Physicians' attitudes toward death and dying

INTRODUCTION: In the study the physicians' knowledge and attitude was examined towards death and dying. During the study a questionnaire survey was executed, including 124 physicians (family doctors from Budapest and from the country, hospital and clinical doctors) in which there were questions edited by the authors and also used the Lester and Neirmeyer scales to assess the fear of death. AIMS: The aim was to assess how much the physicians were prepared during their education to face with dying people and death, how much they are able to get in touch with dying patients, and how much they are afraid of death. METHODS: The questionnaires evaluated by the SPSS statistical program. RESULTS: According to results most physicians in Hungary have a very little knowledge with regard to death and dying. This lack of knowledge, their own fears and refusal in connection with the transitoriness can have a negative influence on their relationship with dying people: their attitudes towards dying are generally negative, many of them try to avoid dealing with the questions worrying the dying people and if after all there is a communication situation most of them avoid the more difficult fields instead. CONCLUSIONS: To draw attention to these problems, to point out the necessity of the gradual education of issues connected to death and dying and to stress how important is to mold attitudes towards dying people. The study is finished with some particular education program-proposals.     

Physicians' attitudes toward breast self-examination: a pilot study

Recent case control studies suggest that breast self-examination (BSE) is efficacious in the early clinical diagnosis of breast cancer. Population studies also indicate that adoption of this behavior depends largely on physicians. This pilot study was designed to determine whether physicians' attitudes on this subject could be obtained through a mail questionnaire. The results show that a self-administered mail questionnaire can be used successfully in physician studies. Although questionnaire length does affect response rates (78% one page, 69% four page, and 57% eight page), it does not affect either respondent characteristics or question response.     

Physicians' attitudes toward health care rationing.

BACKGROUND: Optimal allocation of health care resources under a limited budget is controversial. Particularly important questions are whether rationing decisions should be based on efficiency considerations alone or in combination with equity considerations, and who should be in charge of such decisions. In this study, the authors sought to understand the position of Swiss physicians toward rationing using a previously developed rationing scenario. METHODS: The authors examined the acceptability of various scenarios implementing health care rationing in a mail survey of 1,184 physicians practicing in Geneva, Switzerland. Respondents were asked to choose between providing a suboptimal cancer screening test A to the whole population, which would save 1,000 lives, or selecting half of the population to receive a better but more expensive test B, which would save 1,100 lives. Physicians were randomly assigned to 3 versions of the scenario: Beneficiaries of test B could be chosen by lottery, on a first-come-first-served basis, or by medical associations. RESULTS: Only 26% of physicians chose the more effective selective rationing option; this proportion was lowest when test beneficiaries were selected by lottery (14%), intermediate for the first-come-first-served-scenario (26%), and highest when selection was left to medical associations (39%; P < 0.001). Hospital-based physicians and general practitioners were less likely to endorse selective rationing than community-based physicians and specialists. CONCLUSION: Swiss physicians appear to be more concerned about equal allocation of health services than about maximizing health in society, and they prefer physicians to be in charge of rationing decisions.     

Congress 2000: a continuing medical education summit with implications for the future

The expectations of attendees, the evaluations of themes, and the implications for continuing medical education (CME) identified by "Congress 2000: A Continuing Medical Education Summit on the Practices, Opportunities and Priorities for the New Millennium" are reviewed. A vision was identified with significant opportunities for CME to become a more valuable partner in and contributor to quality health care. The vision suggests that CME should be linked more closely to physician learning at the point of care and that technology might be used more successfully to address physician-learner needs by helping them to manage volumes of evidence for treating patients more effectively. At the same time, health care outcome data to analyze the need for and measure the effectiveness of educational interventions should become integrated into standards of practice for CME providers. Continuous improvement based on research about effective learning processes and outcomes should become an essential construct of the CME culture. Implications are summarized for the profession, organizational CME providers, individual CME professionals, and CME research from this new vision of CME crafted at Congress 2000.     

Physicians' attitudes and behaviors toward home health care services

The authors investigate physicians' attitudes, information-seeking behaviors, and behavioral intentions toward home health care programs. Survey results show that physicians favor the concept, but knowledge and awareness levels about available programs vary with the physicians' specialties. Evidence also is reported on specific problems encountered, sources of information used to make home care referrals, and physicians' perceptions of the impact of home care programs on their practice. Finally, policy implications are drawn for marketers of home health care programs.     

Physicians' and consumers' conflicting attitudes toward health care advertising

The purpose of this paper is to explore the conflicting attitudes held by physicians and health care consumers toward health care advertising in an attempt to resolve the question. The paper introduces the differing positions held by the two groups. The rationale behind physicians' attitudes is then presented that advertising can be unethical, misleading, deceptive, and lead to unnecessary price increases. They believe that word-of-mouth does and should play the major role in attracting new patients. The opposite view of consumers is then presented which contends that health care advertising leads to higher consumer awareness of services, better services, promotes competitive pricing, and lowers rather than raises health care costs. The final section of the paper compares the arguments presented and concludes that health care advertising clearly has a place in the health care industry.     

