The application of Guttman scale analysis to physician's attitudes regarding abortion.

Interviewed a random sample of 40 licensed obstetrician-gynecologists and 25 family physicians about their attitudes toward abortion and their experiences since its legalization. Data suggest that, while physicians in both specialties approved or disapproved of legal terminations of pregnancies in general, their attitudes reflected qualifications based on the circumstances of each specific case. Analysis of Ss' personal reactions to abortion under 11 different circumstances revealed that Ss' attitudes conformed to a Guttman scalogramming pattern. Tests of reproducibility and scalibility yielded high values. Physicians' reactions ranged from high rates of approval of abortion for medical reasons to lower rates of approval for sociocultural, nonmedical reasons, except when the pregnancy resulted from rape or incest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discrimination against gay, lesbian and bisexual family physicians by patients

BACKGROUND: Discrimination against gay, lesbian and bisexual (GLB) patients by physicians is well known. Discrimination against GLB physicians by their colleagues and superiors is also well known and includes harassment, denial of positions and refusal to refer patients to them. The purpose of this study was to identify and quantify the attitudes of patients toward GLB physicians. METHODS: Telephone interviews were conducted with 500 randomly selected people living in a large urban Canadian city. Subjects were asked if they would refuse to see a GLB family physician and, if so, to describe the reason why. They were then given a choice of 6 reasons obtained from consultation with 10 GLB people and 10 heterosexual people. RESULTS: Of the 500 subjects 346 (69.2%) were reached and agreed to participate. Of the 346 respondents 41 (11.8%) stated that they would refuse to see a GLB family physician. The 2 most common reasons for the discrimination (prevalence rate more than 50%) were that GLB physicians would be incompetent and the respondent would feel "uncomfortable" having a GLB physician. Although more male than female respondents discriminated against GLB physicians, the difference was not statistically significant. The proportion of male and female respondents who discriminated increased with age (p < 0.01). CONCLUSIONS: The observed prevalence of patient discrimination against GLB family physicians is significant. The results suggest that the discrimination is based on emotional reasons and is not related to such factors as misinformation about STDs and fear of being thought of sexually. Therefore, educational efforts should be directed against general perceptions of homosexuality rather than targeting specific medical concerns.     

Willingness to perform euthanasia. A survey of physician attitudes

BACKGROUND: In the United States, few studies have examined important variables in physician attitudes toward the practice of euthanasia, such as the patient's underlying disease, mental capacity, and age, and the physician's specialty and religion. We administered a case-based survey to analyze the impact of such specific variables on physician attitudes toward the practice. METHODS: A four-section survey solicited (1) physician responses to three hypothetical cases in which patients requested euthanasia; (2) physicians' general opinions about euthanasia and how its legalization might affect them personally and professionally; and (3) demographic information. Analysis focused on physicians' characteristics as they related to their responses to the various aspects of euthanasia elicited in the survey. Univariate and multivariate analyses, using logistic regression, were performed. RESULTS: Completed and analyzable surveys were returned by 740 physicians. We found that physicians felt more comfortable with euthanasia requests from nondecisional, nonterminal patients who had left advance directives than they did with requests from decisional patients suffering from grave illnesses or injuries, or from decisional patients who had early signs of a progressive but nonlethal neurologic disease. We also found that physicians' specialties and religions correlated with their responses to the hypothetical cases and with their generalized attitudes toward euthanasia. CONCLUSIONS: Given the disparity in responding physicians' attitudes toward euthanasia, along with the fact that values based on religious affiliation or profession may underlie many physicians' opposition to the practice, we conclude that if euthanasia is to be legalized, safeguards protective of patients and physicians must be incorporated.     

Attitudes of general practitioners in Northern Ireland toward abortion and family planning

A survey of the attitudes and practices of general practitioners in Northern Ireland regarding contraception and abortion was carried out in 1994 and 1995 with a randomized sample of 154 physicians. The vast majority of doctors who received requests for contraceptives from their patients fulfilled those request (94%). Overall, 13% of the doctors said a married patient had requested an abortion in the past three months, and 34% had had a similar request from an unmarried patient. Two-thirds thought that a woman together with her physician should decide whether to terminate a pregnancy, 19% did not think the choice should be left with the woman and her physician and 13% were undecided. Sixty-six percent believed that a joint strategy of improving contraceptive use and reducing premarital intercourse is the best approach for preventing unwanted pregnancy among teenagers, 21% specified only improving contraceptive use and 13% indicated only reducing premarital intercourse.     

