenging, and barriers to addressing emotion. They provided qualitative examples of emotion challenges and successes that we analyzed using an inductive thematic analysis.ResultsThere were no significant differences in responses by specialty. Only 10% reported receiving emotion management training, with no evidence that more recently trained physicians received more. Those who had received training on emotion reported greater comfort in dealing with patients’ emotions and were more likely to engage in teaching on emotion. There were gender and career stage differences regarding which emotions physicians found most challenging. The authors identified central themes of emotion-related challenges and successes.ConclusionsTargeted educational initiatives are needed to advance physicians’ ability to navigate emotion in clinical encounters.Practice implicationsDeveloping strategies for managing patients’ emotions may better prepare physicians for navigating the emotional demands of practicing medicine.     

Pharmacy students’ attitudes towards physician–pharmacist collaboration: Intervention effect of integrating cooperative learning into an interprofessional team-based community service

The aim of this study was to evaluate the attitudes towards physician–pharmacist collaboration among pharmacy students in order to develop an interprofessional education (IPE) opportunity through integrating cooperative learning (CL) into a team-based student-supported community service event. The study also aimed to assess the change in students’ attitudes towards interprofessional collaboration after participation in the event. A bilingual version of the Scale of Attitudes Toward Physician–Pharmacist Collaboration (SATP²C) in English and Chinese was completed by pharmacy students enrolled in Wuhan University of Science and Technology, China. Sixty-four students (32 pharmacy students and 32 medical students) in the third year of their degree volunteered to participate in the IPE opportunity for community-based diabetes and hypertension self-management education. We found the mean score of SATP²C among 235 Chinese pharmacy students was 51.44. Cronbach’s alpha coefficient was 0.90. Our key finding was a significant increase in positive attitudes towards interprofessional collaboration after participation in the IPE activity. These data suggest that there is an opportunity to deliver IPE in Chinese pharmacy education. It appears that the integration of CL into an interprofessional team-based community service offers a useful approach for IPE.     

麻醉前谈话的方法和技巧

通过分析麻醉科医师与患者在麻醉前谈话的目的、谈话前需要掌握的情况、谈话时应让患者及其家属了解的情况以及谈话的忌与宜等,从而加强医患沟通,改善医患关系,减少医患纠纷。     

对医患沟通的伦理思考

建立和谐的医患关系,是构建和谐社会的重要组成部分。而良好的沟通是和谐医患关系的重要渠道,因此医务人员应该加强自身的职业道德修养,注重医患沟通,给患者以尊重、理解和人文关怀,缓解医患关系不平衡不对称的矛盾,从而促进医患之间相互尊重,相互理解和相互信任,建立和谐的医患关系。     

重视急诊医疗中的伦理问题

目的探讨急诊医疗中伦理问题的重要性。方法参考相关文献,并融合本院急诊的特点,探讨目前急诊医疗中所存在的伦理问题,以及重视伦理问题的必要性,并根据本院急诊医生小范围调查结果所反映的问题探讨相应对策。结果因目前急诊医疗的特殊性,产生了与其他科室所不同的伦理问题。结论要重视急诊医疗中伦理问题产生的原因,要完善急诊医疗中相应的政策法规和急诊流程问题;要重视病人权益,加强医患沟通,保障病人返家后的安全;同时也要减轻急诊医生工作压力,加强急诊医生可持续性培训和团队合作精神。