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Manning, Blaine T., Daniel D. Bohl, Charles P. Hannon, Michael L. Redondo, David R. Christian, Brian Forsythe, Shane J. Nho e Bernard R. Bach. "Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine". Orthopaedic Journal of Sports Medicine 6, n. 4 (1 aprile 2018): 232596711876687. http://dx.doi.org/10.1177/2325967118766873.
Testo completoAbstract (sommario):
Background: Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. Purpose: To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician’s midlevel provider to patients when initially selecting a physician. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Results: Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician’s midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. Conclusion: As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient satisfaction. Physicians may consider these data in clinical workforce planning, as patients preferred specific services to be physician or midlevel provided. It may be worthwhile to consider midlevel providers in marketing efforts, given that patients considered the credentials of the physician’s midlevel provider when initially selecting a new physician. Patients lacked consensus regarding reimbursement equity between physicians and midlevel providers, despite responding that the physician provides a higher-quality consultation. Our findings are important for understanding the midlevel workforce as it continues to grow in response to the increasing demand for orthopaedic sports care.
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Eberts, Margaret, e Daniel Capurro. "Patient and Physician Perceptions of the Impact of Electronic Health Records on the Patient–Physician Relationship". Applied Clinical Informatics 10, n. 04 (agosto 2019): 729–34. http://dx.doi.org/10.1055/s-0039-1696667.
Testo completoAbstract (sommario):
Abstract Objectives Limited studies have been performed in South America to assess patient and physician perceptions of electronic health record (EHR) usage. We aim to study the perceptions of patients and physicians regarding the impact of EHRs on the patient–physician relationship. Methods We use a survey instrument to assess the physician computer experience and opinions regarding EHR impact on various aspects of patient care. An additional survey is used to assess patient opinions related to their medical visit. Surveys are administered in two outpatient clinics in a private, academic health care network. Results While a majority of physicians believed that EHRs have an overall positive impact on the quality of health care, many physicians had negative perceptions of the impact of EHRs on the patient–physician relationship. A majority of patients felt comfortable with their physician's use of the EHR and felt that their physician was able to maintain good personal contact while using the computer. Conclusion Although physicians believe EHRs have a generally positive impact on the overall quality of care, the EHR's impact on the patient–physician relationship is still of concern. Patients do not perceive a negative interference from the EHR on the patient–physician relationship.
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Hsu, Yuan-Teng, Ya-Ling Chiu, Jying-Nan Wang e Hung-Chun Liu. "Impacts of physician promotion on the online healthcare community: Using a difference-in-difference approach". DIGITAL HEALTH 8 (gennaio 2022): 205520762211063. http://dx.doi.org/10.1177/20552076221106319.
Testo completoAbstract (sommario):
In this study, we use a difference-in-difference approach to explore how physician promotion, the advancement of a physician's offline reputation, affects patient behavior toward physicians in online healthcare communities; this allows us to explore how patients interpret the signals created by physician promotion. The study sample was collected from over 140,000 physician online profiles after 25 months of continuous observation, with 280 physicians who were promoted at month 13 as the treatment group and a control group obtained by propensity score matching. Our results show that a physician's promotion causes more patients to choose that physician, makes patients willing to give more psychological rewards, and makes them tend to give that physician a higher online rating. This implies that patient behavior is susceptible to the signal of physician promotion because the quality of the physician is unlikely to have changed significantly in the short term. These findings extend prior research on reputation in online communities and have crucial implications for theory and practice.
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Wyszkowska, Zofia, Katarzyna Białczyk e Tomasz Michalski. "Komunikacja pomiędzy lekarzem i pacjentem u chorych na nowotwory". Nierówności społeczne a wzrost gospodarczy 65, n. 1 (2021): 156–68. http://dx.doi.org/10.15584/nsawg.2021.1.9.
Testo completoAbstract (sommario):
The main goal of the study was to assess the doctor’s communication with the patient. The detailed goals concerned the assessment of satisfaction with the way the physician communicates with the patient, the assessment of the communication methods used, the duration of the visit to a physician’s office, understanding of the information provided to patients, the physician’s personal culture, and the subjectivity of the patient. A questionnaire developed specifically for the study objectives was used. The analysis used data from 238 questionnaires completed correctly by cancer patients treated in a specialist hospital. The database was created in Excel and the analysis was performed using Statistica software. The analysis of the data shows that the physician’s communication with the patient is a very important aspect in the treatment process. Not all respondents were satisfied with the way the physician communicated information about the further treatment process, which increased the sense of security loss and undermined confidence in the physician’s decisions. Most patients understood the recommendations and advice provided by the physician, but there was a group of respondents who did not understand all the words used by the physician, which may lead to the non-compliance of the patient to the treatment recommendations. Patients highly appreciated the personal culture of physicians but they expected greater subjectivity in their treatment. The analysis of statements indicated that the patients’ expectations in the area of physician – patient communication are growing, which obliges physicians to broaden their knowledge in communication techniques.
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Viswanath Bandi e Rao O R S. "Role of Physician’s Personality on their Drug Prescription Behavior". International Journal of Research in Pharmaceutical Sciences 11, n. 4 (19 dicembre 2020): 6954–61. http://dx.doi.org/10.26452/ijrps.v11i4.3700.
Testo completoAbstract (sommario):
Physicians Prescription behavior is the results of 4P's namely Product, Physicians, Promotion, and Patient's expectation. In today's world of evidence-based medicine with ever-growing demand in patient expectations, physician- Patient-centric managing a pathological condition is gaining acceptance from the normal disease management approach. Like all citizenry is Unique; similarly, physicians also possess a singular personality that responds differently even to an equivalent stimulus. Aiming for better patient care and Patient expectations, research work across the world has been administered for identifying the perfect physician personality traits right from selection of specialty, knowledge dissemination during the study period, and managing patients during the Practice sessions. However, there's little, or no research conducted thus far, in understanding the "Physician's personality" make-up focussing on their motives, values, preferences in their professional practice. Understanding "physician's personality" traits will lay a robust foundation for developing effective medico-marketing initiatives from the pharmaceutical industry with the assistance of smart and customized marketing initiatives resulting in a healthy environment for physician-Pharma association towards adopting better therapeutic interventions for patient benefit. This review is an effort to specialize in the research work done thus far in understanding the impact of "physician's personality" aimed toward improving patient care. Further research in understanding "Physician's personality" and its role in physicians prescribing decisions will help the Pharma industry towards developing much needed medico-marketing initiatives with optimal utilization of resources towards disseminating the latest therapeutic interventions to the physicians for better patient care which is the stepping stone for Physician-patient centric management.
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Williams, Carol A., e Monette T. Gossett. "Nursing Communication: Advocacy for the Patient or Physician?" Clinical Nursing Research 10, n. 3 (1 agosto 2001): 332–40. http://dx.doi.org/10.1177/c10n3r8.
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Communication among nurses, patients, and physicians is a key component of effective health care. In addition to communication with patients, nurses directly or indirectly influence physician-patient communications. This secondary analysis examined registered nurses' interactions with a simulated patient regarding what the physician had told the patient about the reason for hospitalization. Taped interviews (N = 86) were transcribed and content analyzed to classify nurses' approaches to assessment and intervention. The second researcher coded 10% of the transcripts to ensure satisfactory interrater consistency. Major patterns of nursing communication were the following: assessing what the physician had told the patient (85%), encouraging clarification with the physician (62%), encouraging a second opinion, and defending the physician's competence (9%). Findings support literature suggesting that nurses mediate and clarify communications between the patient and the physician. Patient advocacy was also illustrated; however, a small number of nurses advocated most clearly for the physician
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SHAPIRO, ROBYN S., KRISTEN A. TYM, DAN EASTWOOD, ARTHUR R. DERSE e JOHN P. KLEIN. "Managed Care, Doctors, and Patients: Focusing on Relationships, Not Rights". Cambridge Quarterly of Healthcare Ethics 12, n. 3 (luglio 2003): 300–307. http://dx.doi.org/10.1017/s0963180103123134.
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For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings.
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Ferreyro, Bruno L., Michael O. Harhay e Michael E. Detsky. "Factors associated with physicians’ predictions of six-month mortality in critically ill patients". Journal of the Intensive Care Society 21, n. 3 (3 luglio 2019): 202–9. http://dx.doi.org/10.1177/1751143719859761.
