Preventive care for women. Does the sex of the physician matter?

BACKGROUND: Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan. METHODS: We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age. RESULTS: Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology. CONCLUSIONS: Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.     

Psychotherapist orientation and expectations for liked and disliked patients.

Two fictional intake summaries were presented to either psychodynamically (n?=?32) or cognitive-behaviorally oriented (n?=?22) psychotherapists. Therapists rated the personality attributes of and expectations for the course of therapy with these potential patients. Therapists were less inclined to treat hypothetical patients whom they did not like, even though they believed these individuals to be in greater need of psychotherapy. When imagining themselves working with less liked patients, therapists expected to feel less confident of their skills and were more concerned that such patients would engage in countertherapeutic activities. Cognitive-behavioral therapists were somewhat more likely to differentiate between liked and less liked patients in their expectations for the course of therapy than were psychodynamic therapists. Implications for the provision of psychotherapy services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Completing advance directives for health care decisions: Getting to yes.

The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician–hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved—providers, patients, families, and payors—in this most profound process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluation of linguistic variations by college students with and without head injuries.

Evaluated the impact of spoken language on listeners by examining the effects of prior head injury, speech register, and active vs passive listening among 56 head-injured (HI) and 55 non-HI undergraduates. Ss rated the degree to which they liked the speaker and also the extent to which groups of negative and positive adjectives described the speaker. There were no differences between HI and non-HI Ss in how much they liked speakers using the normal register, but non-HI Ss liked the motherese speakers more than did HI Ss. Raters liked motherese speakers less when addressed directly than when they were not being directly addressed. Regardless of listener perspective, HI Ss liked motherese speakers less and rated them more negatively than non-HI Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Young adolescents' comfort with discussion about sexual problems with their physician

OBJECTIVE: To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician. DESIGN: Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations. SETTING: Five primary care pediatric practices at health maintenance organizations in Washington, DC. PATIENTS: A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated. MAIN OUTCOME MEASURE: Adolescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial. RESULTS: Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%), but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (43%) [corrected]. Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians. CONCLUSIONS: This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns.     

Knowing, liking, and judged problem severity in relation to referral and outcome measures in a school-based intervention program.

Teachers, as referral agents, and nonprofessional child aides, as interventionists, rated 709 kindergartners-6th graders seen in a school-based mental health program for how well they were known by teachers and child aides, how much they were liked by them, and how serious their problems were. All evaluation measures derived from 3 instruments--the AML (which measures Acting Out, Moodiness and Withdrawal, and Learning Problems), the Teacher Referral Form, and the Aide Status Evaluation Form. Several interconnected studies describe the ratings' properties and stability, how they differed across demographic groups, and how they related to indexes of referral status, termination status, and improvement. Better liked children and those seen initially as having less severe problems had healthier referral and termination profiles and were judged to have improved more in the program by both rater groups. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telling lies.

Men and women (20 each) were videotaped while describing someone they liked, someone they disliked, someone they were ambivalent about, someone they were indifferent about, someone they liked as though they disliked him or her, and someone they disliked as though they liked him or her. Accuracy at detecting that some deception had occurred was far greater than accuracy at detecting the true underlying affect, and Ss who were good at detecting that deception was occurring were not particularly skilled at reading the speakers' underlying affects. However, Ss whose deception attempts were more easily detected by others also had their underlying affects read more easily. Speakers whose lies were seen more readily by men also had their lies seen more readily by women, and observers better able to see the underlying affects of women were better able to see the underlying affects of men. Skill at lying successfully was unrelated to skill at catching others in their lies. A histrionic strategy (hamming) was very effective in deceiving others, and this strategy was employed more by more Machiavellian Ss, who also tended to get caught less often in their lies. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of Israeli primary health care physicians who treat depression

Primary health care physicians have a pivotal role in treating mental health problems. We determined the proportion of primary care physicians in Israel who treat depression and their characteristics. The study was based on a stratified national random sample of primary care physicians (n677, response rate 78%). From these physicians' reports 22% always treat depression, 36.6% usually, 28.6% sometimes, and 12.6% never. Based on a logistic regression model the physicians who always or usually treated depression were distinguished from the other physicians by their treating more medical conditions on their own, seeing themselves as having more first contact for psychosocial problems, having frequent contact with social workers and specializing in family medicine. Primary health care physicians play a major role in treating depression on their own. This raises new questions about how they treat depression themselves, and under what circumstances they treat or refer to a specialist.     

Seeing approach motivation in the avoidance behavior of others: Implications for an understanding of pluralistic ignorance.

Four studies tested the hypothesis that observers tend to interpret others' actions as approach motivated even when they recognize that their own identical choices were motivated by avoidance. Study 1 found that voters in the 2000 U.S. Presidential election who chose a candidate primarily because of their aversion to the alternative thought that others who voted for the same candidate liked him more than they themselves did. In Studies 2, 3, and 4 participants who learned that others made the same choice as themselves between 2 unappealing flavors of soda or jelly beans estimated that the others would pay more than they would for their common choice. The relevance of these findings for an understanding of pluralistic ignorance is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Female medical leadership: cross sectional study

OBJECTIVE: To assess the relation between male and female medical leadership. DESIGN: Cross sectional study on predictive factors for female medical leadership with data on sex, age, specialty, and occupational status of Norwegian physicians. SETTING: Oslo, Norway. SUBJECTS: 13 844 non-retired Norwegian physicians. MAIN OUTCOME MEASURE: Medical leaders, defined as physicians holding a leading position in hospital medicine, public health, academic medicine, or private health care. RESULTS: 14.6% (95% confidence interval 14.0% to 15.4%) of the men were leaders compared with 5.1% (4.4% to 5.9%) of the women. Adjusted for age men had a higher estimated probability of leadership in all categories of age and job, the highest being in academic medicine with 0.57 (0.42 to 0.72) for men aged over 54 years compared with 0.39 (0.21 to 0.63) for women in the same category. Among female hospital physicians there was a positive relation between the proportion of women in their specialty and the probability of leadership. CONCLUSION: Women do not reach senior positions as easily as men. Medical specialties with high proportions of women have more female leaders.     

