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Biomedical subjects

W Levinson

Publications and source records attributed to W Levinson.

At least 19 recordsLinked to original sources
PubMed1998

Clinician-educators in academic medical centers: a two-part challenge.

As academic medical centers increasingly deliver care in primary care settings, a new category of faculty-clinician-educators-has emerged. Although the shift of education and patient care to outpatient settings makes the expanded role of clinician-educators necessary, it also presents challenges to clinician-educators themselves and to the institutions for which they work. This article examines these contemporary challenges (including financial constraints, undefined processes of promotion, and limited opportunities for professional development) and suggests strategies for meeting them. The number of clinician-educators joining the ranks of medical school faculties will probably continue to increase. As clinician-educators seek to provide the highest-quality education and patient care in the new medical marketplace, their success will be critical to the viability of the academic centers of the future.

Academic Medical Centers↗
PubMed1998

Recruiting physicians for office-based research.

OBJECTIVES: Research conducted in community outpatient offices can provide insight into the common experiences of patients and physicians. However, recruiting physicians to participate in office-based research is challenging and few descriptions of methods that have been used to successfully recruit random samples of physicians are available. This article describes recruitment strategies utilized in a project that achieved high rates of participation from community-based primary care physicians and surgeons. METHODS: Recruitment methods included the use of advisory boards to identify potential barriers to participation, use of respected members of the medical community as recruiters, and obtaining endorsements from physician organizations and prominent members of the medical community. RESULTS: Overall, 81% of physicians contacted from a sample frame agreed to participate in the project. Participating physicians most frequently reported that they participated because the project could provide them with feedback about their interviewing style. CONCLUSIONS: The recruitment methods described here can be generalized to other types of investigations.

Colorado↗
PubMed1997

Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

OBJECTIVE: To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. DESIGN: Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. SETTINGS: One hundred twenty-four physician offices in Oregon and Colorado. PARTICIPANTS: Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. MAIN OUTCOME MEASURES: Audiotape analysis using the Roter Interaction Analysis System. RESULTS: Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. CONCLUSIONS: Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

Colorado↗
PubMed1997

Wrapping things up: a qualitative analysis of the closing moments of the medical visit.

The purpose of this preliminary study is to develop an operational definition of the closure phase of the medical visit. A listening group developed a definition of closure by consensus based on audiotaped data from 22 office visits to physicians. The group noted new problems in closure not previously raised. Closure was defined as the final phase of the medical visit in which the doctor and patient shift perspective to the future, finalize plans, and say goodbye. Two distinct organizational frameworks of closure are outlined. Thirty-six percent of closures were interrupted in some way. New problems occurred in 23% of visits, even those with open-ended beginnings and early physician requests for all patient concerns. Doctors' communication involved expression of emotion, patient education, clarification, summary, and parting comments. Patient communication included expression of emotion, information sharing, and parting comments. Doctors' communication skills for closure are proposed. Closure is a distinctive phase of the visit with an organizational framework and specific tasks. The frequency of new problems in closure suggests that physicians may have the potential to improve their effectiveness.

Clinical Competence↗
PubMed1997

How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting.

OBJECTIVE: To characterize the informed consent process in routine, primary care office practice. DESIGN: Cross-sectional, descriptive evaluation of audiotaped encounters. SETTING: Offices of primary care physicians in Portland, Oregon. PARTICIPANTS: Internists (54%) and family physicians (46%), and their patients. MEASUREMENTS AND MAIN RESULTS: Audiotapes of primary care office visits from a previous study of doctor-patient communication were coded for the number and type of clinical decisions made. The discussion between doctor and patient was scored according to six criteria for informed decision making: description of the nature of the decision, discussion of alternatives, discussion of risks and benefits, discussion of related uncertainties, assessment of the patient's understanding and elicitation of the patient's preference. Discussions leading to decisions included fewer than two of the six described elements of informed decision making (mean 1.23, median 1.0), most frequent of these was description of the nature of the decision (83% of discussion). Discussion of risks and benefits was less frequent (9%), and assessment of understanding was rare (2%). Discussions of management decisions were generally more substantive than discussions of diagnostic decisions (p = .05). CONCLUSIONS: Discussions leading to clinical decisions in these primary care settings did not fulfill the criteria considered integral to informed decision making. Physicians frequently described the nature of the decision, less frequently discussed risks and benefits, and rarely assessed the patient's understanding of the decision.

Analysis of Variance↗
PubMed1997

Men and women in optometry. II. Attitudes toward career and family.

BACKGROUND: Optometry has experienced a dramatic upward shift in the percentage of women entering the profession during the past 20 years. Our survey assessed the mechanisms for sustaining balance in professional and personal roles used by women optometrists and how these mechanisms may differ from those of their male colleagues. METHODS: A survey questionnaire was mailed to a large nationwide random sample of optometrists, composed of equal numbers of men and women. RESULTS: Data were analyzed from 353 men and 358 women; margin of error was +4%. Most of the respondents indicated they derived personal satisfaction from their career. A majority of both groups did not indicate that lack of time for their career was a source of frustration. However, significantly more women than men indicated some frustration in pursuing those activities that lead to career advancement. There were significant differences in response patterns of men and women about the effect of family, child care, and household work on their careers. CONCLUSIONS: Both men and women optometrists are satisfied with their careers and neither group feels compelled to choose between career and family. Optometrists do not fit into one pattern, but instead make individualized career choices on the basis of needs.

