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Changes in medicine: the decline of physician autonomy  [cached]
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2011,
Abstract: No abstract available. Article truncated at 150 words. Thirty years ago when I left fellowship, there were predominantly two career paths, private practice or academics. I had chosen academics by virtue of doing a fellowship at a heavily research-based program, the National Institutes of Health (NIH). However, even at the NIH many of my colleagues eventually ended up in private practice, which was more lucrative and much more common than the academic practice I chose. Now a third path has become more common, practice as a hospital employee. I became a hospital employee over 30 years ago when I became a part-time, and later, full-time physician at a Department of Veterans Affairs (VA) medical center affiliated with a university. Apparently I was ahead of my time. In an article entitled “Majority of New Physician Jobs Feature Hospital Employment” 56% of physician search assignments by the national physician search firm Merritt Hawkins in 2011 were for hospitals (1). This …
Patient and Physician Willingness to Use Personal Health Records in the Emergency Department  [cached]
Anil S. Menon, MD, MS, MPH,Sally Greenwald, BA,Trisha J. Ma, MD,Shoreh Kooshesh, MD
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2012,
Abstract: Introduction: Patient care in the emergency department (ED) is often complicated by the inability toobtain an accurate prior history even when the patient is able to communicate with the ED staff.Personal health records (PHR) can mitigate the impact of such information gaps. This study assessesED patients’ willingness to adopt a PHR and the treating physicians’ willingness to use that information.Methods: This cross-sectional study was answered by 184 patients from 219 (84%) surveysdistributed in an academic ED. The patient surveys collected data about demographics, willingnessand barriers to adopt a PHR, and the patient’s perceived severity of disease on a 5-point scale. Eachpatient survey was linked to a treating physician survey of which 210 of 219 (96%) responded.Results: Of 184 surveys completed, 78% of respondents wanted to have their PHR uploaded onto theInternet, and 83% of providers felt they would access it. Less than 10% wanted a software company, aninsurance company, or the government to control their health information, while over 50% wanted ahospital to control that information. The patients for whom these providers would not have used a PHRhad a statistically significant lower severity score of illness as determined by the treating physician fromthose that they would have used a PHR (1.5 vs 2.4, P , 0.01). Fifty-seven percent of physicians wouldonly use a PHR if it took less than 5 minutes to access.Conclusion: The majority of patients and physicians in the ED are willing to adopt PHRs, especially ifthe hospital participates. ED physicians are more likely to check the PHRs of more severely ill patients.Speed of access is important to ED physicians.
Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology
Mandi L Furlow, Divya A Patel, Ananda Sen, J Rebecca Liu
BMC Complementary and Alternative Medicine , 2008, DOI: 10.1186/1472-6882-8-35
Abstract: Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized.Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM.Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.Complementary and Alternative Medicine (CAM) is defined by the U.S. National Center for Complementary and Alternative Medicine (NCCAM) as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine [1]. A landmark study by Eisenberg et al. published in 1993 was the first national survey of the use of CAM by the adult American public. This study estimated that one in three adults (34%) had used at least one complementary therapy during the past year and that this population made an estimated 425 million visits to practitioners of complementary therapy [2]. A follow-up national survey documented a 25% increase in prevalence of CAM use between 1990–1997 [3]. Between 1997 and 2002, these trends remained stable, and CAM use was reported by 72 million U.S. adults.Although the use of CAM to supplement conventional medical treatment is common among patients, att
Cosmetic medicine and medical practice: what is the physician’s obligation?  [cached]
Fernando Novoa
Medwave , 2012,
Abstract: Increasingly often, normal people ask their doctors for drug treatments or surgical interventions to modify various physical or mental aspects, under the idea that they constitute shortcomings. This type of request-based indication has been called "cosmetic medicine". Due to the magnitude, amount of resources allocated for these purposes, and the consequences that these interventions may entail for the patients, this new medical circumstance must be viewed as an important public health issue. It must be remembered that a clinician has no obligation to provide treatment upon request that is not medically indicated. Notwithstanding, it must be taken into account that the boundary between being ill or not, sometimes may be fuzzy even to medical experts. For this reason in some cases, the indication may be ethically acceptable. When the decision is made to indicate treatment under these circumstances, special precautions must be adopted. The decision must be shared between the physician and the patient-requester, who must be very well informed.