Testo completoAbstract (sommario):
Background Physician's estimates of a patient's prognosis are an important component in shared decision-making. However, the variables influencing physician's judgments are not well understood. We aimed to determine which physician and patient factors are associated with physicians' predictions of critically ill patients' six-month mortality and the accuracy and confidence of these predictions. Methods Prospective cohort study evaluating physicians' predictions of six-month mortality. Using univariate and multivariable generalized estimating equations, we assessed the association between baseline physician and patient characteristics with predictions of six-month death, as well as accuracy and confidence of these predictions. Results Our cohort was comprised 300 patients and 47 physicians. Physicians were asked to predict if patients would be alive or dead at six months and to report their confidence in these predictions. Physicians predicted that 99 (33%) patients would die. The key factors associated with both the direction and accuracy of prediction were older age of the patient, the presence of malignancy, being in a medical ICU, and higher APACHE III scores. The factors associated with lower confidence included older physician age, being in a medical ICU and higher APACHE III score. Conclusions Patient level factors are associated with predictions of mortality at six months. The accuracy and confidence of the predictions are associated with both physician and patients' factors. The influence of these factors should be considered when physicians reflect on how they make predictions for critically ill patients.
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Dalia, Samir, e Fred J. Schiffman. "Who's My Doctor? First-Year Residents and Patient Care: Hospitalized Patients' Perception of Their “Main Physician”". Journal of Graduate Medical Education 2, n. 2 (1 giugno 2010): 201–5. http://dx.doi.org/10.4300/jgme-d-09-00082.1.
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Abstract Background Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions. Intervention We created a survey to judge patient satisfaction and to determine who patients believe is their “main physician” on the teaching service. Methods Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages. Results Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician. Conclusion Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.
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He, Qijun, Yungeng Li, Zhiyao Wu e Jingjing Su. "Explicating the Cognitive Process of a Physician’s Trust in Patients: A Moderated Mediation Model". International Journal of Environmental Research and Public Health 19, n. 21 (4 novembre 2022): 14446. http://dx.doi.org/10.3390/ijerph192114446.
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Trust is considered a critical factor in the physician–patient relationship. However, little is known about the development and impact of physicians trusting their patients. A model that is premised on the integrated model of organizational trust was proposed in this article to reveal the cognitive processes involved in physicians’ trust, with perceived integrity and the ability of the patient as antecedents and the physicians’ communication efficacy as the outcome. A cross-sectional survey of 348 physicians in Zhejiang province, China, revealed that a physician’s trust in a patient mediated the relationship between the physicians’ perception of the integrity and ability of the patient, and the physician’s communication efficacy. The physicians’ educational backgrounds and work experience were also found to moderate an indirect effect: a lower level of education and longer work experience intensified the impact of the perceived integrity and ability of the patient on the physician’s trust, while shorter work experience made the association between the physician’s trust and communication efficacy more salient. This paper provided implications for both physician and patient sides.
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Prager, Elena, Vilsa E. Curto, Alexa Magyari, Marema Gaye e Anna D. Sinaiko. "Tiered Physician Network Plans and Patient Choices of Specialist Physicians". JAMA Network Open 6, n. 11 (9 novembre 2023): e2341836. http://dx.doi.org/10.1001/jamanetworkopen.2023.41836.
Testo completoAbstract (sommario):
ImportanceTiered physician network (TPN) health plans sort physicians into tiers based on their cost and quality, and patients pay lower copays for visits with physicians in the lower-cost and better-quality tiers. When the plans are first introduced, they lead patients to seek care from higher-value physicians.ObjectivesTo examine whether TPNs are associated with patient choice of physician when the plans have been in place for 8 to 12 years and whether there are inequities in patient out-of-pocket costs associated with inequities in access to physicians in lower-copay tiers.Design, Setting, and ParticipantsThis cross-sectional study comprising 46 645 physicians and 585 399 patients in TPNs, including 54 683 patients who had a new patient visit with a physician in a TPN, used health insurance claims data from a large employer purchaser from July 1, 2014, to June 30, 2019. Statistical analysis was performed from November 2020 to August 2023.ExposureEvaluation and management visit with a physician in a TPN.Main Outcomes and MeasuresMain outcomes were new patient market share per physician–carrier–zip code–year, distance from centroid of patient zip code to centroid of zip code of nearest low- or medium-copay physician, and mean TPN physician office visit copay per patient. A regression discontinuity design was used to estimate the association of a physician’s tier ranking, and a difference-in-differences analysis was used to estimate the association of copayment differences across tiers with market share among new patients. Equity in access was measured by comparing travel distance to the nearest physician in a low-copay or medium-copay tier and mean copayments across patient incomes.ResultsThe main analysis sample included 46 645 physician–carrier–zip code–year observations, 9506 (20.4%) of which were in the low-copay tier, 31 798 (68.2%) in the medium-copay tier, and 5341 (11.5%) in the high-copay tier. The 54 683 new patients in the sample had a mean (SD) age of 46.4 (16.7) years and included 33 542 women (61.3%). There was no association of having a worse tier ranking (0.045 percentage points [95% CI, −0.058 to 0.148 percentage points]) or of copayment differences between tiers (0.001 percentage points [95% CI, −0.002 to 0.004 percentage points]) with physician market share among new patients. The patients with the lowest income paid slightly lower mean (SD) copayments for office visits to a TPN physician than the patients with high income ($48.08 [$16.42] vs $51.59 [$16.79], a 6.8% difference).Conclusions and RelevanceIn this cross-sectional study of TPN health plans, there was no association between physician tier ranking and physician market share among any group of patients. These findings suggest there are limitations in TPNs’ steering of patients toward high-value physicians. These plans were not associated with exacerbated health inequity in this setting.
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Greenblum, Jake, e Ryan K. Hubbard. "Responding to religious patients: why physicians have no business doing theology". Journal of Medical Ethics 45, n. 11 (20 giugno 2019): 705–10. http://dx.doi.org/10.1136/medethics-2019-105452.
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A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship.
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Abdulkader, Rizwan Suliankatchi, Deneshkumar Venugopal, Kathiresan Jeyashree, Zainab Al Zayer, K. Senthamarai Kannan e R. Jebitha. "The Intricate Relationship Between Client Perceptions of Physician Empathy and Physician Self-Assessment: Lessons for Reforming Clinical Practice". Journal of Patient Experience 9 (gennaio 2022): 237437352210775. http://dx.doi.org/10.1177/23743735221077537.
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Objectives: Clinical empathy is an important predictor of patient outcomes. Several factors affect physician’s empathy and client perceptions. We aimed to assess the association between physician and client perception of clinical empathy, accounting for client, physician, and health system factors. Methods: We conducted a hospital-based cross-sectional study in 3 departments (family medicine, internal medicine, and surgery) of King Saud Medical City in Riyadh, Saudi Arabia. We interviewed 30 physicians and 390 clients from 3 departments. Physicians completed the Jefferson Scale of Empathy (JSE) and the clients responded to the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). We used a hierarchical multilevel generalized structural equation approach to model factors associated with JSE and JSPPPE and their inter-relationship. Results: Mean (SD) score of client-rated physician empathy was 26.6 (6) and that of physician self-rated was 111 (12.8). We found no association between the 2 ( b = 0.06; 95% confidence intervals CI: −0.1, 0.21), even after adjusting for client, physician, and health system factors. Physician's nationality (0.49; 0.12, 0.85), adequate consultation time (1.05; 0.72, 1.38), and trust (1.33; 0.9, 1.75) were positively associated whereas chronic disease (−0.32; −0.56, −0.07) and higher waiting times (−0.26; −0.47, −0.05) were negatively associated. Conclusion: A physician's self-assessed empathy does not correlate with clients’ perception. We recommend training and monitoring to enhance clinical empathy.
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Ma, Xiaojing, Chanhyun Park, Hsien-Chang Lin, Sweta Andrews e Jongwha Chang. "Factors associated with physician prescribing behavior of dipeptidyl peptidase-4 inhibitors for type 2 diabetes in the US outpatient population". Journal of Hospital Administration 6, n. 2 (7 marzo 2017): 59. http://dx.doi.org/10.5430/jha.v6n2p59.
