Gamma interferon prevents diabetes in the BB rat

OBJECTIVE: Although increased evidence of disproportionate psychosocial risk and other health problems encountered by lesbian, gay male, and bisexual (LGB) youths has emerged, no study has described how the topic of homosexuality is addressed within child and adolescent residency psychiatry training. METHOD: Residency training directors in U.S. child and adolescent psychiatry programs were asked questions about instruction on the topic of homosexuality and the care of LGB patients, the department's view of whether homosexuality represents a pathological condition, the director's awareness of LGB colleagues and residents, and the director's opinion of LGB residents' disclosure of their homosexuality to their patients and patients' families. Asking similar questions facilitated a comparison of survey results with those of an earlier study of general psychiatry training directors. RESULTS: The reported departmental attitudes about whether homosexuality represents a pathological condition were essentially equivalent in general and child programs. Child and adolescent training directors were, however, less likely to have a favorable view of disclosure of sexual orientation to patients, less likely to know LGB residents or faculty, and less likely to report LGB residents an asset to their departments. CONCLUSIONS: The prediction that the majority of child and adolescent training programs would reflect a heightened awareness of the vulnerability of LGB youths was not confirmed.     

Physician and patient communication training in primary care: Effects on participation and satisfaction.

[Correction Notice: An erratum for this article was reported in Vol 28(2) of Health Psychology (see record 2009-03297-015). There was a typographical error in the text on page 521, in the first sentence of the first full paragraph. The corrected sentence is provided in the erratum.] Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. Results: The following significant (p     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

“Physician and patient communication training in primary care: Effects on participation and satisfaction”: Correction.

Reports an error in "Physician and patient communication training in primary care: Effects on participation and satisfaction" by Kelly B. Haskard, Summer L. Williams, M. Robin DiMatteo, Robert Rosenthal, Maysel Kemp White and Michael G. Goldstein (Health Psychology, 2008[Sep], Vol 27[5], 513-522). There was a typographical error in the text on page 521, in the first sentence of the first full paragraph. The corrected sentence is provided in the erratum. (The following abstract of the original article appeared in record 2008-13168-002.) Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. Results: The following significant (p     

Patients' health as a predictor of physician and patient behavior in medical visits. A synthesis of four studies

OBJECTIVES: Although some patient characteristics are known to be related to physician and patient communication in medical encounters, very little is known about the impact of patients' health status on communication processes. The authors assess relations of patients' physical and emotional health status to verbal and nonverbal communication between physicians and patients in four original studies, and combine results across the four studies using meta-analytic procedures. METHODS: In four original studies of routine outpatient visits (consisting of more than 250 physicians and more than 1,300 patients), health status was measured and audiotape or videotape records were coded for verbal content and nonverbal cues indicating task-related behavior and affective reactions on the part of both the physician and the patient. Both physical and mental health data were obtained, using physicians and/or patients as sources; in two studies, physicians' satisfaction with the visit also was measured. All available background characteristics for both physicians and patients were controlled via partial correlations. The meta-analytic procedures used were the unweighted and weighted (by sample size) average partial correlations, the combined P across studies (Stouffer method), and the test of effect size heterogeneity. RESULTS: Physicians showed signs of negative response to sicker or more emotionally distressed patients, both in their behavior and in their ratings of satisfaction with the visit. Sicker patients also behaved more negatively than healthier patients. However, physicians also engaged in a variety of positive and professionally appropriate behaviors with the sicker or more distressed patients. This mixed pattern of responses is discussed in terms of alternative frameworks: the physician's goals, reciprocation of affect, and ambivalence on the part of the physician. CONCLUSIONS: The patient's health status appears to influence physician-patient communication. In clinical practice, increased attention by physicians to their own and their patients' behavior may enhance diagnosis and prevent misunderstandings.     

Communication problems for patients hospitalized with chest pain

In many settings, primary care physicians have begun to delegate inpatient care to hospitalists, but the impact of this change on patients' hospital experience is unknown. To determine the effect on physician-patient communication of having the regular outpatient physician (continuity physician) continue involvement in hospital care, we surveyed 1,059 consecutive patients hospitalized with chest pain. Patients whose continuity physicians remained involved in their hospital care were less likely to report communication problems regarding tests (20% vs 31%, p =.03), activity after discharge (42% vs 51%, p =.02), and health habits (31% vs 38%, p =. 07). In a setting without a designated hospitalist system, communication problems were less frequent among patients whose continuity physicians were involved in their hospital care. New models of inpatient care delivery can maintain patient satisfaction but to do so must focus attention on improving physician-patient communication.     