Familial occurrence of a del(Xp-) chromosome: pitfall in karyotype/phenotype correlation

PURPOSE: To examine the attitudes of physicians practicing in New Mexico toward gay and lesbian medical students, house officers, and physician colleagues. METHOD: In May 1996, the authors mailed a questionnaire with demographic and attitude questions to 1,949 non-federally employed physicians practicing in New Mexico. The questionnaire consisted of questions dealing with medical school admission, residency training, and referrals to colleagues. The response rate was 53.6%. RESULTS: Of all the responding physicians, 4.3% would refuse medical school admission to applicants known to be gay or lesbian. Respondents were most opposed to gay and lesbian physicians' seeking residency training in obstetrics and gynecology (10.1%), and least opposed to their seeking residency training in radiology (4.3%). Disclosure of homosexual orientation would also threaten referrals to gay and lesbian obstetrician-gynecologists (11.4%) more than to gay or lesbian physicians in other specialties. CONCLUSION: Physicians' attitudes toward gay and lesbian medical students, house officers, and physician colleagues seem to have improved considerably from those reported previously in the literature. However, gay men and lesbians in medicine continue to face opposition in their medical training and in their pursuit of specialty practice.     

The physicians and abortion

The position of physicians regarding induced abortion in Mexico deserves closer attention. The attitudes of physicians towards induced abortion have been a subject of study in different countries. It has been observed that such attitudes depend on ethical, religious, legal, political, or medical factors. In those countries where abortion is not penalized, physicians sustain different positions regarding this issue. The experiences of some countries indicate that the institutional provision of abortion services is a controversial and politically serious matter, and that offering or denying them generally depends to a great extent on the physician's discretion. In contexts like Mexico, where abortion is penalized, legal and other restrictions do not prevent many physicians from practicing it in a concealed way, generally for profit. On the other hand, even though abortion is recognized as an important social and public health problem, and laws regulate the conditions for its legal practice, the majority of medical professionals and health institutions maintain a conservative and reserved position on this matter. The professional training of physicians and the legal status of induced abortion as a criminal practice, are central elements in their attitudes towards this problem.     

Report of the Department of Defense, National Cancer Institute, Department of Health and Human Services Office of Women''s Health workshop on the mobile breast care center

The present study examines women's decision making about mammography over a 1-year period, using "decisional balance," a summary of women's positive and negative perceptions about mammography derived from the Transtheoretical Model (TTM). Data were from a survey of women ages 50-74 years who completed both the baseline and 1-year follow-up telephone surveys (n = 1144) for an intervention study to increase the use of mammography screening. A shift toward less favorable perceptions about mammography was related to being a smoker and not having a recent clinical breast examination and Pap test. Change in women's attitudes toward mammography was also related to four dimensions of a woman's information environment. Women who rated the opinions of a physician as somewhat or not important, those who reported that at least one family member or friend discouraged them from having a mammogram, and women who felt they lacked enough people in their social network with whom they could discuss health concerns were less likely to express favorable attitudes about mammography over 1 year. In contrast, women who consistently communicated the value of mammography to others expressed more favorable views of screening over the study period. Interventions designed to promote breast cancer screening must recognize that a woman not only reacts to mammography information provided by significant others in her social network but may proactively reach out to others as an advocate of breast cancer screening, thus reinforcing or changing others' opinions or behavior as well as her own.     

Physician-only and physician assistant statutes: a case of perceived but unfounded conflict

In the 1970s, after the US Supreme Court declared in Roe v Wade that a woman has a fundamental right to terminate a pregnancy, most states enacted laws decriminalizing abortion. Generally, these statutes legalized abortion when performed by a physician. (Only six states--AZ, KS, NH, OR, VT, WV--do not require explicitly that abortions be performed by physicians.) At around the same time, but for different reasons, most states adopted regulatory measures establishing and defining the profession of physician assistant (PA). These laws broadly define the scope of practice of PAs as the practice of medicine by trained and licensed professionals under the supervision of physicians. Inconsistencies between physician-only abortion laws and PA statutes have generated confusion in the medical community as to whether PAs, working under the supervision of physicians, can legally perform abortions. Using three case studies, this article examines the statutory dynamic against the backdrop of the severe and intensifying shortage of trained abortion providers in the United States. The authors conclude that the perceived conflict between physician-only and PA statutes should not preclude PAs from providing this vital service.     

