Artykuły w czasopismach na temat „Physicians”
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He, Qijun, Yungeng Li, Zhiyao Wu i 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, nr 21 (4.11.2022): 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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Aruguete, Mara S., i Carlos A. Roberts. "Participants' Ratings of Male Physicians Who Vary in Race and Communication Style". Psychological Reports 91, nr 3 (grudzień 2002): 793–806. http://dx.doi.org/10.2466/pr0.2002.91.3.793.
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Research has shown minorities receive lower quality health care than White persons even with socioeconomic conditions controlled. This difference may partially be related to racially biased attitudes and impaired communication in interracial relationships between physicians and patients. This study investigated the effect of physicians' race and nonverbal communication style on participants' evaluations. Patients at a local health clinic were participants ( N = 116: 84% Black, 16% White). Each participant viewed one of four videotapes showing varied race of a physician (Black or White) and the physician's nonverbal behavior (expressing concern or distance), and then completed a questionnaire evaluating the depicted physician. Overall, participants did not give significantly different preferences for physicians of the same race. However, participants' evaluations were significantly associated with physicians' nonverbal style. Nonverbal concern was associated with highest satisfaction, trust, self-disclosure, recall of information, likelihood of recommending the physician, and intent to comply with the physician's recommendations. When male and female participants were compared, preference for a physician of the same race was found only among male participants who viewed verbally distant physicians. Results suggest that social skills are more important than race in shaping patients' perceptions of physicians.
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Abdulkader, Rizwan Suliankatchi, Deneshkumar Venugopal, Kathiresan Jeyashree, Zainab Al Zayer, K. Senthamarai Kannan i 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 (styczeń 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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Manning, Blaine T., Daniel D. Bohl, Charles P. Hannon, Michael L. Redondo, David R. Christian, Brian Forsythe, Shane J. Nho i Bernard R. Bach. "Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine". Orthopaedic Journal of Sports Medicine 6, nr 4 (1.04.2018): 232596711876687. http://dx.doi.org/10.1177/2325967118766873.
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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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Viswanath Bandi i Rao O R S. "Role of Physician’s Personality on their Drug Prescription Behavior". International Journal of Research in Pharmaceutical Sciences 11, nr 4 (19.12.2020): 6954–61. http://dx.doi.org/10.26452/ijrps.v11i4.3700.
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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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Miller, Victoria A., Melissa Cousino, Angela C. Leek i Eric D. Kodish. "Hope and Persuasion by Physicians During Informed Consent". Journal of Clinical Oncology 32, nr 29 (10.10.2014): 3229–35. http://dx.doi.org/10.1200/jco.2014.55.2588.
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Purpose To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Patients and Methods Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. Results The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Conclusion Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain.
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Ferreyro, Bruno L., Michael O. Harhay i Michael E. Detsky. "Factors associated with physicians’ predictions of six-month mortality in critically ill patients". Journal of the Intensive Care Society 21, nr 3 (3.07.2019): 202–9. http://dx.doi.org/10.1177/1751143719859761.
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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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Greenblum, Jake, i Ryan K. Hubbard. "Responding to religious patients: why physicians have no business doing theology". Journal of Medical Ethics 45, nr 11 (20.06.2019): 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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Andritz, Mary H., i Matthew P. Rogan. "Drug Dispensing by Physicians: Promoter's Claims Examined". Pediatrics 82, nr 3 (1.09.1988): 504–9. http://dx.doi.org/10.1542/peds.82.3.504.
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Experience in private pediatric practice is used to illustrate some potential advantages and disadvantages to patients and physicians of drug dispensing by physicians. Projections were based on the prescribing trends in the practice, the extent of patients' insurance reimbursement for prescriptions, the laws regarding dispensing, and the costs incurred when physicians purchase selected medications from a repackager or when patients procure them at a community pharmacy. Patients without insurance for prescriptions can potentially save money by purchasing medication at the physician's office but, in general, only if the physician's dispensing fee is minimal. Potential profits to physicians would be cut by an estimated 50% because of third-party enrollees choosing to have prescriptions filled at a pharmacy because of cost savings. Net profits are further reduced and may even be eliminated when the cost of physician and staff time to prepare, label, reorder, and maintain necessary records regarding dispensed medication are considered. Although it may be convenient for the patient to obtain initial supplies of medication at the time of an office visit, obtaining refills may be less convenient. The time and paperwork involved in dispensing by a physician cannot be considered as minimal interruptions in normal office procedure. The broad, attractive claims made in support of physician dispensing by physicians clearly overstate the benefits both to patients and to physicians.
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Patel, Rikinkumar, Ramya Bachu, Archana Adikey, Meryem Malik i Mansi Shah. "Factors Related to Physician Burnout and Its Consequences: A Review". Behavioral Sciences 8, nr 11 (25.10.2018): 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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Mammoliti, Maryna, Christopher Richards-Bentley i Adam Ly. "Understanding attention deficit/hyperactivity disorder in physicians: workplace implications and management strategies". Canadian Journal of Physician Leadership 7, nr 4 (8.07.2021): 160–65. http://dx.doi.org/10.37964/cr24742.
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Physicians with attention deficit/hyperactivity disorder (ADHD) may have unrecognized workplace difficulties because of inattention and impulsivity. If these behaviours interfere with patient care or organizational functioning, leaders may erroneously attribute the physician’s actions to unprofessionalism. As such, corrective efforts with punitive measures may be ineffective. ADHD is a neurodevelopmental disorder that responds to evidence-based treatments, including medications, accommodations, and supports. Physician leaders who understand the unique presentations of ADHD in physicians may better identify when this condition may be contributing to workplace behaviour. Furthermore, physician leaders may have a professional or legal duty to accommodate or support physicians with underlying medical and/or psychiatric conditions, such as ADHD. Using our own clinical experience, we provide a general overview of ADHD in physicians and guide physician leaders on how to help physicians who may be struggling with ADHD in the workplace. We hope that our clinical experience and observations of this hidden problem will spur discussion, awareness, and action for further research and support.
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Hersh, Eitan D., i Matthew N. Goldenberg. "Democratic and Republican physicians provide different care on politicized health issues". Proceedings of the National Academy of Sciences 113, nr 42 (3.10.2016): 11811–16. http://dx.doi.org/10.1073/pnas.1606609113.
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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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Bååthe, Fredrik, Gunnar Ahlborg Jr, Lars Edgren, Annica Lagström i Kerstin Nilsson. "Uncovering paradoxes from physicians’ experiences of patient-centered ward-round". Leadership in Health Services 29, nr 2 (2016): 168–84. http://dx.doi.org/10.1108/lhs-08-2015-0025.