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Objective: Although the use of dipeptidyl peptidase-4 (DPP-4) inhibitors has been increasing after their first approval in 2006, little is known about their prescribing pattern. Therefore, the objective of this study is to evaluate the prescribing pattern of the DPP-4 inhibitors for the treatment of type 2 diabetes mellitus (T2DM) and examine sociological factors associated with physician prescribing behavior in the U.S. outpatient setting.Methods: This cross-sectional study was conducted utilizing data from the 2006-2010 National Ambulatory Medical Care Survey (NAMCS) and employed the Eisenberg model that explains physician decision making in the context of sociologic influences. For independent variables, the following characteristics were determined based on the Eisenberg model: patient characteristics, physician characteristics, the physician-health care system interaction, and the physician-patient relationship. The dependent variable was the use of DPP-4 inhibitors. Multivariate logistic regressions were used for analyses.Results: The estimated population size was 535,158,796 patients during five years, and 3.85% of them were prescribed DPP-4 inhibitors. Among the patient characteristic-related factors, the odds of the use of DPP-4 inhibitors was 73% lower in patients with Medicaid compared to patients with private insurance (OR = 0.27; 95% CI, 0.08-0.88; p = .030). For the physician characteristic-related factor, the odds of prescribing DPP-4 inhibitors for primary care physicians are about 86% higher than the odds for non-primary care physicians (OR = 1.86; 95% CI, 1.17-2.95; p = .008). In addition, physicians in private offices were 3.01 times more likely to prescribe DPP-4 inhibitors than physicians in the health maintenance organizations (HMO) (OR = 3.01; 95% CI, 1.03-8.78; p = .043).Conclusions: Patient characteristics, physician characteristics, and the physician’s relationship with the health care system were associated with an increased use of DPP-4 inhibitors. However, the physician’s relationship with the patient was not associated with an increased use of DPP-4 inhibitors.
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Lee, Stephanie J., Anthony L. Back, Susan D. Block e Susan K. Stewart. "Enhancing Physician-Patient Communication". Hematology 2002, n. 1 (1 gennaio 2002): 464–83. http://dx.doi.org/10.1182/asheducation-2002.1.464.
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Abstract Physician-patient communication encompasses the verbal and nonverbal interactions that form the basis for the doctor-patient relationship. A growing body of research and guidelines development acknowledges that physicians do not have to be born with excellent communication skills, but rather can learn them as they practice the other aspects of medicine. Improvement in physician-patient communication can result in better patient care and help patients adapt to illness and treatment. In addition, knowledge of communication strategies may decrease stress on physicians because delivering bad news, dealing with patients’ emotions, and sharing decision making, particularly around issues of informed consent or when medical information is extremely complex, have been recognized by physicians as communication challenges. This paper will provide an overview of research aimed at improving patient outcome through better physician-patient communication and discuss guidelines and practical suggestions immediately applicable to clinical practice.
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Patel, Rikinkumar, Ramya Bachu, Archana Adikey, Meryem Malik e Mansi Shah. "Factors Related to Physician Burnout and Its Consequences: A Review". Behavioral Sciences 8, n. 11 (25 ottobre 2018): 98. http://dx.doi.org/10.3390/bs8110098.
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Physician burnout is a universal dilemma that is seen in healthcare professionals, particularly physicians, and is characterized by emotional exhaustion, depersonalization, and a feeling of low personal accomplishment. In this review, we discuss the contributing factors leading to physician burnout and its consequences for the physician’s health, patient outcomes, and the healthcare system. Physicians face daily challenges in providing care to their patients, and burnout may be from increased stress levels in overworked physicians. Additionally, the healthcare system mandates physicians to keep a meticulous record of their physician-patient encounters along with clerical responsibilities. Physicians are not well-trained in managing clerical duties, and this might shift their focus from solely caring for their patients. This can be addressed by the systematic application of evidence-based interventions, including but not limited to group interventions, mindfulness training, assertiveness training, facilitated discussion groups, and promoting a healthy work environment.
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Adamson, Matthew, Kelsey Choi, Stephen Notaro e Crina Cotoc. "The Doctor–Patient Relationship and Information-Seeking Behavior". Journal of Palliative Care 33, n. 2 (7 marzo 2018): 79–87. http://dx.doi.org/10.1177/0825859718759881.
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Background: In cancer communication, patients and physicians often understand a patient’s experience and situation differently. This can negatively impact health outcomes and the physician–patient relationship. Aim: To explore how cancer patients’ interpretations of the physician’s role as information giver affect the communication relationship with the physician and their information-seeking behavior regarding different aspects of their cancer care. Design: Participants completed a semistructured qualitative interview addressing their treatment experience and communication with their physician. Interviews were coded and analyzed using inductive thematic analysis. Setting/Participants: Ten patients with cancer treated at a regional cancer center in central Illinois participated in the study. Cancer stages I to IV and 4 cancer types were represented. Results: Participants’ orientations to the relationship with their physician (and their information-seeking behavior) were classified into 4 general categories: (1) “questioners” have a general mistrust toward their physicians and the information doctors are giving; (2) “the undecided” focuses on physician “fit,” often requiring time to step away in order to make decisions and process information; (3) “cross-checkers” are concerned with content of their treatment protocol, often double-checking the treatment plan; and (4) “the experience-oriented” feel a gap between their experience and their physician’s experience (and perspective), often seeking information from other survivors. All categories described a perceived lack of adequate exchange of information and the need to seek information outside of the physician–patient relationship to compensate. Conclusion: Participants exhibited different information-seeking behaviors based on how they interpreted the role of their physician as information giver. This affected what kind of information they sought and how they understood the information received, which in turn affected understanding of their broader experience and care.
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Siminoff, L. A., J. H. Fetting e M. D. Abeloff. "Doctor-patient communication about breast cancer adjuvant therapy." Journal of Clinical Oncology 7, n. 9 (settembre 1989): 1192–200. http://dx.doi.org/10.1200/jco.1989.7.9.1192.
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Candidates for breast cancer adjuvant therapy must not only grapple with the concept of micrometastatic disease, but often must consider the benefits and risks of clinical trials and alternatives. We studied 100 consecutive patient-physician encounters about adjuvant therapy to determine how well we informed patients about benefits and risks and how clearly we recommended treatment. Evaluation included observation and audiorecording of encounters, patient- and physician-completed questionnaires, and patient interviews. Patient-physician agreement on the benefits and risks of adjuvant therapy was poor. Sixty percent of patients overestimated their chance of cure by 20% or more compared with the physician. Poor agreement was partially explained by the observation that patients and physicians exchanged little specific information. Furthermore, decision-making was compressed. Although this was the first meeting with a medical oncologist for 79 patients (79%), 82 (82%) made final decisions about treatment by the end of the meeting. Physicians clearly identified their recommended treatment. Patients generally followed the physician's recommendation, except when clinical trials were recommended. Only 45% of trial-eligible patients chose to participate in offered trials. Physician recommendations of clinical trials were not as effectively communicated as nontrial treatments. Nonstandard adjuvant regimens, similar to the experimental arm of some ongoing randomized trials, were recommended to 30% of patients, especially those with a poor prognosis. In essence, physicians acted as if the trial question was answered, thereby diminishing enthusiasm for the trial. The widespread recommendation of nonstandard regimens similar or identical to the experimental arms in ongoing trials suggests a serious lack of consensus on what questions to ask in clinical trials and whether or not those questions have been answered.
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Fu, Yanhong, David Schwebel e Guoqing Hu. "Physicians’ Workloads in China: 1998–2016". International Journal of Environmental Research and Public Health 15, n. 8 (3 agosto 2018): 1649. http://dx.doi.org/10.3390/ijerph15081649.
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Background: Physicians play a primary role in patients’ health. Heavy workloads can threaten the health of physicians and their patients. This study examined workload changes among physicians in Chinese health institutions from 1998–2016. Methods: This study examined data from the online China Statistical Yearbook of 1999–2017, which is released annually by the National Bureau of Statistics of the People’s Republic of China. Three relevant and available indicators were retrieved: (1) number of physicians, (2) number of patient visits and (3) number of inpatient admissions. Patient visits per physician and inpatient admissions per physician from 1998–2016 were calculated to approximate physician workloads in Chinese health institutions. Results: Between 1998 and 2016, patient visits per physician in China increased by 135% and inpatient admissions per physician rose by 184%. Both indicators demonstrate a stabilizing trend in the most recent five years, including a slight decrease (7%) in patient visits per physician since 2012. Conclusions: Physician workload increased dramatically for Chinese physicians from 1998–2016, a trend that could potentially threaten physicians’ health and the quality of patient care. The findings highlight the importance of interventions and efforts to relieve physician workloads in China.
