Attitudes of medical students and family practice residents toward geriatric patients.

The federal government, as well as teaching institutions, are concerned about the current negative attitudes of doctors, medical students, and paramedical personnel toward the elderly. Increased life expectancy at birth and lowered birth rates are changing the demographics of America. As the number of elderly citizens increases, greater demands are being placed on medical educators to train physicians who can meet the "geriatric imperative." The Institute of Medicine has recommended that comprehensive humanistic medical education in geriatrics be integrated throughout the curricula of medical schools. Research is needed to see if change can be implemented in physician training to improve attitudes toward the elderly. Previous attempts to improve medical students'' attitudes toward the elderly have met with mixed success. Control groups have seldom been used. It is important to determine whether the effects of medical education extends beyond the immediate boundaries of a training curriculum. This article reports the results of a study on negative attitudes toward the elderly among residents, medical students, and physician''s assistant students in the family medicine department at the King/Drew Medical Center in Los Angeles, California.     

Attitudes toward condom use and AIDS among patients from an urban family practice center

As part of an effort to better educate patients about using condoms, a survey was done to assess the sexual practices, attitudes toward acquired immunodeficiency syndrome (AIDS) and condom use by patients who visit an urban family practice center. A self-administered questionnaire was given to 126 patients of whom the majority were black and single. Seventeen percent indicated they had sex with more than one person in the 3 months before the survey. Within the last 5 years, 10% had sex with an intravenous drug abuser, and 6% with someone of the same sex. Fifty percent believed that condoms decrease sexual pleasure for men and 31% thought condoms made sex inconvenient. Twenty-seven percent of those surveyed believed that a man's penis may be too large for a condom and 18% believed that uncircumcised men could not use condoms. Forty-five percent believed they should be screened for human immune deficiency virus exposure. The results highlight attitudes and beliefs that may function as barriers to condom use and should be addressed when encouraging condom use with this population.     

Attitudes toward mental illness and role conceptions of psychiatric patients and staff.

The patients and staff of a psychiatric hospital were asked about their attitudes toward mental illness and how they conceive the roles of various patient and staff groups in the therapeutic community. The focus was on the bipolar dimension of "Custodial" vs. "Accountability" orientation. A Custodial orientation discourages autonomy, promotes submission, and emphasizes the satisfaction of the physical needs of the patients. On the other hand, an orientation of Accountability emphasizes the "healthy" aspects of the patients and encourages autonomy and the sharing of power. These orientations were tapped by the use of a close-structured questionnaire. The results revealed that attitudes toward mental illness and role conceptions were highly related. Patients and nursing staff showed a greater custodial orientation than did other members of the staff.     

Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners

OBJECTIVE: Our study explored the attitudes of patients toward complementary and alternative medicine (CAM) use, their family physicians' role regarding CAM, and models for CAM referral and treatment. We compared patients' perspectives regarding integration of CAM into primary care with attitudes of primary care physicians (PCPs) and CAM practitioners. METHODS: We conducted a comprehensive literature review and focus group discussions to develop a questionnaire, which we gave to three groups: a random sample of patients receiving care at an academic family medicine clinic and PCPs and CAM practitioners employed in the largest health maintenance organization in Israel. RESULTS: A total of 1150 patients, 333 PCPs, and 241 CAM practitioners responded to our questionnaire. Compared with PCPs, patients expected their family physician to refer them to CAM, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. When asked about CAM integration into medical care, more patients expected to receive CAM in a primary care setting compared to PCPs' expectations of prescribing CAM (62% vs. 30%; p=0.0001). Patients, CAM practitioners, and PCPs expected family practitioners to generate CAM referrals in an integrative primary care setting (85.6% vs. 82.4% vs. 62.6%; p<0.0001). Patients supported CAM practitioners providing CAM treatments in the primary care setting, regardless of whether the practitioner held a medical degree (MD). Also, more patients than PCPs or CAM practitioners expected their family physician to provide CAM (28.2% vs. 14.5% vs. 3.8%; p<0.0001). CONCLUSION: Patients, PCPs, and CAM practitioners suggested that family physicians play a central role in CAM referral and, to a lesser extent, that they actually provide CAM treatment themselves. PRACTICE IMPLICATIONS: PCPs need to be aware of their present and future role in informed referral to CAM and, to a lesser degree, in providing CAM in integrative primary care clinics. With the increasing use of CAM, patients may expect their family physician to be more knowledgeable, skillful, and have a balanced approach regarding CAM use. In addition, practitioners should learn how to communicate effectively and better collaborate with CAM practitioners to the benefit of their patients.     