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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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Hartmann, Michael, Christoph Gehrlach, Peter K Link i Tomislav Kovacevic. "Attitudes of salaried and consulting physicians toward critical incident reporting systems". Journal of Anesthesia and Critical Care: Open access 15, nr 6 (15.12.2023): 183–88. http://dx.doi.org/10.15406/jaccoa.2023.15.00578.
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Context: Physicians report their knowledge of incidents and near incidents substantially less frequently than nursing and non-medical personnel. While several barriers to the reporting of incidents into Critical Incident Reporting Systems (CIRS) by physicians have been identified, there are practically no data on the extent to which physician’s attitudes towards financial factors contribute to their underreporting. Objective: To determine whether the attitudes of physicians toward financial consequences of event reporting play a role in the underreporting by physicians. Design, setting and participants: This survey was performed in Switzerland in 2009/2010. Following an initial evaluation and tests of reliability and validity, 234 questionnaires were sent by mail to 171 consulting physicians and 63 salaried physicians at two Swiss hospitals. After the questionnaires were returned, the results were coded and evaluated. Main outcome measure: Physician responses to questionnaire items, correlations between physician responses to questionnaire items and physician subgroup comparisons for questionnaire items. Results: The overall response rate was 45.2 %, corresponding to 106 completed questionnaires from 74 consulting physicians and 32 salaried physicians. 46 % of the respondents considered themselves to have good knowledge of CIRS. 50 % of respondents agreed that legal consequences are possible for physicians and 38 % agreed that criminal prosecution is possible. 16 % of respondents considered financial gain for physicians possible and 32 % considered financial losses possible. 33 % of respondents considered it possible that physicians end their working relationship with the hospital or clinic if, in their view, CIRS implementation is dissatisfactory. 83 % agreed that the introduction of CIRS is a good idea. Conclusion: Physicians are concerned about potential financial consequences of event reporting and this concern may pose an additional barrier to the reporting of events in CIRS by physicians. Salaried physicians are more likely to associate the introduction of a CIRS with financial gain for physicians.
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Wang, Yanan, Hong Wu, Chenxi Xia i Naiji Lu. "Impact of the Price of Gifts From Patients on Physicians’ Service Quality in Online Consultations: Empirical Study Based on Social Exchange Theory". Journal of Medical Internet Research 22, nr 5 (5.05.2020): e15685. http://dx.doi.org/10.2196/15685.
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Background Gift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored. Objective The aim of this study was to explore the impact of gift price on the quality of physicians’ online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations. Methods A dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians’ online consultation service and how this impact changes according to the physician’s service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model. Results Gift price had a positive impact on the quality of physicians’ online consultation service (β=4.941, P<.01). This impact was negatively mediated by both the physician’s service price (β=–9.245, P<.001) and the total number of gifts they received (β=–5.080, P<.001). Conclusions Gift price has a positive impact on physicians’ online behavior, although the impact varies among physicians.
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Hsu, Yuan-Teng, Ya-Ling Chiu, Jying-Nan Wang i Hung-Chun Liu. "Impacts of physician promotion on the online healthcare community: Using a difference-in-difference approach". DIGITAL HEALTH 8 (styczeń 2022): 205520762211063. http://dx.doi.org/10.1177/20552076221106319.
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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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Eberts, Margaret, i Daniel Capurro. "Patient and Physician Perceptions of the Impact of Electronic Health Records on the Patient–Physician Relationship". Applied Clinical Informatics 10, nr 04 (sierpień 2019): 729–34. http://dx.doi.org/10.1055/s-0039-1696667.
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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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VanFrank, Brenna K., Sohyun Park, Jennifer L. Foltz, Lisa C. McGuire i Diane M. Harris. "Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices". American Journal of Health Promotion 32, nr 6 (12.12.2016): 1365–74. http://dx.doi.org/10.1177/0890117116680472.
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Purpose: Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians’ personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians’ SSB-related counseling practices and their personal and medical practice characteristics. Design: Cross-sectional survey. Setting: DocStyles survey, 2014. Participants: A total of 1510 practicing US physicians. Measures: Physician’s SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. Analysis: Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician’s personal and medical practice characteristics. Results: Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). Conclusion: Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.
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Wasserman, Richard C., Bruce M. Hassuk, Paul C. Young i Marshall L. Land. "Health Care of Physicians' Children". Pediatrics 83, nr 3 (1.03.1989): 319–22. http://dx.doi.org/10.1542/peds.83.3.319.
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In anecdotal reports, problems have been cited in the health care of physicians' children, but no systematic study of this issue has been attempted. Pediatricians in a community of high physician density were interviewed to determine whether and how the health care of physicians' children differs from that of children of equivalent socioeconomic status. Of the community's 33 pediatricians, 94% responded to items in a 45-minute structured interview, for which test-retest reliability was demonstrated. Systematic differences in the care of physicians' children included delayed help seeking and increased self-referral to specialists by parents, and poor documentation of psychosocial history, less detailed instruction giving, and a reluctance to discuss problem behavior by pediatricians. Reasons cited by pediatricians for these problems included inappropriate assumptions concerning the medical knowledge of the physician's family, confusion between the roles of healer and help seeker, and embarrassment about discussing personal issues with colleagues. Pediatricians and physician parents need to become aware of and communicate about the potential for problems in the health care of physicians' children.
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Drysdale, Henry, Ioan Milosevic i Eirion Slade. "From physicists to physicians". Physics World 29, nr 7 (lipiec 2016): 48–49. http://dx.doi.org/10.1088/2058-7058/29/7/42.
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SHAPIRO, ROBYN S., KRISTEN A. TYM, DAN EASTWOOD, ARTHUR R. DERSE i JOHN P. KLEIN. "Managed Care, Doctors, and Patients: Focusing on Relationships, Not Rights". Cambridge Quarterly of Healthcare Ethics 12, nr 3 (lipiec 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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Leong, Lucille A. "Achieving Physician Well-Being: The Best Physicians Are Well Physicians". Journal of the National Comprehensive Cancer Network 12, nr 8 (sierpień 2014): 1196–98. http://dx.doi.org/10.6004/jnccn.2014.0114.
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Wachs, Daliah, Victoria Lorah, Allison Boynton, Amanda Hertzler, Brandon Nichols, Joseph Kraft, Jerry Wang, Ivy Dang, Paul Kalekas i Cheryl Vanier. "Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty". Journal of Patient Experience 8 (1.01.2021): 237437352110077. http://dx.doi.org/10.1177/23743735211007700.
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The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.
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Paterick, Zachary R., i Timothy E. Paterick. "Peer Review – Legal and Ethical Issues Faced by Medical Staff: The Mandate for Physician Leadership". Hospital Practices and Research 4, nr 3 (26.08.2019): 76–79. http://dx.doi.org/10.15171/hpr.2019.15.