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Mandell, Harvey N. "Physician-Patient, Physician-Patient's Physician". Postgraduate Medicine 82, n. 6 (novembre 1987): 40–44. http://dx.doi.org/10.1080/00325481.1987.11700025.
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Talen, Mary R., Jeffrey Rosenblatt, Christina Durchholtz e Geraldine Malana. "Turning the tables: Using resident physicians’ experiences as patients for leveraging patient-centered care". International Journal of Psychiatry in Medicine 53, n. 5-6 (25 settembre 2018): 405–14. http://dx.doi.org/10.1177/0091217418802163.
Testo completoAbstract (sommario):
Training physicians to become person-centered is a primary goal of behavioral health curriculum. We have curriculum on doctor–patient communication skills and patient narratives to help physicians relate to the patient’s experiences. However, there is nothing more effective than actually being the patient that gives providers an “aha” experience of the patient’s perspective. In this article, we will share personal resident physician-patient stories based on their experiences within acute urgent care, chronic disease management, and routine well health care. In each narrative, the physician-patient will describe how their experiences had an impact in three areas: (1) their professional identity, (2) their connection with patients, and (3) their experience of the health-care system and teams. Drawing from the key emotional and cognitive experiences from these stories, we will identify training strategies that can bridge the personal to professional experiences as a way to enhance person-centered care. Our goal is to use the physician’s insider perspective on the patient experience as a means to augment the awareness of professional physician role, team-based care, and navigating the health-care system.
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Ogura, Hiromu, Ryoko Nakagawa, Miwako Ishido, Yoko Yoshinaga, Jun Watanabe, Kanako Kurihara, Yuka Hayashi et al. "Evaluation of Motor Complications in Parkinson’s Disease: Understanding the Perception Gap between Patients and Physicians". Parkinson's Disease 2021 (22 dicembre 2021): 1–8. http://dx.doi.org/10.1155/2021/1599477.
Testo completoAbstract (sommario):
Background. Patients with Parkinson’s disease (PD) receiving levodopa treatment often report motor complications including wearing-off (WO), dyskinesia, and morning akinesia. As motor complications are associated with a decrease in patients’ quality of life (QoL), it is important to identify their occurrence and commence immediate management. This study investigated whether differences in the perception of motor complications exist between patients and their physicians in routine clinical practice. Methods. After an Internet-based screening survey, questionnaires were distributed to physicians and their patients in Japan. The 9-item Wearing-Off Questionnaire (WOQ-9) was used to objectively assess the presence of WO; patients with WOQ-9 scores ≥2 were considered to have WO. McNemar’s test was used to compare physician assessment versus WOQ-9 scores, patient self-awareness versus physician assessment, and patient self-awareness versus WOQ-9, separately. Morning akinesia and dyskinesia were assessed by both physician assessment and patient self-awareness with McNemar’s test. QoL was assessed using the 8-item Parkinson’s Disease Questionnaire (PDQ-8) with the Wilcoxon rank-sum test. Results. A total of 235 patients with PD and their 92 physicians participated in this survey. A significant discordance was observed between the WOQ-9 and physician assessment of WO (67.2% vs 46.0%; p < 0.0001 ). Furthermore, patient self-awareness of WO was 35.3% ( p = 0.0004 , vs physician). Morning akinesia (patient, 58.7%; physician, 48.9%; p = 0.0032 ), dyskinesia (patient, 34.0%; physician, 23.4%; p = 0.0006 ), and bodily discomfort (patient, 25.0; physician, 0.0; p = 0.0102 ) of QoL were underrecognized by physicians. Conclusions. This study investigated differences in the perception of WO between patients with PD and their physicians in routine clinical practice and highlighted that patients have a low awareness of the symptoms of WO compared with physician assessments and WOQ-9. Conversely, morning akinesia, dyskinesia, and bodily discomfort were underrecognized by physicians.
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Hagihara, Akihito, e Kimio Tarumi. "Patient and Physician Perceptions of the Physician's Explanation and Patient Responses to Physicians". Journal of Health Psychology 14, n. 3 (aprile 2009): 414–24. http://dx.doi.org/10.1177/1359105309102194.
Testo completo
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Mann, Joshua R., Scott McKay, Damon Daniels, C. Scott Lamar, Patricia W. Witherspoon, Michele K. Stanek e Walter L. Larimore. "Physician Offered Prayer and Patient Satisfaction". International Journal of Psychiatry in Medicine 35, n. 2 (giugno 2005): 161–70. http://dx.doi.org/10.2190/2b0q-2gw0-80l9-n3tk.
Testo completoAbstract (sommario):
Objective: While there is ongoing debate about the role of physician-offered prayer during the physician-patient encounter, many physicians feel inclined to include prayer in their practices. This randomized-controlled trial evaluated patients' acceptance of physician-offered prayer in a family practice setting, and the impact of physician-offered prayer on patient satisfaction with the physician-patient encounter. Method: Subjects were 137 patients in an urban, largely African American, Southeastern family medicine practice who were randomized to receive usual care plus an offer of physician-led prayer or usual care alone. Satisfaction surveys were administered following the clinical encounter. The outcomes of interest were the rate of acceptance of physician-offered prayer and the impact of the prayer offer on patient satisfaction. Personal characteristics and satisfaction scores for patients accepting prayer were compared to those for patients declining prayer. Results: Over 90% of patients accepted the offer of prayer. The offer of prayer had no significant impact on patient satisfaction scores. The number of patients declining prayer was too low to permit comparison of prayer decliners with acceptors. Conclusions: This small pilot trial demonstrated that patient responses to spiritual interventions by physicians can be evaluated using randomized study designs. A large majority of patients accepted an offer of physician-led prayer, but no significant short-term impact on patient satisfaction was detected. Future research with larger sample sizes and more diverse patient populations should evaluate the effects of physician-offered prayer on the physician-patient relationship. Difficulties in conducting such research are discussed.
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Hamel, Lauren M., Robert Moulder, Louis Penner, Terrance Lynn Albrecht, Steven Boker, David W. Dougherty e Susan Eggly. "Nonconscious nonverbal synchrony and patient and physician affect and rapport in cancer treatment discussions with black and white patients." Journal of Clinical Oncology 38, n. 29_suppl (10 ottobre 2020): 121. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.121.
Testo completoAbstract (sommario):
121 Background: Clinical communication is poorer with Black patients than with White patients, but most studies are limited to verbal communication. Nonverbal synchrony, the nonconscious coordination of movement between individuals, has been shown to reflect relationship quality. We investigated nonverbal synchrony’s association with patient and physician affect and rapport in cancer treatment discussions, and if those associations differed by patient race. Methods: We used motion detection software to measure overall synchrony and synchrony based on who is leading in the interaction (similar to leading in dancing) in video recordings of 68 Black patients and 163 White patients discussing treatment with their physicians. Naïve observers rated the interaction for six constructs: patient and physician positive and negative affect and patient-physician positive and negative rapport. We examined associations between patient race, nonverbal synchrony and the six constructs. Results: In interactions with Black patients, overall synchrony was positively associated with patients’ positive affect and positive patient-physician rapport and negatively associated with patients’ negative affect and negative patient-physician rapport. When the physician was leading, synchrony was positively associated with patients’ positive affect and positive patient-physician rapport and negatively associated with patients’ negative affect and negative patient-physician rapport. When the patient was leading, synchrony was positively associated with patients’ and physicians’ positive affect and positive patient-physician rapport, and negatively associated with patients’ negative affect and negative patient-physician rapport. In interactions with White patients, overall synchrony was positively associated with patient positive affect; when the physician was leading, synchrony was negatively associated with patient negative affect. Conclusions: This is the first study to use a dynamic, jointly-determined measure in patient-physician communication. Synchrony was related to patient and physician affect and rapport in interactions with Black patients, but only patient affect in interactions with White patients, suggesting nonverbal synchrony is particularly important in interactions with Black patients. Next, we will investigate associations with patient outcomes, such as satisfaction. Findings could contribute to physician training to enhance coordination and outcomes in oncology interactions.
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Hamel, Lauren M., Robert Moulder, Louis Penner, Terrance Lynn Albrecht, Steven Boker, David W. Dougherty e Susan Eggly. "Nonconscious nonverbal synchrony and patient and physician affect and rapport in cancer treatment discussions with black and white patients." Journal of Clinical Oncology 38, n. 15_suppl (20 maggio 2020): 12116. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.12116.