The RAMBLER study: the role of ambulatory blood pressure measurement in routine clinical practice: a cross-sectional study

Ambulatory blood pressure measurement (ABPM) is a useful and important way of guiding clinical decisions in the diagnosis and treatment of hypertension. There has been little research on how ABPM is actually used in the community where hypertension is mainly diagnosed and managed. We aimed to review the use of ABPM in daily community practice in terms of patient demographics, changes in pharmaceutical treatment and the proportion of patients achieving recommended levels. Six practices using the dabI device for ABPM participated in this cross-sectional study. Patients who had the ABPM performed over the preceding 12 months were included. We recorded demographic details, pre- and post-ABPM clinic blood pressure measurements, the ABPM result and treatment before and after the test. 381 patients were included in the study, of whom 38.6% were male. The mean age was 58 years (SD= 14) and 46.7% were GMS eligible. 33.8%/ had a normal BP result on ABPM. There was a statistically significant reduction in both the mean systolic pressure(10.4 mmHg, CI 7.2-12.9, P<0.001) and diastolic pressure (5.1 mmHg, CI 3.2-6.6, P< 0.05) between the pre and the post-ABPM clinic measurements. It was found that 38.1% had a change in their medication after the test, with 31.7% having a new medication started. This pragmatic study provides information about the use of ABPM in routine general practice in Ireland. ABPM readings appear to have an impact on General Practitioners' decision- making and on the medical management of hypertensive patients in the community.     

Attitudes toward integrative paediatrics: a national survey among youth health are physicians in the Netherlands

Background  

Integrative Medicine (IM) is an emerging field in paediatrics, especially in the USA. The purpose of the present study was to assess the attitudes and beliefs of Youth Health Care (YHC) physicians in the Netherlands toward IM in paediatrics.     

Validity of the Maslach Burnout Inventory for family practice physicians

This study assesses the utility of Maslach's concept of burnout for family practice physicians. Maslach Burnout Inventory (MBI) subscale correlations for the 67 residents in this sample are compared with Maslach's normative sample. The residents scored in the moderate to high range on the MBI subscales. MBI interscale correlations were similar to the pattern reported by Maslach. Significant correlations between job satisfaction and five of the six MBI subscales suggest that the construct of burnout has considerable psychological import for these physicians. The validity of the emotional exhaustion subscale is demonstrated by significant correlations with self-assessed burnout, job satisfaction, and faculty assessments of resident burnout. Independent observers were most sensitive to residents' emotional exhaustion and less likely to assess accurately the less visible aspects of burnout related to depersonalization and lack of achievement, which suggests the usefulness of multiple measures for assessing the burnout phenomenon.     

Attitudes of Roma toward smoking: qualitative study in Slovenia

Aim

To understand the reasons for widespread smoking behavior among Roma in Slovenia for the purpose of developing successful smoking cessation interventions.

Method

A qualitative focus group approach using a combination of pre-structured and open-ended questions was applied to collect the data from the representative members of the Roma community in southern Slovenia. The discussions were audiotaped and transcribed, and the collected data analyzed according to qualitative content analysis theory.

Results

The content analysis revealed that smoking was a strong part of the cultural, ethnic, and individual identity of the Roma. Even children smoked. Doctor’s advice to quit smoking was usually not followed and the attempts to quit were usually unsuccessful. Difficult financial situation was never mentioned as a possible motive to quit. Roma held a tenacious belief that the harmful effects of smoking were in the hands of destiny and did not associate the smoking-related illness with the habit.