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Physicians working in hospitals face challenges when it comes to understanding and meeting the medical, legal, and ethical subjects outlined in the hospital bylaws. Hospital staff physicians and the hospital administration both aspire for high quality medical care and the assurance of patient safety. Unfortunately, when quality concerns surface, there can be reasonable differences of opinion as to whether a physician’s practice pattern met the accepted threshold of the standard of care. Such differences of opinion can lead to conflict that fuels a physician review. One complication for physicians is that many of the issues that surface at peer reviews are veiled in legal concepts and underpinnings for which physicians lack education, training, and familiarity. It would be prudent for all physicians working in hospitals to become familiar with the hospital bylaws and regulations. Physicians must take a leadership role in assuring fair and equitable peer review.
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Valius, Leonas, Daiva Rastenytė, Vilija Malinauskienė i Daina Krančiukaitė-Butylkinienė. "Evaluation of the Quality of Services in Primary Health Care Institutions". Medicina 47, nr 1 (11.01.2011): 9. http://dx.doi.org/10.3390/medicina47010009.
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The aim of the study was to evaluate patients’ satisfaction with the quality of provided services in private primary health care institutions in Kaunas. Material and Methods. A questionnaire-based inquiry of 280 persons registered to family physicians at primary health care settings was performed. The study was carried out using 20-item anonymous questionnaires with questions about the quality of services provided in primary health care settings. Results. More than 50.0% of the respondents stated that they waited for more than 15 minutes at the physician’s office, while 17.0% of the respondents stated that the waiting time exceeded 30 minutes. More than 25.0% of the respondents positively evaluated the possibility to consult their family physician by phone. In 67.0% of patients, the family physician determined the cause of the disorder and administered treatment; in 32.0% of patients, the family physician referred them to a specialist, and 1.0% of patients were urgently sent to hospital. More than 90.0% of the respondents were satisfied with the services provided by their family physicians. Those who were dissatisfied with these services indicated that the provided treatment failed to eliminate the disorder, that they wanted to be referred to a specialist, and that they expected more diagnostic tests to be performed for more effective treatment. Conclusions. A greater part of the patients indicated that the main reason for long waiting at the physician’s office was physicians’ wish to serve too many patients. More than two-thirds (67.0%) of the patients stated that their family physicians determined the cause of the disorder and prescribed treatment. The overwhelming majority (more than 90.0%) of the patients were satisfied with the services provided by their family physicians.
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Saifee, Danish Hasnain, Matthew Hudnall i Uzma Raja. "Physician Gender, Patient Risk, and Web-Based Reviews: Longitudinal Study of the Relationship Between Physicians’ Gender and Their Web-Based Reviews". Journal of Medical Internet Research 24, nr 4 (8.04.2022): e31659. http://dx.doi.org/10.2196/31659.
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Background Web-based reviews of physicians have become exceedingly popular among health care consumers since the early 2010s. A factor that can potentially influence these reviews is the gender of the physician, because the physician’s gender has been found to influence patient-physician communication. Our study is among the first to conduct a rigorous longitudinal analysis to study the effects of the gender of physicians on their reviews, after accounting for several important clinical factors, including patient risk, physician specialty, and temporal factors, using time fixed effects. In addition, this study is among the first to study the possible gender bias in web-based reviews using statewide data from Alabama, a predominantly rural state with high Medicaid and Medicare use. Objective This study conducts a longitudinal empirical investigation of the relationship between physician gender and their web-based reviews using data across the state of Alabama, after accounting for patient risk and temporal effects. Methods We created a unique data set by combining data from web-based physician reviews from the popular physician review website, RateMDs, and clinical data from the Center for Medicare and Medicaid Services for the state of Alabama. We used longitudinal econometric specifications to conduct an econometric analysis, while controlling for several important clinical and review characteristics across four rating dimensions (helpfulness, knowledge, staff, and punctuality). The overall rating and these four rating dimensions from RateMDs were used as the dependent variables, and physician gender was the key explanatory variable in our panel regression models. Results The panel used to conduct the main econometric analysis included 1093 physicians. After controlling for several clinical and review factors, the physician random effects specifications showed that male physicians receive better web-based ratings than female physicians. Coefficients and corresponding SEs and P values of the binary variable GenderFemale (1 for female physicians and 0 otherwise) with different rating variables as outcomes were as follows: OverallRating (coefficient –0.194, SE 0.060; P=.001), HelpfulnessRating (coefficient –0.221, SE 0.069; P=.001), KnowledgeRating (coefficient –0.230, SE 0.065; P<.001), StaffRating (coefficient –0.123, SE 0.062; P=.049), and PunctualityRating (coefficient –0.200, SE 0.067; P=.003). The negative coefficients indicate a bias toward male physicians versus female physicians for aforementioned rating variables. Conclusions This study found that female physicians receive lower web-based ratings than male physicians even after accounting for several clinical characteristics associated with the physicians and temporal effects. Although the magnitude of the coefficients of GenderFemale was relatively small, they were statistically significant. This study provides support to the findings on gender bias in the existing health care literature. We contribute to the existing literature by conducting a study using data across the state of Alabama and using a longitudinal econometric analysis, along with incorporating important clinical and review controls associated with the physicians.
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Alqadheeb, Mohammed, Ahmed Aladhab, Hani AlAbdullah i Abdullah AlQuwidhi. "Satisfaction of Primary Health Care Physicians Towards Electronic Health Information System (WAHED) in Al-Ahsa, Saudi Arabia 2022". Journal of Healthcare Sciences 02, nr 09 (2022): 243–51. http://dx.doi.org/10.52533/johs.2022.2906.
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Background: The implementation and adoption of the health information systems (HIS) in hospitals has increased globally in the recent years. A physician’s perception of such systems is a crucial determinant of their successful use. In this study, we aim to explore physician satisfaction levels with the electronic health information system and to identify the main factors affecting the satisfaction level of physicians. Methods: A cross-sectional study was performed among the primary health care (PHC) physicians in Al-Ahsa region of Saudi Arabia. Data was collected via a survey which was distributed using Google Forms. Physicians' satisfaction levels towards HIS were explored using a validated 19-item questionnaire and analysed in different categories. Results: A total of 215 primary health care physicians were included in the study. Reliability showed good internal consistency (α = 0.809). The aggregated satisfaction ratings for HIS based on the responses showed some variations. A total of 4 (2%) of the respondents gave an overall rating of ‘poor’ to the system, and 26 (12%) of them rated it as ‘fair’, 97 (45%) of them rated it as ‘good’, 80 (37%) of them rated it as ‘very good’ and 8 (11%) of them found the system ‘excellent’. Nationality (p=0.017), HIS training (p=0.001), and stress or burnout (p=0.001) were significant factors associated with physicians' satisfaction levels with the HIS. Conclusion: Overall, physicians were moderately satisfied with the HIS, and that various aspects of the system require improvement. Continued evaluation of installed systems and feedback from users must guide future improvements in the technology. Further research is required to investigate the causes of the physician’s stress/burnout, and non-trainee physician dissatisfaction, and improve the overall satisfaction among primary health care physicians.