Impact of public education and continuing medical education on physician attitudes and behavior concerning cholesterol

Current physician attitudes and behavior concerning elevated blood cholesterol, recent changes, and reasons for change were measured in a survey of physicians in two cities. Those in a community with both continuing medical and public education programs reported changing their practice significantly over the past two years, more so than those in a comparison community. The physicians did not identify specific elements of a continuing medical education program as important in these differences. Physicians in Pawtucket, Rhode Island, identified requests from the public as important and statistically significant factors in their changed behavior, suggesting that the public education program has become an important influence on physician behavior.     

Physicians' attitudes toward an expanded role for pharmacists in an HMO

The study examines the attitudes of physicians in a large HMO toward expanded activities for pharmacists and attempts to determine the physicians and their practice characteristics that account for these attitudes. The setting was the Oregon Region of the Kaiser-Permanente Medical Care Program. The data were obtained from a survey of the physicians serving the membership. The findings indicated that about two of every three physicians favored expanded activities for pharmacists. The specific activities most favored were those least threatening to physicians' roles. Their attitudes were most strongly related to whether they favored prescribing privileges for physician assistants and nurse practitioners. The physicians and their practice characteristics accounted for a small amount of the variation in physicians' attitudes. Large HMOs may be favorable settings for expanding the activities of pharmacists.     

Credentialing physicians: challenges for continuing medical education

BACKGROUND: Professionals involved in the regulation, credentialing, and certification of physicians around the world met in Chicago in June 2000 to discuss systems to ensure the competence of physicians. We learned that public demand for evidence of continuing competence in practice is driving the profession in most countries to explore new approaches to the education and assessment of physicians. Most groups have called the value of traditional continuing medical education (CME) into question and are exploring the use of self-directed CME methods, self-assessment, and quality improvement as the main instruments for maintenance of certification. It seems likely that teachers will be required to integrate assessment with enhancement of competencies, in much the same way that a coach uses an athlete's performance as a basis for continuous improvement. Recognizing the tough challenges ahead and the demand for CME to adapt to complement future plans for continuous assessment of physician competence, conference participants agreed to create a communication network that would facilitate information sharing and avoid duplication of research efforts.     

Journal-based continuing medical education

Continuing Medical Education (CME) has become a practical necessity for most physicians, because CME credit is required by many licensing and other medical authorities and because physicians are expected to follow the most recently published practice guidelines. A useful and relatively inexpensive source of CME credit is provided by journals such as JAMA and Archives of Family Medicine. In this article, the costs of CME to the physician's practice are estimated, and the educational objectives, format, and evaluation procedure of the JAMA Reader's Choice CME activity are described.     

Physicians' and patients' perceptions of patients' communication competence in a primary care medical interview

Considerable research suggests that patients and physicians often perceive aspects of the medical interview quite differently. Despite extensive research into physician-patient communication, virtually no attention has been given to assessing patients' and physicians' perceptions of communication competence during the medical interview. The purpose of this research was to determine the extent of agreement between physicians and patients on what behaviors constitute competent patient communication. The results indicate that there is considerable agreement between physicians and patients on the categories of competent patient communication. However, there is little or no evidence for agreement at the dyadic level on the occurrence of competent patient communication. Moreover, there is little evidence that physicians' and patients' perceptions of competence correlate with patients' actual discourse. These results are discussed with respect to implications for future research on patient communication skills training interventions.     

Continuing medical education and attitudes of health care providers toward treating diabetes

INTRODUCTION: Continuing medical education (CME) is an important tool in improving the care provided to patients with type 2 diabetes. Health behavior models suggest that attitudes are important factors in changing behavior. The aim of this study was to evaluate the immediate and 3-month impact of a diabetes educational program on the attitudes of health care providers toward treating diabetes. METHODS: Health care providers (including physicians, physician assistants, nurse practitioners, and nurses) were attending a 7-hour CME program on type 2 diabetes in one of eight states in the United States between May and September 1999. Attitudes were assessed using the Diabetes Attitudes Scale-3 (DAS-3), which was given immediately before the program, immediately after the program, and 3 months after the program. A convenience sample of 315 providers completed pre- and post-CME measurement. Three-month follow-ups were completed by 146 (46%) of the 315 providers. RESULTS: Following the CME program, physicians had significantly more positive attitudes on two of five DAS subscales. At 3 months, the change persisted on one subscale that measured beliefs related to type 2 being a serious disease. Allied professionals had significantly more positive attitudes on five subscales following the program; however, the change did not persist at 3 months. DISCUSSION: This CME program resulted in different patterns of attitude change for physicians as compared to allied professionals. In both groups, more positive attitudes toward treating diabetes were detected following the CME; however, the change tended to diminish by 3 months after the program. These findings mimic much of the research on knowledge retention following CME.