Conclusions

Traditional strategies for smoking cessation are largely ineffective among the Roma because of their different attitudes toward smoking. Therefore, innovative and culturally acceptable methods need to be developed.According to the 2002 Census, 0.2% of inhabitants in Slovenia are Roma. However, on the basis of reports of social centers and schools, their real number could be up to four times higher than this (1). The socio-economic status, education level, and employment rate among Roma are considerably worse than among other Slovenian population, which places many of them into the category of poor people and thereby, at increased health risk.From the cultural point of view, the Roma are a highly specific ethnic minority. These once nomadic people now mostly live in poor accommodation and have difficult housing situation. The health culture of the Roma and their use of health care are low despite the fact that most of them can obtain full state-provided medical insurance irrespective of their employment status (2). Due to low hygienic and microclimatic conditions, low health education, and excessive smoking, diseases of the respiratory system seem to be among their most important health problems (3-5). Although epidemiologic data hardly exist, the Roma are known to be heavy smokers. The Roma trust in traditional folk medicine and do not believe smoking is a health-threatening habit (2). The percentage of smokers among the Roma in Slovenia is unknown. Studies from other countries show that, similar to other cardiovascular risk factors, smoking is by far more frequent in Roma than in other populations (5,6).Countries with a Roma population, whose health status is usually poor and socioeconomic position the lowest in the country (7-10), realized that research into the health status of the Roma people is needed for the planning of health intervention strategies, such as antismoking campaign (11,12). From everyday practice we know that the Roma never stop smoking and that they smoke heavily. We performed a qualitative study to understand the reasons for widespread and heavy smoking among the Roma in Slovenia for the purpose of developing more successful public health actions against smoking in their community.     

Emotion work and burnout: cross-sectional study of nurses and physicians in Hungary

Aim

To investigate predictors of occupational burnout, such as emotion work, among health care workers and compare the frequencies of burnout and emotion work in nurses and physicians.

Method

A cross-sectional survey was conducted in 2007 and 2008 among 80 physicians and 76 nurses working in a variety of health care settings in Hungary. The survey contained sociodemographic questions and work- and health-related questions from, respectively, the Maslach Burnout Inventory-Human Services Survey and the Hungarian version of the Frankfurt Emotion Work Scale. To identify the dimensions of emotion work associated with burnout, linear regression analyses were carried out. To analyze differences in burnout and emotion work between nurses and physicians, independent t tests were used.

Results

Nurses reported significantly higher emotional dissonance and fewer regulation possibilities, such as interaction and emotion control, than physicians. However, no differences were found in the level or frequency of burnout. Nurses had fewer regulation requirements regarding sensitivity and sympathy. Linear regression analyses showed that emotional dissonance for emotional exhaustion (β = 0.401) and display of negative emotions for depersonalization (β = 0.332) were the strongest predictors of burnout.

Conclusion

The factors that should be taken into account when developing prevention and intervention programs differ for nurses and physicians. In nurses, the focus should be on stressors and emotional dissonance, while in physicians it should be on work requirements and display and regulation of negative emotions.During the last decade, the topic of emotion work has gained a much greater significance in organizational and health psychology. As defined by Zapf et al, emotion work occurs when employees are required by the employer to regulate their emotions in order to display appropriate emotions to the client (1). Emotion work determines the quality of social interaction between the caregiver and client. Action theory distinguishes 3 aspects of emotion work requirements: regulation requirements, regulation possibilities, and regulation problems. Regulation requirements (display of emotions) are related to properties of the hierarchical-sequential organization of action and constitute the complexity of decision. Regulation possibilities refer to the concept of control. Regulation problems, also known as emotional dissonance, are the discord between felt and expressed emotions and occur when stressors disturb the regulation of action (1,2). Current burnout research is greatly facilitated by theories explaining work stress (3-6). Using Karasek’s job demands control model, the research group of LeBlanc and DeJonge investigated emotional job demands (3-5). It was also found that health care workers are at high risk for emotional exhaustion resulting from interaction with clients (6,7).Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment occurring in people-oriented and service work (8). Emotional exhaustion refers to feelings of being depleted of one’s emotional resources. Depersonalization is a negative and cynical attitude and behavior toward clients. Reduced personal accomplishment is the self-perception of a decline in one’s own competence and self-efficacy. Burnout has most often been studied in caregiving professionals, such as clinicians, psychologists, social workers, and nurses (9-17). Indeed, several studies have directly measured the emotional aspects of job demands dealing either with emotion work (18-20) or burnout (21-24). However, few studies investigating the relationship between burnout and emotion work have been conducted in the nursing and health care profession, particularly in Hungary and Eastern Europe (25). The differences in burnout and emotion work between nurses and physicians have been studied in the Netherlands, Germany, and Spain (3-5,14,26). Some studies have suggested that physicians experience more burnout than nurses (14,16), while others have suggested the opposite (17).Recently, burnout has been conceptualized as a psychological syndrome that takes place in response to chronic interpersonal stressors on the job (6). According to Zapf, burnout makes individuals no longer able to adequately manage their emotions while interacting with clients (27). According to the model of emotion work by Grandey (28), antecedents of emotion regulation are the situational variables, eg, interaction between the caregiver and client.A relationship between burnout and emotion work has recently been found in the health care setting in Western European countries (3,4,29-31). Health care professionals, especially nurses, are at high risk of burnout because their job requires a high level of emotion work (18-20,32,33). Most studies have found a positive relationship between emotion work and burnout, suggesting that emotional dissonance may predict emotional exhaustion and depersonalization (25,34). Demerouti (35) argues that contribution of job demands and resources to explaining burnout may vary across occupations because these features differ across occupations. Burnout literature usually focuses on general variables that predict burnout and does not distinguish between predictors across health professions (6,8). Thus, we hypothesized that differences in emotion work can be detected between nurses and physicians, although the predictors of the syndrome do not vary.This study assesses the relationships between burnout and emotion work in a sample of Hungarian health care professionals and investigates how emotional job demands relate to the frequency of burnout.     