Attitude of Health Personnel↗
PubMed1995

Physicians' psychosocial beliefs correlate with their patient communication skills.

OBJECTIVE: To assess the relationship between physicians' beliefs about the psychosocial aspects of patient care and their routine communication with patients. PARTICIPANTS AND SETTING: Fifty community primary care physicians participating in a continuing medical education program and 473 of their patients in Portland, Oregon. METHODS: Routine office visits were audiotaped and analyzed for communication behaviors and emotional tone using the Roter Interactional Analysis System (RIAS). Physician beliefs about psychosocial aspects of care were measured using a self-report questionnaire with a five-point Likert scale. Attitudes were correlated with communication behaviors using the Pearson correlation coefficient. RESULTS: Physicians' attitudes toward psychosocial aspects of care were associated with both physician and patient dialogue in visits. The physicians who had positive attitudes used more statements of emotion (i.e., empathy, reassurance) (p < 0.05) and fewer closed-ended questions (p < 0.01) than did their colleagues who had less positive attitudes. The patients of the physicians who had positive attitudes more actively participated in care (i.e., expressing opinions, asking questions), and these physicians provided relatively more psychosocial and less biomedical information (p < 0.05). CONCLUSION: Physician beliefs about psychosocial aspects of patient care are associated with their communication with patients in routine office visits. Patients of physicians with more positive attitudes have more psychosocial discussions in visits than do patients of physicians with less positive attitudes. They also appear more involved as partners in their care. These findings have implications for medical educators, teachers, and practicing physicians.

Adolescent↗
PubMed1995

Perceived causes of family physicians' errors.

BACKGROUND: Competent physicians occasionally make critical errors in patient care that can lead to long-lasting remorse and guilt. The perceived causes of self-admitted physician errors have not been previously explored. METHODS: Fifty-three family physicians were interviewed in depth and asked to describe their most memorable errors and the perceived causes. The authors analyzed transcripts of the audiotaped interviews to determine the frequencies of the different causes. Errors were classified according to four general categories. RESULTS: Family physicians collectively reported a mean of 8 different causes for each case in which an error was made (range, 1 to 16). In 47% of the cases, the patient died following the error, whereas in 26% of the cases, there was no adverse outcome. Only 4 of the 53 errors led to malpractice suits, and none were addressed by peer review organizations. Seven (10%) of the 70 physicians who were invited to participate could not recall having made any errors. Family physicians attributed their most memorable errors to 34 different causes, which fit into the following categories: physician stressors (eg, bing hurried or distracted), process-of-care factors (eg, premature closure of the diagnostic process), patient-related factors (eg, misleading normal findings), and physician characteristics (eg, lack of knowledge). CONCLUSIONS: Family physicians attribute their memorable errors to a wide variety of causes, but most commonly to hurry, distraction, lack of knowledge, premature closure of the diagnostic process, and inadequately aggressive patient management. Physicians who understand common causes of errors may be better prepared to prevent them.

Adult↗
PubMed1995

Men and women in optometry. I: Economic issues and professional profiles.

BACKGROUND: Optometry is experiencing a sharp increase in the number of women entering practice. How is this demographic shift likely to affect the profession? This survey was designed to describe current economic and professional profiles of men and women in optometry. METHODS: A survey questionnaire was mailed to a nationwide random sample of optometrists, equal numbers of men and women. RESULTS: Data were analyzed from 353 men and 356 women. Margin of error: +/- 4 percent. On average, women optometrists are younger than men, work 9.4 percent fewer hours, and spend 8.1 percent more time away from their regular professional duties. In 1991 men's optometry income averaged $72,200; women's, $54,400. The income differential persisted after adjusting for age, practice setting, work week, time off, and specialty. Men are more likely to be in solo practice; women in group practice or salaried positions. Similar proportions of men and women are employed in corporate optometry. Few gender differences exist in patient services or other professional activities. CONCLUSIONS: Women optometrists have not yet gained economic equity with men. Male-female similarities in practice patterns suggest that optometry is unlikely to experience major changes in consequence of more women entering the profession.

Adult↗
PubMed1995

Lesbian health care. What a primary care physician needs to know.

Many primary care physicians take care of lesbians and women sexually active with women without being aware of their patients' sexual orientation. These women have unique medical and psychosocial needs that each physician must consider. Lesbian identity or being sexually active exclusively with women influences care in areas such as sexually transmitted diseases, risk of human immunodeficiency virus infection, counseling, cancer risk, screening, parenting, depression, alcohol use, and violence. We review an approach to taking a history with all women that facilitates open, comfortable communication with lesbians. We also review specific medical and psychosocial areas of primary care in which caring for lesbians is different from caring for other women. Further research is needed on lesbian health issues to provide appropriate guidelines to clinicians.

Adolescent↗