Premenstrual syndrome: diagnosis and treatment experiences

We sought to examine the diagnosis and treatment experiences of women in the United States who reported having been diagnosed with premenstrual syndrome (PMS) by a physician. A survey of 220 women, randomly selected, ages 26-56, who subscribed to a woman's health newsletter and reported being given a diagnosis of PMS by a physician was conducted. Subjects reported (1) they sought medical help for 5.33 +/- 6.23 years before receiving a diagnosis, (2) they sought help from 3.75 +/- 3.22 physicians for PMS symptoms, (3) they thought the majority (71%) of physicians they used were not adequately informed to diagnose and treat them, (4) only a minority (23%) of physicians used a symptom chart, currently the only way to confirm a PMS diagnosis, when determining their diagnosis, and (5) only approximately 1 in 4 (26%) physicians provided them with a helpful treatment. Seventy-six percent of subjects reported that a PMS diagnosis resulted from their own suggestion, with an agreement by the physician. Eighty-one percent reported that the initial suggestion of PMS came from a non-medical source. The most commonly recommended and used treatments were vitamins, exercise, and diet modification. Current treatment satisfaction was 15.6% not very satisfied, 48.8% somewhat satisfied, and 35% very satisfied. Satisfaction was higher if natural progesterone or hysterectomy with oophorectomy was included as a treatment, although a high percentage of satisfaction was seen with several treatments. Data indicate that physicians from whom most of the women sought care between 1974 and 1994 failed to recognize, diagnose, or treat their PMS using the standards and protocols published in the medical literature.     

The physician perspective of health psychologists in medical settings.

Examined physician attitudes and utilization of psychologists in medical settings by administering a 15-item questionnaire to 397 26–78 yr old physicians (84% male) practicing family/general practice, surgery, internal medicine, or miscellaneous clinical medicine. Although differences in attitudes were associated with age, sex, and specialty, generally favorable attitudes toward psychologists were found among Ss. Results show a recognition by the majority of Ss of the role that psychological factors play in medical disease and an appreciation of clinical psychological skills by a large majority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference?

Obese women are at higher risk for the development of both endometrial and ovarian carcinoma. Biochemical mechanisms represent documented causal factors but the role of psycho-social attitudes has received limited attention. This study examined the difference in the frequency of pelvic screening examinations between obese and non-obese women and the effect of physician and patient attitudes toward obesity on examination frequency. A total of 291 women subjects and 1316 physician subjects participated in this study. Data reported in this paper suggest that attitudes and behaviors are negatively influenced by weight. As subjects' weight went up, negative opinions about their appearance and reluctance to obtain pelvic examinations also increased while the likelihood of having annual pelvic examinations decreased. A substantial minority (17%) and an overwhelming majority (83%) of physicians indicated they were reluctant to perform pelvic examinations on obese and reluctant patients respectively. If physicians are more reluctant to perform pelvic examinations on obese and reluctant women and obese women are more reluctant to be examined, there may be a critical delay in detecting adenocarcinomas of the female genital tract.     

Physician attitudes regarding telephone medicine

OBJECTIVE: To measure physicians' attitudes regarding telephone medicine and identify determinants of these attitudes. DESIGN: Cross-sectional survey. SETTING: Ten internal medicine residency programs in the United States. PARTICIPANTS: Graduates from 1988 through 1992. The response rate was 62% (n = 356). MEASUREMENTS AND MAIN RESULTS: Survey items were assigned to one of four types of variables: demographic, attitude, training, or system variables. We used factor analysis to consolidate information from the individual questions about attitudes. Six scales describing attitudes toward telephone medicine were identified. Cronbach's alpha was greater than 0.70 for all scales. One scale measured physicians' satisfaction and confidence with the management of patient calls. Other attitude scales measured the helpfulness of personal experience or informal education and the importance of formal training in telephone medicine. Three of the scales measured how comfortable the physician felt prescribing over the telephone. We used regression analysis to predict physician attitudes towards telephone medicine using the demographic, training, and system variables. Availability of the patient's chart, feeling prepared for telephone medicine by one's residency training, and being comfortable prescribing narcotics by telephone predicted satisfaction and confidence with the management of patient calls (R2 = .25). CONCLUSIONS: Several physician attitudes regarding telephone medicine can be measured reliably. Our findings suggest that improving systems for managing patient calls and improving telephone training for physicians will improve physician satisfaction and confidence with the practice of telephone medicine.     