Acne vulgaris: myths and misconceptions among patients and family physicians

The objective of the study was to evaluate the health beliefs and knowledge about acne among acne patients and family physicians. A total of 100 patients referred to a dermatologist for management of acne vulgaris and 120 family physicians completed questionnaires. The questionnaires consisted of questions about health beliefs, the natural course of the disease, the causes of acne, and a set of questions about the knowledge of acne therapy. Acne was considered as a trivial and transitory condition by 52% of the acne patients and 44% of the family physicians. The overall score of correct answers pertaining to the causes of acne among the acne patients and family physicians was 11 and 15%, respectively. The percentage of correct answers regarding the natural course of the disease was 6% for both subsets of subjects. Acne was believed to be curable by 96% of acne patients. Most patients (66%) believed that acne would improve immediately after the first treatment. The knowledge of isotretinoin teratogenecity was reasonable among family physicians (55% correct answers), but it was much lower for other side effects (9%). The overall score of correct answers regarding antibiotic therapy among family physicians was only 21%. Impact of the disease was underestimated by family physicians and also by acne patients. Overall knowledge pertaining to the causes, natural course and therapy was very low. Myths and misconceptions still exist among patients but also among family physicians.     

Psychosocial health risk factors and resources of medical students and physicians: a cross-sectional study

Background  

Epidemiological data indicate elevated psychosocial health risks for physicians, e. g., burnout, depression, marital disturbances, alcohol and substance abuse, and suicide. The purpose of this study was to identify psychosocial health resources and risk factors in profession-related behaviour and experience patterns of medical students and physicians that may serve as a basis for appropriate health promoting interventions.     

Knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season: questionnaire study

Aim

To evaluate the knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season.

Method

A questionnaire with 20 questions was developed and sent to 232 family physicians in 3 largest Hungarian cities: Budapest, Debrecen, and Miskolc. The study was conducted in December 2009 and January 2010.

Results

A hundred and ninety eight (85%) physicians answered the questionnaire adequately. Respondents believed that the influenza outbreak represented less of a threat to their practices than to Hungary or the world as a whole. They mostly agreed that vaccination was important and were frequently dissatisfied with the support from health authorities. The proportion of vaccinated patients ranged between 2% and 53%, without differences according to geographical region, age, sex, and duration of physicians’ employment in family practice. Physicians who were satisfied with the payment for procedures and underwent vaccination themselves were more active in vaccination.