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Engel, George L. "Physician-scientists and scientific physicians". American Journal of Medicine 82, nr 1 (styczeń 1987): 107–11. http://dx.doi.org/10.1016/0002-9343(87)90384-6.
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Conroy, Deirdre A., i Matthew R. Ebben. "Referral Practices for Cognitive Behavioral Therapy for Insomnia: A Survey Study". Behavioural Neurology 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/819402.
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This study examined referring practices for cognitive behavioral therapy for insomnia (CBTI) by physicians at University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. A five-item questionnaire was sent via email that inquired about the physician’s patient load, number of patients complaining of insomnia, percent referred for CBTI, and impressions of what is the most effective method for improving sleep quality in their patients with insomnia. The questionnaire was completed by 239 physicians. More physicians believed a treatment other than CBTI and/or medication was most effective (N= 83). “Sleep hygiene” was recommended by a third of the sample. The smallest number of physicians felt that CBTI alone was the most effective treatment (N= 22). Additional physician education is needed.
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Dong, Wei, Xiangxi Lei i Yongmei Liu. "The Mediating Role of Patients’ Trust Between Web-Based Health Information Seeking and Patients’ Uncertainty in China: Cross-sectional Web-Based Survey". Journal of Medical Internet Research 24, nr 3 (11.03.2022): e25275. http://dx.doi.org/10.2196/25275.
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Background In the physician-patient relationship, patients’ uncertainty about diseases and the lack of trust in physicians not only hinder patients’ rehabilitation but also disrupt the harmony in this relationship. With the development of the web-based health industry, patients can easily access web-based information about health care and physicians, thus reducing patients’ uncertainty to some extent. However, it is not clear how patients’ web-based health information–seeking behaviors reduce their uncertainty. Objective On the basis of the principal-agent theory and the perspective of uncertainty reduction, this study aims to investigate the mechanism of how web-based disease-related information and web-based physician-related information reduce patients’ uncertainty. Methods A web-based survey involving 337 participants was conducted. In this study, we constructed a structural equation model and used SmartPLS (version 3.3.3; SmartPLS GmbH) software to test the reliability and validity of the measurement model. The path coefficients of the structural model were also calculated to test our hypotheses. Results By classifying patients’ uncertainties into those concerning diseases and those concerning physicians, this study identified the different roles of the two types of patients’ uncertainty and revealed that web-based disease-related information quality and web-based physician-related information can act as uncertainty mitigators. The quality of disease-related information reduces patients’ perceived information scarcity about the disease (β=−.588; P<.001), and the higher the information scarcity perceived by patients, the higher their uncertainty toward the disease (β=.111; P=.02). As for physician-related information, web-based word-of-mouth information about physicians reduces patients’ perceived information scarcity about the physician (β=−.511; P<.001), mitigates patients’ fears about physician opportunism (β=−.268; P<.001), and facilitates patients’ trust (β=.318; P<.001). These factors further influence patients’ uncertainty about the physician. In addition, from the test of mediating effect, patients’ trust in the physician fully mediates the relationship between their perceived information scarcity about the physician’s medical service and their uncertainty about the physician. Patients’ trust also partially mediates the relationship between their fear of the physician’s opportunism and their uncertainty about the physician. As for the two different types of uncertainty, patients’ uncertainty about the physician also increases their uncertainty about the diseases (β=.587; P<.001). Conclusions This study affirms the role of disease-related web-based information quality and physician-related web-based word-of-mouth information in reducing patients’ uncertainties. With regard to the traits of principal-agent relationships, this study describes the influence mechanism based on patients’ perceived information scarcity, fears of physicians’ opportunism, and patients’ trust. Moreover, information about physicians is effective in reducing patients’ uncertainties, but only if the information enhances patients’ trust in their physicians. This research generates new insights into understanding the impact of web-based health information on patients’ uncertainties.
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Bandi, Viswanath, Subroto Kumar Dey i ORS Rao. "Factors Influencing the Prescribing Behavior of Medicines by Physician’s: A Study on Anti-Allergic Drugs in and around Hyderabad, India." Asia Proceedings of Social Sciences 10, nr 1 (3.10.2022): 27–31. http://dx.doi.org/10.31580/apss.v10i1.2590.
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The Physician’s prescription decision is a complex process that involves a variety of effects. In numerous cases, the choices of physician’s are multifactorial and may take up several strategies when making their prescribing decision, and several kinds of critical heuristics in conducting their duties of patient treatment. Previous studies conducted in different countries deployed various complex propositions to understand how several factors impact physician’s decision-making in their general practice. However, to the best of our knowledge, most of the propositions can’t solely explain the medical rule decision of physicians and affiliated factors. This has redounded in demands for further theoretical exploration to develop better interventions demanded towards understanding the dynamics of physician’s prescribing decision process. The main objective of our research is to develop a framework and understand the factors affecting the physician’s prescribing behavior among respiratory physicians (ENT+Chest Physicians) in and around Hyderabad, India. The individual independent factors based on which framework has been constructed were derived from the literature review, including the questionnaire, and integrated the same with a personality assessment instrument for testing the model and hypothesis of each independent factor on the physician’s prescribing behavior. The determined sample size was 170 physicians with various practice set-ups. For Analyzing the data mixed approach has been adopted consisting of both descriptive and inferential statistical methods comprising of factor analysis, correlation analysis, and regression analysis using the SPSS 21 version. The results showed that a physician’s prescribing behavior is influenced by a set of factors namely, Product related factors, physician professional factors, and Physician’s personality factors. Product Promotional factors from various pharmaceutical organizations, could not influence physicians in their prescribing decision, as the items forming this factor could not reach statistically significant levels.
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Wong, C., S. Lu, D. Wang, S. Dowling i E. Lang. "P003: Productivity patterns in early-career physicians: a multi-center analysis of administrative emergency department operations data". CJEM 22, S1 (maj 2020): S65. http://dx.doi.org/10.1017/cem.2020.211.