Testo completoAbstract (sommario):
12116 Background: Clinical communication is poorer with Black patients than with White patients, but most studies are limited to verbal communication. Nonverbal synchrony, the subtle, nonconscious coordination of movement between individuals, has been shown to reflect relationship quality. We investigated nonverbal synchrony’s association with patient and physician affect and rapport in cancer treatment discussions, and if those associations differed by patient race. Methods: We used motion detection software to measure overall synchrony and synchrony based on who is leading in the interaction (similar to leading in dancing) in video recordings of 68 Black patients and 163 White patients discussing treatment with their non-Black physicians. Additionally, naïve observers rated the interaction for six constructs: patient and physician positive and negative affect and patient-physician positive and negative rapport. We examined associations between nonverbal synchrony and the six constructs. Results: In interactions with Black patients, overall synchrony was positively associated with patients’ positive affect and positive patient-physician rapport and negatively associated with patients’ negative affect and negative patient-physician rapport. When the physician was leading, synchrony was positively associated with patients’ positive affect and positive patient-physician rapport and negatively associated with patients’ negative affect and negative patient-physician rapport. When the patient was leading, synchrony was positively associated with patients’ and physicians’ positive affect and positive patient-physician rapport, and negatively associated with patients’ negative affect and negative patient-physician rapport. In interactions with White patients, overall synchrony was positively associated with patient positive affect; when the physician was leading, synchrony was negatively associated with patient negative affect. Conclusions: This is the first study to use an innovative measure of dynamic communication in patient-physician cancer treatment discussions. Nonverbal synchrony was related to patient and physician affect and rapport in interactions with Black patients, but only patient affect in interactions with White patients, suggesting nonverbal synchrony is particularly important in interactions with Black patients. Next steps include investigating associations with patient outcomes (e.g., satisfaction). Findings could contribute to physician training.
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Matsuoka, Katsuyoshi, Hirono Ishikawa, Takeo Nakayama, Yusuke Honzawa, Atsuo Maemoto, Fumihito Hirai, Fumiaki Ueno, Noriko Sato, Yutaka Susuta e Toshifumi Hibi. "Physician–patient communication affects patient satisfaction in treatment decision-making: a structural equation modelling analysis of a web-based survey in patients with ulcerative colitis". Journal of Gastroenterology 56, n. 9 (27 luglio 2021): 843–55. http://dx.doi.org/10.1007/s00535-021-01811-1.
Testo completoAbstract (sommario):
Abstract Background The relationship of bidirectional sharing of information between physicians and patients to patient satisfaction with treatment decision-making for ulcerative colitis (UC) has not been examined. Here, we conducted a web-based survey to evaluate this relationship. Methods Patients aged ≥ 20 years with UC were recruited from the IBD Patient Panel and Japanese IBD Patient Association. Patients completed our web-based survey between 11 May and 1 June 2020. The main outcomes were patient satisfaction (assessed by the Decision Regret Scale) and patient trust in physicians (assessed by the Trust in Physician Scale). Results In this study (n = 457), a structural equation modelling analysis showed that physician-to-patient and patient-to-physician information significantly affected patient satisfaction with treatment decision-making (standardised path coefficient: 0.426 and 0.135, respectively) and patient trust in physicians (0.587 and 0.158, respectively). Notably, physician-to-patient information had a greater impact. For patient satisfaction with treatment decision-making and patient trust in physicians, information on “disease” (indirect effect: 0.342 and 0.471, respectively), “treatment” (0.335 and 0.461, respectively), and “endoscopy” (0.295 and 0.407, respectively) was particularly important, and the level of this information was adequate or almost adequate. Patient-to-physician information on “anxiety and distress” (0.116 and 0.136, respectively), “intention and desire for treatment” (0.113 and 0.132, respectively), and “future expectations of life” (0.104 and 0.121, respectively) were also important for patient satisfaction with treatment decision-making and patient trust in physicians, but these concerns were not adequately communicated. Conclusions Adequate physician–patient communication, especially physician-to-patient information, enhanced patient satisfaction with treatment decision-making for UC.
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Bruera, Eduardo, Catherine Sweeney, Kathryn Calder, Lynn Palmer e Suzanne Benisch-Tolley. "Patient Preferences Versus Physician Perceptions of Treatment Decisions in Cancer Care". Journal of Clinical Oncology 19, n. 11 (1 giugno 2001): 2883–85. http://dx.doi.org/10.1200/jco.2001.19.11.2883.
Testo completoAbstract (sommario):
PURPOSE: To examine patient preferences as well as physician perceptions of these preferences for decision making and communication in palliative care. PATIENTS AND METHODS: Medical decision-making preferences (DMPs) were prospectively studied in 78 assessable cancer patients after initial assessment at a palliative care outpatient clinic. DMPs were assessed with a questionnaire using five possible choices ranging from 1 (patient prefers to make the treatment decision) to 5 (patient prefers the physician to make the decision). In addition, the physician’s perception of this preference was assessed. RESULTS: Full concordance between the physician and the patient was seen in 30 (38%) of 78 cases; when the five original categories were recombined to cover active, shared, and passive decision making, there was concordance in 35 (45%) of 78 cases. The kappa coefficient for agreement between physician and patient was poor at 0.14 (95% confidence limit, −0.01 to 0.30) for simple kappa and 0.17 (95% confidence interval [CI], 0.00 to 0.34) for weighted kappa (calculated on the three regrouped categories). Active, shared, and passive DMPs were chosen by 16 (20%) of 78, 49 (63%) of 78, and 13 (17%) of 78 patients, and by 23 (29%) of 78, 30 (39%) of 78, and 25 (32%) of 78 physicians, respectively. The majority of patients (49 [63%] of 78; 95% CI, 0.51 to 0.74) preferred a shared approach with physicians. Physicians predicted that patients preferred a less shared approach than they in fact did. Patient age or sex did not significantly alter DMP. CONCLUSION: An individual approach is needed and each patient should be assessed prospectively for DMP.
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DiMatteo, M. Robin, Carolyn B. Murray e Summer L. Williams. "Gender Disparities in Physician-Patient Communication Among African American Patients in Primary Care". Journal of Black Psychology 35, n. 2 (9 febbraio 2009): 204–27. http://dx.doi.org/10.1177/0095798409333599.
Testo completoAbstract (sommario):
This study investigates the role of gender in physician-patient communication among African American patients in primary care. Patients (N = 137) aged 33 to 67 were nested within 79 southern California primary care physicians' practices. In 48 interactions (35%), the physician was female and/or a member of a minority group. The study directly assessed gender differences through audiotaped physician-patient interactions as well as by measuring patients' and physicians' perceptions of their visit. This study employed a multi-informant design, in which independent raters assessed both physician and patient in audiotaped interactions, and both physician and patient self-reported on aspects of their visit. Discussions of prevention and health promotion were found to be significantly more common with male patients than with female patients but only when the physician was a nonminority male; these disparities disappeared when the physician was female and/or minority. Findings are discussed in terms of physician training, particularly for men and nonminorities.
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Hersh, Eitan D., e Matthew N. Goldenberg. "Democratic and Republican physicians provide different care on politicized health issues". Proceedings of the National Academy of Sciences 113, n. 42 (3 ottobre 2016): 11811–16. http://dx.doi.org/10.1073/pnas.1606609113.
Testo completoAbstract (sommario):
Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians’ own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians’ political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues—and only on such issues—Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician’s political attitudes might affect patient care is important to physicians and patients alike.
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Antoszewska, Beata, e Aleksandra Tobota. "Relationship with a physician in the narratives of children and adolescents hospitalized due to cancer". Men Disability Society 44, n. 2 (30 giugno 2019): 99–110. http://dx.doi.org/10.5604/01.3001.0013.5768.
Testo completoAbstract (sommario):
The key value of the physician-patient relationship has been strongly emphasized in scientific literature for a long time. This relationship impacts significantly the patient’s therapeutic process. In case of children and adolescents suffering from cancer, the relationship with physician is of a specific value due to both the age of such patients and the type of disease. Children and adolescents meet various specialists (physicians) during their treatment; however, they establish a long-term and quite intensive relationship with their treating physician. This relationship is, by definition, most important during intensive and maintenance therapy. The physician’s involvement is indisputable and it is directly related to the therapeutic process and its success. However, what is also extremely important is the physician’s interest in a particular patient and a personalized nature of this relationship: treating physician (subject) – child (subject). The manner in which the physician communicates with and treats his or her patient has a significant impact on the patient’s wellbeing during treatment and afterwards. The relationship with a physician also determines the patient’s subjectivity and self-esteem in later everyday life. The paper presents the results of research focused on the opinions of children and adolescents concerning relationships with their treating physicians. The study was conducted in three institutions which belong to the Polish Paediatric Leukaemia and Lymphoma Study Group. It involved 62 children aged 7–17 years old at different stages of their cancer treatment.