Conclusion

Health authorities should provide clear and evidence-based professional support to family physicians and should encourage them to get vaccinated against pandemic influenza, while insurance funds have to establish appropriate reimbursement system.In June 2009, the World Health Organization (WHO) announced the global pandemic of influenza A/California 07/09 (H1N1). In Hungary, the media and the leading Hungarian medical journal reported on the emergence of a novel strain of swine-origin virus (1). The symptoms were usually mild and prevention was important, with an emphasis on the adherence to hygiene and vaccination that was recommended for everyone at risk of becoming ill or of transmitting the virus. It was not recommended for pregnant women in the first trimester, due to a lack of experience with the vaccine in this population. The pandemic had been predicted by infectologists years before (2,3).The Hungarian government established the Committee for Pandemic, and family physicians were ordered to prepare weekly surveillance reports and lists of people who needed vaccinations. Posters on personal hygiene and behavior recommendations were displayed in public spaces (4) and at the end of the summer of 2009 thermo-gates were deployed at airports to detect incoming people with fever.Vaccination was provided free of charge for health care staff, inpatients in hospitals and nursing homes, people over 60 years of age, patients with chronic pulmonary or heart diseases, children and adults who were assumed to be in danger of infection, police officers, workers of the public transport and services, and patients on long-term aspirin treatment (2).Influenza AH1N1 variant arrived in Hungary in July 2009 (2,5). The Hungarian Fluval P (Omninvest, Pilisborosjenő, Hungary) vaccine was developed as a brand of the previously used Fluval H5N1 vaccine, containing thiomersal as preservative agent (6), which was added to other vaccines used in the USA as well (7). Clinical evaluation in Hungary started in August in line with the European Union regulations (8). After some modifications, the pharmaceutical authority allowed its use in adolescents and later in children.During the initial weeks, there were logistical problems with vaccine distribution. The vaccine was delivered by the local offices of the Chief Health Officer. For those who were vaccinated free of charge, the Hungarian Health Insurance Fund offered HUF 200 (cca € 0.75) extra payments to family physicians per injection. For those who were not vaccinated free of charge, the price was HUF 1000-1500 (€ 4-6) per injection.Through September and October 2009, lay press reported on a disagreement between experts on the safety and effectiveness of the vaccine. The most frequently discussed problem was the vaccination of pregnant women and children (1,3).Many family physicians lacked confidence in the vaccine and asked the patients to sign that they assume the responsibility for any side effects or complications. This practice was supported by the Medical Chamber and other professional organizations, but was prohibited by the Minister of Health. One of the patient organizations pressed charges against the government (9). There were family physicians who recommended the vaccination and others who dissuaded their patients from getting vaccinated. The issue whether to start an antiviral treatment with neuraminidase inhibitors was also widely discussed (10,11).For people who were vaccinated free of charge, a network of “vaccination-points” was organized by mid-November 2009 in the county offices of the health authority and in larger hospitals. At these points, the whole reimbursement was HUF 3000 ( ≈ € 11), covering the price of the vaccine and the procedure. However, some suspicions over the financial management of these points were raised (12).Different opinions on the effectiveness of the vaccine were published in daily newspapers and media broadcasts. Some opposition politicians suggested that key government officials were among the owners of the vaccine manufacturer (13). Many of the opposition politicians refused to be vaccinated, while prominent government members, including the Minister of Health, underwent vaccination in a highly publicized manner.In the mid-December, there were reports on deaths of mothers and their newborns attributable to H1N1. The position of the strongest opposition party toward vaccination then changed and the party opened its own “vaccination point” in the center of Budapest (14). One of the leading opposition politicians blamed the government for buying the cheaper vaccine (13). In October, 73% of the polled were against the vaccination and in November only 57% were against it, while 28% supported the vaccination and 15% hesitated. By mid-December, the ratio of vaccinated people was two times higher among the government supporters than among opposition supporters (13,15).The aim of this study was to evaluate the knowledge, motivation, and attitudes of family physicians regarding vaccination in the 2009/10 pandemic influenza season.     

Preparing the personal physician for practice: changing family medicine residency training to enable new model practice.

After two years of intensive study, in 2004 the Future of Family Medicine report concluded that the current U.S. health care system is inadequate and unsustainable, and called for changes within the specialty of family medicine to ensure the future health of the American public. With guidance and encouragement from many disciplines and health experts, a set of 10 recommendations was established to accomplish a transformative change in how family physicians serve their patients and how the essential function of primary care is achieved.From these recommendations came a period of innovation and experimentation in the training of family physicians, entitled Preparing the Personal Physician for Practice (P4). The P4 project is a carefully designed and evaluated initiative led by the American Board of Family Medicine and the Association of Family Medicine Residency Directors and administered by TransforMED, a practice redesign initiative of the American Academy of Family Physicians. Fourteen family medicine programs were chosen to participate and will put their innovations into practice from 2007 to 2012, during which time regular evaluation will be conducted. The purpose of P4 is to learn how to improve the graduate medical education of family physicians such that they are prepared to be outstanding personal physicians and to work in the new models of practice now emerging. The innovations tested by P4 residencies are expected to inspire substantial changes in the content, structure, and locations of training of family physicians and to guide future revisions in accreditation and certification requirements.     