Emotional intelligence and empathy: its relevance in the clinical encounter
Burcher P
Patient Intelligence , 2011, DOI: http://dx.doi.org/10.2147/PI.S11070
Abstract: tional intelligence and empathy: its relevance in the clinical encounter Review (2848) Total Article Views Authors: Burcher P Published Date May 2011 Volume 2011:3 Pages 23 - 28 DOI: http://dx.doi.org/10.2147/PI.S11070 Paul Burcher Department of Philosophy, University of Oregon, Oregon Health Sciences University Abstract: The clinical relationship between patient and health care provider is an emotion-laden experience for both participants. Emotional intelligence has an obvious role in medicine on both sides of the clinical relation. This review examines the impact of emotional intelligence from both the patient and physician perspective. On the patient side, emotional intelligence may have a role in both acute and chronic illness, and the possibility of impacting health care utilization and treatment strategies deserve further exploration. For physicians, patient satisfaction and clinical outcomes may be improved by enhancing and valuing physician intelligence and empathy.
Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner
de Bruijn MC,Kollen BJ,Baarveld F
Open Access Journal of Sports Medicine , 2013,
Abstract: Matthijs C de Bruijn,1 Boudewijn J Kollen,2 Frank Baarveld21Center for Sports Medicine, 2Department of General Practice, University Medical Center Groningen, University of Groningen, The NetherlandsBackground: In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred.Methods: This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared.Results: A total of 234 patients were included (mean age 33.7 years, 59.1% male). Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred.Conclusion: In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further.Keywords: sports injuries, sports medicine physician, primary care, secondary care
Gender in medicine – an issue for women only? A survey of physician teachers' gender attitudes  [cached]
Risberg Gunilla,Johansson Eva E,Westman G?ran,Hamberg Katarina
International Journal for Equity in Health , 2003,
Abstract: Background During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. Method Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. Results The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. Conclusions To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.
Sports medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner
de Bruijn MC, Kollen BJ, Baarveld F
Open Access Journal of Sports Medicine , 2013, DOI: http://dx.doi.org/10.2147/OAJSM.S38073
Abstract: rts medicine in The Netherlands: consultation with a sports physician without referral by a general practitioner Original Research (480) Total Article Views Authors: de Bruijn MC, Kollen BJ, Baarveld F Published Date January 2013 Volume 2013:4 Pages 27 - 32 DOI: http://dx.doi.org/10.2147/OAJSM.S38073 Received: 13 September 2012 Accepted: 23 October 2012 Published: 25 January 2013 Matthijs C de Bruijn,1 Boudewijn J Kollen,2 Frank Baarveld2 1Center for Sports Medicine, 2Department of General Practice, University Medical Center Groningen, University of Groningen, The Netherlands Background: In The Netherlands, sports medicine physicians are involved in the care of about 8% of all sports injuries that occur each year. Some patients consult a sports physician directly, without being referred by a general practitioner. This study aims to determine how many patients consult a sports physician directly, and to explore differences in the profiles of these patients compared with those who are referred. Methods: This was an exploratory cross-sectional study in which all new patients presenting with an injury to a regional sports medical center during September 2010 were identified. The characteristics of patients who self-referred and those who were referred by other medical professionals were compared. Results: A total of 234 patients were included (mean age 33.7 years, 59.1% male). Most of the injuries occurred during soccer and running, particularly injuries of the knee and ankle. In this cohort, 39.3% of patients consulted a sports physician directly. These patients were significantly more often involved in individual sports, consulted a sports physician relatively rapidly after the onset of injury, and had received significantly less care before this new event from medical professionals compared with patients who were referred. Conclusion: In this study, 39.3% of patients with sports injuries consulted a sports physician directly without being referred by another medical professional. The profile of this group of patients differed from that of patients who were referred. The specific roles of general practitioners and sports physicians in medical sports care in The Netherlands needs to be defined further.