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Introduction: Physician metrics extracted from an electronic medical records (EMR) system can be utilized for practice improvement. One key metric analyzed at many emergency departments (EDs) is ‘patients per hour’ (pts/hr), a proxy for physician productivity. It is often believed that early-career physicians experience rapid growth in efficiency as they acclimatize to a hospital system and develop clinical confidence. This is the first study to evaluate the following question: Do early-career ED physicians increase their productivity when beginning practice? Methods: We performed a retrospective review of EMR data of early-career ED physicians working at one or more urban, academic centers. Early-career physicians must have started practice within three months of residency completion, and were identified by privileging records and provincial medical college registration. Physicians were excluded if they did not have at least 36 months of continuous data. Monthly productivity data (pts/hr) was extracted for each physician for their first 36-months of practice. A ‘performance curve’ or graph with a trendline of productivity as a moving average was created for each physician. Each performance curve was visually evaluated by two independent reviewers to qualitatively identify the general trend as upward, downward, or stable, with disagreements resolved by conference. Each physician's first and third year average productivity was compared quantitatively as well, with a significant upward or downward trend defined as a difference of at least 0.2 pts/hr. Results: A total of 41 physicians met the inclusion and exclusion criteria. Overall monthly pts/hr averages ranged from 1.08 to 7.65. Upon visual inspection, six (14.6%) physicians had upward trends, five (12.2%) had downward trends, and 30 (73.2%) had no discernable pattern. The quantitative analysis comparing first year to third year productivity matched the qualitative inspection exactly, with the same six physicians showing increased productivity, five with decreased, and 30 without significant change. Notably, the majority (30/41) of physicians demonstrated radical productivity variations over short periods with no discernable long-term trends. Conclusion: The majority of early career physicians do not demonstrate sustained early-career productivity changes. Of those that do, an approximately equal number will become faster and slower.
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Woolhandler, Steffie, i David U. Himmelstein. "Physicians for a National Health Program". International Journal of Health Services 17, nr 4 (październik 1987): 703–6. http://dx.doi.org/10.2190/c343-w933-786q-1r3t.
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A new organization called Physician's for a National Health Program (PNHP) is mobilizing physician support for a universal, comprehensive public system of health care for the United States. Recent changes in power relations within medicine (the so-called proletarianization of physicians) are prodding many physicians to abandon their traditional reactionary role in health policy. PNHP is working with elderly, labor, community, and health care activist groups to put a national health program (NHP) back on the U.S. health policy agenda. In this article, five key features of an NHP needed to simultaneously assure access, control costs, and minimize bureaucracy are noted.
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Avinger, Anna McNair, Tekiah McClary, Margie Dixon i Rebecca D. Pentz. "Evaluation of Standard-of-Care Practices Among Physicians Who Treat Other Physicians". JAMA Network Open 5, nr 10 (18.10.2022): e2236914. http://dx.doi.org/10.1001/jamanetworkopen.2022.36914.
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ImportanceEthical discussions have suggested that physicians who treat other physicians may put their physician-patients at risk of receiving non–standard-of-care treatment, which may result in worse outcomes. This phenomenon occurs when a physician treats a fellow physician as a VIP (very important person), and is therefore known as VIP syndrome. It is important to assess physicians’ perceptions when treating physician-patients.ObjectiveTo determine whether the physicians treating other physicians have attitudes toward or act in ways that could place physician-patients at risk for VIP syndrome.Design, Setting, and ParticipantsThis 2-part qualitative study was conducted from December 1, 2021, to February 28, 2022. Physicians who worked at a single comprehensive cancer center with experience treating other physicians were eligible to participate. Convenience sampling was used. Emails and flyers were sent out with study information, and if interested, physicians were able to schedule an interview. Of 24 physicians responding, 3 did not have experience treating other physicians, yielding a sample of 21 (88%), which was sufficient to reach a saturation of themes. After the initial structured interview of physicians, follow-up key informant interviews were performed.ExposuresThe structured interview was developed on the basis of a literature review and focused on factors that may contribute to VIP syndrome.Main Outcomes and MeasuresParticipant responses to open-ended questions were qualitatively coded using standard multilevel semantic analysis to assess physician perceptions of treating fellow physicians. A series of Likert-scaled questions were used to identify potential contributing factors to VIP syndrome.ResultsTwenty-one physicians (11 men [52%], 11 White [52%], and 15 [71%] younger than 49 years) participated. Although no physician interviewed stated that they altered their usual treatment plans, 11 (52%) agreed that their physician-patients tried to dictate their own care, and 17 (81%) believed that their physician-patients obtained privileges, such as use of medical knowledge to participate in in-depth discussions of care, ability to obtain and use the treating physicians personal contact information, and receiving faster access to care. Eleven respondents (52%) reported increased stress, and 12 (57%) experienced more pressure not to disappoint their physician-patients.Conclusions and RelevanceThe findings of this qualitative study suggest that when physicians treat other physicians, the physician-patients may obtain privileges unavailable to patients who are not physicians. Therefore, guidelines to help physicians navigate the complex relationships between themselves and their physician-patients are needed to ensure equitable outcomes between physician and nonphysician patients.
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Cornelius, Sarah L., Andrew P. Shaefer, Sandra L. Wong i Erika L. Moen. "Comparison of US Oncologist Rurality by Practice Setting and Patients Served". JAMA Network Open 7, nr 1 (5.01.2024): e2350504. http://dx.doi.org/10.1001/jamanetworkopen.2023.50504.
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ImportanceStudies of the oncology workforce most often classify physician rurality by their practice location, but this could miss the true extent of physicians involved in rural cancer care.ObjectiveTo compare a method for identifying oncology physicians involved in rural cancer care that uses the proportion of rural patients served with the standard method based on practice location.Design, Setting, and ParticipantsThis cross-sectional study used retrospective Centers for Medicare &amp; Medicaid Services encounter data on medical oncologists, radiation oncologists, and surgeons treating Medicare beneficiaries diagnosed with breast, colorectal, or lung cancer from January 1 to December 31, 2019. Data were analyzed from May to September 2023.Main Outcomes and MeasuresThe standard method of classifying oncologist physician rurality based on practice location was compared with a novel method of classification based on proportion of rural patients served.ResultsThe study included 27 870 oncology physicians (71.3% male), of whom 835 (3.0%) practiced in a rural location. Physicians practicing in a rural location treated a high proportion of rural patients (median, 50.0% [IQR, 16.7%-100%]). When considering the rurality of physicians’ patient panels, 5123 physicians (18.4%) whose patient panel included at least 20% rural patients, 3199 (11.5%) with at least 33% rural patients, and 1996 (7.2%) with at least 50% rural patients were identified. Using a physician’s patient panel to classify physician rurality revealed a higher number and greater spread of oncology physicians involved in rural cancer care in the US than the standard method, while maintaining high performance (area under the curve, 0.857) and fair concordance (κ, 0.346; 95% CI, 0.323-0.369) with the method based on practice setting.Conclusions and RelevanceIn this cross-sectional study, classifying oncologist rurality by the proportion of rural patients served identified more oncology physicians treating patients living in rural areas than the standard method of practice location and may more accurately capture the rural cancer physician workforce, as many hospitals have historically been located in more urban areas. This new method may be used to improve future studies of rural cancer care delivery.