Employment-seeking experiences of resident physicians completing training during 1996

CONTEXT: Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment. OBJECTIVE: To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices. DESIGN: Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year. SETTING: A total of 25 067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties. MAIN OUTCOME MEASURE: Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors. RESULTS: After 6 months of data collection, 12135 (48.4%) of 25 067 resident physicians responded to the survey. Of the respondents, 11 200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%),those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%). CONCLUSIONS: Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.     

Effect of evaluator and resident gender on the American Board of Internal Medicine evaluation scores

OBJECTIVE: To examine the effects of resident and attending physician gender on the evaluation of residents in an internal medicine training program. DESIGN: Cross-sectional study. SETTING: Large urban academic internal medicine residency program. PARTICIPANTS: During their first 2 years of training, 132 residents (85 men, 47 women) received a total of 974 evaluations from 255 attending physicians (203 men, 52 women) from 1989 to 1995. MEASUREMENTS: The primary measurements were the numerical portions of the American Board of Internal Medicine evaluation form. Separate analyses were performed for each of the nine evaluation dimensions graded on a scale of 1 to 9. The primary outcome was the difference in the average scores received by each resident from male versus female attending physicians. RESULTS: Compared with female trainees, male residents received significantly higher scores from male attending physicians than from female attending physicians in six of the nine dimensions: clinical judgment, history, procedures, relationships, medical care, and overall. Similar trends, not reaching conventional levels of statistical significance, were observed in the other three categories: medical knowledge, physical exam, and attitude. These differences ranged from 0.24 to 0.60 points, and were primarily due to higher grading of male residents by male attending physicians than by female attending physicians. CONCLUSIONS: In one academic training program, we found a significant interaction in the grading process between the gender of internal medicine residents and the gender of their attending evaluators. This study raises the possibility that subtle aspects of gender bias may exist in medical training programs.     

Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.

Examined the influence of physicians' attributes and practice style on patients' adherence to treatment in a 2-yr longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 yrs later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal communication and physician–patient rapport: An empirical study.

Studied 71 medical residents and approximately 400 patients to examine the relationship between patients' satisfaction with the medical care they received from their physicians and the nonverbal skills of those physicians. Various aspects of the physicians' personalities were assessed with the Personality Research Form, and their nonverbal decoding skills were measured with the Profile of Nonverbal Sensitivity scale. Patients rated their physicians on caring and sensitivity, indicated the extent to which the physicians listened to what they had to say and cared about them as people, and indicated whether they felt they could call the doctor if necessary. Results support the hypothesis that the socioemotional dimension of the physician–patient relationship depends, to a moderate degree at least, on the physician's ability to understand the patient's nonverbal cues of affect and on the physician's ability to intentionally communicate affect through nonverbal channels. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient gender and communication with physicians: results of a community-based study

An observational study of 648 routine medical visits with 69 physicians examined patient gender in relation to patient and physician communication, patient preference for the physician's communication style, patient satisfaction, and the physician's awareness of the patient's satisfaction. Data consisted of audiotapes as well as patient and physician questionnaires. Women appeared to be more actively engaged in the talk of medical visits--they sent and received more emotionally charged talk and were judged by independent raters as more anxious and interested both globally and in terms of voice quality than men. Consistent with the more emotional talk, women reported preferring a more "feeling-oriented" physician than male patients did. Mean levels of satisfaction with communication did not differ by gender, and communication predictors of satisfaction were similar for male and female patients, although they were stronger for male patients. Physicians were significantly less aware of some aspects of female patients' satisfaction compared to male patients' satisfaction. In light of the weaker correlations between patients' communication and their satisfaction for women, we suggest that women provided fewer obvious cues to their satisfaction. Training in communication skills may increase open discussion about feelings and emotions and may also produce greater physician sensitivity to patients' satisfaction, particularly with female patients.     

Preferences of physicians and their patients for end-of-life care

OBJECTIVE: Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves. MEASUREMENTS AND MAIN RESULTS: Study physicians (n = 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients (n = 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7). African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients (r = .51, p < .0001). CONCLUSIONS: Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.     