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Gordon, Howard S., Richard L. Street, Barbara F. Sharf, P. Adam Kelly e Julianne Souchek. "Racial Differences in Trust and Lung Cancer Patients' Perceptions of Physician Communication". Journal of Clinical Oncology 24, n. 6 (20 febbraio 2006): 904–9. http://dx.doi.org/10.1200/jco.2005.03.1955.
Testo completoAbstract (sommario):
Purpose Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment. Patients and Methods Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale. Results Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors. Conclusion Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.
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Ellis, P. M., S. J. Dimitry, M. A. O’Brien, C. A. Charles e T. J. Whelan. "A comparison of patient and physician attributes that promote patient involvement in treatment decision making in the oncology consultation". Journal of Clinical Oncology 24, n. 18_suppl (20 giugno 2006): 6098. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6098.
Testo completoAbstract (sommario):
6098 Background: Cancer patients have indicted a desire to be more involved in treatment decision making (TDM). However, little is known about the attributes of patients, physicians and their interaction that promotes patient involvement in TDM in the oncology consultation. This study compared attributes generated by patients and physicians that make it easier for patients to be involved in TDM. Methods: Semi-structured interviews were undertaken with 19 patients with cancer (lung, breast, prostate, GI) and 21 medical and radiation oncologists at a regional cancer centre. Participants were asked to identify attributes of physicians, patients and their interaction that promotes patient involvement in TDM. Interview transcripts were independently coded by 2 analysts using decision rules to identify specific attributes. Attributes identified by each analyst were compared and a high level of agreement was found. The analysts then independently compared the physician and patient generated lists and identified common vs unique items. There was a high level of agreement on which attributes were common to both lists versus unique. Results: Oncologists identified 173 physician, 59 patient and 9 interaction items. Patients identified 50 physician, 42 patient and 11 interaction items. Patients and physicians identified 17 common physician items, 29 common patients items and 1 common interaction item. Physicians identified 138 more attributes than patients, most of which were physician related. Common patient attributes centred on information seeking (eg prepare for the consultation by reading, be aware of all treatment options and question the options). Common physician attributes focused on specific communication behaviors (eg, make eye contact, tailor information to patient needs, be direct with patients, ensure patient understands information). The common interaction item was to keep the discussion informal. Conclusions: Patients and physicians appear to have different ideas about what is important to promote patient involvement in TDM. Many of the attributes identified can be easily incorporated into current practice. There is a need to develop and evaluate communication skills training to promote patient involvement in TDM. No significant financial relationships to disclose.
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Fang, Hai, e John A. Rizzo. "Information-oriented patients and physician career satisfaction: is there a link?" Health Economics, Policy and Law 6, n. 3 (12 agosto 2010): 295–311. http://dx.doi.org/10.1017/s1744133110000186.
Testo completoAbstract (sommario):
AbstractPatients’ increasing use of alternative sources of information besides their physician and more active involvement in medical decision making may be changing relationships between physicians and their patients. We term patients who provide medical information to their physicians from sources other than their physician as information-oriented patients and investigate the relationship between having such patients and physician career satisfaction. We find that having more information-oriented patients is significantly associated with lower physician career satisfaction. Though healthcare information from alternative sources other than their physicians is thought to promote better-informed patient choices, the adverse relationship with physician career satisfaction found in this study may have important implications for patient access and quality of care.
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Senitan, Mohammed, e James Gillespie. "Health-Care Reform in Saudi Arabia: Patient Experience at Primary Health-Care Centers". Journal of Patient Experience 7, n. 4 (3 settembre 2019): 587–92. http://dx.doi.org/10.1177/2374373519872420.
Testo completoAbstract (sommario):
The aim of this study was to assess the relationship between patients’ demographics, the quality of physician–patient communication, care coordination, and the overall satisfaction rating in primary health-care centers (PHCs). A cross-sectional study was conducted using a patient experience tool. A convenience sample of 157 patients visiting PHCs were retrieved from 10 out of the 13 Saudi regions. A total of 81% of the overall ratings could be attributed to the predictors included in the model. The highest predictor of the overall rating in this model was physicians answering of patient questions, followed by time spent with the physician, type of PHC, and the abilities of the physician to listen carefully, explain things clearly, and show respect. The weakest predictors were follow-up by the health-care provider and physician’s knowledge of the patient’s medical history. Our findings suggest that to improve the overall patient experience and the quality of care at PHCs requires extra attention to physician–patient communication. To improve quality, safety, and efficiency, the Ministry of Health should ensure interpretation service for patients at PHCs either public or private. The Saudi Central Board for Accreditation of Healthcare Institutions should enhance the physician–patient communication as part of their standards for accrediting PHCs.
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Adelman, Ronald D., Michele G. Greene, Erika Friedmann, Marcia G. Ory e Caitlin E. Snow. "Older Patient–Physician Discussion About Exercise". Journal of Aging and Physical Activity 19, n. 3 (luglio 2011): 225–38. http://dx.doi.org/10.1123/japa.19.3.225.
Testo completoAbstract (sommario):
This cross-sectional observational study examined the frequency of older patient–physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician’s being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.
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Khana, Rajes, Manmeet Mahinderjit Singh, Faten Damanhoori e Norlia Mustaffa. "Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study". JMIR Medical Informatics 8, n. 9 (23 settembre 2020): e21584. http://dx.doi.org/10.2196/21584.
Testo completoAbstract (sommario):
Background Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient’s personal medical data excessively with colleagues or the public. Such an act would reduce the physician’s trustworthiness from the patient’s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient’s recommendation regarding the physician’s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty.
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Moslehpour, Massoud, Anita Shalehah, Ferry Fadzlul Rahman e Kuan-Han Lin. "The Effect of Physician Communication on Inpatient Satisfaction". Healthcare 10, n. 3 (1 marzo 2022): 463. http://dx.doi.org/10.3390/healthcare10030463.
Testo completoAbstract (sommario):
(1) Background: The importance of physician-patient communication and its effect on patient satisfaction has become a hot topic and has been studied from various aspects in recent years. However, there is a lack of systematic reviews to integrate recent research findings into patient satisfaction studies with physician communication. Therefore, this study aims to systematically examine physician communication’s effect on patient satisfaction in public hospitals. (2) Methods: Using a keywords search, data was collected from five databases for the papers published until October 2021. Original studies, observational studies, intervention studies, cross-sectional studies, cohort studies, experimental studies, and qualitative studies published in English, peer-reviewed research, and inpatients who communicated with the physician in a hospital met the inclusion criteria. (3) Results: Overall, 11 studies met the inclusion criteria from the 4810 articles found in the database. Physicians and organizations can influence two determinants of inpatient satisfaction in physician communication. Determinants of patient satisfaction that physicians influence consist of amounts of time spent with the patient, verbal and nonverbal indirect interpersonal communication, and understanding the demands of patients. The organization can improve patient satisfaction with physician communication by the organization’s availability of interpreter service and physician workload. Physicians’ communication with inpatients can affect patient satisfaction with hospital services. (4) Conclusions: To improve patient satisfaction with physician communication, physicians and organizational determinants must be considered.
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Jácome, Cristina, Ana Margarida Pereira, Rute Almeida, Manuel Ferreira-Magalhaes, Mariana Couto, Luís Araujo, Mariana Pereira et al. "Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts". BMJ Open 9, n. 11 (novembre 2019): e031732. http://dx.doi.org/10.1136/bmjopen-2019-031732.
Testo completoAbstract (sommario):
ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal.Participants395 patients (≥13 years old) with persistent asthma.MeasuresData on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0–50; medium 51–80; high 81–100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients’ and physicians’ VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation.ResultsHigh inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65–95) mm; 53% VAS>80) and by physicians (84 (68–95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%).ConclusionAlthough both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
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Chikodiri Nwosu, Laurine, Great Iruoghene Edo, Mehmet Yesiltas, Endurance Agoh e Rashidat Adelola Lawal. "Evaluation of factors influencing physician–patient communication in healthcare service delivery". BOHR International Journal of General and Internal Medicine 2, n. 1 (2022): 22–28. http://dx.doi.org/10.54646/bijgim.2023.15.