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Vandersteegen, Tom, Wim Marneffe, Irina Cleemput, Dominique Vandijck i Lode Vereeck. "The determinants of defensive medicine practices in Belgium". Health Economics, Policy and Law 12, nr 3 (22.11.2016): 363–86. http://dx.doi.org/10.1017/s174413311600030x.
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AbstractIn 2010 the Belgian government introduced a low cost administrative procedure for compensating medical injuries to overcome the major shortcomings of the existing tort system. This paper examines, for the first time, to what extent this reform had an impact on physician specialists’ defensive practices and what are the relevant determinants affecting physicians’ clinical decision making. Based on a survey of 508 physicians, we find evidence of a relatively modest increase in defensive practices among physicians in various specialties. In general, 14% of the respondents, who were aware of the reform, reported to have increased their overall defensive behaviour, while respectively 18 and 13% altered their assurance and avoidance behaviour. Commonly used physician characteristics, such as claims experience and gender, have a similar impact on defensive medicine as documented in existing literature. Furthermore, the determinant physician’s access to an incident reporting system is found to have a significant impact on most of the defensive medicine measures. Health care institutions may therefore play an important role in controlling and reducing physicians’ defensive practices.
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Ma, Xiaojing, Chanhyun Park, Hsien-Chang Lin, Sweta Andrews i 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, nr 2 (7.03.2017): 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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Bial, Andrea, Anar Desai i Joanna Martin. "Physician Guide to Home Hospice Visits". Home Health Care Management & Practice 30, nr 1 (3.11.2017): 35–40. http://dx.doi.org/10.1177/1084822317738997.
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The field of hospice and palliative medicine continues to grow, attracting recent graduates as well as more senior physicians looking for career changes. Unfortunately, there is little, if any, training in most residencies regarding the home hospice visit, and there are not enough fellowship-trained physicians to fill the available positions. A systematic review of the literature was made for the years 2000 to 2016 to identify articles which provided practical, clinical guidelines for the physician home hospice visit. No single article provided this needed information. Thus, the authors formulated these guidelines based on the literature and their experiences to aid the home hospice physician—as well as other providers who may work with the physician—to understand the physician’s role in the home hospice visit.
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Teng, Kathryn A., Robert S. Butler, Sarah Schramm, J. Harry Isaacson, Craig Nielsen i Carmen Paradis. "Physicians Caring for Physicians: The Perspective of the Primary Care Physician". Southern Medical Journal 107, nr 5 (maj 2014): 301–5. http://dx.doi.org/10.1097/smj.0000000000000095.
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Wyszkowska, Zofia, Katarzyna Białczyk i Tomasz Michalski. "Komunikacja pomiędzy lekarzem i pacjentem u chorych na nowotwory". Nierówności społeczne a wzrost gospodarczy 65, nr 1 (2021): 156–68. http://dx.doi.org/10.15584/nsawg.2021.1.9.
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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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AlOlayan, Abdullah, Abdulaziz Almutairi, Riyaz Shaik, Mohammad Ahmad, Maathir Alhumam, Shaden Almutairi, Raghad Alghassab, Abdullah Ghazi i Waleed Khalid. "Knowledge, attitude, and practice of physicians toward asthma inhaler techniques in Qassim, Saudi Arabia". Journal of Complementary Medicine Research 13, nr 4 (2022): 111. http://dx.doi.org/10.5455/jcmr.2022.13.04.22.
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Introduction: Asthma is a chronic inflammatory disease of the airways. Inflammation in airways leads to hypersensitivity and airway obstruction which is responsible for the symptoms of asthma like wheezing, dyspnea, chest tightness and cough that aggravates in the morning. The prevalence ranges from 1.1 to 9.9% in adults. Systemic therapy and inhalational therapy comprising of bronchodilators and steroids are the two major treatment options. Aims & objectives: To assess physicians' knowledge, attitude, and practise toward asthma inhaler devices and inhalation techniques, and classify physician’s attitudes as either poor or adequate. Methodology: A cross sectional study was conducted in Qassim, Saudi Arabia among healthcare providers for a duration of 6 months. Practicing physicians in the three major cities in Qassim were included in the study while non-practicing physicians and those practicing in the small cities and peripheries were excluded. Data collection was done by using a predesigned self-reported online questionnaire consisting of 22 items under 3 major sections- demography, knowledge and practice of physicians. Templates were generated in MS Excel sheet and analysis of data was done using SPSS software. Chi square test was the test of significance used and p<0.05 was considered significant. Results: Metered-dose inhaler (MDI) with a spacer (56, 62.2%) was the most preferred device among dry powder inhalers (18, 20%) and nebulization solution (16, 17.8%). Most of the physicians responded correctly that the first and foremost step in correct MDI inhalation was shaking the device (67, 74.4%). More than three-fifths (57, 63.3%) of physicians claimed to have taught the caregivers on each visit to use an inhaler. The increasing age of the physician was found to be associated with a better understanding, positive attitude and good practice. A significant difference was seen based on the nationality (p 0.003) and the speciality of the physician (p 0.012) in their understanding of inhaled corticosteroids. Conclusion: Older male physicians and a family physician rather than a general physician were found to have better knowledge and a positive attitude toward advising patients regarding inhalers.
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Mohd Salim, Nurul Ain, Nurhanis Syazni Roslan, Rafidah Hod, Syahiera Farhana Zakaria i Siti Khadijah Adam. "Exploring Critical Components of Physician-Patient Communication: A Qualitative Study of Lay and Professional Perspectives". Healthcare 11, nr 2 (5.01.2023): 162. http://dx.doi.org/10.3390/healthcare11020162.
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(1) Background: The ability to communicate with patients and their relatives is a crucial skill for a physician. Unfortunately, many physicians and medical students are not well-equipped in this area. Therefore, this study aims to better understand the views on critical components of physician-patient communication to improve their skills. (2) Methods: This qualitative study utilized focus group discussions (FGDs) and in-depth interviews (IDIs). Through a purposive sampling technique, 32 medical students and physicians from the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (FMHS UPM) and Universiti Putra Malaysia Teaching Hospital (HPUPM), as well as patients and relatives from government and private hospitals or clinics were recruited. All sessions were audio-recorded, transcribed, and analyzed thematically. (3) Results: Seven themes were identified: professionalism, content of communication, verbal, non-verbal and paraverbal communication skills, environment, and visual communication. Good eye contact, providing treatment plans, and ensuring patient privacy and confidentiality were emphasized by physicians and medical students. In comparison, patients and relatives focused on the prognosis of disease, physician’s empathy and advice, and physician’s skills in building rapport with their patients and relatives. (4) Conclusion: The critical components that were highlighted by both professionals and laymen in the study should be practiced to ensure effective communication between physician and patient. There were different expectations in terms of the content of information between both groups. Patients and relatives were more interested in the physician’s advice regarding their diet, care plans, physical activities, and daily routine. They were also focused on the prognosis of the disease, which indicates how quickly they would get better. Meanwhile, physicians and medical students were concentrating on management and treatment strategies, such as what additional procedures should be considered and what medications might work best for their patients. We also found that the patients and relatives had a lack of awareness on confidentiality issues. These findings provide an insight on the improvement of medical training and patient education to improve patient care. Patients have a right to privacy protection, and physicians should be well trained to carry out all procedures and treatment plans to ensure patients are treated with respect.