Attitudes of faculty, housestaff, and medical students toward clinical practice guidelines.

PURPOSE: To examine attitudes of faculty, housestaff, and medical students toward clinical practice guidelines. METHOD: In a 1997 cross-sectional survey, a two-part, 26-item, self-administered questionnaire was mailed to all faculty, housestaff, and medical students in the department of internal medicine at Case Western Reserve University School of Medicine. The questionnaire asked for demographic information and attitudes toward clinical guidelines. RESULTS: Of 379 persons surveyed, 254 (67%) returned usable questionnaires: 56% of the medical students, 70% of the housestaff, and 73% of the full-time faculty. Medical students reported learning about guidelines predominantly during clerkships in internal medicine (71%) and pediatrics (68%). Overall, the respondents agreed most strongly that guidelines are "useful for the care of common problems," and least strongly that guidelines are "difficult to apply to individual patients" and "reduce physician options in patient care." Faculty were more likely to consider guidelines a "good educational tool" and less likely than were medical students and housestaff to agree that they promote "cookbook medicine." Of 11 influences on clinical decision making, the three groups together rated practice guidelines eighth or ninth. The use of guidelines for academic investigations was rated most appropriate, overall. In terms of their appropriateness, faculty consistently rated the use of guidelines more favorably except for use in malpractice suits. CONCLUSION: Faculty, housestaff, and medical students have significantly different perceptions of and attitudes toward clinical practice guidelines. Further studies are needed to explain the reasons for these differences. Considerable education and involvement must occur at all levels for practice guidelines to be successfully implemented and understood.     

Pediatric resident and faculty attitudes toward self-assessment and self-directed learning: a cross-sectional study

Background  

The development of self-assessment and self-directed learning skills is essential to lifelong learning and becoming an effective physician. Pediatric residents in the United States are now required to use Individualized Learning Plans (ILPs) to document self-assessment and self-directed learning. A better understanding of resident and faculty attitudes and skills about self-assessment and self-directed learning will allow more successful integration of lifelong learning into residency education. The objective of this study was to compare faculty and resident attitudes, knowledge and skills about self-assessment, self-directed learning and ILPs.     

Promotion of healthy lifestyle: knowledge and attitudes of primary care physicians

This study was conducted in Riyadh city to determine the knowledge and attitudes of primary health care physicians regarding promotion of certain healthy lifestyles. Using a stratification technique, 50% of the male physicians were selected at random. A validated self-administered questionnaire was distributed to (and recollected from) the participants. One physician refused to participate resulting in a response rate approaching 99%. Most of the physicians (77.5%) were shown to have satisfactory knowledge, while only 20% possessed reasonably positive attitudes. Physicians above 40 years of age were more knowledgeable than younger age group (P<0.0001). There was a general pessimism about compliance of patients to lifestyle advice. The relatively acceptable knowledge possessed by physicians was not properly translated into positive attitudes towards promotion of healthy lifestyle. To improve the situation, a greater emphasis should be placed on health promotion during undergraduate and postgraduate training of physicians.     

The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction

This study investigated the extent to which the individual orientations of physicians and patients and the congruence between them are associated with patient satisfaction. A survey was mailed to 400 physicians and 1020 of their patients. All respondents filled out the Patient-Practitioner Orientation Scale, which measures the roles that doctors and patients believe each should play in the course of their interaction. Patients also rated their satisfaction with their doctors. Among patients, we found that females and those who were younger, more educated, and healthier were significantly more patient-centered. However, none of these variables were significantly related to satisfaction. Among physicians, females were more patient-centered, and years in practice was related to satisfaction and orientation in a non-linear fashion. The congruence data indicated that patients were highly satisfied when their physicians either had a matching orientation or were more patient-centered. However, patients whose doctors were not as patient-centered were significantly less satisfied.