Comparison of two low-molecular-weight heparins for the prevention of postoperative venous thromboembolism after elective hip surgery. Reviparin Study Group

BACKGROUND: Many physicians today are employed by another physician, group, hospital, HMO, or other organization. However, the differences in the characteristics, practice patterns, and patient outcomes of self-employed and employed physicians are not well understood. METHODS: The practices of 108 community family physicians in northeast Ohio were assessed using a multimethod cross-sectional design. Physician characteristics were assessed by questionnaire. Direct observation of 3536 consecutive patient visits was used to measure time use and the delivery of preventive services recommended by the US Preventive Services Task Force. Patient satisfaction was assessed with the Medical Outcomes Study (MOS) 9-item Visit Rating Form. RESULTS: Employed physicians were more likely to be female, in group practice, work fewer hours, and see fewer patients. Job satisfaction was similar between the two groups, but employed physicians reported greater satisfaction with leisure and family time. Employed physicians spent more time per patient visit, scheduled a larger percentage of well-care visits, and were more likely to refer to specialists. Employed physicians also spent a greater proportion of their patients' visit time performing history-taking and eliciting family information, and a lesser proportion of time on physical examination, planning treatment, providing health education, and chatting. Recommended screening and health habits counseling preventive services were more likely to be delivered by employed physicians. Patient satisfaction was similar for the two groups. CONCLUSIONS: Primary care physician characteristics and practice patterns differ by employment status. The consequences of the trend toward a largely employed physician workforce as reported in this study should be carefully considered.     

Empathy: an essential skill for understanding the physician-patient relationship in clinical practice

In clinical practice, empathy is the skill used by physicians to decipher and respond to thoughts and feelings in the physician-patient relationship. Empathetic understanding and empathetic response occur in three phases of every office visit: the negotiation phase, the clinical reasoning phase, and the establishment of therapeutic alliance. Masters of empathetic skills is difficult, and before teaching empathy to residents and students, teachers must first develop their own empathetic skills. Development of empathetic skills can occur in Balint training programs, through the use of audio- or videotaped patient encounters, or through one-on-one training with an experienced preceptor.     

Behavioral science training in family practice residency education: a first evaluation

Although behavioral science training is an essential component of family practice residency education, there have been few evaluations of its effects. In this study, selected behaviors of senior residents and their patients in two different family practice residency programs were compared. One program emphasized behavioral science, the other did not. Residents in the more behaviorally oriented program had more positive attitudes toward both social factors in illness and the importance of a warm physician-patient relationship. In addition, these residents claimed to know more about non-pharmacologic treatments for depression and anxiety and felt more confident in their ability to handle them than their less behaviorally trained counterparts. In regard to patient care, patients of residents in the program which emphasized behavioral science were more likely to receive a psychosocial diagnosis and resident counseling or mental health referral than patients of residents in the program which did not. On a patient satisfaction questionnaire, patients of the two programs differed on only one subscale which concerned convenience of care. Although these early results are encouraging, behavioral science training needs continuing clarification and evaluation of its goals and accomplishments.     

After-hours telephone calls in a family practice residency: volume, seriousness, and patient satisfaction

BACKGROUND: After-hours calls are common in primary care physicians' practices. Calls may be unnecessary from the physician's perspective, but patients may have a different concept of the importance of reaching their physician immediately. This study's purpose was to compare physician and patient perceptions of the same telephone call episode. METHODS: Family practice residents (n = 19) recorded all patient-initiated after-hours telephone contacts (n = 192) during July 1993. Study personnel then telephoned, within 1 week of their call, the patients who made the calls. Patients were asked about the reason for their call, its seriousness, and their satisfaction with the handling of their problem. RESULTS: During the study month, 1.1 after-hours calls were received for every 10 office visits. A substantial minority of patients (29%) rated their problems in the highest severity category, while physicians assigned only 8% of calls the highest severity rating. The majority of patients (76.7%) were satisfied with how their after-hours calls were handled. CONCLUSIONS: In matched cases, physicians and patients perceive about the same proportion of calls to be routine versus more severe. Although patient satisfaction was high, further research into causes of dissatisfaction is needed.     

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload.

Conducted a field study of 28 residents in family practice, examining Ss' self-reports of empathy, self-monitoring ability, and affective communication skill, as well as objectively measured nonverbal communication skills, as predictors of patient satisfaction (PS), appointment noncompliance (ANC), and physician workload. PS with communication, affective care, and technical care was assessed, and appointment records were used to determine the number of patients seen by each S and ANC. Results indicate that self-report measures were unrelated to measures of ANC and PS but self-reported affective communication ability was significantly correlated with physician workload. More sensitive Ss experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaborative practice in primary care: Integrated training for psychologists and physicians.

Managed health care has forced psychologists and primary care physicians to expand their practices into areas for which they have traditionally lacked training or experience. This article describes a training program designed to foster collaboration and to bridge the gap between the 2 specialties by having psychology interns and medical residents comanage patients in a primary care setting under the joint preceptorship, of a psychologist and a physician. (PsycINFO Database Record (c) 2011 APA, all rights reserved)