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Kahale, Pravin, Pijush Kanti Biswas, Sunil George, Sree Ranga P. C., Pankaj Singh, Sanjoy K. Nag i Soumen Roy. "Preference and practice of Indian physicians towards the use of vasodilator di-hydralazine in the management of resistant hypertension". International Journal of Advances in Medicine 7, nr 12 (23.11.2020): 1781. http://dx.doi.org/10.18203/2349-3933.ijam20204986.
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Background: The treatment modalities of resistant hypertension (RH) remain a clinical challenge, often requiring secondary/add-on drugs with first-line therapy to control blood pressure (BP). This study was conducted to explore and understand the preferences and practices of Indian physicians towards the use of vasodilator (especially di-hydralazine) in the management of RH.Methods: This was a cross-sectional, observational, web-based physician survey. The study included cardiologist, nephrologist and consultant physicians from different geographical regions of India. A web-based physician survey questionnaire (PSQ) was created in google forms and the link was circulated to the physicians. Responses obtained were analysed.Results: A total of 457 physicians participated in this survey. In majority of the physicians, vasodilators were the treatment choice as secondary or add-on drugs with first line therapy to control BP in RH; especially hydralazine/di-hydralazine preferred the most. Majority of the physicians preferred to combine vasodilator with beta blocker and diuretic in patients with uncontrolled and RH. Cardiac failure, followed by chronic kidney disease (CKD), diabetes, dyslipidaemia, hypertensive emergency and angina were the common patient profile in RH in which majority physicians prescribed vasodilator (di-hydralazine). Majority of the physicians rated vasodilator di-hydralazine as “good-very good” in terms of efficacy, safety, tolerability, patient compliance and patient satisfaction in RH.Conclusions: Overall, vasodilators (hydrazinophthalazine derivatives) are preferred as add-on drugs along with first-line drugs in RH. Physician’s opinion towards the use of di-hydralazine was positive. Di-hydralazine may be preferred as an add-on therapeutic option to control BP in RH, however randomized clinical trials are needed for recommendation in cardio-renal medicine.
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Le Bel, Josselin, Thierry Pelaccia, Patrick Ray, Charles Mayaud, Anne-Laure Brun, Pierre Hausfater, Enrique Casalino, Mikhael Benjoar, Yann-Erick Claessens i Xavier Duval. "Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan". Emergency Medicine Journal 36, nr 8 (24.06.2019): 485–92. http://dx.doi.org/10.1136/emermed-2018-207842.
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ObjectivesTo determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician’s experience (≤10 vs >10 years).MethodsEarly thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist’s CT scan interpretation.Results319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist’s interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist’s interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01).ConclusionsIn clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians.Trial registration numberNCT01574066
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Yashiro, Daichi, Nobutoshi Nawa, Eriko Okada, Hiroaki Kato, Sarara Yonemori-Matsumoto, Ayako Kashimada, Yasuhiro Itsui i Yujiro Tanaka. "Facilitators and barriers to physicians’ entrepreneurial ventures in major Japanese cities: A qualitative study". PLOS ONE 16, nr 10 (27.10.2021): e0258957. http://dx.doi.org/10.1371/journal.pone.0258957.
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Background The Japanese healthcare system currently faces numerous challenges, including a super-aging society and an excessive burden on medical workers; therefore, the need for innovative solutions from healthcare ventures to tackle these issues has increased. Meanwhile, as physicians play important roles in healthcare ventures, the need for Japanese physician entrepreneurs is more important than ever. Given the lack of research examining barriers to physicians starting ventures and what skills, knowledge, and surrounding environments act as facilitators, this study aimed to identify the facilitators and barriers faced by physicians to start ventures. Methods Between September and November 2019 and in May 2021, qualitative interviews were conducted with 33 participants, which included eight physician entrepreneurs; two administrative officers at the Ministry of Health, Labour and Welfare and the Ministry of Economy, Trade and Industry; three faculty members at Tokyo Medical and Dental University (in-depth interviews); and 20 medical students (focus group discussions). The interviews were deductively coded based on the social ecological model. The inductive approach was applied to coding any knowledge necessary to start a business. We conducted member checking with three physician entrepreneurs and seven medical students to improve our results’ credibility. Results The factors influencing a physician’s decision to launch a new business include their willingness to contribute to society, the unique environment in which an individual is placed while in medical school and afterward, negative aspects of the lack of diversity in physicians’ careers, the financial stability provided by a medical license, and self-efficacy. Conclusions Our study revealed facilitators and barriers to physicians’ entrepreneurial ventures. Knowledge about these factors might be useful in supporting physicians to launch or become involved in healthcare ventures.
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Daskivich, Timothy J., Justin Houman, Garth Fuller, Jeanne T. Black, Hyung L. Kim i Brennan Spiegel. "Online physician ratings fail to predict actual performance on measures of quality, value, and peer review". Journal of the American Medical Informatics Association 25, nr 4 (8.09.2017): 401–7. http://dx.doi.org/10.1093/jamia/ocx083.
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Abstract Objective Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. Materials and Methods We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores. Results Across ratings platforms, multivariable models showed no significant association between mean consumer ratings and specialty-specific performance scores (β-coefficient range, −0.04, 0.04), primary care physician scores (β-coefficient range, −0.01, 0.3), and administrator scores (β-coefficient range, −0.2, 0.1). There was no association between ratings and score subdomains addressing quality or value-based care. Among physicians in the lowest quartile of specialty-specific performance scores, only 5%–32% had consumer ratings in the lowest quartile across platforms. Ratings were consistent across platforms; a physician’s score on one platform significantly predicted his/her score on another in 5 of 10 comparisons. Discussion Online ratings of specialist physicians do not predict objective measures of quality of care or peer assessment of clinical performance. Scores are consistent across platforms, suggesting that they jointly measure a latent construct that is unrelated to performance. Conclusion Online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance.
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Saarinen, Arttu Olavi, Pekka Räsänen i Antti Kouvo. "Two dimensions of trust in physicians in OECD-countries". International Journal of Health Care Quality Assurance 29, nr 1 (8.02.2016): 48–61. http://dx.doi.org/10.1108/ijhcqa-04-2015-0041.