Patients' motives for choosing a physician: comparison between conventional and complementary medicine in Swiss primary care
Victoria Wapf, André Busato
BMC Complementary and Alternative Medicine , 2007, DOI: 10.1186/1472-6882-7-41
Abstract: The data were derived from the PEK study (Programm Evaluation Komplement?rmedizin), which was conducted in 2002–2003 with 7879 adult patients and parents of 1291 underage patients, seeking either complementary (CAM) or conventional (CONV) primary care. The study was performed as a cross-sectional survey. The respondents were asked to document their (or their children's) self-perceived health status, reasons governing their choice, and treatment expectations. Physicians were practicing conventional medicine and/or complementary methods (homeopathy, anthroposophic medicine, neural therapy, and traditional Chinese medicine). Reasons governing the choice of physician were evaluated on the basis of a three-part classification (physician-related, procedure-related, and pragmatic/other reasons)Patients seeing CAM physicians tend to be younger and more often female. CAM patients referred to procedure-related reasons more frequently, whereas pragmatic reasons dominated among CONV patients. CAM respondents expected fewer adverse side effects compared to conventional care patients.The majority of alternative medicine users appear to have chosen CAM mainly because they wish to undergo a certain procedure; additional reasons include desire for more comprehensive treatment, and expectation of fewer side-effects.Interest in and utilization of complementary and alternative medicine continue to grow in developing countries, including the USA [1-4]. Understanding the attractiveness of CAM is therefore crucial for providing better service in primary health care. The reasons of choice of patients for complementary medicine are based on both rational and emotional factors[5]. On one hand, those dissatisfied with orthodox medical treatment (who tend to cite impersonal service, low cost efficiency or general mistrust) turn to alternative medicine[1]. Others, in contrast, do not express such disappointment, but rather view CAM as supplementary measures in order to achieve the best possible
Sedation-assisted Orthopedic Reduction in Emergency Medicine: The Safety and Success of a One Physician/One Nurse Model
Vinson, David R,Hoehn, Casey
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2013,
Abstract: Introduction: Much of the emergency medical research on sedation-assisted orthopedic reductions has been undertaken with two physicians—one dedicated to the sedation and one to the procedure. Clinical practice in community emergency departments (EDs), however, often involves only one physician, who both performs the procedure and simultaneously oversees the crendentialed registered nurse who administers the sedation medication and monitors the patient. Although the dual-physician model is advocated by some, evidence in support of its superiority is lacking. Methods: In this electronic health records review we describe sedation-assisted closed reductions of major joints and forearm fractures in three suburban community EDs. The type of procedure and sedation medication, need for specialty assistance, success rates, and intervention-requiring adverse events are reported. Results: During the 18-month study period, procedural sedation was performed 457 times on 442 patients undergoing closed reduction for shoulder dislocations (n=111), elbow dislocations (n=29), hip dislocations (n=101), and forearm fractures (n=201). In the vast majority of this cohort (98.4% [435/442]), a single emergency physician simultaneously managed both the procedural sedation and the initial orthopedic reduction without the assistance of a second physician. The reduction was successful or satisfactory in 96.6% (425/435; 95% confidence interval [CI], 95.8-98.8%) of these cases, with a low incidence of intervention-requiring adverse events (2.8% [12/435]; 95% CI, 1.5-4.8%).Conclusion: Sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely in the ED using a one physician/one nurse model. A policy that requires a separate physician (or nurse anesthetist) to administer medications for all sedation-assisted ED procedures appears unwarranted. Further research is needed to determine which specific clinical scenarios might benefit from a dual-physician approach. [West J Emerg Med.2013;14(1):47-54.]
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