Continued pregnancy among abortion applications. A study of women having a change of mind

OBJECTIVE: A certain proportion of women applying for legal abortion later change their minds. The present study was designed to ascertain whether such women differ from those who choose to terminate their pregnancy, with regard to age, civil status, other demographic characteristics, or reproductive history. SETTING: Department of Obstetrics and Gynecology, University Hospital Malm?, Lund University, Sweden. SUBJECTS: All 1,446 abortion applicants attending the abortion clinic at University Hospital Malm?, in 1989. STUDY DESIGN: A comparison of the women who continued the pregnancy and those who underwent abortion, with regard to the above mentioned factors. METHODS: Semistructured interviews and statistical analysis. RESULTS: Of this series of urban abortion applicants, almost one in ten underwent a change of mind. Women who chose to continue their pregnancy differed from those who held fast to their initial decision above all with regard to age and family situation. Less important was education, reproductive history, and stated reasons for abortion. CONCLUSIONS: To answer the question why some women continue an unwanted pregnancy after a closer consideration is not easy. The complexity of a woman's feeling in the matter seems to be moderated by the kind of support and stability she has in her life situation and also of the stability in relation to her partner. An equally important question is whether this change of mind is associated with a changed attitude to the expected baby (i.e., does an unwanted child become a wanted one?).     

Attitudes toward the dual role of the married professional woman.

Evaluated the attitudes of professional men and women toward the married professional woman's dual role in terms of 6 variables. Data were based on 60 of 90 questionnaires sent to persons affiliated with a university research organization and a social service agency. There were significant differences within the group for the variables of sex and profession but no significant differences for education, age, race, and professional experience. Findings indicate that while married professional women had positive attitudes toward the professional woman's dual role, negative attitudes were held by the case workers and the married professional men. It is concluded that negative attitudes toward this dual role both in- and outside of the professional community may indicate why few women prepare for and pursue professional careers. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Osteogenesis of the fetal bovine skull

BACKGROUND: We wanted to validate reports that deaf persons have difficulty obtaining medical care by comparing physicians' attitudes towards these patients with physicians' attitudes toward their patients in general. METHODS: Two questionnaires were randomly distributed to physicians attending continuing medical education conferences at the University of Michigan during a 3-month period. The questionnaires were identical except that one asked about deaf patients and the other about patients in general. The questions assessed the respondent's perceptions of communication with patients, attitudes toward their patients, knowledge of current information about deaf people, and demographics. RESULTS: One hundred sixty-five physicians responded, 94 to the general questionnaire and 71 to the deaf questionnaire. The two physician groups were similar demographically, but 165 differed significantly in communication and attitude variables. Physicians receiving the questionnaire focusing on deaf patients reported greater difficulties in understanding (P < 0.001) and maintaining free-flowing conversations (P < 0.001), and that these patients had more difficulty understanding them (P < 0.001), trusted them less (P < 0.001), asked them to repeat statements more often (P < 0.001) and were less likely to understand the diagnosis and recommended treatments (P < 0.001). Physicians also reported feeling less comfortable with deaf patients (P < 0.001) and that they asked fewer questions (P < 0.001). Physicians were more likely to say that deaf patients rely on interpreters (P = 0.040), get frustrated easily (P < 0.001), and are harder to communicate with (P < 0.001). There were no significant differences between the two groups in knowledge about deaf people. All physicians, however, displayed ignorance about their legal obligations under the Americans with Disabilities Act to provide interpreters for their deaf patients. CONCLUSIONS: Physicians surveyed about deaf patients reported significantly greater difficulties communicating with and different attitudes toward these patients than physicians surveyed about their patients in general. All physicians were unaware of their obligations under the Americans with Disabilities Act to provide interpreters for deaf patients. Research is needed to determine whether physician attitudes and beliefs affect the actual quality of care they deliver to deaf patients.     