Testo completoAbstract (sommario):
Physician–patient communication has received less focus in the study of healthcare service delivery in Nigeria. The majority of communication relies on message delivery rather than interpersonal communication. Even when doctors have significant knowledge to share with their patients, they frequently lack the interpersonal communication skills required to do it successfully. This quantitative study employed the analysis of 150 valid responses from practicing physicians in Lagos state. Descriptive statistics were carried out to understand the factors influencing physician–patient communication. The results revealed good communication skills among physicians as they agreed to have social conversations with patients, listen intently to them, and promote question-asking. The responses from the survey also revealed that factors such as limited consultation time and unfavorable working environments could negatively impact physician–patient communication. Furthermore, the test hypothesis revealed a significant correlation between physicians’ age and gender (p < 0.05), whereas physicians’ ethnicity and religion had non-significant associations. The evaluation of factors influencing physician–patient communication revealed that several individual and contextual factors contribute to effective communication, including physician communication skills, patient health literacy, and system-level factors such as time constraints and workload. Healthcare organizations and policymakers should prioritize efforts to improve physician–patient communication by addressing the identified factors that influence communication and implementing evidence-based interventions to enhance communication between physicians and patients.
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Bååthe, Fredrik, Gunnar Ahlborg Jr, Lars Edgren, Annica Lagström e Kerstin Nilsson. "Uncovering paradoxes from physicians’ experiences of patient-centered ward-round". Leadership in Health Services 29, n. 2 (2016): 168–84. http://dx.doi.org/10.1108/lhs-08-2015-0025.
Testo completoAbstract (sommario):
Purpose The purpose of this paper is to uncover paradoxes emerging from physicians’ experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician’s professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician’s professional identity was centered. Physicians with more of an I-perspective experienced challenges with the new round, while physicians with more of a We-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians’ professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians’ professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.
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CUI, Hong. "病人自主決定與醫療行善". International Journal of Chinese & Comparative Philosophy of Medicine 2, n. 2 (1 gennaio 1999): 83–93. http://dx.doi.org/10.24112/ijccpm.21369.
Testo completoAbstract (sommario):
LANGUAGE NOTE | Document text in Chinese; abstract also in English.通過對“喉梗阻”患兒案例的分析和感受，本文試圖分別從醫生、患者和哲學研究者的角度進行較客觀的思考。從醫生的角皮看：“自主決定”和醫療行善存在矛盾，削弱了醫生的“自主”決定，醫生的角色是單純的醫療技術掌握者還是用此技術全心全意為病人服務的行善者？從患者的角度看：患者是否都有“自主決定”的能力？若醫生只是單純的醫療技術的掌握者，與患者無情感的溝通，患者在醫院是否有心理上的安全感？從思考者的角度看：在前面論述的基礎上，提出了“善”是相對的，“自主”是適度的，任何絕對的病人自主和醫生自主都行不通。總之，醫療行善，不能拘泥於某一形式。It is important to respect for patients' rights. The patient should be informed of medical interference and the physician must obtain the patient's consent to perform serious treatment. This is a sense of patients' self-determination in contemporary medical practice. This paper argues that, granted its importance, patients' self-determination should not be given unique emphasis independent of physicians' medical beneficence.The paper considers this issue from both Chinese physicians' and patients' perspectives. First, from the physician's perspective, the role of the physician as a professional ought not to be overlooked. Should the physician play a role no more than that of an ordinary salesman by displaying everything for the customer to choose? Traditionally Chinese medicine has always insisted that the physician should do more than. Having studied both human and technical values, the physician should play an active function to help the patient make the right decision. He should not passively follow whatever the patient chooses on the excuse of respecting for the patient's self-determination.Instead, being physician, he is naturally determined to do medical beneficence toward the patient. Of course, there may be fundamental value conflicts between the patient and the physician. For instance, they may believe in different religions. This difference may sometimes lead the patient to want or refuse something that the physician takes to be against the patient's interest. In such cases the physician and patient may best respect each other's fundamental values. However, most medical cases are unlike this. They don't involve any fundamental value conflict. The physician should do his best to persuade the patient to make the right decision, rather than passively to accept whatever the patients chooses.Moreover, Chinese patients' perspective also supports physicians' beneficence. The patient would say this. Look, the physician has been trained specially in their work. Technically they should know better regarding what the patient should do. Being sick is a weak time in the patient's life. The patient does not want to confront it lonely. On the one hand, the patient wants the family to take care of her and take the burden of making the decision in her best interest. On the other hand, the patient wants the physician to help the family in this difficult process of decision making. It is not appropriate for the physician to play a role of salesman and leaves everything in my hands. This is against the nature of physicians as the beneficent healers.In short, both Chinese physicians' and patients' perspectives support the combination of patients' determination and physicians' beneficence. It is inappropriate simply to stress the importance of patients' rights or self-determination without giving significant weight to the role of medical beneficence that physicians should play in medical practice.DOWNLOAD HISTORY | This article has been downloaded 17 times in Digital Commons before migrating into this platform.
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English, Clifford, e Christina de la Torre. "Doctor, Tell Me I Am Sick: Physician Response to Patient Psyco-Social Problems". International Quarterly of Community Health Education 8, n. 1 (aprile 1987): 69–80. http://dx.doi.org/10.2190/t311-0281-kn2h-0ajb.
Testo completoAbstract (sommario):
Considerable evidence indicates that non-psychiatric physicians devote considerable time in dealing with the psychosocial problems of patients. At the same time little is known about the kinds of problems patients present or how the physician responds to these problems. In an effort to determine both the kinds of problems presented and physician response, direct observation of physician/patient interactions and content analysis of patient records were carried out. Five dominant responses of physicians were identified and discussed in detail. In addition, patient expectations and interactions with physicians are explored.
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Schoenthaler, Antoinette M., Brian S. Schwartz, Craig Wood e Walter F. Stewart. "Patient and Physician Factors Associated With Adherence to Diabetes Medications". Diabetes Educator 38, n. 3 (22 marzo 2012): 397–408. http://dx.doi.org/10.1177/0145721712440333.
Testo completoAbstract (sommario):
Purpose The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPREHR). MPREHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results In adjusted analyses, satisfaction with the physician’s patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients’ level of social support. Conclusions This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship.
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Kiyanmehr, Mehdi. "The Responsibility of the Physician and the Hospital When the Patients Withdraw their Previous Consent for Treatment". Jundishapur journal of Medical Sciences 21, n. 5 (1 maggio 2022): 744–57. http://dx.doi.org/10.32598/jsmj.21.5.2465.
Testo completoAbstract (sommario):
Background and Objectives: The patient’s withdrawal of previous permission for treatment is one of the issues in jurisprudence and medical law. The present study aims to discuss the patient''s withdrawal of previous permission based on the general approach to the physician’s acquittal/not acquittal of responsibility. Subjects and Methods This is a descriptive-analytical study with a new insight into the second paragraph of Article 308 of the Iranian Civil Code to assess the physician’s refusal of treatment when the patient withdraws the previous consent for treatment. Results The penal policies of Iran regarding physicians’ responsibilities are not fair. By revising the laws and replacing the civil liability of the government, it is possible to strengthen the rposition of medical community in Iran. Conclusion Physicians have reasons such as preventing harm and death to the patient، the rule of medicine، and the moral responsibility of the physician for not allowing patients to withdraw previous permission. On the other hand، patients believe that the doctor and the hospital are responsible for the status of the patient in the case of withdrawing previous consent. The legislator should solve the government''s responsibility for the physician''s actions or not allow the patient''s withdrawal of permission to remove conflicts in the physician''s acquittal/not acquittal of responsibility.
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Ferrand, Amaryllis, Jelena Poleksic e Eric Racine. "Factors Influencing Physician Prognosis: A Scoping Review". MDM Policy & Practice 7, n. 2 (luglio 2022): 238146832211451. http://dx.doi.org/10.1177/23814683221145158.