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.     

Common pediatric dental problems

Physicians who provide primary care for children have a unique position to provide diagnostic, triage, educational, and preventive dental care for patients. Several papers have been published regarding primary pediatricians' participation in the preventive dental health care of their patients. One publication, a survey of physicians in Alabama focusing on physicians' overall awareness of dental issues, concluded that most physicians believe they have a role in the oral health of their patients, yet most were not aware of the American Academy of Pediatric Dentistry's recommendations. Most physicians report that they routinely perform oral examinations during physical examinations of children and deliver preventive, oral information by the age of 6 months or earlier; however, most recommend that infants' first visit should be at 3 years of age, not at the time of first-tooth eruption as the authors recommend. Furthermore, many primary care physicians do not talk about oral health during prenatal counseling. Many physicians understand the preventive advantages of fluoride, yet most do not prescribe vitamin combinations that contain fluoride. If an understanding of the aforementioned issues of dental care, as well as aspects of preventive care in infants and children, become more uniform among primary care physicians, the prevention-based practice of pediatric dentistry will become much more successful, and children and adults will enjoy better dental health.     

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.     

Social status and patterns of communication in acquainted and unacquainted preschool children.

Communication patterns were investigated related to the emergence and maintenance of social status in young children. 66 preschool children were classified as liked, disliked, or low-impact, using classmates' sociometric nominations. Children were observed interacting in 1 of 2 conditions: as entry child and host to children they did not know, or as entry child and host to children they knew. Results indicated that when entering the play of children they did not know, disliked children were less responsive to peers and more likely to make irrelevant comments than were liked children. With acquainted peers, disliked children were not only less responsive and more irrelevant than liked children, they were also less likely to clearly direct their communication to specific peers. Thus, responsiveness and contributing to coherent conversation appear to be important to both the establishment and maintenance of social status, whereas failure to socially direct communications may occur only after children develop a negative reputation with peers and, thus, may be a factor only in the maintenance of social status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential regulation and ATP requirement for caspase-8 and caspase-3 activation during CD95- and anticancer drug-induced apoptosis

Although widely used, terms associated with consumption of alcohol--such as "light," "moderate," and "heavy"--are unstandardized. Physicians conveying health messages using these terms therefore may impart confusing information to their patients or to other physicians. As an initial attempt to assess if informal standardization exists for these terms, the present study surveyed physicians for their definitions of such terms. Physicians operationally defined "light" drinking as 1.2 drinks/day, "moderate" drinking as 2.2 drinks/day, and "heavy" drinking as 3.5 drinks/day. Abusive drinking was defined as 5.4 drinks/day. There was considerable agreement for these operational definitions, indicating there is indeed an informal consensus among physicians as to what they mean by these terms. Gender and age did not influence these definitions, but self-reported drinking on the part of physicians was a factor. We also asked physicians for their opinions regarding the effects of "light," "moderate," and "heavy" drinking on health in general and specifically on health-related implications for pregnant women, and whether they felt their patients shared these beliefs.     

A comparison of aggressive-rejected and nonaggressive-rejected children's interpretations of self-directed and other-directed rejection

The hypothesis that aggressive-rejected children are unaware of their social status because they are self-protective when processing negative peer feedback was tested in 3 studies. In Study 1, fourth-grade girls and boys were asked to name peers they liked or disliked, as well as peers they thought liked or disliked them. Comparisons of aggressive-rejected, nonaggressive-rejected, and average status groups revealed that aggressive-rejected children were more unrealistic in their assessments of their social status than were nonaggressive-rejected children. In Study 2, rejected and average boys identified in Study 1 were asked to name who they thought liked or disliked other children from their classroom. Comparisons of perceived and actual nominations for peers revealed that aggressive-rejected children were able to assess the social status of others as well as did nonaggressive-rejected and average status children. Because the difficulties aggressive-rejected children demonstrated in Study 1 did not generalize to judging the status of others in Study 2, the self-protective hypothesis was supported. Study 3 provided a parallel test of this hypothesis under more controlled conditions. Subjects from Study 2 viewed other children receiving rejection feedback from peers in videotaped interactions and received similar feedback themselves from experimental confederates. While all subjects rated self-directed feedback somewhat more positively than other-directed feedback, aggressive-rejected subjects had the largest self-favoring discrepancy between their judgments of self- and other-directed feedback. These findings also suggest that aggressive-rejected children may make self-protective "errors" when judging other children's negative feelings about them. Ethnicity differences in evaluating peer feedback emerged in Studies 1 and 3, raising questions about the impact of minority status on children's evaluations of rejection feedback.     

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.     

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.     

Liability in breast cancer screening

The U.S. breast cancer mortality rate has risen over the past 29 years in women 50 years of age and older. This is surprising in light of the fact that the disease is curable when detected early through mammography together with clinical breast examinations (CBE). One major problem is that many women are not being screened. Only about one-third of women 50 years of age and older are receiving yearly screening mammograms, despite published guidelines. Regarding CBE, more women are receiving them, but there is room for improvement. The main reasons given by women for not having a mammogram are: 1) their physicians did not recommend it; 2) they did not know they needed one; or 3) they did not have any breast problems. These responses reflect a lack of awareness of breast cancer screening recommendations and indicate that women are not being given adequate information about breast cancer from their physicians. This paper will explore the medical malpractice literature in order to discuss the question of whether physicians should be liable for failing to inform their female patients.