Maternal attitude toward pregnancy and the risk of neonatal death

OBJECTIVES: Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS: The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS: Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS: These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.     

The effect of physician advice on exercise behavior

BACKGROUND: Although sedentariness, a prevalent lifestyle, is recognized as a significant risk factor for coronary artery disease and other conditions, little is known about the effectiveness of prevention strategies in the primary care setting. This study examines the impact of brief, exercise advice-giving by family physicians. METHODS: During a 2-month baseline period, patients visiting their family physician and who were age 18 or older were queried about their exercise habits and attitudes and whether their physician had discussed exercise. During the following 2-month experimental phase, the same data were gathered, and half the physicians were trained to give brief exercise advice. All patients were followed for 1 month. Changes in exercise duration and frequency were the primary outcome measures. RESULTS: During baseline, a sizable portion of patients were given exercise advice. This was true also of control group patients during the experimental phase, although trained physicians gave advice almost twice as often. A comparison of the patients receiving advice with those not receiving advice revealed significant increases in exercise duration, but not frequency. Patient attitudes were responsive to exercise advice. CONCLUSION: Members of primary care, adult patient population will increase their duration of physical activity in response to physician advice to exercise.     

Demographic factors and pregnancy--who chooses abortion?

The number of pregnancies terminated as induced abortions has been analysed from data recorded in the Norwegian Birth Registry and the Norwegian Abortion File at the Central Bureau of Statistics. During the time period 1 January 1979 to 31 December 1991, 871,439 pregnant women were registered. Among single women the proportion of pregnancies terminated as induced abortions varied between 40 and 75% throughout the study period. Cohabitant women chose abortion significantly more often than married women. Among married women the proportion of pregnancies interrupted varied with the woman's age and the number of children. Among women 20-34 years of age with one or no child, more than 97% of the pregnancies proceeded to term. Women undergoing abortion comprise a heterogeneous group, judged by demographic factors. Future studies must focus on social factors as well as demographic factors, in order to uncover the complexity of the reasons for choosing abortion.     

Effects of analyzing reasons on attitude–behavior consistency.

In Studies 1 and 2, 58 undergraduates were familiarized with attitude objects (puzzle or photographs), and half were instructed to analyze why they felt the way they did about these objects. Both self-report and behavioral measures of attitudes toward the objects were then assessed. In Study 3, 39 college couples involved in dating relationships were or were not asked to analyze their relationship, and self-report and behavioral measures of adjustment (e.g., whether the couples were still dating several months later) were also assessed. In all 3 studies, Ss who explained reasons for their attiudes (reasons analysis condition) had significantly lower correlations between their attitudes and behavior than Ss who did not explain reasons for their attitudes (control condition). Evidence for the hypothesis that Ss in the reasons analysis conditions changed their attitudes in a less accurate direction is presented, and reasons why this change might take place are discussed. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Definitive surgery for duct cell carcinomas of the pancreas

BACKGROUND AND DESIGN: As changes in the health care system aim to reduce the cost of medical care, physicians need to understand and be able to justify their reasons for referring patients. To learn the basis for making referrals, we asked 116 referring physicians why they made referrals to one university-based physician. We also assessed the referring physicians' satisfaction. RESULTS: A total of 112 of the 116 physicians responded in reference to 114 patients. The responses fit into five categories. Fifty of 114 patient were referred for therapy; 16 patients, for a diagnosis; and 16, for a combination of diagnosis and therapy. Other reasons in descending order of frequency were (1) a nondermatologist referring the patient to a dermatologist, (2) self-referral, ie, the patient was not referred by the physician, and (3) the patient's personality was difficult. The referring physicians were satisfied in 94 instances. CONCLUSIONS: The most frequent reason for referral was for therapy. This observation may be generally true for many physicians, since it is consistent with results of two other studies, in different fields, that we were able to find. Eighty-two percent of referrals were satisfactory to the referring physicians. Most of the physicians who were unsatisfied with the referral process stated they had not received a follow-up letter from the consulted physician.