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Introduction. Prognosis is an essential component of informed consent for medical decision making. Research shows that physicians display discrepancies in their prognostication, leading to variable, inaccurate, optimistic, or pessimistic prognosis. Factors driving these discrepancies and the supporting evidence have not been reviewed systematically. Methods. We undertook a scoping review to explore the literature on the factors leading to discrepancies in medical prognosis. We searched Medline (Ovid) and Embase (Ovid) databases for peer-reviewed articles from 1970 to 2017. We included articles that discussed prognosis variation or discrepancy and where factors influencing prognosis were evaluated. We extracted data outlining the participants, methodology, and prognosis discrepancy information and measured factors influencing prognosis. Results. Of 4,723 articles, 73 were included in the final analysis. There was significant variability in research methodologies. Most articles showed that physicians were pessimistic regarding patient outcomes, particularly in early trainees and acute care specialties. Accuracy rates were similar across all time periods. Factors influencing prognosis were clustered in 4 categories: patient-related factors (such as age, gender, race, diagnosis), physician-related factors (such as age, race, gender, specialty, training and experience, attitudes and values), clinical situation-related factors (such as physician-patient relationship, patient location, and clinical context), and environmental-related factors (such as country or hospital size). Discussion. Obtaining accurate prognostic information is one of the highest priorities for seriously ill patients. The literature shows trends toward pessimism, especially in early trainees and acute care specialties. While some factors may prove difficult to change, the physician’s personality and psychology influence prognosis accuracy and could be tackled using debiasing strategies. Exposure to long-term patient outcomes and a multidisciplinary practice setting are environmental debiasing strategies that may warrant further research. Highlights Literature on discrepancies in physician’s prognostication is heterogeneous and sparse. Literature shows that physicians are mostly pessimistic regarding patient outcomes. Literature shows that a physician’s personality and psychology influence prognostic accuracy and could be improved with evidence-based debiasing strategies. Medical specialty strongly influences prognosis, with specialties exposed to acutely ill patients being more pessimistic, whereas specialties following patients longitudinally being more optimistic. Physicians early in their training were more pessimist than more experienced physicians.
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Chikodiri Nwosu, Laurine, Great Iruoghene Edo, Mehmet Yesiltas, Endurance Agoh e Rashidat Adelola Lawal. "Evaluation of factors influencing physician–patient communication in healthcare service delivery". BOHR International Journal of Pharmaceutical Studies 1, n. 1 (2022): 28–34. http://dx.doi.org/10.54646/bijops.2023.04.
Testo completoAbstract (sommario):
Physician–patient communication has received less focus in the study of healthcare service delivery in Nigeria. The majorityofcommunicationreliesonmessagedeliveryratherthaninterpersonalcommunication.Evenwhendoctors have significant knowledge to share with their patients, they frequently lack the interpersonal communication skills required to do it successfully. This quantitative study employed the analysis of 150 valid responses from practicing physicians in Lagos state. Descriptive statistics were carried out to understand the factors influencing physician–patient communication. The results revealed good communication skills among physicians as they agreed to have social conversations with patients, listen intently to them, and promote question-asking. The responses from the survey also revealed that factors such as limited consultation time and unfavorable working environmentscouldnegativelyimpactphysician–patientcommunication.Furthermore,thetesthypothesisrevealed a significant correlation between physicians’ age and gender (p < 0.05), whereas physicians’ ethnicity and religion had non-significant associations. The evaluation of factors influencing physician–patient communication revealed that several individual and contextual factors contribute to effective communication, including physician communication skills, patient health literacy, and system-level factors such as time constraints and workload. Healthcare organizations and policymakers should prioritize efforts to improve physician–patient communication by addressing the identified factors that influence communication and implementing evidence-based interventions to enhance communication between physicians and patients.
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Lerner, A. Martin, e Elliot D. Luby. "Error of Accommodation in the Care of the Difficult Patient in the 1990s". Journal of Psychiatry & Law 20, n. 2 (giugno 1992): 191–206. http://dx.doi.org/10.1177/009318539202000204.
Testo completoAbstract (sommario):
Consumerism, patient rights legislation, and malpractice litigation have created a greater power symmetry between patient and physician. Patients read, question, and insist upon greater participation in decision-making involving treatment. The ideal patient is knowledgeable and an active negotiator in the physician/patient relationship. However, there are some patients who feel so empowered that they are determined to direct and control their treatment. They may request or refuse laboratory tests and attempt to dictate the terms under which diagnosis and treatment should be accomplished. There are as well some physicians who, as a result of conciliatory personal styles, are willing to accommodate to the demands of these patients. In this article, four cases are presented in which physicians have accepted those terms against their better judgment. In two cases malpractice suits followed, ultimately won by the defendant physician. In the last instance a physician patient committed suicide and a malpractice action was settled by mediation. These four case examples establish the principle that physicians, for whatever reason, cannot accommodate the demands of empowered patients that contradict clinical judgment and violate the scientific practice of medicine. Such accommodation may have disastrous results for both patient and physician. Physicians should listen compassionately to patients’ needs and desires, but they may have to refer a patient elsewhere when a negotiated consensus cannot be reached.
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Nolan, B., A. Ackery e B. Au. "P096: Hospitalselfie: a review of implications and recommendations on patients making video recordings in hospital". CJEM 18, S1 (maggio 2016): S110. http://dx.doi.org/10.1017/cem.2016.272.
Testo completoAbstract (sommario):
Introduction: Smartphones are everywhere. Recent technological advances allow for instantaneous high quality video and audio recordings with the touch of a button. In Canada, physician smartphone use is highly regulated by provincial legislature and multiple policies have been published from provincial physician colleges and the Canadian Medical Protective Association (CMPA). Patients on the other hand have no such laws to observe. We set out to look at what legislation and policies exist to provide guidance to physicians in two potential scenarios: when a patient requests to record a patient-physician interaction and if a patient surreptitiously records a patient-physician interaction without consent of the physician. Methods: A literature review searching for articles on patient video recordings and patient smartphone use was completed on both Medline and PubMed. Further review of each provincial privacy act and communication with each provincial privacy office was performed. Consultation with each provincial physician college and the CMPA was also done to identify any policies or recommendations to guide physicians. Results: Patients making video recordings do not fall under any provincial privacy law and there are no existing policies from any provincial physician college or the CMPA to provide guidance. Therefore, physicians must rely on their own institution’s policy regarding patient video recording in the health care setting. Be familiar with your institution’s policy. If your institution does not have a policy, create one with the input of appropriate stakeholders. Patients may surreptitiously video record medical interactions without physician consent. Although this may not be permitted under an individual institution’s policy, it is not illegal under the Criminal Code. Thus, it is important to behave in a professional manner at all times and assume you may be recorded at any time. Conclusion: The majority of patients’ recordings will be done without litigious intentions, but rather with the goal of understanding more about their own health and medical care. Unfortunately there are those who will undermine the physician-patient relationship. Physicians cannot allow this to cause distrust in future relationships, nor should it force physicians to practice more defensive medicine. Physicians must continue to practice the art of medicine and accept that “performance” is a part of the job.
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Shin, Dong Wook, So Young Kim, Juhee Cho, Robert W. Sanson-Fisher, Eliseo Guallar, Gyu Young Chai, Hak-Soon Kim, Bo Ram Park, Eun-Cheol Park e Jong-Hyock Park. "Discordance in Perceived Needs Between Patients and Physicians in Oncology Practice: A Nationwide Survey in Korea". Journal of Clinical Oncology 29, n. 33 (20 novembre 2011): 4424–29. http://dx.doi.org/10.1200/jco.2011.35.9281.
Testo completoAbstract (sommario):
Purpose Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient–physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient–physician concordance. Patients and Methods A national, multicenter, cross-sectional survey of patient–physician dyads was performed, and 97 oncologists (participation rate, 86.5%) and 495 patients (participation rate, 87.4%) were included. A short form of the Comprehensive Needs Assessment Tool for Cancer Patients was independently administered to patients and their oncologists. Concordance and agreement rates between physicians and patients were calculated. Mixed logistic regression was used to identify predictors of concordance and to explore the association of concordance with patient satisfaction and trust in physicians. Results Physicians systematically underestimated patient needs and patient–physician concordance was generally poor, with weighted κ statistics ranging from 0.04 to 0.15 for individual items and Spearman's ρ coefficients ranging from 0.11 to 0.21 for questionnaire domains. Length of experience as oncologist was the only significant predictor of concordance (adjusted odds ratio for overall concordance [aOR] = 2.09; 95% CI, 1.02 to 4.31). Concordance was not significantly associated with overall patient satisfaction (aOR = 1.24; 95% CI, 0.74 to 2.07) or trust in physician (aOR = 1.17; 95% CI, 0.76 to 1.81). Conclusion Our findings revealed significant underestimation of patient needs and poor concordance between patients and physicians in assessing perceived needs of supportive care. The clinical implications of this discordance warrant further investigation.