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Purpose – The purpose of this paper is to analyse citizens’ trust in physicians in 22 OECD countries. Design/methodology/approach – The authors measure trust in physicians using items on generalised and particularised trust. Individual-level data are received from the ISSP Research Group (2011). The authors also utilise macro variables drawn from different data banks. Data were analysed using descriptive statistics and xtlogit regression models. The main micro-level hypothesis is that low self-reported health is strongly associated with lower trust in physicians. The second micro-level hypothesis is that frequent meetings with physicians result in higher trust. The third micro-level hypothesis assumes that males, and older and better educated respondents, express higher trust compared to others. The first macro-level hypothesis is that lower income inequality leads to higher trust in physicians. The second macro-level hypothesis is that greater physician density leads to higher trust in physicians. Findings – The authors found that the influence of individual and macro-level characteristics varies between trust types. Results indicate that both trust types are clearly associated with individual-level determinants. However, only general trust in physicians has weak associations with macro-level indicators (mainly physician density) and therefore on institutional cross-country differences. It seems that particularised trust in a physician’s skills is more restricted to the individuals’ health and their own experiences meeting doctors, whereas general trust likely reflects attitudes towards the prevalent profession in the country. Originality/value – The findings hold significance for healthcare systems research and for research concerning social trust generally.
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Mackey, Christian, Melissa A. Plegue, Marian Deames, Matthew Kittle, Kendrin R. Sonneville i Tammy Chang. "Family physicians’ knowledge, attitudes, and behaviors regarding the weight effects of added sugar". SAGE Open Medicine 6 (styczeń 2018): 205031211880124. http://dx.doi.org/10.1177/2050312118801245.
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Background and objectives: Added sugar consumption is a major risk factor for negative health outcomes and family physicians play an important role in educating patients regarding nutrition behaviors, such as consumption of added dietary sugar. The aim of this study was to describe the knowledge, attitudes, and behaviors of family physicians regarding added dietary sugar. Methods: An online questionnaire was administered to family physician members of the Council of Academic Family Medicine organizations, which support teaching physicians that train family physicians throughout the United States. Survey items underwent rigorous pilot and cognitive testing prior to administration. Descriptive statistics and Pearson’s chi-square test were performed to evaluate physician’s dietary counseling for patients with overweight and obesity. Results: Among practicing family physician members (n = 1196), 72% reported providing dietary counseling to the majority (⩾50%) of their patients with overweight and obesity. Most (90%) believed that their counseling was ineffective for the majority of patients. Frequency of counseling was significantly associated with beliefs about counseling effectiveness (p-value < 0.001). Nearly all physicians (97%) advised against consuming sugary beverages, while advising patients to limit foods with added sugar was less common (82%). Discussion: Dietary counseling is often, but not always, provided to patients with overweight and obesity by family physicians in our sample, though most physicians believed their counseling is ineffective. National attention to added sugar as a risk for poor health should serve as a catalyst for renewed efforts from primary care educators and clinicians to engage in innovative practices to empower at-risk patients to improve their nutrition.
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Ünsal Delialioğlu, Sibel, Sibel Mandıroğlu i Fatih Göksel. "Awareness and attitudes of oncology physicians recommending exercise to patients with cancer". Turkish Journal of Physical Medicine and Rehabilitation 68, nr 1 (1.03.2022): 70–75. http://dx.doi.org/10.5606/tftrd.2022.7120.
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Objectives: The aim of our study was to evaluate oncology physicians’ attitudes and awareness toward recommending exercise to their patients with cancer. Patients and methods: A total of 86 oncology physicians (52 males, 34 females; mean age: 46.7±10.9 years; range, 26 to 60 years) were included in the study between June 2019 and September 2019. A questionnaire was prepared to evaluate the physicians' perspectives about exercise and it consisted of five main sections including the physician's exercise habits, physicians’ attitudes toward recommending exercise, the effects of exercise on cancer-related symptoms and cancer treatments, whether there was an exercise unit in the hospital, and whether the physician was referring the patients and on which subjects the physicians were willing to receive training. Results: A total of 87.2% of the physicians recommended exercise to their patients. There were three reasons for physicians who did not recommend exercise: “I don’t have enough training to recommend exercise; I don’t know which type of exercise to recommend; and I don’t know what I should pay attention while recommending exercise.” A total of 83.7% physicians considered that exercise reduced the symptoms associated with cancer. A total of 73.3%, 64%, and 80.2% physicians believed that exercise increased the effectiveness of chemotherapy, radiotherapy, and immunotherapy, respectively. About 94.2% of the physicians were willing to be trained on the effects of exercise in cancer. Conclusion: Oncology physicians believe that exercise has positive effects on cancer; however, they still need training on this subject.
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Vanagienė, Virginija, Birutė Žilaitienė i Tadas Vanagas. "Do the quality of health care services provided at personal health care institutions of Kaunas city and access to it meet expectations of pregnant women". Medicina 45, nr 8 (13.08.2009): 652. http://dx.doi.org/10.3390/medicina45080085.
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Objectives. To evaluate if the quality of services provided by family physicians and obstetricians/gynecologists at primary personal health care institutions of Kaunas city and access to it meet the needs and expectations of pregnant women. Material and methods. Pregnant women visiting the selected health care institutions at their third trimester of pregnancy were asked to fill in the anonymous questionnaire. The study was conducted at two randomly selected maternity centers of Kaunas city and two family practices of Kaunas city where antenatal care was provided by family physicians. The questionnaires were given to 106 patients visiting family physicians (response rate was 88.7%) and to 202 patients visiting obstetricians/ gynecologists (response rate was 81.7%). Results. Health services provided by family physicians and obstetricians/gynecologists met the expectations of pregnant women in respect of providing with information and communication. The patients of obstetricians/gynecologists significantly more often stated that they were very satisfied with patient-physician communication (P<0.05), they significantly more often understood explanations given by the physician (P<0.001) and claimed having sufficient knowledge about pregnancy (P<0.05), while the patients of family physicians significantly more often asserted that the physician helped them in preparation for childbirth (P<0.05). The patients of obstetricians/gynecologists significantly more often did not face any problems with access to services as compared to the patients of family physicians (z=3.0). Most of pregnant women stated that they were satisfied or very satisfied with the quality of health care at the health care facility providing them with antenatal care irrespective of the physician’s specialty. Conclusions. The quality of antenatal health care provided by both family physicians and obstetricians/gynecologists and access to it satisfied the needs and expectations of the surveyed women. Correction of the limitations noticed, e.g., closer communication, more understandable explanations, more attention to preparation for childbirth, better work planning, could improve the quality of antenatal care provided by the family physicians.